BoneSmart® Hip / Knee Replacement Forum
Knee Replacement & Hip Replacement
Patient Advocacy & Online Community

Core decompression vs THR

Discussion in 'Hip Replacement Pre-Op Area' started by va757, Sep 24, 2017.

  1. va757

    va757
    Thread Starter

    Member Since:
    Sep 24, 2017
    Age:
    55
    Messages:
    5
    Gender:
    Female
    Country:
    United States United States
    I found out two weeks ago I have bilateral AVN of the femoral heads. I had a CT scan for my kidneys and it was discovered. It is not collapsed and appears small. When my PCP called the house to see if I was okay, it was like ‘uh, well I guess not if you are calling’. I have had lower back pain for a couple years that I attributed to over work or sciatic pain. Just self diagnosed and went with it. I am 55.

    When I hung up with PCP I immediately went online and read till my eyes bled lol!

    I waited two agonizing weeks to see a osteopath. He suggested flosamax. I said no. He then moved to core decompression with bone marrow stem cells taken from hip. Like he wanted me to decide right then. I was overwhelmed and ready to cry. I needed to get to work and couldn't make that kind of decision right then. geez!

    So I am a theatre teacher middle school and have a play coming up in December just started a new school year and I asked if this could wait a month or so. He said no I needed to tell him tomorrow.

    Drugs or surgery. I am not in tremendous pain but I have some bursitis in the most offensive hip (L) and no pain or very little in right. But I think it is getting worse...down leg knee. But tolerable. He put me on vimovo (anti inflammatory ).

    So now here I am. I just don't want to have core decompression.

    Plus he said I could have surgery on Friday and go to work Monday. Really? I can drive and only need to use a cane. I walk about 5-8 miles in building a day I work 10 hour days during play season and on Saturdays. I am in theater teaching on a incline stairs just to turn on lights and stairs each end of stage and he seems to want to do it like in next two weeks. Said "there will be other plays but you only have one set of hips". Right! I also have no disability insurance and 10 paid days leave.

    Can't this wait till summer and I can have THR? I mean by what I am reading here there is no grantee I will be able to work at all. I certainly can't on crutches. And I don't know what state disability I can get. I really can't afford to take months off work.

    I am flipping out! Advice anyone??
     
    • Friendly Friendly x 1
  2. MyAussieGirl

    MyAussieGirl

    Member Since:
    Apr 21, 2017
    Age:
    62
    Messages:
    1,315
    Gender:
    Female
    Location:
    Michigan
    Country:
    United States United States
    I have no advice you may want to tag our be nurse Josphine she'd have educated advise.

    I can and will pray and I don't think I like your surgeon's attitude

    :prayer:
     
  3. smstok

    smstok

    Member Since:
    Sep 24, 2017
    Age:
    48
    Messages:
    4
    Country:
    United States United States
    You should inquire how much time the core decompression procedure will give you before you will then need a THR.

    I will be having THR in December and any other procedures that were an option offered no guaranteed longevity. They stated if I were really lucky it could give me another 1 to 2 years before I would then need a THR.

    My point of view .."what's the point?" That's 2 surgeries and 2 recoveries in under just a few years at best. Some people would prefer that path just to prolong having to have what they feel is an extreme foreign object in their body. That's what you need to figure out for yourself.

    I have talked to 3 orthopedic Dr's and many, many, many people who have had one or two THR's and I am told time after time that they wished they'd had surgery sooner and they feel great. I in no way want to have surgery but since I am only 47 I just can't imagine continuing living with the level of pain I have and the limited mobility.


    Sent from my iPad using Tapatalk
     
    • Like Like x 1
  4. djklaugh

    djklaugh

    Member Since:
    Sep 5, 2011
    Age:
    70
    Messages:
    1,686
    Gender:
    Female
    Location:
    Oregon
    Country:
    United States United States
    @va757 Welcome to BoneSmart! I am going to tag @Josephine - she is our wonderful and knowledgeable orthopedic nurse admin. Also check out the library area - there are several articles about AVN, core decompression, and hip replacements. I think it would be much more useful for you to see an orthopedic surgeon rather than an osteopath. Also check out the hip recovery area and read some of the threads marked "core decompression" to learn what some other folks have experienced with that option.
     
