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Best practices for OS to diagnose and recommend a THR

Discussion in 'Hip Replacement Pre-Op Area' started by SelfHelp, Jul 29, 2018.

  1. SelfHelp

    SelfHelp junior member
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    I am 62-yerar old male, good health, 6’3” 260 lbs. In 1994 had left femur neck fracture due to car accident, OS saved the femur neck with 3 pin fixation. Lately hip has become painful, walking and exercise increases pain, stopped all exercise except walking our dog daily. Also, developed a limp trying to limit the rotation of the hip joint.

    OS xray reading notes say: no necrosis, severe osteoarthritis of left hip, bone on bone, subchondral sclerosis and cystic, prominent juxta-articular osteophytes. Recommendation is to schedule a THR.

    I have been reading BoneSmart and learned a lot from all of you.

    I have a question for you: what are best practices for OS to diagnose OA and recommend a THR?

    Is a OA diagnosis and THR recommended based on x-ray reading and patient’s description of pain?
    Are there any other medical evaluation or criteria used to determine if THR is the only or best course of action?

    Reason I ask is that although my xray notes say bone on bone, I don’t have the typical pain in the groin associated with OA of the hip. My hip pain is around my greater trochanter. I can have pain when resting, depending on position, but have sharp pain with extended walking or just standing, pain can shoot down the femur to the knee. But vigorous massage of the GT area reduces this pain temporary. I wonder if my pain is due to bursitis. Could my condition be misdiagnosed?

    Therefore my question: Do OS rely only on x-rays to identify OA and recommend THR? What are best practices to diagnose OA and recommend a THR?

    sh 2.jpg sh 3.jpg
     
  2. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Welcome to BoneSmart! Thanks for joining us. You've come to a great place for advice from those who understand. We can offer support and encouragement as you journey through.

    My OS and I believe most, diagnose by x-ray. I was stage 4 bone on bone when diagnosed for surgery.
    It wasn't a matter of IF I needed the surgery but WHEN I wanted to schedule it. I tried PT, didn't work, rarely took NSAID's mainly because I detest them but wasn't always suffering pain either. I did limp for some time and had great difficulty getting out of my vehicle. I had to manually lift my leg and lower it and it hurt! If I didn't lift it and dropped it naturally it was excruciating. My world became smaller, engagements were cancelled, I found it necessary to weigh out what I was capable of, on any given day, depending upon how I felt physically. In the last couple months before surgery, I too had pain down the front of my leg into my knee. It became necessary to lay in bed with a heating pad on that area at night to get comfortable enough to fall asleep. I was no longer sleeping soundly, waking multiple times throughout the night.

    Check this out and see how you score.
    http://bonesmart.org/forum/threads/score-chart-how-bad-is-my-arthritic-hip-knee.19871/

    I'm also tagging the forum Nurse, @Josephine who has 50+ yrs experience in Orthopedics. She's great at reading x-rays so you'll have a second opinion. She is in the UK though and most likely sleeping now so you'll need to check back.
    A great week to you!
     
  3. Eman85

    Eman85 graduate

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    Cool pics, my L femur looked like yours with the pins. Mine was for different reasons and were inserted back in the 60's. I can't read an x-ray so I don't know how you determine if you need a replacement. Mine was a no brainer as it was suggested to me back in the 80's and most Dr.'s wondered how I walked in to the office. i had limited range of motion and the pain was getting pretty bad.
     
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  4. SelfHelp

    SelfHelp junior member
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    Thank you for the welcome Layla, I have been ready BoneSmart for few months and referred friends that are considering joint replacement to here. There is definitely a lot I have learned from you all at BoneSmart but more importantly is the support you give each other that is so invaluable. I am sure I draw on your support as I get closer to my THR.
     
  5. SelfHelp

    SelfHelp junior member
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    Eman85, I see you had your THR recently. Did the pins affect your THR surgery in any way? Did OS use different approach, hardware, did you have any weight bearing guidelines? I would expect that with 3 holes the femur would be weakened and fracture more easily?
     
