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Am I ready for a THR at 58?

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prairienut

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Hello. I have been browsing this forum, and it has been very helpful so far. I was just told by my OS, Russell Tigges at Northern Dutchess Hospital in Rhinebeck, NY, that I need a THR within a year. He does 500 THRs a year and I have heard many good things about him. However, I am somewhat in shock because of how bad my hip joint has apparently become. The pain is chronic but actually tolerable. I always thought the pain would be unbearable before a THR was warranted. My biggest concern is that I cannot comfortably walk distances or rough ground, and I am an avid hiker. And sometimes the joint feels unstable. So the bone-on-bone joint has really held me back from my beloved activities. Also the OS told me that the cup part of the joint is starting to degrade in one spot and the THR is not as effective if the cup is too far gone. So it is really this latter point that is driving me to have surgery now, not the pain. Plus it would really be nice to be able to walk on longish hikes again in comfort. My second opinion is Wednesday. I have scheduled surgery for April 2 conditional on the outcome of the second opinion. The plan is for a titanium ball and ceramic cup. My other hip is "perfect." I would love to hear from someone who was or is in a similar situation as mine. I am hungry for information...
 
Welcome to this forum Gail! When I read your message, reminded me of me a year ago. I had my RTHR last August at 55. I was still walking (mostly with a limp) but could fake it pretty well to the point that my colleagues were very surprised when I announced last summer that I was having the surgery. I was in so much denial that I had never been to a dr about my hip until end of June when I went to the Os, told him I needed HR, he did an xray and immediately agreed. For me I was tired of limping, stiffness and not being able to walk comfortably. I was making decisions on activities based on my hip. My world was becoming smaller and smaller.

All that said, I have my life back again and can walk, go to the gym, almost run (don't want to push it) and have absolutely no pain. Like you, I have no other joint problems.

Keep in touch. Know your head has to be in the right place for the surgery. All of us (at least most) will tell you over and over that it is so worth it.

Take care,
Laurie
 
Hi Gail--welcome! I'm also 58 and RTHR on Oct. 30. My road to replacement was relatively short--about 16 months from initial pain to surgery.

It started while shaving my legs in the shower--inward rotation became more & more difficult & progressively painful. Within a year, I felt terrible pain upon getting up from sitting, to the point where I had to grab onto things before I could brace myself for that first step. It was "tolerable" after the first few steps, but definitely hindered my usual activities. Primary care doc referred me to an OS, who said "replace" after exam & X-rays.

Though he was a great guy, he only did traditional approaches. I also sought a 2nd opinion. Months before I'd even begun experiencing pain, I ran into a former colleague at a luncheon, who was on her feet, looking great, using just a cane 2 weeks post-op. She told me about her OS & his anterior approach specialty. So when the "replace" mandate came down, I did the research, went to see him, & chose him to do the surgery vs. the first OS.

The "parts & pieces" don't matter--your OS will choose what's best for you. Sounds like you've found someone you trust & with extensive experience.

What you'll likely hear from all of us "hippies" here is , GO FOR IT! Recovery will be brief compared to all the fully enjoyable years of your life you'll regain!
 
Hey Gail! Welcome! O see some of my friends have already told you how much better you'll feel once you go ahead and have it done!
I also had bone on bone! I was miserable,,,,I thought it came on so suddenly also! It wasn't until I saw my 2 year old grandson say "NANA!" & take his little baseball bat & immitatated me limping when it dawned on me,,,,I'm too young to live a life of pain,,,,that COULD be surgically corrected!
I was just so happy there was an answer to my prayers! One of the best decisions I ever made!
Go for it! You'll get all the support here! ;)
 
