Bilateral in January?

[mountaingoat]

Hi,
I've been following this board for a few years and have also been a fairly active member of the surface hippy yahoo site. I'm not yet a hippy but will be as of January 2012.

A little background (to make a very long story short). I am (well, was) an extremely active 36 yr old living in Colorado and enjoying the mountain lifestyle. Until 2008, I was a trailrunner and ran about 25-30 miles a week on hilly trails. I also cycle (road and mtn), hike, telemark ski, swim and do yoga. I began having hip problems in spring of 2008 when I was diagnosed with a labral tear and impingement in my right hip. Had Athroscopic surgery #1 in Jan. 2009 which was a complete failure. I then went to a different surgeon out of state and had bilateral surgery in Oct. 2009 - labral repair, removal of FAI lesions and microfracture. My right hip was significantly damaged by this time and my left was only marginally better but did not have the extensive loss of cartilage that my right did. It took me about 8 months to recover from the revision arthroscopy and then it only bought me another year beyond that - but it was an important year because I was able to finally get pregnant and have a child without having to worry about my hips. My hips did well all through my pregnancy but then began to deteriorate again this spring right before I delivered my daughter in May. I had some x-rays and a high-resolution MRI taken which show that the right hip has suffered extensive loss of cartilage since the year prior and there has been a significant progression of OA in that hip. My left hip does not show real joint space narrowing on x-ray but there is a bone spur and the cartilage is damaged enough that I feel it with any walking or impact activity. In essence, my right hip has significant OA which is painful all the time while my left is relatively mild but still symptomatic enough to restrict my lifestyle a good bit.

I recently consulted with three surgeons about resurfacing; Dr. Rector in Boulder who said he would do the right hip but advised me to wait if I could stand it given my young age and the fact that I may still want another child. He is a great surgeon but known to be on the conservative side and will say outright that he prefers to resurface men over women. I did not speak with Dr. Su but his PA called me and said he would definitely do the right hip but advised me to wait on the left for another year or so. Dr. Gross called me personally and we spoke for a half hour and went over my whole history. He agreed that the damage was worse in my right hip but agrees with me that left is only a little behind it -possibly as little as 9 months or a year.

I am leaning towards doing bilateral in January for a few reasons. First, I do not see the point of going through a major surgery and recovery if I am still going to be significantly limited in my activities by my other hip once I am recovered. Although my left hip does not bother me with every step I take like the right does it bothers me enough that walking/hiking of more than a few miles will really make it ache and be sore the next day. I certainly would have trouble getting back into running, skiing or backpacking with that hip. The other reason is that I do not want to go through a major surgery and recovery if I am going to turn around and need the other hip done in 9 months or a year or even a year and a half. I have a small baby (5 months old) and am already in the extremely unfortunate position of needing to have my shoulder scoped for a labral tear next week - so that will be one surgery in Oct. and one in January. I'd really like to avoid a third surgery in the same year.  Dr. Gross just wants to test my bone density but said he agrees with my logic and thinks I am fine to go ahead with both hips. He also was ok with me having another child after resurfacing which Dr. Rector is not. I'm not sure I will but I haven't been prepared to say absolutely that I won't. I am aware of the metal ions risk but feel that it is really no different than the thousand other things we haven't established are 100% safe during pregnancy.  :-[

Now my question is mainly about the whole cemented vs. uncemented issue and whether bilateral is too much of a risk for someone at age 36. I am definitely leaning towards uncemented bilateral but like many I also like the idea of the BHR track record. At my age, any of this is a huge leap of faith but one I am willing to take to get my life back. I have done a lot of research and have read many threads on this board in regards to the cemented/uncemented question.

I guess I'm just looking for comments or suggestions about how to make this decision and whether I am taking too much of a risk by doing the bilateral. My husband thinks I should just go for it because he wants to see me (and our family) get my life back so we can enjoy all the things we live to do here in Colorado. But this is a MAJOR life decision for anyone - especially someone in their 30s. Could I live another year or so with my left hip? Yes. But would it limit me enough that I wouldn't really have my life back so to speak? Yes. I guess that kinds of answers my question but I'm interested to hear in any feedback others might have. I've learned to accept that I'll probably never have a painfree life again given the problems I've got in my hips and shoulders but I know that it can be much better than it is now.   Thanks.

Amy

[Lopsided]

Now my question is mainly about the whole cemented vs. uncemented issue and whether bilateral is too much of a risk for someone at age 36.

