Both hips at the same time?

[Bob A.]

Hi
Brand new to the forum with a more than a few questions. For starters, I am a 52 yo male with Osteoarthritis in both hips, the right being somewhat worse than the left. I have been having hip pain now for the last several years, but it is getting worse. I'm not too bad when I am up on my feet and walking, but any sitting for any length of time results in quite a bit of stiffness on either side. I have been seen my a good ortho for the last two years. My last visit was about a month ago and he told me then, its really up to me at this point (gee thanks) as to when I get it done. Top it off, my wife is a physical therapist who doesn't paint as rosy a picture about this surgery as some folks would want to believe. I am not a runner or athlete by any stretch of the imagination, but I do like to stay active and do home improvement projects around the house which isn't helped by my current level of pain and stiffness. I would like to be able to get back on my bike, right now I cant even lift my leg high enough to clear the seat

I have been doing quite a bit of research lately on the internet. I like the concept of the Hip Resurfacing vs. the THR. Trouble is, there aren't too many surgeons in this area (Norfolk, VA) doing them (by my count 1 or 2) and the one that I did find hasn't done very many at all. I would be willing to travel a bit, say up to Baltimore where there is a Dr. Jacobs that has done around 1500, but it probably would not be covered by insurance which is a deal breaker. That and I don't know about finding a local surgeon to keep an eye on me after I went out of area for it. I could wait a few years, but there is no guarantee that resurfacing will be more popular by then.

I guess what I am trying to do is get some consensus on what my best course of action would be. I can live with the discomfort right now. I am on naproxen 500MG twice a day though I usually take one in the morning and if I am feeling ok, skip the one in the evening. My primary physician told me he would not prescribe something like Celebrex till we had a chance to see how the Naproxen is working. Lately it hasn't been working all that good. Thats even with two pills. My wife and her nurse buddy are pushing me to use ibuprofen or acetaminophen. I honestly don't see much difference in the results. Only thing that really helps is not doing much for a couple of days which helps it all calm down. I really don't want to have to live my life not even doing simple stuff around the house.

I am a bit apprehensive about the surgery. I trust my ortho, he was hand picked by my wife who deals with just about all the patients of all the surgeons in this area. He's very confident and I like him. From what I read and especially from her, I know the recovery will take some time and won't be painless. At 52, the chances that I may need somebody to go back in and fix things down the road is definitely a possibility. My left hip is trailing my right in its downhill descent so it occurs to me that I should just have both done at the same time and suck it up in one recovery period rather than spreading it out over several years.

So my questions are these:

• Should I hold out a while longer, maybe try going on the Celebrex?
• Are there any long term issues (liver damage) that I may subject myself to by taking NSAIDS in higher dosages to manage the pain?
• Is the resurfacing that much better than the THR?
• What about the minimal invasive surgery, is it more hype or a better way to go?
• If I decide to do it, should I just go ahead and get a bilateral and be done with it.

My appreciation for any advice you may have.

Bob

 

[newwheels08]

I just had both hips done 4 weeks ago and could not be happier. The surgery is no picnic and it takes a dedicated surgeon to agree to even do both...but I had almost exactly the same circumstances you describe. 55 year old male with a bad left hip at first, starting in 2000...and developed right hip arthritis 5 years later. At the end I was living on OTC naproxen 6-8 per day..gained at least 20 lbs of stress weight, had lifts in my left shoe, and was still convinced I could live fine that way. My wife and family were on me constantly to do something..but denial is a strong thing...I was going to beat this and keep my hips.

My boss finally pulled me aside at a trade show last fall and made it clear that the only person I was fooling was myself...I needed to deal with this crippling disease prpcess and he was willing to make sure things were right for me to get it done. I am now 4 weeks post op...walking over a mile a day pain free..lost a noticeable amount of weight and back to work stronger than ever in the past 8 years. I even gained a 1/2 inch of lost height back. Be ready for a crazy hospital stay for a few days and intense rehab....but for me it is worth it. Good luck.

 

[Bob A.]

Wow. Thanks for that feedback. I am probably not as far along yet, but I know its coming. Part of what I am trying to work out is when to say enough is enough and do it. Its not going to get any better but I don't want to set myself up for bigger problems later on. I think its all part of a process that most people go through. I have a twin brother that is also having the same issues, he is very resistant to the idea of surgery. It may take me getting it done first.

What kind of surgery did they perform? What kind of hip did you end up getting?

