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Weight loss and relief of hip pain

Discussion in 'Hip Replacement Pre-Op Area' started by rider1960, Nov 4, 2011.

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  1. rider1960

    rider1960 Post-Grad

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    I have arthritis (significantly decreased joint space and large spurs on the femoral head and acetabulum) in the left hip and a lesser degree of degeneration in the right. The right has a moderate amount of pain, but the left is very painful, mostly in the groin. I can't do anything without a lot of pain--simply walking through my house is painful and sometimes I can barely move the left leg. I also have weakness and can't flex my knee up off the floor (while sitting) or off the bed (lying down) more an an inch, which to me is frightening. It's really getting to me and I can't do any activity that I used to like to do, such as ride my horse, go for a walk with my dogs, hike, go shopping at the mall, etc. Even walking to the restroom at work is difficult.

    I ran into a lot of misdiagnoses along the way and have been dealing with pain and dysfunction of this severity for almost 2 years. I just finally found an ortho who specializes in hips that finally attributed my pain to the hip--thank goodness! This was end of July 2011. I've had hip injections that gave me about 2 months of about 50% relief but they have worn off and a repeat one 2 weeks ago hasn't done a thing. I'm taking the max amount of anti-inflammatories (for 2 years straight) just to be able to do my basic life requirements and be able to keep working at my sedentary job--thank God I have a sedentary job, or I know I wouldn't be able to work.

    The hip ortho surgeon I've been seeing really IS very skilled and knowledgable and is considered by his peers to be excellent and one of the tops in his field. I believe he knows his stuff.

    The problem--I am significantly overweight and he has told me "lose weight or you are looking at bilateral hip replacements" and doesn't want to entertain a hip replacement surgery until I find out if the weight loss makes my pain go away. More specifically, he keeps telling me that if I lose at least 50 pounds my pain will be relieved.

    I realize I'll feel *better* after losing weight ... but I seriously doubt it will cause the pain to get *that* much better that I will be able to do everything I did before and basically be as good as new, as he keeps preaching. I've lost 7 pounds so far, but the weight comes off slow because I can't exercise to burn off calories--diet is the only thing I have to rely on. Even walking in a pool increases the pain to an intolerable level because it feels like there is a knife sticking in my groin with every move of the leg, whether I have weight on it or not (from the bone spurs, I'm guessing?). I feel like by doing this "wait and see" approach, which I honestly think is an unrealistic plan of action considering my degree of arthritis, I'm just losing precious time that I could be spending recovering from surgery and getting my life back on track and feel I should schedule surgery but continue to work on my weight loss during the wait time and get just it over with and get my life back. I have felt like this way too long already.

    I would like to know about others' experiences when they have lost considerable weight and if that lessened their pain and improved their function to the point where they could do active things again and didn't need the hip replacement. I know the arthritis itself isn't going to go away and the doctor certainly hasn't said that. I'm talking about how well you felt painwise and your ability to function despite the arthriits ... or did you still have enough pain and dysfunction to require the surgery.
     
  2. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Hello and welcome to BoneSmart. Sadly you've hit on one of those surgeons for whom weight is an issue. There are plenty of surgeons out there for whom weight is not an issue as they fully understand the connection between arthritis and weight gain. Actually, only this week I was reading an article in the Journal of Bone and Joint Surgery about this very topic. Someone had a done a survey and found there was almost no difference in outcome of THR between people of 'normal' BMI and those of 36+ BMI. Tis true there is a slightly elevated risk of complications like DVT and infection but it's not huge.

    As a matter of interest, what is your present weight - and your height? I've nursed patients with BMIs of 48+ and they do just fine.

    I think, the elegance of this chap's practice notwithstanding, you need to find yourself another surgeon who is more understanding.
    He's not the only pebble on the beach! :wink1:
     
  3. rider1960

    rider1960 Post-Grad

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    Hi, thanks for the reply and the welcome :)

    As much as I hate to admit my size ... I'm 5'4" and weigh almost 250 pounds. That puts my BMI pretty high, even after losing 42 more pounds.

