The ever present "WHEN?!" Question

[bosoxgordon]

Hello again all.
Well I know this is probably a topic that has been covered here many different times but it came up in another thread I started and I thought I'd start a new thread to get some feedback from all of you great folks.

First of all I want to thank Pat for starting and keeping up this awesome website. When I first found out I a facing OA in my hip at a relatively young age I was pretty shaken up and was almost convinced by a couple surgeons that a THR was the only good option for me. It is because of this site that I even knew about and then met the great Dr. Gross. I actually feel like that I can lead a normal life post surgery.

I have done all my research and feel very confident that Dr. Gross is the man for the job for me and after a year on Celebrex I think I am at the point to where I need the surgery..........I think.

This brings me to my current question/dilemma/concern. While I am totally at peace with my choice of Dr. Gross (I am penciled in for early April surgery) I am still conflicted about the timing. I have heard so many stories from others out here about how bad their OA was before the surgery. While my pain and ROM have gotten worse over the last year, I can still walk fine and function ok in most of my daily life. I will admit that I used to workout 3-4 times a week and now hardly do at all. Yes, I have adopted a sedentary lifestyle. However, as I read some of these horror stories about how bad it was for some before they got their surgery, I find myself doubting. I do have pain but it's just not that bad yet.

So, what was your story? What was your pain level? How did you know that it was the right time? I know this may seem like I'm over thinking things or maybe just feeling a little chicken as the date approaches. It is hard for me to not think far down the road. I'm 40 years old, I have a 2 year old son and my wife and I just recently found out we have another child on the way. It makes me start thinking about the life span of this device in terms of my children's lives and not my own. I remember Dr. Gross telling me about all the great sports, running, and activities I could return to after the surgery, but the only thing I care about is being able to work to provide for my family and  pick up my kids and play with them until they are grown. It's a bit scary getting a device put into my body when I think about how old will my child be when I have to have it redone. My hope is that the thing is still in my hip when I die an old man but reality forces me to face the likelyhood that more surgery is in my future.

So, after all that rambling. At what point is a pain free artificial hip better than an arthritic natural hip? I have to admit, this has been a decision that I'm really having a hard time feeling good about. Everything else has been easy compared to this. When is the right time?!
 

[bluedevilsadvocate]

Scott -

Here is a post that I made a while back:

I've had a similar reaction --- that most (or at least many) who post on this site had/have substantial pain.  I never did have much pain; occasionally my hip would sort of "catch", which was uncomfortable, but no severe or chronic pain.  But over time I realized that I had reached the point that my hip was significantly adversely affecting my life and lifestyle.  I used to play tennis regularly, but I couldn't really play effectively, so I stopped playing.  When I vacationed with my wife and adult children, we did a lot of sightseeing by walking; but I reached the point that I felt I could no longer keep up and would just slow the others down, so I stopped our usual sightseeing vacations.  Oh, I could walk, but my stride was limited so I couldn't walk at the same pace as others.

I decided that it was time to get on with my life.  I had left hip resurfacing surgery last fall.  Now we're planning a family sightseeing vacation this coming fall.  (I could go now without a problem, but finding a time when all of us can go has put it off to the coming fall.)  My surgeon recommends no impact sports until 12 months postsurgery, so no tennis for now; but I plan to get back to the game this fall.

I have heard that the "wait until you can't stand the pain any more" approach is "old school", and is more common in the U.S. than elsewhere.  To some extent, I think that it is a holdover from years ago when hip surgery --- especially the longevity --- was more uncertain than it is these days.  Frankly, I don't buy into the notion that you should basically put your life on hold and only seek relief when you can't stand it any longer.  That seems detrimental to your mental and physical health.

I'm very pleased with my decision to get moving again.

But the decision is a personal one, based upon individual circumstances and goals.  Nobody should try to pressure or convince you one way or the other.  You know yourself better than anybody else.