 

[jam5387]

Bob,
I only have a few minutes to reply so please excuse the brevity. I am a 50 year old male also in the Norfolk area. Been dealing with this mess for several years. First no more running then it progressed to as little walking as possible. I took condroiton and glucosamine for several years. That helped for a while but now nothing helps. Read those side effects if you are concerned about the meds. If you must have a healthy liver and kidneys to take them, I assume there is some strain on your healthy organs.

When to do it is up to you. You have to determine how much the disease keeps you from doing what it is you want to be able to do. I have 2 teenage kids and am not able to shoot hoops, kick soccer balls, or go on hikes with them let alone going to the mall (which most of the time I don’t mind not being able to do…).

I am curious who your ortho is. Mine does not suggest doing both hips at the same time and also sticks with the tried and true methods of surgery.

John

 

[Bob A.]

Wow, talk about coincidence. My ortho is Dr. Dowd over at Jordan and Young. My PT wife hand selected him. She knows all the orthos in the area (at least those on the southside). PM me with an email and phone number if you want to chat.

 

[newwheels08]

Wow. Thanks for that feedback. I am probably not as far along yet, but I know its coming. Part of what I am trying to work out is when to say enough is enough and do it. Its not going to get any better but I don't want to set myself up for bigger problems later on. I think its all part of a process that most people go through. I have a twin brother that is also having the same issues, he is very resistant to the idea of surgery. It may take me getting it done first.

What kind of surgery did they perform? What kind of hip did you end up getting?

Bob~
I had bilateral THRs using a lateral/posterior approach during a 3 hour surgery...with relatively small 10 cm incisions and no (or minimal) cutting of the muscle. This procedure required no transfusion or giving blood ahead of the surgery. I was also awake the entire time and had a epidural for anesthesia.

I too explored resurfacing as an option first, but the disease progress was too great (my left femoral head was 25% worn away with large cysts, and the acetabulum was so bad it actually needed grafting to complete the surgery) I really waited too long in hindsight. The surgeons with my care provider were reluctant to discuss it as an option due to the small number of procedures done there... but did give me a referral. I discussed it with the resurfacing specialist and was told that it is equally invasive, more difficult to position, and the outcomes to date less predictable. Still resurfacing sounded like a good option to explore and I did. Several patients in my pre-op crutch class were getting resurfacing, and faced exact same rehabs so I thought that was interesting. In my case I needed THR.

As far as joint options, each surgeon seemed to prefer to use what gave the best success rate for them. The 2 choices I looked at were the cross linked poly on metal and all metal on metal. I ended up opting for the metal on metal, large femoral head type as it seemed to fit my situation the best....but there are lots of options too work through there. Best wishes and good luck.

Bruce

 

[Josephine]

Hello, Bob. And welcome to the forum. Your story is not an unfamiliar one to me. I have a post locked at the top of this forum "How to choose a surgeon and a prosthesis" which contains all my suggestions and advice so forgive me if I don't go through all that again. There is also another locked thread "40 years life span for a hip replacement!!" which details very nicely the fact that "going back in and fixing things down the road is definitely a possibility" is just that - a possibility NOT an inevitability. It's always been my observation that these joints (hips and knees) last an awful lot longer than people (patients, press and medics) give them credit for. If we had to do revisions on even 10% of the many thousands of hips that are done each year, we'd never had time to do any new ones!

To address your specific questions ...

Is the resurfacing that much better than the THR?

The resurfacing is a good option for the younger <40yrs patient but at your age I would suggest it best to go for the THR as I believe their longevity is not that good.

What about the minimal invasive surgery, is it more hype or a better way to go?

MIS has its problems such as faulty alignment, extended surgery time and other issues. Nevertheless the recovery and rehab is better and people I know who have had it and are doing very well thus far.

If I decide to do it, should I just go ahead and get a bilateral and be done with it.

To be honest, though it seems a big deal and some surgeons baulk at the idea, there are many for whom it is a matter of routine. Despite expectations, patients don't get twice the pain as somehow the body seems to be able to perceive the situation just as it would for only one hip. The evidence is that patients having bilats use no more morphine in the first few days than do unilats. You are also saved the hazard and stress of a second op, anaesthetic and rehab which is worth bearing in mind. A friend of mine, a frail little lady with a medical history as long as your arm, had a bilat and was back ballroom dancing with her husband only a few months later! In short, lots of people have bilats and do well on them.

