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Author Topic: Bone density woes  (Read 1239 times)

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Bone density woes
« on: November 02, 2011, 08:15:31 PM »
Hi everyone,
 I posted here a few weeks ago about my plan for bilateral surgery later this winter. I still had not made up my mind whether I was going to go with Dr. Su or Gross but recently there has been another wrinkle in this whole ordeal. As part of the standard pre-op testing for bilats I had to do the DEXA scan. I was quite surprised to learn that my bone density in my femoral necks only (spine and wrists were  normal) was slightly osteopenic. I am not sure whether this is the result of repeated cortisone shots over the years, the removal of FAI lesions in prior arthroscopic surgeries or reduced impact activity in the last few years - regardless, I was pretty shocked as I am only 36. 

At first I was not sure I would even be a candidate for bilateral but Dr. Gross advised that I could still do the bilateral because one of my hips was above his cut-off number and the other was exactly at the cut-off. However, should I determine to do the bilateral I will need to be on crutches for 6 weeks with modified weight-bearing (what they call the 4-point step) so that I am not putting all my weight down each time I walk. I will also have the standard lifting/bending restrictions for 6 weeks and then will need a cane on my left side for 4 weeks following. SO, it will be 10 weeks of very slow recovery. After 3 months the risk of femoral neck fracture for those with lower bone density begins to decrease and becomes about the same as those with normal bone density.

I also spoke with Dr. Su's office as to how they would approach the osteopenia issue and they indicated they did not think my scores were that much of an issue and it was likely that I would be just 3 weeks on crutches, no lifting of more than 20lbs for a month. But, Dr. Su did not want to do bilateral with me from the beginning - he thinks I should wait on my left hip even if only another year because I am still so young to have both done and the damage in the left is not as bad.

I am really torn as to what I am going to do. I have a 6-month old baby and being on crutches for 6 weeks with no lifting and then a cane for another 4 is going to be a colossal pain in the ass for everyone involved. We have a nanny and I have plenty of family support but all the same it is going to be hugely difficult both logistically and emotionally for me. My husband wants to me to just get it over with and do both hips at once because he does not want to deal with another recovery in another year or so.  I tend to agree but I'm also having major questions about whether bilateral is the right thing to do for me.

Ironically, the hip that is worse has better bone density so if I just do that hip I will have the standard 1-2 weeks on crutches and no lifting for 6 weeks then done. If I then do the other hip a year from now I'll still be facing the modified recovery protocol of 6 weeks on crutches with 10% weight-bearing unless somehow I am able to get my bone density in that hip up by one point - which is a complete shot in the dark. So, in most ways bilateral makes more sense in that I'll just be sucking up a major inconvenience for 2+ months and then be done. But, I've still got a lot of fear around bilateral.

My fear is that I am so young and once I do both hips there is no going back. Its such an enormous leap of faith that I am having trouble committing to it. I know that I HAVE to get the right hip done this winter b/c it is so bad that I don't have a choice and really cannot wait much longer. But with the other hip I could conceivably wait a little while longer - it will just mean that I won't get back to all the activities I want to be doing because the other hip is still bad enough that I will be limited to some extent. I think its the permanency at such a young age that scares the shit out of me.  :-[ I mean, I don't get a "do over". When I review other stories of bilats I just feel like I am sooooo much younger than the vast vast majority of those who've had both hips done and it really makes me question my decision.  I know that if I did go through the bilateral and somehow was that unlucky soul to have a femoral neck fracture from my low bone density, I'd never ever get over it and would second guess myself for years to come!



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Re: Bone density woes
« Reply #1 on: November 02, 2011, 09:27:39 PM »

You actually have a good problem, especially if your insurance company will cover either surgeon.  You have the option of 2 VERY good surgeons to do your hips, you really cannot go wrong either way you choose. 

I would pick whichever option seems right for your family.  Dr. Su and Dr. Gross were very high on my short list, I chose Dr. Gross because I love the Carolinas and I am not a city person, but we also have a number of Dr. Su patients who have had very good results.


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Re: Bone density woes
« Reply #2 on: November 02, 2011, 10:21:16 PM »
I had wondered about the density issue also, particularly as it pertains to the weight bearing after the surgery.  Don't know if many (or any) of the members on this site did all-at-once bilats with the low bone density issue hanging over their head or not, but I would think that recovery would be soooo much easier if you can use a non-operative leg to carry your weight.  Certainly a tough call with your lifestyle and family burdens, because the recovery takes a little time and requires a degree of caution.  I would trust either of your surgeons to give you great advice in either case.  Best of luck and keep us posted!  Curt
51 yr, RHBiomet, Dr. Gross, 9/30/11
happy, hopeful, hip-full

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Re: Bone density woes
« Reply #3 on: November 02, 2011, 10:21:55 PM »
Hi Amy

I am sorry to hear that you will have a bit of a slow recovery, but it is never bad to be really conservative after a resurfacing or even a THR.  No one wants a revision.  I know you have a young child, but if you don't get your hips done right and take time to heal properly - that baby won't have an active Mom and that would be very sad.  This is a time in your life when you are going to "put yourself first"   You have to if you want a successful surgery on one or both hips.  You will need to get help from parents, family, friends, church, social groups.  You will have to do some research to find yourself some help if the nanny is not enough.  After you get that solved, then you won't be so worried about your slow recovery.  The slow recovery is for a positive outcome for both you and your baby.

