Lots of ?s

[BigDog Mom]

Hi All,
I am a 48yo that has been told (twice now)THR is my answer. I am not convinced but my lifestyle is seriously affected by limited range of motion and pain. I am fairly active, though I have had to resort to buying a BowFlex and strength training rather than run or power walk my dogs for 4miles every other day. I raise and show Irish Wolfhounds - I tell people they are my mental therapy. But lately I think every one (Husband, 13 yo Daughter and furry kids) is being short changed because I can't do all that I used to.
I can't let go of the revision piece. I can suck it up once but I really am having difficulty with the fact that at my age unless something comes along and kills me first, I will be looking at doing the surgery over again because of immune response to wear particles.
The other question I have is it seems a lot of people are having one done at a time, is there a reason not to just do both at once?
I have not been in a hospital except to visit some one since I was 10 years old. I had my daughter at a birthing center to avoid a hospital. But I am feeling trapped. My active life is slipping away and I am so not ready for that.
I feel guilty about agonizing over this as it certainly is not life threatening but it certainly is life quality threatening.
Thanx for any help.

Donna

 

[Josephine]

Hi All,
I am a 48yo that has been told (twice now)THR is my answer. I am not convinced but my lifestyle is seriously affected by limited range of motion and pain. I am fairly active, though I have had to resort to buying a BowFlex and strength training rather than run or power walk my dogs for 4miles every other day. I raise and show Irish Wolfhounds - I tell people they are my mental therapy. But lately I think every one (Husband, 13 yo Daughter and furry kids) is being short changed because I can't do all that I used to.

Couldn't have put it better myself!

I can't let go of the revision piece. I can suck it up once but I really am having difficulty with the fact that at my age unless something comes along and kills me first, I will be looking at doing the surgery over again because of immune response to wear particles.

OK - I have been through this a few times on this forum but I will do it again for you!!

1. think first about where you are getting this information from - the manufacturer's websites! What is their business? to sell their own products. Therefore, they are naturally going to emphasise the negatives of other products in favour of their own. Example: we advocate the use of ceramic because it is known that wear particles off plastic liners causes allergic reactions .. yada yada.

Now the converse I would put to you is this ... in the UK alone, I reckon there must be around 2-300,000 hips done each year. Lord alone knows how many in the US!! Now these statistics show a very tiny number that have problems of this kind. Metal on plastic has been the bench mark combination of materials since way back to the early sixties. In fact, if you look at the top thread in this forum, the 'stickie', you will see a report of a woman who has had a metal on plastic hip for over FORTY years. She had hers done at a very young age after a road accident. Read it and see for yourself.

The upshot is that hips are pretty much tried and tested. Most have been around for years and years although they have been 'redesigned' and refashioned from time to time, hence the numbers after their name, but they are basically the same prosthesis as I was using way back when.

My advice is this. Choose your surgeon carefully. Ask him these questions

1. how long have you used your prosthesis of choice?
2. how many do you do each year (anything over 500 is good)
3. What is your infection rate (anything 1-0.5% is good)
4. what is your incidence of short term complications (dislocations, wound infections)
5. what is your incidence of long term complications (infections, loosenings, breakages of prosthesis)

Any surgeon worth his salt will not only be pleased to discuss these but will have the figures ready to hand. Any hint of reluctance, offense or waffle, go find yourself another surgeon!

Then accept whatever prosthesis he uses as you can trust that it has a better than average track record. Though to be honest, most do anyway.

The other question I have is it seems a lot of people are having one done at a time, is there a reason not to just do both at once?

Many surgeons do perform bilaterals and they are very successful. Only problem is, it does make for a long op for although a decent surgeon would take about 1-1½ hrs to do one hip, a bilateral would take 3½-4 hrs. This is because they can't do them simultaneously. They do one, then dress the wound, strip off all the drapes, clean the theatre and start again from scratch with a new set of instruments, new gloves and gowns, everything! But the extra time does put additional stress on the patient's heart and general health. A good anaesthetist will keep an eye on that and might even call time if it was felt the patient had had enough after the first hip. Nevertheless, many, many are done each year in the UK alone.

However, there are also surgeons who will not do them and this maybe because they are not prepared to give the time, have had a bad experience in the past or something else.

I have not been in a hospital except to visit some one since I was 10 years old. I had my daughter at a birthing center to avoid a hospital. But I am feeling trapped. My active life is slipping away and I am so not ready for that.
I feel guilty about agonizing over this as it certainly is not life threatening but it certainly is life quality threatening.
Thanx for any help.

Donna

Be reassured, Donna - EVERYONE agonises over it. I can only urge you to read the threads here and in the recovery forum. You will see many members who are saying "WHAT on earth did I wait for. I wish I had had this done ages ago!" and such. It's very natural to be anxious>terrified about such a major op but I assure you, you are worrying unnecessarily. Go get it done. You won't regret it!

