THR Second opinions/shopping surgeons, & timeline after giving the go-ahead

[Solar7]

So many people here have been very helpful, and I know mileage may vary here, just trying to get a general idea. It's been about 6 weeks since I got told I'd need THR at the age of 36, but there were so many questions I didn't know to ask when I got that diagnosis. Come mid-week this week, I'm getting the final MRIs on my knee and thigh to double check for complications. I'm on an ACA HMO plan, so I'm wondering how to approach finding the right surgeon, and checking for opinions. My co-pay is $85 per specialist visit, so I can't go hog wild visiting new doctors.

When would it be best for me to get in touch with other doctors, given that I don't know my current surgeon's approach, and don't have an appointment set with him for a while? Do I wait until I see him next time, "schedule," and then go in a mad dash to see other doctors? Should I be asking them now, and him last? Are there resources for me to find out approaches by doctor, or would the front desk be able to answer that for me?

Also, how long from when you said "okay, let's do this," did it take for you actually have the surgery? Am I looking at like, two weeks from that date? Two months? I'm concerned about getting enough time for a PT to look at my non-operative leg, as it's very weak after a fracture last year, and I don't feel like my primary doc or surgeon are acknowledging how weak it is when it's going to need to do the "heavy lifting," so to speak.

Thanks!

 

[benne68]

Sounds like you are dealing with multiple issues here.

how long from when you said "okay, let's do this," did it take for you actually have the surgery? Am I looking at like, two weeks from that date? Two months? I

There is no one answer to this question because every surgeon's schedule is different and every hospital's availability is different. BoneSmart members have reported waiting anywhere from 1 month to a year for surgery.

In my personal experience, it was 3+ months from the "green light" to my surgery date for my THR. When I had my TKR (by the same surgeon and at the same hospital), his scheduler got me in in six weeks.

Do I wait until I see him next time, "schedule," and then go in a mad dash to see other doctors?

You do not have to schedule immediately when you see the surgeon. You can simply say that you are undecided whether you want to proceed just yet and he/she will give you the scheduler's contact information and tell you to call when you are ready to book a date. (BTW, it perfectly okay to say you want to get a second opinion before you decide to proceed.)

If you like this surgeon, why not wait to meet with him again so you can get answers to all those questions that you didn't ask first time around. In the meantime, do your research on other surgeons so you have a short list from which to choose.

You can use our Surgeon Locator page (https://bonesmart.org/surgeonlocator/) to get started.

If it was me, I would even set up appointments with one or two other surgeons in the week or two following the appointment you already have scheduled.

Remember that this is YOUR hip and YOUR surgery. You have every right control the process and to get the information you need to make your decision.

 

[djklaugh]

@Solar7 Picking a surgeon can be confusing. You want one who does a lot of hip replacements - like about 300 per year. You can use the surgeon locator function here to see if there are other surgeons in your area listed with that function (not all surgeons in each area are listed). If the surgeon you are currently seeing does alot of these surgeries you can stick with him. As for approach - I've seen reports from folks here about every possible approach and technique - and have seen wonderful results with all ..... and not so wonderful results with all. IMO the main factors in guaranteeing a good out come are: 1- the skill of the surgeon; 2-patient's over all health; 3-patient's willingness to heal first and then do strengthening/training before trying to return to strenuous activities. Let the surgeon use the approach he knows best and you should be fine.

IF you want to seek a 2nd opinion that is your right. It's hard to get information unless the surgeon has their own website .... first folks you talk to are usually receptionists/appointment setters and they might not have the information. You can ask if you can speak to surgeon's nurse or assistant prior to an appointment ... don't know if that is possible with all practices.

Wait times to get into surgery vary a lot from surgeon to surgeon and from hospital to hospital. Back in 2011 when I had my surgery it took 6 months from first visit to surgery. And each of my shoulder surgeries also took about that long. But that was then and that was my HMO in my city. Sorry there really is no way to predict how long it would take you to actually get the surgery done.

Generally it is recommended that folks not return to physically demanding jobs for 12 weeks following hip replacement. But every one is different and healing from this surgery is different for each person. You should also talk to your HR department (if there is one) or your boss about this issue and see if there is a policy/plan for phased return to work. When such a plan is available it allows the worker to return either part time or with reduced strenuous activities for awhile.

We are seeing more and more people around your age getting hip replacements ... and returning to very active jobs and sports! In the past year there were 2 police officers in their 30s who have now returned to full active duty.

Best of everything to you!

 

[Going4fun]

You can schedule another appointment with the same surgeon to ask the questions you want to ask. It's totally fine--happens all the time--that a patient comes in and asks more questions. That's legit. That's a major part of the surgeon's job, to explain the surgeon and the patient's condition and prognosis--with the patient!

Anytime you want--you can visit another surgeon.

