Should I go through with the surgery or wait and manage?

[mike1966]

I am a 45 year old male in Tasmania with OA due for BHR surgery in 8 days but I have the jitters and I am unsure if I should be having the surgery now or managing my condition.

I am a teacher and an active sportsman all my life. OA in my left hip has prevented me from doing the kicks in taekwondo (which I teach and from running)

I read your polls about how bad people were pre-op though and i noticed that only 13% can walk a mile without significant discomfort. I can do that fairly easily. I Just sat down from a 3 mile walk and I had only mild discomfort.

I cant run any great distance or kick or sit with my legs crossed but I can walk or cycle or kayak and ride my jet ski long distances with little pain and get through my day as a teacher with very little pain.

My motives for agreeing to the surgery was restoration of a very active lifestyle but most of those having surgery seem to be describing significantly more pain than I am in. My xray reports werent great and the surgeon and my GP seemed to think I needed the surgery but I have read counter arguments to hang onto your own hip as long as you can.

My question is this, have many members had surgery to restore high activity levels rather than pain relief for daily activities and how successful has it been in achieving those aims? Should I do it?

Many thanks for your help

Mike

[ZAP]

I'm having surgery in about 10 days and if I were you, I do it.  I waited and it only got worse.  You start to develop a bone growth.  I forgot the proper name  but its when the bone doesn't grow properly and starts to lose shape. It makes it harder for the surgery.  I know somebody right now that got turned down and has to get the bone shaved and smoothed out before having the surgery.  Some people gets so bad they can only do full hip replacement. Be careful.

[johnd_emd]

Let me just ask you this.  "What, like it's going to go away?"   I race bikes, hunt ducks (my passion), fish, stay active with my kids, coach, etc, etc.  If it hurts you so bad that you've already scheduled surgery, you know the answer.  I know it will be an pain in the butt for awhile, but you'll be glad you got it done and now can get on with things.  Wishing the best for you and your outcome.   But, get it done. 

[lori.36]

I was in a lot of pain prior to surgery, I waited for the perfect timing for my kids and family.  It also took me that long to want to sign up for the surgery and was probably using my family for an excuse.  You know when you need to go.  You could post pone and see what happens in the future with hips.  I would just have it checked every year to make sure that there are no cyst developing and make sure the pain is managable without NSAIDs everyday.
If you go into surgery, you want to know that you want whatever outcome happens.  All I asked the doc, is make sure I am alive when I wake up.  I prefer the BHR but if you need to do something else you are my man.  Just make sure I wake up to be with my kids.
Everything went flawlessly.  I even slept the night before surgery.  Best of luck making your decision on WHEN.

[mike1966]

Thanks for the advice. The surgeon and GP looked at my xrays and seemed to be sure the surgery was necessary but im just not in any real pain unless im doing impact activities. I have modified my lifestyle since the OA diagnosis and scheduling surgery to more non impact activities and i now have very little pain doing those. It has just left me really unsure about activity modification v surgery. I take a couple of paracetamol each day but thats it.

many thanks for the advice

[Woodstock Hippy]

My hips had been deteriating for two years when I decided this past June that it was time.  I could still work as a heavy construction carpenter, no probelm.  I could walk for miles.  Running was painful, I had lost all my strength on the bicycle and I couldn't kick in the pool.  My reason was to get my athletic life back.  By the time I had my surgery in November, walking had become very painful, standing for anytime was like my butt muscles were on fire and I couldn't make it through the day at work without holding on.

Right now, I'm retired from work, I can walk for hours, no more pain in the pool and strength is coming back slowly on the bike.  So far, I'm very happy with my outcome.

Only you can decide but it most likely will continue to deteriate and you can only manage it so much. Good Luck!

[dwbitt]

Mike,
I haven't heard anyone say they wish they had waited longer before surgery. The ability to stay active up to the date of your procedure has allowed you to stay fit, waiting for the pain to limit your activities will make the recovery more problematic.

Regard,
Dave

[obxpelican]

I would be a hypocrite if I told you not to wait as I was bone on bone end stage when I got operated on. 

Some people go down hill very quickly some can linger with OA for years, everyone is different. 

If you are missing doing things in life that you enjoy I would have it done.  In retrospect I wish I had mine done when it started hurting.

The good thing from OA of the hips, you're not going to die from this, not even if the OA gets worse.

Chuck

[hernanu]

We all went through this decision process. I was further along than you seem to be, so the question of having it done was easier for me. I guess it comes down to this - you made the decision to schedule your surgery for a reason. That was the agreement by your doctors that it was needed, your feelings about how you felt and the knowledge of what the disease is doing to your hip.

All the folks above and I reached our own decision, and we all respect yours. If you decide to put it off it's your call, but there are some facts that made my decision clear.

