34 and trying to decide whether to have HR

[w.r.coote]

Thank you for welcoming me to the site. I’m 34 from London, England and I live with my wife and my 1 year old son, Dylan.

My story: Christmas 2014 was the last time I played competitive sport and the end of my active lifestyle. On the 23rd of December 2014 I played squash and then on Christmas eve I played football (as was tradition) with some friends I grew up with. At some point during the football I started feeling like I’d strained something in my right groin. Stretching for the ball or running was painful, I dropped back and took the rest of the game easy. A few days later I went snowboarding. The pain continued but I managed it as best I could with painkillers and tried to enjoy the holiday. Over the next year I tried every physio going but I couldn’t shake the injury.

By the start of 2016 the problem was diagnosed as coming from my hip and I was put forward for a hip arthroscopy. My surgeon identified a minor cam lesion and a minor labral tear in the surgery, both of which were shaved back. This was the last time my hip functioned correctly. The surgery changed my condition from something which stopped me playing sport and flared with certain movements (e.g. getting into the car and into bed) to a constant problem. Three years later (summer 2019) I had a second arthroscopy. The results of this were fairly inconclusive. The surgeon described the joint as a ‘bit of a mess’, he said he did what he could to tidy it up and he removed quite a lot of scar tissue.

My hip has now settled into a pattern. It’s a constant source of discomfort to varying degrees. Some weeks it’s really sore and then I might have a few days where it’s not too bad. I’m not in agony but certainly enough discomfort that it’s a constant drain on my energy and it stops me doing normal things (like going for a walk or playing with my son in the garden) and it certainly rules out competitive sport. It also causes me pain in my back and in my left knee (presumably because my body is compensating). Not to mention the impact it has on my mental health. My MRI March this year compared to one in early 2020 shows further degradation of the joint albeit I'm not bone-on-bone by any stretch. The surgeon I’m now seeing thinks resurfacing could be right for me.

I’m really struggling to decide whether it’s the right decision for me. After the experience of my first surgery and the fact that in lots of ways I live a normal(ish) life. Any thoughts would be greatly appreciated.   

[imgetinold]

Greetings Mr. Coote.


Let me start off by saying that this is obviously just my opinion, and it's not me telling you what you should do.  And most people on this site know exactly how the constant pain affects everything else in your life:  energy, motivation....even happiness.  It's awful.


I was about 7 years older than you when it started.  I was walking home from the bus stop with my son (then in 1st grade) when my hip let out a "yelp".  Out of nowhere a sharp pain.  It subsided, but then came back from time to time.  Mostly just a dull ache.  I went to a local orthopedic doctor who took x-rays and noted the severe arthritis.  He suggested I take a cane with me.  I murdered him.  Okay, I didn't, but I did not like that news.


Whether it is a placebo or not, I started taking Glucosamine/Chondroitin, and the pain literally vanished for about 4 years.  After a move, we ended up in a community with tennis teams, so I started playing a lot.  About a year or two into that, the pain started coming back.  At first it would hurt for a day, then be gone for a month.  Slowly it morphed into more frequent pain periods, and shorter periods of reprieve.  At the worst, I would have weeks of pain where I could barely walk around the grocery store.  It would keep me up at night where the aching would not stop and there was no position comfortable to sleep in.  NSAIDs did nothing to relieve it.  Still, this would not last indefinitely, and it would subside.  I found that I could live a relatively normal life if I just became sedentary.  But...that's not me.  Most of my leisure time is spent doing sports, exercising, tennis, running, mountain biking, etc.


I did my research and found this website.  I probably read thousands of posts, and determined that at my age a total hip was NOT the answer.  Resurfacing is clearly superior for young people, due to the preservation of bone.  And even though the ultimate longevity of the implants is still being determined, I decided that IF it had a 20 year life span, I would rather be less active at age 64 than at age 44.  Even then, a revision at age 64 to a THR is still roughly the same as having a THR done the first time, since you preserve all of your bone with a resurfacing.  And, who knows where the technology will be in 20 years.

So, that's when I decided to schedule my resurfacing with Dr. Gross (the best ever).  Here's what I can say:  It absolutely gives you your life back.  Please read people's stories on here.  There are TONS of people who have arthroscopy and labrum repairs and other things, and - like you - they often do little to nothing or make it worse.  Resurfacing is different (in the hands of an EXPERIENCED surgeon).  I'm not saying that there are no bad outcomes, but a good, experience surgeon has basically a 90-95% survivorship at 10 years and counting.  Until my second hip started acting up about 8 years later, I literally never even thought about my hip.  If you read a bunch of these stories, pretty much everyone says the same thing.  Life changing.  And, I believe this hip COULD last my lifetime.


