Contemplating HR with osteoporosis: post op protocol questions

[Kim]

I am a dancer planning to get my hip resurfaced.  I  have a t score of -2.4 in my femoral neck.  I have been told very different things about post-op protocol given this indication of osteoporosis.  One doctor says I should be 10% weight bearing for 6 weeks after the operation because of the  higher risk of femoral neck fracture with lower bone density; another says I should be weight bearing on the first day to stimulate bone growth.  I am in relatively good shape, am 53, and weigh about 125 lbs.  I am inclined to err on the side of caution, and am willing to be patient with a longer recovery.  On the other hand, I don't want to atrophy any more than necessary.

Has anyone out there had this operation and who also has osteoporosis, and if so what has been your post op PT protocol ?

[Pat Walter]

Hi Kim.

You will find that most of the US doctors are very conservative in their post op protocol. Only a few of the US doctors have done a large amount of resurfacings and the newer doctors just don't have the experience, the more experienced surgeons do.  Most of the experienced doctors I know of allow you to be 100% weight-bearing right after surgery.  Of course, this is not possible, but it only takes a few days to start being almost full weight-bearing.  Most of the doctors feel that the full weight-bearing encourages bone growth.  Some of the newer doctors are very conservative and prefer you to be partial weight-bearing.

I was 61, when I had my hip resurfacing.  I had a loss of bone density and cysts.  The overseas doctors, like Dr. BOSE, and Dr. De Smet said I was a good candidate.  The US doctors would have preferred given me a THR.  I tell you the story to illustrate how differently doctors think.  If you don't like what one doctor is telling you, I would suggest you find another one.  Since you want to be very active and dance after your hip resurfacing, I would suggest you find a very experienced surgeon.  One that has done hundreds or thousands of hip resurfacings.  That way, you will have a better chance to return to dancing as quickly as possible.

You can see a number of athletes stories on this page http://www.surfacehippy.info/athletes.php  and the videos on this page http://www.surfacehippy.info/shvideos/videosathletes.php  these are only a few of the very active in resurfacing patience.  I do know of several dancers that have returned to dancing.  Here is Ruth's story http://www.surfacehippy.info/ruthziegler06.php.

I hope this gives you some idea what you can expect after hip resurfacing.  Again, if you don't feel comfortable with your doctors post op protoco, look for another doctor.  You should not have any lingering doubts.

Good luck!

Pat

[Kim]

Many thanks for your prompt reply and detailed information.  It is actually the more experienced doctor (Dr. Gross, with approx. 1350 ops to date) who recommends being only 10% weight bearing post-op with my level of osteoporosis, whereas it is the less experienced (Dr. Schmitt  with approx. 350 ops to date) who recommends being fully weight bearing the first day.  So given your reply, I remain confused.  Many thanks in any case.  All best, Kim

[rlm869]

kim, it is unfortunate that pat's reply left you confused. let me just say that ALL surgeons are different. just because they have done thousands of surgeries does not mean they will be less conservative. each hip is different, each surgery is different, each patient is different.

it sounds as if you have already found 2 U.S. surgeons that will perform your surgery in spite of the osteoporosis. this is great! i would trust your gut in the long run...longer recovery may mean more atrophy, but you want this hip to last a long time.

good luck.

[Kim]

Thank you very much. This is very helpful and I appreciate your reply.  All best, Kim

[Pat Walter]

Hi Kim

I agree that you do have to go with your gut feeling.

It is, however, quite interesting to see how the doctors vary.  Dr. Gross requires a bone density test before deciding if you are a candidate for hip resurfacing. The overseas doctors don't normally ask for them because they can read your bone density from the x-rays.  I did not need one if I went to De Smet or Bose.

So again, each doctor is different.  Even among the best in the world there is sometimes dissagreement as to what the best option is.  I have seen Bose recommend a hip resurfacing, De Smet recommend a THR and McMinn recommend a hip fusion for one difficult case.

Sometimes Gross will do a case De Smet won't and visa versa. So you do have to go with your gut feeling and what you thing is best for yourself.

I am sorry I can't tell you anything more concrete than that.   Something Dr. Gross sees makes him want to be conservative where De Smet and Bose might not be.

Listen to your own inner voice and not our voices to make a decision.  We can point you to info, but after that you have to believe in your doctor.

Pat

[Kim]

OK many thanks Pat--I so appreciate your thoughtful reply.  I will do my best to follow my gut!  All best, Kim

[gabulldog]

I had a hip resurfacing with Dr. Gross on May 14.  My t score was -1.6 which is osteopenia.  Dr. Gross put me on 10% weight bearing (crutches) for 6 weeks and then a cane for 4 weeks.  Dr. Gross also has me taking in 2000 mg of calcium a day - through supplements and diet.  I will go back to Columbia to see Dr. Gross in 2 weeks.  Hopefully, I'll be ready for the cane.  Good luck with your decision.