Nervous about 1st Hip Resurfacing at 28- AVN

[rysnowman24]

Hello everyone,
           My name is Ryan and I am scheduled to have my left hip resurfaced by Dr. Gross on Dec 18th. I am extremely nervous. I know there are plenty of posts out there about the fears of the unknown. At 28 I am most nervous about what this will mean for me later in life. I have necrosis in both hips. We have caught this early degenerative bone disease early. My 1st recommendation was to get a THR however, I immediately said; "Nope that's not going to happen!" Luckily, I found Dr. Gross and am totally confident in him.
     
  Have I made a bad decision in getting this done now at such a young age? Should I wait until I cant walk? How is this going to further compromise my life and active life style? These are just some of the questions RUNNING through my head.

       I have always been an athletic young man. I may not have been the best at certain sports but I could compete in almost any activity that I picked up.  Over the past 2 years, my activity level has tremendously decreased due to the pain I have had in my hip. My lateral movement has gotten so weak and hurts.  I have toughed through Physical Therapy and have lost weight and gained muscle but there has been no decrease in pain.
       I am looking for support in a big way. My anxiety has been through the roof to the point that I have felt like I cant go through with this surgery. At 28, I feel like I should still be SuperMan! I am pretty depressed about this and just feel like Damaged Goods right now. I am to be married on May 24th and just want to be the best man I can be for my future wife. Right now, I feel like 70%.
            I feel so lucky to have found this site. When people share their experience, strength, and hope with others, great things are possible. I hope that this is the beginning of a great new relationship with my new hip and hippy's. Any words of wisdom and or advice would GREATLY be appreciated.

[Miguelito]

Hi Ryan!

I am sorry you are going through this at such a young age. Unfortunately I don't know much beyond the basics about AVN, so can't comment intelligently about it as it relates to HR, but can comment on some other things.

First off you have picked a fantastic surgeon (also my once and future surgeon). I recall hearing that he believes in HR for AVN, but you would know more about that than I. I also believe that HR is a no-brainer alternative to THR (if those are your two choices) for many people, in particular young, active males such as yourself.

I typically advise people that they will know when they are ready for this surgery (pain, etc.) but maybe with AVN you need to be more pro-active than most.

Being particularly young, the fact that Dr. Gross's device is the only one that I am aware of (I am not an expert) that uses cementless components on both sides may be of particular appeal to you. I have read (probably on Dr. Gross's excellent web-site) that cement-failure is the #1 cause of late failures (i.e. ones that have been implanted in a person for more than a few years). [Correction: This is not accurate. Dr. Gross was stating his opinion, not citing evidence. The quote was, "Although cement holds up reasonably well in femoral resurfacing, I believe that it is still the weakest link in the hip resurfacing construct and that it will be the primary cause of late failures after 10 years." Please see chuckm's later post and my follow up for further discussion].

I am sorry that you are having such doubts so close to your surgery. I hope that others, especially those with AVN, as well as other very young people, can weigh in promptly.

Mike

[oldsoccerplayer]

Ryan, the final decision is yours but try to separate the objective data from the emotions. Yes you are probably younger than most who get HR, but your condition is a fact and if you do nothing there's a 100% certainty that you're going to be physically limited, in pain and  miserable. This can affect not only you but also your interactions with others - pain makes you grumpy!
If you have the surgery, nothing is guaranteed but the numbers are on your side - isn't it >95% success rates, and most of the failures come from people trying to do too much too soon?
I too had pre-op jitters so the evening before I went to Columbia I kicked a soccer ball around for a while; the long limp home reinforced my decision to go ahead and get it fixed.
Even post-op there's fear and uncertainty for a while. I'm not completely over that either but as time goes by I'm feeling better physically and emotionally. I work out regularly, building up my muscle strength and stamina in preparation for going back to Sunday morning Soccer. Even within the limitations I still have (Dr's orders!) I can do things that used to be painful.
 In a few weeks I hit the 6 month mark and will be more qualified to talk about getting back to full activity, but wanted to chime in and let you know that you have a supportive virtual community here to help you through if you do decide to get it done (also if you don't)
Best of luck either way, and congrats on the upcoming wedding.

[einreb]

I think you'd be crazy if you weren't nervous! 

I sympathize with your concern for having to make this decision at 28. Its certainly not easy.  I started pondering it at 35 and put  it off until 40, but my situation was different. That being said... the things you are likely most worried about are all unknowns with a low probability of happening.  What is 100% happening is that your hips are failing, you are hurting, and you have selected a very good surgeon and facility. 