    This surgeon is hard to read. He's very stoic. I don't think he is actually refusing to do the surgery if I don't lose weight because at this point he doesn't even want to discuss a hip replacement and keeps telling me that things will be so much better after I lose weight and he has set the magic "you'll feel better" number at a 50 pound loss. So, he's done the injections in the hope that that will make the pain tolerable while the weight comes off. He's presenting weight loss as a way to prevent surgery.

    Don't get me wrong, I know losing weight will decrease the stress on the joint overall and I am very willing to keep doing what I can to continue to lose weight until the date of surgery, which I can't have done until the Spring anyway for personal life reasons. I would feel better if it were just scheduled and this "wait and see" stuff was out of the picture--that just feels like "there is no end in sight" whereas a surgery in place gives me a goal to work toward--freedom from pain and getting my life back!!!!!! More incentive to lose weight to make the recovery better. I certainly would cancel the surgery if by some miracle I feel that much better by then. But, I just don't believe it's realistic to believe that losing 50 or even 100 pounds will make me (relatively) pain free and functional again and able to do the things I want to be able to do. I don't want to be sedentary forever. If anyone saw how functionally limited and painful I am now, they would understand why I have my doubts about weight loss making things "all better". I can't help but think he threw out the "you are going to have to have bilateral hip replacements if you don't lose weight" at the first visit to scare me into losing weight--you know, fear of having a major surgery. Actually, I was relieved to know that the pain was from the hip arthritis and having a hip replacement could take my pain away and get me functioning again! I'm not afraid of surgery--I *am* afraid of continuing to live my life crippled.

    At first he said I should lose 100 pounds in order to be fully functional again, but I pinned him down and asked him for a more realistic goal of what he thought was the minimum amount I would need to lose in order to be able to feel a significant difference in the pain. He then said 50 pounds. He said he believes in trying all conservative measures before doing a hip replacement, and weight loss is one of those measures. I truly believe we would be scheduling the hip replacement right now if I were closer to an ideal weight--there wouldn't be any more "conservative measures" to try.

    Other than being obese, I have no health problems--no high blood pressure, diabetes, etc, that would complicate surgery or recovery. I had an abdominal hysterectomy in January because a doctor thought that a fibroid tumor in my uterus was causing the groin pain (not!) and breezed through that. I was in the hospital just overnight and took care of myself from the first day home from the hospital.

    I do have an appointment to meet with another ortho to get his opinion, but that's not until December 2nd. It seems like so far off ...
     
  4. DallasSarah

    DallasSarah Post-Grad

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    Hello Rider,

    Your story sounds familiar! Don't get discouraged anybody and everybody always blames weight grrrrrr!

    After 3 years of hip pain that gradually got un-bearable this year and wait years of YOYOYOYO dieting this year was the year to FIX things and change. I was diagnosed with OA 3 years ago and basically given vicadin and some therapy but noone really talked me though what to get ready for, back then weight wasnt my issue. I had good months then bad months of basic pain. Fast forward to this year Jan I started to take anti-depressants adding to my already sleeping pills and tons of advil. Before I babble I did quit smoking October 2010 year prior (YESSS!!) by march I was packing on some weight the shrink Dr gave me another pill to help not eat?!? Pain was bad in my hip!! After a dear friends recommendation found new Ortho group and the wait lists were soooooooo LONG, however one of the older surgeons still practicing could see me, he no longer does surgeries but he could diagnose, prescribe drugs, injections etc. He changed my life because I walked in and said HELP me understand what is going on with me. I was ready for hip replacement, however we could try anti flamatorys, steriod injections under xray into my joint but basically this is a bandaid, I mentioned my weight he said wouldnt make a difference with pain the damage was done. He told me the only 2 things that might help is bike and swimming ease it a little. hang in with me add on the new pill regime by June just before my trade show in Las Vegas I had ballooned to 245lbs, I'm a taller 5'9. I remember packing for my show and thinking I've never taen so many pills before it scared me. I also took a nasty fall while walking my dog which again freaked me out. When I got to my show-job the opening day I spent in my room because of dizziness, dehydration I immediately threw away all my pills (not recommended) but I was fine. Kept sleeping pills only. When I got home had one more injection then went onto a 3 month wait list for the actual surgeon same group fo Dr's. My dr also talked to me about the phase of depression associated with the pain it all was making sense. 3 months waiting was so painful, however the smartest thing I did......1st YES I did go and see a lap band Dr when he told me I could never eat bread and my daily calorie intake would be a 1,000 per day I thought to myself this is silly I quit smoking surely I can control my calories. I called my Ortho dr's office and begged them for either a dietician, nutritionalist referal and BINGO the best investment ever. The woman has changed my life so right now 3 weeks before my surgery I am 35 lbs lighter not taking any prescriptions and feeling mighty good!

