When do you know its time?

[wendell]

Hi, new member and love the information on this site.

I have read through some of the stories and want so much to be pain free. I have also read some stories that suggest that not everyone is completely pain free. As with any surgery, I understand the risks. I have already had three hip surgeries and still have pain. I am looking for a fix.

I had a head on car accident in Sept. of 2005. No blood at the scene, so not that big of a deal, right? Well, after almost two years of dealing with the pain, 4 doctors and 5 rehab specialists, I asked Dr. number 4 if I could get an MRI or something. The rehab wasn't getting rid of the pain. At the time of this request I was still dealing with pain in my right forearm, right shoulder, and right hip. The pain in my arm was so bad that in my dreams I would have pain in my arm. I couldn't get away from it even in my dreams. I know this site is about hips. But, I want to let people know, and I may be preaching to the choir, that you must be very proactive when it comes to medical decisions for YOUR body. I tell people all of the time now, doctors call it a practice for a reason. Don't assume they know everything about you and your body. You know you better than they do. The more information you give them, the better they can help you. Maybe this statement will help somebody out there. In a class of 30 doctors in medical school, somebody finished first and last. Think about it.

I had to ask for an X-Ray and MRI. 2 years after my accident. Why not sooner? I believed the doctors knew what they were doing, so why get involved in the treatment? Don't be a dumb### like me. Get and stay involved in every decision made about your body. The X-Ray's and MRI showed that the pain I was feeling wasn't simply tendinitis and sore muscles. I had a torn tendon in my elbow, torn rotator cuff and junk in the shoulder, and my hip was arthritic.

Between elbow and shoulder surgery, I had my first hip surgery in May 2008. One doctor had already told me that I had to "slow down" and change my lifestyle to compensate for the pain in my hip. I needed to get another 10 years, I was 46 at the time, and then get a THR. I didn't accept this. I made a call to another doctor in Oklahoma City, OK. Dr. Hal Martin at OSSO. He believes in fixing hips instead of replacing them. He went in and cleaned out a tear in my labrum and did some resurfacing without prosthetics and this helped a bunch. Just throwing this out there, you may be able to save what you have before you go metal to metal. Have you asked?

I was probably not the best candidate for success when I went in. You see, the two and a half year wait after the accident caused things to deteriorate inside the joint. Dr. Martin did the best he could and did stabilize the joint. I still had pain though post surgery. In October 2009, I had my second surgery on my right hip to remove an HO(calcified scar tissue) thought to be the problem. Removing this HO helped, but I still had pain. In May 2011 I had my third surgery on my hip. Dr. Martin went back inside the joint and found another tear in the labrum, cleaned it up, and thought that might do the trick. About September 2011, he has made the determination that it is probably time to get a replacement. He has done all he can do for me.

You might think that I am blaming the doctor. I am not. Actually, I have referred several people to him, and things have turned out great for them. If you can fix the natural parts, why not? I unfortunately need to go another path now. At the very least, I will benefit from all of the surgerical experience that has been gained the past three to four years.

As you might imagine, when you have one hip surgery you pretty much dread the second one. When you have had two, you really dread the third. So starring now at the fourth....??? By the way, each of my surgery's rehab was about like having a replacement. Maybe worse, because I had no weight bearing for about 8 weeks for two of them. So, I am looking for some really good advice from all of you.

Up until this basketball season I was able to continue to referee basketball games at the high school and college level. After surgery number three I felt that I was not able to continue this activity. I have an ache daily in my hip. Some days, some moments, and some activities worse than others. I have good range of motion, but pretty much a constant ache. Sitting, standing, and laying in bed. In September the doc gave me a SynVisc One injection in the hip joint. This helped for about three months. I was having a hard time explaining and wasn't able to pinpoint if the pain I was feeling was inside the joint or tendinitis of the psoas or something else outside of the joint. Because the injection inside the joint worked so well, you know in about 10 minutes, it helped the doctor to determine that my pain is coming from within the joint. At a little over $900 just for the syringe, I can't afford to keep taking these injections. And I need to seek other treatment.

So, I have pain. Some that have had HR still have pain. I have good range of motion now. I don't expect that an HR will help too much with my ROM since mine is already pretty good. Since I have dealt with this for about six and a half years now, my new normal is somewhat skewed.

What is the determining factor that makes you decide to pull the trigger and go through the HR? Do you cross your fingers and hope you are the one that is pain free? I don't see a guarantee that I will be pain free after HR surgery? Give me your advice. I really don't want hip surgery number four to be a bust. I can't hardly stand the thought of that.

