acetabular protrusio

[30something]

I am a 39 YO female with a couple issues going on with her hip. I have acetabular protrusio bilaterally with the left hip remarkably worse versus the right. They believe it was a congenital defect that I never knew until about 2 years ago when they found it. I have had issues with this hip off/on since my twenties but mostly bursitis type things that once had to be treated with cortisone. Some days I can walk on it without much grief and other days it just aches and hurts to bear any weight. My lower back is stiff and unable to flex and I am constantly trying to do stretching exercises for it. I had an arthorgram/MRI done about 9 months ago which showed joint space narrowing, fissures, and erosions on the surface. They joint was so narrow they could only get 1/3 of the dose of contrast in the joint space- the rest just kept coming back out on my skin. Yep have mild to moderate OA of the hip. I also have been diagnosed with OA of the inner left knee and inner left ankle. I am assuming this is all related. I have a leg length discrepancy. So I have been to a rheumatologist and a OS. My rheumatologist has told me I need a hip replacement and pretty soon. The OS looked at it and told me to come back when I was ready for surgery(as I am not sure what the magical sign is that tells you that you are ready). The RA MD will not give me cortisone shots into the hip- he says they are a waste and will not help(not that I would want them).

I guess I am not sure what to do. Currently I am taking piroxicam and Ultracet. Living in PA, this time of year brings on the cold, damp weather. I think I am past the revision of the hip repair at my age. My one concern is the leg length discrepancy- will it get worse? I choose not to wear a heal lift at this point, but probably would benefit.

If it stayed where it is currently- I could probably manage. I keep saying that though and I am not sure some days if it is worse or not. Except that it is waking me up every night now(3 am like clock work). I am just not sure how much worse it will get and the fact I think I am making the knee/ankle worse maybe trying to compensate for the hip has me concerned. But even if I do have the hip done- will I still have issues with those? Its like playing dominos- when one starts to fall they all do. I am not sure of the recovery time and how long I would need to take off work- that’s a major concern. I have PTO to cover about 7 weeks, but I can’t be off for long.

I know that nobody can tell me what to do and honestly I don’t know what questions to ask. There are a lot of fear of the unknowns and part of me says “keep the original parts” at least I know what I am dealing with. Then there is the part of me that thinks- if it could be better why not? I just don’t want to go through it to not have anything resolve. Sorry for the novel. J

 

[Poppet]

Hi 30something, welcome to your international BoneSmart family... Yes you have an extend family of happy hippies and soon to be happy hippies..

It is always a difficult decision, most of the time it is classed as 'elective surgery' and the surgeons say come back when you are ready.. I think one is ready when your quality of life is being altered by consistent pain, sleep issues, having to change or modify our activities to accommodate pain, stiffness or discomfort.. but in saying that it took me 8 years to decide... not a good decision for me, waiting caused more issues surgically..

I am now a strong advocate for hopping in and getting shiny new hips that give me back my dignity and quality of life and above all faith in my future to be able to participate in life rather than being an onlooker...

If your OS considers you need a THR, I would suggest going for it.. Pick a good surgeon who performs at least 200 - 300 THR's a year and put your faith in that...

Once again, great that you have joined and welcome

 

[sharonslp]

Hi 30s, welcome to the dilemma we all faced, regardless of age. How do you know when you're ready? Probably anywhere from 2 - 5 years before you think you're ready. Really, many of us dither over this, finally have it done, and then say....I waited _______ years too long.

Somewhere along the way, the realization occurs that your life has become awfully narrow, and is too much controlled by this darn hip. We worry about whether the THR will resolve ALL our issues, or what we still might have to deal with. We accept the current known pain out of fear of the unknown.

But here's the thing....so MANY of us have now gone into the unknown, and come out the other side saying....Wow! I should have done it sooner! It's a pretty safe bet that the surgery will improve things for you. Everything??? Probably not. But enough to make a huge quality of life difference? Probably yes. You may have to deal with the other hip down the road, maybe your knees, but at least the first hip will be done and out of the way.

