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Dual-mobility hip joint?? Plus, scared new forum member

yoga&hike

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Dear bone smart community,

I'm new to this community, and already I have found much solace reading through people's posts. Thank you all! Like many folks on this site, I was shocked to learn that I have end-stage OA in my right hip. At 51 years old, I thought this was too young, particularly since I am still highly active (I know better, now). I'm a mountaineer and yoga practitioner. I used to run but quit (due to what I now realize was hip pain - although I thought at the time that it was referred back pain - I've got back OA too). But I have been an avid exerciser since I was about 15, probably working out in one way or another 5-6 days a week, with a few breaks in there, but not many.

What scares me the most right now is hearing about physical limitations after THA. Hearing about possibility of dislocation doing what seem to be very basic yoga poses (Warrior I, Warrior II, Triangle - even Child's pose) - even years after surgery - makes me super sad. Really? I realize I will likely need to to narrow the scope of activities I participate in and be more gentle on my body - maybe I won't be plunge stepping down Mt. Rainier on a glacier -- but can I do some long, steep, (maybe even multi-day) hikes? My fear of these limitations is making me want to wait as long as possible before doing surgery. My passion is backpacking. I have such a long list of trails I still want to explore!

I recently came upon the work of Jill Miller, who is a yoga practitioner that had a THA in late 2017. She describes getting a dual-mobility hip joint, which apparently permits movement in any and every direction. Her surgery also used the superior approach, which was new to me, since I'm mostly hearing about the direct anterior approach. She's got some interesting podcasts describing her story.

At this very early point in my journey towards eventual hip surgery, while I'm currently scheduling appointments to get second and third opinions, here's the big questions I have:

1. If you have bone and bone hip OA with a "large subcondrial cyst", is it too late to get hip resurfacing done? Is my only option THA?

2. If I have a large cyst in my acetabulum (it's pretty huge), is postponing the surgery going to risk making it bigger? I ask this because I'm still quite mobile. I have bad pain on the 2nd half of an 8 mile hike, so I've had to curtail my mountain sports, but I am still able to do lots of other things and I feel like I could wait. But will I be making the situation for a successful surgery worse? And reading this forum makes me wonder "why wait"? I'd been under the impression that a replacement may only last 15 years...

3. What do y'all know about the superior approach and/or the dual-mobility joint?

I also just want to say thank you, again, to all of you who are sharing your stories and activities. It really helps me feel more normal. I'm getting lots of very surprised reactions from friends and family since I don't consistently have the amount of pain that one would usually consider pre-op.

Finally, I want to express support and empathy to anybody reading this who is in pain, physical and/or emotional, and say that I hope this forum is helping out, and I hope that you are finding multiple ways to manage it. I recognize that I am fortunate to be able to walk up and down stairs and I send my respect and support your way.


Warmly,

hike&yoga
 

alexthecat

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@yoga&hike welcome to Bonesmart! You'll note that I moved your thread from the Social Room to the Hip Pre-op area. You'll get more attention and feedback here.
What scares me the most right now is hearing about physical limitations after THA. Hearing about possibility of dislocation doing what seem to be very basic yoga poses (Warrior I, Warrior II, Triangle - even Child's pose) - even years after surgery - makes me super sad. Really?
No, not really. My THR is more than 9 years old and I don't have any movement limitations. I have no problem with any of the asanas that you mentioned nor with any of the others I've tried.
can I do some long, steep, (maybe even multi-day) hikes?
Of course you can! I bumped into someone online who summitted Everest a few years after THR. I've done a fair amount of hiking and backpacking in the western US and never run into any problems with my hip.
I recently came upon the work of Jill Miller, who is a yoga practitioner that had a THA in late 2017.
Okay, but have you talked to any orthopedic surgeons about THR? They are the real experts and that's who can give you accurate feedback on various devices and surgical approaches. My recommendation would be that you start there and not worry too much about online ads or YouTube videos.

Sent from my SM-S327VL using Tapatalk
 
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Uncivil

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I was turned down for hip resurfacing at a grade 2 on the Kellgren Lawrence scale which is far from bone on bone. I am now grade 3. Everyone I have talked to that had the resurfacing said they wished they had just waited for a replacement. I can't imagine hiking or yoga is a big deal with the THR from everything I read. Running is the biggest thing discouraged. I am hoping to do a superpath hip which from my research has almost no chance of dislocation post surgery. You might look into that as well. I am 44 and hoping to get both mine done this winter. I ride and show horses so I am looking forward to that post surgery as well as hiking! I cancelled a back packing trip I had planned for next month because they are just too painful.
 

gertie

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@yoga&hike I've had both hips done with the direct superior approach. I'm not an athlete so can't speak to whether or not it makes a difference in getting back to yoga and rigorous hiking but my understanding is that it's a less traumatic approach (no dislocation of the joint during surgery, for example). Certainly something to talk with an OS about.
 