 

[BigDog Mom]

Thanks Jo, I did read your responses earlier and copied your questions. Unfortunately my info about the wear particles didn't come from the manufactures (I know better than that) ;). But I have been reading every scientific journal ortho article I could get my hands on. Probably a bad case of a little bit of knowledge is a bad thing. Heck I have even watched my Doc do the operation on my computer.
I have two friends who had it done, who both say don't wait. My father has two titanium hips and two artificial knees. But heck that's my Dear Old Dad...
I am just struggling with the 12 years is a good run, piece. But I guess what I am left with that I can't run with my dogs as I am so I don't have a choice. It's just a matter of when, I guess.
But reading about you and others successes really does help.

Thank you,
Donna

 

[Josephine]

Yes, most people tend to focus on that but remember it is a MINIMUM and even then, certainly not an inevitability. Did you read that thread 40 years life span for a hip replacement!!? I mean, in the 60s we were cautiously predicting a life span of 10 years! And consider this - if all the people who had had THRs in that period 1985-1995 years were coming back for redoes, not only would we have no theatre time left to do any primary replacements, we wouldn't even have theatre time to do all of them!! It's a safety clause, a cautious prediction, NOT an inevitability!

Also, about those articles - do you remember to note how many patients each article was dealing with? Some only use 50 or a 100 individuals which is a very low sample.

 

[ripanco]

Hi Donna,

I answered your question about pre op exercise, and just noticed this one! Sounds like you and I have a lot in common! I raise, show, race Siberian Huskies! And I absolutly love Irish Wolfhounds! I think if they had a longer lifespan there would be one in my life for sure. I also had my last son at home just to stay out of the hospital so I can relate to your feelings there too. And like you, my active lifestyle was slipping away from me.

But, if you want a happy ending story, I can be it. I truly have a whole new lease on my life. Believe it or not, at just over 6 weeks post surgery, I was back in the ring, showing a 13 mon old Siberian. And we really have to move out with my guys, but it went off without a hitch. Didn't get the points that day, but just being able to show my dogs again was the biggest win ever.

I do worry to a point about needing a revision someday, because I am not going to sit on the couch and baby these new hips. But that is my choice and when the time comes I will deal with it. My dad had his right hip replaced when he was 51 yrs old. He is now 86 years old with the same hip! He was a ski instructor, mountain climber, athletic person until a stroke slowed him down a few years ago. So we just don't know. My surgeon is so very please with how my hips healed, he feels I should easily get a good twenty + years even at my activity level. So, in twenty years, maybe I will be ready to slow down!

I also got both hips done the same time. I would do it again in a heartbeat! However, there are some criteria that my surgeon had. He would not do simultaneous bilateral on most people. You need to be young (50s), strong, lean, good home support, good mental attidude. Thanks to just one surgery, one recovery, I got my life back much faster. I completely agree with Josephine's suggestion on finding a good surgeon. I saw 3 before we found the one I went with. I just plain totally trusted him, and I was not let down.

Today, I do whatever I want and really don't even think about my hips. they are as natural feeling as can be, but with no pain. I am still very active and athletic. Go for it girl!

Andrea

 

[Josephine]

My dad had his right hip replaced when he was 51 yrs old. He is now 86 years old with the same hip!

See? Just what I said!!

Thanks for that, ripanco

 

[BigDog Mom]

Wow Andrea,
That does help to hear. We have a big specialty coming up at the end of the month and we have entered 8 and I will be thrilled if I can show 4 of them. Big ring with big dogs and even with better living with chemistry, I am not sure I will be able to do it. It just kills me. I love the dance with the dogs.
One good thing that has come of it is that I now have a lot more family help with the dogs, because Mom can't do it all any more.
I have talked to one Surgeon at The Rothman Institute in Philadelphia and of course was in shock and denial when he told me I needed THR. So I packed my xrays up and went to see another highly recommended Doc at Johns Hopkins and he gave me the same answer. So I guess I have to just suck it up, get it done and hope I'm one of the lucky ones.
Can I ask what type you had put it? I will look at the other thread to see your exercises.
Thank you and Jo so much for your replies.

Donna

 

[ripanco]

Hi Donna,

Where is your specialty(National or regional?) this year? I can't imagine traveling with 8 IWs!!! What type of vehicle do you drive?? Our National is in Gettysburg this year in Oct. My son is a professional handler so lately he has been doing most the dog showing while I have gone to the "dark" side as he says. My first love and passion even before the dogs where horses. Right after getting my hips done, I started riding again and soon found my self owned by a lovely Hanoverian mare. I do hunter/jumper and eventing. So I am more into the horse show world again. But we are all planning on the National. Our male special just took BOS in a good sized specialty in CT a few weeks ago and BOB at a supported entry in Boston. He is still a baby, just getting going so we have some hopes!