So if you think you MIGHT be ready, you probably are. Seven weeks off of work is cutting it pretty skimpy....depending on what you do, and depending on how easily you recover. I was a teacher....seven weeks would have been very difficult for me to return. But I was also a counselor....that I could have done. How much flexibility do you have at work to get up and stretch and walk around, or conversely to sit and rest? We have folks here who return to work before a month is up...and others who beg for 3 months. Sometimes we feel ready physically, but there is still a fatigue factor, mentally and physically, that can linger for several months. On the average, if all goes well, 8-12 weeks is the recommendation, if you can possibly spare that much. If you can't....you do what you gotta do.

The LLD....how much of a discrepancy? A lot of times the surgeon can correct it during surgery, so it very well may get better, not worse. What does your surgeon say about it?

Keep reading the boards here...pre op and recovery. Read articles in our library...they will address a ton of questions you never knew you had. (Click on Library tab at the top middle of the page....go to Library Index). Come back and ask more questions. Do your thinking "out loud" here on the board. We'll stick with you through all your decision-making, and eventually....through your surgery and recovery...whether it's soon or whether you wait. Don't wait TOO long....this stuff doesn't get better on its own, and it can get worse suddenly and drastically. Of course...then you know.

Sharon

 

[Josephine]

I know that nobody can tell me what to do and honestly I don’t know what questions to ask. There are a lot of fear of the unknowns and part of me says “keep the original parts” at least I know what I am dealing with. I am just not sure how much worse it will get

But that's the point you will never know what you are dealing with as arthritis is a progressive, degenerative condition and the only way it progresses is to worse, worser and horrendous! The worst case scenario is the femoral head extruding through the acetabular floor into the pelvis. What is known as a central dislocation as this one is just mm from doing. Trust me, you do NOT want to go there.

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and the fact I think I am making the knee/ankle worse maybe trying to compensate for the hip has me concerned. But even if I do have the hip done- will I still have issues with those?

Not at all uncommon but that will improve once you've had the hips done.

I am not sure of the recovery time and how long I would need to take off work- that’s a major concern. I have PTO to cover about 7 weeks, but I can’t be off for long.

It's a problem for sure but think of it this way - if you leave it and the arthritis gets so bad you can hardly get out of bed much less walk, then you won't have much of a choice, will you? So how much do you want to avoid that and how much are you prepared to invest in yourself and your health and well-being? After all, it's only going to be for a few weeks - 10 at the most with any luck. It could be more if you need to have reconstructive bone grafting of that acetabulum and if not, could be less. There's no way to know until it's done. That might seem like a long time from this side but in a few months time you will realise that it's over and done with very quickly and what's more, that it was worth it!

 

[30something]

Thanks guys! I am a RN- so I am good at giving the advice but I am not good at taking it. My specialty is not orthopedics and I do not run around acting like I know it all- I dont. Thats why we do have the specialties or folks that know one particular area well. I prefer to work in long term care- I have had offers to work in the hospital and my heart is just not there. I am a Director of Nursing for a facility in PA. I am a nurse, but I can do office work and not be on my feet all day. I have been told I probably would not be able to go back to floor nursing with the hip the way it is. SO some of it is that despite the fact that I am not floor nursing now- the idea that I may not be able to go back, is hard. I never thought I would be in administration for ever. I feel locked.

As far as the LLD- its about 1 to 1 1/4 inches different which was taken about 10 months ago. They did size me for a heel lift-gave me the script and it wound up in my car never to be seen again. Lately though I have noticed it more when I walk.(but then I limp more too).

As far as my activity level- its getting worse. My 19 YO will ask me if I am up for doing things with him. We had to go on a college tour and the walk across campus started to take its wear. After the 45 minute drive home I could hardly get out of the car. But once I move it eventually goes away. But I know in time it will not. I used to love shopping, but a trip or two around the mall is about all I can handle so I dont generally go out all day.

I know I have read ICE ing the area and generally agree. Any thoughts with someone with Raynauds and an intolerance to cold. My feet/lower leg actually gets numb when it is cold out and I have to put feet warmers in my shoes. My fingers/hands get cold too. So I generally stay away from the ice.

I am shy and introverted, but I have read alot of posts on here and have found them extremely helpful. I have been able to answer a few of my questions by reading the library articles and others experiences. Thanks for the help and resources.

Thanks a bunch!

 

[sharonslp]

The Reynaud's would make icing a questionable practice. What does your doctor say? Worst case, you don't use ice and your swelling doesn't go down as quickly. Would ice be a problem if someone else applies to the area needed? So your hands and feet never touch it? Ice is very useful, but I don't see it as a make-or-break issue. Jamie, Jaycey ....what do you think?