I appreciate your time. Thanks!

[midiowa]

sounds like you are past ready to me, how about resurfacing now? you have gone thru way to many surgeries when one would have done it. i was in the same condition before having mine done. off on pain not that bad but when it hurt it hurt bad. iam now 8 days po putting most wieght on it and expect to be crutchs /cane free in 4 weeks max. golfing by july, get it done and start enjoying life to its fullest, thats what made up my mind i was tired of being held back to do activities because of my hip. iam only 8 days experience on mine but everything that i had experienced so far has been right on the money from this hippies. its time and its not that bad.most of all pain is gone.good luck.brad.

[Dannywayoflife]

For me I was far younger than yourself inwas 27 when I was diagnosed with grade 4 OA after a hip scope. And 28 at the time of my resurfacing.
Before my hip scope I went from being a super fit young guy who was able to run 10miles in just over an hour and was at a high level in mma. In just 12-16 weeks I went from that to being unable to even dress myself! After my scope I was told in no uncertain terms that I needed a new joint I then battled with what I can only describe as a mild depression up until the present day and am now feeling far far better and positive abou the future. But for me the over riding thing that made me pull the trigger even after being messed around and lied to by numerous doctors was the fact that my quality of life was for me non existent. Resurfacing offered my only chance at getting my former activities back.
Danny

[imgetinold]

Wendell,

I, too, had intermittent pain.  When it didn't act up, I could do most any activity.  When it was acting up, I couldn't walk, stand, sit, or sleep without pain or discomfort. 

I had to give up tennis.  Then, I could only run/bike on and off.  I actually ran 4 miles two days before surgery.

Like Danny, my decision was about quality of life.  I was tired of giving up being highly active, or only intermittently so, and it was only going to get worse.  It was still a very hard decision, and when people ask me if it was worth it, I say "ask me at the six month point".  I'm sure I made the right decision, but I (at 6 weeks) am still early in recovery and therefore mostly sedentary.  Once I can walk farther and do more, I will more fully realize the benefit of doing it now.

As for range of motion, I had gotten to the point where it was pretty hard to tie my right shoe.  When the hip was bad, I couldn't get close.  In fact, I couldn't even lift my leg into the car without help from my arm. 

It is possible to do so much damage to the bone in your hip that resurfacing becomes impossible.  I think that would determine the window of time you have to get it done.  Outside of that, it is your tolerance for pain and quality of life.  There are no guarantees, but it seems to me that a VAST majority of those here have had complete relief from OA pain.  If your pain is being caused by bone-on-bone in your hip, the statistics here will say that HR will provide relief.

[hernanu]

Hi Wendell, welcome to the site, hopefully this helps your decision:

Hi, new member and love the information on this site.

I have read through some of the stories and want so much to be pain free. I have also read some stories that suggest that not everyone is completely pain free. As with any surgery, I understand the risks. I have already had three hip surgeries and still have pain. I am looking for a fix.

The success rate for this surgery as reported in studies done is 96.4 %. Success is measured by a pain free outcome and return to a normal life. The longevity of the procedure is still being looked at, since it is still a young procedure, but results from countrywide studies done every year in Australia suggest a high success rate at 10 years and counting. We have some hippies who are reporting in at 20 years, but those are anecdotal until enough data is gathered using modern devices.

Between elbow and shoulder surgery, I had my first hip surgery in May 2008. One doctor had already told me that I had to "slow down" and change my lifestyle to compensate for the pain in my hip. I needed to get another 10 years, I was 46 at the time, and then get a THR. I didn't accept this. I made a call to another doctor in Oklahoma City, OK. Dr. Hal Martin at OSSO. He believes in fixing hips instead of replacing them. He went in and cleaned out a tear in my labrum and did some resurfacing without prosthetics and this helped a bunch. Just throwing this out there, you may be able to save what you have before you go metal to metal. Have you asked?

I think all of us, to one degree or another have looked at or experienced the alternatives. I didn't get any other treatments, mostly because I was bone on bone on both hips and anyone who looked at it didn't see any other solution. You'll find plenty of people here who've had all or some of the treatments you mention, and still came to HR for relief.

As you might imagine, when you have one hip surgery you pretty much dread the second one. When you have had two, you really dread the third. So starring now at the fourth....??? By the way, each of my surgery's rehab was about like having a replacement. Maybe worse, because I had no weight bearing for about 8 weeks for two of them. So, I am looking for some really good advice from all of you.