VSlowLife

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@yoga&hike The superior direct approach is also called the northern approach, and based on the instruments the surgeon uses, it can also be called SuperCap (developed by Dr. Stephen Murphy up in Boston at New England Baptist Hospital back in 2003, or SuperPath, which Dr. Murphy consulted on along with Dr. Chow from Phoenix.
Not may surgeons do this approach. It involves a million dollar Mako robotic arm that helps the surgeon guide tools.
The Hospital for Special Surgery in NY has three Mako robots but they do not market their use. Some of their surgeons use them for anterior approaches, I have learned.
Many of the doctors who do superior direct, also do the more conventional surgeries because some folks are not good candidates, for various reasons, for one approach or another approach.
Although recovery may seem quicker on the outside, using superior direct, you will learning from reading the posts of others here, there is still much healing that needs to go on inside, no matter which approach. Also, some superior direct type surgeons may still want you to follow some restrictions for 6 weeks.
I am learning about this too. Hope this helps you.
 

sharonslp

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@yoga&hike As you can already see, there are a variety of approaches now to hip replacements. When I had mine done, people were starting to tout the supposed amazing benefits of the anterior approach. Then we started hearing about Superpath. And now you are talking terminology I haven't heard about. When all goes well (and usually all DOES go well), some approaches may sound far better than others. But here's what we've seen over and over again here in the forums: most people get pretty great results with whatever approach they end up with; some people have problems with whatever approach they end up with. The one variable that is probably the most accurate predictor of success is the skill of the surgeon. If your OS is using a fairly new approach, especially if it requires mastery of new technologies and equipment, it's very important to find out how much experience he has. How many surgeries a year does he do overall, and how many using this particular approach. These are questions you should feel free to ask when you meet with him. And yes, even though he may tell you that you will have few to no restrictions immediately after surgery, that gives many people a false sense of confidence about how much they really can or should do in the first year when there is so much healing of the soft tissues going on.

So bottom line is that today's new hips have a good likelihood of lasting way longer than the 15 years that used to be common. And many many many of us returned to an active and fulfilling life pursuing the passions we love. Will you have to make some accommodations in your yoga practice or in your hiking goals? Maybe yes; maybe no. Maybe a little bit. Maybe at first, but not later. It really depends on a lot of variables which you can't know now. But the overall prognosis is quite positive.

Some articles from our library that might be of interest to you:
THR approaches or incisions
Choosing a surgeon and a prosthesis

Come back with any more questions, and let us know how you progress in your decision-making. We all found ourselves overwhelmed when we hit that ton of bricks call an OA diagnosis. And it's terribly common to put it off if we think we can just get by a little longer, and a little longer. But a few years down the road, when it's all done and all healed, we wonder why we waited so long.
 

Jaycey

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Looks like most of your questions have been addressed. I'll chime in on this one:
If I have a large cyst in my acetabulum (it's pretty huge), is postponing the surgery going to risk making it bigger?
Waiting does have a risk. I had the same pain and thought it was lower back issues. I waited 3 years until one morning when I woke up and literally could not walk unaided. I stupidly thought this was due to a decrease in my visits to the gym and soldiered on for several weeks. I finally visited my GP who promptly sent me for an x-ray of my hip. I remember the x-ray technician asking if I needed assistance getting back to my car. That should have been a big clue. Three days later my GP informed me my hip had collapsed.

A collapsed hip means a longer and more complicated recovery. Your body quickly adjusts to trying to stay off a sore hip. Once that hip is replaced it is very hard to break old habits.
is it too late to get hip resurfacing done
You may not be a candidate for resurfacing. Only your surgeon can assess this. However many surgeons are no longer performing resurfacing on female patients.

I know all this is very scary. But I would encourage you to find a surgeon you trust and let the experts guide you through this. Most surgeon are no longer imposing restrictions post op. There is lots of living to do with that shiny new hip.
 

Going4fun

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Keep talking to surgeons until you find one who is confident that you can do yoga and all the activities you want to do. Of course, make sure this is a reputable surgeon ... and you might look online and in local magazines to see recommendations for top surgeons. I think the top surgeons feel they are confident about preventing dislocation ... Hip surgery today is far different than a decade ago ... a friend of mine had her surgery about a decade before I did, she was banned from running. I will be running later today. I have no restrictions from the surgeon (other than the fact that I'm 57 still thinking I'm 27).

But when you go into meetings with surgeons and you can schedule as many of those as you want ... even within the same practice! ... you say I want to do X and Y and Z after surgery. And the surgeon will react to that and tell you if they are comfortable with those activities. Lots of us have no restrictions. I have none.

