Hip Arthroscopy vs Hip Resurfacing

[hipnhop]

Two years ago I suffered extreme hip pain at the 13 mile mark of the Marine Corps Marathon. I finished the race and immediately went to see my doctor the following week. I was diagnosed with severe bi-lateral hip arthritis. I am an active 46 year old Triathlete. I was told that I would need hip replacement before I was 50.  I continued in the sport taking 800mg of Motrin once a day to help me deal with inflammation and pain.

I received one round of Cortisone shots six months ago in preparation for a Half Ironman race.
The shots helped a little and I finished the race with minimal hip pain.  I notched up my training for a full Ironman scheduled to take place 6 months later.  Throughout the training my hip pain was bearable and I was able to complete 7 months of 15-20 hour a week training with little to moderate pain.

Two weeks before the full Ironman I decided to have my second round of Cortisone shots. I thought they might help keep discomfort at bay during the race. After the shots I felt a severe pain in my right hip (left ok).  I waited  24-48 hours to see if it was a Cortisone Flare. The pain never decreased. I went to see my doctor and he informed me that I needed to give it more time. Two weeks later the pain was still unbearable pain and I can't walk. Doc give me Percocet and Voltaren and told me “things will get better.” 

At the third week mark I demanded xrays. Doc told I need to have hip replacement. I got so frustrated I went for a second opinion with a HR certified Ortho Surgeon.

The new Doctor looked at my x-rays and MRI. I was told that there may be lose particles in my joint space and a possible labral tear. He stated that I still have Cartlidge in both hips and advised against hip resurfacing at this time.

He advised a Hip Arthrospoy. I never made it to the Ironman and I am now faced with doing a Hip Arthroscopy or just fighting for Hip Resurfacing. If the hips only have a few more years left why not just do the full surgery now?

As for why the Cortisone caused this problem, no one is talking.  Any comments of which procedure should I take?

[littleb]

Try sending your xrays to Dr. DeSmet, you'll find his link under the list of resurfacing doctors. He should be able to tell you if you are ready for resurfacing.

I had the arthroscopy by one of the best in NY for labral tear and impingement. He promised 65% improvement which at the time was better than where I was at with pain. After the scope he said I was looking at replacement down the road. Fast forward 2 years and I was a candidate for resurfacing or THR. I'm a little over 2 months now with the resurfacing. I don't think I was at the point for anything more than the scope when I did it and it did help alot for a while.

Maybe the injections moved particles around to a place where they are causing wear and pain?

[hipnhop]

Littleb, thanks for sharing. I'll take 65% improvement but it will just put me back to where I was before the Cortisone shot. How long did it take you to recoup from the Arthroscopy? I wonder what percentage of Hip Resurfacing patients have tried Arthroscopy prior to HR? Does it actually "buy time?"  I am so glad I found this site where we can share our experience with this debilitating disease.

[John C]

I think that my story might be relevant. I am a full time athlete; either skiing, windsurfing, surfing, or playing tennis 4-8 hours every day. My hip started getting pretty bad about 15 years ago when I was 45, and I was told that I would eventually need a replacement. When I was in my early 50s, it was to the point where I was constantly limping, had to give up tennis and surfing, and sometimes had severe pain when I was skiing. I went to a surgeon who was one of the few doing a lot of hip arthroscopies back then, and he said that I had labral tears, and would be a good candidate since the cartilage did not look too bad yet. His best guess was that it would buy me 5-10 years before I would need a replacement. He pointed out that one of the big advantages of gaining a few years, was that there would possibly be some advances in joint replacements during that time, and he certainly was correct. I was back to skiing within a month of the surgery, but had horrible pain afterword. He said that it would improve at 3 months, and he hit it almost to the day. I would say that I got about a 60%-70% improvement for a few years; enough to help skiing and walking, but not enough to get back to tennis. By the time that I was about 6 years out, it was getting pretty bad again. I then tried an injection of my own stem cells mixed with a small amount of cortisone directly into the joint. This was a total disaster much like you described, and I was never able to walk without a cane or crutches after that. A few months later, I had my resurfacing, and things improved a lot. I am back to all of my sports 4-8 hours a day, including tennis. I still have some minor aches and twinges, but at an active 60, who doesn't. No limp, and I can do whatever I want.
One thing that you might find interesting: the first time that I visited Dr. Gross (who I, along with many, think is one of the top resurfacing surgeons), was before the stem cell injections. He said that my x-rays still did not look horrible. We talked about the possibility of sending me to someone for an open surgery to try to repair the joint. In order to know if this had any chance, he said that we really needed something better than an x-ray, and I went for a CT scan. When Dr. Gross and I looked at the CT, it was clear that my hip was shot, so he said that it was time for a resurfacing.
So there is my story, that addresses some of your concerns. My only advice after all of that, is that x-rays do not tell the whole story inside the joint. If you really want to find out if an arthroscopy will help, you need to know everything going on in there, and you need a CT scan or MRI for that. If it really is only a labral tear and some loose particles, you might have an excellent result from an arthroscopy. If you are like me and have a lot of cartilage damage and bone cysts that do not show up well on the x-rays, the arthroscopy may not do much good, and it time for a resurfacing.
Good luck.