Amy, I do not understand 'bilateral is too much of a risk for someone at age 36.' When I as in Belgium three patients had bilateral, one in his early twenties, one in her forties, and one about sixty.

As for uncemented, I certainly believe in it. There is now an uncemented C+. The C+ has been around for almost as long as the Birmingham, with some surgeons showing better results.

D.

[jjmclain]

Hi Amy,

I think you can get your life back and get it back pain-free. I am a very active small female, age 49 (soon to be 50 at the end of November!). I am a long distance triathlete and fitness instructor. I had a full rotator cuff repair on my right shoulder at age 47 and a left BHR at age 48. I am 10 1/2 months post-op from my BHR and doing fantastic! I feel great and can say that I am pain-free. I have no start up pain, no lingering issues etc. from my hip. My right shoulder doesn't feel as strong as my left and it has been almost two years, but I can swim and do any activities I want pain-free. Shoulders are a little more tricky than hips. But, my BHR hip feels just like my normal one! I plan to get back to racing next year.

With that said, the decision for surgery is yours and yours alone. We can all just offer good advice. If I were in your position, I too would go for the bilateral surgery instead of going through the recovery twice. But there are plenty of hippys on this site who have done them separately and glad they have. Those who did both at once are also glad they have. I wish you luck in your decision! I just wanted to let you know that you can get your life back and get it back pain free!!!!

June

[mountaingoat]

Lopsided - my issue with bilateral is more just the question of whether it makes sense at such a young age to wait a little longer on my left hip because it is still not terrible the way my right hip is now. If both hips were bone on bone, I would not even question the decision to do bilateral regardless of my age. But my left is still only mildly arthritic on x-ray even though I feel it every day.
June - its good to hear you are recovering well from your surgery. I have heard from many that the shoulder is a harder recovery than the hip. I have prepared myself for that at this point and just want to get it over with - luckily I don't need an RC repair but I may have to have my biceps cut and re-attached which is equally yucky. I am hoping that I am not being unrealistic to schedule my resurfacing in mid/late January which will be about 15 weeks after the shoulder. I know my shoulder won't be in any way healed by that point but hopefully it will be normal enough that I can use crutches for support.

I do know that its possible to live a pain-free life as I had about 10 months of pain-free living after my second hip scope but it all seems like a distant memory at this point!

Thanks again.

[hernanu]

Amy, there are many ways you can manage this, but ultimately it's your choice. You've listed several reasons to have both done, with a very good surgeon backing you up on that. There are also good reasons to have one done and wait for the other.

I had both done, but one followed the other after three months. If I had had the choice to do both, I might have chosen that, but my surgeon preferred the wait, and I chose to go with that. Three months is not long to wait, I probably would have balked at a year, due to the pain. Several people here have done either at the same time or with only a few days wait, which to me is at the same time.

To me (only my opinion) I would do them together, deal with the longer recovery (not that long, in the scheme of things) especially when someone like Dr. Gross is doing it. It is, though in the end your decision and yours only, so good luck.

[Aerial]

I can not comment on the bilateral issue but I will say that I had a consultation with Dr. Gross and he seems to me to be a very straight shooter.  If he says it can be done I think it can be done.  All the positive comments about Dr. Gross from patients on this website leave me comfortable with selecting him for my doctor.  I think you are making a good choice in terms of doctors if you go with him.  Keep in mind I am saying that based on how clear and scientific he was when I had my appointment with him (I have not had my surgery yet).  In terms of being a straight shooter he pretty much told me he would have never done hip arthroscopy on me with an MRA that showed arthritis and a severe labral tear.  I had hip arthroscopy a year ago with another doctor for FAI and labral tearing.  Like you it failed miserably and I've been limping along for the past year never fully recovering from the arthroscopy. It would have been nice to have everything fixed with one surgery as you can surely appreciate. I have had a three year downward spiral of right hip problems and I too am ready to get my life back!

[Anniee]

Amy, I am a Dr. Gross patient, but much older than you.  I had my right hip resurfaced last April.  At the time, my left one was not hurting, but looked pretty bad on X-rays.  Fortunately, I scheduled surgery for it several months ago, more based on insurance issues than pain issues, and I'm having my next surgery on October 12 (6 months after the first one).   Since the first surgery in April, my left hip has deteriorated significantly, and I am very thankful that I scheduled the surgery when I did, because I have been in a lot of pain in the last month.

