When to have surgery?

[captainahab]

 I'm new to the discussion.  I've had a "sore" hip for over 10 years, but was always able to bike, hike, swim, and generally be on by feet all day every day.   Last year after an 80 mile backpacking trip, the right hip started to really hurt.  Still I didn't limp, but I stopped all the exercise I had been doing to get ready for the aforementioned hike.  I was climbing steps for hours and walking 15 miles with a pack.  Maybe that was too much, but this year it seemed to catch up.  Since it was hurting I started to swim instead.  The hip hurt so much worse!  The kick of the side stroke and that same kick as I swam overhand made the symptoms much worse.  Stopped that and the symptoms got  better.  Radiographs say my hip is bone on bone.  I have trouble tying my shoelaces.  Putting my right ankle on my knee is pretty limited and sometimes very painful.  Lifting my foot off the floor and to the gas pedal in the car sometimes hurts.  All that but then some weeks everything seems fine.  I'm 67 and always been active.  Are there certain symptoms or tests that definitely say "Get your hip fixed!!"  Or is it just up to me to do when ever I want.  It would seems keeping my natural hip as long as possible is desirable, but then I am getting older every single day.  Just retired and want to do things besides be laid up with the post-surgery months of rehabilitation.  I need advice or encouragement on what others have done with similar decisions to make.

[blinky]

I think you are ready. Time to start interviewing doctors.


Your X-ray shows bone on bone, you can't do things you love, you are beginning to have trouble with everyday activities. And you are 67.


The only piece you are lacking is having pain interfere with your sleep. Don't wait for that symptom!It won't spontaneously get better on its own.


(From someone who waited too long. Age 53, but it hurt all the time and I had trouble sleeping. It wasn't a horrible pain, more of a low level simmering pain, but it was with me all the time. My BP was climbing up, I think due to the pain and drinking coffee to combat the lack of sleep.)

[moe]

Your symptoms will only get worse if you are bone on bone. If you wait too long you may not be a candidate, at your age it may already be too late. I believe some surgeons have an age restriction now. Get it done and get on with your active life. If you can't get a BHR a THR will also help you.

[captainahab]

Interviewing doctors?   I thought if they have did 3-4000 hip resurfacings they probably have this down pretty good.  I've followed surface hippie site for the past 10 years.  Mostly I read of Dr. Gross in South Carolina, but then heard of Dr. Brooks in Cleveland Clinic Complex.  Both have good results and both have thought I was a candidate for the surgery.  What interview process do you suggest?

[blinky]

That's it. Read up on them. See who looks good to you. Contact them and see if you are a candidate. See who takes your insurance. Figure out when and how you will get to them if you don't live close by.


If you aren't a candidate for HR, then start the process with other orthopedic surgeons. That will look more like an interview as you won't have this resource to pre screen them and so you will have to go to them and ask them questions.

[hernanu]

I'm new to the discussion.  I've had a "sore" hip for over 10 years, but was always able to bike, hike, swim, and generally be on by feet all day every day.   Last year after an 80 mile backpacking trip, the right hip started to really hurt.  Still I didn't limp, but I stopped all the exercise I had been doing to get ready for the aforementioned hike.  I was climbing steps for hours and walking 15 miles with a pack.  Maybe that was too much, but this year it seemed to catch up.  Since it was hurting I started to swim instead.  The hip hurt so much worse!  The kick of the side stroke and that same kick as I swam overhand made the symptoms much worse.  Stopped that and the symptoms got  better.  Radiographs say my hip is bone on bone.  I have trouble tying my shoelaces.  Putting my right ankle on my knee is pretty limited and sometimes very painful.  Lifting my foot off the floor and to the gas pedal in the car sometimes hurts.  All that but then some weeks everything seems fine.  I'm 67 and always been active.  Are there certain symptoms or tests that definitely say "Get your hip fixed!!"  Or is it just up to me to do when ever I want.  It would seems keeping my natural hip as long as possible is desirable, but then I am getting older every single day.  Just retired and want to do things besides be laid up with the post-surgery months of rehabilitation.  I need advice or encouragement on what others have done with similar decisions to make.

I'd say all of the symptoms you listed are really good indicators.  You've also had some respected surgeons tell you that you are ready.


Human beings seem to be able to get accustomed to some incredible things. I was bone on bone as well, and progressively cut down my athletic activities from


tae kwon do, league basketball, weights, soccer
to
league basketball, weights, soccer
to
weights, soccer
to
weights


I had an excuse for each, but it really was the pain, and in the case of soccer, my left hip started to dislodge from its moorings. That's right, I was dislocating my hip several times during a game (I'd pop it back in).


Stubbornly, I clung to what I was doing because I didn't want to do surgery. Once I got both of my hips done (three month interval), I did therapy, worked out and was fully back to all five sports (no more league BB, though, just regular) and progressing.


It's your call on when to do the deed, but I can tell you it's an incredible relief mentally, emotionally and physically when you do. Bone on bone is a good time to do it.

