THR I think its time...THR.

tanvat

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Good afternoon all,

I came across this forum a year or so ago while beginning to seriously consider and research the pros and cons of my inevitable bilateral THR. It has been a great source of information, realism, and reassurance. Thank you for all of your contributions. I'd very much appreciate any feedback and wisdom you may have for my situation. My apologies in advance if this is too long.

I'm a soon to be 50-year-old guy with a reasonably active past. I've always enjoyed the outdoors, particularly hiking and multi-day backpacking trips in the West. Around February 2020, my left hip started - for lack of a better term - catching. It sould click and thump, but I'd just limp for 10 minutes or so and it would work itself out. Later, in the summer of 2020, just a after returning from a 5-day hiking trip in the Wyoming, my left hip just seized up - almost a full stop. It was difficult to walk and go up the stairs even though the I'd carried a pack over a mountain pass the prior weekend - crazy! I assumed it was some latent injury and it would go away. It did not.

After a few weeks, I went to get x-rays to confirm nothing was dreadfully wrong; no cancer, fractures, anything like that. Instead, it was, in the technician's terms, "just some arthritis." OK ... well, I figured I'd see if it would subside and I could get back to normal. Once again, it did not.

In the Spring of 2021, I went to two orthopedic surgeons. They both said my left had "severe" degenerative osteoarthritis. Both noted the latest x-rays showed deformation of the "ball" with the "socket" closing up to prevent dislocation; thus the decreased range of motion. Both said the left hip was basically bone on bone. My right hip (this portends nothing good) had "moderate to severe" OA.

The first doc strongly discouraged me from doing THR because of my age (then 48). He said I could expect to get only 10-12 years out of an implant, maybe less, and would then face multiple increasingly risky revisions - in short, sucks getting older. The second said I was a prime candidate and gave me the clearance forms. I liked the second doc b/c I liked his advice and b/c an older acquaintance had used him for a THR following a serious pelvic fracture and had nothing but rave reviews of the second doc (the patient/acquaintance now bikes, hikes, etc. as well as any 65 year old out there).

I did not do the surgery. I was still holding onto the hope - as irrational as it may have been - that I'd hit a window of time where it didn't bother me too bad and I could squeak out a few more years. And I did hit that window in the summer of 2022. There was about a three month window where the symptoms really subsided. So much so that I was able to do a very short but very fun hiking trip out West followed by another in the Appalachians. Fast forward to now, and BOTH hips are constantly stiff, achy, and sometimes downright painful. I can walk around with short steps. I walk gingerly b/c any step can result in a fairly sharp stab of pain. Yet, I can do my daily activities. I just got back from the gym, where I do upper body workouts without much limitation. I do a lower body workout with very restricted range of motion and very slow movements just trying to keep range of motion and some leg strength/endurance as a form of "prehab" for any future THR. I avoid anything that hurts and stop if it does. So, while I'm limited, I'm by no means disabled. I'm tired of the constant ache and the inability to to walk around the neighborhood or in the woods. But the symptoms gotten worse and my physical limitations have increased noticeably and progressively over the last three months. The current trajectory is not great.

After all that, I guess I just am interested in any feedback from others who have undergone THR, particularly those who underwent THR years ago while in their 40's or early 50's. I know results vary and its my decision. I understand I may well with any luck) outlive an implant and require a riskier revision surgery. But there is also life to live now. Anyway, I'd value any feedback and perspective positive or negative. I think I should probably do it, but that decision is irrevocable and I want to go in eyes wide open.

Thanks for reading. I look forward to any responses and, if and when the time comes for me to get a THR, paying it back by offering my own experience, good or bad. Thanks again for all the contributions to this forum - I've learned a lot.
 
Hi, @tanvat Welcome to the BoneSmart family! :welome: As you’ve discovered, as much as we would like our bad hips to just go away and leave us alone, they don’t and won’t. With the improvements in prosthetics and techniques, you won’t be looking at a revision any time soon if ever. You’ll stop having to plan activities around how much pain it will cause you. You’ll be able to return to your active lifestyle without pain. You’ll even start forgetting that you even had hip surgery. All worthy goals. There are many members here who have had surgery in the 40-50+ years, as well as having both hips done. Maybe they’ll stop by to give you their personal scoop.