[Ross]

You make me feel like I have traveled back in time.  We all have been there especially me.  I was 41 when I had bilateral with Dr Gross.  I was angry, depressed, mad, scared, and uncertain.  I have two children under two.  I wanted to be active with my family and was unwilling to be old before my time.  When ever I would see someone running on a sunny afternoon, I was so angry and jealous that it was not me.  While the recovery is not easy, Dr Gross is an expert within his trade.  At some point, you will have to commit and write out your long term and short term goals.  You will love the hospital and staff.  I am the worst critic and they beat HSS hands down.  I had very minimal pain while in the hospital and the southern hospitality was great.
Ross

[hernanu]

Hey Scott, you bring up something we've all dealt with. I put mine off by a good five years, for no other reason than that I wasn't 'bad enough'. I was encouraged in this by my doctors, since they all have that old time religion about deferring it and living with the pain.

The thing is that you know and we all know it doesn't improve. It gets worse every day, sometimes in small increments and sometimes in large; with me it wasn't a gradual decay, it was small and then went bad fast.

I went from a very active martial artist, soccer player, basketball player, man about town to a stilted, cranky and depressed fellow who had trouble walking up and down stairs. I stubbornly hung on to soccer even when my left hip started dislocating (I'd pop it back in and keep running), but gave up everything else.

The things I gave up weren't just activities. I became more withdrawn, lost sleep (was down to about two hours per night by the end), and could see the concern in my kid's faces when I walked.

I took my girls on a vacation to the old country (Ecuador) a year before my surgeries and was in continual pain since we were walking everywhere. My cousins, who I hadn't seen in a while commented on my slowness and weight gain, which I had to chuckle at and take, since no one really sees the open wound you have inside of you.

So outside of the personal challenges and fears that we all have had (they are normal), I also became aware of the toll it was taking on my family to see the pain I was in. The surgery and recovery will take a bit, but you are functional to the basic level you want to be at fairly quickly, then the whole thing improves.

You want to run with your kids, not just when they are teenagers but I loved running around with my girls when they were two, three. I think you stand a good chance of doing that.

As to the longevity, nothing is guaranteed, especially since we are at the forefront of this procedure still, but all indications from the Australian registries are that for all surgeons and devices (both good and bad), after 10 years the survival rate without revision is 94-96%. The curve is fairly flat at that point, so the projections I would see is that the survival rate would continue high. Just my opinion ( I'm not a medical person).

Surgeon selection is very important, so if you know you've chosen a good one, that increases that rate. Again, no guarantees but one thing you are guaranteed is that left alone, this disease gets worse.

That's my take on it, and after two years, I can tell you that it is the best thing I've ever done for myself, and I no longer see that scrunched look on my daughter's faces when they see me walk. Now they just bust me like all good young adult daughters should bust their old dad.

Good luck, just my 2 cents.

[PattyM]

Hi Scott,

I can tell you when I had my surgery 5mos ago, I could not walk, sleep
or be civil to anyone! I gradually got worse over 10 years,  I guess you
don't realize what activities you stop doing when it happens over a long period.

Everyone is different, but if I had known about resurfacing and how much of my life I
missed out on, I would have had it done 10 years ago!
it's not only a physical improvement but a mental one too!!
I'm 50 and I felt like I was  70. Now I feel 20 again (not kidding).
My other hip is bothering me , like the old one did maybe 9 yrs ago.
Out it goes!! I am scheduled to have it done also.
No waiting this time, life is too short.
Our kids deserve to have us running around and being active!

Also I want to mention that my father had a THR when he was in his 50s and
so he needed that replaced in his 70s. That was a difficult recovery, they have to cut
father down the leg bone.  After seeing that , I know I would rather take my chances
with resurfacing, Even though I am female .
Sorry to ramble. Hope this helps.

[Boomer]

Scott - I can't say it any better than Hern. But I will add a bit to his post.  I was a shadow of my former self before having both of my hips resurfaced. Everybody around me was limited by my disability and uncomfortable with my pain. Now I have no limitations, nobody mentions or thinks about my hips when planning events or activities and I can do everything a healthy 58 year old should be able to do.

