THR Bilateral THR due to AVN
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While it is ultimately up to the surgeon to determine if a patient is appropriate for a bilateral hip replacement, it is, IMO, the best way to go if one has 2 very bad hips! It was my surgeon who recommended doing a BTHR for me - I had one hip that was so bad it had fused to my pelvis(ball of femur was so worn down and misshapen my body decided it was broken so grew new bone to "fix" the problem) and the other was bone-on-bone. While the deterioration was due to arthritis not AVN it still was very painful and debilitating. And I am very, very glad to have done both hips at same time.
The reasons my surgeon gave me for the BTHR were:
1- I was 64yo, in generally good health, had had no problems with anesthesia from previous surgeries and he felt that it would be less of a risk for me to have just one surgery/one session of anesthesia and one hospital stay. (back then, before COVID, hip replacement patients usually stayed in the hospital for several days - now many go home the same day as surgery). There are risks with any surgery - though most rarely occur.
2- I would have just one period of healing and recuperation
3- I would be able to regain a normal gait faster as I would not have to limp on unrepaired hip between surgeries.
4- He felt he would be able to better assure that both legs ended up the same length and thus avoid a leg length differential problem that does some times occur when hips are replaced at different times.
Every person's history and experience with hip replacement is different so it is impossible to predict how exactly things might go for you. But BTHR is definitely worth considering if surgeon is willing to do that.
The link to my post op hip thread is in my signature - it's old and I don't up date it much. Feel free to read that and any other Bilateral thread you find.
While it is ultimately up to the surgeon to determine if a patient is appropriate for a bilateral hip replacement, it is, IMO, the best way to go if one has 2 very bad hips! It was my surgeon who recommended doing a BTHR for me - I had one hip that was so bad it had fused to my pelvis(ball of femur was so worn down and misshapen my body decided it was broken so grew new bone to "fix" the problem) and the other was bone-on-bone. While the deterioration was due to arthritis not AVN it still was very painful and debilitating. And I am very, very glad to have done both hips at same time.
The reasons my surgeon gave me for the BTHR were:
1- I was 64yo, in generally good health, had had no problems with anesthesia from previous surgeries and he felt that it would be less of a risk for me to have just one surgery/one session of anesthesia and one hospital stay. (back then, before COVID, hip replacement patients usually stayed in the hospital for several days - now many go home the same day as surgery). There are risks with any surgery - though most rarely occur.
2- I would have just one period of healing and recuperation
3- I would be able to regain a normal gait faster as I would not have to limp on unrepaired hip between surgeries.
4- He felt he would be able to better assure that both legs ended up the same length and thus avoid a leg length differential problem that does some times occur when hips are replaced at different times.
Every person's history and experience with hip replacement is different so it is impossible to predict how exactly things might go for you. But BTHR is definitely worth considering if surgeon is willing to do that.
The link to my post op hip thread is in my signature - it's old and I don't up date it much. Feel free to read that and any other Bilateral thread you find.
I tend to agree with the idea of bilateral hip replacements if needed. We’ve seen a lot of successful ones here on the forum. If you want to read some of the threads, go to the main index page (HOME link at the top of the screen), scroll down until you find a thread with BTHR as the prefix, and then click on that prefix. That will give you a list of members who had both hips done at the same time. You can read what led to their surgery and how things went.
I don’t think I had my AVN very long. My left knee was getting painful in 2007 and I went to see an orthopedic surgeon for the first time about it. In hindsight and knowing what I know now, it was very painful because I had overworked an arthritic knee by bending over for hours chipping ice from the road at our lake house so we could get the truck packed and drive home. The surgeon was a young guy just starting out and now I realize he was not very experienced. He looked at the X-ray and saw some issues with my meniscus. He suggested an arthroscopic clean out and I agreed to it because my hubby had this type of surgery successfully years before.
When I came home from the procedure, I had tremendous swelling (something hubby didn’t have). I called the office and they told me swelling was normal….not at all excited about it. So I tried to tough it out until weeks later and my entire leg had swelled to where I could not put any weight on it. It was so inflamed that I believe it damaged my knee to the point that led to the necrosis. By the time I saw the surgeon about it, the necrotic spot was there and about 1/4 inch in size on the X-ray. The young surgeon was in shock at this. I could see it in his face and it terrified me. He said I needed a knee replacement. He offered no explanation or comfort and just walked out of the room. It was awful. I made a second appointment with another good surgeon. Before I saw him, I did a lot of internet searching about AVN and (because I hadn’t discovered BoneSmart yet) feared the stories I was reading about people who became wheelchair bound because of the pain was my fate. The second surgeon explained in our meeting that the knee replacement would take care of the problem, but I didn’t trust that information. I was so scared. So I went to a third surgeon that a nurse friend recommended and he confirmed that while I did have AVN, replacing the knee would remove the dead bone, healthy bone would accept the new implant, and I would be fine. And I was.
