Too young for a THR?

[Anna]

I will look into it before my appointmet Danny, thanks 

Ruby, we need to sinc our sleeping patterns. If we try get our hips to behave and sleep, say, between 2 and 4, then the rest of the time can be spent chatting!! x

[rubyred]

LOL That's why I text you at about 1am this morning, I was wondering if you were awake! x

[Anna]

Well .......

Today I had my appointment to see my new surgeon (The appointment ive waited 5 months for). I made to 500 mile round trip only to find my surgeon was unavailable (I love the NHS!) So I spoke to his collegue. The converstaion went along the lines of;

Doc - "You have severe dysplasia, over 50% of your femoral head is outside the acetabulum, your femoral head is mushroom shaped, you have significant artiritis and numerous cysts, basically your f****d" (Ok, he didnt quite use that word)
Me - "Oh, so are we gonna do a THR?"
Doc - "Yeah, the waiting list is quite long so were looking at around february"
Me - "What kind of prosthesis would you use?"
Doc - "I dont know, I will have to ask the surgeon"
Me - "what about the stems? Lengths etc? Short stem / mini hips blah blah blah?"
Doc - "I dont know, I will have to ask the surgeon."
Me - "Right, what about long term restrictions?"
Doc - "No impact sports and stick to the 90 degree rule."
Me - "The 90 degree rule? No I mean, what about long term / life long restrictions?"
Doc - "Yes, we advise the 90 degree rule for life to eliminate risk of dislocation"
Me - (A little speechless)

90 degree rule for LIFE?!!! Has anyone else heard of this for a THR? Im not so sure whether the guy was just being really cautious, whether (as danny suggested) they use a prosthesis with a small head or whether its my specific case.

So .... after a day of travelling and alot of money later, its been confirmed that I need a THR. Other than that im just totally confused, fed up and wondering whether im perhaps getting a wooden hip. Any ideas?

He is going to discuss my case with my surgeon on tuesday and will get someone to ring me with a decision..... but I still have a million and one questions and am left wondering whether I will get a chance to ask them.

On a plus note, thanks to Ruby who came with me to hold my hand .... and feed me with wine 

Anna

[rubyred]

Other than the fact that the doctor you saw was very nice in the looks department, he didn't appear to give you the answers you so desperately need.

As I said to you, I think it's a positive that something is going to be done to help you, but you definately need to be well informed and comfortable with what will go ahead before February turns up. You deserve and have the right to know what they're putting inside you.

And you're welcome for the wine and hand holding, shame about the food eh?

[Mike D]

Anna,
 That is unbelievably dissappointing. Incredible and just not good enough that you wern't told in advance you would be seeing someone who couldn't answer your questions.
The only thing I can suggest is to arrange a phone call with the main man, or an email with your list of questions.
Keep forcing the issue, Anna-be the one who shouts the loudest and they will hear you.

I asked about restrictions at my 6 week check and was told there's only one-no heavy running.
Running for a bus was fine as was kicking a football around in the garden, just no pounding the streets.
No mention at all about 90 degrees. Mr Treacy said my hip would allow me to 'crawl into awkward spaces' knowing thats what my work involves.
Sounds like you say, this guy was being overly cautious.

[Anna]

The guy was very nice, and polite and made time for me so Im trying not to complain too much, im just really disapointed. It was such a long way to travel and I feel I have no real answers. ... although, on a plus note, at least I know they will operate.

Mr Treacy knows what he is talking about Mike! I just dont get this 90 degree rule. It makes me wonder whether they use a different prosthesis.... and if thats the case then I really dont want it! I need to speak to the main man. I will see what happens next week and then perhaps see about emailing him or trying to get another appointment. Its just all a bit annoying 

[rubyred]

I've never heard of this 90 degree rule being a permanant arrangement. Something just doesn't add up there.

After you've heard from someone next week, why not ring Mr Witt's secretary and ask whether or not it would be possible for you to have a phone call with him, rather than do all that travelling all over again, plus the expense too.

[Dannywayoflife]

Sounds like a registrar who's not very clued up to me. Find out what device he uses ie which stem which acetabular and femoral components I'd be asking for a large head device as they don't dislocate easily like a small ball hence the 90 degree crap

[Jason0411]

It is all a matter of difference between ball and cup. Sounds like he is quoting from his medical text book which deals with small metal ball and large plastic cup. I think more and more surgeons are trying out large head THR's now. It is such a shame you got to see the Monkey and not the Organ Grinder.
Jas

[Anna]

Thanks guys,

I think I just need to see whats said next week and then try get more answers .... whether that be by email or paying to see the man privately. I think you are right Jason and prehaps I was jumping the guns a bit yesterday ...... the guy I spoke to didnt know what prosthesis I would get so I suppose couldnt advise on restrictions and was probably reading from the text book.

I guess the waiting continues .....

[Tim Bratten]

The guy was very nice, and polite and made time for me so Im trying not to complain too much, im just really disapointed. It was such a long way to travel and I feel I have no real answers. ... although, on a plus note, at least I know they will operate.

