Dr. wants me to wait 10 years if possible?

[tooyoung?]

Hello everyone, this is an excellent site with lots of information and opinions. Now maybe some advice for me.

I am a 41 year old male that has right hip pain in my groin area for a year and a half now, seeming to get worse. In June I finally had enough and went and had an x-ray and sure enough, severe OA. I Went to a well respected Dr. in Burlington VT and was told that I would need a THR but he doesn't really want me to do it until my 50's if possible but he will if I want it. He wants me to lose as much weight as possible (I am 6'3" and was 327lb on 8/17 now 305 after 40 days).

I do have a surgery date for Nov 6th, and have a pre-op visit to make up my mind on October 24th. He believes if I keep losing the weight, more walking and aqua therapy will lessen the pain. I agree to a point because some days it does feel better, but driving a car is painful from gas to brake, taking a full gaited step hurts that hip and tying my shoe is impossible now, and some nights it is really difficult to sleep comfortable.

He has also made me nervous of the revision surgery concerns that may arise, and told me the new hip with my weight may only last 8 to 10 years. He uses the Smith and Nephew Oxinium implant that is "supposed to last up to 30 years" (only 8-10 years for me kinda stinks).

I do plan on losing hopefully 100 total pounds and I believe it may be easier with the THR and by the way I also need my right knee replaced also (injury) but I have put up with that for almost 20 years and am used to that pain but this pain is sharper and more debilitating than my knee.

I know this is a long post but I'm nervous about the possibility of revision difficulties and length of time the new one may last. Any comments or help would be so much appreciated, the time is getting short for me to make a decision. Thanks.

 

[Knitter4444]

I am from the knee side but I know the hip people will tell you. Quality of life and worry about the revision if and when the time comes. Gift yourself with a painfree life. Gee whiz, I bet doctors would never walk around with a bad hip joint for very long.

 

[Josephine]

Welcome to BoneSmart - the land of the free-from-pain! I suggest you find yourself another surgeon, I'm not too impressed with that chap. Anyone who can cheerfully tell a person to stay in pain for another 10 years shows a decided lack of compassion in my book. Your BMI is a 'mere' 40 which is pretty borderline as I have nursed lots of patients with much higher BMIs than that. there are plenty of surgeons out there for whom weight is not an issue. I suggest you find one. Mind you, I would want to quash your efforts to lose weight because that's always to the good even if your weren't having a hip replacement!

As for trying to scare you by saying your new hip would only last 8-10 years, that's rubbish! Statistics are showing that more and more hips are lasting upwards of 30 years (S&N ads notwithstanding!) and there is a lot of talk around the conferences about the "forever hip" already being with us. Besides which, a really good surgeon will choose a device more suited to the larger person. This has been so for decades - I know because I was there!!!

All of this applies to knee replacements as well, btw. You might like to read these
Longevity of implants and revisions: how long will my new joint last
Stories of amazing hip recoveries
Hips that have lasted 40 and 32 years

 

[JaneyGS]

Hi too young,

I'm 40 and I had my left hip replaced on Friday. I've waited since I was 18 which was when I was diagnosed with hip dysplasia and I knew that I would end up with OA. It actually sounds as if you are struggling more than I was pre op. I was just finding it difficult to do work in the garden and my gym classes had got too painful and driving the car was just getting uncomfortable. I can't imagine how you could manage for 10 years from where you are now so I think the advice from Josephine to find another surgeon makes a lot of sense. Good luck (and well done so far!) with losing the weight as well as that will only make it easier as well!

Jane

 

[Jaycey]

Hi tooyoung, I agree with Jo - find another surgeon. And please don't worry about revisions. I attended a conference recently and the reconfirmed just what Jo is saying - these things last a lifetime. Your user name is right - you are too young to live in pain!

 

[rider1960]

I think your surgeon has some valid concerns that the prosthesis won't last as long at your current weight. Mine said the same thing. I don't weigh as much overall as you do, but I bet my BMI is similar at a shorter height. It makes me wonder if it's not the BMI that will predict the life of the prosthesis, but more of the actual weight that the prosthesis has to handle. Say--perhaps it would last longer in a 5 foot, 100 pound woman than a 6 foot, 190 pound man who might each have around the same BMI???? I don't know this, but it makes sense to me. You are going to always be a big guy anyway, considering your height alone--you will never weigh what a smaller person will weigh. The hip joint has to take the brunt of all the body weight above it, so it may be even more important that you stay at a healthy weight for your height. Just speculating.

OK ... that said ... from my own personal experience (2 hips replaced recently and I'm significantly overweight, as I said before, although I'm shorter--5'4), I did fine with the surgery and the recovery (except I tried too hard at PT and tore a hip flexor muscle with the last hip, which had nothing to do with my being overweight). BUT, I do believe my surgeon (hip specialist who does primary and revision surgeries at mega-numbers compared to most surgeons and has pretty much seen it all when it comes to hips) when he has told me that my prosthesis is likely to only last 10 years at my current weight--it just makes sense to me that it will wear out sooner being an active, overweight young adult than it would if I'm thinner. Although I should lose 100 pounds to get to a textbook ideal weight, he's not asking me for that--he has told me that if I lose even 50 pounds, it should extend the life of the prosthesis to 20 years or possibly more. I'm going to aim for even more, although I don't think I'll get to an "ideal" weight--ever, lol.

