Every doc I see against THR, may loose 7-30 surgery date

[SuburbanLife]

Hi All,
I'm new to this forum, but not new to forums, The Knee Geeks forum helped me thru my TKR and hoping the same will be true for this site if I actually get my hip done!

Some background, had my right TKR in 2005, first spinal fusion, S1-L3 in '06, 2nd spinal fusion, L3-L2 last year, now I am scheduled for 7-30 to replace my left hip.

My problem is that today is my pre-op and my surgeon, who thought he had another opinion to support his decision to replace my hip, has now lost that support. I am concerned that will cause my OS to back out of doing my hip. When my OS was researching what to do about my hip, he sent me for a second opinion, she said no to the THR. My OS had every scan done, I had deep cortisone injections, the works, then the 3rd opinion, that agreed there was significant loss of cartiledge and it was degenerating fast enough to see total loss within a year, he agreed with my OS on THR.

The scheduling nurse ordered my pre-op tests, which I had done in early July, then when I get them done, she cannot offer me a surgery date until Sept. 3rd! So I decided to see if the 3rd opinion doctor had an opening to do the hip, since I was given the choice of which doctor I wanted to do the surgery, and I had stuck with the surgeon who had done all my previous surgeries. The other doctor had x-rays done and he decided there was not enough loss of cartledge from April to now to warrant the THR and he refused to do the surgery, instead recommended I seek pain management from my primary care doctor and try waiting until I am 60, I am 48 now.

I saw my rheumatologist yesterday, who at first was dead set against the replacement as well, but after hearing my reasoning, and my position, he felt that I should try stronger anti-inflamatories, ( I have been on anti-inflamatories and muscle relaxers ever since my spine started going) and told me to give those a try for a month, and if they don't work, then maybe the THR is my best bet. So, a vague, kind of an approval from him, but he told me he wasn't going to post an opinion on the surgery in his notes.

I don't know about any of the rest of you, but I have had nothing but trouble getting pain meds. My OS doesn't believe in refills, so every stinking time the pharmacy has to fax a request for refills, then I have to wait for approval from a doctor who is only in the office 2 days a week. I don't believe my primary will be willing to offer pain management, trying to deal with getting my pain taken care of for an indefinate length of time scares me. The pain is the worst I have had, far worse than anything with my knee being bone on bone before being replaced, a degenerating spine, nothing compares to the hip pain. Plus, I have never gotten so much flack over a surgery before. I was 45 when I had my knee replaced with hardly a flinch from the medics, but all I get is bad news from every doctor concerning replacing my hip at 48. I want to trust in the doctors, but the pain and dealing with the pain, pushes me for total relief, which could come from a replacement. I know there are no guarantees, my stinking knee needs a revision, but the pain from that is far less than it was before it was replaced, so I just deal with it.

Sorry I have rambled on so, it's just so frustrating. I see my OS this afternoon and I will know my fate by then. Any suggestions? Simular problems with being "too young"? It's the only time I've been "too young" for anything lately!

Thanks so much...Lisa

 

[Texas]

Hey Lisa Welcome....Too young ugh? I cant stand that I'm 41 and heard to. Only mine was the knee. I would just explain what you have explained here. Why wait till 60 when you are wasting all that time. You could have the surgery and be well on your way to recovery and have a pain free rest of your life with your hip. I know some Don't get it some dont care about age. I would just plead your case or print this out and read it to him...It was very good. You poured your heart out here so do it there. I really hope that he listens to you. I cant see why they would want anyone in pain for yrs then have it done and yet you have wasted all those yrs that you could have been moving on with a new hip....Really plead your case. But I would do it nicely you get more that way....I hope it works out please let us know how it goes today......Good Luck

 

[Judles]

Welcome Suburban! So sorry to hear of your dilemma!! Are all these doctors giving you their opinions in the same practice/ affiliated with the same practice? It DOES seem very peculiar that the OS' s had such a radical change of heart so soon to your surgical date! So if you are BOT satisfied with these doctors, research FURTHER! There is NO WAY you should be living for your next dose of pain killer and round of cortisone shot! This is another example of how YOU now have to be your OWN advocate! You're certainly NOT too young to have the surgery....we' have members of the forum that are in their 20s! Don't give up!!! Of course you're upset and frustrated! Who wouldn't be! But bottom line! This is YOUR LIFE!!! You have EVERY right to live it pain free! Hope you get a differenT opinion this afternoon, do post and let us know! If not, seek out other specialists! Believe me, there are PLENTY! !

 

[JudyS]

Dear Lisa
Welcome. You sound like me although I get I've had too much surgery lately instead of being too young. I am 52. I am confused as to the surgeon and OS are they different people?
I sure know about wanting things fixed instead of staying on pain meds. My pain management doc just dropped me last week. My spine suregeon is sending me to another one, but she is out of town for the next 2 weeks. So am I so I guess it will work out.

