FiremanSam - need reassurance!

[zauberflöte]

And if I'm being really greedy, allowing me to get back to indoor rowing, cycling, weight lifting, walking big hills and elliptical trainer!!

I didn't get through all three pages of your thread, so I don't know if somebody has already covered this-- I think you need have no fear about getting back into all those activities! A year after my hip, we moved into a house at the bottom of a nearly mile-long hill. So much more fun than a treadmill! As I got back into shape from not having done hills in 7 years, I enjoyed booking it up the hill as fast as my sweat would allow me. I also got back into "lady-like" weight-lifting, which made me very happy and much stronger By two summers later, other health concerns (left hip gone bad, and cardiac) had come along, and hard exercise was limited. Fast forward to now, with a deteriorating left hip but a renovated heart, I look forward to scheduling my left THR at the surgeon's earliest convenience, probably this summer!

We have 20-something ballet dancer, older contra-dancers, horse-women, ski instructor and skiers, kayakers, competitive runners and bikers, scuba divers, and as has been mentioned, a number of first-responder types, who've all gone on to regain their abilities to do the jobs they are passionate about. Regarding the elliptical, I was told that the elliptical would be my friend from now on-- I really would like to die with this original hip in place, which could mean another 25 years, given my mother's age! I am allowed to run, but if I want to prevent wear, I should not do it for exercise, only sprinting the parking lot in the rain or the like. I have a doctor whose wife is tiny (105 lbs), and only after her bilateral hips in her 40's was she able to run!

Best of luck!

 

[Nivea]

Awesome news! Not only can you have your job, you will have shiny new hips and be pain free!

 

[AlGroomer]

AlGroomer, what type of hip replacement did you have?


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Sorry I just now read this! I'm having my surgery April 12th, he's doing it Anterior. My opinion that's the best way! They don't cut any muscles or tendons, you don't have the 90 degree restriction. Good Luck! Hope you can find a doctor in your area. You could fly to Birmingham, Alabama [emoji16]


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[Constanze]

I had the lateral approach and minimal invasive (small incision on the outside of the thigh) - not posterior. I also had no nerves cut and it healed fast. My surgeon said I would have the classical hip restrictions for 6 weeks maximum but could "break" them sooner if I trusted myself - in other words - there was no risk of dislocating. So I broke the "classical rules" long before the 6-week limit and happily bent down to put my socks on normally (without the sock aid) when the nurses and trainers at rehab weren't looking . They favoured a more conservative approach and didn't have the information from my surgeon.
I believe the lateral approach is common in the UK because I read posts about it here on Bonesmart. I don't know whether they do the anterior approach in the UK. That may have disadvantages, too. I've heard from some posters on bonesmart that a very small area (about 5 square millimeters or so) in the front of the thigh may feel numb for a few days and one may feel stiff when trying to cycle or something. Try to consult several surgeons. I consulted three different ones. Good luck - Constanze

 

[FiremanSam]

Thankyou for all the comments.
It's my first appointment today with orthopaedic surgeon following my X-rays. Any questions I should be asking??


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[Constanze]

I would ask what approach will be used (anterior, posterior or lateral), the material that's used - I think titanium stem with ceramic ball and ceramic lining are the most durable materials, and then whether or not uncemented. They will probably use an uncemented device for you, since you rank among the young and active patients. This - again - is more stable for young and active people, because the device will make a "bond" with the bone when healing. Another important thing you might want to know is what hip restrictions you'll be facing (if any) and for what period. Hope this helps. Surely - the experts of Bonesmart will have some more good advice to give - best! Constanze

 

[Jaycey]

This was my list of questions pre-op my first THR:

Surgical approach?
What type of prosthesis?
Cement or non-cement?
How long does the procedure take?
Can I have anti-nausea meds?
Will I have weight bearing restrictions (if yes for how long)?
Anaesthesia (spinal or GA)?
Will I have a catheter post-op?
What restrictions will I have and for how long?
What is your post-op pain management plan?
Stitches or staples?
Bathing/shower how soon?
Can I function on my own at home from day 1?
PT how soon (home or outpatient)?
When can I drive?
Who can I contact with any post-op problems?