It's not about the pain. It's about all the things you are letting go of as you slide down the OA Shute. You can halt that slide by showing up for your surgery as planned.

If Dr. Gross says its time to get you hip fixed, relax and let him make you better.

Boomer

[Tin Soldier]

Scott - I can't say it any better than Boomer, but I'll add to the post.  My story is almost the same as Ross' and yours.  I'm not sure if I am just a tough guy or I just really didn't have that much pain, but it seemed like I should have put it off a little longer, at least that's what I thought about a year prior to scheduling surgery.  Looking back, I'm glad I did it when I did.  The pain wasn't going away and I began noticing more and more the closer I got.  Now I realize how pain I was in.  Didn't really know it until I had no pain.

Angry, depressed, BP rising, not getting any good exercise, along with numerous other minor and major changes in my life that added up, all added to the decision.  I think the actual decision came when I was in a tree with a chainsaw trying to trim some branches, my rope and harness was all tangled, could barely shimmy up the tree, it was raining, my hips hurt pretty good from the weird positions and kept trying to bring my leg up and I couldn't get it far enough up to get around the rope and some branches.  It was more the limited ROM that got to me.  That was enough.  But there was about 6 months of deliberating on it. 

After getting it done and looking back and hearing more stories here, I think my timing was right.  I think you'll find that your timing, whenever you do it, will be right. 

I wouldn't worry too much about the longevity issue.  McMinn recently presented info on a 20 year patient who is going strong.  Would a THR limit your job?  I don't think so, so even if you had to get a THR or revised HR in 15 or 20 years, is that all that bad?  Gross has excellent results and I think he's got some patients that are in the 12 or 14 year range.

I would probably lean towards the sooner with regards to the kids.  Six months from the operation you'll be pretty much back to better than you were in recent years at least as far as ROM and activity.  Pain should be gone quickly after surgery.  I know exactly the position you're in.   

Good luck

[curt]

The fact that you are asking the question probably means that you're ready.  The speed with which my hip deteriorated made me literally beg Dr. Gross to fit me in earlier.  I could have saved myself 9 months of alternate and ineffective therapies, shots, PT, accupuncture etc.  It would have also saved me from a very frustrating and painful period.
    While I think Dr. Gross loves his art, I do not think he would tell you that you are in need of his services if your hip wasn't bad.  He's seen a LOT of them.  My kids (twins) are now 9 years old and I can RUN with them, play lacrosse, and lots of other activities that would have been impossible without the surgery.  My kids and my family benefit from the surgery every single day, and not just because I'm physically engaged -- its emotional too, and for that I will always be grateful.

[Jason0411]

When I first saw McMinn he was ready to do my hip but I was not sure so he let me go away and said call me when you are ready. It took 3 months to ring him as my hip went downhill like you would not believe. So I would say if the Doc is ready then he can probably see something you can't feel yet. Don't leave it until it keeps you awake. Go for it.

[Dee Dee]

Scott,

ROM was a major factor for me.  When my activity level was severely impacted by pain and discomfort in basic activities like s#x and shopping, I knew it was time.  After years of looking for answers, the 5 month wait seemed short.  I used that time to lose a few pounds, research on this sight and prepare myself mentally.  I was ready to "get fixed" and so glad I did.

Where I struggled was with the second hip because it really wasn't as bad as the first and I knew surgery would actually make it worse before it got better.  BUT I am glad I got the second one done in the same year and can work on both hips to get the muscles strong.  Walking is great now.  I am still sore on both hips from the second surgery and my goal is pain free ROM in the future.  I know it takes time and effort to get there.