• The problem won't go away on its own. OA is progressive and gets worse.
• HR is effective and eliminates the OA.
• There are possible bad outcomes, but the odds are good for a positive outcome.
• The recovery time is comparatively quick ( I know someone who broke his ankle and was on crutches for quite a while longer than I was).
• the compromises you make will just grow from here, with its impact on the rest of your body. At first it's just not tying your shoes, in my case it got to hip dislocations and sleeping 2-3 hours per day.

These and more led me to the surgery, but like I said, the choice was more stark for me and easier in that way. I thought , if I have a chance to lead my life well again, I've gotta take it. The recuperation is not easy, but it is manageable and you hopefully see improvements all along.

Like Dave mentioned, no one afterwards says that they wished they had waited longer.

[mslendzion]

My surgeon told me you will know when you need to have it done.  If it starts to interfer with your life, it is probably time.  I was also advised the advantages of waiting, the HR may need to be replaced at some point so consider the pain and timing.  I'm finally starting to feel 'over the surgery' and it is amazing that the pain is gone.  I'm still  a bit sore from the surgery but I definitely see that I'll be having the first active summer in quite a while.  Being able to walk and sleep without pain is incredible. 

[Woodstock Hippy]

Another thing to think about; I'm having the most amazing recovery that I've heard of around here.  I think a large part of that, besides having a great surgeon and great PT and working so hard on my recovery is that I didn't let it go down to the bitter end before I had the surgery.  I got  it early and got it fixed before my muscles and tendons deteriorated from lack of use.


The one thing you hear over and over with HR patients is ''I only wish I did it sooner''

[lynne123]

Tough call!  Well, let's see what we know is fact.  It will deteriorate further. Your pain will increase. As it deteriorates you will continually have to cut back on day to day activities to alleviate pain. You currently have the coverage and appear to be in the financial situation to go ahead with the operation (could that change in the future)?  You can conceivably wait too long and push yourself out of being a candidate for hip resurfacing.  Here is an example.  I had pain in both hips, my right hip hurting far worse than my left.  About one to 1 1/2 years ago I had and MRI of both hips with my local surgeon. He saw the arthritis and one labral tear in my right hip and very minimal arthritis in my left hip and no labral tears.  I was in alot of pain sleeping and after dance classes.  There was no more sitting "Indian style" or straddle sit without having to crawl to the wall to get up.
Two months ago Dr. Su had MRI done of both my hips and my left hip had progressed way past my right and was bone on bone. Had I waited too much longer I could've waited myself right into a THR.  About two months before surgery I could walk three miles, walking was fine. By one month before surgery I could only walk one mile before pain set in.  It can deteriorate very quickly.

Good luck in your decision   

[PistolPete]

Mike, for me my hip deteriorated very quickly.  I started having mild pain but could do almost anything.  Then I noticed that I was losing flexibility and couldn't kick high anymore and couldn't do certain things.  I then noticed my right leg was almost 1" longer than my left.  Started with my PCP and he sent me to a chiropractor and wasted many months.  Things were getting worse almost by the day until I could no longer do much of anything.  I could no longer sleep at night and couldn't do Martial Arts anymore.  This was in about a year time span and I had my surgery almost 4 months ago.  That being said I no longer have any pain.  I'm back at training Martial Arts again going easy.  I walk without a limp and have normal gait. 

I too got the gitters right before my surgery.  The week before mine I got an ear infection and almost backed out of the surgery thinking I would be better off postponing it for a few months.  Thank god I didn't and that I got it over with as now I'm further along with my recovery.

[Two4One]

Hi Mike,

One day I was fine, and the next day I was confined to a hospital bed, circa Fall '09.  It can get that bad that fast.  While out walking my dog, both of my hips' femurs protruded almost through my acetabular sockets at the same time, even further than their already abnormal congenital position that I didn't know about, and they essentially crunched down to bone on bone, BOOM!  The bone on bone also sawed off both hips' labrums right at that moment as well.  I was unable to walk one step further, it took 20 minutes to cross the street in front of my house to get in the door, and I was sobbing uncontrollably.

In the week before, I felt great!  That week's activities were my usual: walking an hour daily, two one hour yoga sessions/day, cycling for a little under two hours 3x a week, doing plyometrics & 'getting air' over my aerobics board 2 to 3x/wk, heavy gardening about an hour everyday, daily housework, plus shopping and preparing three fresh meals from scratch everyday.

Bottom line, Mike: the better shape you are in and the more fit you are prior to resurfacing is directly linked to a faster and full recovery.  Waiting simply gives your OA more chances to stop the signals firing to your body's hip area, thus atrophying your muscles without you even realizing it until it's so obvious 'that even a caveman would have resurfacing! (*dumb joke referencing to Gieco's Caveman TV Ads*).

Good luck, Mike, and I hope my post helps you make the best decision for you.

