THR Bilateral THR due to AVN

[emersonf]

Hello again,
Thank you all for your comments. Just an update…
So, I saw the consultant surgeon 2 weeks ago who recommended THR on both hips. I asked him about core decompression as according to the MRI report, the AVN in both hips is early stage. But the surgeon dismissed CD, told me it almost never works and that I would end up with THR anyway so I shouldn’t prolong the pain. I was shocked and after leaving there I did a lot of research and agreed with the consultant’s opinion. However, a few days ago I received a call from his secretary telling me he wants me to go back and see him again ASAP. I was quite worried and went the next day. He started telling me that I should consider CD with stem cells to preserve my joint, that I am still young (I’m 57), he reviewed my scans and it’s still early AVN etc… In the meantime my pain had increased considerably so he requested new scans (having them tomorrow). I am completely confused now and not sure why he is now offering CD after being quite negative about it. I am panicking about the future as I have AVN in both hips and knees and they are also scanning elbows and shoulders because of pain in the joints. I am overwhelmed with the prospect of managing this on all joints and the painful surgeries ahead. Any advice, thoughts, are welcome. I live in London.

 

[Layla]

Hi emerson,
I would be curious about the consultants opinion changing so quickly. I would question him on that.
Please try not to panic. While AVN in multiple joints is serious, it's certainly not hopeless. There are paths forward. You're young and hopefully in a position where you can deal with this in stages, focusing on the most important joints first, while others are monitored.

From what I've read, the femoral head doesn't have great natural healing potential once necrosis sets in.
Drilling a hole, as in core decompression, relieves pressure and may slightly improve blood flow, but it rarely regenerates bone or halts collapse in hips under daily mechanical stress.

Here is an article from the BoneSmart Library on Core Decompression -

https://bonesmart.org/forum/threads/core-decompression-of-the-hip.6383/

I will also leave threads where Core Decompression is mentioned, if you care to take a look.

Search results for query: Core Decompression

bonesmart.org

Please prepare a list of questions for the next time you meet with the consultant and know that we're here for support if you need us. Wishing you comfort and peace of mind. Stay in touch!
@emersonf

 

[emersonf]

Thank you so much Layla, that’s very helpful. I was just very surprised by the consultant’s opinion change! He had told me at our first appointment that he had never seen a patient who was pain free after CD even months or a year after the procedure and all ended up having THR - which he highly recommended because of the high success rate! So I’m very curious about him changing his opinion. I had already decided the CD is not for me because of the long and non weight bearing recovery. As I have pain in my shoulders and elbows from AVN, I wouldn’t be able to walk with crutches. And I am 57 years old so I’m not what they consider too young for THR. I’ll see him again in a couple of weeks and will keep you updated xxx

 

[Layla]

And I am 57 years old so I’m not what they consider too young for THR.

Hip replacements aren't just for the oldsters.
I do think the average age is around 65, but a growing number are getting them in their 40's and 50's because people want to stay active and want pain free movement. For people like you waiting may just mean more pain, more disability and added stress on joints like your knees and back.

Joint replacement surgery is one of the most prevalent surgeries performed worldwide. The outcomes of these surgeries have become excellent based on a number of techniques changing over the years. The implants are durable and long lasting, with longevity much greater than before offering an increase in the likelihood you’ll never have to experience this procedure again

There are many recovery threads here of those in their 40's and 50's so you're not alone. Stick with us and we'll support you through whatever you decide to do. Stop back often for encouragement if you're feeling the need. We'll be here. Hugs!

 

[Layla]

As an example, here is Deni444's thread, a current member on BoneSmart.
She's healing right now from her first THR at age 56 and facing a second soon.

THR Thread 'left it TOO long: Left THR Posterior'

Mar 27, 2025

Hello lovely Bone Smartie

Day two still in hospital. Came out of surgery yesterday at midday, surgery took just over an hour. Spinal with enough sedation to be asleep. Just like a GA but without the consequences. I came around in the theatre as they were preparing to move me to recovery. Chatted away with everyone in recovery for 20 minutes. Felt totally normal! Wheeled back to my room.