I hope you get the peace of mind you need to make the best decision for you. 
Dee

[maxx6789]

it's a very personal question and decision that only you can decide.

for me ... it came down to one question a friend asked ... "if you could stay at your current condition for the next 5 years, would that be okay?". the answer for me was a big "NO". i had given up so much already. and we all know the OA only gets worse overtime. it is strange to say but ... for me ... have these two operations when i did was one of the best decisions i have ever made. my results (to date) have been in a word ... amazing.

although you need to feel (in your gut) it's the right decision, my guess would be if you already booked a surgery date, you probably are mentally and physically ready.

best wishes to your with your decision and hip!!

[packman]

Scott,
I am pulling the trigger and about to schedule either end of March or April - maybe we will pass each other in recovery?
For me, it's about removing uncertainty. Right now it's like that episode of Cheers when Cliff Claven gets electro shocked by his psychologist whenever he says something obnoxious. Well I get those more frequent shocks of pain when walking and any slight twists and just freeze a bit. Certainly makes you gunshy to walk further or faster.
Beyond the pain flashes, I am also choosing to look forward with the optimism and confidence of a friend that had this done, the colleagues on this board, the professionalism of Dr. Gross and his team, and being able to return to some key activities (golf and outdoors nut)

[Ross]

Knowing that you are broken is a terrible feeling and  extremely hard to admit to yourself.  Lots of emotions but know that in the end your family will benefit from there old dad being happy and healthy.

[Tin Soldier]

old dad being happy and healthy

Good point, not sure I mentioned it above, but that is probably the most important part of it for me.  I was a grump, felt like an old dog when somemone touches him, he barks or snarls.  "insert grumpy dog icon"  The pain wasn't that bad at first, but it just caught up to me and changed my attitude about life.  Not good.  The family wanted an active and happy Dad back.  "insert happy dog with flowy hair bouncing around in the waves on a sunny beach-icon"

[Dan L]

The thing is that you know and we all know it doesn't improve. It gets worse every day, sometimes in small increments and sometimes in large.....

Hernanu said it exactly as far as when I knew it was time, and the x-rays and mri confirmed all the issues.  I'm really glad I did not go down the road to partial fixes for the torn labrums, and after a couple hip injections that only offered temporary relief, went through the surgeries as soon as possible.  I'm 3 weeks away from 1 yr anniversary on 2nd one, and lifting of all restrictions, and the amount of relief, and ability to do what I want, without pain is incredible.  Like magic.

It is something you have to be comfortable with, because it is a commitment to a major surgery and recovery that requires patience, which for the type A folk, is not always easy.

Good luck,

Dan

[Baby Barista]

I had my first BHR at 37, the second at 38. Here's how I've come to view the question of when.

Since we don't know for sure how long these things will last, we have to assign an arbitrary number if we want to quantitatively assess the question. So, let's say 20 years. If I waited four years to have surgery, I would have been in pain until age 42, just so my devices would last until I'm 62. Now, which would I probably enjoy more: gaining those four years on the front end or the back end?

For me, that's a no-brainer. If these things have a finite life, what do I care if I need something new at age 58, or four years later at 62?

My kids are young now, my life is now... I want to be the best "me" now. This is a conclusion I've come to over the last year, and not one I'd reached before surgery. It's a profound decision to make and one that takes careful consideration. Hopefully this will give you another perspective to think about. Best of luck!

[bosoxgordon]

Hello again all,
First of all I want to thank everyone for their thoughtful and sincere responses. Every time I post something on here I am blown away by how many people I have never met before take the time and effort to share their experiences and feelings with me on this topic. I have even had the pleasure of speaking with a few hippy patients and its amazing that they took the time to talk and answer any of my many questions. I say all that to simply say thank you to all of you that have taken the time to help me through this challenging process.

I never imagined that at the age of 39 I would be diagnosed with hip OA and underlying FIA (I never even heard of that) and it was unsettling to get that news. I think I have some perspective though. About the same time I was finding out about my "bum hip" I had a good friend my same age find out he had cancer. My friend fought hard for a year but eventually lost his fight and left a wife and two small children behind. I often think of him and I know if he could have traded his cancer for some hip arthritis he would have done so in a second. But the human heart is desperately selfish at times and I still end up feeling sorry for myself and the impending surgery.