To be fair, a surgeon usually answers all these questions during their discussion with you. But it's good to have a list just in case. Don't feel rushed through your appointment and I always suggest writing down the answers to your questions while you are there.

 

[FiremanSam]

Update following ortho appt : Doesn't feel I need a hip replacement yet. There is some cartilage just none on edges. He says there was some restriction of movement but if not in pain carry on until I am in pain. Might be 1 or 2 years, might be 5 years. He did say I wouldn't be a front line fire fighter for 20 years!!! Also gave a poor prognosis on longevity of replacements???


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[Jaycey]

Also gave a poor prognosis on longevity of replacements???

Well I guess he is not up to date on his technology. I would find another surgeon! Here's some reading for you on this subject.
67½ years old - the THRs, not the patient!
Hips that have lasted 32, 40, 41 and 45 years

 

[sammylou99]

How strange - I have been given an indefinite amount of time for my ceramic on ceramic uncemented. My OS told me it will be very long lasting and I may not even need a revision if I look after it (I'm 52). He had also cleared me next year to do all sorts of activities.
I would also not recommend waiting until the point that the cartilage disappears completely (mine had) as it is impossible to manage the pain and you will have a longer recovery because the muscles waste in the leg and I was walking with a limp.
I would get a second opinion if I were you - maybe with one if the surgeons Josephine recommended just for peace of mind.
Take care,
Sam


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[Constanze]

Not a front line fire fighter for 20 years? Poor prognosis on longevity of replacements? What utter and complete rubbish . I couldn't agree more with Jacey, and I would find another surgeon. I wasn't very pleased with the surgeon with whom I had my first appointment: He rushed through the list of questions (not good according to Jacey) and tried to impose a life-long ban on jogging/running on me post-op. I've been a marathon runner for 10 years. No more running would have had an adverse effect on my quality of life. People do run post-op, and there is no scientifc evidence that you wear out your device prematurely through running. So why should firefighting be a problem? As regards my situation, I've done 2 half-marathons and 1 marathon (partly walking) since the operation, and the result of my last half-marathon was 2 hours 10 minutes. Life is too good to be spoiled by discouragement.

So try to get a second opinion from a second surgeon. I would also recommend a hospital that specialises in orthopaedic operations, like the one where I stayed. There is a lower risk of infection (multi-resistance germs) and quite early on they do the right type of physiotherapy especially designed for recovery after orthopaedic surgery. Would you be prepared to travel within the UK or even abroad. My hospital and my surgeon are excellent: I was operated at the Aukamm-Klinik at Wiesbaden (you can google them). However, I'm quite certain, you will find a competent surgeon in the UK - take your time and read some recovery threads from people in the UK. - Best - Constanze

 

[Horseshoe]

@FiremanSam on one hand it must be a relief to put off the thr but on the other hand, the condition will not improve, unfortunately. This extra time can enable you to get a second or third opinion and schedule it when it best suits you.

Upon my diagnosis a few years ago, severe OA in both hips, I was told to come back when I was older, dr said to wait five to ten years. Only a few mos later, both hips deteriorated very quickly and very painfully, the intensity caught me off guard. The timing could not have been worse for me in so many ways, argh!

The sudden onslaught of immobility and pain was surprising, hadn't a clue that OA could be so crippling so quickly, naively thought OA was just stiffness that could be manged with exercise and occasional Tylenol -that is most def not the case when it becomes severe!

I would have done things very differently if I knew then what I know now

Good luck with your decision.

 

[FiremanSam]

The ortho also advised that the ceramic in ceramic can be problematic around the edges of the cup??
TBH at the moment I only tend to ache after a long walk. Occasionally get a jolt pain but nothing that requires pain relief so I'm happy to continue if I stay the same for the next few years.
I'd really like any tips on best practices to maintain being pain free. I've only got no cartilage on the edges of both hips. The middle shows cartilage.
Also when the time comes I will definitely be requesting a referral to the ortho at Wrightington Hospitalas recommended by @Josephine.
Spoke to my father who following an unsuccessful revision a number of years ago has been left without a hip joint. The ortho I saw today wouldn't perform surgery on him again and since talking to me I think my Dad is going to seek a second opinion with the same ortho at Wrightington Hospital!!!


