Are you ready yet?

[whozethere]

My hip resurfacing is scheduled for mid January.  I was thrilled to find out I was a candidate , yet almost out of the window when resurfacing could be done.  Your posts scare me a little.   My surgeon has years of experience with THR, but he has only done a resurfacing or two.  I do know his stats with THR are excellent.  Sadly, it's an insurance issue and I have no choice on where to go.  I am a nurse and the hospital where I work is self insured.  If anyone in our system offers the procedure, I cannot elect to go elsewhere unless I can pay for the surgery myself.

I find the "are you ready for surgery" piece to be the hardest decision.  I have seen two orthopedist for the first time since I was a teen and I still find the decision to be difficult. 

I was in a car wreck 35 years ago and fractured my pelvis at the age of 13.  I had a crusty old orthopedist who first told me it would be 4-6 months before I would be done with crutches, wheelchairs, walkers, etc.  He went away for a month and I loved his associate who was so kind.  The first doctor returned, cursing, screaming, etc.  My mother requested my care be turned over to the doctor I liked, so I was walked and discharged from the hospital by the crusty doctor with no type of PT or anything.  On a return visit, the next year, he screamed "you are the girl who did not want me for her doctor."

I only had a big arthritis flare after my second child was born.  (I think I have been attributing my arthritis s/s for a long time to other things.)  I can remember my hip pain being so bad in the winter that I would have to soak in a hot tub before I could weight bear or get ready for work.  In the last 15 years, I thought I was suffering from fibromyalgia.  Although I did stretches and exercises with my post cardiac rehab patients, I would come home exhausted with muscle pain & spasms which often turned in to severe migraines.  I basically would be done only to recover in time to return to work.  Over time, I was able to do less and less after work and it started getting harder and harder to work through all the muscle aches and pains in the morning.  Occasionally, I would see a chiropractor or a PT to have my muscles released since they would shorten and tighten.  Both made comments about my source of real pain seemed to be coming from my non-aching hip.  The little things I remember is buying a firm couch and not being able to lay on the couch because it was “too firm” and hurt my hip and back.  This was 12 years ago.  Three years ago, I bought a new mattress set with a plush pillow top and ended up adding a 4 inch tempurpedic topper because it hurt so bad to sleep on the set.

Summer before last, I would have pain swimming and discovered being in a pool less than 88 degrees would start muscle spasms, pain and pain in my hip..  Last winter, my blood pressure was very high.  I finally told my doctor that I didn't think my blood pressure would come down because my hip was hurting and felt in bed just like it did years ago when it was broke.  The x-rays revealed "bone on bone" severe osteoarthritis of my left hip.  I ended up taking the maximum amount of Ibuprofen around the clock with some improvement, but every 3-4 hours I would experience break through pain.  The first orthopedist I saw put me on Mobic and Loratab.  Although I still get muscle spasms if I do too much, I haven’t had a single migraine since I started the Ibuprofen.  I was told because I am not 50, I needed to put off surgery as long as possible since I could only have THR done once and “no credible doctor would do hip resurfacing.”  I felt like he was talking out of both sides of his mouth.  He told me to wait getting the surgery, but I needed a handicapped sticker for my car and had needed it for some time.

Anyway, I have worked with staff development for the past seven years.  I am having trouble standing to teach a class.  I ride an electronic cart to grocery shop.  I can’t bend and get things off the floor.  I can’t lift anything very heavy.  I am having to pay someone to clean my house.  I take a half of Loratab about 4 times a week.  I could do it nightly, but I do fear addiction.  A full one drugs me up so much that I sleep for around 9 hours.  When I wake up, I am still in a lot of pain because I didn’t toss and turn as much as I needed to do so my hip still hurts.  A half dose keeps me awake and mobile.  I feel I have little quality to my life at 49 and yet, when an orthopedist looks at me and says, “so you really can’t take the pain anymore?“  I feel like I am a wimp.  I am sure if I didn’t have to work, I could pace myself for a few more years.   I have heard how bad many people’s hips are prior to T”HR and mine isn’t as bad.  I know some things need to be documented for insurance purposes and legal purposes, but I would like to live my life again. 