Of course you have to weigh the risks and come to your own decision.  Let's say you're in the 95% of people with stellar outcomes.  Imaging playing with your son in the garden (backyard, as we say it :-)  ) on Friday evening, and then playing football with your team on Saturday, and then going hiking with the family in the evening, without EVER thinking about your hip.  That's what resurfacing can do. 

When my second hip started hurting, I scheduled my surgery right away.  I've got too much to do to deal with that pain.

You also have access to some of the most experience BHR surgeons in the world.  Dr. McMinn and Dr. Treacy.  https://surfacehippy.info/hip-resurfacing-doctors-over-1000-hip-resurfacing-surgeries/

Make sure your surgeon has done a LOT of them.

Best of luck to you! 


Andy

[w.r.coote]

Hi Andy,

Thanks so much for your post - that's really helpful! Sorry to hear that your other hip has started to give you pain, do you know what might have caused it or do you think your hip problems are hereditary?

Before your first HR was the pain and aching at night etc always the same or would your hip pain manifest anywhere else? I think this is one of the things I really struggle with because my ‘hip pain’ is so holistic now, it seems to pass around my body from my knees to my back to my other hip. My big fear is that I have the surgery and some of the secondary pain persists.

Thank you again for your advice, I will have a thorough read through the posts on here. The surgeon who I’m seeing is experience ed with the BHR but is also involved in a ceramic on ceramic implant trial, is this something which is being discussed in the US at all?

All the best for the second surgery!

Cheers,
Will

[petemeads]

Hi w.r. - and welcome!

23rd December 2014 saw me walking 5k in 48 minutes just 5 weeks after my BHR operation - and Xmas day I knocked another 4 minutes or so off that by jogging a bit at parkrun. I was age 64 at this time, I had done my research online (McMinn website mainly) plus remembered an old Tomorrow's World program whivh featured BHR plus had an acquaintance who had a BHR fitted locally 10 years before. I ended up using his surgeon both for convenience and ability. Bone quality not great but successful operation and still going strong. Not so lucky with the other hip, femoral head snapped off during placement so I got a ceramic/ceramic THR which also works very well and even gives me a bit better range of movement than the BHR.

For you, 34 is young and a THR would not be the best choice, BHR gives you an extra bite at the cherry, but I expect a modern ceramic bearing to last nearly forever - it's the stem in the femur that I would worry about in the long term.

Is your surgeon Professor Cobb at Charing Cross? His department was trialling the new ceramic device, one of the first patients has been on this forum, but no recent updates and I thought the trial had paused for a while. He is a strong believer in the benefits of resurfacing, TriHardAlan of this parish and I met him in 2016 to give a patients perspective on resurfacing and sport, good bloke.

Back to your current discomfort - I waited too long because pain was not continuous but sleep was getting disturbed. I could not tell which hip was worse but the x-ray said the right one still had 2 years to go - and this proved correct, it held up well for that time then complained very suddenly and sharply, 4 months later it was replaced. No regrets, fully active since with running, biking, climbing and mountaineering - but at my age, I have nothing much to lose - equally there are younger than you that have had resurfacing and are doing well. Good luck going forward,

Pete

[PalmettoGolfer]

Hey w.r. welcome!

I'm a bit older than you and I didn't wait as long to have mine done, but I'm 6 weeks out from my HR and all of my pains are gone.  The only thing left is the "pain" which I would describe more as tightness from surgery and that gets better every day.

As far as your secondary pains, I had pains in my leg all the way down to my ankle, knee, groin, outer thigh, inner thigh and lastly the hip, and yes it would throb at night, sometimes even worse than during the day.  Near the point of when I made my decision it would hurt more at night that it would during the day.  Dr Gross, who did my surgery said many times the pains are everywhere but the hip.

I was running and working out 4 times a week then one day, back in October of last year, I felt the pain in my outer thigh and the whole thing went down hill from there.  I was diagnosed bone on bone in April and a couple weeks later I was under the knife   :)

Like imgetinold, I won't tell you what you should do I can only tell you that I did.  Looking back at it, I'd make the same decision.

