Newbie decisions and steroid injection question

[Kate321]

Hello, I’m a 49 year old female with a very active job, been suffering hip pain for years and finally have a diagnosis of arthritis in both hips. Left worse than right, not really a surprise but upsetting none the less. Consultant suggested total hip replacement on left with possibility of steroid injections to reduce pain before that.

That was 2 weeks ago, I’ve been reading, found this group (thank you Pat Walter!). Thought resurfacing would be better for me, but the consultant I’ve seen doesn’t do it. So I need to start again. I’m in Herefordshire UK if anyone has recommendations.

Should I go for the steroid injection? It’s done under imaging guidance, into joint capsule. Consultant says it might help, might not…

I’d like to put off surgery if possible/sensible. I’ve spoken to two work colleagues who’ve had resurfacing, one is working and super happy but his surgeon now only does private work (I’d be nhs). The other chap is also happy but he now has knee and ankle trouble (not necessarily related to his surgery).

So much to think about and I’m just not sure what to do next.

[catfriend]

I'm in the US so I can't recommend any UK/European doctors from experience. Regarding the steroid injection, it's a tricky call. When my right hip was bone on bone it was recommended to me to have the injection. That particular doctor told me I would get 6-9 months of relief out of it, and I could repeat for a few years until I was old enough for a THR. (Like you, I was/am a woman well under standard THR age.) So I had the shot, which even with my insurance, cost me $900 out of pocket. The good news: it relieved the pain. I felt great. I was able to start walking/hiking, and upping my activity level. The bad news: it lasted five weeks. After that I was in more pain than I had been before the shot. Within three months I found a resurfacing specialist and had that hip resurfaced. When my left hip failed I didn't bother with an injection, I just went straight for resurfacing.

So...Your consultant is right. It might help, it might not, and even if it does it might not last for long. If it's on the NHS and you won't have to pay a shilling for it I would do it. If you have to pay anything for it, I wouldn't. The little relief I got was not worth the $900. Also, will it help you or hurt you in your quest for surgery? The thing with arthritis is that you may have good days and bad days but you will never get better. You're on a downhill slide that you can't arrest. The sooner you have surgery the sooner you will feel better and be active again. Yes, I get that it's major surgery, and that it isn't fun. Been there, done that. I can tell you that most of the participants on this forum wish they had had surgery sooner, not later (although there are a few people for whom it is not successful). If having an injection would help you get on a surgery schedule sooner then do it. If it would knock you further down the list, don't. Good luck.

[LDub]

Hi Kate

Welcome to the forum. Like most of the people on this forum, if you opt for hip resurfacing you will probably have to travel to whichever surgeon you settle on. Your experience so far is pretty typical. The first orthopaedic surgeon you consult will not recommend resurfacing. Largely because they do not do it. And as you've probably discovered resurfacing (BHR) is often a superior alternative to replacement (THR).

My wife has had both her hips resurfaced (at age 49 and then 50) by Vijay Bose. Fortunately for her BHR prosthetics were still available in small sizes at that time. That is no longer the case and unless you are unusually large boned you won't be a candidate today.

However, there are two  ceramic on ceramic (CoC) prosthetics now available for smaller sized patients. There is the ReCerf CoC, which was in clinical trials up until a week ago. I had this prosthetic implanted by Dr. De Smet last September in Belgium. All the women having surgery while I was there received the ReCerf CoC. The trial has since reached 500 patients and has been paused while they assess the data. I have no information about when it will resume. Of the 500 surgeries they had a single failure (not with Dr. De Smet). I have no details on the failure. There is a recent post by Dr. De Smet stating that the trial is currently paused.

There is also a video from Mike Tuke on youtube: https://www.youtube.com/watch?v=RZKNtthJcn8  and here is a paper on ReCerf if you want to read about it: Annals of Joint Volume 5, April 2020, Danielle de Villiers, Laura Richards, Michael Tuke, Simon Collins. If you look for my name in the forum posts you will find other threads with other references as well. Also you can go to Pubmed or SciHub and search the literature. I did a lot of reading prior to getting the CoC. I suggest anyone thinking about it do the same.

The second CoC prosthetic (SK Lab H1) is available in the UK (https://www.imperial.ac.uk/msk-lab/research/clinical-trials/h1-hip-resurfacing-arthroplasty/). But I don't know a lot about it. At the time I was researching things it was only available to UK residents and so I dismissed it for myself. Like ReCerf I believe it is in trials. I believe Justin Cobb at Imperial College, London is developing it. See this video on youtube: https://www.youtube.com/watch?v=rTjnDk23HJw  There will be information in the literature also. I am not sure if the trial is still on or if they are taking patients.