I’ll leave you with some of our pre-surgery guidelines to ruminate on. We feel that of all things to consider the most important one is the experience and expertise of your surgeon. You must have total confidence in him or her. So take great care in investigating surgeons with that in mind. Keep us posted as to your decision making process. Feel free to stop by often with any questions or concerns.

HIP PRE-OP GUIDELINES

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 stories of amazing hip recoveries
 
Hi @tanvat,
Your description sounds like mine.

I originally thought maybe I could manage my right hip. I was so wrong.

A bone on bone hip only gets worse. OA is the devil that can't be bargained with.

I am 53. I had my right hip done on 9/12.

Don't live w the pain.
 
@tanvat Welcome to BoneSmart! The first surgeon you mentioned is IMO very old school! We see lots of folks here getting hip replacements in their 30s, 40s, and 50s -- even some as young as teenage years! And many of them return to physically strenuous jobs and activities. With in the past year there were 2 police officers in their 30s who returned to active duty following hip replacement. And that first guy was wrong -- implants are expected to last 30+ years and some of the original implants lasted 40+ years.

Although I was older than you (64) when I had my hips replaced, if you need both done I would recommend getting the bilateral procedure if your surgeon says you are a good candidate for that. There might be medical reasons for not doing both at once so decision would be surgeon's + you.

As my surgeon explained to me in his opinion there was less risk doing both at once (both of mine were really bad!) 1- less risk as it was just one surgery and one session of anesthesia. 2- less risk of hospital based infection (rare these days) as it would be only one hospital stay. 3- one recovery period meant faster return to normal activities. 4- Return to normal gait faster as if he did one at a time I'd still be limping on "bad" hip between surgeries and 5- I'd be less likely to have problems with leg length differential issues (were one leg ends up being a bit longer than the other).

Arthritic joint do NOT get better! They just get worse and can collapse which is extremely painful and an emergency situation.

Best of luck to you. And do let us know what you decide ... we do like to help!
 
Hi @tanvat

:chuckmarch:Bilateral THR at age 53 1/2
Absolutely mortified at diagnosis of end-stage OA and the "only cure" Hip Replacement.
Super active, labor intensive job, hard player on weekends...
Beset with chronic pain and ever increasing mobility for over 2 1/2 years....:blackcloud:

I am convinced these are my forever hips, and I no more regret getting rid of my "rotten " hips as I would be replacing a rotten tooth!

I understand the anxiety involved, but am glad to be pain free, not Sleep deprived, and healthy and strong.
 
HollyNY and Djklaugh, thank you so much for the feedback. I like the idea of a bilateral, simultaneous one-stop shopping procedure just to get it done and embark on total recovery that much sooner even though it would be more challenging. The issue of fracture or collapse is something that has not really been in my calculus. It should be I suppose, as just another reason to not put it off.

I have an appt. with a new ortho in early February and, the first of March, another visit to the second doc I visited initially. The reviews of both seem positive and an acquaintance with a more complex hip replacement issue had a great experience with the second doc. I'm going to sit down with both and go with who I trust based on how they answer my questions, etc. - I see it as a job interview for them in a way. A patient is a consumer and while I have full respect for the ortho's expertise, its my hip on the line and I have to do my due diligence. I think the second doc is in the lead at this point and his office said they are scheduling 4 - 5 weeks out following consultation. That means I could do it in April! Its sort of daunting, but also exciting to think of what could be. Thanks again.
 
Mojo,

Thanks for the encouragement! We sound like we share similarities, except I have a desk job where typing and is about as aerobic as it gets! That's great to hear. I love the analogy to a cavity, never thought of that way. That's what my hips are, cavities that ache and don't work and need to be fixed with brand new implants.
 
Hi, @tanvat - thanks for stopping by my long, rambling pre-op thread!

