Not enough OA for resurfacing

[Slinkycarrot]

cheers Karlos.


I would have stopped at 2 scopes on both hips but I was getting married and in significant pain leading up to it, so decided the more prudent path was to give it one last shot (before going down the resurfacing/replacement route). Turns out they didn't work so should have bitten the bullet then. 


I think the dysplasia/piriformis release surgery is what is causing the problems, they say scopes in dysplastic patients are less successful; as once they've operated on the capsule it can create instability.  Ive been unlucky that on my right I keep getting scar tissue which is causing the cartilage to keep retearing, its in bad shape.  My left has been hampered by my piriformis release surgery i had 6 years ago  (worst mistake ever) which has made me even more unstable, even with physio.


Good news though, Dr De Smet is happy to do both hips.  I think i should be ok to do bilateral as I am pretty strong (even though very unconditioned) and just want to get on with my life rather than dragging this out for more years.


Thanks again

[karlos.bell]

 :) :D Hey Westro awesome news about De Smet if he will do both. Now check it out with him as he releases the piriformis tendon to get back in there properly. He may even put your hips to as normal as he can get them for someone like you which will be different. Mine were real deep so its different now they work totally loose as I would say. Good ROM compared to my old deep hips.
But check out to see what he can do try and make the piriformus as normal as possible when doing the operation. He is fast so he don't muck around.  great hospital, great people as well, nice hotel to stay in after.. Good luck if you go...

[Slinkycarrot]

thAnks Karlos, thats good to know re piriformis as a good reminder to ask him - if he can fix what the other surgeon messed up that would be fantastic.


Glad to know you got good results with him - when you organise from abroad you feel a bit more like a ticket number rather than a patient..

[Ljpviper]

 Well I tried PRP shots in both hips in November did nothing except waste 800 dollars.

I spoke to Dr.Gross again last night about my current situation. He reviewed some current xrays and saw the joint space the same as last year. He is still a little hesitant to go forward because of that. I am still in pain daily especially sitting and any activity it will flare up, also knees and back have been taking a beating lately. At this point I don’t think it’s worth waiting for a miracle, I am 44.

He mentioned to try another scope with Dr.White in Colorado might help. I don’t think it’s worse the risk and time to try another scope. Dr. Ratterman who I saw in May stated that another scope is like opening a hornets nest in your hip.

Dr.Gross is so passionate about his work thus he wants to make sure I am happy with the outcome, that’s his concern. Most of his patients are bone on bone, unfortunately I fall in the grey area of hip resurfacing patients.

Thanks,

Larry

[chuckm]

Larry, isn't your condition bone on bone when you are in a seated position?

Chuckm

[Ljpviper]

Yes, the two bad spots are where the microfracture failed. They are deep in the socket, thus aggrivated by sitting or bending at 90 degrees. The rest of the joint is fine, thus is why Dr. Gross is a little hesitant. I understand he does not want failures and told me i would live with the resufaced hip even if I didn't like it, in very stern words.

[blinky]

Have you taken your case to Dr White or another doc who would do a scope? Would he do it? Or would he reject you for that spot of OA?


You are in a tough situation. Reading patient stories, people with less OA are less satisfied with their HR. The new, bionic joint isn't as good as the one God gave you. Whatever you decide, go into it with your eyes open.

[jd]

I'm still surprised by Dr Gross' comments here too Larry. My pre-op x-rays weren't bone-on-bone through the entire joint and still showed some remaining space (although similarly, I was bone-on-bone in one big area where microfracture had failed). I'm also younger. Despite that, Dr Gross had no hesitation in saying he thought I was a good candidate for resurfacing. He didn't seem worried about implant longevity in my case and stressed that he thought the waiting for full bone-on-bone was a myth.

Is his concern that he thinks your pain *isn't* from the joint?

[Ljpviper]

JD,Not sure why, I guess he hates to sacrifice a good looking joint for one bad spot. I beleive that is his concern all the pain is not coming from the joint. He sees cases like mine and yours infrequently, but it appears he is searching for the correct care if not with him with another scope surgeon. Like i said we are gray area patients

Blinky, he mentioned Dr. White, I just think another scope is not worth the risk of it failing again. JD knows, its a very difficult recovery. Dr. Ratterman who I saw in May-15 does not like to do repeat scopes, and he does both scopes and HR. He was a little more gun ho about the resurfacing and said i should do it.

Thanks,
Larry

[jd]

That's got to be frustrating Larry!

My understanding was that repeat microfracture really didn't work very well (much lower success than primary microfracture), but I may be wrong in more recent data.

Did Dr Gross say he wouldn't do it? Or just that he thought you had better options first?

What are you going to do next?