It was quite an experience, but I got a fast lesson in orthopedic surgeons and procedures. Afterwards, I made an appointment with that first young surgeon for the sole reason of providing feedback to him on his treatment and bedside manner. I wanted him to know the huge impact his fear and just leaving me hanging had on me. He actually was very nice about it and apologized. I believe it was helpful for him to realize that his behavior could have such an impact. Months later I learned he no longer operated on knees….only shoulders.
I don’t think I had my AVN very long. My left knee was getting painful in 2007 and I went to see an orthopedic surgeon for the first time about it. In hindsight and knowing what I know now, it was very painful because I had overworked an arthritic knee by bending over for hours chipping ice from the road at our lake house so we could get the truck packed and drive home. The surgeon was a young guy just starting out and now I realize he was not very experienced. He looked at the X-ray and saw some issues with my meniscus. He suggested an arthroscopic clean out and I agreed to it because my hubby had this type of surgery successfully years before.
When I came home from the procedure, I had tremendous swelling (something hubby didn’t have). I called the office and they told me swelling was normal….not at all excited about it. So I tried to tough it out until weeks later and my entire leg had swelled to where I could not put any weight on it. It was so inflamed that I believe it damaged my knee to the point that led to the necrosis. By the time I saw the surgeon about it, the necrotic spot was there and about 1/4 inch in size on the X-ray. The young surgeon was in shock at this. I could see it in his face and it terrified me. He said I needed a knee replacement. He offered no explanation or comfort and just walked out of the room. It was awful. I made a second appointment with another good surgeon. Before I saw him, I did a lot of internet searching about AVN and (because I hadn’t discovered BoneSmart yet) feared the stories I was reading about people who became wheelchair bound because of the pain was my fate. The second surgeon explained in our meeting that the knee replacement would take care of the problem, but I didn’t trust that information. I was so scared. So I went to a third surgeon that a nurse friend recommended and he confirmed that while I did have AVN, replacing the knee would remove the dead bone, healthy bone would accept the new implant, and I would be fine. And I was.
It was quite an experience, but I got a fast lesson in orthopedic surgeons and procedures. Afterwards, I made an appointment with that first young surgeon for the sole reason of providing feedback to him on his treatment and bedside manner. I wanted him to know the huge impact his fear and just leaving me hanging had on me. He actually was very nice about it and apologized. I believe it was helpful for him to realize that his behavior could have such an impact. Months later I learned he no longer operated on knees….only shoulders.
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@emersonf
What we call a "signature" is the section in smaller type right below the line near the bottom of each post. It lists the dates of our surgeries, and sometimes, a link to our recovery threads.
Here's what dlklaugh's looks like. If you scroll up to her last post you will see this at the bottom
![[Bonesmart.org] Bilateral THR due to AVN](https://bonesmart.org/forum/attachments/1749823211354-webp.91065/ "[Bonesmart.org] Bilateral THR due to AVN")
What we call a "signature" is the section in smaller type right below the line near the bottom of each post. It lists the dates of our surgeries, and sometimes, a link to our recovery threads.
Here's what dlklaugh's looks like. If you scroll up to her last post you will see this at the bottom
@emersonf I'm sorry you are having trouble finding the link! Hope this will help:
Bilateral THR Thread 'Both Sides NOW!'
If you’re accessing BoneSmart on your smartphone, you may need to turn it horizontally to see all the links and information when viewing the site.
emersonf
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Hi all,
Feeling a bit overwhelmed and disheartened by my recent ortho appointments. The surgeons are always very keen to do the THRs either staged or bilateral. But once I mention the knee problems and the see the notes about bilateral knee AVN, they begin to backtrack saying that it’s better to continue with conservative management and monitoring. All the articles and papers I read about AVN, emphasise that it’s crucial, vital, important etc to diagnose and treat AVN early. And yet, even though my AVN in all four joints was diagnosed ‘early’ and pre-collapse, there has been no treatment at all since diagnosis (end of April). So basically we are monitoring and waiting for collapse? I don’t know what to do. I’ve seen three surgeons and it’s the same story..
Feeling a bit overwhelmed and disheartened by my recent ortho appointments. The surgeons are always very keen to do the THRs either staged or bilateral. But once I mention the knee problems and the see the notes about bilateral knee AVN, they begin to backtrack saying that it’s better to continue with conservative management and monitoring. All the articles and papers I read about AVN, emphasise that it’s crucial, vital, important etc to diagnose and treat AVN early. And yet, even though my AVN in all four joints was diagnosed ‘early’ and pre-collapse, there has been no treatment at all since diagnosis (end of April). So basically we are monitoring and waiting for collapse? I don’t know what to do. I’ve seen three surgeons and it’s the same story..
Have you ever asked precisely why they think waiting is a good idea? Personally, I don’t agree with that as AVN doesn’t ever improve. But it can get worse. Why would anyone want to risk that?