Boy, oh boy, does your story sound familiar:

Around February 2020, my left hip started - for lack of a better term - catching. It sould click and thump, but I'd just limp for 10 minutes or so and it would work itself out. Later, in the summer of 2020, just a after returning from a 5-day hiking trip in the Wyoming, my left hip just seized up - almost a full stop. It was difficult to walk and go up the stairs even though the I'd carried a pack over a mountain pass the prior weekend - crazy!

Yep. I'd feel relatively OK for almost an entire week - think, 'what's the problem?' and then, WHAM. There's that catch that stops you in your tracks. Or I'd get through a workout at the gym, no prob, and then, once, as I was going up the stairs, I was hanging on the rail so hard somebody asked if they could carry something for me. It is so, so hard to accept sporadic pain as needing joint replacement surgery, but I can promise you that catching will never go away without it. You will be at the mercy of your hip as long as it's bone on bone.
After a few weeks, I went to get x-rays to confirm nothing was dreadfully wrong; no cancer, fractures, anything like that.

Oh, yes, I completely thought I might just have a tumor lurking around my hip.
There was about a three month window where the symptoms really subsided.
My wife would tell me "enjoy the good days, but remember you don't have any control over whether it's a good or bad day."

So, while I'm limited, I'm by no means disabled.

If I can offer any lesson here from what I've seen my mother-in-law go through, it's that you DO NOT NEED TO WAIT until you're bedridden. By the time she got in for surgery, the surgery was much more complicated (as in, she needed a bigger cup than anticipated, which will take longer to heal, etc.) and her recovery will be a long, long road. And your hip isn't going to wait on your timeline. My MiL started with doing fewer outings with family, then fewer errands, then less cooking, then not moving as much from her recliner which then turned into a lift chair. Then not going upstairs. Then not moving from her lift chair. It was awful. It's an absolute miracle to see her get up and around with a walker without off the charts pain.

Anyway, the couple of things that helped me make up my mind to have a hip replacement I'll share and maybe they'll help you:

I tried PT for a few months and discovered my glutes weren't firing. This convinced me that whatever was happening was serious, especially when the pain didn't resolve. You may want a session or two to see what all isn't working; it's kind of eye opening.

Tried a cortisone shot. This, if nothing else, confirmed my hip was the issue, as the relief I got from that shot was amazing. For 2 weeks. Then back to on/off sporadic pain. Still, I knew it wasn't my back or anything else and that helped get my confidence up.

I spent the money on copays to go talk to several surgeons about my goals for the recovery. Mostly, I walked in, sat down and said, "can I play hockey after a replacement?" And when they said yes, that sealed the deal. Also helped knowing that exercise, especially low impact stuff like hiking and weightlifting, are strongly encouraged. The surgeons want you to stay active. That's part of their goal. So I'd highly recommend talking to as many surgeons as you want to pay about what your goals would be and get their thoughts. It will be very reassuring, I imagine.

I mean, all the brochures I saw pictured nice people hiking (in mountains!). :thumb:

Keep thinking and keep posting - and trust yourself.
 
I waited and put mine off for years until I felt the time was right. I wanted them to last and not have to have them redone. Technology changed a lot over time so it worked out for me.
 
That first surgeon who said the device can only be expected to last 10 to 12 years--they are totally out of touch.

Like wildly out of touch.
 
@tanvat I'm currently 52. Had my right THR at age 45. Been active with weight lifting and boxing since 2016. Prior to the surgery I had years of doing weights, karate, jiu-jitsu, and yoga. Prior to the surgery my surgeon wasn't too keen on my going back to jiu-jitsu so I looked at more 'hip friendly' activities - that's how I landed on boxing. At my 6 week post surgery follow-up I got the ok to go back to jiu-jitsu (as long as I was careful) but decided to pass.

I first started considering the surgery several years earlier but wasn't ready. Recovery was great and the reduction in pain has been incredible.

The locking in the hip, for me, happened around 1988 and was due to a torn labrum and loose bits of bone and cartilage floating around the joint. I had surgery then to clean up the hip but likely ultimately contributed to osteoarthritis.
 