    I dont want to sound like a hypercrit, just over a year ago I was a pack a day smoker for 32 yrs and basically a walking train wreck, not that unhealthy but not taking care of myself. The 35lbs I just lost (I'm laughing right now) I literally cut out all the fake food, starches and oyyy I do drink a gallon of water a day which I hated at 1st but love now!! I sleep well, my skin is glowing. I eat veggies, protein, mostly no diary, no sugar, no carbs. Basically lots of great spinach omelettes for breakfast loaded with mushrooms, tomoatoes and goat cheese, salads, chicken etc, first few weeks little tough hardest part is planning. I dont exercise its a mental thing plus I hurt. Wow I've babbled!! The weight is important for the recovery phase and I do believe to loose the weight it will help preserve the new hip. I agree or trust my Dr's who never once said my weight was an issue so there are Dr's out there can see we have hit a brick wall and it sucks! I think to take a proactive approach to your weight will help build your confidence, dont think of it as 50-100lbs try the slow route of 2lbs a week it works I promise.

    Thats my BIG tale tonight. I'm a happy optomistic creature by nature, however I will never deny this has been a crappy, painful, discouraging journey once you find the right Dr it gets better really! Then you can work on fixing things!!

    Night Night!

    Sarah

    PS I'm a horrible speller so if typos sorry :)
     
  5. DallasSarah

    DallasSarah Post-Grad

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    PSS - babbled about pills because this adds to the weight, thats why I'm proud of my new eating routine and now not taking any pills I didnt think of this 3 months ago but now and here's some humor to throw in my thought is I'm pretty healthy not taking pills so those great pain meds are going to work on me like a charm (hahahahah sorry couldnt resist that) Even if you drop 5-10lbs you will feel amazing! Yes I do also cheat when I travel for my job I just chowed down on the bestest chocolate deserts ever, however 95% of my routine is healthy. This lady who helped me also weighs me bi-weekly. Its like having a personal trainer but for eating. I'll pause for now I just get pasisonate because I know its very discouraging when you hit that point of no return!!
     
  6. rider1960

    rider1960 Post-Grad

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    Sarah, congratulations on all the life changes you have made!!!!! GREAT!!!!! And, best wishes for your upcoming surgery.

    I'm not clear about something you wrote, though--Did the 35 pounds you lost make the pain significantly less (my question mark key isn't working...) I'm fine with losing weight (and I have lost some so far) and I will keep doing this even if my surgery is scheduled--I know I'm too heavy and I don't want to go through a recovery from surgery with extra weight on board. But, I'm wondering if the weight loss really does have that much of an impact on the pain level--is it reasonable that my pain will be pretty much gone if I lose considerable weight like my surgeon is suggesting (again, my question mark key isn't working ...)
     
  7. DallasSarah

    DallasSarah Post-Grad

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    Sorry!

    My current dr's felt weight loss would not have much of an impact on my bone to bone damaged hip! My loosing the 35lbs since June had been a personal choice knowing I was heading down surgery path. To date has the weight loss helped mmmmmmm maybe by 10-20% yes hard to say, I also had a injection maybe 3 weeks ago. Does the weight loss feel good YES! I think weight loss has other benefits not just cosmetics. You just move & feel better. To make a choice now while waiting or looking for a surgeon you can only feel better.

