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Hello, I have questions about managing OA

beach73

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I have been reading many threads here and have learned so much already.

5 years ago when I was 40, I was told I had early R hip OA. The MRI report said joint space narrowing and in view of a relatively shallow acetabular this potentially relates to a degree of dysplasia. Xray report said mild osteophytes. I have only just seen the MRI report from 2014 and I don't recall them mentioning the dysplasia, it just said early OA and offered a steroid injection which I declined. I had wondered why I would have OA at the age I was as I didn't think I had any risk factors, no family history, healthy BMI etc.

The last few years the pain is worsening. My ROM has decreased and I have muscle weakness in my R leg, despite regular exercise and doing the exercises the physio gave me to do. I have been taking ibuprofen regularly for about 2 years and it does help. I had an xray last week that says moderate osteoarthritic changes are seen. Joint space narrowing superiorly with subchondral sclerosis and marginal osteophytosis. No deformity of the femoral head.

I am being referred to orthopaedics. I am in Australia and don't have private health so will be dependent on the public medicare system. From what I have read hip replacement in the public system isn't an option until hip OA is severe.

My work is physical with a lot of walking. I am managing currently but get very fatigued by the end of the week. I would be interested to hear how others managed as their hip OA progressed.

My gait has changed in the last few months. It sort of feels like my back and pelvis are twisting to swing my leg forward when I walk, and I have been getting lower back pain as well as the shin, knee, thigh and groin pain.

Has anyone else had back problems from hip OA? Do they resolve after hip replacement? Is there any lasting damage to the back?

What sort of questions should I ask the orthopaeds when I see them?

Your experience and knowledge is much appreciated.
 

Ptarmigan

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Hello, @beach73 -

Unfortunately, I live in the US and am not familiar with navigating your public system. I am glad to hear you’ve been referred for an orthopedic consult, however, as the status of a hip can change unexpectedly - particularly when work requires consistent weight bearing activity.

My doctor advised me to take Tylenol for pain rather than NSAIDS, and it is the best OTC pain relief I have found. Other pain relief that has worked for me: TENS, heating pad, topical creams/patches, extra pillows for comfort in bed. All of these things work to a degree. The pain never goes away entirely.

I have had to adapt to insomnia and pain-related fatigue by building in more rest to my life. Stress reduction has been essential, as has adhering to a very healthy eating routine (fresh fruit and vegetables, good proteins, healthy fats - skip the sugars and processed foods). I can’t overstate how important this is - quality sleep is your very best friend, and quality fuel is a close second.

It’s sensible to plan ahead for surgery now, and catch up on any outstanding medical or dental issues (checkups, weight loss if needed, standard tests, medication adjustments...all these things affect surgical clearances and surgical outcomes). This can be more or less time consuming, depending on your circumstances, and it’s sensible to be prepared.

Some people also start to work with PT before surgery to resolve the compensation you describe in your gait. This might reduce your discomfort now, and shorten your recovery later, depending on the quality of therapy you can access, and whether you have the time and insurance coverage to take advantage of this approach.
 
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beach73

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@Ptarmigan,
I think I might try Tylenol/panadol again. I tried it a while back without much effect but it would be good to get off the ibuprofen.

I do need to plan ahead financially as I don't know how much longer I will be able to keep working or if I have a THR, I will need some savings to pay the bills while I rehab.
I do generally eat healthy low carb high protein diet and apart from the OA am well, not on any other medications.

I have recently started going to PT/physio. I haven't noticed a difference yet but am doing the exercises they recommended. They are working on my pelvis muscles which they said are really tight on the R side. My leg just wont bend backwards anymore. Hopefully it will work.

Some nights, which are becoming fewer, I sleep well. Other nights the pain has a party. I think I have found a comfy position then after a few minutes the pain kicks in again. I find a pillow under my leg when on my back often relieves this weird pulling pain that goes from my groin down my leg. I haven't tried heat packs or patches. What are patches? I will get some heat packs.

