When's a good time to have Hip Resurfacing?

[Kiwi]

Hi,
I'm 42yrs old, have moderate arthritis in my left hip & mild in my right. I was extremely active prior to the pain limiting my sports (squash, diving) and exercise. I still play squash twice a week but only doubles with limited lunging and have not competed for 3 years due to not being able to train properly. I take pain killers to play & recover - mainly diclofenac & Codeine.
I'm very concerned with going under the knife as feel it might be a slippery slope but have been reading the stories on "surfacehippy" to inspire me. My main concerns are about shavings in blood stream, playing with my 3 young children & being able to play sport again. I have had advice to wait at least another year from my surgeon which I'm inclined to agree with. I've been living with the pain for about 6 years - but only badly for the 3 years. I have to take sleeping pills sometimes to get a good nights sleep - but really don't like taking them as find them addictive.
What made you decide to go ahead & how long ago was your op? Any regrets?
Thanks,
Simon
Wellington
New Zealand

[Anniee]

Hi Simon,

Do you know why your doctor wants you to wait another year?  Is he talking about resurfacing or total hip replacement?  If you have had bad pain for "only" 3 years, and sometimes have to sometimes take sleeping pills to sleep, is your arthritis really moderate?  

I can relate to what you are saying, because I was in the same situation for about 1 1/2 years before my surgery. My range of motion was getting pitiful, I hurt pretty much all the time, but the pain was especially bothersome when I was trying to go to sleep at night.  I was not properly diagnosed until I went to see Dr. Gross who told me I was bone on bone in both his (only my left one hurt a lot less at the time than my right one for some reason). I decided I had enough of pain and problems sleeping because of it, and I know it was only going to get worse, so I had my right hip resurfaced a little over 6 weeks ago, and it already feels a whole lot better than my left hip - better range of motion and no arthritis pain.  It probably helped that one of my coworkers, who is about 20 years younger than I am, and very active (aerobics instructor, competitive cyclist, etc.) had resurfacing 6 years ago by Dr. Gross, and she does everything she wants to do, including running now.  I have no regrets.

Can you get a second opinion from a different surgeon?  I don't know what type of system you have in New Zealand, but I do know several of the best doctors listed on this site will give you a free consultation if you send them your X-rays.

I wish you the best of luck!

[Lopsided]

I've been living with the pain for about 6 years - I take pain killers to play & recover - mainly diclofenac & Codeine. I have to take sleeping pills sometimes to get a good nights sleep

You do not need to live with pain. You should be able to live without medication.

I'm very concerned with going under the knife as feel it might be a slippery slope ... My main concerns are about shavings in blood stream

What slippery slope? What shavings in blood stream? Really make sure you get a good surgeon. If you have these concerns about any doctor, run (or limp) away and find a real surgeon.

playing with my 3 young children & being able to play sport again.

You will. Resurfacing gives you your life back.

I have had advice to wait at least another year from my surgeon which I'm inclined to agree with.

If you are taking the types of gear you list above, you really should consider getting done now.

Any regrets?

None.

I put off surgery as long as I could, and when I got resurfaced, I was told I had a cyst that needed to be filled with a bone graft. If I had left it another year, I might have limited the type of device I could get.

D.

[Kiwi]

Thanks for this - appreciate your feedback and happy to hear you have no regrets. He is Dr Hugh Blackley - based in Auckland [found via this website] and is probably the most experienced resurfacing surgeon in NZ. The local surgeon in Wellington had only done two resurfacing's when I last spoke with him, so I wanted someone more experienced.  

He [Dr Blackley] is talking resurfacing, the one year being based on [last years] Xrays and our conversation pre-Xmas was that I continue to do what I can physically and get more X-rays a year later. That has just happened and he's yet to receive the latest Xrays. I think the result of our conversation was that I could probably get at least another year out of my current hip without impacting the bone density for resurfacing option. I expect these Xrays will deliver some more up to date news - although pain does not always correlate to xrays.

Does your coworker have any noticable side effects - or is it as good as new 6 years down the track?

[hernanu]

Welcome to the site, Simon! Just the fact that you're here tells me you're getting to the point where you are making up your mind about this, it's a good step. Most of us took some time to reach the decision. You'll reach it the right way, just make sure you don't wait until you have to switch from resurf to another device.

One thing already suggested is to take a copy of your X-rays and send it to some of the surgeons that provide free consultation. This will add good information to what you need to consider; the best thing for you is to get the best advice possible.

As to shavings, I assume you mean the metal ion issues, which are individual metal ions, not large metal shavings. I think those have been talked about extensively here, and while they are a concern, it seems to be tied to making sure the surgeon does a good job of placing the components in the hip correctly. The percentages of bad outcomes are not huge, but you do need to consider them, which is why a good, experienced HR surgeon is important.

