How did you know when to finally have surgery?

[strost]

Hi,
Need some advice on when to have hip resurfacing surgery. I've read articles that say wait until you are in so much pain that is not relieved by anything - drugs, shots, etc. They say the people who are most dissatisfied with the surgery were the ones who did not have much pain prior. However, I don't want to progress to that point and lose muscle mass and conditioning.

I'll give you some background and then please give me your guidance based on your experience.

Almost 47 year old female, 120 pounds, decent shape (but still recovering from back surgery in Oct - ruptured L5-S1 with severe sciatica and numbness in foot). I have gone skiing (mild stuff) twice this winter and I get out to walk the dogs about 1/2 mile to 1 1/2 miles several times a week. Since the back injuries and surgery, I have not been doing my PiYo class.

My xray shows severe osteoarthritis with bone on bone as well as bone cysts. Range of motion is 16 degrees external but only 6 degrees internal - other hip is about 45 degrees and has good range of motion. 3 surgeons have said I can have a hip replacement or resurfacing whenever I'm ready. Most seem surprised that I don't have more pain and activity limitations.

My PT and even my chiropractor are telling me to consider the surgery due to the compensatory damages I might cause to my other hip, SI joint, low back and knees. I do walk with a limp and have for at least the past 2 years.  Need to get my new one added - some additional deterioration but not major. Dr Gross was the first doctor to suggest that I might have a CAM deformity where my femoral head is not quite at the correct angle relative to the femur neck. He also thought the other hip might need done in the next 5 or so years (mild osteo at this point). Pain is not significant most of the time - more of a deep dull pain with occasional sharp pangs. Pain is more noticeable during the night.

In Dec, I was having more pain above my left knee as well as a fair amount of pain at night. I scheduled a surgery with Dr Gross and the earliest date I could get was mid-April. In the meantime, I've been using the ARPWave Direct Current therapy to break up scar tissue as well as retrain my muscles to fire in the appropriate order. I also use the MRS2000 (pulsed magnetic therapy), infrared, laser, Integrated Healing and Emotion Code energy work, plus my best friend when I can't sleep at night - the biaxial PowerMag. My pain at night has improved and my knee pain is not a issue at the moment. Someone needed my surgical date, so I let them have it and moved mine till late summer.

However, I'm still wondering if now is the time to consider the surgery or not. I have preteen and teenaged kids and I don't want them to only think of me as "the hip". I feel they have already forgotten that I was the only Mom on the street out playing in the yard and jumping on the tramp with them. I can still ski and hike (nothing too steep or long). However, I can not really run (only a really pathetic looking jog) - hope I'm with you if we are being chased by a bear! Tennis is out and I'm not sure how golf would be. I had to skip 2010. I can no longer do yoga since I feel I interrupt the class due to my lack of flow. PiYo was a good compromise for me. I have a hard time picking up things off the floor using correct body mechanics. I cannot bring my knee to my chest and sometimes have difficulty tying my shoe.

I do believe that God designed the body to heal itself given the right tools. I've researched tons of modalities ranging from diet, exercise, lifestyle modifications, alternative therapies, technologies and energy work. I'm definitely seeing some results, but I'm also tired of the huge amount of time I spend thinking about and doing the treatments/exercises. However, I wonder what is just around the corner. As you can guess, I don't have any interest in taking the drugs or doing the steroid shots. However, I'm not excited about having foreign material implanted in my bone as well as the muscle damage and scar tissue too.

Hopefully that was not too much info, but really want to get some solid advice from people who have been there and done that. Let me know if there are any missing pieces of the puzzle.

Any insights will be greatly appreciated.
Thanks!
Susan

[Tin Soldier]

I understand your dilemma well.  I didn't have a ton of pain unless I "over did it", mostly limited ROM and then everything started falling apart, gimpy walk, couldn't really run, couldn't bike very well, couldn't do much general labor without turning into to Frankenstein both physically with my back and gait, and also mentally.  My decision mostly came down to my kids/family and also my health.  I did not want to be hobbling around, losing the rest of my health, while my kids (both 14 yr) are just getting more and more active.  Ever since they were little we were always doing really active stuff with them and I felt like I was losing that at a time when they were really gaining activity. 

I think there are lots of folks on this forum that have asked this question, there may even be a thread for it.  Everyone will have their own circumstances that will drive their decision.  For me it really had more to do with my family and also my general health.