Everyone has to make their own decision about surgery, of course, but as others here have said, Dr. Gross is a straight shooter.  As one of his patients, I trust his judgement completely. As he has more than enough patients, he does not push anyone into surgery he does not think they need.  I'm pretty sure he thought I should have scheduled the second hip much sooner, but he respected my feelings and circumstances, and just asked me if that hip was not hurting (which it really was not at the time). As you say yourself, it does not seem to make sense to fix one hip, only to be limited by problems in the other one.  In my own case, I know that my complete recovery from the first surgery has been limited by pain in my other hip.  For example, I can no longer walk as much as I really should.  If I had known back in April how quickly my other hip would deteriorate, I would have definitely scheduled the second surgery much sooner. 

Best of luck to you!

[rbt2011]

Moutaingoat:

Now my question is mainly about the whole cemented vs. uncemented issue and whether bilateral is too much of a risk for someone at age 36. I am definitely leaning towards uncemented bilateral but like many I also like the idea of the BHR track record. At my age, any of this is a huge leap of faith but one I am willing to take to get my life back. I have done a lot of research and have read many threads on this board in regards to the cemented/uncemented question.

I guess I'm just looking for comments or suggestions about how to make this decision and whether I am taking too much of a risk by doing the bilateral.

First of all congratulations on making the decision to move forward and to get your life back.  Whether you decide to go uncemented, cemented, one side, or both at the same time, you are going to be moving in the right direction. 

Your story really hits home with me as I just turned 37 and need both hips done, too!!  I also had a scope in 2009 that bought me about a year.  I am scheduled for the right side with Dr. Su in January 2012 and, just like you, I agonized over the decision of what surgeon, what device to use, and whether to do one at a time or just get them both done.

My suggestion for making a decision for the device is to read and research the New Zealand Registry (found on Vicky and Pat's site under medical research).  This really gives some great data on the diagnosis, device, device size, and age which all put you in different risk categories.  I too struggled specifically with what device I felt most comfortable with and the data from the registry helped me make a decision that I feel confident with.  Not to sound like an ageist, but you and I have 50 years left of life expectancy and this decision is super important for us. 

For the surgeon, I would just say to follow your heart.  Whomever you think would give you the best possible outcome, then go with that person.  And, if you need to switch surgeons, reschedule, postpone, whatever, then do it.  You get one shot and I would say to go with whomever and wherever you feel most confident.  If that means spending a few thousand bucks on airfare, hotel, whatever then consider that a down payment on the next 30+ years (I am optimistic) of pain free living. 

For the bi lat decision, I would say go with what the surgeon recommends.  I know it sucks to have to potentially endure this recovery twice, but I personally am just a bit hesitant to pull the trigger on both sides before I know what I am getting in to.  That being said, if your surgeon says you can do both at the same time and you are comfortable with it, go for it.  Like it has been said by others, there are a LOT of people out there with both hips done that are back at life 100%. 

Best of luck in your decision and definitely keep in touch. 

[newdog]

Amy,

You wrote a very good description of your hip situation and you have really good questions regarding HR and your upcoming surgery. January 2012? That will be my one year anniversary as a Dr. Gross bilat.

The cemented vs. uncemented issue is one that only you can make the decision on. It's a personal choice and is somewhat of a leap of faith for some people. I have complete confidence in my decision to go with the surgeon I went with and the uncemented device. But that's me and I have total respect and understanding for anyone who prefers a cemented device.

All I can say is, Dr. Gross has been using the uncemented Biomet for over three years now and has not had a single loosening or problem with it. There are other Hippys on this site who are uncemented and are very active physically doing activities that are pounding their new hip(s).
Just so you know, you can contact his office with any of your questions and concerns about your upcoming surgery. Maybe you already are aware of that. Lee or Nancy will get back to you within a day or two usually, sometimes the same day.

IMO, if your other hip is only going to last maybe 9 months then I would go ahead and have it done also. I know Dr. gross would not do an unnecessary surgery on anyone. But that is my opinion and like I and others have said, you have to make the decision. There was no question about doing both of mine, they were really bad. But then, my hip problems started with just my left one. It went bad over a period of 3 or more years then the right one went bad very fast. Something like a year. That's how fast the hips can deteriorate once they start losing the cartilage. Dr. Gross must see that the other hip is not healthy and won't last much longer. I would trust his judgement. If you go ahead with both, you won't look back and wish you hadn't.

