Hip arthroscopy or resurfacing

[daveyboy]

Hi all. I'm relatively new to this site and I'm looking for some advice. I have bi- lateral FAI and a double labral tear on my right side.  After a long journey I'm currently on a waiting list  to have a hip scope. I've seen numerous registrars / surgeons about this with conflicting responses. One, a hip preservation specialist reckons I have grade 2/3 OA and a hip scope may, or may not,  give me 5 years before I need a full hip replacement. On getting a second opinion from another hip arthroscope specialist, his response was that a hip scope would be of no use and that I should have a double hip replacement .

Thanks to this site, upon receiving the news, I booked a further appointment to see Mr Ronan Treacy. After looking at my X-rays he advised me not to bother with the scope and book in for hip resurfacing in 6 months to a year.

Maybe I've seeked too many opinions but I'm not sure what to do now? Clearly the full hip replacement is not an solution. I'm 46 and have been a pretty serious athlete all my life . Like many here, I'd like to return to impact sports so clearly resurfacing seems the better option. However, I'm not sure whether I should go with the scope? If this could give me 5 years then should I try it? If so, would this jeopardise my chance of resurfacing at a later date?

At present, if I keep activity to a minimum, my hips are OK.  However, after a days strenuous work or a workout on the mat, I do Brazilian Jiu Jitsu, then my hips, bust mostly my back,  flare up and I can be in a bad way for quite some time.
Beyond that I have the classic traits of FAI and OA, meaning that it's a struggle to do my shoelaces up.

Sorry for the lengthy post but I'm pretty confused about the best course of action.

Any advice would be greatly appreciated and thank you for taking the time to read this.

[chuckm]

Daveyboy, this is the right place to be asking. I have not heard of anyone on this site NOT being able to get a resurfacing because they had a previous hip scope, but they do report very mixed results from hip arthroscopy. 

I was 46 and had my left hip resurfaced a year ago. I returned to competitive soccer in six
months and at the same level I was. If you are dedicated to the healing process, hip resurfacing is really good and it lasts.

Here is the thing: you sound like you are still pretty fit. If you get a scope you will return quickly to where you are. If you resurface, it could take a year to get back to where you say it is just as good or better than it was. But once you are resurfaced, it takes a while but it is pain free and will last. The scope will help you come back fast but within a year or two you are back to declining which will really be a downer.

Chuckm

[daveyboy]

Thanks Chuckm.

In my mind I'm happy to do the rehab but I just want it to last so I can get back training. If I had two scopes and it gave me 5 years pain free on both hips then I'd jump at it. But from my reading, and as you mentioned, I gather that hip scopes are a bit hit and miss?? However, when I spoke with the registrar last week he reckoned that if I went down the road of resurfacing then I could be looking at a revision to a THR in the next 10- 15 years. He then went on to say  that if the hip scopes  did work then I could have use of my own hips for another 5 years and when it does come to resurfacing then I'd be that bit older, meaning any THR revision might not have to happen until I reach my late 60's. I'd imagine at this point in my life I'd be slightly less active and so the chance of dislocating a THR would be less of a problem??

I'm not great at decision making at the best of times but this seems a big one?

[whyme]

It's a very difficult process ... The temptation of arthroscopy is strong, as it gives you an extra "life", but do not to get blinded by that. If you aren't the right candidate, it won't solve anything and will cause a lot of grief (and cost money).
It's a good decision to see Dr Treacy, or one of the other top specialists.

Try to determine if FAI is the only issue you have or there are other factors (for example, a degree of dysplasia), how much cartilage is left, if you've osteophytes... that could compromise the success of the keyhole surgery.
Not sure about stats on the hip arthroscopy procedure, but it would be good to get them (general, and also specific to your surgeon).

In my case, the surgeon I was going to go with proposed resurfacing in one hip (already quite damaged) and keyhole surgery on the other, he estimated it would give me a lease of 5 or 7 years before needing resurfacing too.
I wasn't sure, and had a free consultation with Dr. De Smet (you can send him the X-Rays too if you wish), he said yes to resurfacing one hip and "too late" for arthroscopy on the other. I decided to follow his advice, and in fact went to Belgium to get my first HR done by him.

