Slow Rehab Protocol for Dr. Gross patients

[mountaingoat]

I am interested in hearing from people who were on Dr. Gross' "slow protocol" b/c of bone density issues and how they fared long-term. How were you at 3 months? 6 months? One year post-op. Do you feel that the bone density issue has had any long-term inpact on the success of your resurfacing? Do you feel that all other things considered equal your implant has met your expectations?
 
If I choose to go with bilateral resurfacing I will need to be on the slow protocol b/c the bone density in my left hip is at Dr. Gross' exact cut-off for the slower protocol. My other hip is one point above. I am young (36) so I was quite surprised by this - have no idea why I have borderline osteopenia in both femoral necks but everywhere else is normal/above. I have an infant and being on crutches for 6 weeks with no lifting is going to be extremely challenging/near impossible so I am questioning whether to go through with this right now. I would also have to be 4 weeks on a cane after that. Its not that I don't respect Dr. Gross' decision to implement this protocol b/c I know that it has done alot to reduce his already-low number of fractures post-op but I just do not know if I can make it work with my own personal situation. I am also just concerned that I will not have as good a result as others.

Is there any reason to think that my resurfacing would be less successfull overall b/c of the osteopenia. Dr. Gross believes that after 6 months the risk of femoral neck fracture becomes the same for those with low bone density as it does for the general population so I would assume this means I should be able to return to whatever activity I like. I just do not want to do this surgery if it means that I am going to be forced to baby my hip forever. I'm in pain but I'm used to pain and I'd rather deal with it for a few more years than constantly worry that I am going to ruin my resurfacing b/c of my low bone density. That said, I am right on the border and likely should not have a huge issue.
 
Thanks for any insight/comments.

[Pat Walter]

Please remember since you are borderline now with your bone density, if you wait too long, you won't be able to have a hip resurfacing.  Perhaps that is not important to you.  If you miss the window of opportunity for resurfacing, you will have to have a THR.  Of course, then you won't have to worry about femur neck fractures. The problems with getting a THR so young is how many revisions you will need in the future.  The body just seems to eventually not continue to maintain the bone growth around hip devices.  Then when the devices or stem from the THR starts to slip, there is great pain and you need a revision. Each revisions becomes more diffiuclt since they have to use longer stems each time and place them deeper into your femur.

I just wanted to make sure you realize you can wait too long for a resurfacing. In fact, that is basically almost where you are now and that is what is causing the surgeons to be very conservative with your recovery.  You have many years ahead of you, so if you have to be slowed for for a few months, it is a small price to pay to be able to be active and out of pain with a resurfacing.  You will be able to do more with a better attitude and without pain meds with your baby if you get your hips fixed.  Most people with pain and problems don't realize how much of a toll it takes on their lives.  Other people see your pain and your overall outlook is affected by pain and limitations.

Pat
Good Luck.

Pat

[curt]

     Dr. Gross is obviously very concerned about bone density and neck fractures because they were one of  the very few causes of HR revisions in the past.  I had good bone density, but will take the Fosamax drug for 6 months anyway.  Why?  Because like Glucosamine, doesn't seem to hurt and might very well help.  He seems to follow the credo that rather than tell someone that they cannot have a resurfacing, figure out how to make it successful instead.  That goes for necrosis, cysts, density, dysplasia, placement, metal on metal the whole works.
     As the father of just turned 8 yr old twins, I can say there is no perfect time, but I could not wait any longer.  Two months of crutches and cane will allow you to regain all of your mobility and hopefully keep it for a very long time.  If your hips deteriorate more, which situation would impact your family more?  Keep asking the questions and you will get closer to the answer that fits you best.  Good luck, Curt

[mountaingoat]

Hi Pat,
 I definitely do not want a THR at my age. I just meant that since my OA is not nearly as bad as some people's I could still wait a bit longer as necessary. Ironically, I have low bone density but that doesn't seem to translate to advanced degeneration in my hips -  my right (bad) hip has moderate OA with extensive cartilage loss but does not even yet appear to be bone on bone but my left hip is only mildly arthritic. Dr. Gross said he would do the bilateral because he understood my predicament in terms of not wanting to go through a major recovery twice in a two year period especially with a baby. But Dr. Su did not even want to do the other hip. I of course would not want to miss the window of opportunity for resurfacing but I wasn't thinking I was at much of a risk of that but perhaps I am. I have no idea how much bone density decreases each year especially when one is my age and still premenopausal.

[Pat Walter]

Perhaps, that is a question you need to ask both Dr. Gross and Su.  How long can you wait if you feel you need to wait.  Only the surgeons have a real feel for how things deteriorate and it is different for everyone.  So they do x-rays to watch how things are progressing.

I know you have a diffiuclt decision and understand that. Please don't think I am trying to sway you either way, I am just trying to bring up things to think about.  I am much older and look at things differently than you would since you are 34.  Personally, if I were your Mom, I would tell you to worry more about yourself so you can be there for your baby later on without any restrictions.  6 weeks is a very short time period when compared to a lifetime, but it is diffiuclt to understand that when you are facing the 6 weeks or more.

Good Luck.