I'll be three years out in February.  This year I did over 20 road bike race/criteriums and  13 cyclocross races.  Hip pain free.  A huge mental and physical burden was lifted after the surgery.  Yes, there was surgical and recovery pain, but the bone pain was gone and I could focus on getting stronger rather than focus on things getting worse.

Its as much of a mental challenge as a physical one... work on both aspects of it as you prepare and as you recover.  Good luck!

-Bernie

[Miguelito]

Ryan,

Just looked at your post again and saw that you had specific questions:

"Have I made a bad decision in getting this done now at such a young age?" If your options are to limp around in pain until you have it done, or to have it done, having it done appears the better choice. I know I wish I had my first done a couple of years earlier than I did (a common sentiment here). I am not going to let my other hip get as bad as the first one (another common sentiment here), having been through some very high-end pain, not being able to walk sometimes (for short periods).

"Should I wait until I cant walk?" No. Especially with AVN, I imagine. I think at 28 the arguments for delay aren't even as good as someone who is say, 55 (and it's not really a good argument there, either). At 28, I imagine the likelihood of an inevitable revision is probably pretty good, so there really is no point in waiting (if you are convinced this is the ultimate surgery for you), unless you like suffering.

"How is this going to further compromise my life and active life style?" I think it is fair to say that no replacement can ever be as good as our original equipment (absent arthritis, of course). But the chances are very good that it will be a lot better than what you currently have, or will have again until it can be fixed in some way. And it makes sense logically that HR will more naturally mimic your original equipment than a THR would. While my recovery has been hampered by the rapid deterioration in my "good hip" post surgery on my "bad hip" (so it's kind of hard for me to tell what I can actually do with my resurfaced hip) the only ways I can tell that my hip has been replaced are the (small-ish) scar, and the way my resurfaced hip tends to "drift" a little bit when i turn in the other direction when walking. I am about 20 months post-surgery, so maybe that will continue to fade as time goes by.

I am not trying to talk you into this surgery, especially due to my lack of AVN knowledge. That being said, I never regretted having this surgery done, even in the first few difficult days after surgery. I sound like a broken record, but I, and others, believe that the first two weeks after surgery, particularly the first few days/week, are tough, and not to be minimized. But you will be taking a bunch of drugs so you will get through it.

Mike

[obxpelican]

You've done a great service to the long term outcome of your hip by picking an experienced surgeon.

Whatever age you are you are going to think you are too young, I was 49 and thought I was too young.

The important thing to remember is that you will be walking without pain again no matter at what point in life you are.

Personally I think with some luck and Dr. Gross skill you will take your device to the grave with you a very old man.


Chuck

[Dannywayoflife]

I was 28 at the time I had my bhr installed and as chuck say sim confident ill take it to the grave!

You've selected a top surgeon and that's probably the most important factor so your sitting pretty I'd say

[whyme]

Hi Ryan,

1. CORRECT DIAGNOSIS
I'm sure you've seen the best specialists that can confirm if you really have AVN (Avascular Necrosis). On my first MRI scan the imaging consultant suggested AVN but the hip surgeons later told me it was 'just' arthritis.

2. BEST TREATMENT FOR YOU
Once that's confirmed, over time you would have discussed with your doctor the possible options: Medication (NSAIDs, osteoporosis drugs...), Therapy (Rest, Exercises -it seems contradictory but it's not-), and finally Surgical procedures (Core decompression, bone transplant, osteotomy, joint replacement).
Depending on each case -we are all different- some (or most) of the treatments are not an option for you, others might have been tried and didn't work.
For example, not sure if Core decompression, Osteotomy etc would apply to your case at all.
Again, Dr. Gross and other specialists you've seen would have discussed that with you. He surely is well qualified, one of the best, this is reassuring. Note that, from what I read, he also does THRs and Revisions, that's important.

So, it seems Hip Replacement is your best option in their opinion. Then you had to choose between THR and HR. And you leaned towards HR.
In the end, it's always the patient's choice. It's hard to take a decision when you dive into the unknown.

3. THE FEAR
There is never 100% guarantee it will work perfectly. But this is a given, the best way to minimize the risks is to be thorough while you walk through steps 1. and 2.