When I told my children about my hip, they weren't surprised.  They both commented on how little physically I could do with them when they were little.  My daughter said she has noticed that I have been dragging my leg for several years.  I also have fallen a few times because some days it is hard to pick up my left foot.  I hate those public doors with the metal raised piece at the bottom.  Anyway, some encouragement, tips, etc. would be appreciated.

[tseeley]

Your fear of an experienced thr surgeon, but an inexperienced resurfacing surgeon doing your resurfacing is not unwarranted. As i'm sure you've learned reading this web site, there is a definite learning curve for resurfacing. If this surgeon is in fact your only option, you should ask alot of questions, and then ask them again. Pat has the list of questions posted. The other option is that if you can scrape up the funds, do it, and go to an experienced surgeon. Pat also has some of the great ones listed here. Good luck and there is no reason for you to live in pain if there is an option to relieve it.

tom

[Pat Walter]

Hi

I can understand that you have fear about hip surgery.  Sometimes fear is a good thing because it makes us search for more answers to our questions.

You probably know from reading my website that I always encourage people to use experienced surgeons.  The reason I do that is based on medical studies I have read and posted on my website that there is a steep learning curve for hip resurfacing and I have read literally hundreds of personal hip resurfacing stories on the Yahoo Surface Hippy Discussion Group.

There are statistics and they have now changed since the US doctors have joined the ranks of the doctors from the rest of the world.  The survivorship for BHRs to be now 96.1 %      It use to be 99+% in the rest of the world. 

About the BHR, what has happened is a lot of new surgeons are now doing the BHR in the US.  They are learning and having problems.  If you don't mind taking a chance and hope you are not one of their learning statistics - use the new doctors.  If you want to try to make sure you have the very best chance of getting a hip resusrfacing and not have any post op problems or quick revision of your new hip resurfacing -  USE AN EXPERIENCED DOCTOR!

Can't say it enough.  This whole argument about my doctors is the great THR surgeon has nothing to do with performing a hip resurfacing.  Hip resurfacing is a much more difficult surgery and the instrumentation to place the hip device properly is not very plentiful.  THRs have been done a long time and there are lots of instruments to help place the hip.  Hip resurfacing is new. You need a doctors that has done hundreds to make sure you won't get a loose cup, have a femur neck fracture, get an infection or just need to have the hip resurfacing revised from surgeon error.

It is happening - that is why that stats have gone from 99% to 96.1%   Someone has to be in the 3-4% category of problems and revisions.  They best way to statistically make sure it isn't you is to use an experienced HIP RESURFACING SURGEON.

I can't say it any more clearly.  I would turn and run from a hip resurfacing surgeon that has only done a couple unless you just feel you need to give him some practice.  Odds are you will probably be OK - but you can't argue with the statistics.  Someone has to have the slipped cups and femur neck fractures.  There are been 10 slipped cups in the last year or so on the Yahoo Group.  That meant that these peope went back into surgery and were opened up again while the surgeon attached the loose acetabulum cup!  Not fun to do major surgery twice since the surgeon did not place the cup properly.  Loose acetabulum cups are surgeon error according to Dr. De Smet, Dr. Bose and others.

You should take a look at my doctors list and find someone experienced.  If they are out of your insurance group - consider going to India to Bose or Belgium to De Smet like many of us have.  De Smet has done over 2700 Hip resurfacings and over 3000 THRs.  He will never give a THR if he can do a hip resurfacing.

Many of the new, less experienced surgeons will often change to a THR when the going gets tough.  If you have any special problems with your hips, they will elect to do a THR because they don't have the experience to tackles difficult hip resurfacings.

So you must ask your doctor what the odds are that he/she will change her mind and you wake up with a THR instead of a hip resurfacing.

I hope I haven't frightened you more - but the numbers don't lie.  If you want to play it safe - use an experienced hip resurfacing doctor.