[HowieF-16]

I know exactly what you are going through.  I had terrible OA in my right hip (stage 4), but there were also some loose bodies floating around and embedded in my labrum.  I opted for a hip scope 2 years ago to buy some time, pending a THR five years later...my goal was to reach 55.  Unfortunately, I have an active 14 year old son and couldn't participate in too many activities with him, so I opted for a hip resurfacing and will be getting the procedure tomorrow with Dr. Raterman in Tampa, FL.  I chose HR versus THR for several reasons.  First and foremost, for an active 50 year old like myself there seems to be better outcomes.  Second, a THR at 50 may mean a revision at age 70 and I wanted to preserve as much bone as possible.  Finally, it seems like the HR folks can go back to high-impact sports and activities whereas the THR recipients are somewhat limited.  I will continue to post on your thread as I progress and you can make a better decision.  good luck.

[Miguelito]

Hello Daveyboy!

Sorry you are going through all this. I think the best people to advise you are people who had the surgery to fix the labrum/FAI, and then ultimately had the HR. There are some people on this site in that category, but it may take them a few days to weigh in. I hope they do. Naturally having one HR I am going to recommend the HR over THR, but the decision you are struggling with is HR or arthroscope.

I am in more or less the same situation as you, though I had one hip HR'd in 2012 as it was just gone. I am 43, male. I went thru the same process of discovery that you are going through. Most of 2013 I was still exploring arthroscopy. The basic takeaway I got from that is that with FAI, north of 40, there is generally significant enough damage to the cartilage (for active people like yourself, myself) that the outcomes for arthroscopy/fixing the impingement are not great. At best (typically) it is a holding action for a period of time, maybe five years. Of course, Dr. Gross said I would be coming back to him in maybe five years for my second hip and it won't even be two, so...

All that being said, there is at least one person on this site who's opinion I value highly who got five years or perhaps a little more out of the arthroscope/etc. and felt it was worth it, so I do not mean to dismiss that option.

In my case, as I had already had a (so far) successful HR (and again that hip was so far gone arthroscopy was out of the question) so I was already leaning toward HR over arthroscopy when the arthroscope surgeon who I had been seeing took the option off the table a couple of months ago. In my case it was a relief more than anything.

You are going to have to decide what is best for you. But I will say that the 10-15 year revision timeline you were given is suspect, as (don't quote me) I believe the survival rates for the BHR (which I imagine would be your option as you mention Mr. Treacy) project to be far above that, especially for males. I can't recall the exact statistics, but I recall percentages north of 90 for a period longer than 10 years.

Mike

[Beth]

Daveyboy,
I had hip arthroscopy on both hips in 2012 at the age of 48. I am female and active.
I enjoyed running 5ks, hiking and recreational biking. I started to have a lot of pain in my hips when running 2010. The right always worse than the left. MRI's showed 1 large tear in my right hip and 3 smaller tears in my left. + FAI both hips. I had surgery on my right hip  5/12 and on my left 8/12. I was non-weight bearing for 4 weeks post surgery for each hip.  On xrays I still had normal spacing/cartilage but at the time of surgery the surgeon found I had a dime size area of grade 4 arthritis in the right and a smaller area in the left. My rehab went really well. I used an AlterG treadmill which is an anti-gravity treadmill. BUT... things started going south when I went back to running at full body weight 1/13. By the end of February I was hurting so bad that I had to quit ALL exercise. I am a RN and soon work became difficult. I return to my doc in August 2013 and a MRI (on the right) showed more labral tears. An xray showed bone spurs on both femur heads. A cortisone injection in the right hip helped for 1 week.

What my ortho doc said is that as more and more hip arthroscopies are being done, they are finding that patients with ANY arthritis usually do not have long term relief and patients in their 40's have a even lower % of success.