You haven't mentioned it but I guess one of your overriding thoughts is to wait, as some better alternative could come up in the not distant future.
That was my hope too. Later I came to the realization that any alternatives to hip replacement are not there yet, and even if there are they won't become mainstream for a good few years, because hip replacement (THR or HR) has a proven record with good outcome worldwide, and they last longer than before (even if placed earlier in life, when we are more active). And there are revisions now available (which were difficult not long ago), so there is a prospect of decent lifestyle for many years for patients that need surgery younger than usual.

But the real reason why many of us dreaded surgery is hidden behind that thought of "something new will come up", and it is a more powerful one: once you commit to do it, there is no way back. You get a piece of metal and the old (or young) hip is gone for good.

Life is full of irreversible processes, that's the 2nd law of Thermodynamics anyway, and hip replacement is just one of them!

4. HOPE
This is not a jail sentence, it's a solution to a very serious problem, you should be grateful there is a solution!
Once you've gone through steps 1, 2, 3 and the surgery is scheduled, you need to think positive and embrace it.
The homework is done, it's time to get ready (mentally, physically and logistically) and trust the professionals.

Think back 28 years and HR didn't exist (properly), THR was there but the materials weren't as good as now and expected lifespan for those joints was 10-15 years, Revision was in its infancy.
Doctors wouldn't be sure if you had AVN or something else until they cut you open, as MRI scans weren't there, and keyhole surgery was just about starting.
They would be afraid to operate on a young patient like you, you would have to wait until you couldn't bear the pain and miseries anymore.
Nowadays, still most of the population wouldn't have a chance for HR and many tests and procedures.
You are lucky. We are.

5. OUTCOME
Nobody can guarantee.
For me I had a few, incremental goals. Some of them I'll have to wait and see, as I'm only 14 weeks post-surgery.
1. Get through surgery and post-surgery without major complications. DONE.
2. Joint pain disappears. DONE.
3. I can walk without limping, and stand for as long as I want. DONE.
4. No more pain sitting, or with certain movements. DONE.
5. Get back to regular, pain-free, exercise. IN PROGRESS.
6. Get back on my bike. I WILL.
7. Jog. I WILL TRY IN TIME.
8. Run. I HOPE.
9. Run faster. WHY NOT.
10. Triathlon. I WILL (if I can't run, just walk).
11. Ironman. I DREAM.
12. The implant lasts longer than me. WE'LL SEE.
...

[chuckm]

Miguelito, can you find the data about those late failures of cemented femoral components? Most of us on this site have hybrid devices and your comments could upset some people unnecessarily in my opinion. I think Dr. Gross is referring to the cement "mantle" devices that are no longer used.

My studies of the subject show just the opposite. Except for some devices no longer used, cemented femoral components are not coming loose even after seventeen years of history.

Some of the hip resurfacing devices (ASR is one) had a cement "mantle" layer that was between the bone and the device. The cement layer did not hold up well under the forces resulting in lysis or loosening of the femoral component. I think those devices are no longer being implanted.

The BHR, among others, does not have a cement "mantle (layer)" between the bone and the device. There is cement, but the device and the bone are a precise match leaving no room for any cement layer. When the femoral component is pounded on, the cement is driven into the porous bone leaving no cement layer to break down between the device and the bone. The forces of a patient's activities go directly from the metal device to the bone.

Dr. Gross admits in interviews the results of the hybrid system of the BHR are very impressive and he only makes a reference that the cement could somehow be the weak point over time and that is why he has developed his cement less femoral component. However, the BHR history is in its seventeenth year and Dr. Gross’s prediction has not been correct. To date, Dr. Gross' device stats are excellent, but the stats have not been better than the BHR.

Mr. McMinn says the results of his cemented femoral components have been so “spectacular” that he sees no reason to try to change it.

Chuckm

[Miguelito]

Chuckm,

Thank you for the correction, and the opportunity to not put words in Dr. Gross's mouth that he didn't use. Everything you wrote looks accurate, you obviously know more about this subject than I do. I checked out his website and think I found what I had read prior to my original surgery. Dr. Gross wrote (in 2008), "Although cement holds up reasonably well in femoral resurfacing, I believe that it is still the weakest link in the hip resurfacing construct and that it will be the primary cause of late failures after 10 years." I am not aware that he has changed his opinion (could have, but doubt it).

Later on in the same article he also states, "It is not clear, if uncemented technology on the femur will be better or worse then cemented femoral components at this point." So he is pretty clear that at that time there was no evidence to support his opinion. He is a very evidence based guy.