Welcome, Gail! Ditto everything the others have already told you! I had RTHR just 19 days ago at age 54, and I already know that it was one of the best things I've done for myself. Mine came on rapidly, I was just diagnosed the end of October, and it seemed to get worse weekly if not daily after that. The bone on bone pain would sometimes be manageable, and other times totally intolerable - especially when putting on socks, tying shoes, and getting in the car. All my other joints are fine - this one was caused by hip dysplasia at birth, even though it was treated. My parents were told at the time I might develop arthritis early in that hip, but I really never even gave it a thought until I was diagnosed. I, too, thought I was way too young for it, but if you've read many of the posts here, we are really about right in the middle of the ages having it done. I honestly thought I would chicken out or something would come up at the last minute (miraculously cured?) and I wouldn't have to have it. NOT! And I can tell you it is already so much better than before surgery - easier getting in and out of the car, my husband said I don't even have as much of a limp as before surgery! Well worth it if you want your life back! Take care and let us know how the second opinion shakes out!

Karen
 
Thanks for the fast response and the good words. It helps to know there are others out there. My mom didn't have her first THR until age 70 so I am surprised I need on this soon but so be it. Unless the second opinion is really out of whack with the first, I will probably go ahead with it. I've asked around about the OS. He has a great reputation. Just one person said she thought he was overrated and had heard of one of his patients getting an infection and other who ended up with one leg longer than the other. After doing a lot of reading, I see that these are uncommon complications but not completely avoidable. I hope it doesn't mean the surgeon is not as good as his reputation would say. I have also read about different surgery approaches: anterior, posterior, superior (coming in from above), lateral, with various pros and cons for each. How were your surgeries done? Also, were your surgeries computer guided? My OS is using computer guidance and is in fact teaching other surgeons how to do this.

I'm taking a hip replacement class at at the hospital on Thursday which should help with my many questions. See my GP on Friday to discuss pre-surgical testing. A busy week.
 
Welcome, Gail! Glad you decided to join our family. I'm from the knee side, but you have PLENTY of company here with "hippies." You'll be hearing from a number of them, no doubt. Please post any time you have a question or concern....or.....just to say "HI!"
 
Welcome Gail - you've come to the right place for advice and reassurement! I had a LTHR 16 weeks ago at the "young" age of 49 - traditional posterior approach. I have to say it was THE best thing I could have done. Bone on bone - labral tears - bone spurs etc and constant, aching, grinding pain for over 12 months. Struggling to get around with a walking stick and swallowing pain relief all day every day - all GONE! :)
I have to have my right hip replaced as well - and have no qualms whatsover about having it done. It's only natural to have some reservations about this type of surgery - but I'm here to tell you "I have my life back" and it has never been better! I will never take walking normally for granted - ever again.
Good luck with it all - let us know what you decide to do.

Peta
 
Hi and Welcome Gail

I am 51 very active and also a hiker. I had my hip replaced last June 6th, posterior approach, ceramic ball and highly cross linked poly liner. At 4 weeks I was walking a llittle under 1/2 mile to our town pool and swimming for about an hour. Within a few weeks doing the same , but swimming for a mile a day.
At 3 months when all my restrictions were lifted I headed up my local trail. It was great. The operation is awesome, do it.

The events leading up to it. Well, it was not excrutiating or constant pain, just annoying. I always seem to have had a problem with range of motion and flexibility, the right being far behind the left. The pain factor got a lilttle worse on certain steps, I had 2 injections the first maybe helping a little the second hurting so bad and doing nothing positive. Then one day it kind of gave out on me , made me severly limp for a few minutes. After that it was maybe once or twice a week it did that. Anyway I went to a hip doc (my spine doc had been helping me with it, then sent me to a partner of his) MRI with dye showed only mild arthritis. My doc did a hip scope and found severe arthritis and told me I would need a replacement within a year. So i decided to schedule it and not wait a year.

WE are all here for you . Good Luck with the next opinion
Judy
 
Welcome to BoneSmart, Gail.

I have but one question to ask you after reading your post - just how disabled did you want to get before you decided to have a THR?

It's my opinion that people sometimes tend to over analyse their situation, worrying over minutiae instead of standing back and looking at the broader canvass which is ...

1. your hip is painful
2. your activities are restricted
3. it's not going to get better!

After that, all the rest that you have said in your post, though not actually irrelevant, is pretty much beside the point; you need a new hip - end of! Congratulations on making a wise choice!

