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Should I go ahead with THR?

CafeFan18

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I fractured my hip about 2 years ago. I had three pins put in and all went well until about 6 months ago, when my pain started increasing. I was diagnosed with avascular necrosis. I don't know what stage.

My pain is very manageable at this point. It is up and down and I don't take any pain medication, and I don't use a cane. I am able to walk about 20 minutes no problem. But I do sort of haul myself upstairs clinging to the banister. I do already have the feeling of being "disabled" i.e. there are certain things I used to do that I won't try due to my somewhat painful and limpy walking abilities such as long walks. I have to grab onto things to get off the floor or a seat, etc. I realized compared to the stories I've read on this board that my problems are pretty minimal in comparison.

I understand that this is degenerative and that THR is almost inevitable. I work on a campus, so having surgery between semesters would be ideal for work.

Should I go ahead with the surgery this summer even though I am tolerating the pain and walking OK? Or do I wait until I can't stand it any more?
 
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Bionic

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@CafeFan18
Have you been told that you need a hip replacement? If not I think thats where you should start.
When my OS told me I need a replacement he said that only I knew how much pain I was in so the decision was mine. Initially I put it off but the pain got worse and WORSE until there really was no decision to take. I had a RTHR in July 2018 followed by the left in Nov 2018. I think my hips have healed well and that awful OA pain has gone but because I also need a knee replacement (being done 1st March) I haven't been able to test out just how good the hips are.
So, in short, if you need a replacement get it done. Once you are over the surgery the op will change your life for the better.
 
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CafeFan18

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Thanks for your reply. I guess I'm asking a question nobody can really answer. The doc said I would need a THR at some point with almost certainty (he did say a very small percentage of people with this condition opt not to do it) and that it would get worse and worse with time. So it is almost inevitable that this will have to be done at some point. If I could live with a "normal" hip, I would certainly prefer it. Although it's not currently awful, I am conscious of it all the time and feeling limited by it. So unless someone can suggest a downside with going ahead with it, I'm leaning toward getting it done.
 

Jaycey

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@CafeFan18 Welcome to BoneSmart! Don't wait - get this done while you are still able to move around.

I waited years for my first THR and ended up with the hip collapsing. Believe me, you don't want that pain. The limping around waiting for surgery meant the recovery was longer and more complex.

The minute my right hip started complaining I had that replaced. Very simple recovery and far less pain.
 

alexthecat

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My hip pinning only lasted nine months before I needed to have THR, so you have me beat there. I went from being mostly okay to being in a wheelchair and hardly being able to walk at all. That happened very quickly. I would not recommend taking that risk. If you can get that hip replaced soon, I would do it.

I was also working at a university when I had my hip fracture and surgeries. I had my THR during spring break and then was on leave for the rest of spring semester. I took the summer off and returned to work in the fall. That worked great for me, but I realise not everyone is able to take that much time off work.

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CafeFan18

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Thanks very much for your replies. They are very helpful to get your perspectives.
 

Eman85

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Here's my story. My hip was pinned back in 69, but for different reasons and the joint stayed healthy but painful. For many reasons I went on until a couple of years ago when I started considering a THR. One of the biggest factors that made me decide to do it was what my GP said. He's a straight shooter and that is the reason I drive an hour to go to see him 2 counties away! His opinion was that I'll never be as young and healthy as I am now, so recovery will be as good as it can be. Why not do it now, especially since I was considering it anyway. It still took some time before I went to see an OS, and I went a few times to see if I was comfortable with him. I've been through my share of bad Dr.'s and a Dr. has to earn my trust before I agree to anything especially a surgery.
The downside for you as I see it is your concern for work more than your hip. It's not going to work out good, you have to go all in for your health over anything else. This is a major surgery no matter what well meaning people tell you. If you go all in it will work out great. If you rush things and don't accept that it's a slow steady recovery that needs at least 3 mos, it's not going to be as smooth.
 

Josephine

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Should I go ahead with the surgery this summer even though I am tolerating the pain and walking OK? Or do I wait until I can't stand it any more?
First off, walking is not the only thing that defines our quality of life. I suggest you print off this form I've attached to this post and get a really sound idea of what your QoL really is because it sounds pretty rough to me!