Puckhead, Eman85, Going4fun, JayP

Thanks so much for your thoughtful replies. I really appreciate it. Its reassuring to hear the experience and perspective of others, particularly those with similar situations. In the last two weeks, it seems I've had pretty sudden and noticeable decline in my range of motion as well as the pain/discomfort level just walking. Sitting upright here at my computer in a comfy chairs OK, but for instance I cannot separate my feet more than maybe 6 inches apart while sitting upright in a chair. And that hurts, basically have to keep my feet together or cross or else if feels like my hips are going to snap apart. Oh well, suppose that is my body giving me yet another sign that its time. That is new in the last several days.

9 hr., 20th anniversary flight to Europe tomorrow on a trip booked some time ago during the last window of lessened symptoms. Not too concerned about the flight, it'll probably be uncomfortable but whatever. Don't see a lot of walking the streets of the the City of Lights happening, but I think I'm gonna use this trip to go out in style before getting swapping out these bum hips. We'll sit in some cafes and sip wine - adjust and adapt, right? So grateful for a wonderful first 50 years and for what's to come - pretty incredible that we have a real chance to fix what in the not too distant past would be the end of mobility. .

I'll check in when we return. I want to get this done as soon as I can and get back to my regularly scheduled life.
 
@tanvat Have a good trip. I dealt with increasing pain and loss of range of motion. For me the loss was in toward centre and up toward chest. I was dealing with that but my trigger point for the surgery was aching pain just lying in bed.
 
Welcome to the forum! You will find a lot of great resources here as well as patient experience and a great place to ask questions.
Only you would know when it is the right time for you, but I will say this-don't wait until you can't handle the symptoms to decide to go ahead and do it. Once you start having significant issues that affect your quality of daily living, the symptoms tend to start going downhill quite rapidly. You also don't want to risk damaging or making your other hip worst because it has to work that much harder now.
 
@tanvat - I was nearly the same as you. Had my left hip replaced after just turning 50. I was doing kickboxing, self-defense, kettlebells, etc. and really toughed out the pain and lack of flexibility for a couple years until I found myself unable to walk for any distance beyond a half mile without my back locking up and bad pain in the hip from the constant catches. I couldn't keep up with my wife who is a foot shorter than me. My doctor told me it wasn't getting any better and cortisone and rehab really just delays things for a few months at best. To me, quality of life while I'm still "young" and active was more important than having to deal with revisions in 20-25 years (10-12 years is crazy nonsense unless you are a bull rider!).

Now I'm going under the knife again in two days for the other hip which hurts differently than the left, but no less annoying. It even hurts in my sleep. I just don't see the upside of continuing deterioration and me being less able to participate in things with my spouse, family and friends. Life is for living not watching! I will take my chances in two decades with a continued improvement in technology and skills.

After my left was done, it was amazing. I won't lie that the first week was pretty painful and annoying to sleep, but week by week I could do more and more, and by about 5-6 weeks I was doing some light exercise, and at 7 I was back in boxing class, moving gingerly, but still moving! After 3 months, all restrictions were lifted except "extreme yoga" which is not an issue for me lol.

Hope Paris is/was fun. I was there last month. Your jolts of pain while there will (probably) unfortunately reaffirm your decision to get the surgery. You won't regret it. Good luck!
 
Caison113,

Thank you. Paris was wonderful. I just returned from an ortho appt. and got a left hip THR surgery date of April 13. The surgeon will do an anterior approach. Assuming all goes well, the right hip will follow about 8 weeks later, in mid-June.