Mr Treacy knows what he is talking about Mike! I just dont get this 90 degree rule. It makes me wonder whether they use a different prosthesis.... and if thats the case then I really dont want it! I need to speak to the main man. I will see what happens next week and then perhaps see about emailing him or trying to get another appointment. Its just all a bit annoying 

Hi Anna:
I would try to make sure they don't use a 28mm plastic on metal cemented implant. Apparently from what Dr. Su said (in response to the Lancet article) this is still commonly used in England. Maybe that implant is OK if you're getting your first hip replacement when you're 80, but (IMHO) is bad news for young people. From what I've read a 36mm ball is the (approximate) cutoff point at which dislocation stops being much of a problem (although it can still happen in rare cases).  I know someone who had the 28mm ball implant in his fifties who dislocated his hip three times: the first time at more than six months after surgery just bending over to pick something up off the floor. I have a 40mm ball and am fairly confident that it will not dislocate even though I am rock climbing fairly aggressively on it (I was kneeling down on the floor within about a week or so of surgery -- although I'm definitely not recommending that you do anything I did/do!). 

[Dannywayoflife]

Tim I'm fairly sure that the majority of surgeons here in the uk would only use a cemented THR if the bone quality was very very poor.

[Tim Bratten]

Tim I'm fairly sure that the majority of surgeons here in the uk would only use a cemented THR if the bone quality was very very poor.

Yeah, I really don't know, but in the Lancet article (see abstract: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60989-1/abstract) the researchers say the data on THRs is between 2003 and 2011 and they clearly say they are comparing results (five year revision rates) in young patients of HR with patients who have a "28 mm cemented metal-on-polyethylene stemmed THR". Based on this data they recommend HR should not be done in women.

[Anna]

Hey Tim, thanks for the input. I think you are right in the sense that surgeons in the UK still use the old plastic on metal, however I think that is predominantly for older people .... my 88 year old granny has just got one!

Im hoping, seen as my surgeon specialises in dysplasia, young adults and sporting injuries, that he uses the most up to date devices. I will definately not be agreeing to anything though until I know the in's and out's. I will be asking about larger heads as dislocation is a huge worry for me with all the silly sports I do. I think perhaps the guy I spoke to just wasnt prepared for all the questions from me. I suppose alot of people just go in and agree to whatever they are told. Now I have had a few days to step back and think about what was said, I think I just need to speak to the surgeon himself and grill him. Im pretty sure he will have the answers I need to hear! 

[Anna]

P.S. Im loving the rock climbing pictures Tim. Its nice to see and gives me a bit of hope! Keep them coming 

[hernanu]

I like that attitude, Anna - just take control of things, it'll pay off in the long run.

[Anna]

Thanks Hern 

[Tin Soldier]

That's weird about the 90 degree rule for life.  Maybe it's specific to more extreme dysplasia, such that without totally rebuilding a pelvis, the shallower ace might require more control by the operator (you) to keep from dislocating.  You should at least talk to Treacy so you have confidence in what they are telling you.  Sorry.  On the good side, sounds like you've got a new friend.  That's pretty cool Ruby, being supportive like that, for real, not just on the forum. 

[Anna]

Tin - the more I think about it, the more I just think that it was just the surgeons assistant who didnt really have the knowledge. I will find ot though when I talk to the surgeon himself. Fingers crossed.

.... and yes, you are right. Ruby is awesome! 

[kayeah]

Anna,
I too was told that I was "too young" for THRs, I had begun to have severe pain as I was 5 months pregnant at age 28 (as soon as the pelvic bones begin to shift in pregnancy). First I was told it was normal to experience twinges, but they of course were NOT twinges. I underwent P T for a number of years, off and on, took anti-inflammatories after 2 pregnancies, then got to the point of pain med. I also was looking rather worse for wear in my gait and walking was so much pain I would rather not do it. I even had to do DisneyWorld from a wheelchair, which if you are in pain does not feel like a happy minnie mouse experience. MRI's should be done, although they cannot be conclusive in many cases (mine failed to show congenital malformation of hips). Finally, at age 46 I found an orthopedic surgeon who said why not get these out and see if you can have a better quality of life. It is something I longed for. I was excited and full of hope. Now, let me just caution you that although no one should tell you that you are too young for hip replacement as they are NOT walking in your painful steps each day and truly have no idea the coping skills and the coping your knees and other muscles and bones have had to do to get through each step each day. I imagine you have had alot of hot hot baths to ease the discomfort, hot pads on the painful points in the evenings, referred pain to where you think you must be crazy, it must be your KNEE after all that is injured, that sort of thing. I would say to you that you need to be emotionally ready, know that you will be confined to home a while, it will be painful (a different sort of pain, almost a welcome relief because it is so different and the old pain is gone), it may limit your mobility in some activities for life, no more horseback riding or hang gliding for instance lol, you never know what your limitations may be. It certainly will affect you in some ways for life though, at least mine has. BUT, it for me, was absolutely the right answer, even as I am now in a bad situation with metal on metal metallosis, and needing a revision. I will get my revision and I will revisit you in this forum and let you know if I still think revision is a viable option to withstand again and again for younger people who want to remain active and not miss a moment of life! Please get the best surgeon possible, PLEASE!!!!