[Ljpviper]

I am going forward with the hip resurfacing, he says he will do it. As stated, my knees and back are taking a beating. I dont want to try a scope again, to much risk it will fail again.
Larry

[jd]

Alright, good to hear! Perhaps he was just making sure that you were clear that there was a chance most of your pain wasn't from directly in the joint.

I know you've been headed down this path for awhile so, while it's frustrating to get get a ringing "yes" from Dr Gross, I bet you're relieved to just be moving forward.

When is it going to happen?

[karlos.bell]

 :) Hi Viper  8) Exactly that. Your back, That is also your whole spine... knees, even your feet will take a beating. Same if you have a crook shoulder the pain radiates down the arm even into the hand... Worse in a hip due it is weight bearing so the muscles change to accommodate the worn joint. 15 of them I think...
I am doing well, yes I had scopes but realized they are just if you have little issues. I also found out once that joint starts having issues and showing a small amount of wear it is never going to stop (the issues) . They always find more issues out when they do the total operation Like Dr De Smet. I asked if it was possible to have un - cemented femur  components. After the op he said no my femur  blood supply and bone was not up to it so he had to cement it, yet I am young and healthy (so far touch wood). Was the issues I had for years due I could not have un - cemented.
It is a hard road and yes he is exactly right you may be left with what he gives you there is no turning back...... Also the joint on paper looks good so why should he do it???  but it is not standing up to the pace. Same as me. The issues started and as cartilage cannot replace only repair you are left in no mans land... Stay the same... Floppy joint.. worn joint.... It is a hard decision for a surgeon but all you ask him is to help you and do the same job as every one else. Normally the same result will apply. So with that be confident and your rehab may even be longer than the others due your issues have been there for a longer time.
Been 8 months now up and down but still have issues but I was able to do a 3/4 hour walk and no issues the next morning so things are looking up.... Its a long rehab I feel the longer your issues are. Not sure how it goes for example I was on and off crutches for seven years to aid me walking yet on paper my joints were fantastic in the eyes of Radiologists in  NZ but to De Smet it was No.
Yes  my knees have taken a beating especially the left knee and may never recover and I will have to live with it.
Be confident in your self that you are making the right decision that then gives confidence sometimes to the surgeon.
If he is willing to do it for you under it all he must want to help you so why take the risk??
Good luck and hope it all goes well.
Cheers K

[Ljpviper]

Thanks for the words Karlos, my OS just emailed me that did the scopes he does not think trying another scope is a good idea cause of the articular cartildge damage.

JD, now that you have had you hip resurfaced a few months do you feel it any different in movement compared to your natural hip. Like the joint itself, is it just as smooth? I wonder why Dr.Gross stated i might not like it compared to my natural hip, but it sures beats an arthritic hip.

Thanks,
Larry

[jd]

The joint itself feels 100% normal as far as I'm concerned.

I have tweaks at extremes of ROM (which are still less than my non-op leg) but I think that that will continue to improve (and many people claim better ROM long-term).

There've been a few discussions on this idea that it'll be worse than a natural hip but I think the consensus here is that most people think their hips are at least as good as they remember a natural hip being. I suspect that if there's much difference, we've all long forgotten what that was like!

[Ljpviper]

Thanks JD, just the answer i wanted to hear.

[jd]

Of course the counter-argument is still that if you have fundamental major problems with soft-tissue, the surgery probably won't solve that, leaving you with residual pain and issues. As long as you know there's some chance that that's the case but you feel comfortable enough in thinking it's the joint and Dr Gross is willing to do the surgery, I think you're all good?

[karlos.bell]

 8) Hi Viper again, and others reading this post..
Rom of these Resurfacing joints are amazing to say the least to a natural hip. but it depends on the natural hip depth and ROM  of the native hip. I know now what a normal hip should do. I was watching a You tube video one day of a couple of USA PT's. The bloke real tall just sat down and put one hip at right angles to the other (he was about 50 +) and I went "man alive" that is amazing. So it depends on the depth. I now almost can do that due the tissue is freeing up in the joint so they are to me amazing ROM. I have no impingement issues in any hip...
They do clunk around a bit due to they do not have the depth or a Labrum but they have stability, ROM,  the muscles around the joint once they get stronger and more available to work this seems to stop due then the joint cannot flop around or slightly clunk.
That is if you have had this muscle weakness along time.
Cannot see into the future but I am really hoping it's real good.... Cheers K

[Ljpviper]

Got my surgery date April 13th, doing the right first, i am excited to be pain free!!!!

[Quig]

Congrats on the scheduling the surgery. I'll see you there, I'm scheduled for bilat with Dr Gross April 11 and 13. April can't get here soon enough...