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Bilateral THR Pre-OP Thread - Concerns etc.

Lester.Frea

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Hey fellas!

Long time lurker, first time poster :) Finally took the plunge and joined the forum. I realize that the forum is more US/Anglo focused (and I'm from India), but reading a lot of threads and inputs from y'all, especially Josephine :) Really addressed a lot of anxieties I had, and finally helped me let go of my never ending fear of getting the bilateral THR, as it's seriously debilitating for me.

Now bit of a history (I'll keep it short, I swear lol): I'm a 29YO who had multiple issues - basically a long episode of pneumonia + severe asthma, during which I had to undergo high dose steroid treatment when I was around 15-16, post which I suffered from severe osteoporosis (my Z score was <-6, if you can believe it!). Took a course of of parathormone for around 12-14 months and it improved significantly. Now all scores are at least in the positive lol.

However, turns out I've had arthritis issues which totally went undiagnosed - and by the time I got it diagnosed (two years back), my neck range of motion is severly limited (coz of fusion owing to ankylosing spondylitis) and while I've always had a bit of hip problem, it's gotten worse over the years, and doctor's had always recommended THR. I've been postponing it, mainly owing to my worry re: surgery and revision surgery later (since I'm very young). Now it's really debilitating - while I've been ignoring the severly limited ROM, now the pain is pretty bad and I can't even do moderate exercises that puts even some stress on the joints.

So I'm planning to do Surgery on 23rd of next month (after all the eval).

My main concerns:
  1. My surgeon suggested Ceramic on poly. I know that material wear/tear depends heavily on the usage (I'm a bit underweight if anything and I intend to mostly avoid high impact activity as a routine) and generally there's no overwhelming evidence either way, is this still a good choice? Any downsides to COP?
  2. I'm concerned about hip dislocation. Now doctor has suggested the 90 degree rule and whatnot and he's said that ideally I should always respect the 90 degree rule (even in the future post recovery). So is there any serious risk of dislocation once the hip muscles heal and pseudocapsule develops? And should I go for dual mobility implant? Currently, the one suggested by my surgeon doesn't have dual mobility, does it have a serious added advantage?
 
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Lester.Frea

Lester.Frea

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Also, if there are any good threads that point to bilateral post op recovery tips, that'd be super :) Coz many of the tips involve "the good leg", and I don't have that unfortunately :P
 

Pumpkln

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@Lester.Frea
Welcome to BoneSmart, glad you joined us! :welome:
You will notice I have added you to the March Musketeers 2021 Hip Recovery Club, there you will find other members having surgery around the same time as you.
Your history is extensive and you have been through a lot, glad you are going ahead with your Bilateral THR's.

To find others anticipating a bilateral THR just click on the Bilateral Banner Pre op banner,
for members who have had a Bilateral THR click on the link.
We have had a number of members in their teens who have had THR's Teenage hip replacements .

The most important choice you will make is the surgeon, they will use the implant they are most familiar with, and have found to be very successful. The ceramic on poly should work very well for you.

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
 
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Lester.Frea

Lester.Frea

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Hey thanks a bunch, @Pumpkln! I'll go through them.

Thankfully I'm underweight if anything (132-133 lbs and 5'11 tall), hence my pain on weight bearing is minimal. However since I'm almost bone on bone, moderate activity really worsens the pain. Like anything even stressing the ROM of the joint. For instance, even Swimming, which is low impact makes the joints hurt after a while (not during, but a few hours later). I really experienced excruciating pain after some high impact running/jogging (and that was hardly 10-20 minutes per day) and couldn't get out of bed for days coz of the pain. I even experience pain in sleep if my legs are not in a good posture and is stressed with the ROM (which is very little as it is). So yeah, I have to do it, I guess. No point in postponing this further.

I really appreciate all the support I get from here, really helps to read all the experiences and bracing myself for the surgery :)
 

Mojo333

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:wave:@Lester.Frea and welcome to BoneSmart.
This forum was such a big help to me and getting advice and reassurance from staff and members who have "been there and done that" was invaluable to me.

I am sorry that circumstances have led to BTHR at your young age but the great news is.... given the proper patience early days... This surgery is amazing.

I was getting so restricted prior to my double hip replacements and sleep deprived and just So tired of being in pain.
I found most activities would just aggravate things and the best thing I did was keep up my upper body strength so I can safely get myself up and down those early weeks.
All Temporary struggles and well worth it.