 
Josephine, That is exactly what my Dr told me, after showing me my xrays, he was direct and to the point. Said that nothing short of a HR would fix the problem and the good news was that he could give me my life back with a new hip. At that point, my decision was an easy one. And he was right.

Gail, go for it!!!!


Laurie (off to work after power walking 4 miles this a.m. in frigid weather with no pain and spring in my step)
 
Actually, I think I may have poached it off you a few months ago, Laurie. But it seemed such a great quote, I've since used it frequently!
 
Hi Gail!

No one can make the decision for you, but you may feel some reassurance knowing my case~

I'm only 26 (almost 27 on March 3rd) and will be having RTHR on 3/17. I've dealt with this arthritis for 6 years now (unknown as to why it developed so young). I'm at the point where I do have some really good days where I'm not in constant pain. However, I realize that is because I limited my activity to NOTHING in the previous days. I want my life back and I want to be able to enjoy walking and doing normal things without knowing the constant numbing, stiff pain will be right around the corner.

My surgeon let me know even at my age, there is a chance the procedure will last a lifetime; however, I may need to get revision surgery in the future.

Why wait -enjoy your life now!
~Melissa
 
After doing a lot of reading, I see that these are uncommon complications but not completely avoidable. I hope it doesn't mean the surgeon is not as good as his reputation would say. I have also read about different surgery approaches: anterior, posterior, superior (coming in from above), lateral, with various pros and cons for each. How were your surgeries done? Also, were your surgeries computer guided? My OS is using computer guidance and is in fact teaching other surgeons how to do this.

Unless a surgeon has only a handful of surgeries under his belt (in which case I'd graciously allow him to continue honing his skills on someone else!), I bet there's not a single one on the planet who has either attained total perfection or has the ability to control every variable or circumstance. So I wouldn't worry too much about a couple of opinions when all the rest are very positive. "Interview" your surgeon yourself (there's a list of suggested questions on this forum) and trust your gut.

As for approach, since you already seem to have narrowed down your choice of docs, it's probably a bit of a moot point--they will use the approach with which they've had the most experience.

However, since you asked . . . I was so impressed by a friend's amazingly quick recovery & the glowing reviews she gave her surgeon, I actually decided I was going to see him long before I ever knew I would need a new hip myself! He specializes only in hip & pelvis surgery & is our area's expert in direct anterior approach. (I'm only half kidding when I say it was the perfect choice for me because of the total lack of post-op restrictions: I swear I was born crossing my legs--there's no way I could refrain for 6 weeks!) My surgery was not computer-guided, but did use a special orthopedic table that assists leg manipulation and positioning of the femur, as well as "live" x-rays that allow the surgeon to view the alignment of both hips.

Long story short, no regrets. And while I certainly hope I'll never have to replace my other hip, if I do, I choose the same surgeon and approach in a heartbeat!
 
Thanks for the fast response and the good words. It helps to know there are others out there. My mom didn't have her first THR until age 70 so I am surprised I need on this soon but so be it. Unless the second opinion is really out of whack with the first, I will probably go ahead with it. I've asked around about the OS. He has a great reputation. Just one person said she thought he was overrated and had heard of one of his patients getting an infection and other who ended up with one leg longer than the other. After doing a lot of reading, I see that these are uncommon complications but not completely avoidable. I hope it doesn't mean the surgeon is not as good as his reputation would say. I have also read about different surgery approaches: anterior, posterior, superior (coming in from above), lateral, with various pros and cons for each. How were your surgeries done? Also, were your surgeries computer guided? My OS is using computer guidance and is in fact teaching other surgeons how to do this.

I'm taking a hip replacement class at at the hospital on Thursday which should help with my many questions. See my GP on Friday to discuss pre-surgical testing. A busy week.


