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THR Hip Replacement information (Aussie)

AussieHipster

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Hey folks

I’m a 43 year-old Australian male living in Melbourne, and was diagnosed with Stage 4 Avascular Necrosis a few months ago. My GP referred me to an Orthopaedic Surgeon, and I went with her first recommendation. At the start of December this surgeon completed bone decompression on both femurs, which he said had a 50% chance of repairing the damage; if not, I’d be looking at a total hip replacement in both hips.

Two weeks after the surgery and I was in extreme pain, which got worse over following weeks, leading to me hitting the ED for pain after high doses of opioids stopped working. I have just finished five days of Ketamine infusions as an inpatient to try to treat the pain, and during this stay had further X-rays and CT scans on my hips by a different Orthopaedic Surgeon. It turns out the first surgery went rather badly; it actually pierced the top of the right femur, where I have intense pain, and drilled into my pelvis. 3 times.

I'm a tad angry, as this *seems* to have caused irreparable damage. I'm now unable to walk due to the pain, and have had to postpone an important celebratory trip to Europe with my partner at great expense. However, I know that I can only move onwards to try to repair the damage, so am remaining optimistic about it all.

I rushed blindly into the first surgery without doing much research. In hindsight, not smart. As an ex-journalist, I tend to research the heck out of every important decision in my life, but foolishly placed this decision in the hands of "trusted" experts, and I’m not going to do that again! Unfortunately, I’ve found that surgeons don’t tend to like many questions being asked – how many operations they’ve done, their success rate, thoughts on life-span of the devices, etc. I've also found hugely conflicting information on total hip replacements; the second surgeon claimed less than 1% of his patients developed serious complications, while recent Australian reports quoted in the media show between 25 and 40%!

So then, the point of this post – how the heck can I educate myself better on finding a good Orthopaedic surgeon in Australia, and on viable alternatives to a total hip replacement? I’ve had a few word of mouth recommendations, but would really like to find some good data on success rates of various surgeons and procedures.

Any advice, no matter how basic, would be hugely appreciated. Fingers crossed you can help point me in vaguely the right direction, as any (good) information is better than no information.
 

Pumpkln

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@AussieHipster,
Welcome to BoneSmart, glad you joined us! :welome:
Sorry to hear about your bad experience with core decompression.
You are going to want to look for a surgeon that specializes in complex joint reconstruction. You can check web sites, or call in your search.
You might want to check the Australian Joint Registry for a more reliable sources about outcomes.
Good luck in your search for a skilled surgeon to perform your revision surgery of your Core Decompression.
We have several members from Australia, they may be able to help you in your search for a surgeon.

Please post your surgery date, a moderator will add it to your signature for you. Having the exact date will help us properly advise you. Thanks!

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
 
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AussieHipster

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Thank you very much for the info - apologies for calling a core decompression a bone decompression! You can see how new I am to all of this.

I'll look into those links you've provided and see how I go. Regarding my surgery date, are you referring to the date of the impending hip replacement? If so, it's not booked in - I'm not doing so until I'm more comfortable with my decision making. Thanks again :)
 

tgn

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@AussieHipster, welcome.
Glad you made it from the WP forum :)

You may want to look at this which is the Australian Joint Registry Annual Report for 2019 - Lay Summary:

Unfortunately it doesn’t provide specific surgeon data, Alfa as I can see.
It provides summary statistics and information about implants.

I selected my OS based on recommendation from a colleague. But this was for a straightforward hip replacement due to osteoarthritis.
 

Jaycey

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@AussieHipster Welcome to BoneSmart! What was the reason your surgeon decided on decompression? Since you had stage 4 AVN why not straight to THR? Decompression is nearly always a tougher recovery and considerably more painful than THR. And unfortunately we see many members go from CD to THR fairly quickly.

I am afraid there are no alternatives to THR. But the statistics you listed in your first post don't sound right at all. Sure there are times when there are complications. But the incidents of that is rare.

Have a read around our hip recovery forum. Plenty of very satisfied hippies in recovery and getting back to living without pain.
 

GrannyC

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I chose my surgeon based on a recommendation of my GP. He was part of a practice that included several other orthopedic surgeons. In their office they had a brochure showing how many hip/knee replacements were done each year and what the complication rate was. The number was somewhere under 2%. Then that 2% was broken down into types of complications, most of which did not seem that serious to me. My surgeon performed about 500 replacements (hip and knee) a year.

