Unsure about what to do

[Frannie]

I have been told that I need a complete hip replacement â€" right side.

When I first went to the doctor, he only talked about THR … I recently found out that he has done a few hip resurfacings (not sure how many until I talk to him next week).

I am 60 years old and 5 ft. 1 in., female â€" if that makes a difference. I was told a year and a half ago that I have osteoporosis. I am wondering if anyone here can tell me if I should go ahead with the THR or try to see about resurfacing. I am apprehensive about either one â€" and to be truthful â€" afraid.

The thought of THR makes me more apprehensive than the resurfacing. I have a hard time thinking about cutting away bone and putting a metal rod in place of it. But with the osteoporosis â€" it might be the only solution.

I received the news about my hip in Dec 2019. I decided to just get the shot in my hip to begin with. I should have already had another shot, but everything shut down about the time I should have done gotten the shot, so I put it off.

Right now, I am to the point that I can take muscle relaxers for 3 nights and get a good night’s sleep for those nights and 2 more nights without taking anything. But the 3rd night without, starts getting miserable.

I have read about the possibility of a bone fracture below the resurfacing if your bones are weak and about the metal levels in the blood getting dangerously high with the resurfacing.

Any input would be helpful, before I visit with my doctor next week.

[petemeads]

Hi Frannie, welcome!
You are a small woman with osteoporosis,  I'm afraid that as such you will probably find only a handful of surgeons who have access to a suitable device and the confidence to attempt resurfacing. On the other hand, a modern ceramic/ceramic or ceramic/poly THR would probably suit you very well.

I had my BHR in 2014, osteopenic 64 yr old, and that works well - I wanted to be able to run, bike and climb and I do all these things. My attempt to get the other hip BHR 3 years later was met with the femoral head snapping off during the operation, hence the ceramic THR. I was told I could continue doing all the things I wanted to, and have done. In some ways the THR feels better but both feel near-normal, I have run over 900 miles in the last year and sleeping comfortably is such a luxury!

I don't like the mechanical aspects of a rod stuck down my femur but at the moment everything is working well. I did not like the sound of Fosamax/Alendronic acid as a treatment for osteoporosis but some surgeons will prescribe 6 months or so for extra bone density. I take vitamin D as this has more than just bone benefits, and make sure I eat plenty of calcium in dairy. If you think the femur is a weak point, the metal stem will act as reinforcement to an extent - or so I tell myself! Good luck in your research.

Pete

[Saddlepal3]

Hi Frannie,

You're situation sounds familiar. I'm a 70 year old female, 5'3", 115lbs, osteopenia.
When I was 55, I had my Right hip resurfaced by Dr. Pritchett in Seattle. That went well for 12 years until I discovered I had the beginning stages of metallosis. This was in 2018, age 67. As you may know, metallosis is more of an issue with small framed females. Although I had since moved to Florida, I flew back to Seattle and Dr. Pritchett revised the joint with a poly-lined acetabulum cup, but kept the resurfaced joint. Operation was a success.

Coincidentally, my LEFT hip went bad the same year as the revision, in 2018. At age 67, with all the other factors, I was no longer eligible for resurfacing. Consequently, I have a Total Hip Replacement in my left hip and a Resurfaced hip in my right hip. A Florida surgeon did the THR. To be honest, I can't tell a difference between the two. They both feel great. I'm not an athlete, but I'm pretty active: walking, ellliptical, swimming. Exercising about 2 hours a day.

I also did a 4 month course of Forteo, which is a bone building medication. This is approved for use in patients who have severe osteoporosis. Because I'm not in that category, I knew I'd have to pay for it out of pocket. It's really expensive, $1700/month, but I decided to do it and was happy to see that my bone density increased 12%. Currently, I take alendronate, Vit D, calcium and do a lot of weight bearing exercise.

Given your factors, you may/may not be eligible for resurfacing, but I recommend that you consult with Dr. Pritchett. He'll need to see your x-rays and T scores from your bone density test. His consults are free (by phone). If Dr. Pritchett gives you a thumbs up, work with him. Absolutely do not ask for a resurfacing from a doctor who has only done a few. It's a very complicated and precise surgery, far more so than a THR. If you end up going with a THR, you will probably be happy with the outcome.

It's completely normal to feel overwhelmed by the prospects of this, but I predict that you'll be SO happy 4 months after the surgery (maybe even by 4 weeks, but there is a period of recovery to get through). Feel free to message me with any further questions. Good luck!

[Ergo]

Hi Frannie! By now you have had your appointment with your doctor already, but if you are still deciding on your course of action, I would highly recommend that you fill out Dr Gross' new patient packet (https://grossortho.com/forms/new-patient-forms) and he will call you for a consultation. He has a slightly different post op recovery plan for patients who are good candidates but have lower bone density. He can also address your concerns about metallosis and has data from his 6000+ (I believe) resurfacings.

I'm 5'3" 130 lbs and coming up on my one year anniversary... still improving! My friend who is about 5' and 110 lbs had both her hips done by Dr Gross and is very happy with her outcome. Good luck!

[catfriend]

It sounds like you definitely need surgery. Both Drs. Gross and Pritchett are excellent. I am a woman a little bit younger and a fair bit bigger than yourself, and I do not have osteoporosis. Dr. Pritchett resurfaced my right hip five years ago, and he's doing my right hip next week. I have good bone quality, so I can't talk about osteoporosis issues or what your best course might be. But I know the pain you're in. Do what you need to do to get out of it.

[dannythebeerman]

+1 on catfriends post.

[imgetinold]

As two other posters suggested, Dr. Gross specializes in difficult cases.  And, in my totally biased opinion, he is simply the best resurfacing surgeon there is.  He will consult for free, so nothing to lose.