As to waiting, I guess the question that I finally asked myself was why? The recuperation period is comparatively short for any surgery (I was independently mobile by 3-4 weeks), and the results after 6-8 weeks are very good, after 6 months it is superlative for me as compared to before. So the question is - why suffer when you don't have to? Your body is taking punishment that it doesn't have to.

Regrets - none. The reverse, as a matter of fact: I am much more optimistic, can sleep through the night after waking up five or six times per night for five years. No more grinding pain, I am already more active athletically than I was on the two years prior to the surgeries. I ended up having my hip dislocating at will as I was walking, sleeping, etc. then having to periodically pop it back in. Don't let it get that far.

[Kiwi]

Thanks so much for all the encouraging feedback. It's great to hear from people and in particular anyone who's returned to physical sport. Like most - I feel I'm way too young for this but I know it won't beat me 

Are there any kiwi's out there that have been operated on Dr Hugh Blackley or recommend anyone else in NZ? From my understanding he's pretty experienced but I'll definitely get some references from people he's operated on.

Cheers for now and thanks again!

[23109VC]

I'm 38.  I had pain for almost 10 years, with about 2-3 where it was really bad.  I could still jog up intil the past few years....when I could no longer tie my shoe it really hit me how bad my hip had become.

I'm only three months post op and it is GREAT!  My pain is gone.  I used to take aleve at night to sleep, and no matter how I positioned myself, I could never really get comfortable...my hip was always throbbing.....  Now.......my hip is "quiet" and I fall asleep in peace.

I domt take pain killers.  I might take an aspirin here and there....but no pain meds or anti inflammatories.

I have ZERO regrets....fixing my hip was the best thing I've done for my health.I wish I had done it sooner.

I watched the YouTube videos of the surgery, was scared, and postponed it almost a year.  Having now been through the surgery....it really was nothing like I had imagined.  I was afraid of needles, pain, and all the what ifs..... The surgery was no big deal....I know it is a serious surgery...but honestly....it was not very scary, I felt no pain, and before I knew what happened it was over and I wad done.

When u feel like your life is affected to the point that you are unhappy...fix it.  Life is shirt and you don't have to live in pain.  Only you will know when the time is right.

Talk to more than one doctor and go to a good one!

[maxi]

im 50 and put up with constant pain for 2 yrs and built up quite a huge pain reliever resistance which led me to have to "get off the stuff".
i was on 60 mgs of oxycontin per day.  it didnt become obvious to me as to where the pain was directly coming from as i suffer with back probs as well, so that led me down the drug path. im happy to say im all free now thanks to my BHR. now 4 mnths out and getting happier every day. weaned off the meds under docs regime and alls good.  .

why i tell you this is to encourage you to have the operation, get your new bit, and try to wear it out  .....

you wont look back .....

my new hip is much more flexible and my ROM is great. although my 'good' hip is feeling a bit worse for wear  ... 

i walked 6 ks on the beach this morn (and it was a breakthrough day for me) and feel fine tonight here (aus) ..

go for it  . .   NOTHING TO LOSE .... MUCH TO GAIN  . .


you dont have to put up with pain anymore ... 

[lori.36]

It took me nearly a year after the diagonsis of OA endstage, before I signed up for surgery.  I was in pain for 4 years, but these were my baby making years also.  I swear for me a light went of in my head that I needed to do something and I needed to do it now.  These were my reasons:
Health insurance was changing, and my MOP was going up $1,000.
My Husband did not have a job, so I would have help at home.
I was done with having babies
Work would allow me to take off four weeks.
It was a no brainer for me, I knew the surgeon and the surgery that I wanted performed and the timing was perfect.  Dont rush, do it when you want to do it.
I am now at three weeks out and back to work part time.  My husband is going to start work tomorrow, I tell you insight or should I say, things have a way of working out if you let them.

[Tin Soldier]

When you have insurance, that's a good time to do it.  I'm 42 and I was in the saem situation with no pain killers, but not good sleeping and so and so forth like eveyrone else here.  I wouldn't wait around much.  Being able to walk with out pain, sleep most of the night,...my ROM is not back yet, but it's slowly getting better.  Otherwise, I'd just do it.

I'm so happy with HR, I'm going bakc for more in August .  DOn;t want to go through the surgery and early recovery part, but I have to if I want to fix my right hip. 

Also, I spent about 3 moths here before scheduling surgery last time and there's so much positive info and great stories, that it's hard not to wait to get it done.  If not ready, then spend more time here and try to get as much info as you can to support your decision.  Good luck.

[Anniee]

Does your coworker have any noticable side effects - or is it as good as new 6 years down the track?

The only side effect, if you want to call it that, she has is that the operated side is not quite as flexible as the unoperated side.  She demonstrated this to me the other day (after I showed her my latest PT instructions from Dr. Gross), by standing up in her office, putting her leg, with the knee bent approximately 90 degrees, up on the desk, and bringing her upper body down on top of the leg.  She could not get completely all the way down on the operated side.  Other than this so called problem, she can do everything she wants to, and the hip is as good as, if not better than when it was brand new.