I very much appreciate you feedback as well as the kind words and useful information from others on this forum. I feel relieved to have a date and to get along on a recovery track, whatever that happens to be in my case. Perhaps I'll experience little pain and will be up and about before I know it. Or, maybe it will be considerably more challenging. Either way, I can't control how my body will react, so it will be what it is and I - like you all have - will deal the hand I'm dealt. I am, however, reasonably confident that by the spring of 2024 I'll once again be able to walk our wonderful neighborhood and local trails with relative ease and markedly less discomfort. And I hope and believe that in the summer of 2024, I'll return to the mountains I love (with a lighter pack!) with the people I love, reveling in the in the fact I'm back and that hip arthritis does not have to be an irrevocable ending to lifelong passions. And if my surgery doesn't work as well as I hope and that hope falls by the wayside, then nothing will have been lost because I likely won't be able to see the backcountry places that I love if I don't get two THRs. At the very least, barring the rare worst-case outcome, I think I'll be more comfortable and more able next year than I am now. I think its a good bet, and I can't wait to get started. I'd do it tomorrow if I could. I'll keep you posted. Thanks again for all the feedback and encouragement.
 
I forgot to ask a question re others' experience of returning to work. My work is purely sedentary, consisting solely of research and writing from the very same laptop on which I am typing this message. I am fortunate that I can work at home or the office. I work in a setting in which I am the sole person tasked with a certain segment of the work. B/c of the nature of the work, it cannot simply be delegated to others, nor can it wait indefinitely. This odd work situation is temporary, and will end when additional staff come on board later in the year. I know recovery is unpredictable, but in discussing my availability for work, is it - based on your experiences - within the realm of reason to say that I will be in a spot to start back up two weeks following surgery working remotely - at my own pace - so that I can fulfill my work obligations and not get too far behind. This would literally be reading documents, reviewing online databases, and then providing my findings/recommendations in writing. No physical work at all, just reading and writing. Again, I know its unpredictable and my recovery is job one, but I do want to try and stay abreast of my work, particularly since I'll likely be restarting the recovery process 2 or so months later. Any thoughts/insight? Thanks!
 
@tanvat We generally recommend that folks allow 12 weeks before returning to work and/or work with their HR department to arrange a phased return to work. Given your particular situation you might be able to return to work sooner particularly if you can work from home mostly. HOWEVER you should allow yourself at least a couple of weeks before trying to get back to work. You will find that recovering from major surgery is exhausting and a lot of healing occurs when you sleep. Plus pain medications might make you not only fatigued but also might make you rather fuzzy headed and unable to concentrate for extended periods of time. After my hip replacements I had "nap attacks" (body saying go to sleep NOW) for about 6 months.

You might experiment now with seeing if you can manage laptop plus having leg elevated... can you get work done in a semi reclining position? That leg is going to be swollen, stiff, and sore (not the bone on bone pain of now but the incisional and healing pain of post hip replacement) and that in and of itself can be very distracting.

Best of everything to you!
 
@tanvat hi! The return-to-work thing is so hard to predict! It depends on so many factors that we can't control... with my first recovery, my BP tanked for months. I was very tired and had little energy. My brain was foggy from the GA, and I had trouble reading because GA apparently messed temporarily with my vision! I fell asleep at the drop of a hat for many weeks-- lots and lots of naps. My work involves being an in-shape flute player, but with that hip I had nothing to prepare for and my brain couldn't have done it anyway.

Second hip was so much easier than first all around. I had no vision problems, no BP crash, plenty of brains, needed a nap about once every three days, and had to play at a family memorial service in 5 weeks. I think I took three days off playing, and it felt very good to pick it up again.

So... which one ya gonna choose? It's just impossible to know. I think if your brain works, you will be happy to use it! Do lots of deep breathing as soon as you wake up and for several days, to clear the drugs from your system. They will likely give you an incentive-izing device to encourage you lol!
 
Thanks again for all the feedback. Its time to switch this thread from I think its time to I know its time. Tomorrow morning, I will have a total replacement of my left hip with an anterior approach. I'm so ready to on the road to recovery. Ironically, my left hip is the most deteriorated but its my right hip that is giving me more trouble. I would like to get it replaced ASAP. My understanding is 3 months is a typical time period for staged bilateral replacement and that a minimum of 6 weeks is typically recommended to mitigate clot risk. Do any of have experience with getting a second HR less than 3 months after the first? I just want to get it done so I can get back to my regularly scheduled life in 2024.
 

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