  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Well I can tell you that your hip is pretty bad and does need a replacement without any degree of doubt.
    Well it's quite common for an arthritic hip to also have trochanteric bursitis. That doesn't invalidate the diagnosis of arthritis so very clearly stated in the report and shown in the xrays.
    Well some surgeons do MRI or CAT scans but in truth, an xray tells us just about all we need to know. And there is no alternative procedure to be considered.
    Not at all because they will have been removed and the holes will mostly be removed with the bone that is excised as part of the replacement. Only the holes in the side of the femur will remain and that will be supported by the femoral implant.
    The surgeon will use whatever approach, hardware or post-op guidelines he normally does. Your having had the pinning of your hip won't influence that one iota!

    Hope that helps. Feel free to ask anything else.

    I also have a chart for assessing your pain and issues at this time. It should give you a clearer picture of your need for a hip replacement. The results are for you so don't post them here as they will mean nothing to anyone else.
     

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  7. Eman85

    Eman85 graduate

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    My OS was prepared for my pins and scheduled me 1st in line for the day. He uses posterior for everyone and I was no different. He came to see me in post op and gave me the how he did it report. To him it was just a little more complicated but he was well prepared. In the xrays you could see the shadow where the pins were and one very small piece of pin that is still in there. No weight bearing restrictions, I was full weight bearing the day of surgery.
     
  8. anny

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    Hi @SelfHelp welcome to the forum! I asked my surgeon how he decided on a THR and he said it's mainly on what I tell him about how I feel and how it's affecting my life. My xrays only show moderate OA, so I questioned whether it was 'bad' enough for such a drastic op but the first one was stuck so that I couldn't quite straighten up and had to limp, which meant I couldn't walk far.

    After the op he said it was pretty bad, much worse than the xray showed. The other hip is also moderate, radiographically, but it keeps me awake at night with its constant deep aching. Will be interested to hear what the surgeon reports about that one. I was surprised that my GP referred me straight to the surgeon as soon as she told me I had OA (no previous history, not even a suspicion that I had it!). Then the surgeon was immediately talking about THR, no intermediary physio/meds/injections etc first, so I too wondered what the usual practice is as many people seem to have gone from OA to THR with a few side journeys before the op
     
  9. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    :wave:
    I was shocked to finally get a diagnosis of OA in both hips, after all I was suspecting I was dealing with a disc problem in my lower back.
    My OS broke the news with...PT will just make it worse..injections won't help!
    Made my decision easier as I was already miserable, though still soldiering on with a very active job, and seriously sleep deprived as there was no way to get comfortable.
    My surgery have me my life back.
    :ok:
     
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  10. Bchbum4evr

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    I too didn't have pain in groin area, it was outer hip area around trochanter. He used only xray for diagnosis. We tried different things for 4 years for relief as I was considered 'too young' for THR.

    All I can say is I woke up in recovery and hip pain was gone. 2 weeks later, no pain, just soreness from muscles and tissues finding their new home.

    Do the THR - you will wish you'd done it sooner!
     
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  11. SelfHelp

    SelfHelp junior member
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    Thank you Josephine for reviewing my x-rays and giving me your opinion. I just have to accept that THR surgery is only real solution to this problem, stop dwelling on the risks and find a surgeon and hospital I trust. I have procrastinated too long and let the hip pain limit my life.

    Thank you anny, Mojo333 and Bchbum4evr; You were fortunate you found an OS you trusted. Was the decision to go with THR as simple as you make it sound?
     
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  12. dlp

    dlp senior

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    I'm not any of those three, but hope you don't mind a 4th opinion. "Simple" might be an oversimplification, but for me it was fairly easy to decide that I needed to do this. The pain had gotten to a point where it was ruining my life. A full night's sleep was impossible. During the daytime I was half-zombie from the lack of sleep. Driving was getting to be impossible without pain since I owned a manual transmission car.

    If there was some chance that I could be pain free I was willing to take it.

    It's a big decision, and shouldn't be made lightly. Only you know when the time will be right, but I can tell you that it won't get better. As my first surgeon told me, it's not a question of if, it's a matter of when.

