I'm getting on the Board

[Asalisbu]

Heyo Hipsters,


After getting the fun news in November at 40,  I am just one last phone call away from getting on the board. This site has been invaluable during this time to help navigate this decision process.....and I suppose after being told I'm bone on bone that HR is better then my back up plan of a steady liquid diet of Jameson. 


Dr. Brooks and Dr. Gross said I was a very good candidate.  I had a list of written questions for Gross waiting for his call and of course he nailed me when I didn't have the list but found him extremely patient and thorough.  When I say patient, not patient by a surgeons standard, which on average if you can hold onto to one of them for more then two minutes people are ready to canonize them, He was regular person patient, I think we talked 40 minutes and only stopped because my next questions were about to be what his favorite football team was and his current position on whether we should incorporate a flat tax.


So we left it for me to call his nurse to schedule a date.  I played the dial the number, then hang up game more then I did trying to ask a girl out on a date in high school but finally left a message and am waiting for a call back(she better hurry before I chicken out again).


Sorry for,the rambling I find it cathartic, but onto my questions:


1. To bilateral or not too bilateral that is the question (that's right a Shakespeare reference). My right is toast and my left only looks good when compared to my right. The left catches sometimes but seems to have more mobility and nowhere near the pain but it's coming I can tell. I have read all the pros and cons here plus I am a devout follower of what I affectionally refer to as the Blinky Chronicles. I am amazed with Blink's progress but am worried about recovery time as my job will have some patience with a recovery but eventually they will not want to see me limping and using an aid for a long time.


2. Friggin knee is hurting.  I have a cartilage pot hole behind my knee cap and on the outside of knee ( sweet cartilage what did I ever do to you) but at least imaging wise it looks way better then my hips ( good spacing decent but not huge sized defects) but feeling wise not always the case.  I'm exploring knee resurfacing (arthro surface, supposed very similiar strengths of HR) but am hearing mixed things even though their website shows everyone grinning like happy fools after getting their knees done. I just don't want one to get in the of other with rehabbing. I am leaning towards hips first as I believe I read somewhere proper hip function is essential in proper knee function but necessarily other way around.  Anybody got any thoughts (doctors just say whatever hurts more, as if I could predict from day to day). 


3. 90 degree rule. It's really freaking me out and I don't know why.  I guess because I'm very tall and just about everything violates this rule.  Driving sitting in a plane, chairs. I want to get back to work even if it's riding a desk ASAP if possible and I have been experimenting in the car to no avail. How gospel is this rule? Some surgeons do it, some don't, what is the risk if in the car I have to break it by a few degrees? I do have the leave to take six weeks but I think getting to some routine as soon as tolerable is better for me. Forces me to move around and work can be a distraction for obsessing.


Whew. Got all that off my chest.  I know I'm going to do the hips and the knee as I am tired of pushing through everything. I have managed to stay active but I am becoming more detached from my family and life just to get through the days. I get long good spurts but they are coming less and less and for shorter and shorter.  If having all this metal gets me 15 more then at least I am comfortably in retirement and my kids will be to old to want to play with their dad anymore.  I had rather have these more comfortable years up front then later when I can sit on my butt all day if I choose. Thanks for suffering through my rambling diatribe and appreciate any thoughts to my questions.

[Quig]

My situation is extremely similar to yours... right down to the right hip being significantly worse than the left and whiskey being a poor alternative to surgery. 


After doing TONS of homework here I've opted for bilateral with Dr Gross in slightly over a month. I too have a thread here somewhere asking for advice on bilateral or not. After some great advice from folks here and talking to a friend who had bilateral resurfacing done by Dr. Su a little over a year ago I decided it was the way to go. One recovery, while a harder recovery, seems like the best decision. As the date gets closer I'm equal parts terrified and excited.


I too have had knee and back issues as my hips have deteriorated. I'm hoping and expecting those issues to improve dramatically with properly functioning hips. Time will tell...


I can't help you with input on the 90 degree rule but I'm sure some of the extremely helpful folks on here will be by to shed some light on that topic soon.


Good luck!

[Kingrob]

Asalisbu,

Not sure how tall you are but I am 6' 1" and I had my RT hip done by DR Gross. The 90 degree rule was not that much of a problem for me to be able to manage. I raised my toilet seat prior to the surgery and I took 6 weeks off from work so I could be in a controlled environment during this period. The 90 degree rule kind of takes care of itself. if you go beyond the 90 degrees it hurts so it is not like you are going to forget about it. Getting in and out of the car is where I sometimes got a jolt of pain because I was not being careful enough. I would recommend taking the 6 weeks, but I understand that if you have other surgeries down the road you may not want to use all your leave.