[rcurr10]

I am in a similar position as Mr. Coote and am leaning towards the resurfacing given my age, activity level, etc.  It's confusing though as I have seen a few hip replacement surgeons who suggest that the modern hip replacements are expected to last a very long time, that they do not require activity restrictions, and that if an eventual revision is required, its not a big deal?  They do admit the data is not in yet on the longevity of the new implants, but I have spoken with some young people who verify what I've mentioned.  It makes the decision difficult, because if indeed this is all true, then the metal issue could be eliminated.  Any thoughts would be welcome? 

[w.r.coote]

Thanks Pete,

Yes - I'm seeing Mr Cobb. He's a really positive guy and he's really enthusiastic about the benefits of the surgery which is lovely to hear. I think my nervousness all stems from my initial failed arthroscopy. I must have seen 7 or 8 hip specialists over the course of my injury and one affliction which they all share is having no time. You spend 10-30 minutes with them, and after a quick physical examination (often with shoes and trousers on to save time) they're making a call on life changing surgery.

I came on here hoping somehow I'd magically find out for certain whether this was the right decision for me, and I know this is unrealistic. But reading all of the positive experiences has been really helpful.

I think if I was in significant pain I would have no doubts about going for it now. The harder decision is whether to take a chance now to live a normal life again or to wait until the pain makes the decision for me. I think on balance I'm better to take the leap now.

Thanks again for your comments! Amazing recovery from your BHR and interesting that your THR gives a better range of motion than your BHR. 

[w.r.coote]

Thanks PalmettoGolfer,

That's really helpful to know that I'm not alone in the pain sometimes coming from everywhere but the hip! I've had nightmares where I'm waking up from HR surgery and I still have all the same issues.

Fantastic to hear that you are pain free! It seems you went from initial injury to bone on bone really quickly.

How are your activity levels now? How have you (and others) found your gait after the surgery?

[w.r.coote]

Hi rcurr10,

It's made harder by the fact that each surgeon favours the procedure that they do. On balance, for me HR is a better fit. Primarily because of the bone retention. The issue with my hip has always been fairly minor. The symptoms far outweigh what you see on my scans. And for that reason I want to retain as much of my bone as possible. I can always have a THR later if it's not successful.

Good luck with whatever you decide to do!

W

[DD8]

w.r. coote, There may be another option.  It may not prevent the eventual need for a HR or THR but at 34, I think you've understandably expressed concern about longevity of either device.  The other option is to focus on the muscles, tendons and ligaments that control your hip joint and every other joint in your body.  I am not a doctor, and this is only my opinion, but I've also been down the same road you are on, albeit at roughly 20 years older. 

I, too, also had hip pain in my late 30s.  I was very active in multiple sports from childhood into my 30s and 40s, but I was also sedentary much of that time with many years of college/professional studies and an office career.  It was basically a lot of sitting, family time, and then intense sports when I had free time.  My body and hips held up, until they didn't. 

I don't think major joints fail in a vacuum.  The body is an entire system working (or not working) in unison.  When one area becomes symptomatic, it is rarely in a vacuum unless there was a traumatic injury.  For me, it was back pain in my early 40s that preceded the hip issues.  Like you, I turned to doctors for diagnosis and recommendations concerning my hips.  I was told I was too old for arthroscopic intervention and my hips were too bad.  (The more I learn about arthroscopic hip procedures like yours, the more I hear stories about the need for further procedures and/or THR after arthroscopy.)  After a number of consultations with some of the top THR and HR doctors (in the US and abroad) I was told I was a candidate for both procedures.  But like you, while I was in pain (both hips), I was still functioning with most basic daily tasks.  At that point I had already shut down most of my sports and other strenuous activities. 

Fast forward from then (roughly 2016/2017) to now.  I am more active than I was before the hips started to hurt.  My hips are not perfect, but then again, I don't think there's a "perfect" joint, especially for someone who is active and older.  I was told in 2017 that I had two years or so before I would need THR or HR.  I was told to take it easy and wear soft shoes by one doctor.  I wasn't ready to make the commitment to HR or THR (although I was extremely close), plus I wanted to become active again, so I looked for other options.  I had already tried PT but it didn't help that much; there was no strategy to it and it was mostly textbook exercises.  I continued to look.  What I found was a program that focuses specifically on hip training and dealing with hip FAI and other hip issues.  I immersed myself in it.  I learned my hip anatomy (muscles) and other body anatomy.  I learned about how hips are supposed to function.  I also learned about how the pelvis, knees, back, and even feet and ankles are related to hip function.  I realized my hips and legs were weak, I had poor range and poor rotation, and I didn't understand proper hip mobility.  I could have attributed some or all of that to FAI, arthritis, labral tears, etc. (all of which I was told I have), but it made sense to me that muscles, tendons and ligaments control how the bones (and therefore body) move, so I went all in on this approach.  I had nothing to lose.