Sounds like you want to hear about a timeline. I'll give you my process. I'm a teacher and I got to the point when I said "I'm ready for the surgery." I had delayed it for seven years. Now, my arthritis wasn't nearly as crippling as other people's. I would have to stop for periods and then I could resume activities like dancing and jogging and weight lifting. Finally the pain just got too annoying and something clicked that said, "I'm ready."

Once I knew I was ready for surgery, I thought about the schedule that would be ideal for me. I wanted to have the surgery in the fall. I would take that term off from teaching and I would be able to recover without having to walk on ice and snow. So my goal was surgery in September.

In March, six months before September, I started making calls. And I scheduled appointments with two different surgeons. I had read tons of reviews on different sites about both of these surgeons. I met them and loved the first surgeon and loved the second. Both were great communicators, really informed on the latest research and both thought it was safe and reasonable for me to be able to run on the new hip. Both had surgery appointments available for September, and I scheduled surgery with both of them (on different dates).

Then when I made the final decision, maybe six weeks ahead of time, I called the one and canceled.

BTW: if I didn't find surgeons I really liked, I would have kept looking. Surgeons assume a lot of patients are going to multiple surgeons for consults.

 

[Solar7]

@benne68
Thanks for your reply! I definitely know it's going to be variable for when they're available, I guess I'm just trying to get my ducks in a row. Like, if I'm going to be wheeled into surgery 2 weeks after giving the doctor the green light, there's a lot of stuff I can't pack in, like prehab, getting my house in order, etc. I know in a sense that's up to me, but my parents are relatively anxious to have me get this done and over with, and back to working (which is fair, no one wants to be taking care of their mid-30s son with no job).

The surgeon locator looks like a great tool, and thanks for the timing.

@djklaugh that's a lot of great information. Unfortunately I currently don't have a job, which is really mucking things up. I don't feel like I can find a job while telling them that I am going to have to have hip surgery knocking me out of work for nearly three months within the first year of them hiring me, and I can't find a new job immediately after the surgery that will "phase me in." (And to be fair, I also don't want to be working somewhere and use all of my vacation so that outside of the brutal pain of recovery, I don't get to do anything with my life for a year.) I have a career that should allow me to find WFH work, but it's still difficult to find when you're very limited and tired. Not to mention - when I work, I'm generally so overloaded that I think my recovery will go by the wayside.

@Going4fun, thanks! I'm definitely trying to sort out a reasonable timeline. Everything you said makes sense. I can't put this off for too much longer, as I have AVN and it's eventually going to collapse on me, but I want to figure out what's right and not rush into it. Plus getting major surgery right in the thick of mid-July with temperatures up to 120 degrees sounds less than ideal.

 

[hiking_in_2024]

I'm also looking for a surgeon in Las Vegas. I'd like to get the THR done in late September or October so that I am ready to travel again by February next year. I have an initial appointment with Dr. Joseph Yu tomorrow, I was referred to him by my PCP. I'll probably try to schedule with another surgeon for a 2nd opinion after my appointment tomorrow.

 

[Solar7]

I'm finding out that my insurance currently only covers four surgeons... and they all work in the same office. I doubt a second opinion even makes sense now.

 

[LeftKath]

Hi Solar7, I had a similar limiting experience with my insurance and hip replacement surgeon. Fortunately my brother-in-law had recently had both hips replaced by one of the insurance approved surgeons so that gave me a confidence boost. It's not unusual for insurance companies to only have certain doctors within their network, but my insurance went a level further, requiring Hip and Knee Replacement surgeries to be performed only at certain hospitals. The back of my insurance card notes this restriction too. There's just insurance fine-print everywhere!

Unfortunately these certain hospitals are still dealing with a backlog of elective surgeries and with post-Covid staff shortages. Because of these delays my surgeon's office was able to petition for an exemption to operate on me at another facility. Otherwise I would have been waiting a year for each hip replacement. Instead I waited 7 months and 5 months. But of course your community may have shorter wait times. (It's also possible that since you have AVN the surgeon might even squeeze you in sooner.)

Advice: Review over the fine print with your insurance to double check for any special restrictions.

Most hip and knee replacements require prior approval. Your surgeon's office will gather up your x-rays and notes from your file and submit to the insurance for approval.

Anyway there was a lot of paper pushing in my situation but the staff at my surgeon's office took good care of me and I now have two brand new hips.

Take Care

 

[kneeper]

Yes, so much is dependent on our insurance. If your surgeon is part of a decent sized medical system he or she is probably just fine, especially if they do a lot of joint replacements. I was on an HMO with my first knee and there were limited joint surgeons in the system but the one I was referred to was excellent.

And yes, do go over your plan with a fine tooth comb and don't hesitate to call the insurance company to make sure all your ducks are in a row. At the least you will need to follow a preauthorization procedure.

Like benne68 said, it's not like they will schedule you instantly. I'd expect a month or more to even get on the surgeon's operating schedule.