[johnoke]

I can't speak to the arthroscopy, since I've only had the resurfacing. Of course, they address two totally different things. I had little or no cartilage left in my right hip, just bone on bone. I play hockey a few times a week (goalie), but no where near the athlete you all are. 3 months post op, including 2x week PT for 2 months, I was back on the ice and am playing regularly now, feeling 10x better than when I gave up hockey 2 years ago. At that time, I was doing what you're doing - playing in much pain, to the point of barely being able to limp to the dressing room, and taking pain pills after each game in order to even walk. I love my resurfaced hip. It's given me my life back.

[Luann]

Hi ed,
 I faced the same thing about 4-5 years ago. I had had hip pain on and off for about 2-3 years before this, and finally went in for a dx. The first Dr said I had a labral tear most likely, and sent me in for a MRI. After it came back, he said he couldn't help me and sent me to another Dr who did arthroscopic (sp?) sx. She said my hips were not in correct alignment for my body/pelvis relation, and that I needed many bone spurs removed (easily seen even by me in the x-rays). She did not advise me on a hip replacement.
 I got three more opinions, and each of these was a Dr who either did THR, HR or both. They said that I had more damage than just bone spurs (but still plenty of cartilage with just a little narrowing/damage of the cushion) and that since a THR or HR would be inevitable in a 2-3 years, they did not think artho. sx would be worth it, or help me much. I guess with bone spurs, they can come back very quickly.
 I decided since I would need a hip replacement eventually anyway, and that 3 out of 5 Drs didn't think the artho. sx would help, to just tough it out and wait for the HR. I did, however, decide not to wait too long. I am also 46. These are some of the best years of our lives, and I did not want to waste them just sitting around in pain not able to do anything. I just had my HR done in June of this year, and I'm doing so well now, I'm thinking I should have had it done about 6 months to a year earlier.
 Hope this helps, my advice is to get as many Dr opinions as possible!!!  Good luck!  Lu

 PS. I too, had a steroid inject. in between the dx's and the final HR. It hurt a lot (although I did not have lingering pain as you are) and did not help AT ALL!  I will never do another in any other joint. Lu

[littleb]

Ed,

In my case I tore the labrum at work. It was so painful I thought I had stress fractured my hip. Worker's comp allowed me to go to my ortho who along with their own nurse new immediately from my symptoms what was wrong but I needed an MRI and they wanted me to have it done at their facility. Their people said they saw nothing. I won't go into the horrible experience I had with that. Anyway, my doctor didn't believe it and sent me to HSS for a second opinion. 5 months and another MRI and the damage was obvious. First we tried the shots and they did nothing for me so I had the arthroscopy. I had bone shaved as well as particles removed and it was noted that a big chunk of cartilage was gone. That's when THR and resurfacing were first mentioned. Recovery from the scoping was worse than what I have gone threw so far with resurfacing. It was never completely better but so much improved from where I was I was happy with the improvement.