So I'm diligently working on losing weight as quickly (but resonably) as I can. But, if I had had to wait until I lost that much weight BEFORE my hip replacements, I think I would have been crippled up and in a wheelchair while taking the time to do that; things were getting worse with my hip very rapidly. I went from moderate arthritis and significant but not disabling pain in July 2011 to bone on bone arthritis by October 2011. I think my surgeon was even surprised at the rapid progression. When I first saw him in July, he had thought I would be able to stay comfortable enough to delay the surgery (using conservative measures and losing weight to take stress off the joint) for a few years, but the arthritis had a mind of its own.

An interesting conversation with my surgeon when I first started talking surgery specifics with him: I said "Are you comfortable performing a hip replacement on someone like me?" He said "What do you mean 'someone like you'?" I said "an overweight person like I am? You've made a big deal about my weight ever since I first saw you." He looked surprised "I do hip replacements on people your size all the time and I've done some twice your size! The discussions about your weight are nothing different than I have with anyone who is significantly overweight whom I see. But it's become clear that you are getting worse and in a lot of pain that can't be managed by conservative measures. Since you can't wait the time necessary to lose the weight, I'm happy to proceed with surgery now." And, then he explained about the increased risk of infection or other problems (which were not THAT much different that a skinny person).

Since I don't have the horrible arthritis pain anymore and feel better about life, and can move around more freely (although still limited more than many because of the hip flexor problem--which will heal--and some pre-existing unrelated back pain that isn't any where near as bad as the arthritis pain was), I've been able to lose 25 pounds (since the first replacement).

Maybe some people would call this an excuse or a cop out, but I just couldn't handle the stress of making diet changes significant enough to lose the weight when I felt so horrible with hip arthritis pain. I just couldn't! I was barely existing day to day. Quite frankly, food was the only thing I had to rely on, which I know isn't a good way to deal with it--but that's where I was at.

Sure, it would have been easier getting around right after the hip replacements if I had been significantly thinner, but it definitely wasn't worth delaying it and being in severe hip arthritis pain while taking 6 months or whatever to lose 50 pounds ... even if I could have handled the additional stress of trying to lose weight.

Now that the replacements are done and over, I have a much better mind set and look forward to each day. I have the energy and the motivation to do what I need to do in order to lose weight. I want my hips to last as long as possible. And, I do believe they will last a lot longer if they aren't lugging around extra weight--that makes perfect sense to me, so I believe my surgeon when he says it. It's just that NOW I feel like I can do it; before ... too much fatigue and pain ... I just couldn't.

I see you are upstate NY. So am I. I'm guessing, though, that you are WAY up north, since you went to Burlington for your surgeon visit. If you want to check out my surgeon in Syracuse, let me know and I'll give you his name and contact info.

Dorothy

 

[bellaroma]

Boy, wait 10 years! Is he kidding. From my perspective even it it meant I had to have my hip replaced again in 10, which isn't true anyway, I would rather be able to enjoy 10 years of pain free life and movement.

 

[Jaycey]

Apparently they are just starting to track hip failure rates to BMI. But nothing yet confirms any correlation. In any case, I agree with Poppet - life's too short.

 

[tooyoung?]

I want to thank everyone for their input and support. I'm just getting to respond so thanks. I agree that my Dr. seems harsh but he did use the excuse that his x-rays looked like mine at his age and he just had his done at 52 years old. I don't know if he is trying to encourage me to "man up" due to his personal experience or what.
He will do mine if i want it, but just wants me to be aware of the worst case scenarios and i suppose 2nd guess myself? I have a buddy that has to be close to almost 500lbs, same height. The same Dr. replaced his with great results so it isn't as if he can't do large people. This is a big part of the reason I went to him. And just today one of my customers talked to me about his hip replacements. He is close to my height and weight and his first hip is 19 years old and still fine and he had his other one last 5 years before he had a problem with the stem loosening and having to have a revision, but the new one is 12 years old now.
So in summary I have been second guessing myself because of the worry about a "possible revision" sooner than later, and worried about moving the wrong way and dislocating the implant. After reading this forum, your responses, and now hearing about my customers own experiences it has definitely eased, and made up my mind to absolutely live for today PAIN FREE! and remain on track for my surgery date of November 6th. And probably go ahead with my TKR within a year to get rid of that pain also. I feel a great burden and unnecessary stress has been lifted so thank you very much! Dean

 

[rider1960]

Dean, your surgeon sounds like he may be a little like mine--when I finally let my guard down and told my surgeon in no uncertain terms that I couldn't stand the pain any longer and stopped putting on a "I'm tough; I can take it" facade ... then he switched right over to discussing surgery as the next step with no further talk about waiting. I don't think he realized how bad I felt. My x-ray wasn't that bad at the time and I was newly diagnosed (by him) and hadn't tried all the conservative measures that are usually done in situations like mine before proceeding to surgery. He didn't have a problem doing the replacement when it worsened and I came clean with how I was really feeling. Have you told your surgeon flat out "I want the hip replacement"? Or, did you just ask him what he recommended and that was the end of the conversation?

