I Think I Have Changed My Mind

[emichel]

Hi all -- In spite of my previous post about deciding on THR instead of resurfacing, now I am thinking otherwise.  It is true I am in a higher risk group, being a female with an estimated quite small component size.  Even with the best surgeons, it is just factual that this means there is a higher risk of complications.  What had made me lean towards THR is my passion for karate, and desire to test for my black belt a year from March.  We only have one chance a year to do this, and I have been training hard for nearly 5 years already (in addition to past training).  Since I need to have both hips done, my thinking was that if I went with replacement it would be much more of a sure thing, and Dr. Pritchett made it sound like with a large ball MOM replacement I would be able to do most of what I want to do with karate.  Both hips are limiting, so I just wanted to do both in quick succession, (he won't do them simultaneously), then get on with my training and my life.  I felt that with resurfacing, if I had one, then the other, then one of them went wrong within a year or so, right before the black belt test, I would be just devastated.  Two surgeries within a short time is challenging enough, but I did not feel that I could handle three.  Now I am thinking... I should do resurfacing on one side and wait a while, see how it goes, and if it ends up being successful after a while, do the second side later.  I am thinking I might be able to get through the black belt test in March 2012 (which is actually for a provisional black belt, I will still need to test for another one no sooner than a year after that), even with the other hip being kind of messed up, then doing that one, then test for my full black belt.  At least that is my latest thinking.  It sure is a challenge figuring this all out, and I sure wish I had a crystal ball to see how it was all going to turn out.

[Lopsided]

Eileen,

I am pleased for your passion for your sport but cannot understand why your desire to excel is more important than two hips. I believe you should continue with your sport but realize that there are more important things in life, family and long term health.

If you are going to have both your hips done, with any procedure, total or resurfacing, it will take a year for a full recovery. And in the meantime, you might well discover that other parts of your body are beginning to wear out too. You are not thirty years younger!

I am really pleased with my recent resurfacing and would love to return to competitive sport. But that is gone. I revel in my family and my work and I stay healthy. I am currently considering what sport I should do that is not excessive.

I do hope that resurfacing is a better alternative for you, and that with it you continue your karate, with real perspective.

D.

[littleb]

This is a tough thing to decide. I'm at 10 weeks with a size 44. So far so good. Just a lot of muscle work and learning to walk correctly again. I plan on taking it extra careful through the first year. I have the rest of my life to go crazy. I'm already horsing around on the floor with my 3 year old grandson, something I'd lost due to the pain in my hip before surgery. At 6 weeks I danced at the wedding of one of daughters and not just the slow ones. I've already met 2 of my goals in having the resurf over THR, I can wait till next summer to start running and hiking. Oh, skipping and hopscotch too.

[emichel]

The thing is... Karate ismy life!  It probably sounds crazy to anyone who's not into it.  I just wanted to write a short post here... if all goes well, I would not plan to get back to hard training until at least 6 months, hopefully by no more than 9 months to a year.  There is a lot of mental stuff (we have to take a written test, too) I could work on for the BB test, and upper body stuff, and visualization.  I feel that having this as a goal will help me with my rehab.  How it all turns out remains to be seen, but it seems better to have a crazy goal like this than to become a couch potato!  :-) -- Eileen

[John C]

Hi emichel,
Firstly, I do understand where you are coming from. There was a time in my life when I trained in Karate at least five days a week, for many, many years. I even spent periods when I lived in the dojo, and did nothing but train for months on end. I did receive my Black Belt back in about 1976. By about 1983, I had to give up Karate because of my bad hip.
Though I strongly believe that you must do your own research, I will share with you some of my impressions that might be relevant. I think that the large ball THR that Dr Pritchett is offering could take care of your Karate needs, in terms of flexibility and avoiding dislocation issues, about as well as a resurfacing. However, if you are planning on putting much impact into those hips, such as kicking a heavy bag, you might want to ask some serious questions about how much impact the THR can take. Most doctors are more concerned with impacts when a THR is involved relative to a resurfacing, and some will advise strongly against it. If you are going to be involved mostly in kata and light contact sparring, a THR might be fine, but take into your considerations how much hard impact you expect your hips to take, and weigh that against your risk category for resurfacing.
I had to give up Karate because of my hip 30 years ago. Though there are many success stories of people getting back into high level Karate after resurfacing, I can say that at two years post surgery (and going on 60 years of age), my resurfaced hip would have trouble getting back into high level Karate. Luckily I have many other passions such as Tai Chi, skiing, surfing, windsurfing, and tennis that keep me from becoming that couch potato.
Your decision is not an easy one. Do your research thoroughly, and good luck.