Your husband will have to understand that this is very important and he will have to take an active part and not just wish you would get it over with.  He needs to be supportive of either solution you choose.  If you are having problems, then you should talk to a consular and get some emotional support.  Then explain that you only have 2 hips and you need to make the decision that is correct for you - not your husband.  I am sorry, but you are young and you need to get your hips done properly for a life long solution. 

Both surgeons are great and that is something you will need to make up your mind about.  You need to feel that you selected the surgeon that you feel most comfortable with.  It should not be based on the recovery because no matter which way you go - you are going to have to be very conservative.  You want to go with the surgeon that your "inner self" feels comfortable with.  You need to feel comfortable, not your husband.  He is there to support you at this time of your life facing major surgery.

Take time and talk it all over with your husband, family and outside consular if required.  You have to be emotionally calm and positive before you make your decision and go forward.  Take time to think and take a deep breath.  You will make the right decision and will get support.

Good Luck.

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Re: Bone density woes
« Reply #4 on: November 03, 2011, 02:06:53 PM »
Amy, very good advice from everyone.

In my case, both of my hips looked equally bad on X-rays, but my right one was hurting much more than the left one. No bone density issues.  I had my right one resurfaced last April, and the left one a few weeks ago, in October.  In the 6 months between the surgeries, my left hip started hurting really bad, and I got to the point that I could barely walk for the last few weeks before my surgery.  At that point, there were many times I wished I had bitten the bullet and had both of them done last April, even though the recovery would have been a little longer. 

You are young, but there are many on this site who were younger than you are when they had the surgery.  Your hips will not get better by themselves, so there really are no alternatives, other than wait and stay in pain or have surgery.  It is a scary decision, but most everyone here who have already made the decision and had the surgery says they wish they had done it long before they actually did.  Now, when I can walk with no pain in either hip, it is absolute heaven.  The relief is enormous.  And I do wish I had not waited as long as I did!  And the end result was definitely worth it, even though I had two recoveries to deal with.  The recovery time, whether you have one side done at a time, or both at the same time, is only a short period in your life and then you will have no more hip pain!

Whichever way you decide to go, I wish you the very best of luck!  You have consulted two excellent surgeons, and I'm sure you will have a great result.
Annie/ Right Uncemented Biomet 4-20-11/Left Uncemented Biomet 10-12-11/Dr. Gross


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Re: Bone density woes
« Reply #5 on: November 04, 2011, 03:14:10 PM »

This is a really hard decision.  I would say do them both now, while your little one is not walking or running around.  It will be a PIA for everyone, but she will not remember, because she is so young.  I think with a Nanny you will have help with the baby, and she can bring the baby to you and you can hold her, while you are sitting.  Surprising, I had a lot of cuddle time while I was healing after my surgery, which was good medicine. 
In regards to the one shot chance, that is true, but you have to look at the statistics and they show very promising for someone of our age.  I think with Dr Gross you would be in good hands, I think I would go with him, because I would want cementless.  Seems to make sense to me, but I was not willing to travel for that reason alone.  If you go to Dr Gross, how long would you stay in the Carolinia's?  I would recommend staying for at least two weeks and renting a house for you and the family and team of care givers.  Try to make it a vacation for all that are in play, even you.  Think when you are in the hospital you will be able to sleep all night long and only wake up when you wake up.   :)  Yep I kinda liked the hospital.   ;D
best of luck with your decision, nice to see you on this group.  They have really helped me.
L-BHR 5-11-2011 Dr Rector
R-HR 9-11-2015 Dr Gross


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Re: Bone density woes
« Reply #6 on: November 04, 2011, 09:38:58 PM »
Hi Lori,
Thanks for your response. Yes, It is a super hard decision and I figured I should get in touch with you again about the whole issue of managing a small child with this surgery. I think your youngest was around 18 months when you had the surgery, right? Under normal circumstances, this whole thing wouldn't be that big of a deal because I would be off crutches in 2 weeks and all the other restrictions would be lifted at 6 weeks. I don't think Dr. Rector has the same lifting/bending/90 degree rule that Dr. Gross has so maybe that wasn't an issue for you in terms of carrying your toddler.
The issue is now that because of this bone density problem I am looking at such a long, slow recovery with even more restrictions that I don't know if I can do it.  I have help - that isn't so much the issue. I just don't know if I can mentally take this on right now - it just seems so monumentally overwhelming to think of myself on crutches for 6 weeks, followed by a cane for a month, with no walking or driving allowed and not being able to carry my baby. I have such a massive fear of being immobilized b/c of the prior surgeries I've had where I have been laid up for so long with so much pain. I feel like over the last few months I've been mentally preparing myself for the surgery and was able to just accept that it was going to be tough for the first month and then things would be better...and now I am looking at essentially 2.5 months of things being really challenging for me and my family and I just don't know how I can get my head around it. And the most maddening part is it is all over one DEXA scan point - literally - if my left hip were ONE POINT higher than I wouldn't have to go through all this!

I guess that because I will have the lifting/bending restrictions for 6 weeks regardless of whether I do the bilateral or not it makes sense to do them both at the same time and get it over with. Another point in favor of doing both is that if I do want to get pregnant again at some point I will need to wait probably 18 mos - 2 years for the metal ion levels to go down so doing both ensures that I won't have to go through the waiting period twice...and I might be young for resurfacing but I'm certainly not that young overall>  :-\

But, I'm still just so uncertain as to whether I shouldn't just wait it out on the better hip and see how things go. It just seems like such a massive undertaking in the first year of having a baby that I do not know if I should be having a lobotomy instead of hip surger!  :P


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