Author Topic: Too Young for BHR?  (Read 1768 times)

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Too Young for BHR?
« on: July 13, 2012, 10:45:43 PM »
Hi everyone,

I am a 24 year old dealing with some pretty bad right hip pain.  I guess I should give the details of my story.

Back in college, I used to play a lot of basketball.  Was in the best shape of my life by jogging/playing basketball, and then one day playing flag football of all things I blew out my right hip.  When extending for a pass I felt this enormous pop in my right hip.  I hit the ground with horrible hip and groin pain, and was sore for an entire 2 weeks.  I never was the same -- tried getting back into hoops but never had the push, and my hip got stiff/sore/gave me sharp pains minutes into a game.  My internal rotation completely disappeared.

After 2 years of constant and worsening pain, and tired of my sports med talk telling me it was "just tendinitis", I finally saw a hip arthroscopy doc.  Turns out I had miserable FAI on my right hip, and the MRA showed a gigantic labral tear in the right hip (though good joint space on x-ray).  Had my right hip scoped in January 2011, and they did their best to recontour my hip joint (cam and pincer impingement), repair what was left of the poor labrum, and unfortunately had to microfracture a 7mmx7mm articular cartilage defect I had in my acetabulum.  Unfortunately, my post-op protocol was awful, as the doc/PT told me that for the 6 weeks on crutches I should essentially do nothing.  So I really had little to no movement (makes me think now obviously that post-op scar tissue is an issue).  My recovery from this surgery was awful.  Constant hip pain -- supertight hip flexors, persistent joint pain and this weird clicking/crunching in my joint that I did not have pre-surgery.  I got the tight musculature under control with ART/shockwave therapy -- that in fact made me feel good enough to try and get back into jogging after 8 months.  I'd feel pretty good while running, but the crunching and clicking pain in the joint never went away (regardless if I was in my running routine or not, the joint always crunches these days, and it's very painful).  Sitting in a chair is OK, but getting up is dreadful because I get that huge and painful crunch.  I stand a lot for my school/job, and anytime I move the leg after standing in one position for awhile, I get that awful pop.  While I may be able to do some jogging (with some admittedly awful stiffness/sharp pains later, basketball is completely out of the question, no way I could do it with this hip).  It's getting to the point where it's just depressing these days.  I'd obviously take a resolution of the pain/mechanical symptoms alone, but I'm 24 and want to get back into jogging and basketball.  It's really depressing to see all these other 24 year olds around me going for runs, shooting hoops, and just being active.  I feel 24 with the exception of my right hip, which I feel belongs in some 80 year old man.

Anyways, I've tried everything.  Like I said, shockwave therapy and ART does help with the surrounding soft tissues, but I think as long as the joint is screwed up, this stuff keeps recurring.  PT helps, but I've tried it all and I can't do the active things I want to do.  I even tried dextrose prolotherapy and bone marrow injections to the right hip (taken from my tibia -- with the "hope" that the mesenchymal stem cells would repair the defect, as the microfracture is originally intended to do) from the prolo expert (Dr. Ross Hauser), and after 5 sessions (4 of those bone marrow -- very expensive), I can safely say I'm no better.  I may still see if Dr. Hauser has anything up his sleeve (PRP, stem cells from fat, concentrating the bone marrow), but I'm beginning to think repeat arthroscopy to remove scar tissue/adhesions, or just jumping to a BHR.  I know I'm super young, so of course I'd like to avoid a replaced joint at this age but I'm starting to get frustrated, exhausting every other option.  Also, I'm in medical school at the moment (starting 1st year in August) so I can't really have an arthroscopy/resurfacing done until next summer when I get 6 weeks off.

I've looked on this forum, and have found a couple people near my age facing similar problems.  Is 24 too young to be getting a BHR?  If someone like me got a BHR and ran/played hoops a couple times a week, how long would that be anticipated to last?  If I had all the time in the world, I might be willing to try an arthroscopy next summer to see if removing scar tissue/adhesions could help, but I'm starting to think my pain is more related to a failed microfracture/lack of cartilage (and I really don't want to have go through all the pain of an arthroscopy again just to have it fail/do nothing/make matters worse).  To get a resurfacing, do docs require that all your cartilage essentially be depleted?  At the time of the scope, I only had that one bad defect, and the rest looked good, but I'm still in a lot of pain and just want to get back to an active life.  My x-rays still show normal joint space -- do docs not do BHRs on people like me then?  My MRIs showed more evidence of osteoarthritis.  Assuming I bypassed further scopes and wanted to get a BHR next summer, is 6 weeks enough time for me to recover enough so that I can go back to school after that?  I would want to have any scope/BHR done in the USA, and I gather that two of the best are Dr. Su in NYC and Dr. Gross in SC -- do they take e-mails?  I apologize for the length, but I feel like my early 20s passed and I wasn't able to do the active things I love doing -- and I don't want my later 20s to be more of the same.  Any help is greatly appreciated!  Thanks!



