How do doctors decide if it's time to do resurfacing?

[Plonanon]

I am a 51-year old woman who used to walk a lot and walk very fast. For around two years now I've had pain and stiffness in my right hip and walked with a limp. Recently, my right knee has been hurting, I think because my abnormal gait has put pressure on the knee.

Unsurprisingly, a recent x-ray showed joint space narrowing and a rotated femoral head. (Does anyone know what this rotation means?)

I will be seeing an orthopedist for the first time in a week, and a physical therapist at the end of April. While the severity of my symptoms is quite variable, I am finding that walking for more than a few minutes is getting more and more uncomfortable. Needless to say, this is quite troubling. I cannot say that I am in excruciating pain or anything close to it, but I do find that my leg and hip bother me a lot.

I have just begun reading about hip replacement, particularly hip resurfacing, and I am wondering how bad your condition needs to be before a doctor will recommend resurfacing. My sense is that for a THR, you have to be fairly incapacitated and in a lot of pain before they will agree to it, especially if you are considered to be young for THR. Is this less true with resurfacing?

I understand that bone density is a major issue in resurfacing. My bone density is less than stellar (-1.9 total hip), though I gather from what I read here that if you can improve your bone density through medications, that puts you in a better position to do resurfacing.

I am also wondering how much benefit you can actually get from physical therapy without a hip replacement. I suspect that it is not going to help much.

I'd appreciate any information you can give me on the issues I've raised.

Thanks.

Plonanon

[Pat Walter]

Hi

Welcome to Hip Talk.

It is not possible for someone to tell you when a doctor will tell you it's time to have a resurfacing.  We are not medically trained. There are many issues a surgeon will consider including the information he sees from your x-ray, your bone density, your pain and your activity level.  There are so many things that an untrained person could not tell you.

You really need an experienced surgeon to look at your x-rays and tell you if you are a candidate.  I don't know any experinced hip resurfacing surgeon that would do either a resurfacing or THR if they felt it was not time to do the surgery. They are all VERY busy and are not looking for business. The top surgeons have people waiting for months for surgeries.  You can also wait too long and miss the window of opportunity for resurfacing if your hip deteriorates too long.  Your pain level is not the only indicator of your hip deterioration. Some people have a great deal of pain and not much deterioration, while others have a higher tolerance to pain and have very deteriorated hips.  Only an x-ray can tell a surgoen what shape your hip is in.

Some people have had shots of steroids into the hip capsules that can help for a month to many months.  Doctors will usually only give those a couple times because the steroids destroy cartileage.  Pt can help build muscle, but can never regrow cartilage.  So sometimes PT can help, but it will not stop hip deterioration.  There is nothing available yet short of replacing a deteriorated hip.  Surgeons will generally try all non-surgical methods first inculding meds and shots into the hip capsule. After that, there are not any other options available if you want to be out of pain and active. 

Again, there is no diffeence between a THR or resurfacing if you are in pain and inactive.  Both will resolve the probelm. Both are very major surgery.  Resurfacing, however, allows you to keep a large part of your femur bone and generally gives you a more natural gait. That is why the people here have choosen resurfacings.

51 is not that young to require a resurfacing or THR.  Your hip condition determines that you need a hip replacement - not your age.  I have stories posted of teenagers and people in their twenties that have had hip resurfacing.  Hip problems occure reguardless of your age.

So the answer is once again, choose a really expeirnced hip resurfacing surgeon from my list and get input from a professional. http://www.surfacehippy.info/listofdoctors.php   Only an experinced surgeon can tell you what shape your hip is actually in.  If you choose less expeirnced surgeons and those that don't do resurfacing - they will suggest THRs.  If your case is diffiuclt, the less experinced surgeons will also often opt for a THR.  Choose a surgeon that has done 500 or better a thousand or more resurfacings.  Normally they are not in your home town, you have to travel.  You only have 2 hips and need the best surgeon available to make sure they work right after surgery.

Good Luck.

Pat

[resurface]

Hi,

I tried physical therapy for almost 6 months straight with a sports therapist!  I saw some benefit but my range of motion remained limited.  I then decided to try yoga.  Wonderful experience but still did not address the soreness and lack of mobility as compared to my left hip.  For me, these activities were helpful but not a cure.  I should note that I thought that the impingement could be fixed via hip arthroscopy.  I came to learn that this intervention must be done very early.  Who knew?  I should also say that I have lifted weights and riden a bike my entire life.  Ok, so maybe I have ADD!  LOL.

I am 47 now and having my right hip resurfaced in May.  It seems to me that once one is on this degenerative path that it is only a matter of time.  I still walk and seem to have less pain than you.  I also can still ride.  Did a quick 20 miles yesterday.  A bit sore after but not too bad.   I say this as my surgeon is doing my hip and you seem to be in more pain than me.  For me, why wait and have two, three or more bad years.  I want my lifestyle back!

You should have an honest discussion with your surgeon.  I would select a surgeon who does both so that you can gain from his/her experience.  In my opinion, HR and a THA are proven procedures when done by an experienced surgeon [more so for a HR].  I also believe that they are not the same and patient selection is more critical for a HR than a THA.  Just my opinion.  This is a great site from which to learn.  Best wishes...

[Plonanon]

Thanks for your replies.

I hope I will be able to do resurfacing, and if it looks like I am a candidate, I will probably be back with more questions.

Plonanon

[SFHip]

I agree with "resurface" - it boils down to living your life vs. not, but with some risks in the procedure. As soon as I was diagnosed, I lost 15-20 lbs and started using a stationary bike to exercise without any weight on my hip. This helped me tremendously - almost to the point where I thought of putting off the surgery. But I realized it wasn't going to get any better, so I went for it and am now 10 days post op. It's a slog after surgery, but I'm really glad I got it done and can now focus on getting back to what I love the most.