Good Luck today. I hope you can convince your doc that this is needed. I hope you have a hip surgeon doing this. It is important that they do a lot of this type of surgery to get the best outcome. I have a wonderful spine surgeon , but I sure would not let him replace a hip. :shk:

Let us know what happened today
judy

 

[Jamie]

Lisa, Welcome to the BoneSmart forum.

I know it is frustrating to plan for something and then have the plans change at the last minute. Until you speak with your surgeon, you don't really know that he won't do the surgery, so it might be best to talk with him soon.

I do have some questions, though. Why are you being told you you should not have a hip replacement? Is it your age? Other health issues? The hip is not bad enough? Surgery won't help? A combination of reasons?

Also, what is your current problem with your hip? Obviously it must hurt. But what kind of lifestyle limits are you having?

Do you know why your surgeon felt he needed additional opinions? Normally this is not done unless there are unusual circumstances.

We have a large group of caring members who are here to provide support for you. Our forum nurse, Josephine, has decades of experience in orthopedics. So you have come to the right place to voice your questions and concerns.

 

[SuburbanLife]

Hi All,
Thanks so very much for all your support, I will definatly post after my visit.

To answer questions:

Yes, the OS doing my hip is the same doctor who did my knee replacement, and both my spine surgeries. I really feel comfortable with him doing the hip, so far he has only improved my life.

The main reasoning against replacing the hip is my age. The magic number I keep hearing is 60. My hip is just over half way bone on bone, Arthritis is degenerating it. I have Arthritis in every joint and they are all in different stages of bothering me.

My life basically just revolves around the pain. I'm a miserable, unhappy person. I still do what I have to do, basically because I still can and sitting around focusing on the pain only makes it worse. I stay busy to keep my mind on something other than the pain. The Rheumatologist phrased my situation well, there is just not enough medical evidence to support the amount of pain I am in.

My surgeon wanted other opinions just to support his, I guess to make the overall decision to replace a more solid one, that is why I am concerned he will pull my surgery date. The standard line I hear is that if I get my hip done too early, I am sure to need a revision in my lifetime and revisions on the hip are less successful than other replacements. The 3rd opinion doctor told me that people my age are more active and wear out their hips faster, older people who get their hips replaced are less active and obtain a better result, that's his words, not mine, I think he is way over generalizing the numbers, I know many who are in their 60's who are way more active than me!!!

A bit of background helps explain my wanting the July surgery, and not the September. I own my own business, I make my own product and sell every weekend, October thru April. Without me, the business doesn't go, and I need the business to support the household. So I only have May-September to get a surgery done and get myself recovered in time to meet the October start of my season. Last year was pure torture toward the end, standing and sitting at a work table all day is something I just cannot tolerate any longer, I can lie straight all day if I like, but cannot stand or sit for long periods. Even the July 30th date is cutting it close, I kept my spine surgeries in early July, but with those it's a flat 3 months of no bending, twisting or lifting, and that I could work with. If I do not get the surgery done the 30th, I will have no choice but to wait another year, and next summer is when I am due to have the hardware removed from my spine.

...Lisa

 

[Jamie]

Thanks for the additional information, Lisa.

Are you in a small community? I ask because it seems a bit odd that a single surgeon would do hips, knees and spine surgery. In a larger city, you have specialists who do exclusively one (or maybe two) types of surgeries. This can be very important because they are more experienced in the techniques and hardware for their specialty.

As others have said, you are not "too young" for a hip replacement. It's all about quality of life - as you have figured out! What good is a great hip at age 60 if you've suffered for 20 years before that? And, when you wait in pain all those years, you risk doing additional damage to other joints and soft tissue as your body tries to acommodate and compensate for the pain. Waiting makes no sense to me if your joint is deteriorating.

I believe that part of your problem stems from not dealing with a hip specialist. I know you have had good results with this surgeon in the past, but if he does not agree to the surgery, try to find a surgeon who does hips exclusively. I don't know if you would be able to get the surgery done in time this year before your busy season, but you could try.

The thing I believe is VERY critical is that you not rush into the surgery just to get it done. Success of joint replacement surgery is VERY dependent on the surgeon doing the work. Their skill at this particular procedure is EVERYTHING! It would make me nervous that the person doing the surgery was not confident enough to make the decision himself and would need additional opinions (unless there were complicating circumstances, which you don't indicate are there). You might ask how many of these surgeries he has performed. I am concerned about his experience level with hip replacements for an active, young person.

 

[SuburbanLife]

Hi Jamie,
Thanks so much for your concern and advise!

I live in a fairly large city, and my OS is part of a large medical group, he has been a surgeon for a long time and I guess I just never gave any thought to a specialist doing the surgery since he has done all my previous ones. Of course, in the medical group, I would need to be referred to a specialist, but the subject has never come up.