A few people here have had several hip surgeries, you might look at their stories and see how they progressed from their reluctance for another surgery to a successful outcome. Again - no guarantees with this, since we also have some of us who have had an unsuccessful surgery and you can read their story here as well. Keep in mind the overall statistics, and that the solution to an unsuccessful hip resurfacing is the total hip resurface, so hopefully in the end, even for those of us whose resurfacing fails, the result is hopefully no pain and a normal life.

Up until this basketball season I was able to continue to referee basketball games at the high school and college level. After surgery number three I felt that I was not able to continue this activity. I have an ache daily in my hip. Some days, some moments, and some activities worse than others. I have good range of motion, but pretty much a constant ache. Sitting, standing, and laying in bed. In September the doc gave me a SynVisc One injection in the hip joint. This helped for about three months. I was having a hard time explaining and wasn't able to pinpoint if the pain I was feeling was inside the joint or tendinitis of the psoas or something else outside of the joint. Because the injection inside the joint worked so well, you know in about 10 minutes, it helped the doctor to determine that my pain is coming from within the joint. At a little over $900 just for the syringe, I can't afford to keep taking these injections. And I need to seek other treatment.

I've found this to be the treatment. I think we all know the pain you're in, and I can tell you that on both hips for me it is completely gone. There is no lingering pain in either hip at all, and my activities and life are expanding on every front. I can only tell you the truth about my experience and it has been great. There is a long period of recuperation, but it was a very functional recuperation for me. I was weight bearing right away and was up and walking with a walker within 2 hours of waking up. There are some of us who had weight bearing limitations, I'll let them tell you about that, but I was completely off crutches by four weeks.

So, I have pain. Some that have had HR still have pain. I have good range of motion now. I don't expect that an HR will help too much with my ROM since mine is already pretty good. Since I have dealt with this for about six and a half years now, my new normal is somewhat skewed.

Like I mentioned, the number of HR patients that have pain is comparatively small. This does not lessen their pain, the stress on their lives or the difficulty of migrating to a THR, but the bulk of HR patients to date appear to have success.

I also dealt with mine about the same length of time, so I can tell you that I REALLY wish I had done this earlier. The ROM may or may not be better later, I had great ROM before the OA, having done martial arts with the stretching that's involved, but I find that things are very easy to do now, after a year + on both hips. Who knows?

What is the determining factor that makes you decide to pull the trigger and go through the HR? Do you cross your fingers and hope you are the one that is pain free? I don't see a guarantee that I will be pain free after HR surgery? Give me your advice. I really don't want hip surgery number four to be a bust. I can't hardly stand the thought of that.

I appreciate your time. Thanks!

I didn't cross my fingers, just looked at the statistics, and took my chances. There are no guarantees, but a 90+ % success rate even counting bad doctors is great. If you choose a good doctor and the right device, your chances increase greatly.  I couldn't stand still, since I would have been on crutches and eventually in a wheelchair the way I saw it, and here was a tangible solution. It may not last forever, although my desire is that it does, but even if it doesn't it is giving me a freedom for the time it does that I would not trade in for anything.

You mentioned that you want so much to be pain free. This is the way that I did it, given the same condition you're in. I recommend it.

Good luck, we'll be glad to answer any of your questions that we can.

[Tin Soldier]

Hern took the words right out of my mouth.    ;)

Also, the weight bearing issue, not sure if that was mentioned above, but with HR (posterioer approach at least) generally full weight-bearing is actually expected right out of the gates.  Sure you'll be a little tendor for a few days, but I think the expectation from most docs is that you would be putting all your weight on it during a few crutch sessions here and there through the halls of the hospital.  Once home, you'll be expected to slowly increase the amount of time of your crutch session.  Within 2 weeks, generally folks are walking around with crutches or cane and putting most of their weight on the hip through a full stride.  There is going to be a bit of limp and some tendorness, but the doc is not going to be expecting you to lay around for 8 weeks with no weight on the hip. 

Also, with the continued pain after 3 surgeries, I think a lot of that is associated with material that will be removed during surgery.  The labrum is removed, so you won't be dealing with the dreaded and ever-so popular labral tear.  Osteophytes on the femoral neck and extra bone on the acetabulum are removed to receive the components.  Although there is consideration for not remving too much material on the neck because that is the weakest spot in the chain.  You might be really surprised at how much pain relief you get from fully removing the cruddy stuff.  I had a lot of nerve pain down the legs that is totally gone now (gone the day of surgery, even). 