So Dr. Gross makes clear (2008 again) that this is his opinion. I will modify my earlier response to reflect this.

Thanks again for the opportunity to clear up my earlier error.

Mike

[chuckm]

No problem Mike. Theoretically I can see Dr. Gross' point. But I agree with you I don't think he has changed his mind about cemented femoral components.

I guess we can all see at 20 years and then 25 to see if he is right. The consolation though is even if he is completely wrong, his alternative is performing very well too so either way it is a win-win situation with Dr. Gross. If you get a good surgeon with a good hybrid or cement less device, these things last a long time.

Chuckm

[Dannywayoflife]

Yes I believe that the bad press regarding cement is down to the devices that use a high viscosity cement. The bhr uses low viscosity cement and is in surgeon speak line to line. That means as said above the device to bone fit is very tight some devices ase a lot looser and so have a mantle

[obxpelican]

On Dr. Gross's opinion on cement, I am on the fence, I've always believed that your body's way of doing things and using bone growth is the best way but nobody has ever proven Dr. Gross right, this is not to say another 10 years down the road Dr. Gross won't be proven correct. 

Who really knows, time will tell, but the BHR has been around a while and there seems to be no reason to believe the cement will start failing.  I think we all want to believe our path to walking straight lines was the best decision, it's very possible that we all took different paths to the same great result.

All I can say is, I hope we all go to our graves with our implants very old men and women.

Chuck

[Dannywayoflife]

Well put chuck!

[Reno]

Hi Ryan-

Well, you have gotten some wonderful advice from seasoned Hippies and I hope your fears have been reduced, at least a bit. I am 67 years old and I had my THR 4 months ago this coming Monday, and I can still remember the fear that seemed to build up as the time grew nearer for my surgery, up until the anesthesia did its work on the operating table. But, when I awakened I realized I had made it. My best friend was with me and she says when I woke up I said, "I feel great."  It seems my fears were mainly about not making it through the procedure. I had faith in my doctor, Dr. Kirk, here in Cincinnati Ohio. And, you seem to have confidence in Dr. Gross, who is a world renown surgeon.

What you and I have in common is AVN in both hips. But, while I learned I had it inadvertently 7 years ago, it did not bother me until 6 months ago when I suddenly had pain in my lower back. It was quickly downhill for me, causing me to not be able to walk and the most excruciating pain I have ever experienced. When an MRI was finally done it was determined that my right femoral head had completely collapsed and the only option for me was THR.
As WhyMe stated in his post regarding some of the options for AVN, you probably have discussed those treatment options with your doctor. My concern for you would be if you wait you could minimize your options and be forced to have a THR, which is certainly not the end of the world. So, I encourage you to weight your options again, make a final decision that is right for you, and go for it! One thing is for sure and that is your AVN will not get better on its own. And, another thing I know at 4 months post surgery, is that I am free of that pain...

Good luck with your surgery if you choose to have it! And, please keep us posted.

[bestbob]

Hello Ryan, Although I am not as young as you and do not have AVN, I too was very nervous/scared about going forward with a BHR. As others have said, you will know when your ready. My turning point was when my physical activity got to the point of just working, coming home and staying home because I was in too much pain. Emotionally and mentally I was exhausted. This is no way to live. You have made a great choice in choosing a doctor, and once post-op recovery is the next phase. One theme you will read on recovery is don't push it, listen to your body, and let it happen. I am now 6 months, and for the first 6 to 10 weeks it was up and down. Now I feel pretty good, and getting better every week.

Please keep us posted.

[Reno]

Hey Best Bob-

Congrats on being 6 months out! I am glad to hear that you are doing well. Tomorrow I will be
at 4 months out! Like you, the first few months were touch and go but I am feeling better and stronger as the weeks whiz by.

I hope that by the end of your second six months you will be completely better!!!

[sharleen]

Whyme - That was an EXCELLENT piece that you posted on December 13th. Anyone with any concerns regarding having this procedure done should definitely read it! very well thought out and spot on!

[rysnowman24]

Thank you all to commented on my story. I appreciate ALL the advice and guidance. I am going to go through with the HR tomorrow. This time tomorrow I will be on the road to recovery with my new hip. I look forward to sharing my experience with you all.
                                                   -Ryan

[whyme]

Very best of luck tomorrow, Ryan.
Then, take a day at a time and remember there is a very long road ahead, at times it can be twisty, but definitely will get you somewhere better than what it is now.