PAO v THR

[HastobeKatt]

I have had hip pain for many years and was diagnosed with bilateral dysplasia about 15 years ago but it was not followed up.  I had just had the first stage of re-constructive foot surgery and had had DVTs and multiple PE's so the rest of my foot surgery was put on hold.  Fast forward to a couple of years back and, in the absence of further surgery, my foot / ankle problems had progressed to needing an ankle fusion.  My orthopaedic surgeon decided to go ahead with the surgery but use prophylactic LMWH injections.  I was three months in a cast non weight bearing.  During this time I found it very difficult to mobilise as my right hip was extremely painful and, despite the LMWH (which was stopped once I was mobile again) I quickly developed a massive clot (lower calf to groin).  I am now on warfarin (possibly for life). 

Following my ankle fusion my hip pain was investigated and I have 'a poorly formed acetabulum with lateral subluxation of the femoral heads'.  The right is worse than the left.   The report said nothing about joint space narrowing so I have no idea if there is any damage to the surface of the hip joint.  I am being referred for either a bilateral osteotomy (PAO?) or a THA.

Researching on line it seems that the three indicators for a THR rather than a PAO are age (I am 50), degree of joint damage and a poor fit between joint and socket.  I would prefer to preserve my own hip as long as possible so would rather have a PAO.  A PAO also seems to give far fewer limitations post op.  First of all though, I have the hurdle of my clotting problems to overcome.

I guess my queries are:

Have any 'older' people here had a PAO?
Has anyone had to make the choice between PAO and THA and which way did you go and why?
Has anyone else had to deal with issues of a thrombophilia and major hip surgery?
Who are the best surgeons for PAO in the Midlands (Stoke-on-Trent) area?

[Dee Dee]

I hope you get some responses by those in your area of the world about good surgeons.  I think McMinn or Treacy would be worth checking out if you are interested in resurfacing.

In talking with my doctor about PAO because my daughter may be following in my footsteps with dysplasia.  he seemed to think that it is only temporary and often unsuccessful.  Resurfacing is bone preserving over THR and more like your own mechanics and is showing a great longevity so far.

Read about resurfacing here and wait to hear from others. 

Dee

[HastobeKatt]

Many thanks for the reply Dee Dee. 

I believe that hip resurfacing requires more than 70 percent contact between the bone and metal socket to be effective?  My acetabulum is so shallow from the dysplasia that I now have subluxation / dislocation of the right hip so I'm not sure I'm a suitable candidate for hip resurfacing?   I posted on here because I came across another thread via a Google search where posters were discussing PAO v THR...

The two consultants I have some across who are expert in PAO are Marcus Bankes and Johan Witt but both are based in London

[Pat Walter]

I am sorry to hear about your hip problems.  I am assuming you are in the UK by what Dee said.  I definitely would at least check with McMinn or Treacy before making your decision.  You can't, as a patient, really know what an experienced hip resurfacing surgeon can do even with bad hip problems.  Mr. Treacy and others have done some very diffiuclt surgeries for hip resurfacing. Check out Mr. Bloom's diffiuclt surgeries here

http://www.surfacehippy.info/unusualhipresurfaces.php

We as patients can't assume what can and what can not be done.  Take the time to check with the top hip resurfacing surgeons before making a decision.  Remember that hip resurfacing is a very diffiuclt surgery, much more than a THR, so even the top resurfacing surgeons would be a good choice for a diffiuclt THR.

Check out the contact info here:

http://www.surfacehippy.info/listofdoctors.php

Good Luck and keep us updated when you can.

Pat

[Dannywayoflife]

Get yourself an appointment with mr Treacy he is the most experienced resurfacing surgeon in the world

[rubyred]

I would agree with Danny. Don't make your decision before considering seeing Mr Treacy.

I was going down the PAO route until he saw my CT scan and worked a miracle. A PAO isn't really a permanant solution, at least not in my case with dysplasia, and would have ended up needing a THR or thankfully a BHR anyway.

[Mike D]

Ruby, How's it going? The last time I read about you, you had a few aches and bruises from your chiropractor treatment, hope its going well for you.
Do you know how Anna is doing? I've not seen her posting on here for a while.

[rubyred]

Ruby, How's it going? The last time I read about you, you had a few aches and bruises from your chiropractor treatment, hope its going well for you.
Do you know how Anna is doing? I've not seen her posting on here for a while.

Hi Mike, I hope you and your new hip are doing well!

I've just made a new post in my thread over the way. Sadly there's not much positive news in there.

I didn't hear much from Anna over Christmas. But I've texted her recently and she seems OK from what I can tell.

[HastobeKatt]

Since I posted there has been a slight hiccup in the process. 

I was diagnosed with homozygous Factor V Leiden last week - with possible ATIII deficiency - which explains my clotting issues and my failure to respond to heparin anticoagulation.  It makes the prospective surgery a tad complicated and may limit me to NHS treatment (even if I could afford private care!) as my orthopaedic surgeon will have to work very closely with my haematologist.   

I also have Ehlers- Danlos Syndrome (EDS) (which is a causal factor in my hip failure) so they also have to take into account tissue fragility which, again, may mean that any hip surgery is contraindicated.  I have been warned that they may decide surgery is not an option and I may have to live with my damaged hip. (Others I know with EDS and similar hip problems have been told surgery is a big no no and have had to adjust to a wheelchair ) 

My appointment with my NHS surgeon is on 2 Feb so I'll have a better idea of my options (if any) then.