I will have plenty of questions when I see him this afternoon. I guess since he has done so much with me already, I just feel comfortable with him, and that can be a good thing or a bad thing. The course of treatment has brought me to this point and I will go forward with it and see where it goes. Trust me, it's not from lack of respect to you or your opinions, it's just a comfort factor. I will ask for sure how long and how many hips he has done, but he is well respected in this group, so I would think he has done his fair share, altho it doesn't hurt to ask, and I will.

I am not sure why it was so important to my OS to have an opinion that matched his. He has always told me he was treating me, not the test results. The ball has always landed in my court with him, in the end, he asked me if I was ready to do a surgery, and when I said yes, it was done. I really don't know why I think this time is any different, maybe it's because so many different opinions have landed at my feet.

If I had either taken that September surgery date, or one in July had been available at first, I never would have sought out that other doctor to do the surgery and his approval would have been the last word my doctor saw. So I guess the blame could land on my shoulders for stirring the pot!
...Lisa

 

[Jamie]

No, no, Lisa. Never ever feel that any of this is your fault. You are doing the right thing by seeking other opinions and questioning. After all, this is MAJOR surgery that will impact the rest of your life. You want that impact to be positive and so taking time to research and ask questions is the right thing to do.

You sound very level headed and I understand your feeling of the comfort factor. That is important too. I certainly am not saying that your surgeon will not do a good job with your hip, just that it is something to think about if he only does one or two of these surgeries a week. A specialist will do many times that number.

You will likely know how you want to proceed once you have a frank discussion with him. Please do continue to post because we care about what happens and want the best for you!

 

[SuburbanLife]

Well, final word is no surgery, my surgery refused to do the surgery on me since the other doctor backslid on his approval. I really don't know how I feel. I told my surgeon that my issue was the pain, that I just can't take it any more. My surgeon agreed that if I am to wait until the hip is totally bone on bone then I should be in pain management. My surgeon told the nurse to fast track me into pain management and get me a rush appointment. He promised that with his recommendation I would be assured a place in pain management and that they would get my pain under control.

I have to say that odd circumstances were placed in the path of my surgery that got it cancelled, so maybe this is the way that things are supposed to work out. If I get my pain under control, that's as good as getting the hip replaced but without the recovery time. I just hope this really happens and I'm not left out in the cold with this pain.

Thanks for the encouragement and support, but it's no replacement for me for at least a year! Good luck to all!
Lisa

 

[Texas]

I dont know if you have gotten an opinion out from either one of those Drs someone who knows nothing about those 2. Just a thought and cant hurt. I cant see why you should sit in pain. If they agree that it is damaged then I would go to another Dr. Dont leave it like that if your not satisfied. Pain management might work but it wont save your hip. Which is what it sounds like you need. Just think about another Dr. We have a gentlemen on here that went to 3 different ones till one agreed what he needed was to have it replaced. Good Luck to you and sorry it wasnt great news, but dont give up really !!!!!!!!!!!!!!!!!!!!!

 

[Judles]

So sorry to hear your doctor's decision! The ironic fact is that this is such brilliant surgery and I fail to understand why this doctor would want you to continue suffering like you are! Once you would have HAD the surgery, and gotten the surgical pain under proper control, you would no longer NEED all these additonal pain meds! BTW, please be aware that cortisone can further weaken the bone structure which would make eventual surgery even more difficult to recover from! I'm definitely NOT preaching to you! But from my own personal experience.....I am living a very active life again,,,,,,and I am NOT 60 yet!!! Good luck to you!! I wish you made an appt with MY surgeon...he's internationally renowned, brilliant and COMPASSIONATE! When I see him, I go out of my way to hug him....and thank him for giving me my life BACK!!!

 

[aussie]

Hi Lisa,

I'm sorry you can't have your surgery just yet, but as you say maybe it is meant to be.

I hope they get your pain under control for you, but I have to say I disagree with filling someone up with medication when there is such a life changing, medication free (after initial recovery) alternative.

I was 48 when I had my hip done and yes if I live long enough I may have to have a revision but sobeit.

I understand totally what you say about being unhappy, I lost so much of myself in the pain, it wasn't until I was painfree that I realised it. It affects all parts of your life.

I do hope this next year is comfortable for you, but know too that you can always look elsewhere if it's not. You need to do what you need to do for quality of life.

Best wishes

 

[Jamie]

Lisa, since you indicated that for financial reasons you couldn't have the surgery in the months from (I think) September through April, why don't you use that time to research a hip specialist in your area, meet with him, and be evaluated by someone who does many, many of these surgeries. Heck, meet with two of them. This decision is one doctor's opinion who is not in my opinion an orthopedic specialist. He may be nice and you like him and all, but he is a general surgeon if he does hips, knees and spines alike.

