Alternatives to Total Replacement???

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Steve W

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For the past eight months, I've been trying various methods to avoid surgery for "moderate osteoarthritic changes in the right hip" (articular cartilage thinning, joint space narrowing, subchondral cyst formation, reactive bone marrow edema and degenerative labral tear). These methods include acupuncture, non-force alignment, occupational therapy, Aston Patterning and water aerobics. My goal is to resume an extremely active lifestyle that includes competitive racquetball, extensive recreational cycling, kayaking and hiking. As I approach my 70th birthday, I'm exploring all of the options. Can any readers help answer these two questions?
1. Are there any realistic possibilities for healing?
2. Are there any effective surgical options to total replacement?
 
Steve W

Welcome.
I have a question about your level of pain and activity currently. Are you able to comfortably do all your recreational activities now??

If not, I would think having a replacement could only improve your life.
I don't know about competiteve raquetball, but don't see any problem with the other activities.
Of course I am speaking as a new hippy. My doc told me I could do pretty much anything except running. Of course trail running is my favorite activiity.
Our wonderful nurse, Josephine will answer your questions .

Good Luck
Judy
 
Well, the brutal facts are that osteoarthritis is a degenerative condition. It doesn't heal, won't ever heal and indeed cannot heal . It only degenerates. Some 'alternative' practitioners will tell you different, or that by strengthening the surrounding muscles and ligaments the pain and disability can be lessened or even cured.

The procedure of THR is pretty routine and extremely successful. It has a history of almost 50 years behind it. There is a thread at the top of this forum
40 years life span for a hip replacement!! That lady's hip was put in in the 1960s and is still going strong!

I strongly recommend that you cut your losses and get it done. You have little to lose except a whole heap of pain.

Are there any particular reasons you are striving so to put off the event? Perhaps we can address any concerns you have.
 
Steve
As Josephine pointed out, it only gets worse, not better. As far as I know, the only two viable surgical options are THR and resurfacing. Resurfacing saves more of the femur, but is a more complicated surgery, and as such is not performed by that many surgeons yet in this country. From what my doctor tells me, it's greatest benefit is that it makes revision surgery easier if you need it down the road.

One other thing to keep in mind is that an artificial hip is not a real hip and as such will not stand up to long term abuse like your natural hip will. My wife is a PT and read me a part of a manual she got not too long ago that talked about post hip surgery precautions. Bottom line is that some exercises are pretty low impact such as cycling and kayaking since they dont pound the joint all that much. Others like raquetball and running are anything but low impact and will exact a toll on it over time. This particular manual specifically said that raquetball is not recommended. Now the question is, at 70 or close to it, how much longer do you think you will be hitting it hard? I liken it to getting a new engine in a car and then running out to the dragstrip to see how fast this baby will go. You can do it for a while, but like anything that is pushed to its limits, it will wear out faster. When it does, don't complain.

Now if you limit your activities to those that are "joint kindly" then it will probably outlast you. You can continue to live with your hips the way they are, but the problem will only get worse over time. If you are in pretty good shape at this stage of your life, then that would bode well in a quicker recovery then you might have later in life. You might also want to look for a doctor that will do a minimally invasive form of the surgery, the recovery time is quicker and less painful. I'm jumping in with both hips into that one in less than two months. Good Luck
 
Well put, Bob. However, I would point out that resurfacing is a procedure that was specifically developed for the younger patient of of 20-40 yrs. It's not generally regarded as being appropriate for the older patient.
 
Hip resurfacing is NOT only for young patients. I know quite a few people in their 60's that have had successful hip resurfacing done. It depends on a persons bone quality, and activity level. I was 48 years old when I had my hip resurfaced and I would not have it any other way. I have absolutely no limitations to what I can do. A friend of mine had his done three weeks after I did which was almost three years ago and since then he ran a marathon just two days short of three months post op and has finished 6 Ironman triathlons and two Ultramans. There are MANY athletes that have had their hip resurfaced. Floyd Landis is one well know one. I have another friend that had both hips resurfaced, one in 2001 and the other in 2003 and last year he got his 6th degree black belt in Japan. Feel free to email me if you would like to find an experienced resurfacing surgeon by you. I am a major patient advocate for hip resurfacing surgery and have interviewed over a dozen of the top resurfacing surgeons in the world. Take a look at Vicky's corner on the surfacehippy.info website.

Vicky
 
Steve -

Wow, I am surprised Biomet is a corporate sponsor of this site, since they're a key provider of resurfacing implants and I don't see resurfacing much mentioned here. But speaking of resurfacing, Steve, that's what I want to bring to your attention.

At age 51 (4 years ago), I had right hip resurfacing by Dr Thos. Gross in Columbia, South Carolina. In a short couple months, I was back to vigorous activity and today I run, bike, hike, ride horses, do yoga, cross my legs with impunity and generally do not think about my resurfaced hip.

Back when my hip failed in early 2001, I was morosely perusing a THR support site when a woman who had had resurfacing me emailed me aout the technology. She was the catalyst who restored my athletic life, and I guess I'm just trying to pay forward her favor with this post. Seriously - check into resurfacing.

Laurel
Cape Elizabeth, Maine
 
To those considering THR,

I am one of those (Olympic) athletes that had resurfacing done. After my initial diagnosis in 2000 by one of the top hip surgeons in Toronto, I did not relish the idea of losing part of my femur and then being limited in my activities by the normal THR surgery.

After a LOT of research and appointments with many hip surgeons, I finally discovered a terrific and talented surgeon in my own back yard who was experienced with hip resurfacing. In April 2004, I had my right hip resurfaced.