Other points to consider
a) get it done while you still have some mobility left else you'll be struggling to regain your activity and limberness
b) get it done while your pain is still manageable
c) don't wait until you are deprived of a decent level of activities of daily living
 

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CafeFan18

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It's now two months since I was wondering if I should go ahead with surgery. I got good advice on this forum. I reluctantly (at the time) started the process of getting myself scheduled (and it's now scheduled for May 28, though I still have one more insurance hoop to jump through before it is definite). In the mean time my hip has continued to deteriorate, and I now have to use a cane to walk to the nearest bus stop to get to work. My concern that I was "jumping the gun" is now gone. Now I just want to get this over with.

I have been mentally preparing and trying to figure out what I need to do to get ready. One concern I have is my bed. I'm in a two-story, so I was planning on staying on the livingroom futon during recovery. This is where I perched during recovery from the fracture and pinning and it was fine. I left the futon in "up" position, so it had a "back," which gave me something to lean against so I could kind of sleep "on my side" without actually going on my side. The problem is that if I have a 90 degree restriction (which I don't know yet), it's hard for me to imagine how I would get up from this futon as it is rather low. Did others out there sleep on livingroom sofas? I don't think I'd want to sleep in a recliner, as some have mentioned.

It's kind of hard to prepare for things without knowing about the 90 degree restriction. I guess I will find out in my pre-surgery meeting with the surgeon May 15. But I hate to wait until then to figure things out.
 

gertie

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The problem is that if I have a 90 degree restriction (which I don't know yet), it's hard for me to imagine how I would get up from this futon as it is rather low.
Getting up from low furniture is something I obsessed about with my first hip replacement and ended up getting my couch put up on risers. Is that possible with the futon? Risers under the legs of the frame so that it's easier to get up and down? You might also find you can climb up to your bedroom sooner than you think.

Looks like we're surgery twins!
 

Klassy

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I’m glad you have your op scheduled, it’s definitely the right decision.

I slept downstairs for at least a month, as I was anxious about going downstairs (ie, I feared if I went upstairs once, I might be stuck there for days or weeks before I mustered the courage to come down.). Then I could shuffle to the kitchen etc even in early days. Plus our shower room is downstairs. The bed I used is low, so husband put 2 solid bits of timber at right angles to the timber supports it stands on. We tested that this was stable under all circumstances, don’t want to toss and turn and collapse the whole thing! If your bed is the type that has 4 legs you can get risers to fit.

But most people seem to cope with stairs from the start. I’m just cautious, and our staircase is awkward.
 

Carriemay60

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Check to see how bent you are at the hip if you sit on the futon. That might make the decision for you. You will almost certainly have a 90 degree restriction if I am not mistaken. I know I have had the restriction for both a posterior and lateral but maybe someone who has had anterior will also chime in. It is also very difficult to get up from a low seat so think about a toilet riser. You can get the "furniture risers" on Amazon and you should be able to tell from the pictures there if they will work for your futon.
 

Hoppy Nanny

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I had no trouble getting upstairs at all after both my THR’s.. however I did have 90 degree precauctions so getting on a low futon was definitely a no no.
Your hip certainly made the decision for you to have the op... you won’t regret it as life just gets smaller & smaller with pain... good luck x


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gertie

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I know I have had the restriction for both a posterior and lateral but maybe someone who has had anterior will also chime in.
I had direct superior on my left hip, which generally doesn't require restrictions, but even so, things are stiff and weak and I would have had a hard time getting up from a low seat.
 

GrannyC

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I had anterior and absolutely no restrictions except for no bungy jumping! You could always call the OS before your appointment and ask them if they could tell you which surgical approach you will have. Can't hurt to try. Our toilet is a couple inches higher than most so I didn't get the seat riser and it worked fine. I had asked the OS and he said I wouldn't need one so we never purchased one. I live in a single level home so I didn't have stairs to contend with. I do think anything too low might be a problem to get up and down from in those early days unless you have someone right there to help you. I'm glad to hear you went ahead with scheduling as it looks like your timing is perfect. Pain is worsening and THR is already scheduled! You made the right decision.
 

SarahBee

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I had anterior and, as GrannyC said, bungee jumping was out. The only other restrictions I had was falling (duh) and the golfer's reach with leg extended behind due to hyper extension.

Elevating the futon might be the best approach
 

Jaycey

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@CafeFan18 they will teach you how to safely go up and downstairs before you leave the hospital. No need to sleep on that low futon. In any case you should definitely avoid and low furniture in the early days of recovery.
 

Cecropia

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:wave:@CafeFan18
Not sure if your surgery is still on for tomorrow. May 28. If so wishing you all the best through your surgery....
 

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