    • Like Like x 1
  5. Jaycey

    Jaycey Moderator

    Member Since:
    Jan 27, 2010
    Messages:
    22,236
    Gender:
    Female
    Location:
    Yorkshire
    Country:
    United Kingdom United Kingdom
    If you read any of the articles djklaugh referred to (in our Library) you will learn that stem cell treatment only works if there is very little damage - in most cases no symptoms. If it were me I would run a mile from this person who is pressuring you to go the CD route.
    Yes but the pain is not going to go away and it may get worse. Meanwhile I would look for a surgeon who is willing to work with you - not pressure you.
     
    • Like Like x 1
    • Agree Agree x 1
  6. Josephine

    Josephine NURSE DIRECTOR Administrator

    Member Since:
    Jun 8, 2007
    Age:
    75
    Messages:
    72,608
    Location:
    The North
    Country:
    United Kingdom United Kingdom
    I totally agree with Jaycey. Just what I was going to say!

    However, to address some specific points you raised
    That was a very good decision. The side effects of fosamax can be substantial, like jaw bone death so teeth fall out! I wouldn't take it they paid me to!
    You know, this smells to me of someone who is an enthusiast for a particular procedure. I see them all the time for a variety of 'band aid' procedures. None of it is reliable treatment and the evidence most certainly is that it's really only effective in the very early stages of the disease, like no symptoms at all! I too would run a mile from him!
    Well a) bursitis us is not connected to a hip issue but is caused by a limp or poor gait. b) it also not infrequently runs in with the iliotibial band. You can read about it here where you will notice that the best treatment for the bursitis is a cortisone injection which stands a good chance of resolved the bursitis and the referred pain. Have a word with your PCP to see if s/he will do that for you.
    Dead right too! Read this where you can see the various realistic options but none of them are mich good and most have a long recovery period Core Decompression of the hip.
    You can do anything you want to! You said this issue wasn't too troublesome right now so it may be you can stick it out till then but nobody can give you any guarantees that it won't suddenly worsen and maybe even collapse in which case it would be .... unfortunate!

    Here are some more articles that might help
    AVN: ischaemic necrosis
    Baker's cysts and other knee bursae
    ITB (ilio-tibial band) issues
    Longevity of implants and revisions: how long will my new joint last
     
    • Friendly Friendly x 1
  7. va757

    va757
    Thread Starter

    Member Since:
    Sep 24, 2017
    Age:
    55
    Messages:
    5
    Gender:
    Female
    Country:
    United States United States
    Thank you all so much for your replies...I did see an orthopedic surgeon. Sorry I wrote the wrong title above.
    I have read so much here before I decided to post so thank you for all the reading. I read here till my eyes were falling outta my head...yes I hear you I am aware that it may be more symptomatic down the line-but I am willing to deal with it for now. If it does collapse what will that be like? from what I read it is like a lightning bolt and then next question ...would it be emergency THR then? Or just too agonizing to live with?

    I have been told not to drink alcohol. I am a smoker ...long time but for last two years have been vaping..so only smoking a few a day (not that there is safe smoking) and mostly vaping. But due to nature of vaping probably too much nicotine-Anyone heard of vaping leading to this ? Concern being nicotine..and the continued constricting of blood flow, high cholesterol for me more constriction ...I can not drink but I now need to quit smoking totally and maybe consider vaping 0 nic level. And this is all very stressful and honestly I am scared. I have made an appointment with pcp tomorrow -maybe chantix, thoughts?

    Other thing I wanted to ask is if cortesone is a steroid wouldn't it be a bad idea to inject into my hip? For the bursitis ?
    And I have made an appointment with another Orthopedic surgeon next week, for second opinion. Already called to pick up cd films of Ct scan.

    Side note - I have had two rotator cuff surgeries left arm. One right arm. Both hands carpel tunnel surgery and bunion surgery left. What is with my joints?

    I had a doctor do rotator cuff over holiday weekend. Told me I could go back to work Tuesday and I was on heavy pain meds driving and teaching -completely out of it and in agony...so I have heard this lie of ,you'll be fine after a weekend" before and I don't want to do it..I feel I would rather have the THR in both hips and plan for it...if I can ??? Sorry for the long posts...
     