I'm on all kinds of pain killers but I haven't experienced anything more that a mild ache since surgery. They said to let them know when I feel anything near an achy...

• Deni444
• Replies: 446
• Forum: Hip Surgery Recovery Area

• 
• 
• 

 

[emersonf]

Hello everyone, I’m reading all your stories with great interest and find comfort in your (mostly) amazing recoveries. I am seeing the surgeon next week to plan my THRs, probably staged but it depends what he advises.

I have a question: when you guys say you had posterior or anterior approach THR, was it a recommendation from the surgeon or did you choose a surgeon that offers that particular approach? Apparently the anterior approach is somewhat less invasive and leads to a quicker recovery so I’m wondering why it’s not everyone’s preferred option? Forgive my ignorance if it’s not something appropriate for everyone. Also, does anyone know when doctors use 3D scans before surgery? Looking forward to your input x

 

[benne68]

was it a recommendation from the surgeon or did you choose a surgeon that offers that particular approach?

There are actually 3 different surgical approaches -- posterior, anterior and lateral -- because no single approach that works for every patient. Each has advantages and disadvantages. The surgical approach is chosen based on your anatomy, body type, medical history, etc. (For example, your AVN may be a determining factor for your surgeon.)

While some people say that the anterior approach is a "quicker" recovery, that is not always true. Every patient is different and we've had members with anterior whose recoveries were difficult. You will get the best outcome by choosing an excellent surgeon and then letting him/her decide which approach, which implants, etc.

 

[benne68]

does anyone know when doctors use 3D scans before surgery

CT scans are only used when the surgeon is planning to do a robotic assisted surgery using Mako. There is some evidence that this type of surgery may result in more precise placement of the implant. Here's an article about it:

Computer-Assisted Robotic Hip Replacement Surgery

In computer-assisted robotic surgery, a robot acts as an extension of the surgeon’s eyes and hands in a minimally invasive surgery to replace an arthritic hip. The robotics help surgeons operate more effectively through a smaller incision. Learn more about this fascinating technology here!

bonesmart.org

Again, based on my own experience and my time chatting with other hippies here on BoneSmart, I would always opt for an excellent surgeon who does the traditional procedure over someone who is not as skilled but uses robotic-assist. If you happen to find someone who has both, great.

But remember that it is the skill and experience of the surgeon that is the best predictor of your outcome.

 

[djklaugh]

@emersonf Don't worry too much about what approach is to be used - we've seen wonderful out comes from all the different approaches ... and less than wonderful outcomes from those same approaches. Let your surgeon do what he is trained to do. IMO the best predictors of wonderful out come is 1- skill of the surgeon, 2- general health of the patient, 3- patient's willingness to be patient and take things slowly after surgery.

And IF your surgeon is willing to do a bilateral procedure for you (both hips replaced at the same time) I would strongly urge you to seriously consider that. You'd get back to full functioning faster rather than waiting for a 2nd surgery to fix the other hip.

Not all surgeons are trained to do the robotic assisted surgery - training is extensive and expensive! If your surgeon is trained for that = wonderful! If not - that's wonderful too. He is the one experienced and trained to do these surgeries ... trust him to do the very best for you. My BTHR was done with the "old fashioned" just surgeon doing it all and with what is called anterior lateral incisions ... straight down the out side of each hip. Worked just fine for me

 

[emersonf]

Thank you all so much for taking the time to respond and for all the advice. I am checking reviews first surgeons now - hard to choose, there are so many. That’s why I thought to look for a specific approach /technique.