When I was diagnosed I was not offered any other options but to 1) put up with the pain 2) hip arthroscopy. 
I wish I had experience more relief. I likely would have if I had not attempted to return to being active.
Now my only option is hip resurfacing which is planned for February for my right hip and a date TBD for the left.
This is a tough decision. If you only had a glass ball that you could look into!
Let me add- just like hip resurfacing, make sure you get a good surgeon who is not new to the procedure if you decide to go the hip arthroscopy route.
Good Luck,
Beth

[chuckm]

Daveyboy, Mike makes a good point about the timing and the longevity of the BHR resurfacing system.

Currently, it would be best to look at BHR statistical outcomes from top surgeons (since you are contemplating Mr. Ronan Treacy - a top surgeon). 
For men, 98% of BHR's are surviving after 15 years. Even if you factor in all the other surgeons too it is still better than 90%.

I think the modern BHR is only 17-18 years old and if 98% are still around it doesn't seem likely that they are suddenly going to start failing in large numbers.

So statistically it is very likely you would have a BHR still working into your 60's - at least.

Visit Mr. McMinn's website and listen to his videos about the BHR that he invented.

Chuckm

[hernanu]

Hey Daveyboy, we've had several BJJ guys get HRs and return to trainining. Some in particular were Mr. Treacy patients. So the chances are good, assuming all goes well.

I'm a Tae Kwon Do guy, and have gotten back to full function in that. We have many others who also have gotten back to one martial art or another, so the odds are good for you.

It takes a while and is not easy. I got back to serious training probably about 1.5 years after my procedures, but I did have two and that may allow for the extra half year. As an athlete and martial artist, it is a different kind of recovery and parts can't really be rushed, so count on at least six, more likely twelve months of recovery before going into anything you recognize as training now.

The good thing is that I am fully functional now, and am doing full impact at high speed.

I'm sure martial artists will be chiming in, there are quite a few on the site. Check out the martial arts discussions for what others have done and what their recovery looks like.

As to the scope, I had no experience since in my case it was far past that as an option.

[daveyboy]

Hi all.

I'd just like to say thanks to everyone for their considered responses. It's a great comfort to know that I'm not alone in making, what I find, a tough decision.

I had a call today from the hospital to say my hip scope op has been scheduled in for the 22nd Jan. I told the receptionist that I would call tomorrow and let her know; one way or the other. Basically, I was stalling for time!!!

I've been re- reading all your posts and I found Beth's comment interesting, which  related to the high failure rate for hip scopes in people over 40 with signs of OA. Obviously I tick this box. Taking this into consideration, and the recovery time for not one, but two, hip arthroscopes, I'm starting to think that I may cancel the scopes and go straight to the bilateral BHR with Mr Tracey.

Clearly, as we've all no doubt felt, this is not a decision that one jumps into without some trepidation. However, considering that my OA / FAI etc, is not going away then I suppose all we/ I can do is make a decision based on good information and rational judgment?? And then trust this is the right thing to do?

Once again, I'd like to thank everyone for taking time out to reply to my question. You've made me feel less alone in making this tough call. 

Daveyboy

[Dannywayoflife]

Hi Dave sorry to chime in late!

I had both an arthroscopy (grade 4 OA) at age 27 which if I'm honest was a waste of time and then had a bhr installed by Ronan Treacy at 28. I am also a martial artist and a competitive grappler. If I'm honest I rarely see any positive outcomes of a scope when OA is established. If I were you and if you want to get back on the mat ASAP listen to Mr Treacy and leave it 6 months and go for a bhr with him.

At your age I would be very very confident of never needing a revision of a bhr. The recovery is not easy but then the harder things in life are generally the worthwhile ones!

Drop me a pm if you want a chat mate

Danny

[daveyboy]

Hi Danny

Thanks for your comment  mate. Much appreciated. I've seen from reading the forum that you're another Bjj man so i was really keen to get your opinion. It seems like we're both travelling down the same road?!

I'll pm you later today if that's ok.

Best

Dave

[Dannywayoflife]

Ok mate look forward to it

[Munch]

Hi Daveyboy,  in a way I don't have much insight so am writing to wish you good luck.  My one thought is that having been reading/resesarching  a lot for my own bilateral resufacings (done a month ago) it sure seams like Treacy is a great doc and someone to listen to...also it seems like a HR would hopefully last a long time and allow you to get back to BJJ.  Best of luck with your journey!