    I do hope you find a dr who will offer surgery without mentioning your weight!!
     
  8. DallasSarah

    DallasSarah Post-Grad

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    More thoughts because I'm bossy plus being on this website reading lots armed me with questions.

    I would go back to your current dr and ask him point blank would he perform surgery now? If he says no ask why and get specifics plus is he confident that if you loose weight the pain would stop? I'm not a dr my gut tells me the weight wouldn't stop bone to bone pain, logically it doesn't make sense if the hip is that damaged, plus this isn't a reversible condition!

    Josephine is the expert on medical things!

    Your in my thoughts
     
  9. rider1960

    rider1960 Post-Grad

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    Sarah, thanks so much. I appreciate your advice and posting about your experience. I can feel your happiness and enthusiasm about the changes you've made and that you are feeling better--and you will feel even better after your surgery. :)

    I definitely am going to talk with my current ortho about "will you do the hip replacement or not" next time I'm there. I hadn't done that because the injection had been holding me enough that I was willing to be patient and see if his "lose weight and you will feel so much better" approach would actually work. Now that the injection wore off and the recent one didn't work and I'm in more pain again, I don't feel quite so patient.

    My situation has been so frustrating overall--it took me over a year to get a correct diagnosis and then losing more time while I work on weight loss, testing out injections and medication changes. I feel that my life is ticking away and I'm not able to live it.

    I think back on what the whole process has been like and just can't believe it--it really makes me question the competency of our medical providers.

    Even though I am currently frustrated with my ortho, he is the first doctor I saw who was able to correctly diagnose the problem (he said it was "obvious and very clear") and try something to get me some relief. I'm very grateful for that. Prior to that, I had been through the mill with incorrect diagnoses and treatments for conditions I didn't even have. I am still amazed that no one made the connection of groin pain to the hip, since I've found that groin pain is a classic symptom of a hip problem.

    It wasn't until I was misdiagnosed with fibromyalgia and told that I was just "going to have to live with the pain and that it's up to you how you chose to feel about it" that I said enough is enough and set out to *finally* find a competent doctor. I just knew the type and location of my pain couldn't be from fibromyalgia.

    In general--this pain and trying to get the best plan of attack against it gets really old after a while, as I'm sure many of you have or are experiencing. I look forward to finally getting a resolution.
     
  10. Tykey

    Tykey Forum Advisor

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    I think you need to make your own judgement, rather than rely on reputation, and judge by what you see with your own eyes. They are very good at creating an image. I still remember a doctor Shipman in the uk, who had a wonderful reputation, yet murdered about 300 of his patients.:hate-shocked:

    It seems highly unlikely that losing 50 lbs will stop the pain, doesn't it. At best you might expect it to ease just a bit. As Judge Judy would say "If it doesn't make sense, it's usually not true:biggrin:"

    If it was me, I'd find another surgeon.
     
  11. plinej

    plinej Member

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    rider1960 Your history sounds a lot like mine - started having problems 2 years ago (bone spurs on both acetabelum and femur with slight thinning of joint space). I would have pain like razor blades cutting through muscle with certain movements and groin pain. A year later, moderate OA, now severe bone on bone. 2 bouts of PT and 2 rounds of injections with only slight to moderate relief. Doctors didn't even consider surgery until it got to bone on bone and then not really pushing it - I really hate that they leave so much of the decision making up to you!!! Anyway, my surgeon commented on my weight (I was only about 25lb over, mostly put on when I stopped being able to exercise). I am 5'0" and 144lb now, having lost about 9lb so far. I have been doing a lot of Lean Cuisine and Healthy Choice meals (help me a lot on portion control - I get them on sale and try to get the healthiest ones). The weight is coming off very slowly but it is coming - hope for another 10. I don't think that the weight loss will eliminate the pain, as has been said the damage is already done, but it should help with the recovery and general good health.

    DallasSarah, your healthy life changes are inspiring!
     
