Too young for a THR?

[Anna]

So, ive been thinking a little (not too much though, it hurts my brain)

Im 29. Im hoping to have a THR at some point in the near future. All I ever hear from surgeons and people in the medical profession is 'your too young to have a THR. You need to wait as long as possible'. In my eyes, im too young to waste my life away. Im too young to be in pain every day and im too young to not be able to do all the things I want to and should be able to do.

What I would like to know is ... why exactly am I too young? Does the fear of the operation going wrong come into play at all? One surgeon told me that you can only have so many revisions and that a revision is never as good as the first. If every THR I get lasts say 20 years then im looking at revisions at the ages of 50, 70, 90 ... 110, 130 ... ok, perhaps not. I may not even make it to 50. Id probably only be looking at 1 or 2 revisions. How many THR's can one person have in a lifetime? Whats possible? Do they even know? If I have one now then am I looking at a significantly less active life when I hit 50? Is revision surgery from a THR to another THR really that complicated and does it create significant risks?? I can see some bonuses for you BHR guys and saving that bone.

In all honesty, I want my life back now as I could die tomorrow. Id be a bit peed off if I hobbled around in pain for the next 5 - 10 years only to turn up at those pearly gates at the age of 40. Plus, come 20 years time, perhaps technology will have moved on and revsions will not be an issue? Any knowledge or thoughts?

Anna   

... and just an after thought, could you imagine if hip replacements didnt exist. Thats just not even worth thinking about. We hippys are, I believe very lucky we have options ... even if they are slightly scarey.

[Mike D]

Anna-
I'm 50 and that comment from people about age and having a THR is the most common thing I hear when they find out what I've had done, I got it today-again.
It used to be ' What's wrong with your leg, you're limping a bit arn't you?'
Now it's ' What, a hip replacement? Thats for old people isn't it?
It amuses me as I wouldn't dream of saying that to someone but thats the view people have.
I saw it like that up to last year, when like you, my life was being taken over with OA-and thats the bit they don't get. As you say, you need your life back now, at 29.
Not hanging around for years delaying surgery based on the lifetime of of the hip joint that you get.
Who knows what advances there will be in revision surgery in 25 years?
I'd have definately taken a resurfacing if it were possible but like you, my poorly bones needed immediate attention and I took the best option available to me.
You're on course for the same.
 Mr Treacy told me it takes most people 1 year to mentally accept that they have a hip replacement,
and I think there's a huge acceptance required beforehand of what we need well before the surgery.
In the lead up to my THR, I could go from being ecstatic about it to absolutely dreading it within hours and I don't think I'm alone there.
At 7 weeks post op, I'm enjoying pain free recovery and wouldn't change a thing.
Keep focused on the pain free future and all the things you will be doing again, try not to dwell on any negatives-it worked for me!

[hernanu]

Anna, one thing I see in all of your posts is your love of life. That type of vibrancy and happy lack of dourness is a refreshing and invigorating pool of happiness in you.

I think all hippies to some degree are wells of hope, striding on despite the harsh turn we've been dealt. There are few people who are not hippies who understand the battle we've fought and are fighting still. The lovely thing is to see those we love and who love us try to help and be what we need in our struggle and recovery.

The rest of the people won't understand, they see us young and can't see beyond that to where this is an affliction like any other. Someone who wouldn't dream of saying the same about a handicapped person seems to have no issue with remonstrating with someone who has arthritis. In some respects, it is accepted to be so cavalier with it since we don't bear our wounds externally and they have no concept of the pain involved.

So in my pain, I grew to trust those people who understand or who try to understand. The rest of the people, including old and trusted friends who just don't get it I put on a shelf until my struggle is over. I cut them some slack, they are not capable, so they need time out, living on my shelf until I get to a point where they can be friends, although I do remember their lack of capability.

Take your opportunity for life. I've never understood waiting in increasing pain for some future time when you can minimize the number of revisions. Life is meant to be lived in its full measure, not in some limbo of pain. Like ruby mentioned in another thread, trust in your surgeon, keep up your spirits and in due time (wishing a quick turnaround for you) you'll be fixed and listening to us boring you with calls for patience  . Until then, my heart does go out to you, but I know you'll fight to a good conclusion.

We all could go tomorrow, or we could last much past our expected expiration date. The great part about being human is the lack of that knowledge - you're right, why not make it as happy and beautiful as possible?

Let the Anna awesomeness continue.

[Dannywayoflife]

Anna try not to think about how long it might last and think that once done you will be pain free again! You might end up with one of the THR's that last over 40 years! Look at that lady who mr McMinn has on his website! She was even younger than both of us and her THR is and I quote "as good now as the day it was put in!" live for now not for 20 years time.
I still worry that I will need multiple revisions in my life time but I will cross that bridge when I come to it! For now I'm just happy that I'm on the mend and will be able to do the things I love again.
Danny xx

[Anna]

Hey, thanks guys.

Im glad you all agree with me! Most of my friends and family tell me I should get it done asap as they 'want Anna back' but its the professionals, the surgeons, the physios, the ones who know all about OA, who all say wait. I just dont understand it which is why I was wondering whether a revision is a greater deal that what I believe it to be.