    We're here for you when you need us!

    (I don't know if I'm different than most people, but I've never had a fear of doctors, hospitals, dentists, etc. I think I was fortunate to grow up having good medical care and care givers. Many months spent in hospitals over the years as a teen for my father's medical issues probably helped de-sensitize me, too. I even worked for a hospital for a year before moving to California. I don't get spooked by this stuff.)
     
  13. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    :wave:@SelfHelp !

    This too was my situation.

    Also exactly my thoughts.

    I understand the anxiousness but I didn't have the reluctance...I was too desperate for a chance to get my life back.
     
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  14. Windsong

    Windsong junior member

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    Like a lot of people, I wish I had made the decision to have THR earlier than I did. My OS told me last April I could have THR when I was ready but since I wasn't in a whole lot of pain I decided to wait. He did say there was no way to tell how quickly things would get worse so I hoped for the best. I made the decision at the end of the year to go back to my OS in February to set the date but life intervened and I didn't actually see him until April. By then it was bone on bone and I was pretty miserable with the pain. Long story short, found out he was retiring from surgery so had to start all over with a new OS - surgery date is October 23rd. As I found out the hard way, things can go south pretty quickly - but at least now I can look forward to a new beginning and getting my life back.
     
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  15. Eman85

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    I struggled with the decision, the pain just became normal since I'd had it for so long. I knew it was the only fix for over 30 years. My GP told me "you'll never be any healthier than you are now", which was a very good point. He knew what the recovery would be and he let me know that healthy people recover much quicker. Mine had also gotten to the point of locking and popping. Then of course there was the pins to be concerned with, which my OS was prepared for. Also I had to plan around my timing for work, FMLA, and the chance I wouldn't be going back to work.
    Now even though I'm sitting here with a pain from overdoing I feel I made the right choice.
     
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  16. SelfHelp

    SelfHelp junior member
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    Fortunately or should I say unfortunately, I don't yet have the difficulties and pains you all describe, for me moving around, daily walk are pain-free for the most part. I had to make adjustments, like give up exercising, slowly develop a limp and bad posture, limited to sleeping on good side, not being able to stand for longer periods ... adjustments have taken years, therefore I don't feel the desperation to have it fixed. Also, I wanted to understand the risks of THR, focused a lot of time on infection, DVT, dislocation etc. Inevitably you ask myself, is this THR worth the risk? I felt that some of risks, like infection are not really understood.
    Either way, time is not going to cure the hip OA, and as Eman85 said "you will never be any healthier than you are now".
    Since THR is inevitable I had wanted to loose some weight before scheduling the surgery, but so far that has been wishful thinking.
    I am sorry for rambling on this forum, these are thoughts I have as I come to terms with my hip OA and THR.
     
  17. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    Rambling allowed.
    Is a big leap...but in my case
    No regrets!
     
  18. SelfHelp

    SelfHelp junior member
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    Thanks for tolerating my ramble.
    Did you all find on-line surgeon ratings sites helpful?
    www.checkbook.org
    projects.propublica.org
     
  19. Eman85

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    I didn't use any online anything before surgery. My GP who I trust. I've been through a bunch of GP's I didn't, referred me to my OS. After the first get acquainted visit with OS I did my own asking around and it turns out I knew some of his patients personally. As I stated earlier I pretty much knew I was getting a replacement, but saying it and doing it were 2 different things. And as my OS stated at the first appointment when I showed hesitation, a bad hip won't kill you it just hurts. He knew I wasn't sold on the deal the first visit especially because of the pins. Once I felt confident in him and the hospital I had my 2nd visit where I said let's do it. I still had reservations up until the night before when I finally came to peace with it.
    Don't worry about what anyone else thinks, it's your life and your decision. When I made the decision I was all in for it. Read some of the pot-op posts and you'll understand what you'll be in for. It's not a simple deal, it's pretty major. I've had more than a few ortho surgeries and this is the big show compared to the others.
     
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  20. SelfHelp

    SelfHelp junior member
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