And find an excellent surgeon ... no approach executes itself ... still there's a human being who has to do the cutting and pulling and the surgery ... The top surgeons use all the various approaches, not just one.
 
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yoga&hike

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Wow - thanks so much to all of you for these helpful and encouraging responses! I have several appointments with surgeons set up and am just impatiently awaiting them. In the meantime, hearing from your own experiences is very helpful.

I'm wondering if any of you out there had a bone graft. I think my biggest fear until I talk to some more doctors is that large cyst and whether/how having to have a bone graft may limit my success or options with a THR. (I've seen one doctor who was the one who told me that I have bone on bone and will need a graft due to the cyst. I was so stunned by the news - it's sinking in - but I feel the need to get some more opinions and find a doc I trust, like what y'all are suggesting).

Many thanks again for the suggestions, ideas, sharing, etc.

If anyone who has a dual-mobility joint reads this, I'd love to hear what you have to say about it!

Warmly, yoga&hike
 

julesglass

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Morning @yoga&hike. I was reading your thread and had to Google dual mobility hip replacement. Fascinating is all I can say. It would be interesting to found out how many have had this type and when all said and done how it performances over the course of let's say two years compared to standard unit. As one that enjoys an active physical life I would want to know is there a quality of life difference between the two implant for my life style. There are alot of very physically active people here that could give you insight to how their new hips has performed over the years. I guess I look at new technology as " let them get the bugs worked out before I jump in". That's me. Good luck, best wishes.
 

dapplega

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There are a couple of threads on here regarding dual mobility: https://bonesmart.org/forum/threads/dual-mobility-acetabular-cup-vs-traditional-implant-1.36586/. The technology has been around since the 70's and originated in France: https://link.springer.com/article/10.1007/s00264-017-3420-7
My OS uses dual mobility exclusively. He also uses a mini-posterior approach (I don't think approach will make much difference after the six week mark) and my scar is 2.25 inches long. The wear data in the registries seems to indicate at least equal performance to standard THR. I don't have any different limitations that I'm aware from standard THR. The theoretical advantage is decreased dislocation/increased range of motion. The trade off is an additional wearing surface, risk of a different type of dislocation (very rare) where the head dislocates from inside the ball (IPD it is called).
I also considered resurfacing but didn't want to deal with the metal monitoring.
Best wishes to you as you navigate through all of the information and what can feel like an overwhelming situation...
 
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Going4fun

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I didn't have a dual mobility device, but I sense that they're a reasonable choice for a surgeon.

Just my two cents: ... no device implants itself ... and every surgeon has their quirks and their unique experiences ... So what you want is a surgeon who has had great success with a dual mobility device. You can ask your surgeon about how many dual mobility devices they have used, their success rate, their confidence level, what they like about the dual mobility device. They should have great answers to these questions.

But worrying about the device gets a bit circular because the best surgeons pick devices they are really good with. So really find a good surgeon you trust. Good surgeons use devices that they have had great success with ... and operate with approaches they've had great success with.
 

zauberflöte

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Hi @yoga&hike Welcome! I'll just add my 2 cents worth on the activities. I was 61 and 65 for my replacements, not dual mobility, and anterior. I am not a flexible person so some yoga poses would be completely off the table for me. I can do a version of the folded-up child pose that's only a few degrees off complete. I am not going to run for exercise again as I don't want my hips to be a problem in old age, but that is self-imposed (OS's PAdid say they'd last longer if I didn't run...). My only other restriction is some yoga pose that I don't know the name of, only with the rear leg turned in. I don't do yoga either! (Never have)
I have gone back to ballet after 30+ years, and my only problems involving hips are soft tissue things. I have started taking Barre classes, which are fabulous for me. I am allowing myself to see if I can get into a modified front/back split, which is scary because of the rear leg, but so far not a twinge. Side split ain't never gonna happen, but if you look at the sticky thread about amazing recoveries, look for the young ballet dancer Shugaplum. Her mobility post-op was superb.
I will probably not do extended hiking at altitude because of other health issues, but with walking, again, it's all soft tissue. I get sore but my hip joints themselves are silent and invisible, and so far as U know I have ordinary cups (of two strikingly different shapes!).
If you tend your recovery well, you should certainly be as active as you like:spin::dancy::happydance:
 
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yoga&hike

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Thank you for the additional info about dual-mobility. As I'm new to the forum, I don't know how to send a PM - I'm trying to contact dapplega individually since he is from Seattle, which is where I'm likely to get my surgery. I'd love to PM you if possible with a few more questions and to find out who uses dual-mobility in Seattle.

Whey I select the "Send a PM" button, it says I don't have permissions...

I'm eager to talk to more doctors about all the options. I wonder if my large cyst will limit the type of approach they end up having to take (perhaps ruling out a superior approach, for example). But i'm guessing at everything... need more info!! :)

Thank you all again. It's great to have the reference to the dual-mobility thread - thank you dapplega.