I have virtually no limitations now - I downhill skied this past winter, I swim regularly, I hike, I bike, I play tennis, I stand up paddle board, and I learned how to surf over the last year.  And, I do a lot of strength, mobility and flexibility training for my hips and the rest of my body; probably 2 hours on average every day, spaced out during the day.  This was a complete paradigm shift for me, and I had to restructure and reprioritize some things in my life, including sitting a lot less for work.

As I said above, my hips are not perfect, and my X-rays and MRIs show all sorts of "pathology".  My hips also ache occasionally.  But I haven't taken any painkillers in a few years, and I don't think I have a particularly high threshold for pain, so I attribute the improvement in function and pain levels to the approach I've taken.  And in the course of doing this, my back rarely bothers me, and a few other body parts no longer bother me.  I'm actually stronger and more mobile than I was in my 30s.  How long will I be able to maintain this?  I'm not sure, but I've seen continual improvement in strength and mobility and what I've been able to do, so I see no reason to abandon this approach.  Plus, if I do decide in the future to take the HR or THR path, I feel that I will have sufficient information about both procedures, the pros/cons, and the latest technology.  Plus my hips and the rest of my body will be in the best possible shape, which can only help with recovery from HR and THR. 

Please do not misunderstand me.  I think HR and THR are excellent options and have helped many, many people, but in my case I was able to push that option to the future.  And in time, maybe other options, such as stem cells and regenerative medicine, will become additional options.  Everyone needs to make their own decision about what to do and when, but perhaps sharing my story will help you assess all of your options.  Feel free to private message me if you have any questions.

[PalmettoGolfer]

I'm almost certain I had pains going back further than 5 months but just wrote them off as over work.  The real pain started about 5 months ago when it started affecting my  golf game but also my walking.  I was unable to walk a city block without having to stop and rest my leg/hip.  I went to a different ortho Dr.,  PT for 2 months and 2 massage therapist again thinking it was a muscle problem because the pain was everywhere except my hip.  Nothing helped.

I was very frustrated with the response from my first ortho, and kept telling myself I just wanted to know what the problem was and I would do whatever it took to get better.  I got a second opinion from Dr. Gross.  He looked at my x-ray and told me what the problem was (bone on bone)and what he thought I needed to do to fix it (HR)  you can imagine my shock, my mouth literally fell open but the pain wasn't getting any better so I decided to go for it.

I've made significant strides with my gait and walking in general.  It gets better every day.  My post op limp is almost completely gone (until I over do my walking regime). My ROM is a little limited but again, I decided not to push anything until I talk to Dr Gross tomorrow.

[jimbone]

Mr. Coote-

There are several highly skilled and regarded HR surgeons in the UK.  Find one with extensive experience and in their hands you will receive state of the art treatment.  I've heard only good things about Cobb and McMinn who was referenced and is a professional colleague of Dr. Pritchett the surgeon that did my bilateral HRs that resulted in a complete recovery and return to a life worth living.  Regarding the above posters indications there might be alternative to surgery let me weight in:  If you have OA, it will not get better, it will get worse.  The schedule of deterioration is unknown- it could take a decade or two or it could happen in a matter of weeks where in the pain and restrictions will reduce the quality of your life to less than worth living.  PRP for the hips is still both unproven, ineffective, not covered by insurance and very expensive- none of which stops those selling their products.  HR, in the hands of one of the top surgeons provides positive improvement to quality of life with the caveat: there are no guarantees or very few in medicine.  There are risks but they are know, dealt with and reduced to a set of odds that outweigh them.  Continue to read through the forums stories, examine your goals, your condition, your pain levels, and the opinions of the surgeons you speak with and research their experience and volume so that your decision is informed.  As a friend facing scoliosis surgery told me when I was on the fence with accepting medical prosthesis, "When the pain gets bad enough you will do it".  My last year prior to surgery after 15 years of deteriorating chronic pain was spent needing crutches for the first few hours of some days.  I woke up from surgery free from OA pain, had the second procedure 8 weeks later and after 2 months was walking miles and in the gym 5-7 days a week enjoying every minute of my recovery.  3 years later I have no doubts it was one of the best decisions I ever rolled the dice on.  Best wishes.

