Too much joint space

[BGH]

Hello,

I am a very serious adult ballet dancer (have been in ballet for over 2 decades, but started really late).

In 2016, I began to have hamstring and anterior "clicking" pain in my right hip when I would stand up from sitting. Pain progressed and in 2019 I had a right hip arthroscopy (labral debridement, synovectomy). This "well known" doc later said I had "too much arthritis" for a labral repair - saying I had grade 3-4 arthritis. Needless to say, symptoms continued (pain and lots of clicking).

In 2020, my left hamstring and hip began exhibiting the same symptoms. I had a PRP injection in the left, but that did not help a bit. I've done many months of PT. A recent right hip MRI shows, "severe arthritis and osteophytes, BUT SPACE IS MAINTAINED." My left hip hurts so bad now, but the left MRI shows just a labral tear, WITH SPACE MAINTAINED (fyi, I will be getting a 2nd opinion on that when another radiologist reads the MRI for the left).

I'm nearing my 40's and would like a simultaneous, dual-mobility hip replacement due to my activity in ballet. Both of my hips hurt everyday, but the OS is making me go through "diagnostic" cortisone injections (first extra-articular then intra-articular) to narrow down if I would truly benefit from a hip replacement (if the intra-articular cortisone decreases my pain more). I'm highly symptomatic even though I'm fairly young and "have joint space." Do I have to be crippled and totally bone-on-bone for my OS and insurance allow for hip replacements?

Thank you for any assistance,
Gerlonda

 

[Jaycey]

@BGH Welcome to BoneSmart! If your x-ray is already showing severe arthritis I'm not sure why the surgeon is wasting time and money on any injections.

I would suggest you get a second opinion on both hips. No, you don't need to be bone on bone for replacement. In fact it's better if you get a replacement before the hips are that far gone.

 

[ljpviper]

Hello I was in the same situation at age 40 I have two failed scopes. My surgeon also found grade 4 arthritis. The right hip was never great i had mild pain till it finally gave out 2 years later. I have a dual mobility now it feels very natural. My X-rays also showed good joint space like you, even though I was in constant pain.

I also tried, pro, etc. It was just wasted money.

Good luck

Larry

 

[subie2021]

Diagnostic injections aren't unusual. I had a couple of years of PT, multiple imagings, and then injection before my THR. My OS told me that imaging isn't the final answer; some people have horrible looking hips but no/little pain while others look no-so-bad but have a lot of pain. THR is elective and can have serious consequences, both good which we all hope for, and bad, that nobody wants. It's not a procedure to be taken lightly.

In my case, my right hip looks worse than my operated hip did but it doesn't give me grief. Both showed OA, osteophytes, cysts, and labral tears. The ultrasound guided injection gave me 18 days of almost total relief and the minute it wore off the surgeon scheduled the replacement for 3 months later (in order for the steroid to clear).

Maybe you can talk more with your surgeon and also your insurance rep in order to get the answers you need. Sometimes the two tangle each up.

Good luck, best wishes for a quick resolution.

 

[djklaugh]

@BGH Please check your profile - your age shows as 37 but in your post you mentioned you are "in my early 40's"

Some insurance companies insist that patients try any/all "least invasive" (AKA Less expensive) methods of treatment before agreeing that surgery is needed. For joint problems those include PT, steroid injections, and maybe other things too. Yes I'd agree a 2nd option is a good idea -- this current guy sounds a bit "old school" to me ( here old school usually means someone who believes you shouldn't have a hip replacement until you're at least 50yo).

 

[Sigma1]

I suggest seeing a doctor at a place that specializes in hips and knees.

 

[BGH]

Thank you so much everyone- your advice has been terrific. I live in the South but I have been going back and forth to HSS in NYC as their docs seem to be more on the cutting edge regarding dancers/performing artists.