I think if you have a reputable surgeon, they will not mind answering a question about their success rate. Here on the forum if I remember correctly, they suggest you choose someone who does at least 100 replacements a year. I’m sure someone will correct me on that number if it isn’t correct. I wish you well in finding a good OS.
 

Mojo333

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So then, the point of this post – how the heck can I educate myself better on finding a good Orthopaedic surgeon in Australia,
If you decide THR is your best option, perhaps our newly recovering hippy Aussie friend @mcane21 has a recommendation?
He seems to be doing well.
 

mcane21

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I had my THR surgery in Adelaide. I’m from the desert so I opted anywhere but regional. I once had resurfacing done with Dr David Young and co in Melb. You may know him as he has a lot to do with the western bulldogs afl team. I woke up with garry Zimmerman in my face. I would highly suggest to book in to see Dr Young as he is one of the countries top specialists. If based in Melb I couldn’t recommend my one better in mine and thousands of others opinions. Good luck!
 
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mcane21

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Otherwise the crew at Adelaide hip and knee centre are fantastic. Professor Mark Rickman originally from England I found were the ducks. Has so much experience with hips and his resume would excite you. Couldn’t have been anymore professional and knowledgeable.
 
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AussieHipster

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Hi guys

Thank you all so much for your valuable recommendations. Regarding why we tried the CD instead of THR, it was due to my age of 43; the thought that it was better to try to save the hips rather than THR.

Based on your suggestions, I've been in touch with an old friend of mine is a nurse. It turns out she specialised in orthopaedic surgery for several years! Even stranger coincidence is that one of her top recommendations for a surgeon is the same guy I saw for my second opinion, Jim Kiellerup! I'm now seeing him tomorrow for my first official consult. Do you guys have any suggestions for questions I should ask of him?

Thanks again guys, it's such a relief to hear from those in the know, as this is such a daunting and rather scary bit of fact-finding for me. You've made my day :)
 

mcane21

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Due to your age? I’m 37 lol.
 
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AussieHipster

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Haha, yep, the original surgeon thought 43 was too young.

By the way, I just emailed him to point out the three new holes in my acetabulum. According to him,

"The wire takes multiple passes to get into the right position and may potentially have penetrated a small hole into the acetabulum but once I was happy with the wire position the drill bit itself is carefully drilled up the femur only."

Funnily enough, the holes aren't small - they're the size of the channels drilled into the femur. Sigh, who to trust eh?!
 

Jaycey

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Do you guys have any suggestions for questions I should ask of him?
Start making a list now. Here is my list pre-op LTHR:
How many THRs do you perform yearly
What approach will be used
Which prothesis
Cement or non cement
Any weight bearing restrictions
What anaesthetic
Any post op restrictions
Plan for post-op pain management
What type of wound closure
Bathing/shower how soon
Can I function on my own at home
PT how soon
PT come to home or transport to
When can I drive

In most cases the surgeon answered all my questions during our discussion. Do let us know how your appointment goes.
 

leejaa

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Can I shower right after or if have to wait- how long.
Staples or glue on the incision?
Why do you use ______ prosthesis?
Any restrictions long term after recovery?
What do you use for anti coagulation and for how long? ie. aspirin or other meds or injections

Other questions that are important to your life. If have someone in your life ask them what questions they have also for the surgeon - it is interesting how someone else can really come up with questions that are important to you also
 
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AussieHipster

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Hi guys

Thank you all so much for the advice. The cause for my AVN was a bad scuba dive where I ended up with Joint Bends, but the Balinese nurse I saw at the time didn't diagnose it properly, causing me permanent joint damage. If she had of, I could have done a quick trip to the decompression chamber, and saved my joints. I now have joint pain in my hips, knees, ankles, shoulders, and certain digits. Moral to this story – if you go diving and get severe joint pain, you may just have joint bends. Take it very seriously!

Now, based on your recommendations and those of others, I first posted on a few forums including this one, and also got in touch with a friend who worked with Orthopaedic surgeons as their nurse. She recommended a surgeon, who just happened to be the same surgeon who gave me a 2nd opinion. I'm now booked in for a total hip replacement on my right side, using the Trident Exeter implant. I was well prepared for the consult with the surgeon thanks to your question suggestions.

Wish me luck!
 

Mojo333

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I'm now booked in for a total hip replacement on my right side, using the Trident Exeter implant
Glad you're on the docket so you can get back to a happy healthy life!:yes!:

Do you have your surgery date? If you provide it, we can add it to your signature and add you to our preop hip group so you will know who your recovery buds will be.
 