I dealt with hip pain for a long time but I got the surgery when I started getting knee pain in my left knee. Years of limping takes its toll. I am sure that a hip can affect the knee as it did with me. I am pretty sure that it can work the other way around as well, but the knee is a lot more complicated joint than the hip. The hip is just a ball and a socket. Since the surgery my knee pain has completely gone away. I think I would go with the hips for two reasons. The knee being a more complicated joint, does seem like it can be negatively affected more than the hip by limping. Second - as new as hip resurfacing is, it has been around longer than knee resurfacing. While your getting your hips done first you will be allowing the knee resurfacing surgeons to perfect their craft on someone else's knees.

I am not a DR so take everything I say with a grain of salt.

You can't go wrong with DR Gross - he is exactly as advertised.

[blinky]

Go bilats!


At four months out, I am very pleased I did two in a week. I feel pretty normal now and am counting the days until those final restrictions are lifted and I can once again squat, lift more than fifty pounds, cross my legs, and, most of all, RUN. If I had done them separately, I would be looking forward to another surgery and recovery, not to normal life.


It is tough that first week, you will need help, but then it gets better. You figure it out and become more independent. And I will add that if you are bad enough off to need both hips done, you really don't have a good leg to rely on if you do them one at a time.


What do you do for a living? How much standing and walking do you do? I felt mentally clear at two weeks and could do sitting down work. I could walk and stand quite a bit at six weeks, but I didn't have work that required me to do that. I did need a cane at six weeks....was thinking of dumping it at eight-ten weeks, but didn't really leave it completely behind until twelve weeks. You are younger and may be in better shape than me.


I agree with Kingrob on the 90 degree rule. It isn't an issue at first because you don't want to bend. The last two weeks you want to, but are tight and stiff enough to be reminded not to. When you see Dr Gross, ask him exactly what you can't do; he is more lenient on some of those 90 degree related restrictions. (He is also very tall fwiw.) To get ready, yeah, get that toilet riser and claim your bathroom. Also put up higher the things you will need the most: food in the fridge you eat most, clothing you will wear most, remote controls and electronics (and the extension cords, if needed). You can more independent if you move the things you need within reach.


Good luck! I am excited for you to do this and get on with your life. Instead of getting worse and worse, you will be getting better and better.

[frankx99x]

I did a bilateral with Dr. Marwin who uses the anterior approach. No 90 degree rule, no restrictions beyond avoiding jumping or running until 6 months post surgery. It's been 5 months now and I am doing great. Was back to work in a little less than 4 weeks.

[Saf57]

Frank--glad to hear you are doing well. Just to note, Dr. Marwin actually uses a direct lateral approach. He, as you state, does not impose a 90 degree restriction.

[frankx99x]

yes, it's an anterior dislocation. I really should know more about it. How are you doing Saf? The whole experience at NYU was great except for one Dr. at the Rehab Center, who did not accept my insurance.

[Asalisbu]

Thanks for the replies. 

To answer the questions I am 6'5" tall maybe down to 6'4" with all the missing cartilage...bah du dum dum.   It does make sense that the 90 degree rule will be rather moot do to the pain you are feeling anyway.  I am also very curious about the fact the approach Dr. Marwin uses doesn't require a 90 degree rule be put into effect.   It begs the question as to the advantages or disadvantages on the approach for the recovery and outcome.   Does anyone have a clue about this......I don't know why but the 90 degree rule is stressing me out, probably unnecessarily but I am the type that will obsess about every jolt of pain as something I did and ruined the procedure. 

Blinky to answer your question (look at me talking to Blinky, been avidly following the Blink posts since Blinky was getting started with bilat exactly as I was diagnosed. I anxiously follow the updates to see how the bilat recovery stats are progressing like a kid looking to see how their favorite ball player did the night before.)  Anyway, again to answer your question I am in law enforcement for a living.  We do have light duty and I can get assigned to Desk duty during a recovery period.  I am in Senior Management so I eagerly anticipate when I can dump the desk and at can least show up on scenes for a few hours to stand around and look tough for my guys.  Dr. Gross said that he thought I could be doing that at six weeks but stressed for me not to chase anyone, which I told him is definitely not a problem.  At six weeks think this is possible?

Again thank you to everyone on this site for all of this........its so very useful

[blinky]

You make me want to go out and have more adventures and test the hips more! 


