What should I be doing?

[gary]

For several years I have known that there was something wrong with my right hip. I am 61 and very active playing basketball 2-3 times a week in addition to working out and hiking. My sports are very important to me.
This spring I had x rays, the report stated "Moderately sever OA affects the right hip. Concentric joint space narrowing, osteophytosis and sclerosis are present. Milder OA affects the left hip, with joint space narrowing and sclerosis".
My initial plan was to manage my activities and do physio etc on my hip. Up to very recently my hip was tolerable. Last month I was playing ball and I must have rotated my hip and the pain was so bad that it made me drop to the floor.
I continue to play ball and have been going to physio. My hip feels less stable but no further issues. Unless I overdue it the pain is minor.
My questions;
What does moderately severe mean? Is severe the next step and I will need a new hip? Will my activities hurry me along? Is there something I should be doing or not doing? In Canada I understand there can be a 2-year wait to see a surgeon.
Gary

 

[Josephine]

Hi there Gary

First off, I'll go through some of the things on your report.


Moderately severe OA affects the right hip.
This means that the arthritis is in a reasonably advanced stage but not so bad that one might expect it to be disabling or to overly effect the patient's ability to walk and get about. It might, however, include the occasional use of a cane.


Concentric joint space narrowing
Concentric means evenly applied and the space narrowing as seen on an xray is due to the loss of soft tissue, i.e. cartilage. Soft tissue does not show up on xrays. Therefore, when the bones or joint surfaces show as being closer together than normal, one can reasonably deduce that the soft tissue is either much degraded or may even absent. Most of this wear occurs on the hip end of the thigh bone (head of the femur or femoral head) because that's the part of the joint that bears the most weight but the socket (acetabulum) also takes its share.


osteophytosis
osteophytes are little irregular spicules of bone that develop as part of the degenerative arthritic process. If you've ever seen metal on metal in an engine that is very worn, like disc pads for example, you'll know that the edges become deformed in much the same way. The presence of many osteophytes is called osteophytosis.


sclerosis
sclerosis is medical term for hardening of tissues, in this case the bone. It will be the joint surfaces, specifically the femoral head, being referred to here and caused because where the cartilage is gone, the bone wears upon bone and the end result is instead of that nice soft, shiny surface you see when you open up your Sunday joint of lamb, the bone has compacted and become hard and polished like porcelain. The effect on the xray is of a denser and whiter bone layer which is typical of the condition.



The side-effects of all this is that
a) you get areas in your joint that are bone on bone and
b) the stuff that's been worn away is like debris inside the joint.

Thus, so long as the debris stays out of the way of the actual weight bearing surfaces, it's not too bad but should bits get in the wrong place, it's just like you suddenly get a sharp stone in your shoe and whilst one step is okay the next is "Ouch ouch!!". The rotation of your joint in the game might also have just really forced a bald patch on your femoral head against a bald patch in your acetabulum. People often don't realise that the bone is actually a very sensitive organ and very capable of relaying much pain to the pain receptors. This you found out when you were "grounded"!

Under the circumstances, I would say the time to have your hip replaced is now as there is one thing for sure - degenerative conditions don't improve with keeping! Your age is about right and if,as you say, you have a 2 year wait to even see an orthopod (and we thought we were badly off in the UK!!) then by the time you get there you will be more than ready for it.

My advice is to crack on with the referral and to avoid anything that entails excessive twisting and turning. Keep active but don't overdo the extra physical stuff.

Let me know if I've missed anything!

 

[gary]

Josehine, thank you for the information. Gary

 

[Annemarie]

Hello gary. Canada here (Mississauga) it took close to seven months of wait for my left hip and 4 months for the right hip. This was in 2006 and now the first THR is already 15 months old and the second 11 months, both were uncemented, ceramic on ceramic. I had a wonderful surgeon at Credit Valley, he even came to check up on his patient for the first three days post op. I was 65 at the time. Since I am now so much more active, weight has gone back to normal, naturally. No doubt the first week is tough with leg lifting excersises etc. starting the day after the op., but it does get better fast. I do hope you get help soon, two years waiting time is just too long.