Sharon

 

[Josephine]

I agree. Don't ice if you have Raynauds. tut tut, nursey - you should know better than that! But a big welcome to BoneSmart. We've had so many nurses on here I was thinking of creating a nurses only forum! (just kidding) Here's some articles you might find helpful during your recovery.
Pain management and the pain chart
How Long Does Healing Take ......
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy Drain for THRs
Elevating your leg to control swelling and pain
Activity progression for THR
Some suggestions for home physio (PT) and activity progress
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds


But I had to chuckle when you said about your young colleague asking if you were up to doing things with him! When I was working in the hospital (about 63 at the time) a young male nurse stood and watched me entering stuff on the theatre computer and then said (somewhat patronisingly) "Aah, that's nice." I asked what was nice and got the reply "That you're learning to use a computer at your age"! I asked him old old he was and he said 30, so I informed him that I'd had my first computer when he was still at junior school! Cheeky varmint! (but a sweetheart with it!)

 

[Jamie]

Hi and welcome to BoneSmart. I see you've already met some of our members and have some reading to do. Jo is right.....we have had LOTS of nurses on the forum over the years. Typically they are so used to caring for others that many find it difficult to put themselves first. You must!!!

I did note that someone had given you mis-information about what you'll be able to do after a hip replacement. You most certainly could go back to floor nursing once you are healed!!! I don't know where people get these ideas. We have BoneSmarties who go back to sports and occupations with physical demands (plumber, firefighter, police officer). And they are quite successful!

Please do read the articles Jo gave you. Also check out the BoneSmart Library (link at the top of the page). You'll read about successful hippies and hopefully begin to see that you can have a wonderfully normal life after hip replacement. Feel free to ask any questions as you work through your decision of when to have surgery. Know that you are NOT too young! We've had folks in their 20's with hip replacements.

 

[Josephine]

Oh I missed that! 30something, let me tell you about a hip surgeon I worked with not so long ago - he had a hip replacement about 6 years before he retired and worked a full, long day as these guys often do. I joined the team about 2 years after his op and it was FOUR YEARS before I heard he'd had a THR! I never even suspected. Don't ever let other people put negativities in your head like that. As far as the hip is concerned, you can do anything you set you mind to.

 

[30something]

Thanks again. Sorry for the delay- works been crazy. The other issue I deal with is that the Orthopedic and Rheumatologist have differing views on what is causing my issues. So, I am caught in the middle- I recognize treatment is different based on the cause. My latest Arthogram read:

"I believe this patient has RA with bilateral protrusio acetabuli deformity. There is unilateral left hip process consisting of fissure in the articular cartlidge of the acetabulum. The fissure in the cartlidge communicates with the supra acetabular portion of the left innominate bone which extends to the subchondral bone. Underlying bone changes, likely representing early erosion of inflammatory process."

The Rheumatologist says no way----it is OA(according to blood work and other clinical data). The OS didn't want to touch at first because he said it is RA and inflammatory. The Rheumatologist is writing a letter to the OS- we will see what happens. Unfortunately I am the one who has the dull ache all the time. The last two weeks or so it has been getting sharp jabs every now and then too. As I said earlier other joints(knees-ankle) are starting to ache now too. :P

Josephine my son makes at least acknowledges that this may be his future. He has Chrons disease though so I hope not. He just had surgery for a stricture, so I dont wish him to have to go through this too.

Thanks again for the reference material and help. I am just trying to do what is best.

 

[Josephine]

Oy, what it is when two 'experts' disagree! I feel for you. Have you thought of getting a second opinion?

 

[30something]

Working on that now.....trying to get another OS opinion.

 

[Josephine]

Good - looking forward to hearing about it.

 

[alexthecat]

I guess I'm like the OS Jo mentioned. Other than my family and a few close friends, no one around me knows that I have an artificial hip. I teach Body Pump and Spinning at a health club and my students have no idea about my hip. I certainly don't find that it limits me personally or professionally.

 

[30something]

Well appointment with OS is December 3rd- we will see how it goes and what he says. Fingers crossed that God's planned is laid out in front of me(and slaps me into what I should do)