I do think some surgeons err on the side of caution--depending on what you are telling him or how you are presenting physically when they see a patient. You may not have seemed functionally as bad as you truly feel--and were trying to put on a brave face. I know I don't like to act as bad as a feel when I go to a doctor--I feel like such a baby or whiner. So, I can sit there in pretty severe pain and keep a straight face, speak coherently and organize my thoughts, etc. Doctors who don't know me don't realize how bad I feel. By the time I get to the point of NOT being able to do these things, I'm VERY bad off and they would need to take me to the hospital by ambulance, lol.

Things can be different with joint replacements, since it's an elective surgery so your life isn't in danger. My guess is that if you tell him point blank that you will accept the additional risks and that you want the surgery done sooner, rather than later, he will agree without giving you a hard time. You will get it done and feel a lot better.

Dorothy

 

[Josephine]

 

[tooyoung?]

Thanks Dorothy and Josephine for the encouragement. I guess I more or less let him run the conversation, put doubts in my head and make me feel like I could live with the pain. It kinda worked, i tried talking myself into his thinking and friends and family were supportive with that decision also, so it definately cast more doubt on getting a replacement. It also didnt seem to hurt as much for a few weeks.(hmmm the power of suggestion) The last few weeks though have been worse and I know I just need to get it done and tell him YES, I WANT IT DONE! and stop worrying about what may happen in the future. Sincerely, Dean

 

[Jaycey]

So glad you are moving ahead Dean. You won't regret it! THR is the beginning of a new life. It's only after the surgery that you realize how much your world shrinks due to the pain. Stick with us here. We will help you through this journey. I see you are now a November Nimble - well done!

 

[Road_Clam]

I was the one who was putting off my hip replacement (I am only 46). My doctor has been recommending a hip replacement for me for for the past 3 years since I was first diagnosed with hip arthritis back in 2006. He commented "it will never get better, hip arthritis gets incrementally worse every year" . He was correct. I'm sick and tired of the aggravating pain and stiffness, and my current poor quality of life with respect to activity. Find a surgeon who is on the same page as you...

 

[Dingbat7]

I agree with the comments I'm 49 and my consultant happy to do them when I wanted them done, obviously if you can lose weight it will help as less strain on you new joint, waiting may cause more joint problems ie your knees and back if walking badly .

 

[sharonslp]

Dean, I'm still fixated on your statement that you lost 22 pounds in 40 days! That is a fabulous accomplishment, and if you can continue losing, even if the rate slows down somewhat, you will be at a very reasonable weight by the time you have done most of your recovery from the surgery.

I'm very jealous. It's taken me 5 months to get rid of 16 pounds. I know it's easier for men to lose weight, and it's easier for the entire world to lose weight than for post-menopausal women, but still!!!!!

So let's both of us keep plugging away at it. I know you'll be delighted with your new hip, and being worthy of these hips is a great motivator to keep fit.

Sharon

 

[tooyoung?]

Thanks for the encouragement Sharon.Today I was down to 302 and hopefully by the time surgery gets here I will be close to 280. I am working with a health coach through the Medifast program, (TSFL.COM) It costs a little, but no more than I was spending on lunches and fast food dinners.I can get you his info if you or anyone else would like, he is a very nice southern gentleman .

 

[sharonslp]

My local hospital has an Optifast program, which I think is similar. When I got very serious back in the spring, I researched what they offer, and I felt that if I could not be successful any other way, I might eventually try it. I had good results with Weight Watchers at one time, but of course gained it all back. But I decided to concentrate on sensible food and really strong portion control....which is a part of what Medifast accomplishes, I think. And it is working....it's just so slow for me. But I am feeling good, and I've gone down a full size, and if I could knock off another 20 pounds, I'd be quite satisfied. And then I'd have the just as hard job of not gaining it back.

Are you on the plan where you do the shakes for two meals and one regular meal? What happens while you're in the hospital?

 

[tashia]

I have heard that myth of being to heavy. I think the doctor is missing a point and is if you don't hurt you are more active. Have the replacement and enjoy life. After its done and feeling better I think you will be more active and therefore lose more weight. I know I have. After each replacement I got more active and now will all done and pretty much out of pain I find I am more active and did lose weight. Keep us informed on how you are doing. We do care and most important welcome to the site. Take care. Tashia

 

[titac]

Hey tooyoung; I 40 and I had my left hip replaced in July and going for the right in October. Living will all that pain is no way to live! I suggest you find another surgeon and in the meantime continue pursuing your weight loss goals.