And another thing, I bet some of the really experienced HR surgeons could look at you images both x-ray and MRI and they might be able to tell you right off the bat, that removal of this and that will gain a huge amount of relief.   

[John C]

Hernan did a fantastic job of going over the numerous factors that helped all of us in the decision process; thanks Hernan. I feel somewhat bad in bringing this up, but considering the first paragraph in Wendell's post asking about pain free outcomes, their is an important distinction to make when we quote "success" rates.
In all of the studies that I have read, "success" is specifically defined as not requiring a revision surgery. Success in these studies is not measured as a pain free outcome, but as one that is sufficiently good to not warrant revision. I do believe that the vast majority of resurfacing patients, including myself, end up essentially pain free; but I have read individual studies (not by the most experienced surgeons) where as many as 20% of the "successful" patients were dealing with some sort of ongoing discomfort, most often groin pain. I think that for the most experienced surgeons, their "pain free" rate is much closer to their "success" rate; but in quoting studies, the two are not the same.
Sorry Hernan, I do not mean to detract from your heartfelt and thorough job of helping Wendell with these tough decisions, but his specific query about pain free outcomes goes beyond the "success" rates quoted in the studies, and it seemed that it needed clarifying for him.

[Jeremy76761]

John that is an excellent point and I had been wondering about HR outcome stats for problems below the threshold requiring revision. If you come across any of those studies again, could you post them?

Being not a surface hippy I don't have any advice for Wendall, except Wow, that's a lot of surgeries. May you have but one more.

One thing the surgeons and people on this site advise is that many of the top surgeons will in fact review X-Rays and MRIs for free. That way, you can assess your candidacy and avoid allowing the hip joint to become too damaged for surgery.

Let me just add that the support provided on this site -- Tin Soldier, Hernanu, Danny, HipnHop and others-- is really useful. Speaking for myself, and there must be many others, the informative and uplifting posts have been a Godsend from Day One. Thanks -- endlessly.

Jeremy

[hernanu]

John, no need to feel bad for bringing knowledge and care for someone looking for information. I agree that we need more info about what underlying pain there may be. The more and better info we have overall the better  :)

[wendell]

I appreciate all of the replies. This site is awesome. It's nice to know that I am not going through all of this alone. It helps to have advice from those who have gone before me. I will take any and all suggestions that I can get. Thanks for the passion and honesty. Keep it coming.

[Anniee]

Wendell, I was somewhat similar to Hernan in that I was bone on bone in both hips and really had three options:  resurfacing, THR, or wheelchair in a year or two.   I had my right hip resurfaced in April of last year, and the left one last October. I had so much pain before I had my second hip done that I had a hard time walking for more than 10 minutes. I even had to stop using the elliptical because it hurt too much.  Before I got to that point, the elliptical had seemed to actually help with the hip pain.

I am not totally pain free at this point.  The muscles around the hip area (both sides) still get quite stiff when I sit for long periods of time, and it hurts a little bit before they loosen up and I can get going. (Possibly some of that has to do with my age - I'm 65).  I also still have intermittent groin pain and soreness on the left side.  However, the awful, sharp bone-on-bone pain in the joint was gone immediately after surgery.  Now that I have had both my hips fixed, I can walk as long as I like (that feels like a miracle), use the elliptical (with resistance!!), sit comfortably, sleep all night without waking up because of aching in the hip joints.  I hope to be totally pain free sometime (I still haven't reached the 6 month mark for the second surgery), but even if I never quite get to that point,  the post-surgery improvement is huge.  I have no regrets at all!

[Dan L]

Listen to all these very insightful hippies here, they lead me down the exact right path, and now one day after the 2nd one, they have been aagain been proven to be very, very on target.

I was ready when i had more limitations that I thought good for a 50 yo male, and tired of the searing bone on bone pain, fed up with the ending aches when doing things I love, and the mental wear and tear of chronic pain that drags one down into depression.  one year from yesterday i will have no restrictions and I could not have made better decision on this, largely due to the folks here at surface hippy.

[hipnhop]

I tried to postpone my need for hip surgery through a cortisone shot. That didnt work and I ended up in severe pain and unable to walk. The shot destroyed the remaining cartilage and tissue I had left. It took my insurance provider three months to figure out what happened to me  and another 4 to approve HR. It was a nightmare. I would not wait. I am 3 weeks post number 2 and about to go boxing.