As far as type, I have Stryker highly x/linked poly with titanium alloy. As Josephine has mentioned, I went with my surgeon's recommendation. After doing lots of my own research I was pretty sure I wanted ceramic/ceramic, but after talking with my OS, who took lots of time with us and explained all his reasoning, I defered to his experience.

Plan on being one of the lucky ones! Get strong. Stay positive. Just start thinking how wonderful it will be to dance around the ring again.

Tomorrow (Monday), I am leaving for India for 16 days. My middle son is marrying a girl whos family lives in India so the wedding will be in New Delhi. So it will be a while before I check in here again, but I hope to see lots of good stuff on this board when I get back. Hold down the fort, Josephine!!

Andrea

 

[Josephine]

As I write this I am watching the winners of the dancing dogs section at the Cruft's final night on TV. It's caused ever such a kerfuffle there! The snobby purists are saying it lowers the tone of the show (perlease!!!) but it is a delight to watch. Those dogs just look sooooo happy and fulfilled!! Such bonding with their owners! No matter what the stuffy purists say, it's gone down a treat with the crowds.

 

[BigDog Mom]

This is almost scary Andrea...I used to ride (seems much like a past life at this point). We traded in tack for grooming equipment about 18 years ago. The first dog show we went to we were beside ourselves with glee because of the reasonable hour and preparation.;) No dawn braiding and my hounds are pretty wash and wear.
The first regional is in Annapolis MD. Kinda' our spring fling. I entered 8, 4 of which are 7 month old puppies. I am really worried that even with meds and my own adrenaline going that I won't be able to show any of them. My right hip has gotten so bad that my brain tells it to move and it doesn't. Please let me know about your Gettysburg trip and I will try to come down and meet you. Gettysburg is not too bad of a drive for me.

Donna

 

[BigDog Mom]

Well I did it.
I went into the Rothman Institute (Philadelphia) and met with the surgeon armed with Josephine's questions and several of my own. He is confident I can have my life back no holds barred so... I scheduled my surgery for Aug 12th.
He is going to do both at once. When I had x-rays in Dec I had just a sliver of cartilage left on my left side, now it is gone along with my range of motion. My secret hope is that if I sacrifice my hips to the ortho gods they will leave my knees alone.
He will perform the surgery using the anterior method and replace my worn out parts with ceramic on poly.
So between now and then I will strength train like crazy, do my hyro therapy and try not to look upon Aug 12th with dread. But keep building the hope that I will be able to run my dogs again.
Any bilateral success stories and suggestions are greatly appreciated!!!

This really is a wonder thing you are doing here Josephine thank you so much!

Donna

 

[Josephine]

So come, spill! How did he react when you produced the questions and proceeded to go through them? No-one's ever told me!

BTW - glad to hear it all went so well. And good for you you're having a bilateral. You won't regret it. Doing them both done at once is not at all uncommon. A couple of friends of mine had that done and they were back to (gentle) ballroom dancing within a few months!! Do read around the threads in the After Hip Replacement - Recovery Discussions forum, you will find several posts from people who have had it done and are delighted.

 

[BigDog Mom]

Well the resident that did the leg work was a little taken a back at first, when I asked to see what had changed on the x-rays. You see when I went in, in Dec, the left one was not bothering me nearly as much as the right. Sure enough about three weeks later I woke up in agony with the left. So he actually pulled them (Dec & Now) up side by side and showed me the difference. He was a little intimidated by the questions but answered them.
Then Dr. Hozack came in wanted to know if I had any questions when I said the resident had done a pretty good job answering them, he said let me see them and proceeded to go through again writing down his answers on my sheet. He is very confident that I will recover my old life and basically said there will be no restrictions on what I can do. He didn't even blink when I asked about doing bilaterals and the time issue. His response was that the spinal was good for about 4 hours regardless of whether he did 1 hip or 2. He exuded confidence and vitality. Which I guess he should. He didn't strike as the arrogant puffer fish that a couple of OS, I know, are. Kinda came across as a high level athlete does...Just supremely confident in their abilities that have been honed by their years of training.
So let's hope I guess. It's not like I have a choice, unless I want to go from showing my dogs to drawing pictures of them from a chair. ;) And I am thankful it is something that can be fixed. Doesn't mean I have to like though.

donna

 

[Josephine]

Well, now, that's the kind of reaction I would say is good - he was not only totally accepting of the questions but had the numbers right there in his head. Didn't have to go and look them up. Which means he pays attention to those issues. I like the sound of him - don't think you could do much better!