[Kiwi]

You guys rock! I'm about to post my latest Xrays to Dr Blackley & ask him a few questions that I've found on this website. I want to know whether he has access to latest devices & references etc.
The insurance comment is very relevant - both hips require doing @ 20k (NZD) a pop and my work insurance covers it so lucky I survived our latest restructure!
Cheers
Simon

[Tin Soldier]

Just wait for the next restructure.  Sadly, here (US) it seems insurance coverage changes every year.  There is always some new way to get a little more money out of you.  That's just how it is.  My right hip is bad, but not as bad as the left was, but part of the reason I'm going in for #2 is because the deductible is done for me for the year.  I'm such a cheapskate that I'm thinking of getting a few more PSA tests, seeing a dermatologist for pre-cancer spot removal, getting that bony knob on my big toe removed, and a colonoscopy to top it of, all in the same deductible.   

Seriously, If a deductible is not horribly huge, then I'd say don't use that as a balancing factor on when you should do it, or if so, that should be a small part of the decision, not the main reason.

[Anniee]

Tin, I'm doing the same thing you are, partially because of the deductible.  The main reason is that I do not want my left hip to get as bad as my right one was before I get it fixed!  Almost annual "restructurings" (I guess that sounds better than lay-offs) where I work is another factor.  It's kind of sad - in an ideal world, the only consideration should be your health needs.

[Anniee]

Tin, I'm doing the same thing you are, partially because of the deductible.  The main reason is that I do not want my left hip to get as bad as my right one was before I get it fixed!  Almost annual "restructurings" (I guess that sounds better than lay-offs) where I work is another factor.  It's kind of sad - in an ideal world, the only consideration should be your health needs.

[ScubaDuck]

It is sad when we have to play around and wait for medical procedures because of deductible concerns.  On the other hand we (US) are lucky to not have to justify something like hip resurfacing in a country with socialized medicine. 

Although my girlfriend in Canada has had fairly good experiences she is now having to wait until October to get an MRI on what could be a torn rotator cuff.

Dan

[Anniee]

Dan,

That is ridiculous!! October is a really long time away!  If she does indeed have torn rotator cuff, she will be in pain for way too long.  I've been there with the rotator cuff issues.   This type of thing seems to be typical of countries with socialized medicine, so I guess those of us in the US with good insurance coverage are better off in spite of the deductible issues.  Those that don't have good insurance - not so much.  We need to get to some kind of happy medium everywhere.

[ScubaDuck]

Four months out for an MRI seems a bit much.  She has had pretty good results with the system up to this point.  She has been in pain for at least a year but the doctor kept saying it was just a pulled muscle.  It has gotten much worse so they finally did an ultrasound.  I guess they don't think it is a big deal.  I hope she can get an orthopedic doctor involved to speed things up.

Yes, there are definitely some things about the US system that are good and some that are bad.  There should be solution to health care that is more reasonable.

Dan

[Kiwi]

Response from Dr Hugh Blackley.... (note the websites he's recommened!). Looks like it's sooner rather than later!!

Dear Simon,
 
You will note from your x-ray report, and I agree, that there has been significant progression of your hip arthritis since your x-rays in May 2009 and May 2010.  You are now getting to the stage that there are significant changes, and if your hip is symptomatic you are probably best to consider hip resurfacing this year rather than to leave it until 2012, in which case there will be further bone stock damage and there is the possibility that you get to the stage where hip resurfacing is not a sensible option.
 
You can consider hip resurfacing rather like putting a crown on a tooth.  Dentists will tell you that it is better to crown the tooth early rather than late when there is more structural damage, and also the crown will tend to last longer when the structural support of the tooth is good.  If the decay is too much in the tooth then you need a tooth extraction and a whole new dental implant, which is rather like a total hip joint replacement. 
 
If you are considering hip resurfacing it is important to realise that this procedure is similar to a total hip joint replacement and at some stage the hip resurfacing will fail and you will need to be converted to a total hip joint replacement.  Generally the risk during surgery of fracturing requiring a total hip joint replacement is about 0.5% and another 0.5% risk over the first six months after surgery.  Then over time hip resurfacings can fail from loosening, late fracture and a rare condition where there is metal ion build up in the hip called metalosis.  Overall the success rate at 10 years is approximately 96-98% survivorship.  Hip resurfacing gives you good functional outcome while preserving bone for total hip joint replacement in the future.
 
Please find enclosed some websites at the bottom of this email that may be of benefit to you.  Please feel free to contact me directly if you have questions or concerns.
 
If you decide you wish to proceed with surgery, we will need to see you here up in Auckland for a pre-operative visit, and then once again when you come up for surgery.  Most people are quite comfortable flying back to Wellington approximately three days after surgery.
 
Kind regards.
Hugh Blackley
 
www.mcminncentre.co.uk
www.surfacehippy.info
www.hughblackley.co.nz

[Lori Cee]

Looks like it's sooner rather than later!!

How soon do you think that you might do it?