    • Like Like x 1
    Last edited: Sep 25, 2017
  8. Jaycey

    Jaycey Moderator

    Member Since:
    Jan 27, 2010
    Messages:
    22,236
    Gender:
    Female
    Location:
    Yorkshire
    Country:
    United Kingdom United Kingdom
    Unrelenting pain and you will develop a significant limp trying to stay off the hip. Basically I planned my activities to avoid putting any weight on the hip. It's not considered an emergency by the medics but if it happens to you, you will think differently.
    In some cases the injection brings pain relief. There is no way to predict whether it will work for you.
    I hate this! Setting unrealistic expectations only frustrates and confuses. You won't be back at work within days. More like 10-12 weeks and then a phased return if you have THR.

    Please let us know how your second opinion appointment goes.
     
  9. smstok

    smstok

    Member Since:
    Sep 24, 2017
    Age:
    48
    Messages:
    4
    Country:
    United States United States
    You have some really good questions here. I guess what would concern me if I were you is the cortisone shot providing pain relief and then you carry on with your activities in a way that may bring about more injury to your hip to a point that you would then need immediate surgery. My pain is a constant reminder to not overdue it and slow down and yes I have acquired a limp which I am absolutely embarrassed of. But of course I have to suck it up and push on. At my last appointment My Orthopedic heavily advised me to get a cane since a fall would be detrimental at this point. Since I limp or drag my foot at times that could easily happen. That idea just about sent me over the edge but of course I listened and use it mostly when my pain and limp are worse than usual and I find it beneficial for stability


    Sent from my iPad using Tapatalk
     
  10. va757

    va757
    Thread Starter

    Member Since:
    Sep 24, 2017
    Age:
    55
    Messages:
    5
    Gender:
    Female
    Country:
    United States United States
    Thank you for your thoughts and replies. Your age? Do you work currently? I don't really want to use a cane either I mean teaching middle schoolers in a theater will make it tough and makes me feel old. I mean I am but I don't want to look and feel as old as a cane would make me feel.
    So you mentioned you opted not to have core decompression I am with you two major procedures with long recovery in two years is not what I want either.
    Should I try to stay off my feet ? Like sit more ? Not walk so much? I walk a lot at work I think. Not unusual for me to walk 19.000 steps but average 9,000 to 12 daily just at work not counting all the stuff I do on weekend..lots of lifting carrying stuff putting mess on shelves. Not sure if it matters or if I should try to stop or if the activity is best.
    Is heat good for it. Like on a heating pad...I go to second opinion appt. on Tuesday went to primary care dr today he was like both doctors (the one I went to ) and one I chose for Tuesday are well respected and experienced in the community. But I am not in a big town...Hampton roads, va not like Washington, Chicago etc.
     
  11. Susan209

    Susan209

    Member Since:
    Apr 23, 2017
    Age:
    39
    Messages:
    112
    Gender:
    Female
    Location:
    Sydney
    Country:
    Australia Australia
    Hi @va757 I avoid lifting things like the plague. Does not do me any good at all.
    I find heat helps a bit, not so much with the pain, but for the stiffness and also with my back, which has started giving me much grief as well.
    Hope your second opinion helps with your decision.
     
  12. va757

    va757
    Thread Starter

    Member Since:
    Sep 24, 2017
    Age:
    55
    Messages:
    5
    Gender:
    Female
    Country:
    United States United States
    So I went to get a second opinion and the next doctor told me pretty much the opposite of the first. I asked if he could guarantee me with some degree of certainty or even with what percentage of success he could assure core decompression could offer...
    He says he wouldn't do core decompression though he did offer it as an option but when I asked IF he would do it if it were him or his wife or mother -he said no.
    Gave me a cortisone shot for bursitis -wants me to go to PT for the left hip bursitis (which is wear my pain is coming from) then come back in December to check the progression of AVN.
    It is looking more like I will have the bilateral total hip replacement -just a matter of time.
    But I will not go on the medication and this doctor did not suggest it. He also felt everything the other doctor told me about having core decompression with bone marrow from iliac region on a Friday and back to work with a cane on Monday was "optimistic" at best. That I would be in a lot of pain and non weight bearing and a cane would not be enough for a number of weeks. When I asked if This could wait till December when the play I am directing was over and I had time off work...he said of course it could wait... so pretty much nothing like what I was told by the previous doctor.
    But thanks to all my reading and this forum i was way better informed -
    I said I didn't want to have two major surgeries with recovery in two years. As did the person above. The doctor agreed with a resounding yes and high fived me...a little weird. -I don't usually high five my doctor but whatever.
    By the way both of these doctors are well respected reputable doctors within the community. One is much younger than the other. Guess which one?
     