[tommyhip]

It's time to get it done!!. Your age may be an issue - if not now sooner than later. A Dexascan will tell you if you are still a candidate. The BIGGEST issue is this: Resurfacing unlike "Total Hip" cannot substantially change your post-op leg length - so with the cartilage gone already combined with any additional wearing away of bone due to the grinding your operative leg is likely a bit shorter already. So get it done. I was a lifelong athlete in all sports and I just did. I have no regrets post-op. The last decision you need to make is -Should you have a cemented femoral component or uncemented?  I researched this issue EXTENSIVELY and for me (my two cents) I chose to go uncemented. That leaves out BHR. I went to Dr. Gross in Columbia (Biomet) and the results were fantastic!!  He believes - and only time will tell - that cement may become the weak link in the femoral component down the road and may result in early failure. It would be a shame to have an implant that would otherwise last for years fail early due to a cement failure. Cementless with proper bone ingrowth seems to be the future. Just look at the NEW H1 ceramic in England - it also is a cementless install. Good luck.

[LMS]

When it gets to bone on bone, you are ready.  As to resurfacing or THR, it'll depend on the quality of the bone & probably other factors.  At your age, don't be surprised if they recommend a THR, which is fine.  That's what I had to get as my bone quality wasn't there anymore to qualify for a long lasting resurfacing.  I was 57 when I got the THR.

[Maureen]

I'm new to the discussion.  I've had a "sore" hip for over 10 years, but was always able to bike, hike, swim, and generally be on by feet all day every day.   Last year after an 80 mile backpacking trip, the right hip started to really hurt.  Still I didn't limp, but I stopped all the exercise I had been doing to get ready for the aforementioned hike.  I was climbing steps for hours and walking 15 miles with a pack.  Maybe that was too much, but this year it seemed to catch up.  Since it was hurting I started to swim instead.  The hip hurt so much worse!  The kick of the side stroke and that same kick as I swam overhand made the symptoms much worse.  Stopped that and the symptoms got  better.  Radiographs say my hip is bone on bone.  I have trouble tying my shoelaces.  Putting my right ankle on my knee is pretty limited and sometimes very painful.  Lifting my foot off the floor and to the gas pedal in the car sometimes hurts.  All that but then some weeks everything seems fine.  I'm 67 and always been active.  Are there certain symptoms or tests that definitely say "Get your hip fixed!!"  Or is it just up to me to do when ever I want.  It would seems keeping my natural hip as long as possible is desirable, but then I am getting older every single day.  Just retired and want to do things besides be laid up with the post-surgery months of rehabilitation.  I need advice or encouragement on what others have done with similar decisions to make.

A few comments:
1)  You will  likely not be "laid up" for months with post-surgery rehabilitation.   I had my surgery 8 days ago and have been walking (with crutches) every day since.  Yesterday, I did about a half mile with one crutch and zero hip pain!   I definitely have bruising, swelling and soreness at the incision site but from day one that has been for me a much much lesser pain that what I was trying to hobble through on the bone on bone hip!   Of course, the level of activity and speed of recovery are based on individual conditions (a Dexa scan would inform where you would be placed on the fast or slow recovery protocol from Dr Gross anyway)
2) there is a point that is too late for HR.  I needed some bone grafts to fill in holes in my bones from waiting too long.   Not sure how much more damage I could have done and still been a candidate but it would have been sad to go into surgery and find out I had waited too long and done too much damage... 
3)  The one person I talked to beforehand said that he had been unable to tie his socks and shoes when he had his first hip resurfaced (10 years ago) but when his second hip started to fail, he made the appointment immediately because he KNEW how much better it would be!   It was comforting for me to hear :-)
Good luck with your consult(s) and keep us posted!
Maureen

[imgetinold]

I agree with other posters...GET IT DONE if you are a candidate.  Bone density could be an issue, but easy to measure.


I was 44 when I had mine done.  I hadn't stopped doing much, but paid for it every time.  If I did nothing, I had little pain.  If I, say, played tennis, I would hobble for days and lay awake at night because of the pain.


So, I thought to myself: If this only lasts 10-20 years, after which I have to be less active, do I want to do that at age 64, or 44?  No brainer.  I'll do it now, and pray that in 10-20 years the technology is even better.  Best thing ever.  No pain.  If it were me, I would do it now and enjoy being pain-free for the next 10-20 years.

[captainahab]

      Thanks for all the replies.  I'm currently booked with Dr. Brooks at Cleveland Clinic.  I do wonder about the different techniques- glued vs glueless and the different implants used.  But there is certainlly more than one way to do every job.  Dr. Gross and Dr. Brooks have did a lot and surely both are trying to improve all the time.    I'm hoping it can last 15 plus years.  If so I'll be pretty inactive by then.  My knees are also an issue.  Do they get twisted pretty well when the hip is dislocated for the surgery?   Is that an issue to even think about, as they have to twist the leg to move the head of the hip.   Anyway thanks for all the replies and I'll talk again during the recovery.   

[ArthriticHip]

Hi Captain - I had my left hip resurfaced by Dr Brooks on 2/26/18. My 6 week check up is next week. I've had a good recovery to this point. Hip pain is gone, dealing with re-building the leg muscles both from the surgery, and from inactivity for about a year prior to surgery. As you may know, Dr Brooks recovery process is very conservative - 75% weight bearing with 2 crutches for 6 weeks, then a full year with no running or high impact activities. Dr Brooks' mentality is that you will still see healing/strengthening in the bone for up to a year, and why return to high impact activities prior to when your bone will be at it's absolute strongest. I did ask Dr Brooks about the cement used in the femur cap, and asked if there have been reported problems with that coming loose, and his answer was reassuring. He said that of the 150,000 or so of these implanted devices, there have been ZERO reports of problems with the cement. He said that there just hasn't been any evidence to show concern is warranted. Good luck, you are in great hands with Dr Brooks.