I live alone and haven't disclosed my concerns to anyone in real life except Dr and physio. I occasionally limp and I don't think my gait change is noticeable to anyone else. If anyone asks about my limp I just brush it off. I think its mainly because I am still in a bit of denial. But I am also practical and realize now this isn't going away anytime soon.

Thank you for taking time to reply I appreciate all your suggestions they are all very useful to me, reinforcing some of the things I am already doing and new ideas of things to try.
 

Ptarmigan

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@beach73 I have had better success with the 8-hour extended release Tylenol, particularly at night, than the standard formula. Josephine, our resident orthopedic nurse and expert, reminds us the maximum dose per day is 4000mg from all sources (cold medicines and other pain medicines can include Tylenol). My doctor didn’t ask me to discontinue NSAIDs entirely, just to restrict my usage to particularly tough flare ups.

Based on my reading here, and my own experience, I think a lot of us start out in a little bit of denial. For me, it was both educational and a bit of a shock to see my X-rays and have the orthopedist explain them to me. Reading and posting here has been very helpful with that.

I don’t know the brand names where you are, but here the patches and ointments are Salon Pas, or Icy Hot or equivalent.
 

Jaycey

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@beach73 Welcome to BoneSmart! Unfortunately there is little you can do to manage any OA. Once it resides in the joint it will only get worse, not better. Injections and PT help for some. But requiring that joint to move will eventually takes its toll.

THR will fix all this. Many of our members experienced lower back pain pre-op and report great improvement post THR. I would talk to your surgeon about quality of life. As you world narrows daily living becomes more of a challenge. Certainly if your work is impacted by this bad hip that is a prime reason to move ahead quickly. Hips can go from tolerable to horrid very quickly.

Please keep us updated! Here are some articles you might find helpful:

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:

Score Chart: How bad is my arthritic hip?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

And if you want to picture what your life might be like with a replaced hip, take a look at the posts and threads from other BoneSmarties provided in this link:

Stories of amazing hip recoveries
 

mainegirl1

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Managing OA is a nice idea. But for most of us it manages us. I felt great after a short bike ride Friday. So I walked 1.5 miles in the woods yesterday. And was on my feet all day. Last night the pain was horrid. Today I am thinking of renting a wheelchair though I finally slept for a few hours.

Today the pain is better. I have been taking 1000 mg Tylenol every six hours pain or not. Better to be ahead of pain but the flare ups can ruin your day.

Aug 19 can't come fast enough
 

leejaa

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With my first hip, no one including me thought my symptoms were from the hip - the inability to walk right, groin pain, inability to lift foot to do stairs, back pain, stiffness, sleep deprivation, etc. I had spine injections, multiple sessions of PT and still the pain persisted. Finally when I saw my PC instead of the PA and he me he ordered a MRI and it was my hip. I then saw my OS and after waiting to get on his surgical schedule had the hip replaced. It was such a relief to have all that pain gone and all the other symptoms resolved. I felt like a new human.

Unfortunately, the same symptoms decided to manifest in the right hip with pain all around the joint, inability to move the leg freely, lift the leg to do stairs, pain and limping in the entire leg all the way down to ankle. I saw the OS right away and am scheduled for replacement in 6m. I did have an injection as we needed to do conservative treatment to meet insurance guidelines and it did decrease the symptoms by 20-50% depending on my activities.

With OA progression is the path and the only solution with the joints seems to be to get shiny new ones and get back to living. Good luck with your appointment - do stress the work issues and life issues with the OS - chronic pain is not healthy.
 

Josephine

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The MRI report said joint space narrowing and in view of a relatively shallow acetabular this potentially relates to a degree of dysplasia.
Dysplasic hips are quite common amongst the younger age group.
I have only just seen the MRI report from 2014 and I don't recall them mentioning the dysplasia
Well they wouldn't if it's mild. One radiologist sees/knows a bit more than the previous one, or takes a bit more trouble reporting it. It's actually of no particular consequence as an arthritic hip is an arthritic hip!
I had wondered why I would have OA at the age I was as I didn't think I had any risk factors, no family history, healthy BMI etc.
If anyone knew why we get OA, they'd be a pretty wealthy person! Truth is, no-one knows, just as no-one knows why some get dysplasic hips. It's a mystery!
From what I have read hip replacement in the public system isn't an option until hip OA is severe.
Really? That's not anything I've seen reported by any other Australian members.
Has anyone else had back problems from hip OA? Do they resolve after hip replacement? Is there any lasting damage to the back?
Since your pain is almost sure to be referred from your arthritic hip, it will definitely be resolved after a replacement. And no, there will/should be no lasting damage to the back because the pain isn't in your back, it's in your hip!
What sort of questions should I ask the orthopaeds when I see them?
There's a vast array in here - take your pick! Choosing a surgeon and a prosthesis
 