Take care.
 

Jaycey

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@yoga&hike You need a minimum of 5 posts to be able to send a PM here. But I would encourage you to ask your questions on this thread. There may be other members here with the same questions or concerns. Your "conversation" will help other members as well.
 
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yoga&hike

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@yoga&hike You need a minimum of 5 posts to be able to send a PM here. But I would encourage you to ask your questions on this thread. There may be other members here with the same questions or concerns. Your "conversation" will help other members as well.
Thank you for letting me know!

My questions are to find out who dapplega 's surgeon was, and how things are going now that it's been several months out. Did you get a dual-mobility replacement? Are you happy with the results? Do you have recommendations for any other surgeons in Seattle?

Take care everyone!
 

dapplega

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@yoga&hike - sent you a PM.

I had my surgery with Dr. Bruckner out of Overlake (he also does surgery at Swedish in Issaquah).
Dr. Bruckner uses Biomet Dual Mobility (Dual Articulation). My surgery was about 2 years ago and was successful. Dr. Bruckner is well respected and has worked on three generations of my family. He has also done many people I know in the Issaquah area. He was the first OS recommended to me. I also had second opinions from Dr. Crutcher (Virginia Mason) and Dr. Claubeau (Virginia Mason). Dr. Crutcher uses a traditional implant. Dr. Claubeaux uses a dual articulation. None of them do resurfacing but mentioned I should see Dr. Pritchett if that interested me (you can find out a lot about Dr. Pritchett online). I was in good shape going in and my recovery was non eventful. Back in gym (light duty) about week 8. I just did a lot of walking before then. Biggest adjustment for me was mental. I was running about 5 miles a day before this happened and likely had a big ego about how good a shape I was in for my age. Having to accept I needed a replacement was hard. The OS's don't really prepare you for possible depression. Mine hit about week 10-12. I'm doing well now. Feel free to ask questions. I know it can be a hard experience to get your head around... :)
 

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@yoga&hike I live in the greater Seattle area, and these are the surgeons I would have suggested you consult as well. (I am in the Kaiser system, so they were not available as options for me.) That said, my understanding is they will offer you a choice of approaches, implants, and hospitals. If you need/want more names, consider using the Surgeon Locator tab at the top of this post.

I agree with @dapplega wholeheartedly; surgeons don’t really address what an enormous impact this diagnosis and subsequent treatment/surgery/recovery can have on one psychologically. My PCP has really been a great ally in this, and short-term psychotherapy is a good option to consider, too.

This is too large an elephant to eat in one sitting - it’s truly the one-bite-at-a-time variety. I am the worst offender about dwelling on the unknowable future, but my better days are spent in the here-and-now, calmly chipping away at the things I can do to prepare for surgery.
 
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yoga&hike

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Dear @dapplega and Ptarmigan,

Thank you both for the helpful messages! A friend's sports-medicine-doctor-brother also recommended Dr. Bruckner to me, and I have an appointment scheduled w/ him in a couple of weeks. And guess what? I also have appts scheduled with Drs. Crutcher and Pritchett! So I'm happy to hear that these are also the folks you felt good about. I'm not sure if I'll keep all of these appointments, as I'll likely have to pay for some them out of pocket, but I was trying to be sure I could get folks on the schedule and want to learn as much as I can before making any decisions.

I appreciate that you both discuss how hard it is to wrap your head around all THR. I'm still often in denial that this is really happening! Thank you for sharing that it got difficult with post-op depression; it's good to think ahead to those possibilities (I'm struggling already at this point!).

Ptarmigan, I love Ptarmigan Ridge at Mt Baker and hiking off of 542 in general, I'm assuming you might know where that is :).

dapplega, I'm curious to know if your dual mobility joint has any range of motion limitations. If you wanted to do yoga, like pigeon's pose, could you (maybe you already do!)? When I called the clinic where Dr. Crutcher works, they let me know that none of the docs there will use dual mobility. Was this a hard decision for you to make?

Thank you for being willing to engage in conversation and let me ask questions. Good night!

yoga&hike
 

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@yoga&hike If you read my thread, you’ll see my dad was a member of the Ptarmigan Climbing Club; the Ptarmigan Traverse is named for them. They completed it in the summer of 1938, Cascade Crest from Dome Peak to Cascade Pass, including half a dozen first ascents, several second, third and fourths. By the time I was born, however, rheumatoid arthritis directed him to a more sedentary life; he was a nationally competitive bridge player. My hiking exploits are pretty limited, but I understand the lure.

I think you’ll find that talking to these excellent surgeons will definitely help you process your diagnosis and treatment. It’s also very helpful to keep reading and posting here.
 

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