What kind of car do you have? I am not 6'5, just 5'7, but found a sedan to be the toughest car to get in and out of. SUVs and vans were easier because the seat was butt level. I could sit and then swivel my legs into the vehicle. However, with strong arms (especially triceps) and with legs more under your control (two weeks out?) you can do it handily. 


Back to a desk job? Okay, YMMV but it seems do able in 2-3 weeks, especially if you are a person who will get restless at home with nothing to do. Again, it depends, but I think  you could do some standing and walking and visiting of crime scenes at six weeks, probably with a cane, just in case, but without much limping. With the right cane you can look more bad ass than crippled. (FWIW I do enjoy people's expressions when they hear I did TWO hips at once.)

[MattJersey]

Regarding the stressing about every jolt of pain, I don't think you will avoid that so better to expect a lot. But despite many jolts of pain, things turn out ok. I stressed about the jolts a lot, and it is easy to really overdo the worrying, but all was unnecessary. I expect many if not most forum members would say similar.


So, expect many little jolts of pain, try not to worry, it's just the soft tissue. Pain that is sharp and longer lasting (hours or permanent) will warrant a call to the surgeon's office. Pain that is dull and lasts longer probably comes from walking too far too soon or something the day before and will probably fix itself in a day.


I'm 10 months out (single hip only) and all the little jolts and worry we're very much worth it.


Best of luck.

[Saf57]

Asalisbu--I believe that Dr. Marwin feels that the direct lateral approach obviates the need for a 90 degree restriction, although I think that there are doctors who employ a posterior approach--like Dr. Gross and most others--who also don't follow the 90 degree limitation. It seems to be, among these doctors, a personal preference. It is possible, with respect to Dr. Gross, that it has to do with the fact that he is using an uncemented femoral component, but I'm not sure of that. Perhaps others here can chime in. Frank--I just had my 6 month checkup with Dr. Marwin, and all seems perfect, was given the go ahead to resume running and jumping. I'm looking forward to playing hoops again shortly. You'll be there soon.

[JHippy]

Well I asked Dr. Gross about that and got the impression that it's a combination of avoiding dislocations and not putting too much stress on the injured tissue after surgery. He wants it all to heal well. And I see his point, why add a potential for complications for so little benefit. He told me he does close up the capsule really well (I know Dr. Su claims that's the reason why he doesn't feel his patients need the 90-degree limitation).

@Asalisbu: I worried about that too but in reality it's not so bad at all. I only had one hip done though.

[Saf57]

I believe that with the direct lateral approach, according to Dr. Marwin, there is no resection of the hip capsule, and it is entirely preserved. That, together with the fact that with a resurfacing you have a very large ball that likely won't dislocate in any event, suggest that a 90 degree restriction isn't necessary. Even with a posterior approach, with these excellent surgeons, I think the chance of dislocation is almost nill. Dr. Gross, I assume, is erring on the side of conservativeness/cautiousness.

[Asalisbu]

Hey everyone,


Thanks for the responses on approach vs 90 degrees.  In general it does come off rather moot as it does make a lot of sense that you won't feel like it anyway until right about the time the restriction is lifted.


So check this... I went to the Cleveland Clinic in Florida today to talk to an ortho about my knee and his general thoughts on the resurfacing of it and his opinion towards knees versus hips and what to tackle first.  I gave him MRI from December of hips and knees and he basically confirmed that the hips are thrashed and the knees have arthritic changes and maybe a meniscus tear which he didn't think was clinically significant.  I won't bore you with all of it but when I talked to hip about my plans to resurface my hips he basically said 40 year olds don't get metal put into them. He wanted to know why I was so determined and I told him I have read tons of info on HR and talked to two prominent surgeons and the appeal is FULL ROM and LITTLE to No ACTIVITY restrictions.  He physically scoffed at me.  I challenged him by saying I talked to one of your colleagues, Dr Brooks, at the Cleveland Clinic main campus and he just said he didn't know him.  He knew enough to reference the Birmingham Hip resurfacing but said it wasn't really done at the Florida facility.


He wasn't a bad guy but I was shocked that I seemed to know more regarding the outcomes and details of HR.  I told him I appreciated his opinion but I was likely pressing forward with getting this done as he suggestions was shots and medication until I could retire.   I told him I really was just here to ask about knee options and he did set me up with the guy who helped invent the arthro surface knee procedure who will be seeing patients here starting April.   What a mind trip........to be sitting in a prominent facility like that feeling like all the research and people and talks you talked two for past five months are completely wrong.   I told the guy to look up this site to see all the people who rave about the benefits of this. 