[daveyboy]

Hi Munch

Thanks for the post. I'm really interested to hear how you're getting on? I see that you had the two operations 2 days apart. Seeing that I will need to go down the bilateral re- surfacing route, I'm just wondering how you feel and are coping after the operations. ?

Also, was it you or the surgeon that suggested doing both together?  I ask this because when I asked Mr Treacy about doing both hips at the same time, I got the impression that he would probably not want to do this? I may be wrong but in my mind if they both need doing then why not together as this saves on having to endure two recovery periods. It seems to make sense?

[China Lady]

I am now 7 days post-op bilateral BHR on both sides in one go. I am 56, female, not sportive, overweight........ I feel great and go home today. yesterday I walked 100m and 1 flight of stairs up and down. my surgeon is Dr. Jason Brockwell, Hong Kong.
if I can do it : you can do it!

[Munch]

Great question.  Dr Gross confirmed that both hips were bad (the left was definitely worse but not much cartilage on right either)  and said if we just did left the right would keep me from getting back to a more active lifestyle.  I asked him how bilateral would work and he said some people do them 6 weeks apart, 6 months another option, but I might consider getting it all over at once, and for that he prefers doing them on a Monday and then the following Wednesday.  (I believe Dr Su in New York City, another highly regarded doc, does them both in one session).  He said it would be very unlikely that I would need a transfusion (and this proved correct- no transfusion needed) and maybe biggest drawback would be no driving a car for 6 weeks, since I wouldn't have a non-operated leg to use on the brake.

I'm now about 4 weeks out and I feel it was 100% the right choice for me.  I just turned 53 a couple of weeks ago and was pretty fit (avid swimmer) and trim- 6 feet tall and 158 pounds.  Still the first week was tough, second much better but slow going, and steady improvement since then.  The way I see it now, to get the benefit of getting it all over at once (which is big) you really pay upfront.  That first week- 2 surgeries might be 3 times as bad as one, with no good leg to do the majority of the work...just 2 logs to drag around.  second week still a lot worse maybe...but at 4 weeks I feel like it's not really much worse...so what if I'm slow on both sides...at least I'm balanced and I couldn't do sports either way...so getting through phase 1 recovery all at once, phase 2 as one...is a HUGE plus.

Sorry this has turned into such a long post, but hopefully there is some helpful information in here.  I am happy to answer any and all follow up questions you may have.  i see why some docs would hesitate, and it's tough at first, but with a good doc, I sure think getting it all over with at once is a good way to do it.

[Dannywayoflife]

Dave many surgeons don't like doing both hips at the same time as the percentage that then require a blood transfusion is far far higher

[Munch]

Wasn't sure if that transfusion issue was a big part of it, but again, in my case, Dr Gross said it wasn't likely to be an issue (I believe he said that less than 1% of his bilaterals had to have an infusion, and also there's a statistic in some of the literature I think that sates he did 50 consecutive without the need for a transfusion).

I got surgery reports and didn't lose much blood in either surgery...

[Ross]

Hi Dave,
I spoke with two of the top hip arthroscopy Dr Kelly, HSS and Dr. Alston Stubbs.  If you have anything more than minimal OA, they don't recommend it.  I wish that I had that information before I had arthroscopic Sx.  I had Sx with Dr Bharam at NYU and 3 months later the hip failed.  Full thickness cartilage loss.  At the same time I was dealing with the failed hip, the L hip failed and that was when I found the other two surgeons.  I had bilateral with Dr. Gross two days apart.  I would think hard before I did it.  It is not like getting one done.  You have to rehab both hips.  If You can wait 6 months after having the first one done because of your life schedule, I would.  My oppinion about hip scopes is that if you have a traumatic event and tear your labrum without FAI or Cam lesion, a hip scope from Kelly, Byrd, Stubbs, or Phillipon would last years maybe even a life time.  With underlined disease in the hip, go for the resurfacing.  The traction that they use to pull your hip down to get the scope into the space is damaged my facet joints.  Hope this helps...Ross