Hip resurfacing or arthroscopy

[Alex]

Hi everyone,

first of all, I would like to thank Patricia and everyone contributing to the website and forum. All the information, stories and experiences shared here have been extremely helpful.

So I would like to share my story as well. I am currently deciding between getting a hip resurfacing and giving an arthroscopy a shot. Maybe some of you have been down a similar path and have some advice. Maybe someone will read this in the future and will find it helpful for their own decision or some comfort that they are not alone. :) Partly, I just feel sharing it will make the situation feel less heavy/lonely.

I am a 34 year old man and enjoy hiking, tennis, surfing, skiing, running, .. really anything active. I have noticed that my left hip feels a bit tight for a couple of years actually.. but never thought much about it since it did not keep me from any of the thing I like doing.

About three months ago after a not-too-crazy gym workout, the situation escalated and forced me into a full activity stop. Since then, even walking for an hour has been pretty painful, sitting for an extended time is difficult too. The pain is mostly in the groin and thigh. I had some X-rays and MRIs taken and they show an extensive CAM impingement and quite advanced OA (stage 3 out of 4 the docs say).

I consulted with some of the top resurfacing surgeons listed on this site: they all say it is too late for scope and time to resurface. I also talked to some high volume scope doctors: they say its too early to resurface and I should have a scope... soo  :)

I've been researching for quite a long time and am leaning towards resurfacing considering that (i) arthroscopy often does not do it for advanced OA patients, (ii) resurfacing seems to last a long time,... but then some days I think it would be crazy to not at least try to save the joint before replacing it at a young age.

I will update this once I have made a decision & date for (whichever) surgery and share how things went. For now, thanks a lot for taking the time to read this!

All the best,
Alex

[LarryBud]

I would ask the scope Docs how long they think they can give you? 

Common sense says to start with the least drastic and escalate as needed.  I faced this decision at 60 and went right to resurface but we have quite a delta in age.

If you get a resurface job, go to one of the experienced pros.  Don't take a chance with someone who " dabbles " in the procedure.

[Alex]

Thanks Larry! The scope docs were vague / did not give me a clear answer to "what could be the best case result?" .. only "maybe a couple of years". One mentioned he had a similar case with a patient that is still doing great four years out, another had a similar case going to THA within the next year.. I guess the success of arthroscopy with present arthritis is fairly unpredictable.

[LarryBud]

If you're in the States, Dr. Gross will do a remote consult.

All of the info is on his website.  I think you would want to at least check in with him.

[Alex]

Yes, great idea, just wrote to his team! :)

[Kingrob]

Alex,

I have had both my hips resurfaced by Dr. Gross. The first one on my right side I had done in 2015. I started having problems around 2006, and I had it scoped in 2010. The procedure did not work; I was still limping and was bone on bone until I had it resurfaced. I think there is definitely a point where a scope is just not going to work. I trust Dr. Gross. He told me my left hip would probably last 5 years by looking at the XRAYS. He was spot on. I was just glad the scope did not do anything to prevent me from getting the resurfacing.

[stevel]

Hi Alex,  For my right hip, my local orthopedic surgeon did not recommend arthroscopy but hip resurfacing should my symptoms intensify.  I had an x-ray showing arthritis progressed to severe (bone on bone) from moderate (joint space narrowing) in a year, so I proceeded with a right hip resurfacing.

[Alex]

Hi Stevel and Kingrob,

thanks a lot to both of you! Did you also have FAI? I got another extremely honest and helpful evaluation from Dr. Hyman - a scope specialist - who suggests with my case of FAI and Tönnies Grade 2 OA (so not bone-on-bone yet), results of a scope are unpredictable ... with both substantial upside (no further deterioration) and downside risk (fast wear after and quick transition to implant).

By the way, if anyone is facing a similar decision... I found this article ( https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/ajo04311e255.pdf ) co-authored by Dr. Su suggesting that prior hip arthroscopy does not have a detrimental effect on later hip resurfacing success! I think that is/was a worry for many in a similar situation.

For me, I don't think I am willing to gamble on arthroscopy with a significant chance of having the resurfacing anyway within a year or two.. but I changed my mind before :)

I'll wait for Dr. Gross' evaluation and then I think I have a good set of information to base my decision on.

Thanks again and all the best,
Alex

[stevel]

Hi Alex,

No, I did not have FAI.  I inquired about arthroscopic labral surgery, if needed and Dr Schwarting (my local orthopedic surgeon) did not recommend the surgery due to the degeneration of the hip and instead get a hip resurfacing if symptoms intensify.  I have been getting yearly and then bi-yearly x-rays of my left hip resurfacing including the pelvis since 2008 for Dr Su so I monitored the degeneration of my right hip over the years.  It progressed from moderate arthritis with joint space narrowing at the superior head to severe arthritis with subchondral sclerosis and bone on bone contact at the upper margin of the acetabulum in a year.  So I did not delay and scheduled my right hip resurfacing with Dr Su a few months later.