This surgery for me back to a healthy happy life.:happydance:
 
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Lester.Frea

Lester.Frea

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:wave:@Lester.Frea and welcome to BoneSmart.
This forum was such a big help to me and getting advice and reassurance from staff and members who have "been there and done that" was invaluable to me.

I am sorry that circumstances have led to BTHR at your young age but the great news is.... given the proper patience early days... This surgery is amazing.

I was getting so restricted prior to my double hip replacements and sleep deprived and just So tired of being in pain.
I found most activities would just aggravate things and the best thing I did was keep up my upper body strength so I can safely get myself up and down those early weeks.
All Temporary struggles and we'll worth it.

This surgery for me back to a healthy happy life.:happydance:
Woo, thanks a bunch Mojo! So glad to hear that things have worked out great for ya! I'm looking forward to the same, and once I've recovered enough, hopefully, I can get back to swimming and hiking and tons of stuff (obv low impact stuff mostly lol). But yeah, I gather that it's a slow process and might take longer, well prepared for that - at least this darned OA bone-on-bone pain will be gone!

Just wanted to ask, and I know this might vary from person to person, but how long did it take you to recover enough to do, let's say, walking cane free for a reasonable distance (let's say a mile)?


Also, if you did replace both hips in one go, how hard was the recovery process? Was it super difficult, post op?
 

Mojo333

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The first 6 weeks was definitely a slow go, but I was so happy to be rid of that bone crunching relentless OA pain immediately. The surgery trauma had its own pain, but I took my meds on schedule and really gave myself time to heal before asking my body to perform.
I had bilateral hip replacement almost four years ago.:chuckmarch:
I wouldn't say super difficult after the first week...I definitely needed some assistance then.
Just wanted to ask, and I know this might vary from person to person, but how long did it take you to recover enough to do, let's say, walking cane free for a reasonable distance (let's say a mile)?
I wish my memory was better...I actually went back to work part-time (really too early) after 6 weeks...5 hour days and I was pretty mobile but kept walking to short stints many times a day versus longer walks which would stress still healing soft tissue and put me on ice for days.
I think at 3 months things really eased off so I could walk further for longer periods of time.

The first year, I was careful and feel like my slow transition back to the "fun things"...hiking, swimming, fishing and riding ATVs...all which I do now without discomfort or restrictions.
You will love your new life.:tada:
 
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Lester.Frea

Lester.Frea

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Woah that's great to hear! Super reassuring, thanks a bunch! :wow: Glad to have this great support here, difficult to convey these things to family/friends coz none of them have even peripheral understanding lol, and family is anyhoo nervous and I try and reassure them as much as I can :D

Your implant is not dual mobility, yes? And also, how worried are you about dislocation? Coz that sounds scary :/
 

djklaugh

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@Lester.Frea Welcome to BoneSmart :welome: Whether or not the dual mobility implant is the best option for you is something to discuss with your surgeon. There is some early research ( dual mobility implants have only been in wide use for for less than 10 years so long term studies are not available) that suggests the dual mobility implants may have a lower rate of dislocation than other models. But even with the more standard implants the rate of dislocation is actually quite low. And dislocations are more apt to occur fairly soon after the surgery. The hip precautions - 90 degree rule, etc -are primary to prevent extreme torquing of the new implants and prevent the dislocations. I seriously doubt you'd be required to follow that restriction for your life time. In my opinion (and I'm NOT a doctor or even a nurse!) it would be totally unrealistic to expect anyone to never break a 90 degree bend from the waist. This restriction usually is only in place for about 8-12 weeks while the surgical sites are healing and new bone is growing around the implants.

Also the current implants of all kinds are expected to last for 30+ years (and there have been reports of older types of implants working well for over 40 years!) so barring any unforeseen problems the chances of you needing a revision is quite low.

I had my BTHR done 9+ years ago ( and was considerably older than your self when I had it done) and I am daily thankful for having had the surgery and doing both at once! In that time I have not had any dislocations and am NOT worried about that aspect at all! As Mojo said the first 6 weeks or so are difficult but if you take things slowly, follow your surgeon's instructions, and pay attention to all the excellent advise you will get here, you will most likely be back to doing all the fun things you like to do within a relatively short period of time.

Each person's journey through joint replacement is a unique experience. And since you have had an already difficult set of medical problems in your life, your surgeon and other doctor(s) you see regularly - the ones who know you and your history well - are the best people to advise you on the way to achieve optimum success with your hip replacements.

Best of luck to you and please keep us informed of your progress - we do like to help!
 

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