[halfdone]

In retrospect I waited too long for my first HR.  I went ahead earlier in the progression with my second.  Why did I wait first time?
"Is this HR thing really as good as the success stories suggest?"
"What if they can't do an HR and I end up with a THR which I don't want?"
"The pain's not so bad today, maybe I have this under control"
"Surgery sucks (and if I'm really honest I find the whole prospect scary)"
"I'm OK for the time being and this is a busy year for work/family/travel....etc., so maybe I should wait a while until things settle"
"Maybe if I wait I'll have a better chance that the HR will last a lifetime"
"It's not so bad, I can still ride my bike"
and 300 other reasons to defer the day.......

I went on vacation.  I couldn't walk with my family on the beach.....It was time.  Only after the op could I appreciate how much the pain and limitations had eaten away at my (and my family's) quality of life.

Good luck.

[jjmclain]

Hi Susan,

I am a 49 year old small female 3 1/2 months post-op. I was 48 at the time of my surgery. Everything you wrote sounds so familiar with the pain, etc. I am a long distance triathlete, but the last couple of years my running became so pathetic and even a short jog ended up painful. Walking was even worse! Cycling didn't hurt, but I had trouble getting on and off the bike due to decreasing ROM. I have a 10 year and a 14 year old, soon to be 11 and 15, and I too have always been the active "Mom" out there throwing the football, etc. But it got to the point where I was limping for the last couple of years....I didn't realize it until I was told by so many people. I think the endorphins of exercise masks a lot of the pain during the day. Nighttime was always very rough for me as well as sitting in a car or at the movies.

I am so happy with my BHR! No more hip pain, knee pain, shin pain, foot throbbing, etc.!!! It is hard to believe how great I feel and I haven't completely healed yet. I haven't felt this good in years! I am a happier person and therefore a better spouse and Mom! I wish I had known about this surgery sooner. I am being very cautious and listening to my very conservative surgeon. I don't know when I will be allowed to run again...but I will run again and I will race Ironmans again...I just know it! Please feel free to write me if you have any questions regarding the surgery. All I can say is that it was a success and I am so thankful for my surgeon, this website, etc. etc.

June

[einreb]

Put me in the 'waited too long' camp.  The physical and emotional burden that has been lifted just 2 weeks out from surgery is amazing. 

I put this off for years, actually postponing a surgery with Dr Gross last August.  If I had done that, I'd be running now instead of recovering. 

[newdog]

I read your post last night and wasn't sure what to say or the right way to say it. It seems those who have had it done were at different stages of pain and disability when they finally committed to the surgery.

I could sleep O.K. and if I would lie still on my back on my couch there was no pain. I could sit for short periods of time O.K. Even one year before my surgery I had good days and bad days. When you have those good days and can get comfortable by relaxing in certain ways or by doing rehab type activities and exercises, I think that is when the second thoughts about having the surgery set in. I went to physical therapy, took a joint supplement, went to a YMCA heated therapeutic pool every weekday for 6 months and floated with the "old people" (what the heck am I doing here, I thought). These things would make me feel a little better and then I would have that "good" day and YES!, it's finally getting better. I don't need that surgery and I'll prove I can heal myself and won't need it.

The good days and bad days turned into all bad days in a very short time. Less than one year. It's one thing to have to give up the activities that you have done for years and love to do. The sports or leisure activities that may even define who you are, gone forever. When you can hardly do everyday tasks, that is when it's really bad.

The lost cartilage and deformed bone surfaces will not get better and will not reverse. It will get worse. That's bad news and can be really hard to accept and come to terms with. No one wants to have hip surgery and have metal or ceramic put in their bodies. What is the alternative? I went from active, physically fit to a limping, hunched over mess in less than 3 years. That is a very short period of time. Some have suffered much longer.

I did not know what hip resurfacing was until about 7 months before my surgery. Before that I was so depressed and just didn't know what I was going to do. When I discovered HR it sounded so exciting that I just jumped right in and in two months was scheduled for surgery. Pain and suffering will push people to act and that is what happened to me.

Read halfdone and Tin Soldier's posts again. When you can't even go for a simple walk with your family or friends, that's even worse than not being able to do your own personal activities. I would not go for walks with my wife anymore because I just couldn't deal with the pain I knew would happen.

The pain and limitations will affect the family and friends. Everyone here will tell stories of their mood swings and just being downright mean because they didn't feel good before having the surgery.

It can be a tough decision. For myself and I'm sure others there just was no way I could continue living that way if there was an excellent alternative. I hope my post isn't too wordy. You will find this website to be a very helpful source of information and advice. The people on here are very enthusiastic and sincere about helping others with their HR advice. Good luck and I hope you arrive at a solution that works best for you.

Steve (newdog)

[newdog]

I don't mean to hog this board but I just read einreb's and jjmcclain's posts. Susan, you will see positive and uplifting stories like theirs on this forum. Maybe these stories will help you decide.