Mike - I was walking down the river in York a few months back and a guy actually stopped and asked me if I was ok and whether I needed an ambulance. I tried hard not to laugh at him but it made me realise how much I probably limp without even realising it and perhaps how much ive got used to the pain. People ask me all the time now ... and when I tell them I need a THR they just laugh and think im joking. I also go from being 100% positive I need this, to being absolutely terrified and talking myself out of it. Im not gonna back down now though.

Hern - As always, you are right and thankyou for your kind words! I suppose ive started with a little shelf too. Theres alot of people who have no idea of hippy pain and I tend to avoid seeing them now. Its not that I dont like them anymore or that I wont still be friends with them in years to come, but the physical and emotional pain I go through when I meet up with them is just not worth it. I get dragged around, left behind, comments as to why I cant keep up or get called lazy (One thing Im positive im not is lazy!) and I just end up feeling sad. As selfish as it sounds, I dont need that right now.

Danny - Live for now hey. I will text you. Hope you are a little happier too

And now to the other end of the spectrum - My 88 year old granny is going in for her 2nd THR on 06/10/12. Shes unbelieveably fit for an 88 year old and has absolutely no health problems whatsoever. I certainly cant keep up with her!  My parents expressed their concerns about her going for the op at her age and stated that perhaps she should just leave it and live with it. I told them I 100% back her and to not write her off! Why should she put up with the pain? Enjoy and take every singe breath of life hey?!! She has only waited a month to get her date for an op .... im still waiting ad its been 8 months now. To me, I think that just shows the difference age makes and the fact that surgeons just do not agree and do not want to operate on youger patients.

Anyway, please wish my granny all the luck in the world!!! 

Anna

[Dannywayoflife]

I'll say a prayer for your gran Hun! Xx

[Spanielsal]

Good luck To your Granny, Anna, it won't e long before the pair of you are racing each other!  I'm very much of the live in the moment kind of girl. I really think that to some surgeons who can't feel the pain you are in and don't know the limitations you have in your life, they see putting off the surgery as the right thing. BUT, it is only you who can weigh up your pros and cons, it is only you who should make that decision - yes a fully informed one - but the buck should stop with you. You are so young with your life galloping on around you and you should be in it. Push and push and push some more until you have a surgeon who respects you, who will allow you to be the decision maker in your own future. I think your new surgeon Mr Witt is that man, he does thr on young patients and he WILL help you. He's also one of the top guys in the world treating dysplasia. Go for it girl, with our head held high.  Our Tigger needs her bOing bOing back. Xx

[rubyred]

Anna, what your surgeons have told you was the same story I got for a good 2 years. I was constantly told that I was too young.

In the end I flipped in the doctors office and wanted to know why and was told that I'd have to keep coming back in to have it replaced and it was down to having the same scar re-opened or something. At that point, it was just before I discharged myself from my awful surgeon down here, I was at my wits end in pain - if I could have gotten onto my knees and begged him to fix me, I would have done!!

I just didn't understand why they are so flippant at leaving us in pain, just because we're younger than the standard THR candidate. I think it's almost barbaric. You wouldn't treat an animal that way. In my view now, looking back, I think it was more down to money and my local trust not wanting to spend however many thousands it costs to do THR's given how many I might have had to have in my lifetime.

I think it boils down to having the right surgeon on your side. Mr T was prepared to give me a THR if a BHR wasn't possible once he opened me up. Even when I first saw Mr Bache he was trying to tell me to wait - wait for my hip to go completely, nice eh?

I'm sure you're in good hands with Mr Witt especially if he's so experienced with your situation xx

[Anna]

bOing bOing

So is reopening the scar an issue? Hmmm I need to google ......

[Anna]

"Revision hip replacements are more complicated surgeries and the outcomes are not as good as the first hip replacement. Technical problems include the quality of the bone and the ability to adequately secure the revision hip replacements into position. Furthermore, removing the old hip replacement can necessitate more extensive surgery. Together, these problems often require the revision hip replacement to be much more complex. Careful planning by your orthopedic surgeon is needed to ensure he or she will be able to construct a hip that will allow you to adequately recover.
Another problem with revision hip replacement is that the surgery itself can be more complicated. Patients tend to be older, and less tolerant of long surgical procedures. The procedure is technically more difficult that primary hip replacements, and the effects on the patient are more significant (longer surgery, more blood loss). Because of this, revision hip replacement must be carefully considered and planned. Involvement of general medical doctors, anesthesiologists, and the orthopedic surgeon are all important."

So basically, a revision outcome will not be as good as the initial replacement and the surgery itself is more complex and carries more risks. Hmmm.

[Dan L]

Anna;

When I met with my surgeon before the decision to get my hips resurfaced, he explained revisions and re-revisions of THR's, he showed the actual devices used for HR and THR and THR revisions.  Each THR revision has a longer "spike" and there is more bone removed with each one, and a deeper channel is required to hold the new device.