It's really good that you have done a lot of research and reading. Good luck and keep coming back to this forum.

[wayne-0]

Hi Amy, I had bi-lateral surgery almost three yrs ago. I had both hips done on the same day. I am so glad i did it that way mainly because i had only one recovery. Yeah it was more difficult the first 8-10 days than having one done, however it got easier and easier as the days passed. You can get back to a very active lifestyle after surgery, i know that first hand as my life has become very active again. You write about not ever being pain free again, but that is not necessarily true. Believe me the pain you are experiencing now is far worse than after surgery. BTW i am one of the lucky ones who pretty much woke up pain free after surgery and continue to be that way to this day. The only pain I have is in my mind knowing i have two ASR implants but so far everything is good and i hope it continues to stay that way. Good luck with your decision and surgery.

[Lori Cee]

I'm 33 and put of surgery for about 10 years. As it ended up, I needed BMHRs as the standard resurfacing was no longer suitable. (My BMHRs are still MOM)  Given the damage and condition of my hips post-op things took a little longer than the other bilats, but there are still a few things in common that I would like to share.

My surgeon recommended that I get both at once and though I had a couple of moments where I thought 'what have I done' I really think that it was the very best solution for me.  The rehab was more difficult but I don't think it was twice as difficult.

The pain post op is truly nothing compared to the pain I had pre-op.  Post-op it was fatigue and weakness more than anything else. This really is a start to a pain free life.  (For the first time in over 20 years I'm off arthritis and pain meds - its incredible!)

Recently there was a good thread about making the decision to get them both done at the same time:  http://surfacehippy.info/hiptalk/index.php?topic=2750.0

I was also asked independently of this to comment further and replied by writing a fairly long post about whether I think I did the right thing - which I really do think that I did.  Rather than repost it - it's here if you want to read it:  http://bilateralhipreplacement.blogspot.com/2011/09/would-i-recommend-bilateral-bmhrs.html 

On the metal ions thing and pregnancy - I've discussed that with my surgeon pre-op and he isn't concerned about it.  THe reading that I have done shows that the levels that we should normalise to are well below anything that could be an issue.  I did consider the 'what ifs' and did a lot of research before going ahead with the surgery. 

Every one is different and it may or may not be the right one for you.  Regardless of what you choose, the people here are awesome and if you have any other questions you just need to post :)

[mountaingoat]

Thank you everyone for your thoughtful, compassionate responses. I really appreciate all the support. Everyone on this board seems so happy with their decisions and can offer alot of feedback about my dilemma.

I'm not certain yet what I will do - most likely going to go for the bilateral uncemented but have a few more months to think about it. No question I will be doing my right hip at the very least. Right now January cannot come soon enough.

I try so hard to be positive but honestly the idea of another winter spent recovering from surgery is enough to make me scream and tear my hair out. I've missed 2 ski seasons recovering from hip surgery in 2009 and 2010 and then didn't do much last season b/c I was pregnant. Its tough living in Colorado and not being able to play with everyone else on the weekends.  :-[ I'm not feeling sorry for myself but I truly cannot believe some times that I have spent nearly 4 years of my 30s (from age 32-36) dealing with these injuries and at times being unable to walk my dogs 2 miles. Of course I want to return to all my sports and such but what I really plan to celebrate is just the freedom to be able to walk wherever and whenever I want!!  >:(

Anyway, thanks everyone for your support and feedback. It has helped me a ton this week.

Amy

[Tin Soldier]

I'm 42, had my left done in Feb of this year and my right done last month.  About a 2 years ago after researching this stuff, I releazed this was not going to be a half year deal.  I don't expect to be skiing any time soon, might get back into soccer after a year from now, might do a little running before that, but generally I've accepted that I will be recovering from these surgeries for a year, or more.

My right was not that bad and I thought about putting it off for another year or more.  I hate to be materialistic here, but part of the reason I had my right done in the same year was because I already met my out-of-pocket max for the year when entered the OR for my left hip.  If the doc said I might be able to go 5 years before getting the right fixed, then maybe I would have held off, but one year or less?  sort of like you.  I'd just get them both done, in one event, or separated by 5 to 6 weeks which is pretty common, or a few months. 

You can be pain-free and get your life back.  Good luck with your decision.