I am 7 weeks post op and it is hard to describe the feeling you get just walking into a grocery store and walking among people. That is what I did yesterday. No pain, limping, that feeling I got before surgery of people looking at me because I walked abnormally. Now I walk straight up with confidence I haven't felt for a long time. What a feeling! I have a little stiffness and soreness but that's nothing compared to before, not even close! I think I smile a lot without realizing it. Before I didn't want to be around people, now I can't wait to get back out there!

I'm still off work and stopped in to visit for the first time yesterday. I was told I look much healthier and better. When you hurt all the time, you don't realize what it does to your facial expression and I guess.

[hernanu]

My symptoms started about 7 years ago. I started with pain after league basketball games that I attributed to just hard workouts. I was also playing soccer, and I started to get worse with speed, flexibility and started to feel pain. The pain and lack of ROM increased to the point that about three years ago I started having trouble going up and down stairs, standing up from couches, bending over to get anything and putting my socks / shoes on. In time, the limitations made me stop basketball, then martial arts, then walking any kind of distance.

The real decision time came when playing soccer (the last thing I gave up) and my hip dislocated. It had dislocated a month earlier when sleeping, but I convinced myself (after popping it back in) that it wouldn't happen again. It started doing so when playing soccer, then when walking. I had tried everything - Physical therapy, massage every week, stretching, even a workout boot camp to shock me back to health. Nothing worked.

I then bit the bullet and talked to an orthopedic surgeon who told me that yes, I had no cartilage left on my left hip and almost none on my right, I had bone spurs around my bones (both sides) and I needed surgery. He wanted to do a THR, but I had been reading about hip resurfacing since there was a local tv show about it, and about Dr. Snyder. I talked to Dr. Snyder and scheduled both surgeries. I had my left done on 8/24 and my right on 11/29 (both 2010).

It has been a great experience. Each surgery went very well, the staff at Newton-Wellesley Hospital were incredible and the suite I had to myself was amazing. I had home PT and then outpatient PT for both, and am now mending (12 weeks) from the second. I have no limp at all on my left, and a slight limp on my right which will be fixed now that I will be able to walk a lot after this brutal winter (New England).

A problem with people who are athletes and have a high threshold for pain is that we are used to dealing with pain and bypassing it to accomplish a goal. It makes us uniquely resistant to recognizing when we need help. I can tell you that I wished I hadn't waited to when my life was so compromised and only now do I see the compromises I made. The hip won't get better, the cartilage won't grow back and you shouldn't let this condition steal your time with your family away from you.

[B.I.L.L.]

When you start poking around in here that may be a sign lol. 
 I know for a fact I waited too long and in retrospect not using the muscles around my bad hip for years and years (and years) probably didn't do me any favors when it came time for them to recover and start working again. I will say it's in your best interest to go into this thing as light and strong as possible, you'll be happy you did when you get on "The other side" 
I waited until I was miserable almost 24/7, I wish I knew then what I know now, I would have A. Not waited as long and B. Gone with a resurfacing specialist, not a great hip guy who has done a few resurfacings, don't want to sound like a dick but let those guys learn on someone else, seriously go with one of the big names you will read about on this site. I kept putting it off saying it's not so bad today, maybe it will get better, I can't afford it, what about work and on and on and on. Duh, bad move on my part. I don't know how much your life revolves around your hip, so it's all your call, but that was my experience, weigh it all out and make a decision I guess Good luck !     

[jjmclain]

Susan,

So many of the stories posted are so similar to some of my experiences...newdog..the one about facial expressions, LOL!!! I was told afterwards how different my face looked, not in so much PAIN anymore! The longer you wait, the worse the cysts can get. I had a very large cyst that my surgeon was able to handle, however, I wonder if I had waited longer, if I would have had to get a THR. Do the research, especially in finding a good surgeon, and get as many opinions as you need. But the stories on this site are testimonies to how we have all gotten our live's back! Good Luck!!!

June

[Dayton96]

Hi Susan,

I knew your post would get some interesting responses. 

You sound like you lean toward holistic medicine, which is great.  Unfortunately, as you have probably discovered while doing your research, there does not seem to be anything out there right now that will replace/grow cartilage.  I suspect in a few years there will be, and then it will take a few years more to get FDA approval, and in the meantime your body is off balance, other joints are getting stressed, such as your knees.  You simply must weigh what you have to lose with what you have to gain. 