By the way I'm officially on for a bilateral in the end of July with Gross. I might call Marwin just to check availability.  That's a little bit longer then I thought I would have to wait and with my paranoid mind time and thinking and thinking and over thinking aren't my friend. 

[blinky]

The waiting is the hardest part. I scheduled my surgery date, then doubled back and got some second and third opinions and put my fears to rest.


Just one woman's opinion, but I think medicine is very decentralized in the US, for better or worse. Even with cancer, there had to be an effort to get best practices and best ideas out to all doctors (the comprehensive cancer centers we have now). Some docs as well as some patients have read about the bad results with metal and generalize them to all metal hips. Not every resurfacing doctor who gets good results publishes either. He is too busy treating his patients. (FWIW Dr Gross does speak at big ortho conventions and has even won a couple of awards. One local doc here had heard of him, but in a vague way---"some guy in NC (sic) who is getting really great results." )


The bottom line is that you are your own best advocate.

[Quig]

I agree, waiting is very hard. I'm almost exactly one month out and can't hardly stand it!


And, I too had a similar conversation with a local hip doctor who very nearly laughed at my questions about resurfacing. He told me it was "Old News" and sort of rolled his eyes. He patted me on the knee and smiled and told me he was going to put a metal on polyethylene hip in and we'd just simply go back in and change the cup(s) after I wear them out in 10 years! Seriously, he acted like me wearing out the implant and needing a revision was a foregone conclusion and totally no big deal. When I pressed him on the issue of resurfacing he did finally suggest that I was an excellent candidate. Needless to say, I didn't go back and have since pursued my own hip plan and this site has been invaluable.

[Saf57]

I have said this before----the traditional, entrenched orthopedic community has never, and will never, embrace resurfacing. Most orthos, even the top ones here in NYC, know very little about it, and are happy to dissuade prospective patients from getting the procedure. And we are now almost 15 years down the road from when the first clinical trials began here in the US, with overwhelmingly excellent results. Those of us who did our own research to discover that resurfacing exists as a viable alternative to THR are the fortunate ones, and we owe a debt of gratitude to Pat and others who have championed the cause. Asalisbu --I would never advise anyone to forego Dr. Gross--he did my first hip 13+ years ago, and is an amazing surgeon(and person). However, if the wait is really bothering you, Dr. Marwin is equally skilled, and I believe, from my experience with him, could get you in to surgery more quickly. In any event, best of luck to you!

[jd]

Asalisbu,

One thing you can do to keep focus is start working on strengthening while you wait for your surgery (if you can tolerate it). Push-ups and pull-ups will give you helpful arm strength for the post-op period. Side planks (and possibly side planks + side leg raise) will help a lot on your gluteus medius strength which I found key post-op. Core strengthening also wouldn't hurt.

You also have time to get things sorted out around your house in preparation for the recovery. Don't worry, the time will pass!

JD

[catfriend]

Regarding the 90 degree rule: While sitting and not breaking it is the first thing you think of, in my experience it's the daily living chores that would violate that are more difficult. For example, you won't be able to bend over and put dishes in the lower rack of your dishwasher, or put clothes in/take them out of a standard dryer. If you have animals and feed them on the floor, you won't be able to bend down to the floor. And on and on. You can deal with it, but it gets to be a grind. Also, as noted, just because your restrictions are lifted doesn't mean you can suddenly do things. At just past seven weeks I still can't tie shoelaces, or shave my legs, or push a heavy garbage can up and down my driveway. As for going back to work after two weeks, you may want to reconsider. In my case I would say that the narcotics had an effect on my mental abilities for two to three weeks, even after I was done taking them. Looking back, I can see that I was making little cognitive errors. As for getting back and forth to work, if it is your right hip being operated on you still may not be able to drive even if you are cleared to do so. I was cleared to drive as soon as I was off the narcotics. But I still couldn't move my right foot back and forth between the brake and gas pedals for several more days. Forget public transportation. You won't be strong enough to put up with the jostling and movement of a bus if you have to stand. If you have six weeks, take them.

[jd]

For the benefit of everyone who reads this, the 90 degree rule is a *lot* easier with a unilateral operation. Being able to kick out the operated leg straight behind you and bend down on the good leg means you can do almost all of the chores that catfriend mentioned. I actually don't know how you bilaterals do it