If there are any other particular questions you need answering do ask away. I have worked in orthopaedic operating theatre all my life and can address most questions.

However, I prefer not to answer questions about specific medications as that is not my field.

 

[BigDog Mom]

Hi Bob,
I am a (almost)48 yo 140lb woman who has OS in both hips. My father is a bionic man both hips and both knees. So I guess I won the genetic lottery.;) My only guess is I get the privilege earlier because I'm a runner and I spend my free time running around dog show rings with dogs that weight more than I.
Any way I would not settle for one opinion. Even if you have to pay out of pocket for the second. If you are in VA maybe a trip to Hopkins in Baltimore? Do not settle for what is close if there is something better in your coverage area. Find a center of excellence that your insurance will cover and go there. If you get the same answer then you know what you have to do.
FWIW, my family calls me the penguin because my range of motion is so affected. I take Mobic daily and darvaset as needed and I really don't want to live this way. I want my life back and found a surgeon who is willing to do bi laterals without hesitation. I do understand however that a lot depends on the rest of your medical condition. I just didn't see any reason to go through two rehabs and months of wasted time when I could just get it done.
I have scheduled to have both done in Aug. It is terrifying but I want my old life back.
Best of luck!!!

Donna

 

[Josephine]

Yeah - with you all the way there, BDM!!

 

[mredick]

Hi
Brand new to the forum with a more than a few questions. For starters, I am a 52 yo male with Osteoarthritis in both hips, the right being somewhat worse than the left. I have been having hip pain now for the last several years, but it is getting worse. I'm not too bad when I am up on my feet and walking, but any sitting for any length of time results in quite a bit of stiffness on either side. I have been seen my a good ortho for the last two years. My last visit was about a month ago and he told me then, its really up to me at this point (gee thanks) as to when I get it done. Top it off, my wife is a physical therapist who doesn't paint as rosy a picture about this surgery as some folks would want to believe. I am not a runner or athlete by any stretch of the imagination, but I do like to stay active and do home improvement projects around the house which isn't helped by my current level of pain and stiffness. I would like to be able to get back on my bike, right now I cant even lift my leg high enough to clear the seat





Bob
I have been doing quite a bit of research lately on the internet. I like the concept of the Hip Resurfacing vs. the THR. Trouble is, there aren't too many surgeons in this area (Norfolk, VA) doing them (by my count 1 or 2) and the one that I did find hasn't done very many at all. I would be willing to travel a bit, say up to Baltimore where there is a Dr. Jacobs that has done around 1500, but it probably would not be covered by insurance which is a deal breaker. That and I don't know about finding a local surgeon to keep an eye on me after I went out of area for it. I could wait a few years, but there is no guarantee that resurfacing will be more popular by then.

I guess what I am trying to do is get some consensus on what my best course of action would be. I can live with the discomfort right now. I am on naproxen 500MG twice a day though I usually take one in the morning and if I am feeling ok, skip the one in the evening. My primary physician told me he would not prescribe something like Celebrex till we had a chance to see how the Naproxen is working. Lately it hasn't been working all that good. Thats even with two pills. My wife and her nurse buddy are pushing me to use ibuprofen or acetaminophen. I honestly don't see much difference in the results. Only thing that really helps is not doing much for a couple of days which helps it all calm down. I really don't want to have to live my life not even doing simple stuff around the house.

I am a bit apprehensive about the surgery. I trust my ortho, he was hand picked by my wife who deals with just about all the patients of all the surgeons in this area. He's very confident and I like him. From what I read and especially from her, I know the recovery will take some time and won't be painless. At 52, the chances that I may need somebody to go back in and fix things down the road is definitely a possibility. My left hip is trailing my right in its downhill descent so it occurs to me that I should just have both done at the same time and suck it up in one recovery period rather than spreading it out over several years.

So my questions are these:

• Should I hold out a while longer, maybe try going on the Celebrex?
• Are there any long term issues (liver damage) that I may subject myself to by taking NSAIDS in higher dosages to manage the pain?
• Is the resurfacing that much better than the THR?
• What about the minimal invasive surgery, is it more hype or a better way to go?
• If I decide to do it, should I just go ahead and get a bilateral and be done with it.

My appreciation for any advice you may have.

Bob,

consider resurfacing, it has been successful in austrailia and they can always go back and put in a stem, but once bone is gone its gone. Also consider a direct anterior approach, it cuts less muscle. good surgeons doing both of these are in charlotte nc.