It's good you asked around about your surgeon but did you ask him leading questions as well? Those are often more revealing as others' opinions can be a bit of a gamble. The questions to ask are listed in my post How to choose a surgeon and a prosthesis. Be sure to read this post carefully. Computer guided surgery is good but as yet lacks comprehensive data so I'd want to be really sure his outcomes are what he says they are. That he's teaching others the technique may be a good point but I'd still want to know what his outcomes are as they say much more than anything you can glean elsewhere. The key to interviewing a surgeon is in his body language. He should be keen to answer your questions, not take offence or be reluctant and the answers should be on the tip of his tongue! If he shows any negativity or unwillingness, I'd seriously rethink my choice.

The reason I'm saying all this is not because I want to put this guy down. I'm sure he's a wizz at the job. But you do sometimes get people who get enthusiastic about something to the point that they are zealots, meaning they have more enthusiasm than expertise. I've seen some in my time so I have learned to be rather cautious about people in any sphere who delve into the less usual stuff. I want figures to prove that they really are experts. Do you see what I am saying?

Having said all that, computer guidance is a great tool, it's just it's still very new and there are not too many people around using it.

I'd 'interview' him and get some real info on his outcomes, good and bad, and then consider again.
 
Hello again ! It was great to hear from all of you. I feel not quite as alone in my preparation for this big step in my life. I met with the 2nd opinion surgeon today. He is a long-time, highly regarded OS in Poughkeepsie, NY. He agreed I was a good candidate for THR and that there was not any value in waiting. He knows the surgeon who I had already seen and had high regard for him. They do use different prostheses -- one uses Depuy, the other Stryker. (I want to do a bit more research on that.)

Josephine, I had asked the first OS about infection rate which he said was less than .5%. His number of surgeries is more than 500 per year, and only hips. So I'm feeling pretty confident of his skill. I did not ask him about incidences of short-term and long-term complications as I did not find this forum until after the visit. I'm thinking I need to schedule a follow-up appointment to get the remaining questions answered. I want to hear his rationale for his choice of Depuy orthotics and ask him the questions about complications. I think the answers will probably be OK, but this decision came along so quickly, I hadn't done my homework until now. At least I am firm on my decision to go ahead with a THR. I just need to confirm my choice of surgeon and understand the orthotics he uses.

Anyone out there with Depuy parts? Can anyone comment on minimally invasive surgery? Personally, I'd rather have a longer recovery time than compromise in any way the surgery result.

Gail
 
Hmmmm.....less than 5%? That might be like 20 people out of 500? I don't know what the percentage SHOULD be (help, Josephine!!!), but that seems a bit high to me. What was the response from your second doctor?
 
Jamie, The number was less than 1/2% not 5%. I think you missed the decimal point in front of the 5. The second Dr. said that in his career which would be thousands of surgeries, he had only one case of primary infection following surgery.
Gail
 
Gail, Jo will tell you that the majority of "parts" info out there is from the respective manufacturers, so it will always have the best possible "spin," and we lay people aren't really qualified to judge & choose. Totally objective info is nearly impossible to find, even in medical media sources, which usually print manufacturers' press releases verbatim anyway. (I've been in marketing & PR my entire career & can spot the canned lingo from a mile away!) Consumer press usually pays attention only if there's a catastrophic failure, recall, etc.

Since you say you want to hear his rationale for using Depuy, & seem like research-driven gal, thought I'd share this info, however. The interesting thing you CAN learn from manufacturer web sites is whether your OS has received any compensation from them. (This court-mandated annual disclosure resulted from a lawsuit settlement & applies only to US-based companies or those that market their products here. Since it must be prominently posted & easy to find, you'll often see a link to a PDF document on their home page.) Can't remember now what brought this about, but the disclosure ruling was apparently quite comprehensive--you'll see everything from many thousands of $$$ to those serving as R&D and testing consultants, to a $3 burger for a small-town doc who stopped at the plant for a tour. I discovered all this AFTER I already had my hip, but found it fascinating nonetheless!
 
Hey - that's news to me, Jamie! And most interesting! My own take on choosing a prosthesis is - don't! Choose your surgeon and accept whatever he uses because that's what he'll be best at using. Other than that, Jamie covered it very well.

Oh, and by the way - 0.5% is excellent!
 
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