[Pat Walter]

Hi Eileen

Many people with THRs require revisions too.  The rate is a a little less than resurfacing at this point.  If you look at the national registries, you can see the revision rates.  THRs are not a guarantee of never having surgery again.  Too many doctors don't mention that. http://www.surfacehippy.info/nationalregistries.php

You still might want to talk to several other surgeons like Dr. De Smet who does both hips at one time and Dr. Su who does a lot of bilaterals  http://www.surfacehippy.info/hipstories.php#Dr._Su_Hip_Stories_

This is one of the most important decisions in your life and being a small woman, I would only want the absolute top surgeons doing my hip.  Most of us had to travel to get our resurfacings since few surgeons are that expeirnced.  You can email Dr. De Smet and send a copy of your x-rays, he will answer all questions.  He has done way over 3000 resurfacings.  I am not sure if Dr. Rogerson of WI does both at one time.  Only a few surgeons will do both.  They need to be very expeirnced so you are not laying on the operating table too long.  De Smet is very quick and feels there is no problem doing both at one time.  Many insurance companies will now cover his surgery.  I ended up just putting it on my credit cards since I was an older woman and wanted on of the best in the world to do mine.

Please keep in touch.  Dr. Bose of India also does a large number of athletes.  He will also give you a free email consultation.  Dr. Gross will too.

Good Luck.  Think all this thru carefully. Then listen to your inner voice - you will know what is best for you.

Pat

[edfskins]

Hi Eileen,

Today I drive from Yakima to Seattle for my two week check up with Dr. Pritchett.  I'm a 46 year old PE teacher and did extensive research before deciding on hip resurfacing.  Dr. Pritchett is not going to make the decision for you or guarantee you THR or BHR will work for sure.  I realize you're slight and that you're in a slightly higher risk category for femoral neck fracture, but I truly believe that you should go with a BHR; two of them in your case.  With your activity level and age, a THR won't last you and you'll almost certainly be looking at a revision down the road.  That means a longer stem, more loss of femoral bone and diminishing options if the revision were to fail.  Save your bone, go with the BHR and delay your athletic goals if necessary. 

[fenceman]

Elieen,
I want to second what John C posted.  I was into high level Chinese Martial Arts but had to slow down due to a BHR at 44.  I'm 46 now and still practicing but not doing any spinning flying crescent kicks or things like that.  I could probably work back into them but not sure I want to at this point in my life.  I am afraid that the pounding and stress on the rest of my joints will put me back in the same position in my 50's.  Karate is a great thing but I recommend not overdoing to save your body in case you reach the age of 65.  I also wouldn't recommend hard training until 1 year.  You could practice many of the katas that are ground based (no jumping or kicking) before that time.  I did a lot of Tai Chi.

Good luck with your decision.
Bill

[emichel]

Hi JohnC and fenceman/Bill -- Nice to hear from other martial artists on here.  Thanks to everyone for your responses.  One thing is for sure, whatever operation(s) I get, I am not interested in messing it up!  I do not see any hard slamming falls to the floor or heavy bag work in my future -- not that I even do much of that now.  I will be very happy if I can some day to some kata, basics (with easy, low kicks until well healed), light point sparring and drills, also after well healed and with trusted classmates, and teaching, with increased flexibility and less pain.  I plan to take it very easy at first, listen to my body, and go as slow as is needed.  I think they will cut me some slack on the BB tests, due to my advanced age,  and I don't think I'll be foolish enough to push it too far, after going through all this!!!...  Eileen

[BerkeleyGirl]

Isn't the greater risk to smaller-framed people (usually women) that there is greater metal edge wear due to the size of the device? And thus there's a greater potential for metal ion reactions in the soft tissue in the hips, which could cause a serious problem for a later revision? I had been told that was much more the issue than femoral fracture.

[emichel]

Yes.  Please see Dr. Pritchett's latest article on his website, "Metallosis of the Resurfaced Hip".  Very interesting. 

[Pat Walter]

If you use the very expeirnced surgeons that will determine if you are a good candidate, you resurfacing device will have no more edge loading because it will be installed at the correct angle.  The experinced surgeon's know who is the best candidate and it is not based on your actual x-ray, physical size and activity level.  Some surgeons like Dr. Bose of India do a large amount of small women in India.  He actually used the ASR half the time and so far has a very good record.  So much of the problem is in the hands of the surgeon. 

If you use one of the top surgeons, I would not spend my time worrying about your size.  I would accept their opinon and move forward.

There are many, many problems with THRs.  MOM THRs are the same metal as a resurfacing.  It takes skill to place them properly, too.  In all cases, it is so important to use a really expeirnced surgeon.

It is alway very wise to be conservative during your recovery.  You will begin to be very active at 6 months, but complete healing takes 1 year. There is no way the mind will control the body for quick healing.  A positive attitude helps, but it is a fact that healing takes time.

You have the rest of your life to do your sport or activity, if you push too soon, you could face a revision that will slow your progress down.  Even with a THR - you have to let your body heal.  You have been given a complete life to live, hopefully, so you just have to take time away from your sports for a short time and let your body heal.  If not, you are going to be a very sad person going thru revisions.   Patience is very important - as important as your athletic skills.  If you have the ability to train and become very skilled - you have the ability to use your brain and let your hip heal before you compete again.

Pat