I certainly understand your concern about the surgeons you’ve seen. Please don’t get discouraged. Just keep looking until you find a doctor who will address your hips NOW. There are some conservative treatments for AVN, but they are really mostly a treading water thing since the bone death is not reversible in the areas where it exists. The idea is to engage in a treatment that will get rid of the diseased bone and let you start again with healthy bone and a new joint.
I certainly understand your concern about the surgeons you’ve seen. Please don’t get discouraged. Just keep looking until you find a doctor who will address your hips NOW. There are some conservative treatments for AVN, but they are really mostly a treading water thing since the bone death is not reversible in the areas where it exists. The idea is to engage in a treatment that will get rid of the diseased bone and let you start again with healthy bone and a new joint.
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emersonf
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They think THR recovery will be challenging because of the knees and because the MRI did not show progression of the hip AVNs they are waiting to see if it stabilises. It may not show progression on the MRI but function has definitely deteriorated since April. So even if it stabilises, I am not happy to stay as I am (I have to use crutches or a cane to walk). But maybe they think I don’t have a good prognosis anyway because my AVN is systemic.
I suspect it’s more a case of just not being familiar with this type of AVN in multiple joints. That is more of a specialized situation. If you can get additional opinions, try calling each surgeon’s office you’re considering and ask if they have experience with AVN in multiple joints.
You are right that it really doesn’t matter what the MRI shows if your quality of life has taken a dramatic turn for the worse. I still believe that when you are as disabled as you describe and experiencing pain, a “wait and see” approach is not the best. I’m sorry this is happening to you, but try not to let it get you down. You’ll feel better if you take proactive steps to take charge of your treatment. That means look for someone who can help you now.
You are right that it really doesn’t matter what the MRI shows if your quality of life has taken a dramatic turn for the worse. I still believe that when you are as disabled as you describe and experiencing pain, a “wait and see” approach is not the best. I’m sorry this is happening to you, but try not to let it get you down. You’ll feel better if you take proactive steps to take charge of your treatment. That means look for someone who can help you now.
emersonf
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Thanks Jamie,
I think the general approach in the UK is ‘wait and see’. I’ve seen the most experienced hip surgeon in the UK and she also suggested to review in 3 months. But my despair comes (not so much because I’ll have to wait a bit longer) but from the poor prognosis about my condition ie AVN in four joints is likely going to impact my mobility significantly no matter what I do.
I think the general approach in the UK is ‘wait and see’. I’ve seen the most experienced hip surgeon in the UK and she also suggested to review in 3 months. But my despair comes (not so much because I’ll have to wait a bit longer) but from the poor prognosis about my condition ie AVN in four joints is likely going to impact my mobility significantly no matter what I do.
I understand the “wait and see” with the underfunded and overworked NHS, but does this even hold true with going private? @EalingGran ?
You have one really big thing in your favor. You know that you have AVN and are dealing with it now. So many people don’t get that early diagnosis that is important. I guess in the scheme of things, a 3 month wait isn’t going to make much difference one way or another, especially if you feel you’ve exhausted all your surgeon options. Can you make that 3 month appointment now so you don’t have to wait even longer to be seen and have a new MRI?
The fact that you have AVN diagnosed in all 4 joints is not necessarily going to mean serious issues with your mobility. If it holds relatively stable in your knees and you can get your hips done, that will make a big difference. Then after a few months you could consider knee replacements if they are needed. It may be that once your hips are replaced, you’ll see a noticeable improvement in your knees. The fact that you have bad hips impacts your knees too, as they are working to compensate.
The best thing you can do right now is to consider your reduction in activity as “treatment” for your bad hips and knees and try to keep inflammation minimized. Focus on the good things you’re doing now and don’t let your mind drift to the “what ifs” down the road. When you feel yourself going that way, call a friend, do something fun that occupies your mind, watch a funny movie, or find something that replaces those negative thoughts. You can always come chat with us….we’ll help and understand.
You have one really big thing in your favor. You know that you have AVN and are dealing with it now. So many people don’t get that early diagnosis that is important. I guess in the scheme of things, a 3 month wait isn’t going to make much difference one way or another, especially if you feel you’ve exhausted all your surgeon options. Can you make that 3 month appointment now so you don’t have to wait even longer to be seen and have a new MRI?
The fact that you have AVN diagnosed in all 4 joints is not necessarily going to mean serious issues with your mobility. If it holds relatively stable in your knees and you can get your hips done, that will make a big difference. Then after a few months you could consider knee replacements if they are needed. It may be that once your hips are replaced, you’ll see a noticeable improvement in your knees. The fact that you have bad hips impacts your knees too, as they are working to compensate.
The best thing you can do right now is to consider your reduction in activity as “treatment” for your bad hips and knees and try to keep inflammation minimized. Focus on the good things you’re doing now and don’t let your mind drift to the “what ifs” down the road. When you feel yourself going that way, call a friend, do something fun that occupies your mind, watch a funny movie, or find something that replaces those negative thoughts. You can always come chat with us….we’ll help and understand.
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