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[Jaycey]

The ortho also advised that the ceramic in ceramic can be problematic around the edges of the cup??

Not the norm and I am not sure why this would be a consideration. Your surgeon will choose the implant that they have the most experience using given your own medical condition and lifestyle. I am quite concerned that your OS is not up to speed with this.

Have you researched how many THR this surgeon does per year? You can do that on the National Joint Registry website. If your surgeon is not listed on the NJR site I would be even more concerned.

 

[confused newb]

@FiremanSam, ultimately only you can decide when to proceed with having a replacement surgery. I would echo the sentiment on the board that you should consider a second opinion before deciding to live with it or to have the surgery now, it's always good to have more information before making such a decision.
Hopefully your father is able to get another opinion too, depending on when he last had a referral, technology and technique may have improved enough to give him an option as well.

Good luck!

 

[FiremanSam]

He's done 178 replacements in 12 months. I just wanted to hear better news re longevity and wearing properties of prosthesis. He tends to use ceramic ball with the new polyethylene cup??
He provided some literature stating 90% of replacements last 10 years and 70% 20 years


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[Irish Joe]

Goodness me @FiremanSam
Something amiss with that surgeon. My first responder friend assures me that he knows of Active Duty Firemen with Hip Replacements.
I don't remember if I posted on your thread before but there is a lady in my Village who has her replacement in 31 years and I'm sure technology and parts have improved considerably since then.
I think those stats are quite a bit off also.
I think I'd take your Dad and yourself off to see someone else.
Joe......

 

[Horseshoe]

I too wanted all ceramic as I was very active, still youngish and concerned about wear particles, ceramic particles being least offensive to the body. My non medical understanding is that ceramic liners are not as "forgiving" as polyethylene so placement must be near perfect but again, surgeon expertise is vital for all thr's. I have CoP for the first thr and in an unexpected course of events, have MoP for the second which I'm not pleased about but will deal with it later.

Sorry to hear about your father, how awful to not have a hip, I hope with modern techniques and knowledge, something can now be done for him.

 

[Josephine]

The ortho also advised that the ceramic in ceramic can be problematic around the edges of the cup??

Not at all. The first round of ceramics had issues such as squeaking and shattering but all these have been overcome with enhanced biomechanics. No need to worry about them any more and any surgeon who tells you this is not keeping up to date!

so I'm happy to continue if I stay the same for the next few years.

Well that's the problem. You know when car tyres are worn and you keep on thinking they'll last a few more miles? The suddenly one day - boom! - and you have a blow out! It's the same with hips - ask @Jaycey, she knows whereof I speak!

I'd really like any tips on best practices to maintain being pain free

Honey, if there were any, we'd have told you about them by now. Honest.

The ortho I saw today wouldn't perform surgery on him again and since talking to me I think my Dad is going to seek a second opinion with the same ortho at Wrightington Hospital!!!

Yay, Dad! Good for you! The Wrightington is the place for revisions.

I just wanted to hear better news re longevity and wearing properties of prosthesis. He tends to use ceramic ball with the new polyethylene cup??

I thought I'd already told you this but obviously not! Sorry about that.
So do read these
Hips that have lasted 32, 40, 41 and 45 years
67½ year old - the THRs, not the patient!

 

[Josephine]

recommended by @Josephine.

Sam, can I ask you to please not make my name a tag when you just mention my name in conversation? I already get many tags every day and it's a waste of my time when I get here to find I'm not really called here for a specific reason - you know what I mean!

Also, it's really unnecessary to quote a post just to reply to it. Just scoot on down to the bottom of the page and start typing! Unless there is some specific phrase you want to address, of course!
Then do it like this How to quote a post.

Thanks for understanding!