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  12. redbedhead

    redbedhead Member

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    I can totally understand where you are coming from. I have Severe Psoriatic Arthritis, and a HUGE weight problem. I had 4 knee surgeries (Orthoscopic) to clean out the arthritis and make the pain better between 1996 and 2003. at that time I was told I would need both knees replaced probably within 10 years, and that my surgeon would not do it unless I weighed under 300 pounds (At that time I weighed 325 and was 5'6") I did not loose weight instead I GAINED up to 363(while on weight watchers, and Jenny Craig) and developed more arthritis in hips, shoulders, and elbow, as well as knees. I finally decided to do something about the weight and the something I chose was Weight Loss Surgery (NO it is not for everyone and i would not necesarily recomend it, but it is an option if you want more info private message me)

    I had that Surgery on 10/14/08, lost 180 pounds, BUT DID NOT HAVE ANY SIGNIFIICANT REDUCTION IN PAIN FROM THE ARTHRITIS! I had 2 more othroscopic surgeries on my knees in 09, and found out last august that i needed both hips and both knees replaced. Had my first hip replacement on 10/5/11 and it feels so much better.

    IF this is the surgeon you WANT, then you will have to loose weight to get him to do the surgery, but you should be able to find another surgeon who will work with you even at your current weight.
     
  13. rider1960

    rider1960 Post-Grad

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    redbedhead wrote: "IF this is the surgeon you WANT, then you will have to loose weight to get him to do the surgery"

    -----------

    Actually, he hasn't said he *won't* do surgery if I don't lose weight. The closest he's gotten to discussing surgery at all is at the tail end of an "if you lose weight, your pain will be a lot less and you probably won't need surgery" talk, he has tacked on ... "And even if it doesn't relieve the pain enough and you need surgery, it will be less complicated and an easier recovery if you weight considerably less". I understood that last statement to mean that he was OK with doing surgery at my current weight--if he absolutely had to and I couldn't stand the pain any longer.

    He doesn't talk a lot and doesn't elaborate on things. I'm a very verbal person (can't you tell by the length of my posts :snork: ) As I type my concerns about this situation here, I realize that I really need to pin him down and tell him I need more explanation about where he stands on doing surgery on me. Maybe until now I had been buying into the "your pain will be controlled by weight loss" theory of his and didn't want to dig deeper into a surgery discussion. Now that the injection has worn off and the repeat one hasn't had much effect, things are different for me and I'm thinking "just chop this bad hip off and be through with it!!!" So all these questions and concerns are coming up that I was willing to wait on previously.

    This board is great for hashing out what is going through my head. Glad you are all here to help me.:friends:
     
  14. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Okay, so he's being stoic whilst you are in pain! Nice, compassionate doctor - not!

    Here's a suggestion we sometimes make in these situations: you need to make a list of all the things that, in an ideal world, you would enjoy doing, the things you need to do and the things you have to do. Then cross out all those that you can no longer do or find very difficult to do because of this problem. Then show him the list and tell him this is why you want your hip done now!

    Things you should add include the following


    Personal hygiene and grooming
    Sleep
    Dressing and undressing
    Self feeding
    Functional transfers (Getting from bed to wheelchair, getting onto or off of toilet, etc.)
    Bowel and bladder management (getting on and off the loo easily)
    Ambulation (Walking without use of use of an assistive device (walker, cane, or crutches) or using a wheelchair)
    Housework
    Shopping for groceries or clothing
    Transportation within the community - driving or using the bus
    Care of others (including selecting and supervising caregivers)
    Care of pets
    Child rearing
    Health management and maintenance
    Meal preparation and clean up
    Safety procedures and emergency responses - like if there was a fire in your house or someone collapsed or had an accident, would you be able to help them or call 991
    Don't forget to add personal enjoyment activities like walking, swimming, sports - you get the picture.
     