 

[Jamie]

Many times the approach that’s used by a particular surgeon is simply the technique he or she was trained in. The more important thing than the approach is the skill and experience of the surgeon. As mentioned above, recovery from any of the approaches is about the same. Some people do see a slight early improvement in mobility from the anterior approach, but by the third or fourth week, patients are at about the same spot with recovery. There are pros and cons on each of the approaches, so don’t let that be your determining factor.

If you’d like some assistance finding surgeons to interview, I’m happy to help. Just let me know and I may have some contacts in your area or within reasonable driving distance.

 

[emersonf]

Hi Jamie
Thank you for this. Any recommendations would be appreciated. I live in London. I’ve seen Mr Oragui at the Lister Hospital but I feel that I should get a second opinion. It’s a big decision and I’m really scared

 

[Deni444]

One other consideration if you are going on an NHS waiting list would be how long you'll wait for different surgeon's. It's worth knowing that with a little digging you can track down the contact details for particular NHS surgeons and their secretary can give you an idea of their waiting list. I was frustrated when I was told my preferred surgeon had a 10 month list. I looked at alternatives just to find out some of them had an 18 month list.

I found the joint register for your surgeon. You'll find key data about his surgeries

https://surgeonprofile.njrcentre.org.uk/SurgeonProfile?gmccode=6129793

 

[emersonf]

Thanks @Deni444 , I can see he has a lot of experience? How would he compare to yours? I’d go private as we have health insurance and they would cover it. He said he has 4-5 weeks waiting lists privately

 

[Jamie]

I’m sorry I didn’t notice you were in the UK. I don’t have many surgeons on my list from the UK…most are in the US. But here are a couple close to you to check out:

Mr. Vivek Gulati
Go-Orthopedics
The London Clinic
116 Harley Street
London, UK
Phone: 0203 963 5059
Hip and knee primary replacement, private pay only

Miss Sarah Muirhead-Allwood
HCA Healthcare UK
The London Hip Unit
30 Devonshire Street
London, UK
Phone for initial appointment
Hip primary and revision. Other surgeons at this clinic are good as well.

 

[emersonf]

Thanks Jamie xx

 

[Coddfish]

If you are going privately but using health insurance, I guess you have to check which hospitals / surgeons accept the relevant insurance. The National joint registry has details of the procedures carried out by all uk orthopaedic surgeons. It’s best to find someone who is high volume in hip surgery. When you have your initial consultation, trust your instincts on whether you feel comfortable with them / whether they see you as an individual rather than a case. As well as understanding what surgical approach they would use, you might also want to understand whether they would recommend a cemented or cementless implant for you, and why. I would be wary of someone whose answer is always to do the same thing, regardless of the patient in front of them. There’s no universal right answer, and you will likely get a good outcome either way, but it’s more about understanding their logic.

 

[emersonf]

Thank you so much for this. I appreciate it. What would count as high volume? The surgeon suggested Direct Anterior approach with cemented stem for me (because of osteoporosis) but without robotic assistance. I am terrified about the surgery and complications, pain, prolonged recovery. I did like the surgeon but then he asked me to go back to discuss joint preservation surgery as opposed to THR even though in our first meeting he was certain that THR was the right and only option. I left confused and now I don’t know what to think.

How is your recovery?

 

[Jamie]

You want a surgeon who does at least 100 of the procedure you’re considering each year. Some surgeons will count “knee surgeries” versus “primary hip replacements” in their surgery count, so if you ask about this be sure to be clear about what type of surgery you’re asking about.

 

[djklaugh]

@emersonf To assess high volume ... ask surgeon how many (on average) hip replacements he/she performs in a year. The good ones usually do 300-400 per year.

I don't know how it is in the UK, but over the pond many insurance companies insist on patients trying or considering the "less invasive" treatment options (AKA less expensive). Those other options might include things like physical therapy, steroid injections, and the "hip preservation surgery". Alas when a hip (or both) are really deteriorated those alternatives don't do much .. and can actually prolong suffering and end up costing insurance company and patient more money and time. But documentation of those "less invasive" options might be required.