With all that being said, if you are miserable, my 2 cents is that doing a THR or BHR at any age with a reasonable expectation of overall improvement, is the thing to do.  Life is way too short to be miserable, and although any decision for an implant is a big decision, living in constant pain isn't living.  Of course you have to be comfortable with the implications and future risks.  The worse I got, the more I became comfortable, and I am incredibly glad I got both done.

With the quality of surgeons in your neck of the woods, you should have a great outcome.

Good luck,

Dan

[Spanielsal]

Great Post Dan

the loss of bone is what made me push for a Mini-hip.  the thought of revisions scares me but i am really enjoying living without pain.  Anna, you have to make your decision based on as much info as possible but from the sounds of things, your quality of life is much lower than it should be. 

have you written down cause and effect of activities on your hip?  have you noted how much or little sleep you get?  have you kept a diary of pain or pills.  these are all things that might mean stuff to your surgeon and might affect his decision process.  i told my surgeon that a walk on a good day of less than a mile caused such pain that night that ordinary doses of medication had to be retaken at 4 am.  1 hr ironing had the same effect.  your hips are different to mine, your case is different.  but a list of things (like the ambulance offer) might help. 

only 30 more days to go.... I'm confident that Mr W will sort you out.  sending very very positive vibes. xx

(man, typing on the proper keyboard is really great!  i've been using my ipad and have been getting more and more terse as the typing is so difficult!)

[Mike D]

Anna-
There's a definate distinction to be made about what we ( of the bad hips) want, and what we really need.
Nobody would choose hip surgery but its not an age thing, it's what we need to enjoy a decent quality of life.
I replied to a post from Spike the other day who was concerned about his revision to THR aged 62 (I think),
I was concerned about having it at 50 but the alternative was awful-you know it-keep taking strong painkillers, keep trying to get through the day.
I don't think there is such a thing as a 'correct' age. You either need it or you don't.
Can I park a bit closer? Do I have to walk right back over there? That's gonna hurt, no I won't bother. Dance? Well, I used to!
That's just me, but none of that should apply to someone at 29.
Reclaim your life, get the surgery you need and enjoy the freedom it will give you.
One eye on the future, yes, but no way should you let your hips give you such a miserable time now when there's an alternative.

We need this London hippy convention to happen-think of the support and and advice we could all give-I'm up for it!

[Anna]

Hey, thanks guys.

Dan, that makes perfect sense. I remember Sal saying I should ask for the possibilities of getting a replacement with a shorter stem. I shall ask Mr Witt when I go see him and quiz him regarding stem length. Does anyone know if there are implications of getting a short one?

Sal / Mike - you talk sense as always. 'Can I park a bit closer?' - yup. That rings some bells. As does getting half way round the supermarket and remembering you forgot something on isle one. Sigh. Ah well, one month to go till I hopefully get some answers. Mike, are you still above water? 

[hernanu]

My brother in law (and Sal) got the Corin mini hip.

It's been excellent for him, no problems, less invasive as far as bone loss than a full THR. I think there are equivalents with the Birmingham BHMR, others I'm not sure of, but they seem to be effective. You might bring that up to your surgeon as a possible alternative, maybe that would cut down the impact of a later revision if needed.

BMHR:



Corin minihip is on the left, the two on the right are the revision increments that can be used with this system:

[Anna]

Oooooh, I see. Thanks Hern 

Its something I will definately ask my surgeon about ... although my hips are so odd im not sure whether it would be a possibility. Definately something to look into though! Thanks

[Spanielsal]

Am so jealous Hern, I tried to post that pic only to fail utterly! Technologically challenged!  Good stuff tho, Anna, the silent hip is of the same idea and also the delta motion, I think. Jon Conroy in Harrogate is working with the silent, I believe.

It s definitely worth asking, lose less bone, stay mobile for longer, all being well.

[Dannywayoflife]

Jon conroy is a good surgeon and a nice bloke. He was my scope surgeon. The problem with the silent and maybe the BMHR and mini hips is they need the right anteversion in the femur to be able to work (from my understanding and I'm just an interested patient not a surgeon!) I believe the stem Dr Bose uses has one of the longest and best track records and that's the corail.

[Anna]

Sigh 

That was my worry Danny. My anteversion is all wrong hense why I cant have a BHR. Oh well, I can still look into it

Anna

[dav0]

Hi Anna,

Here's my 2p input... No one should be faced with this at 29 years of age, but i think to some extent you have answered your own question here.  Whatever time we get here is luck - you will be aware of this more than most - and you can be rubbed out in any number of weird and wonderful ways in an instant.  As others have commented, you come across as a vibrant, energetic person who is now effectively 'imprisoned' because of your hips.  Who knows what the future holds, but if there's a chance you get your life back for the next 15-20 years, then i'd seize it with both hands...  You don't seem like the sort of person to be fobbed off in any case.
I think surgeon experience and skill will again be a big factor in revisions - as well as the placement of the original device - but who knows what advancements will be kicking around in the orthopaedic world in 15 years time?



Me? I'm treading water right now, still in pain, but not bad enough to go touting for a BHR just yet.  But i've squared it away in my head that there's one in my future at some stage - whether that's six months or six years, who knows?