CricketHip

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Congratulations on your surgery decision! My husband and I are divers.. your story is a sobering one. I'm sorry that happened to you.
Soon you will have a strong, functioning joint, though. Things just started looking up for you!
 

Skydove

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Hi Aussie Hipster and fellow Aussie,

Welcome to Bonesmart. You’ve certainly had your share of things, that’s for sure.

I’ve had a left Anterior Total Hip Replacement and will be having a right ATHR very soon. I live in Western Australia and I thought I’d give you some information that helped me.

I did a lot of research before finding my Orthopaedic Surgeon (OS). I went through a lot of reviews and asked several doctors for recommendations before making a decision. I also obtain 3 referrals to 3 different Orthopaedic Surgeons before I made a decision and in hindsight that was the very best thing I could have done!!

I was looking for a Specialist OS who had excellent reviews, was at the top of his field, lectured at a University, had a lot of experience and knew everything there is to know about joint replacement. That was number one, the second and most important thing for me was that he had to be personable. I know this sounds a bit funny, but I find I need to have a specialist who I can talk to, who will listen, who is open to me bringing in articles and also has a sense of humour.

I was extraordinarily lucky in finding Mr Mark Hurworth from Murdoch Hospital’s Orthopaedic Centre. He has a fantastic reputation and is certainly someone you can talk to and is happy to answer questions. He is a compassionate man who is extremely talented as a surgeon and certainly has a sense of humour.

He performed my left Anterior Total Hip Replacement and will be doing my right THR very soon. He will also be carrying out total knee replacements on both my knees.

I think it is mportant to ask you surgeon what approach he is going to take and tell him what you would prefer, ie Anterior, Lateral or Posterior. Surgeons may like to do their operations a certain way, but you do have some say in it. So research this as it will effect your recovery. Find out which approach will give you the best result. For example, which way do you sleep? With an Anterior approach the incision is on the front of the leg, which usually makes it easier for people to sleep as not that many people sleep on their tummy. The posterior approach would be difficult for those who sleep on their back and I would definitely find the Lateral approach to be the most difficult as this incision is on the side. Having said that, there may be specific medical reasons why your surgeon would use a certain approach, so it would be important to find out why he prefers Lateral, Posterior or Anterior.

For me, my OS performed a front anterior incision that was clean and straight and now you can hardly see the scar. He did not use staples to close the incision, he used dissolving stitches so I did not need to have staples or stitches removed (great for me).

Other things that may play a role in your choice of surgeon, would be your lifestyle. Do you do any activities that require heavy weight bearing, this in turn may effect the type of prosthetic the surgeon uses. Ask to see a sample or mock up of the prosthetic and ask what it is made of. For example, will he use Titanium metal, is the ball joint Ceramic or Cement. All important things to know as this could effect outcome for you activities post-surgery.

FInd out what type of pain meds will you be given and are you allergic to any of them or even anything they may use during the surgery, for example I’m allergic to iodine and this is one of the main things they use on and sometimes in your body during surgery, so best to check.

Good idea to check what things you’ll be required to do post-op, for example will they be wanting you to self administer a course of Clexane Injections. I had this once for Cancer treatment and didn’t enjoy it at all. I mentioned this to my OS and he said “we’ll change that so you don’t have to do it, I’’ll give you some pain medication in tablet form”. So you don’t necessarily have to agree to take or have any of the drugs or injections that they give you, you can ask for things to be different.

Ask about exercises, rehab treatment and restrictions after surgery. This is very important for recovery.

I don’t know where you live in Australia but if you are willing to travel to Western Australia to get a highly skilled Orthopaedic Surgeon then I can’t recommend my OS highly enough. I know like all people he has his moments and can be blase’ (can’t we all) but on the whole he is a talented, caring and compassionate surgeon, one that you can easily talk to and whom you can have complete faith in.

All the best and hoping this has been helpful.

Cheers

Skydove
 

Celle

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I think it is important to ask you surgeon what approach he is going to take and tell him what you would prefer, ie Anterior, Lateral or Posterior. Surgeons may like to do their operations a certain way, but you do have some say in it. So research this as it will effect your recovery. Find out which approach will give you the best result.
@Aussie Hipster - don't get hooked up on wanting one approach or another. It's far more important to choose a surgeon who has great skills and good outcomes, no matter what approach is used.

While the different approaches may make some difference in the early days, in the end, the final results for all approaches are similar. The most important factor for success is the skill of your surgeon, not the type of approach that is used.
 

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