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THR Seeking Advice, Need Both Hips Replaced

ScruzEngineer

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Hello and I'm excited to find a forum where perhaps I can get some good advice. Due to severe OA in both hips, I need two total replacements. Currently I am on disability due to this issue as the pain and instability severely limit my mobility.

My biggest hurdle seems to be weight: due to a high BMI (just over 50), the first two surgeons said they could not operate. I have been diagnosed with DVT, but besides that, I am in reasonably good health (no prior health issues, no diabetes or cholesterol issues, etc.)

Any recommended surgeons near Santa Cruz, CA?

Also, I am in need of health insurance as I was "terminated for medical reasons." Any thoughts on Kaiser versus say Dignity Health for my issues?

Thanks for any help you can provide, I appreciate your time and assistance.
ELI
 

djklaugh

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@ScruzEngineer Welcome to BoneSmart :welome: I'd say get the insurance issue sorted first - I have Kaiser in Oregon and have been very happy with them (insured by them for 40+ years and worked for Kaiser -not in orthopedics - for 24+ years) - like any big bureaucracy there are problems but over all they provide very good medical care. I've had bilateral hip replacements and 2 shoulder replacements through Kaiser and have done very well with those surgeries. I do not know anything about Dignity Health. Perhaps someone else here will have information for you.

Since Kaiser is an HMO it is hard to get info on surgeons within the system as they do not have individual websites and usually do not show up on any other rating site. Within the system (if that is the way you choose to go) you will need to see a primary care physician first and get a referral to an orthopedic surgeon. I do not know what Kaiser in California's policy on BMI measurements and surgery might be. Do the best that you can now to lose some weight ( difficult I know when your hips hurt!)

And do ask specifically to be referred to a surgeon who is willing to do bilateral hip replacements - IMO that is the best way to go when one has 2 deteriorating hips. BTHR=one hospital stay, one surgery, one recuperation and more rapid return to a normal gait - all the reasons my surgeon gave me for doing both at once. Though having said that, and not being a doctor and not knowing your medical situation - there might be medical reasons why BTHR would not be a good option for you. That decision would be up to the surgeon.

Best of luck to you and do keep us informed on how you are doing. We do like to help.
 

SunSequitur

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@ScruzEngineer First of all best of luck with everything. I am just at 7 wks post op from RTHR. Doing phenomenally well. I was right on the cusp of having a BMI that was too high for surgery. I struggled because my hip was too painful to move or exercise and I have hypothyroidism Which just aiding in packing on the pounds. Consuming a balanced but low 1000-1100 calories a day and I could not lose an ounce. Once my Surgery was confirmed and surgeon assessed me it Was very clear that my weight was his only, but a large, concern for complications. So once we agreed to move forward I enlisted the help of my GP and endocrinologist to help me drop weight. In the 3 month lead up to surgery they put me on liguratide (Saxenda is the trade/ brand name) and I lost 38 lbs that brought my BMI into a very safe zone for the surgery. (I am still quite overweight and continue to work on it but this gave me a great head start ). My surgeon was thrilled. And as I said my surgery and recovery went really, really well. Once you get your insurance sorted it might be worth a consult with your docs about getting medication help/ support to help with weight lose to help set you up for the most successful outcome possible.

All the best!
 

Going4fun

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Dr. Michael Parks at the Hospital for Special Surgery in New York City operates on patients with high levels of obesity. There was an article in the newspaper that said he is on some committee for an orthopedic association dealing with weight and joint replacement.

I suggest you google him and find his office number and call and tell the office of your situation and ask if Dr. Parks can recommend anyone on the west coast who is comfortable operating on people with your weight situation.
 

BrandyinPA

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Hi. I understand your dilemma as I was just there myself. I live in PA, and my insurance company would not approve surgery until I got down to 40 BMI. However, they just approved it as “medically necessary” and not elective. I did have to lose 20 pounds, which I lost by going swimming and taking water aerobics. I am bone on bone in both hips, so it’s impossible to do anything outside of the water in terms of exercise. I got a health coach (through my insurance), a mobility scooter (through my insurance), a nutritionist (insurance), do physical therapy (which hurts like hell) and a membership to my local YMCA(insurance paid for it). I also consulted a bariatric surgeon so that it can be documented. And because I’m in so much pain all the time, I went on short term disability for my job.

I did all that through my insurance so they can see I’m willing to do my part. All of those things show the insurance company that I’m trying… so they went ahead and approved surgery even though I’m not at the BMI that they would like (45.9 bmi).

You can do this! Even if you lost 10 pounds, and did all the things that I stated up above, you could probably call your insurance company and get them to agree to surgery. The doctor will also have to agree to do the surgery, but the hurdle really is the insurance company. Dr. shopping may not work as it most certainly didn’t work for me. Five surgeons all told me the same thing, “lose weight”. But the last doctor told me if I did the best I could, and called my insurance company for approval, then he would work with me and do the surgery when they approved it. But still the bottom line is, at least in Pennsylvania, it’s completely up to the insurance company whether they’ll pay for it or not. I truly wish you good luck. It’s awful to live in constant pain. If I can do it so can you!
 

Eman85

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Have you looked on the Health Insurance Marketplace through Healthcare.gov? I was using insurance through it with my 2nd THR and had better coverage than when I had my first through my employers health plan.
 

Pumpkin

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You might want to look into Dr Sah or Dr Dearborn, they are both located in Fremont CA.
 

Sigma1

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I would think bilateral hips would not be good. Moving around is hard enough with one hip done. I think worst hip first, and then 2 months before the second would be about right. Bilateral I would think would be for more athletic folks, that could do pushups and pullups, for example. I would think a trapeeze above the bed would help to drag yourself up and around.

I am confident your surgeon will want to do one at a time, and I think that is going to be best for you.

I would suggest a lift chair that fits both height and width. That would be a lot easier for getting up and down, particularly during the first week.
 
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Jaycey

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On the contrary @Sigma1 - anyone who is a candidate for bilateral THR should not be dissuaded from going that route. One procedure, one recovery. We have many members who have had BTHR with no regrets.

As with any THR patient - PT and OT will provide assistance in the best ways to move around in the early days.
 

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