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beach73

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@Jaycey thankyou for the welcome and the links, i have read through them all. The scorecard was really useful, mostly 2’s with some 3’s. Although I couldnt score some things because I dont do them. It was interesting to see the vast range of areas in my life that are affected. The idea of it getting worse and not being able to do things is scary.

@mainegirl1 I hope August 19th does roll round quick for you and you get some more great days of bike riding. And I guess it is managing me a bit because I did nothing on the weekend as I was exhausted but the benefit of that was today at work my hip gave me a lot less grief than normal and I am feeling a lot more energetic this evening.

@leejaa Thankyou for sharing your experience and I hope your next THR is just as successful. And yes I have been making a list to take to my appointment. I havent got a date for it yet, but I am going to be prepared.

@Josephine Thankyou for your reply I found it very reassuring. Is the dysplasia something I need to ask about? I think I read somewhere it can affect the fit of the prosthesis or is that only in severe cases?
 

Jaycey

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I had dysplasia in both hips and didn't know about it until my left hip collapsed. It's very common and your surgeon will know how to handle this. Ask about it but please don't worry.
 

Josephine

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I need to ask about? I think I read somewhere it can affect the fit of the prosthesis or is that only in severe cases?
No you don't need to worry about it any more because, according to the xray report, it is only mild. And yes, what you said is true, it is only in severe cases.
 
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beach73

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I rang outpatients where I have been referred to check if they received my referral and yes they have but its going to be a 12 month wait to get an appointment. I was a bit shocked at this but have accepted it more or less now. I just have to wait.
This is my first winter in 20 years after moving south from the balmy tropics. Do you think cold weather can make arthritis more painful, I have been thinking my hip does not like it? I have been limping a bit more and more people are commenting on it and recommending everything from chiropractor, naturopath, and all sorts of supplements.
I have googled a few of the suggestions and boron and MSM seemed to have good reviews so I ordered some, I figure I have nothing to lose but a few dollars.
I dont like the idea of a hip replacement but know this is the only real option for me one day, i have never had an operation but I want to get rid of this pain and to move freely, and I want it out of my consciousness.
 

Mojo333

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That does seem like quite a long wait...Try to manage to hang in there. (No choices right?):unsure:
If you find something that helps with that OA pain, do tell.

Maybe a cancellation?
 

Barbaraj

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Ugh, @beach73, so sorry to read you've got a long wait ahead of you before achieving relief from miserable hip pain. I don't have any brilliant ideas for coping until then. My OS just said to stay as active as I was able (I was doing a few PT exercises daily until I had surgery last September, and I even managed a couple of short, low resistance workouts on an elliptical a few times a week), and don't gain weight. Otherwise, I "treated" myself to a dose of Aleve (naproxen) every other week. I don't like taking medication and I was pretty disciplined despite bone-on-bone arthritis in my right hip. There really isn't any permanent fix other than hip replacement, unfortunately, but suggestions offered by other posters on your thread all make sense to me. I think it's great you're doing some PT, and even if it doesn't relieve your pain much if at all, it will help to build up some muscle strength--and having strength in your core, glutes and quads will be very useful to you in recovery, and help you get up and around more easily/quickly. Best of luck to you--keep posting as there are lots of folks here who're going through the same wearying journey to hip replacement surgery.
 

Layla

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Being forced to wait so long is really unfortunate. I'm sorry you have to deal with that. I don't know if cold weather can make arthritis more painful but if you're not used to the frigid temps, possibly your body feels more tense and that is contributing? While none of the things you mentioned, chiropractic, supplements, naturopath will cure arthritis, some may make it more tolerable while you wait for a date to be scheduled.