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  15. sheryl7

    sheryl7 Graduate

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    Hi I am from the knee side, but thought I would visit the hip side, as my left hip does bother me as well as my knees, any i am all for losing as much weight as you can be it before the surgery or after. I know i need to lose about 60 lbs to be a normal for my height range, i am your height and 200 lbs.
    However i still think a surgeon should do the surgery even at our weight. I know that if i were to at the very least have my left knee replaced, I would be after recovery alot better at working out as will be less pain. i would assume that would be the same for you, you would be able to lose weight easier and faster if you were in no more pain, or alot less of it.
    I know with my knees they have been messed up my whole life, but he pain has gotten unbearable in the past 8 yrs and i was very thin 8 ys ago, and then the pain kept getting more and i was able to work out on less and less, and through lack of excericies from the pain, i packed on the pounds. I have went from 110lbs to 200lbs which I attribute to lack of exercise, and of course not eating exactly the proper foods, but i think the lack of mobility was the most significant cause.
    So i guess what I am trying to say, in your defense to your doctor, you could say I feel without the pain of the hip I would have more energy and ability to exercise if the thr was done sooner then later. good luck to you, hope you choose the best os for you and your circumstances. Take care...Sheryl:thumb:
     
  16. Aileen

    Aileen Junior Member

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    Hello Rider, I think I can sort of answer your question.

    Early this year I inadvertantly lost almost the amount of weight you need to lose due to gall bladder, pancreaititis problems. I went from 161 lbs down to 116 lbs. I'm 5' 5" and trust me it wasn't a good look. Positively skeletal !

    Did it make a difference to the pain in my hips, absolutely not. If anything it was worse as the damage had already been done and had obviously progressed further over those months.

    Hope this helps a bit :)
     
  17. DallasSarah

    DallasSarah Post-Grad

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    I love the list - its a shame the dr's don't include these questions in their packets!

    I'm no poster child for healthy living plus have 35lbs more to loose. I just feel more in control & happier it took me a while to get it :)

    My big takeaway today regardless of your situation this is definitely a personal choice! I just love knowing I'm not alone and there are lots of people out there in tougher situations!
     
  18. rider1960

    rider1960 Post-Grad

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    I love the list idea too. I thought about all of those things and thought "I can do most of those things", but then I put it into perspective and realized that although I can do most of necessities of daily living, many things are difficult and I guess I've just gotten used to things being difficult and many things I want to do, and used to do, are not possible now. Kind of a sad thought ...

    I've been thinking more about my current ortho. It may be time to change orthos. He was great when I first started seeing him and I was very grateful that he was the first person who seemed to take my pain seriously and came up with a diagnosis that finally made sense after going so long undiagnosed and not knowing why I was hurting so bad. Last visit, though, felt like "Oh, she's here again complaining about pain ..." Maybe I'm reading too much into it, but that's how it felt. I have a follow up appointment scheduled with him in mid December and an appointment a week before that with a different ortho. I'll let you know how things go.

    My injected hip is feeling a little better today. I hope that means that the injection is finally kicking in. That would be such a relief. Although it doesn't take the pain away, it knocks it down to a more tolerable level.

    Thanks again! Just talking things out here has really helped me become more clear about things and your input has also been very helpful. Glad I found this site
     
  19. haldox

    haldox Post-Grad

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    Im with Aileen, sure weight does affect lots of things but if your hip is so far gone its not going to matter whether you weigh 5 lbs, that evil pain will still be there.

    If you feel your current OS is just brushing you off, please find another one. I just cant think that pushing the "lose weight, you;ll lose hip pain" is even humane(more like an ignorant remark)!!I do understand how some OS's arent comfortable performing surgery on an overweight person but at the same time, Im thinking a lot of overweight people wouldnt be overweight if their hips/knees werent in pain.
     
  20. Jamie

    Jamie Administrator

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    Hi, rider.....you've received excellent advice and it sounds like you are carefully analyzing your options. So many overweight people have had successful hip replacements, that I just hate seeing anyone lose precious days and weeks on a surgeon who insists on weight loss first. I think your idea of some straight talk with your current surgeon plus getting another opinion is right on track.
     
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