I'll admit, I did not jump into a resurface right away.  I researched for months, saw several local surgeons, and searched on line.  I finally scheduled my hip resurface with
Dr. Gross for December 2010.  In the meantime, I was still seeing a local doctor for knee pain.  My local doctor was not convinced that my knee pain was related to my hip (I had very little pain in my hip at the time).  He encouraged me to try a couple of months of PT on my knee before I took the "drastic" step of having a hip resurface.  My family doctor also recommended holding off.  I emailed back and forth with Lee and Dr. Gross and, even though Dr. Gross strongly suggested that my knee pain was directly connected to my hip, I went ahead and cancelled my surgery.  After all, what did I have to lose by waiting? 

I then went through those two months of PT for my knee.  When it was over last December, the physical therapist and the knee doc both said that in fact, much of what was going on with my knee was most likely related to my hip (exactly what Dr. Gross told me months earlier).  In the meantime, my family doctor, the one who had told me to hold off because I was obviously not in that bad a shape yet, had in the meantime done a little research of his own on hip resurfacing and he decided I should go ahead with it.

I'm now scheduled for a hip resurface with Dr. Gross in three weeks.  When I went back to them to schedule a new date, they were very nice about it.  I would guess that people change their minds all the time.  As it would happen, the hip that hadn't been hurting me before, has started bothering me now.  I will wake up in the middle of the night and the hip keep me from getting comfortable.  Sometimes I just get up and walk around a little and then head back to bed.  I'm taking no medicine right now because I'm not a big fan of pain killers, etc.  The pain comes and goes but is not unbearable.  It helps to know I have the surgery just a few weeks away.  It also helps to know there are a lot of folks on this site who are here to answer questions and share their experiences.  In fact, there have been three or four people who post here who have recently had their hip resurfaced by Dr. Gross.  Reading what they have written, and reading other stories, I feel that I am pretty well prepared for my surgery.

I'm rambling here, so let me just get to the bottom line.  If you don't think you are ready, then you probably are not.  On the other hand, if you are not sure, then don't cancel that surgery quite yet.  Take the next month to follow the posts on this web site.  Talk to us.  Ask questions.  You can still change your mind.  I don't regret canceling that Dec surgery.  Deep down inside I don't think I was ready.  Now I am. 

And one more thing, if you go through with the surgery, many of the folks on this site will still be here to help you with recovery issues.  Including parents with young kids, who can give you advice on juggling family, work, and surgery.

Good luck. 

Mac     

[FlbrkMike]

Very good advice, Mac.  

I'd like to add a short anecdote to this discussion.  My OA in both hips must have been developing for 20 years or more, but I never realized what the actual cause was until a couple of years ago, and had never heard of resurfacing until probably September or Ocbober of last year.  I had my LBHR (the more painful side) three weeks ago and am scheduled for the RBHR on 3/11.  Even though the left side is still recovering, if I had any doubts about getting the other one done they are gone.  I'm more convinced than ever that I need to get it done ASAP.

[23109VC]

Many others have already said it very well...so I won't write a lot...

For me, I started thinking about surgery when the pain was bothering me enough that it was impacting the routine things in my life.  I reasearched it, watched YouTube videos of the surgery, read a lot on these forums....and a couple years ago, I decided the pain wasn't bad enough .... So I waited....

Fast forward a couple years.  The pain had just become more intense..the "good" days Steve mentioned became fewer and far between....and it was bad days and really bad days.  The things you take for granted became impossible or very hard to do.  One day I just got sick of it and decided it was time to het my life back.  The little things that really bothered me were not being able to put my shoes and socks on....

Eventually it will get to a point where you no longer want to deal with it. Where "that" point is ...is different for everyone.

I remember reading a similar thread on this forum where it was discussed "when" you know it's time for surgery..and someone said something like.... "you will just know". I know that's  not very specific.....but honestly, I found it to be very true for me.  There came a point where I stopped thinking about the surgery and decided it was time...when you get there you will know.  

[halfdone]

Susan, one other quick thought for you.
One of my uncertainties/questions/anxieties about HR was how does it feel having this alien metal body part deep in there???  Despite all the great stories about (athletic) people returning to full and happy function I just didn't quite have the confidence that I would feel "normal" with an HR.  All I can say is have confidence in all the good stories.  It didn't take me very long after my first HR for my "bad" hip to become my "good" hip and vice versa.  I am now 5 weeks post op from the second HR (5 years after my first HR) and enjoying 2 "good" hips.
You're the only one who can make the decision when to go ahead, but many of us think we waited too long (in retrospect). You know there's no better choice than the doctor you have lined up, so when you decide to go ahead, IMHO you should feel good about your decision, despite the anxieties that we all share as we proceed.