[dannythebeerman]

I am in a similar position as Mr. Coote and am leaning towards the resurfacing given my age, activity level, etc.  It's confusing though as I have seen a few hip replacement surgeons who suggest that the modern hip replacements are expected to last a very long time, that they do not require activity restrictions, and that if an eventual revision is required, its not a big deal?  They do admit the data is not in yet on the longevity of the new implants, but I have spoken with some young people who verify what I've mentioned.  It makes the decision difficult, because if indeed this is all true, then the metal issue could be eliminated.  Any thoughts would be welcome?

I have no known metal allergy issues.  When selecting a Doctor I focused more on their track record, was fortunate not to worry so much about the device as the doctor had 20 years and 6000 implants with it, a doctor may trust the device they use for great outcomes on past experience.  I felt comfortable with that, but that was my circumstance.

[imgetinold]

Hi Will.


I'm not sure if it's hereditary or not, but my surgeon even noted the beginning of deterioration on my second hip.  At my 1 year follow up he asked if I was ready for #2, which luckily I wasn't.  But for me it is congenital.  I have an odd bump in my femoral neck, and this bump just chipped away at the cartilage over the years.


I didn't really have pain manifest anywhere else, so I can't speak to that.  But, I understand not wanting to do this only to have other pain persist.  My FEELING on it is that we often accommodate our pain by changing something (gain, weight distribution, etc.) which end up causing those other problems, but that is speculative of course. 

There are several prominent folks doing ceramic on ceramic.  In the US, Dr. Pritchett in Seattle is doing a lot of them, and he's one of the best.  As for your guy, I appreciate that you like him and that he's enthusiastic, but how many has he done?  Experience is the #1 determining factor in long term success.  If he's done, say, 100 of them, I would go elsewhere.  I realize the catch 22 in that he'll never have more if he doesn't DO more, but not on me thank you very much.


Best of luck.


Andy

[imgetinold]

DD8,


I appreciate that you did a deep dive into the biomechanics of everything, and that you spend 2+ hours every day on stretching and mobility, but that is impractical for most of us.  That's why we're here to discuss the merits, risks, and outcomes of of resurfacing.


Andy

[petemeads]

Thanks for your comments w.r. - I was very impressed with Professor Cobb and his department - he did the judges from Strictly Come Dancing by the way. Just realised from the other current post that Andy Murray is also aged 34 - unfortunately he messed about with repair surgery and wasted time before committing to a BHR, look how well he is doing!

[hipmedicine]

w.r. coote,

I'd like to help you feel confident in your decision. I live with my wife and 2 y/o son. I had my hip resurfaced by Dr. Gross 12 days ago at the ripe age of 30. Ive been stalking this forum incognito for a while. I'm sorry you had a poor outcome from your hip arthroscopy. The question of when to get a joint replacement is deeply personal. I struggled with it for a couple years. I felt so young I played collegiate American football and wrestled so when I discovered I had severe arthritis from cam impingement at 29 I was devastated. In your case from, what you have said, you feel like you still can lead a normalish life. Dylan is 1, in another few months he will graduate from stumbling to walk to running (I speak from experience). I'm guessing you will want to run with him. Hip pain/impingement/arthritis is a horrible mistress to live with. She feel good one day and the next day she'll ruin you for a week. I've enjoyed my divorce from her over the past 12 days and look forward to living my life with out her.

Hope that helps.

[23109VC]

Did you ever decide to fix it? I saw your post but it’s months since you posted.

I am now almost 50.  I had my left hip resurfaced when i was 38 by Dr. Gross.  I had 24/7 pain, was horribly limited in what I would do before surgery, and after ward, it was like a miracle.  I have been able to resume a normal lifestyle.

I”m back on here b/c my OTHER hip is now bothering me and I will likely need a surgery on the other hip..but I can tell you that after I had my first hip fixed with a HR - it was like a miracle.  I got my life back.  Prior to surgery I limped when walking and had constant pain.  It was awful.  Don’t suffer in that pain and get it fixed.  IM me if you have specific questions.

Good luck.