Here is a (broken link removed: https://bonesmart.org/clinic_lookup.phpto get you started in your research. You can find specialists near your zip code. Even if you had to drive a little, this is your quality of life you're talking about - something that is extremely important. Once you have a few names, Google them online and read about their backgrounds. There is a list of questions to ask them in an interview along with some other information at the top of the index on the Hip Surgery forum (click on HIP REPLACEMENTS in the red bar at the top of any page and then click on HIP SURGERY DISCUSSIONS). Use this as a guide when you meet with the surgeons.

You don't have to resign yourself to pain and lots of meds!! Besides, remember....if your hip really is in bad shape, masking the pain only causes you to wear it out more which can impact a later surgery. Please, please take time to see someone who is a full-time hip person.

What major city are you near? It may be that some on the forum also have recommendations for you.

 

[Josephine]

That is all so much rubbishI! People as young as 20 get their hips done. It's about quality of life, not age. I've nursed people of 48, 38 and 28, even 18!, with THRs. Pain is pain and trust me, a pain management clinic will not more be able to do anything much about your pain than they could a toothache!

So you're willing to let them rob you of more years of your precious life before you get mad and do something about it? There are surgeons out there who will do your hip. Get searching! His reluctance tells me he is an inexperienced hip surgeon and is scared of litigation down the line!

Also - ask him why he did your knees if you are 'too young'. They have all the same problems of wear and revision as hips and are a darned sight more difficult to redo.

 

[SuburbanLife]

Hi All,
Thanks for the words of support and encouragement!

The doctor I saw for my 3rd opinion, who's refusal to do the surgery is what ultimately led to my OS refusing the THR, is a joint reconstructive specialist. I saw my Rheumatologist Tuesday, who also sided against the sugery. So I ended up with a total of 4 doctors against it and my OS felt it irresponsible to go against so many negative opinions. I get that. No one says the hip is good, they all just don't think it's that bad yet, only about 1/2 of the joint is bone on bone. All these doctors are from the same medical group.

Since I cannot do the surgery now, I have no choice but to wait until next summer. I am taking this time to follow all the recommendations of the joint replacement specialist, taking stronger anti-inflamitories, going back to Weight Watchers to get more weight off, seeking pain management. Since I have the choice, I will follow up with him once I have seen someone about the pain. He said he would recommend regular x-rays to watch the progress of the hip, so really, that's all I can ask for at this point since I can't do anything about it, there is no time to seek out another surgeon and get this done in the time frame I have left.

I don't have many alternatives for now, but I do have plenty I can research and see what can be done next summer. It really does sicken me to think of having to deal with this for another year. I am scared I won't get my pain managed, but if by chance I do, that will make the wait more tolerable. I am slowly coming to a place of acceptance, with the limits I have on when I can have a proceedure done during the year, it makes it very hard to get my needs met, but you can make very sure I will do whatever it takes to make sure I get this done as soon as I can, which, for now, is May of next year! UGH!

Seriously tho, thanks so much for listening to me, it really does help!
...Lisa

 

[Jamie]

Lisa, you are taking a wonderfully practical approach to the situation in which you find yourself. I feel pretty sure that a good pain management doctor will get your pain to a manageable level so you can make it to next spring. It might not be perfect, but you'll get through it. You are smart to keep the overall goal of replacing the hip next summer.

You need to get out of that medical group for additional opinions, though. If all the doctors you have seen are in one medical practice, you don't really have THREE opinions. What you have is ONE opinion and a lot of consultations. Doctors in the same practice rarely will contradict each other. What you need are several independent opinions. That can only come from searching out a couple of different practices near you that have surgeons specializing in hip replacements. You will find a surgeon who understands your quality of life issues and you will be able to get this done with a little searching.

In the meantime, we're here for you for whatever support you need. Please post whenever you have a question or concern...or even if you just want to give us an update on how things are going.

 

[Oscarsmum]

Lisa,

If your hip is deteriorating but not bad enough yet for a THR have you researched or talked to your OS about a resurfacing? I know several women who have had that in their forties and had amazing results. It may be that you need to look around for an OS in your area that has experiance in it, but it might be worth an opinion.
If the pain is bad enough that it is affecting your daily life then you should find a solution of some sort. I went from OS to OS for about 4 years, the first told me my hip was fine , but I didn't give up because I knew it wasn't. It turned out I had severe dysplasia, my hip was subluxing constantly, and am now 10 weeks post-op from a PAO. It has been a long and difficult few years but I persevered and found the right OS and am finally starting to see the light at the end of the tunnel .My view was always that quality of life is what counts and I didn't want to live a life of limitations and pain.
Good luck
Kate

 

[UTdave]

Why are they removing your spine hardware?

 

[aussie]

Lisa,

Maybe you could do some OS hunting during the waiting period and get your op all lined up for the minute you are able to do it. Just a thought:sct: