Took the first step: bought the recliner

[blinky]

Biolox made by Ceramtec.


You could have knocked me over with a feather when I heard I could run on it.


What I read on mainstream THR sites still has the standard cautions about high impact activity and pretzel-like positions. And as noted, some OS still warn against running. I have seen bloggy websites where people with THR do run, however. None of these guys has been doing it for years and years. As I continue with my due diligence I will talk to other OS.


The one funny part of this last meeting was that while this doc didn't do resurfacing, he said he knew there was a guy in North (sic) Carolina who was highly successful at it.

[chuckm]

Keep in mind the basic theory for a long survival life with metal on metal resurfacing versus polyethylene on ceramic (or metal) total hip replacement.

Both wear and shed debris from the surfaces. Both shed even more debris when they are not aligned optimally.

With a properly aligned resurfacing device, the metal on metal debris that sheds is managed and excreted by the body. The body is already familiar with these substances because they are already present in the body. 

With polyethylene and ceramic, the debris cannot be managed by the body regardless of how well it is aligned and it accumulates around the device.

When the polyethylene device finally "wears out", it usually means that too much debris has accumulated and the device loosens from the bones because of a reaction called aseptic loosening which is the leading late term failure for THR.

With the most modern polyethylene, the theory is that they can keep the debris low enough that it won't reach that point where there is too much for a longer time.

So the question still remains, will the rate of debris shed from this latest type of polyethylene be low enough that the device will survive longer?

Chuckm

[blinky]

Thanks. I am interested in loosening of the stem, that long necked stem.


Note that I know the name of the head, not  the details of the stem or the cup. I asked for that info and it will be sent to me.

[chuckm]

The stem and cup is what I am referring to. The polyethylene debris buildup eventually leads to a reaction called osteolysis which is a destruction or resorption of the bone. It is the bone that eventually lets go of the stem and or cup - no matter what it is made of or who makes it. 

And that is the main reason to reduce impact on a polyethylene device. The longer it takes to build up debris the longer it is likely to last.

Don't get me wrong there are plenty of happy THR people out there who are enjoying themselves and who are active. But the young patients will face this problem so that's why they don't recommend it for younger patients and especially younger active patients.

But the latest polyethylene does show promise not to shed debris nearly as quickly so that is probably why some surgeons are claiming it could last longer. But like resurfacing, time will tell.

I still say that even if you are a woman, as long as you pick a really good surgeon that your outcome will be good with resurfacing.

Chuckm

Chuckm

[JHippy]

What MattJersey said, plus what are his stats? How many of these types of operations, how many revisions, complications, etc.

[blinky]

These are all good points and take me back to my original reasons for choosing HR: wanting to stay active, having an easier revision, and more recently, finding a top notch surgeon. I was surprised when THR was offered as a alternative that satisfied #1 and claimed to take #2 out of the  picture. I had assumed that a 53yo active person would wear down whatever device was put in her hip before she died.


The local doc does not have super high volume, an average of one hip a week. He didn't give me hard numbers on revisions and complications, more squishy impressions of how his numbers look. I am sure what he says is true, and also true he isn't asked for hard numbers very often, if ever.


About the attributes of the THR I was offered: Probably it is relatively new (though he said it isn't a super new, cutting edge device; it is supposed to be tried and true) and so there are no long term numbers on its performance. Once I find it exactly what it is, I can find out more.

[blinky]

Taperfil by DJO.


If I am looking at the right device, it IS pretty new: implanted since 2013. So there won't be data on how well it works/how long it lasts. Could be great, could be meh.


It looks like some other short stem THR devices designed for anterior placement. I could see how those are doing.


Anybody with greater Google skills than I have is welcome to contribute!

[blinky]

So the recliner is in a month early. I take that as a good sign. Heck, I could have surgery now!


jk I have kids to launch to college first.


In another sign that the universe is smiling on me, I am dreaming of making journeys to SC. No surgery takes place in these dreams, but I experience a pleasant and successful trip.

[Comfortably Numb]

"I experience a pleasant and successful trip"


That's the ONE thing you can count on!  Propofol is wonderful.  Your dreams already know this 8)

[blinky]

Ha! Something to look forward to.


Two well functioning limbs so am swimming more regularly. As my world narrows due to the OA pain, I need the swimming to feel normal and to be able to sleep at night. I am fortunate enough to live near a great masters program and a 25m outdoor pool that is open year round. My coach continues to challenge me despite my limitations, not letting me coast on the "I can't kick" excuse. (I can kick, just not very well.)


I see one more local doc and continue to ferret out folks who have had hip surgery in my community. Dotting the i's and crossing the t's, making sure I am comfortable with my decision to go for HR.

[blinky]

So I saw the second and final local doctor today. He is part of a large and thriving sports med practice. I was seen first by a resident, who took her time and answered my questions to the extent she knew the answers---she didn't know how many hips the doc did a year, for example. The doc himself was brusque and fast talking. If I had not done a lot of research, I would have been upset and lost. As it was, I let him talk, then asked the questions I had left unanswered by the resident. I didn't tell him what I already knew/was thinking, just let him talk, then asked pretty standard Qs, like what device do you use.


This doctor has moved from the anterior to the anteriolateral approach after suffering too many (2/15, so not really that many) incidents of nerve damage. He told me what muscles he cuts through and what areas of weakness will arise. (and that PT will help, but to be aware) He didn't tell me not to run, but did say he wouldn't advise it. Quite amazing to me that no one tells me not to run! Are they all on hip runner? Or do they know runners will try to run no matter what you tell them? He does impose lifetime bans on certain motions, like sitting with legs crossed and squatting. That surprised me. I thought I would be told not to run, but not that couldn't sit with my legs crossed.


He uses a pretty standard Stryker poly on ceramic device, not a short necked device. Accolade and trident components. Ball size maybe 36. (The previous OS gave me a larger one).


He does more procedures, 150 a year. He also does lots of knees. Because this is a really busy practice, he is scheduling three months out. That also kind of surprised me. General anesthesia.


The one thing that threw me in this meeting was he told me I needed to do something asap because I was in such bad shape. On X ray I mean: I look good clinically and always get the speech about PRP shots.


My take away: 1) THR will be limiting. That's why I want HR. Can I go the rest of my life without bending over? 2) maybe I should be on Dr Gross' cancellation list? If I am that bad off? I did submit that question.

[MattJersey]

Judging by the research done and conclusions reached it seems like you're in a similar place to most of the forum users.


I was looking back in the thread to see your date scheduled but couldn't see it, and saw a couple of other things which reminded me how May this year, operated on 28 April, is a bit of a distant memory. Whilst I still remember, here are a couple of thoughts:


Your scheduled date will arrive pretty quick, and as ready as you are I expect you will still take a big gulp as you get closer to the operating theatre. Only natural. But you'll wake and within a few days will realise you're not far from being in a much better place. Patience required though as there are painful moments when you twist more than intended or something. You will feel you have spoiled all the good work, but you won't have. Then a few weeks later, as these occasions diminish, you'll be as happy as you can be.


Regarding toilet risers in earlier posts. I didn't get one. When I was in hospital and had to go there was no riser, and I asked if I needed one. They all, nurses and physiotherapist agreed no. Only really tall patients need them. I am 5'8".




Painkillers. It is rightly noted that you want to stay ahead of the pain. I didn't find pain a particular issue, and took my painkillers regular but tried to reduce early, and during the night I found it most irritating. But, I definitely overdid the painkillers immediately post op, overdoing the advice of the physio who noted that managing pain is important to enable the exercises. So I had extra oral morphine even though I now realise I wasn't really that bad off. This was counter productive and meant I didn't really get walking on crutches until third day post op, when all of my buddies were walking next day. I was upset about that. So, manage pain but don't go mad!


Patience: I recall being eager for the op, and then even moreso for the recovery. I think you might find yourself feeling the same. I learned this was a mistake too. I was monitoring every twinge, how much of a limp, pain levels and worrying far too much. Basically, the first six weeks take time to pass and there will be a lot of ups and downs. Nothing serious, but enough to have you worrying. With the benefit of hindsight I put myself under unnecessary stress. So, be prepared for that. (And I don't really buy that going mad with exercise works. Enough per doctor's advice, diligently, carefully, especially the strengthening exercises. But I think going mad on walking a lot might actually slow the process.)


Sweats. Get some towels for overnight. Hopefully you won't be affected but I think this was one of the more unpleasant (not painful of course) side effects, and started about a week in, and ended about after 3 weeks. I am convinced this is due to the pain meds. But don't under do those. Catch 22.