  13. djklaugh

    djklaugh

    Member Since:
    Sep 5, 2011
    Age:
    70
    Messages:
    1,686
    Gender:
    Female
    Location:
    Oregon
    Country:
    United States United States
    @va757 Go for the bilateral - I think you will be glad you did. I'm coming up on 6 years post op and it was the best thing I've ever done for my self. I rarely even think about my hips unless I sign in here :) I would guess the progressive, up-to-the-minute surgeon is the younger one - mine was also :) The reasons my surgeon gave me for having both done at once (and it was he who suggested/highly recommended it) were that a) it would be just one surgical session, one session of anesthesia, one hospital stay and therefore less risky for me (and I was 64 at the time), b) it would be only one recuperation period lasting about the same length of time as doing just one hip, c) I would be able to return to a normal gait faster (doing one at a time would mean limping between surgeries), and d) I would be less likely to have a leg length differential problem as he would be better able to make sure both legs were same length doing both at once.

    6 months after my BTHR I traveled across country for a school reunion, danced, walked a lot, drove a lot, waded in the ocean, went off roading with my brother, and had a marvelous time! Now a days I stoop, squat, bend to the floor, get down to and up off of the floor, ride bike, etc, etc and the hips are pain free and feel just like natural hips!

    If you have not done so yet feel free to read some of the Bilateral threads over on the recovery side - the link to mine is in my signature Best of luck to you and keep us informed :)
     
    • Like Like x 1
  14. zauberflöte

    zauberflöte

    Member Since:
    Mar 8, 2013
    Age:
    65
    Messages:
    4,927
    Gender:
    Female
    Location:
    Central Virginia
    Country:
    United States United States
    @va757 Hey there! I lived in Portsmouth for 7 years, and had a particular OS recommended to me from three separate sources. Anthony Carter, at Hampton Roads Orthopedic and Sports Medicine in Newport News, Thimble Shoals Rd just off I-64. I went to him, he did my first hip. I was so pleased with it that when we moved back home to Richmond and I needed the other one done, I went to him again. I am even happier with this one. If you decide to go THR and feel like checking some more surgeons, I can recommend him highly. I also recommend Mary Immaculate, where he has his own surgery suite, highly. The level of care I got was something I'd never experienced before, with several major surgeries under my belt in my 20's and 30's. Food ain't bad either :wink:
     
    • Like Like x 1
  15. Jaycey

    Jaycey Moderator

    Member Since:
    Jan 27, 2010
    Messages:
    22,236
    Gender:
    Female
    Location:
    Yorkshire
    Country:
    United Kingdom United Kingdom
    @va757 Sounds like your second opinion doc really knows his/her stuff! Bilateral and no fussing with stem cell. I think you are on the same page. Well done!
     
  16. va757

    va757
    Thread Starter

    Member Since:
    Sep 24, 2017
    Age:
    55
    Messages:
    5
    Gender:
    Female
    Country:
    United States United States
    Hey zauber ...Dr Carter did my moms knee replacement.
    I went to dr Haynes since he was top rated for avn (avascular necrosis of hip). First doc was younger dr Cummings
    i do feel Dr. Cummings was pushy and particularly for the core decompression.
    Dr Haynes does not replace with hip marrow becuase the healing is so painful in the hip that you remove and that bone marrow will fill in from drilling into ball socket without having to remove marrow from iliac region.
    I will go back on December and continue to check progress of avn and see where I am at but Mom Mom also highly recommended Dr Carter. I thought he was a knee specialist so I didn't consider him. So thanks for the vote of confidence in him for hips.
    Thanks everyone for all your help.
    I will keep you posted on results in December.
     

Share This Page

Sponsors
Close X