You're not alone. I don't believe a single one of us would choose a replacement hip over their natural one. It's currently our only option to lose the pain and move forward in life. What helped me appreciate the thought of it was that a mere 50 yrs ago, rather than receive a prosthetic hip and lose the pain, we'd most likely end up in a wheel chair swallowing pills daily in an effort to control our suffering. With that thought in mind it's easy to say Sign Me Up! Wishing you comfort and many pain free days as you wait.
@beach73
 

mikeycat

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Hi. I never had surgery before and ended up with a BTHR on May 31. Like you I did not want to accept this but no choice (went 12 years with a bad left hip) bone on bone, no cartilage, osteophytes, cysts. I was unaware of how much pain I had because of conditioning.I am 3 weeks post-op and doing well.I am sorry your wait is so long. As for me they wanted it sooner and I did not.I was extremely active--believe the contributing factor-marathons- to my condition--no familial history. I did athletic therapy. Maybe water exercises as it conditions you without the stress of weight bearing. Did that too.
 

julesglass

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Hello @beach73. I live in Iowa and have found the winters are more painful, harder to walk outside. So sorry you've got to wait so long. My right hip was going down hill I know about 12 yrs ago and then it took 3yrs to get diagnosed. By the time surgery came for right hip I was barely walking. Do what you have to do to get to the goal. I got three more weeks for lefty's eviction. Some find heat soothes others ice. I found I had to do grocery one day and not much else. If I mowed, same thing not much else. If you have a cane it does help taking stress off good joints and less stress on bad hip. Stay here for helpful info encouragement and hugs. We are all in this together.
 
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beach73

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Hi all, good news my pain has significantly decreased, its less than it has been in a long time. My limp and decreased ROM continues. I know the pain will be back but for now I am just so relieved especially with the break from the night time pain.
I had gotten a bit desperate and scared and went a bit over the top. I bought a heap of supplements boron, iodine, msm, boswellia extract, magnesium, zinc and vitamin B. I stopped all exercise apart from the activity required for work. Have basically had pyjama days every Saturday and Sunday for the last 6 weeks. Binge watched a lot of shows and played a lot of chess. Switched to an antinflammatory diet but not strictly adhered too and lost 5kg. I have no idea what if any of these changes made a difference but suspect it is the rest. Maybe it would have settled down on its own. For the last week I have stopped taking Brufen and haven’t needed it.
Just before the pain settled I got what reminded me of growing pains in my right leg, has anyone else experienced this prior to pain settling? Optimistically I thought maybe this was a sign the bone was healing is this possible?
I still have a long wait for an appointment and I still do have pain but much much less. Pyjama days aren’t sustainable because I have run out of shows to watch and I want my life back. I plan to ease back into my normal activities and hope the pain doesn’t reoccur.
Chronic pain in itself is a serious health issue, i really am greatful for this break because I was at the end of my tether and exhausted.
 

Ptarmigan

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It is wonderful to read this news! It’s so impressive - the number and variety of supportive care strategies you put in place to help both pain and insomnia. Well done! Well done, indeed! It’s so helpful that you found your way to something- anything- that will work!

You have now found the two outer limits of the waiting game (the time you will live with an end-point hip before surgery). Like others here, I choose between activities of real life I either can’t or won’t miss, and the therapeutic activities/non-activity you describe above. It’s a balance. Too much activity, and I am back suffering with pain/sleeplessness. Too many pajama days, and I get cabin fever. The hip isn’t a stable element in all this either, and you will adjust to feedback from it, over the months.

We’re here with you, in this together. So glad to see you’ve made good progress.
 

Jamie

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So sorry to hear of your long wait to see a surgeon. Maybe that means the time to actually schedule the date will be short. That's my hope, anyway. In the meantime if you're not on the doctor's cancellation list, call his office and tell them you'll take an earlier appointment if someone cancels. Hang in there! Don't hesitate to ask any questions you may have. We're here to support you.
 

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