I have a very physical job that involves standing 8 - 14 hours, lifting, twisting, stooping and reaching with weights up to 50 lbs common. I was on restrictions for the weight but the wear and tear was still going on. Some days the limping was back. In January of this year I was reaching up and pulling cases forward on a high shelf and herniated a disk in my back. From there it just seemed my hip went downhill and no improvement with the back either. (I did have the shot in my back and though the first one did not help, the second just before my resurfacing did. It's wearing off now so I may be trying another.) Dr. Kelly sent me to see Dr. Su which lead to the resurf.

I got about 2 years out of the scope at about 65% of where I was before any injury. Bursitis and IT issues were the biggest problems post op then.

[hipnhop]

Thanks all. Your stories inspire me. Things got worse today.  I was notified, as a result of recent lab work, I may have an infection in the hip joint. I must be the result of the Cortisone shot.  They want to do something called a Hip Aspiration followed by surgery to open the joint space and clean out the bacteria.  I must be honest. I am sick and crying.  How could a Cortisone shot cause all this mess?  They admitted me to hospital this am but i left because I feel they are moving too fast. I don't understand: Why do surgery, why not just do a HR? Why do Aspiration, just do Arthroscopy? However after what I read, arthroscopy does not seem to be a sure bet. 


Also  little b's comment about orthroscope recovery worse than HR recovery is scary. I would rather just do HR if they would allow it.
     

[John C]

As I mentioned in a prior post, I also had an injection that caused a lot of pain prior to my resurfacing. One of the concerns, which luckily was not true, was that there might be some infection from the injection. My resurfacing Doc made if very clear that if there was infection, and we went ahead with the resurfacing surgery while there was still any infection present, it could be a real disaster, since getting infection out of any artificial joint can be really tough, and in some cases involve weeks in the hospital, possibly replacing the prosthesis with spacers for weeks, and even then, it may not be successful.
From what I understand, you may not want to proceed with anything like a resurfacing until you are absolutely sure that all of the infection is gone.
On a positive note, one of the fellows (Spencer Roberts I think) on this site had a surgical infection in his resurfaced hip, and they were able to totally eradicate it with IV antibiotics, and no further surgery. You can do a search on this site and read about his experience. He has also been really good in the past about communicating directly with people.
Sincerely hope that your luck turns around soon on this.

[Pat Walter]

Hi Ed

You got a lot of good advice above.  The only thing I will say, again, is to choose several of the top resurfacing surgeons and send them your x-rays.  Let them give you good input to make a decision.  Ask them what they think will be the best solution.  I do know many people had arthoscopy and took a long time to heal and in the long run, still needed a hip replacement.  You can see the top surgeons on my list - those that have done a 1000 or more.  Many will give you a free consultation if you send them an email with a copy of your x-rays in a digital format - Dr. Gross of SC, Dr. De Smet of Belgium and a few others.  Do some more research and get more input so you can make good decisions.  http://www.surfacehippy.info/listofdoctors.php  ONly the top surgeons can tell you what they think is best - we are all patients and don't have that background to look at your x-rays and give you good recommendations.  You can read how well many patients did with resurfacing - but you need to make some decisions with good information from the top surgeons.

Pat

[littleb]

Ed,

Please go back and take care of the infection. I don't think any surgeon is going to do anything with an active infection. Also, the infection can get into your blood stream and then you will not only be sicker, you probably will be further away from any kind of relief with your hip. Whatever you choose later, Pat is right, get advice from the big guys. I am pretty sure they will all tell you to take care of this infection first then advise you on which surgery is right for you.

[hipnhop]

Third day post Arthroscopy surgery. Surgery went well. Doc said he saw little sign of an infection and sent me home with oral antibiotics. He will let me know the results of the biopsy and culture in a few days. The incredible pain has gone away I only have pain when I stand and put pressure on hip.

Going to make sure there is no infection then moving rapidly on hip resurfacing.

thanks to all

[emichel]

Hey ed etc. -- I don't have anything really intelligent to say, but I just wanted to say I am really sorry for all your troubles.  Hang in there, and keep us posted as to how you're doing.  I very much hope you are on the upswing! -- Eileen