Pat

[whozethere]

I had an appointment with a more experienced surgeon.  It just took way to long to get in and someone started doing the procedure where I work.  I have been sick since.  Divorced, two children in college.  I have no way to raise funds to do things differently.  As a matter of fact, I had started picking up extra time only to discover I can't walk any more.  My only other choice is to let him do THR.  My grandmother lived until she was 97.  I would definitely have to have a least one redo.  As a nurse, the stats may even scare me more than the average person.  I just pray some other options opens up or I can convince him to get the new guy in the practice who has done more to help.

I do want to add something.  I saw his partner first and was hoping to get a clear referral out of town to the more experienced doctor.  It was just like being 13 again with the crusty physician.  I am a nurse who can be very aggressive for my patients.  I can stand up to any doctor, but the first guy was such a jerk that I ended up shutting up. It has taken me almost 6 months to get with a different doctor just because all the orthopods are so backed up that they will not accept a patient who has an orthopod already.  Getting one within the same practice took a lot of political posturing and getting the OR Nurse Educator to talk with him.  The only way I got over to him was the fact the first doctor did not offer hip resurfacing, but he did document that I had asked about the procedure.

[Pat Walter]

Hi

Please know that  I am not trying to criticize you or even say your are weak or not trying - honest.  I have heard these stories forever on the Yahoo Group. These doctors are difficult to deal with. I just understand why you are so concerned using a doctor that has only done a couple hip resufacings.  I wish you could use someone else.  I guess you could also figure that your odds of being one of the 4 out of a hundred that will have problems is really small odds.  My hubby was given a 5% chance of death or bad outcome of his triple bypass surgery.

I can also tell you a couple things.  Dr. De Smet and Dr. Bose will both give you a free consultation via email if you send them your story with an email and your x-rays attached in a digital format  like a .jpg   Keeping them under around 600 pixels wide or long.

That way you could get free input from some of the very best and most experienced hip resurfacing surgeons in the world.  They are honest and will give you a good evaluation as to your hip situation.

One more note, it would cost about $10,000 to go to Dr. Bose in India.  I spent $18,000 and am deep in debt at 63 since my husband lost his job and insurance.  He had a heart attack and ended up with a triple bypass costing $104,000   We were very lucky that the hospital and doctors wrote it all off to charity for us.

So I have been there and done that - being poor and without options is no fun.  I was lucky to have empty credit cards.  I was able to use them to get my hip.  I could have received a free THR in Columbus Ohio - but would not accept it. I put off having a hip for 10 years until I learned about hip resurfacing.  Then in 2005 I knew what I wanted and paid dearly to get it.  It was the best investment I ever made in my health.  It will take us most of the rest of our lives to pay off our great debt -but it was worth it.  We had to live on our credit cards for over 6 months.

So please understand - I am not criticizing - only trying to help you find other solutions to get what you want.

Pat

[whozethere]

I did not take your post that way at all.  I just didn't want you to think I was cocky enough to go to someone inexperienced if I could scrape up funding for a different option.  I will send picture of my hip and story to them.  I would liove to hear their input. 

[Terry_Smith]

Whozethere,

   I sent off my x-rays to Dr. Bose a few days ago, and hope to hear what he has to say soon.  I'm also sending copies to Dr. Gross in SC, and have a consultation with a Dr in San Diego this month.  Fortunately I have insurance, but depending on what can or can't be done, I might even try to go to India if all else fails.  Whatever you do, don't delay.  My first doctor here had done 1 BHR, and only 30 -40 THRs, and even after I told him that if I needed a THR that I wanted a MOM, he still tried to convince me that the new plastics are better and breakdown far less.  So, he certainly isn't the one for me.  Every day it seems I'm slowing a bit more as my hips wear me down.  Personally my only fear is that my left hip won't be suitable for the BHR, but if that's the case, so be it.  The surgery itself doesn't faze me.  I'd rather get it soon than end up in a wheelchair.  I think given your situation, if its a choice between a doctor with a few BHR's or having a THR, I'd personally want the BHR, and hope for the best, especially after hearing how the BHR has improved so many lives through the Surface Hippy website.  I know that thanks to Pat I know far more about my options and will refer anyone I know who may consider hip surgery to look at this option.

Terry