Good luck

[Tin Soldier]

I don't feel like I have anything alien in me, even though the thing is 2 inches in diameter, crazy.  Anyway, I already mentioned why I finally made the decision, but I'd like to add, that this website and all the positive info folks have posted was really the catalyst for me.  So keep poking around here, ask your questions, and you'll get lots of great info and after awhile you'll gain a lot of confidence in hip resurfacing.   

[tony b]

waited till i could not even stand on mine .i limped for 6 months before i went to the doctor .after going i got another month out of it and went for surgery .

[LWChafin]

Susan,

It's been 3 weeks since you posted this and you haven't put any responses up, but if you're still checking in I can say that waiting only makes the whole process worse.  The knee pain is typical - I had it from guarding and compensating for the bone on bone pain for maybe 6 months before I finally got off the dime and contacted Michael Mont. Before that it was just at nuisance level. I looked around a bit - back then the big 3 were Amstutz, Gross and Su, and Mont was just finishing up his clinical trials of the Wright C+.  He was within driving distance for me, so I went and saw him.  Best decision of my life (well, aside from 2nd marriage and having kid - and some days the kid part makes its way somewhere belopw the hip  . )

In all seriousness, you think you do, but you don't appreciate how much the hip impacts your life because of the gradual nature of its progression.  But you will not believe how much the resurf will impact your life because of the rapid improvement when you take away the osteo pai. 

There is no better time than now to schedule this.  Choose a good doc from among those who get good writeups on this site and go for it.  You'll kick yorself for waiting until now. BTW, I'm a proponent of having it done where you can drive to & from - unless you can afford 1st class, an airplane seat and dealing with airports is not something I'd want to do 3 days after this surgery, but there are others who would disagree.  Just grist for the mill.

Larry
Mont, R,C+, 4/06 (I think)

[strost]

Thanks for all the insights. I've been checking the site every day and emailed a few people, but didn't think to put up a reply. While the posts definitely help me think the timing is just about right, I'm scared to totally commit. Even my chiropractor documented that he thought my prognosis was poor unless I would get surgery. While the range of motion in my right hip has improved slightly, my left hip is getting a little worse (10-15 external and 0-1 internal and about 90 degrees is the closest I can bring it to my chest). My pain overall has improved and I no longer have the knee pain, however, I had a bad day where just about every step hurt (pain in the front side instead of just in the back). I was thinking if I had pain like that everyday, surgery would be a no-brainer. I had trouble getting my on my bike the other day too.

I'm hoping the surgery will address the stiffness in my low back and pelvis (most likely from compensation). I'm hoping it will allow me to get stronger so I age better versus just fighting off further decline. I know if I postpone it longer (scheduled with Dr Gross in late July now), that it will just be more focus on my hip. I want to focus on life and my family as I only have a handful of years left with my kids at home. I want to do many of the sports I have given up again as well as do the ones I've been doing better. Do you still think about your hip now that you've had the surgery or is it just a background thought like it should be?

I'll continue to dig around on the site. What kind of tests exist to make sure you don't have any sensitivities to the materials used in the implants? Do you feel the implant when it is really cold out? Tell me more on what it is like to have so much metal in your body?

Got to walk the dogs now, but would love any additional insights that would help me solidify my confidence in surgery as the best option.

Thanks!!!

[halfdone]

I'm hoping it will allow me to get stronger so I age better versus just fighting off further decline.  It will
I want to focus on life and my family as I only have a handful of years left with my kids at home. So now's the time for the HR
I want to do many of the sports I have given up again as well as do the ones I've been doing better.You will
Do you still think about your hip now that you've had the surgery or is it just a background thought like it should be?No, I just enjoy doing everything I like to do
What kind of tests exist to make sure you don't have any sensitivities to the materials used in the implants?Choose a good surgeon and this will not be an issue - and you have already
Do you feel the implant when it is really cold out?No, nor when it's hot
Tell me more on what it is like to have so much metal in your body?No different than without, except at airport security, and I know I'm bionic  

I hope you don't find my responses too flippant, I know this is a big decision. I just want to encourage, based on my personal experience.  With a good surgeon (and there's none better than yours) , this is a great decision for you and your family (and your dog  .  Bring them in to your thinking, I think you'll find that they support you 100%.

[newdog]

I can't say it any better than halfdone.

You have made an excellent decision in your choice of a surgeon.

I will add my experience of having metal in my body. I can't feel it EVER. And I have two. I even wondered if they warm up when on long walks (I can't run yet). You know, metal rubbing against metal. The answer to that is NO. I have to really think about the fact that I have those parts in me. It's kind of weird. Of course a good weird.

You will do fine, don't worry. Keep us posted.