It's not the surgery I necessarily fear. It's the fact that this is a "one way decision gate" as some people may call it. There is no turning back and for the rest of my life I will have a foreign object in my body. Yes my natural hip hurts and doesn't move we'll at times, but when is it worth the long term risk of having a prosthesis in me?

Anyway, that's just a bit of the rambling that's been going on in my head over the last year. The reality is that the pain is slowly getting a little worse can day. When I go for a hike or exercise I pay the price that evening. I know I must do something soon. Celebrex has bought me about a year but I'm not sure how much more it will if I wait. I think Barista said what I've been thinking when it comes to the lifespan of this device. If I'm lucky I hope and pray I will get 20 years (or more) out of this thing. What good will it do to suffer through one more year just to make it to 61 instead of 60 when I would need a revision. Also, the wild card is any new technology they come up with by then.

I am penciled in for a date with Dr. Gross in April. I'm completely at peace with him and his team. I'm convinced there isn't anyone better for the job. I just need to feel at peace for the timing. When I lay my head down on that surgical table and close my eyes I don't want any second thoughts about doing this too soon or not exhausting an other option. I recently talked with another "Gross hippy" and he said "trust me you don't know how much pain your in now, you've grown accustom to it and you won't realize that until you wake up from surgery, you'll be pain free and it feels awesome!"

I hope and pray he is right.

[IslandCatt]

Hi bosoxgordon,

I thought I would comment on your situation, since I'm sort of in the same boat as you. My left hip was so bad, there was not question about getting it done. I could not walk more than a block without crutches. I am about 4.5 months post surgery on my left hip. My "new" hip is so good, that, other than a couple of flexibility issues, I hardly even know I have a resurfacing there.

My quandary now is the right hip. It is not nearly as bad as the left was. The only symptom is a severe limitation in the flexion of the hip joint. I cannot flex that hip enough to even put on my shoes and socks. Trying to do that causes severe pain and is very inconvenient, as it doing anything that requires me to bring my knee up into my chest. That is my only limitation, however. I seem to be able to do everything else pretty much pain free (other than the occasional pain after exceptional stress on that hip). I take no pain medication for it at all and the symptoms do not seem to be getting worse.


I am tentatively scheduled for my second BHR in July of this year, but I am currently debating whether or not to have it done. It would definitely be nice to have two fully functioning hips, but I'm not sure not being able to put on my shoes and socks like a normal person is enough reason to have it done. My surgeon says it's pretty much up to me.

Right now I feel kind of stuck in terms of making the final decision.

[Dan L]

Bosox;

I had the same anxiety about the one way street as far as the changes, it is definitely part of the mulling, and very understandable to have that reservation.  I thought about that alot as I prepared for surgery. 

Since I've had them, I will say they do not feel like a foriegn object, if that helps at all.  I walk so much smoother with them, they were an upgrade to what was left of my natural hips.

Best regards,

Dan

[Bryan712]

Welcome Bosoxgordon

I had my right hip BHR on November 19th, and like you I was hesitant.  Three kids 4, 7, and 14 all active in sports.  T-ball was coming up this spring and my little one wanted daddy to practice, I can confidently say it was the right choice to go ahead.  I not only gave myself a gift of being pain free, but my kids and family like many mentioned here were wanting their "other" dad back. Living on pain on average of about 5 out of 7 days per week, I did not realize how it was affecting them as well. I went to the doc he looked at the x-rays and said I needed a BHR and was a great candidate.  I asked him what was next an MRI, he said no its obvious there is no need, I asked "when will I know is time?" He just said "you'll know, just call me back when your ready".  I called him back after about 90 days more of contemplating and hurting.  None of us knows our future, everyone's body is different its a personal decision.  But for me it was right