'One

[hipnhop]

Mike, it will only get worse. I tried everything - even Tart Cherry Juice mixed with Monavi, meditation, special cushioned sneakers and a portable ice pack.  When you have the surgery it will only get better. Get it over while your young and adjust your performance to your new hip. 

[Anniee]

Lots of really good advice here!  Please don't wait too long!  I cannot remember a single person on this site wishing they had waited for the surgery, almost everyone wishes they had had it done sooner than they did, including me.  I am currently having to go to PT to learn to walk normally again, not because of what was done during the surgery, but because of what happened to my muscles and tendons while I was waiting to make the decision to go ahead with the surgery.  I did not have as much pain, and did not have the really bad ROM that many others had pre-surgery, but my joints were not functioning normally, I had just adapted.

Also, when I had my first resurfacing, my other hip was not hurting, although it looked bad on X-rays.  About 2 months later, it started hurting so badly that I was suddenly unable to walk for any length of time, use the elliptical trainer, etc. 

Nobody on this site would try to talk you into unnecessary surgery, it's just that we've all been there.  The joints will not get better by themselves.

[Jeremy76761]

OK. Here's my answer to this post.

Having not had a resurfacing, I might make myself unpopular by going against the grain. BUT, this is just my decision for my body.

I was diagnosed February 2011 at 36 years old with left hip OA. A year previously I started to have very mild groin pain just when training grappling/BJJ and getting into my car. From March 2011 I started to have much more pain walking/standing all the time because I let my left leg/glute atrophy to let some quadracepts tears heal.

After a couple of rounds of quality physical therapy, I can honestly say I am FAR better off than 11 months ago. However, the daily pain has never completely gone away. If I miss the right strengthening in the right combinations, I have pain just walking, standing in the shower, and milling about the house. However, if I strengthen properly I am pretty much fine for daily activity.

I still have a plan to get back to running even with this OA at least recreationally. I can do this because I trust my physical therapist.

I am NOT going for a hip resurfacing now for the following reasons:

1. The longer I wait, the better the chance of stem cell or cartilage repair treatment. Unlikely, but an opportunity worth maximazing.
2. The longer I wait, the better the stats on BHR longevity, the effects of various impacts, and ways to extend/protect longevity.
3. Waiting now pushes back the time a BHR of mine will ever (potentially) need revision, and thus gives more time for better post-BHR alternatives to develop.
4. I get to enjoy the fact that I have my own, natural God-given hip. Yes, it is generally deteriorating, and I'm not as able bodied as I was a couple years ago. But I'm in minimal pain most of the time and have good reason to expect I'll be able to get back to most sports, albeit with modifications, for years go come.
5. Waiting longer allows a greater span of time to benefit from medications in development that may slow the rate of enzyme production that limits fixation.
6. Vijay Bose just keeps getting better and better, more experienced and more experienced!
7. Any major invasive surgery in which my body is cut open for 5 hours has its risks. I'd rather not take those risks any sooner than necessary.
8. X-Rays and MRIs are excellent ways of monitoring the joint to ensure I don't wait too long.
9. More information about long term metal ions becomes available over time.
10. Synvisc, cortison, and medications... gotta buy a couple of years.
11. Global catastrophe and economic collapse look unlikely! BHRs aren't going anywhere!

So there you have it. My personal assumptions and why I choose to wait. Time is on my side.

Note: I'm fortunate in that I have been informed by several top surgeons my hip does not yet need resurfacing. Others might be in a different situation!

[mike1966]

I really appreciate all the time people have taken to reply to me. What really struct me were the comments that everyone who had it knew it was time. I have postponed. I know I will need the surgery and I will probably regret my decision but when I go in, I will be sure and im not sure at the moment. I cancelled yesterday and have spent all day today regretting it. Surgeon understood and just said to call when I was ready. Truth is, I dont like any of the options I dont want to live with OA and I dont want surgery! I do know I need to get my head sorted and be ready to do it.

Your wonderful support is very much appreciated

[ZAP]

"11. Global catastrophe and economic collapse look unlikely! BHRs aren't going anywhere!"   

 REALLY?     Are you American?  Did you buy gas lately?   You know the warmongers are at it again, trying to start a war with Iran and Syria.  The Dollar has lost 99% of its value over 99 years.   Greece is sucking all the life out of Europe.  The Fed wont stop printing money and inflating the dollar, I could go on and on, but that is one of the reasons why I'm getting the surgery as soon as possible. 

[Jeremy76761]

LOL!!!!!!!!!!!!

ZAP. You may be right!

No, I'm not American but in Europe gas prices have been a lot more than in North America for years. Hey, I'm glad now people are finally starting to think about real conservation, and not just a bit behind the 8-ball, but I digress.

Hopefully hip resurfacing gets made an even greater priority given the costs of gazillions of invalids off work. Especially as the Boomers come online.

It is an interesting question, though.