Since that time, I have recommended this surgeon, and hip resurfacing in general, to many friends, both athletes and non-athletes. As a matter of fact, my original judo mentor was in his 70s when he had his hip resurfaced last year.

Similar to Vicky's post above, I am a 6th degree black belt in judo and have had absolutely no limitations on the activities I can do, including judo, weight training (squats), running, cycling, you name it...

Eight months after my surgery, I slipped on a patch of ice and fell directly onto my resurfaced hip. It was an extremely hard fall onto concrete and I was unsure about what had happened to my hip. Other than a bruised outer trochanter, an x-ray revealed no damage whatsoever to my hip or uncemented prosthesis. I still wonder what would've happened had it been a THR prosthesis.

As far as recovery goes, I have had a joint replacement in my big toe that was more troublesome, even after two surgeries, than my hip resurfacing.

I cringe when someone tells me that they just had a total hip replacement, especially if it's an athlete. It happened again just the other day.

People, do your OWN RESEARCH. You may not be eligible for resurfacing but make sure that you get that diagnosis from an experienced hip surgeon who performs both THR AND hip resurfacing procedures.

Sometimes you regret certain decisions that you have made in your life, and wish you could go back and change. Fortunately for me, this is NOT one of them! I am forever grateful that I came across hip resurfacing.

Rainer
 
Steve W,

To add one more thing that I am sure will interest you, The resurfaced (hip resurfacing) doubles team of Alan Sherrill (Dr. Vail, bi-lat) and
Jay Cappell (Dr. Gilbert, one side) just won the U-S Handball Nationals
championship... Age bracket: 60+ in June of this year!

As you know, handball is just as grueling if not more grueling than raquetball. Both got their hips resurfaced and here is a post from one of them from the Yahoo surface hippy board.

Mon Jun 23, 2008


"Hi, Hippies:

A word of encouragement. I am just back from Overland Park, Kansas.
I was competing in the United States Handball Association national
four-wall handball tournament. I was lucky enough to win the 60+
doubles division winning four matches in four days beating the #1 seed
in the semi-finals. The format is two-out-of-three games to 21, with
the third game being a tie-breaker to 11. It is a court game played
indoors in a 20 X 40 foot court. We did not lose a game.

Dr. Thomas Vail did my bilateral hip resurfacing at UCSF in December,
2007. I still have start up pain on the left side, no problems with
the right.

By the way, my partner, Jay Capell, had one hip resurfaced in February
of this year by Dr. Gilbert at Cal Pacific in San Francisco.

So Team Titanium (ok, chromium steel) came through thanks to our good
Docs.

Anything is possible.

Alan Sherrill
Watsonville, CA"

Life is extremely good after hip resurfacing. Do NOT think you are too old for this, as you can see from the post above, this is a guy in his 60's that just got both hip resurfaced and then went on to WIN the U.S. National Handball Championships against others that don't even have metal hips!



Vicky
 
There seems to be a lot of disinformation here about resurfacing. Some facts:

It is not lmited to people in their 20s and 30s. I am 69 and was resurfaced on the right hip in 2004 and the left in 2005. At the time I had Osteopenia!!!.

I commonly walk 5 miles per day; I also run (a little - poor lungs), jump and leap small ditches in a single bound.

At the other end of the scale, there are teenagers who have been resurfaced and mothers in their twenties who have had children AFTER resurfacing.

I have also met a woman who had both hips resurfaced when she was 76 and plays tennis, a pair of ice dancers in their 50s, a 6th Dan black belt, a triathlon competitor, an English Fell runner champion, a number of handball, squash and racquetball players, and a host of "normal" people ranging from 20 to 80.

They all had one thing in common - they did their research and made the decision only after talking with hip surgeons who did both procedures.

It is simply NOT TRUE that resurfacing is in limited use in theUK. It is now recommended ny NICE (National Institute for Clinical Excellence) as the preferred operation for those with sound bone.

For those who want first hand information, you may e-mail me. I would also recommend at least one web site: www.hip-clinic.com which is the site of the ANCA clinic. The surgeon, Dr.De Smet has perfomed both total hip replacements and hip resurfacing to a total of over 2,000 of each. He now will not give a THR unless the patient is unsuitable for resurfacing.

My first hip was done there when Canadian surgeons would not accept me and when I had been told that BHR was "failed technology" That hip is now 4 years old and has never given trouble, no restrictions on sports, cycling, lifiting or crossing legs. In contrast, the same surgeon who told me that BHR was failed technology gave my wife a THR and restricts her lifting to 10 lbs!

Visit the web site, do your own research, and above all make sure that your surgeon does BOTH operations before you accept his opinion. Also try to ensure that he has performed 100 or so resurfacing operations, since then you may get reliable statistics from him and he has learned his trade.

Chris Saunders
Right BHR De Smet June 23,2004
Left ASR Antoniou May 27,2005
 
Hi....My name is Karen and i had my right hip resurfaced by Dr.
Harlan Amstutz two years ago this month. I am 64 and had really
bad bone density and so was a poor candidate for this procedure. I am a dancer and wanted a bone conserving alternative to a THR. I
really pushed him to do this surgery. I had to be 50% weight bearing for the first four weeks and i was so there would be no fracture of the femoral head. I have never had a fracture in my life
and have danced since i was four and have done and am doing yoga
and pilates along with taking two jazz classes a week . So some of
us old folk can have a succssful bone conserving procedure also! Karen
 
Vicky,
I really appreciate the responses that I received from you and ten others. I will now look into the pros and cons of resurfacing for my particular condition. I'd very much appreciate your help in finding the world's most masterful resurfacing surgeon, especially one who does both and is not just hyping his or her own specialty. Feel free to send e-mail or call on my cell 510-813-1426.
Best,
--- Steve
 
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