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Re: Too Young for BHR?
« Reply #1 on: July 14, 2012, 12:12:11 AM »
Hi Brian, youngest patient Mr Mcminn performed a BHR on was 13, also he doesn`t believe you have to be with no cartilage to operate. He does take emails that I know. As for the two excellent surgeons you mentioned am sure many on here who have seen them will be able to confirm whether they do too. Hernanu and Pat will definately know. Good luck, I was young too, so can empathise.
Bilateral BHR Dr McMinn 6Dec2011


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Re: Too Young for BHR?
« Reply #2 on: July 14, 2012, 02:28:16 AM »
Hay Brian, i was 28 when I had my BHR put in. It's not a matter of age per say more a matter of are you clinically ready? Only a surgeon can tell you that. If you want any help or anything pm me on here.
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
60mm cup 54mm head
Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England


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Re: Too Young for BHR?
« Reply #3 on: July 14, 2012, 08:01:19 AM »
Hi Brian, It might be a good idea to guage the opinion from several experts in HR. There are several you can email your xrays and story to, Gross and Su being two of them I think. Maybe have a private consultation with some. I think you really need to try and get a balanced honest opinion. From there you can think what was said, discuss it with folk on here which may help you decide what to do next.

Its a tough one and is not a simple decision but it has to come from you guided by experienced experts and with support from this site. All the best and keep in touch.
LBHR - 58mm ball, 64mm cup
7th June 2012 - Mr J P Holland - Newcastle


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Re: Too Young for BHR?
« Reply #4 on: August 15, 2012, 03:45:28 PM »
sounds like you have some mild OA and possibly some loose bodies in the joint
i would try a hip arthroscopy first to remove the loose bodies before committing myself to a resurfacing loosing bone stock and eventually requiring a revision. it sounds also like your post scope physio was lacking - perhaps see a different hip arthroscopist for consultation.

good luck



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Re: Too Young for BHR?
« Reply #5 on: August 18, 2012, 12:44:45 PM »
Get opinions from the experts like Gross, Su, etc...several of them will do free phone consults after you send them X-rays.  See what they say and also talk to the doctors who could re-scope your hip...if that is possible...what would the possible outcomes be..

I'd probably want to try something less serious than HR if I had an alternative....but I'd also want to ensure that these other surgeries wouldn't affect the potential success of an HR.  is there any chance that these additional scoping operations could make a future HR not an option or less likely to succeed?

If you ultimately decide to do an HR, and they tell you that you are a good candidate for one...it is like a miracle fix.  For me it was.  I was a bit oldr than you, 38, when I got mine...but I was probably on the younger end of the spectrum...but not as young as you. 

If you can wait...waiting is not a bad thing either.  It depends what you can still do and whether you can be happy in life with your current status.  I was in a fair amount of pain with limited activity from 26-38... Mine was a gradual degradation.... I had to quit certain sports at 26 because they Made my hip hurt too bad afterward...but I could do others...it wasn't until my mid 30s that I hit that 24/7 pain, couldn't do anything without pain,  and couldn't tie my shoes...even then I put it off a year or two out of fear of the surgery, nervousness, researching doctors, etc.  now that I had it done, I love it.  I adjusted to less and less mobility..until it got to a point that I couldn't take it anymore.

I don't do a ton of sports now...I don't want to overdo it...but I feel great.  I can run, jump, etc.  no pain.  If I run more than a half mile,I do feel discomfort.. So it's not "perfect"... But considering before surgery I could not ru AT ALL.. I limped everywhere.... Now,I could sprint full speed and haul ass for half mile before I felt a twitch of pain.. I am happy.

The upside of an HR at your age is it gives you back mobility and no pain...but you have to realistically assess the likelihood of ending up with a revision to a THR ... And then the big question is...when would the next revision be and what happens when you at 60. 70?  One of my concerns was how long my HR would last...and if it failed ... Would I be old enough that a THR would last long enough or would I be on one of those people with multiple revisions....which sounds like something to avoid... The multiple revisions sound like they are not really successful and never work as well work  as the first one.

But...you also have to consider your quality of life now.

Very tough decisions to make.  If you can wait...new devices or procedures could develop as well.

You will know when you can't wait anymore.  I put off surgery for prob longer than I should but I eventually got to a point where I knew I had to do it.  I couldn't tie my shoe..I was in pain all the time and my quality of life sucked.... When you get to that point... You just want relief from the current pain..and you worry less bout the what ifs and maybes lie down the road....

Sorry you are so young to be dealing with this.  Just be glad that at least there is a fix, albeit not a perfect one.  20-30 years ago, us hip people would be screwed...the stuff they can do now is amazing in comparison.

good luck.
Dr. Gross- Biomet uncemented, 2/23/11


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Re: Too Young for BHR?
« Reply #6 on: August 20, 2012, 09:52:17 PM »
Great advice on here so far. You're never too young to get your life back.
Dr. Gross did mine about 4 months ago, after sending file of film and a phone consult. First time I met him was day before surgery.

Just know that recovery is a pretty long road. Gross says no running till 6 months post op. But I keep reminding myself that I wasn't doing anything for last couple of years due to the pain and discomfort....but I'm already starting to cheat (jogged about one block during daily walks). Is it worth shutting down for a month or two, so that you can get back to your active lifestyle? That's the deciding factor.

I'd suggest you read up, do some research. Find a good doc you can work with (that insurance covers) and get on their schedule. I had to wait about 4 months once I committed. You will also hear that people travel to use the best surgeons. I was one of 5 Dr. Gross had done on my surgery day...and all were from out of state.

Good luck...feel free to ask questions and gather advice/info...jb

You will also hear....I wish I hadn't waited so long...from almost everyone on this site.


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