[blinky]

Thanks. Yes, I am eager to get this show on the road. I have about eight weeks to go, unless I get a move up.


Getting those second opinions undermined my confidence in my body's ability to hang in there. I did email Lee and she did suggest some things I can stop doing to be sure I last long enough. Probably a good paradigm shift for me. When I got that surgery date, I started listing all that had to be done, including what I would do to get physically ready, like lifting weights, swimming MORE often and MORE meters per workout, etc. The same habits of overdoing and sucking it up that got me into this mess came into play again. So I have put my fins away, will focus on pulling, and will pull out a cane if I have to walk a long way.


I will check out the normal heights of our toilets. I am 5'7. Some of our potties are pretty high, some are low. I think the lower ones are all upstairs. My husband is dreading the raised toilet seat.


The pain vs constipation/PT issue will be interesting. I will go in aware there is a trade off.


With summer winding up, I will be busier and have less time to stew over this. We launch one more kid to college soon. That is a distraction, and then when he is gone I am freer to grab a cancellation date if one pops up.

[blinky]

Got my preop assessment moved up so I can be a candidate for an earlier HR if a space opens up. In the meantime, swimming without fins and lifting. I tried to basically pull through the whole main set today. The water was unseasonably cool, which made me feel great. It anesthetized the hips and made me feel like I could go on forever.


Oliver Sachs passed alway over the weekend. I am a fan. Reading his obit, I saw he had written on recovering from a serious leg injury, and so I ordered that book to save and read during my recovery.

[blinky]

Aaargh! So not every doctor has the reliable staff and patient focus of Dr Gross. My internist cancelled my preop appointment, No explanation, and it was done through the patient portal not even with a phone call. I have been out of town and came home to find this out. So tmro I have to call and see what happened and why. I have been researching new, younger practices that might be taking patients in case I need to switch doctors over this. When I first saw this guy years ago, he was highly recommended. Now I see it is not unusual for him to cancel appointments out of the blue.


I have time, it will be fine, but very annoying. Why couldn't he get someone else to cover? This is a big practice; there are plenty of other doctors.

[blinky]

So made the new appointment and let's hope this date holds.


In the meantime....thinking about how I will live for six weeks after bilateral hip repair. No driving. Husband home for two of those weeks....with parents for one week....home with son(s) and maybe not husband for weeks four through five...everyone back for week six.....thinking about how it will go....


I hit upon a food delivery service called Blue Apron that sends ingredients and recipes for X number of meals a week. It looked like an option for me when I am stuck at home, puttering around the house, cared for by either husband or college aged son(s). My men don't cook, but they can read directions, and are up for a challenge. It looked like an interesting option. I sent a link to Son1 to get his reaction.


His response? soylent.com "Much easier, Mom."


(Who remembers Soylent Green? The movie with Charleton Heston?)

[blinky]

Creeping towards readiness.


I had that PreOp appointment, finally. I am sure everything will be fine. The irony is that the office cancelled the annual they insisted I schedule. Again, no notice to me except on the portal. If I hadn't checked, I wouldn't have known and would have shown up. No problem, though, since I didn't really want to keep that appointment anyway. I wonder if they have a computer program or an admin who goes through and looks for duplications on the schedule, otherwise it doesn't make sense that they canceled me.


Hotel and plane reservations made. H insisted on doing it. I told him to do it weeks ago but he didn't, I don't know why. Maybe he thought I would suddenly get well?!?!


I sound crankier than I am. Everything is moving forward.

[blinky]

And the PreOp report made its way to Dr Gross's office. Concerned given the appointment cancellations, I got a copy of the report myself just in case, but it was all fine.


I need to take iron pills. All my numbers are normal, including iron, but since I am going to have two operations in a row, my iron levels need a little boost. To have the best outcome possible, I will take them, but dread the likely constipation. I had to take iron when pregnant and remember that side effect. So I will be buying iron and prunes today.


H and I did have some fun looking up where we could go to eat calf liver. We do eat it and like it, but seldom do because, typical middle aged man, H worries about his cholesterol. So we will have a nice liver outing out of this.

[blinky]

Helpful hint if you need iron: there is a $40 off coupon for Finerva you can print out if you google it.

[oldsoccerplayer]

This might be TMI (Too Much Information) as they say, but along with the prescription for iron pills (post-op) Dr. Gross also gave me one for a stool softener.