Pat

[curt]

     I imagine that there is some latitude in evaluating moderate, severe, mild OA, but I didn't go to medical school to find out.  Dr. Gross commented that while my non-operative hip was not the junk heap that my bad hip was, it had moderate OA and would need help in the next few years.  My decision to only get my right hip done was that my left hip had never HURT!  I certainly would like to have been economical as far as recovery and insurance copays go (20%), but I couldn't see having two major surgeries done, when physically I felt I only needed one...for now. 
    If in the next two years my "good" hip gets worse and I cannot sleep, walk, etc., then I'll get it done.  As nice as my hip resurfacing feels right now, I don't want to treat major surgery lightly and get something that I absolutely don't need yet.  I'd feel like a dumba** if something went wrong.  Every surgery has risks, and until the gains warrant it, I'm waiting.
    As Pat said, the questions I'd ask Dr. Gross would center around what the implications are to you for waiting.  Does your scan indicate that you cannot afford to wait on it?  An HR is most likely the better route than a THR, but mild OA seems to indicate that you can hold off for a pretty long while if your density is not an issue.  Just grousing on your behalf.  Curt

[Tin Soldier]

I, like Curt have 2 twins, but at age 14.  They can actually help out during recovery.  I do not think there is ever a perfect time with regards to children.  My concern as they got older, is that I would be missing the really active stuff, like riding bikes, unicycling, hiking, skiiing, and all the crazy stuff that we like to do as a family.  I indeed, have missed about 2 years worth of soccer, biking, and other things because of the hips.  Certainly, it would be rather tough if they were infants, because of lifting, chasing, cleaning,...but as Pat points out, it is a rather short period of time.  I don't know how Gross's low bone density restrictions differ form the usual restrictions, but most surgeons recommend a long period of time, 6 months to year before resuming any heavy types of impact to the hip like running, soccer, skiiing,... I didn't have time for that anyway, when the kids were little.  My preference would be to get it done sooner than later, at least the bad one.     

[Anniee]

I think everyone here understands your concerns and sympathizes with you. We also know that if you do wait too long, resurfacing may no longer be an option.  The decision to go ahead with surgery, and whether or not to have both hips done at the same time is never easy, even without the bone density and baby complications.   I would definitely discuss your situation again with Dr. Gross.  Since neither of your hips are bone on bone yet, perhaps you can wait for some time without giving up the chance of having resurfacing instead of THR.  Not being a doctor, I don't know if the low bone density would affect how quickly your joints might deteriorate.  Definitely is a question for the experts!

Sorry that this does not answer your question about Dr. Gross's slow recovery protocol.  Hopefully, there are some people on this site who can answer that question!

[bigblue]

I had my surgery 3 years ago and was on the slow protocol. I had my checkup in Aug. and everything was fine as it has been at every step. Dr. Gross is more conservative when it comes to bone density issues but I think it is better to err on the side of caution. My HR by Dr. Gross is one of the best decisions I have ever made.

[Josephine18]

I can very much relate to your story as I had my first hip resurfaced when I was 37 by Dr. Gross, and due to low bone density, I too had to face the six week slow protocol. I was supposed to have both of my hips done a few days apart, but I had to abandon that plan and return a year later to get my second hip done at 38.  I had exactly the same worries you expressed about the challenge of the six week slow protocol and the concern about the long term impact of my bone density on the success of the surgery.  I first have to say that looking back, I can't believe I was ever worried about the six week lay off of "normal" activities. At the six month stage, I felt so much relief that those six weeks were like a distant memory. Six weeks is nothing compared to the relief I experienced and hope to feel for the rest of my life.  It was not easy, and I had little help, but I planned ferociously before the surgery setting up my entire house to make it "slow protocol" friendly.  Everything that was high or low got switched to seated or standing level.  I got myself a rolling chair that could move up and down to zip around the kitchen as I prepared family meals (probably the best investment I made besides the new hippy hardware itself!).  I stockpiled groceries and got each room I would end up spending time in set up to accommodate my needs.  I spent weeks thinking through my daily routines and came up with ways that I would handle any situation that would arise.  The intense pre-planning made my life so much easier after the surgery. 

In regards to the bone density and the fear of having to baby your hip for the rest of your life, I was very concerned about this as well. I trusted Dr. Gross though and regard him as one of the best surgeons in the country, so I vowed to follow his protocol exactly, and of course, he was right.  When my precautions were lifted at the six month mark, I celebrated by going skiing.  At one year after my first surgery, my operated hip felt 100% normal, and I can remember thinking to myself that my hip had never felt stronger or more stable than it did at that point.  That feeling has persisted now over two years out of that first surgery and my other hip has followed exactly the same course.  I still though do take care of my hips.  I don't do anything crazy, but I am VERY active.  Nobody would ever guess that I have metal hips, and sometimes, even I forget until I pull my x-ray card from Dr. Gross, and think "how cool is this!"

[Boomer]

Josephine,

Great post for those of us awaiting our journey to the other side. Nice to see people getting their complete lives back.

Boomer

[mountaingoat]

Josephine,
 Sounds like we have had very similar situations. I was suprised that Dr. Gross was ok with doing both hips at the same time but I guess my scores were still just on the border of osteopenia so he wasn't too concerned. One of the main reasons why I am strongly considering bilateral is  because I don't want to have to go through this twice in a year or even two years especially with an infant. Since he restricts all his patients from lifting for the first 6 weeks it doesn't make all that much difference since I would have that restriction both times in terms of carrying my kid so I guess part of me thinks I should just get it over with in one surgery.

I am so glad to hear that you haven't had to worry about babying your hips. I asked Dr. Gross' staff about this and they said that after 6 months all my restrictions would be removed and I wouldn't need to worry about anything anymore than anyone else so I guess this is good.

Six weeks is going to be a long long time for me with a 9- month old baby. If it weren't for that I know I'd be able to manage it a lot better. But as others have said, there is really no good time to have surgery when you have kids.

When you say you are very active, what kinds of things are you doing? Do you run? Sounds like skiing has been ok on your hips which is great.

Amy