Hope this helps.

LDub

[petemeads]

Hi Kate, I'm in Leicestershire.

Catfriend and LDub have pretty much covered it, if you need NHS treatment then I don't think you will get a resurfacing in the UK until the H1 ceramic trials restart. I met Professor Cobb at Charing Cross hospital just before the trials started, very impressive and a true believer in the benefits of resurfacing over replacement. He resurfaced the Strictly judges whilst the BHR was still available to women.
I have a left BHR from 2014 but by 2017 my bone was not good enough (age 66) and I ended up with a Zimmer Biolox ceramic/ceramic THR in my right hip. The joint feels really good, if anything better than the BHR for range of movement, but I always worry about the stem stuck in my femur. At my age I do not expect either to wear out and metal ions have not been a problem. I run, hike, bike, climb and mountaineer and am currently training for a 48 mile/17,000ft challenge in the Lake District. I can fully understand why a young person would not want to settle for a THR if a resurfacing was available - but the freedom from pain probably outweighs the worries about needing a revision after 20 years or so and a 'free' resurfacing could be a long way away - try getting in touch with Professor Cobb's team to find out what the chances are but don't worry if you have to have a THR, as long as your surgeon approves of your activities. Mine did! Happy to answer any further questions, and would love to hear how you progress through the system.

Cheers,

Pete

[Kate321]

Thanks so much everybody, I really appreciate your thoughts/experience.

My vague plan was to pay for the first steroid injection (about £700 I think, eeek) rather than wait, but I’ve clearly got some more thinking to do. Apparently it can be done on the nhs but obviously there’s a long wait.

As suggested, I need to contact some other surgeons and see if resurfacing is even a possibility at the moment. I’m not a teeny tiny person, I’m about 170cm and average build, so that might help. Good to hear about successful THRs too.

It’s really hard to get motivated to do something that I don’t really want to do, if that makes sense, but I know it’s not going to get better…

[Kate321]

Update.

I don’t feel like I’ve got very far but this is what I’ve found out thanks to the comments above.

I’m not sure (wish I could get a straight answer) but I think I can get a resurfacing in the UK. NICE guidelines from 2021 say surgeons are “more likely to offer resurfacing to men than women, mainly due to size”.

Mr McMinn isn’t working any more, some scandal...  I’ve spoken to Ronan Treacy’s secretary and she says he does a Polymotion hip privately, that’s a metal head in a polyethylene cup but she wasn’t sure about NHS. I’ve message his NHS secretary but not heard back yet.

I’ve contacted prof Cobb’s team in London about the H1 ceramic resurfacing. As said above, the trial is over but they hope to be cleared for safety in 6 - 12 months, so that could be an option.

Other surgeons locally don’t do resurfacing in women.

I still haven’t committed to steroid injections, but the thought of being pain free is so tempting… but if it was worse afterwards I’d be gutted

Pete - how’s your training going? I’m so impressed. I really need to be able to do high level activity, I’m a firefighter and still have 9 years to go

[LDub]

Hi Kate

Although the trial with ReCerf is currently off, you might consider sending Dr. De Smet an email to discuss your options. Send him your most recent x-rays if you have it. It's a free consult by a highly regarded resurfacing surgeon so it's worth the effort. Even if Belgium doesn't necessarily look like an option. It's helpful to get as many informed opinions as you can. Best of luck.

LDub

[Kate321]

Hi Ldub, that’s good advice, I know more info is always good. I have a link to my X-ray and mri but i can’t view them on my iPad (I don’t have a PC) and they’re password protected. I’ve requested them in another format so that I can share them. Thanks :)

[LDub]

Hi Kate

I was told by Dr. De Smet  that an MRI wasn't necessary. So if you have difficulty sending that image don't sweat it. A recent X-ray as a jpeg is all that is required to evaluate you. I don't know if other surgeons want the MRI though. My X-rays came on a CD that I had to search for jpg images. Ten years ago when my wife had her X-rays done it was a completely different imaging format. I don't remember what the file extension was but I had to use photoshop to pull it out and convert it to jpg. There are also numerous online file converters if you need to convert your image.

Cheers,
Les.