THR When to time hip surgery?

[EalingGran]

I am new to hip area but am in recovery from a partial knee replacement ( 10 weeks out) and want thoughts/ advice about timing of a hip replacement. I post on the knee recovery forum as EalingGran.
I first had deep groin/ hip pain in March 2022. It was intermittent but very severe and worse at night. I was post Covid and hoped at first it was due to that.
I had had some knee problems for a couple of years- Bakers cyst/ pain on stairs but this was also getting worse in 2022. I then got really awful sciatica on the right for about 8 weeks in the late Summer/ Early Autumn.
MRI shows moderately severe osteoarthritis in my right hip with osteopaths and a small labral tear.
The knee MRI showed severe osteoarthritis in the lateral compartment/ Bakers cyst/ pes anserine bursitis/ mild to moderate arthritis in other compartments. Lumbar MRI showed quite severe arthritis in a couple of disc areas and some bulging in one disc on right with scoliosis to right. The hip pain pretty much resolved with naproxen and the sciatica went after 8 weeks ( ? helped by pregabalin- which I no longer take)
I have always been knock kneed mainly on right but it had got much worse in 2022 with almost 30 degree deformation. My OS reckoned that straightening my leg with bone cuts during a lateral partial knee replacement would improve my alignment such that my back and hip problems would improve if not resolve.
I am now 10 weeks post PKR and it has been tougher than I estimated - although my leg is way straighter and my walking is better.
The plan was that I would stop naproxen before I see him on 18th January to see if hip pain came back. Trouble is that if I try to stop naproxen currently both my knee and hip flare up again.
I don't want to take naproxen forever. I have a congenital megaureter and although my renal function is good I know the risks. Plus there are heart risks.
Sorry this is such a long post- but my dilemma is when/if to have hip surgery and I would appreciate views from people who have made that decision.
I have found rehab from the knee tough and painful- although I gather hips are supposed to be less painful?? My surgeon says I will probably need a hip replacement at some point but there is no rush. Is it better to wait until it is bone on bone or do it earlier when you are younger and hopefully a bit fitter? How have other people made the decision?

 

[subie2021]

Imaging showed my hip to look 'not that bad' but my back looked like a train wreck. I went a long time - a miserable almost 2 years wherein I forgot what being pain free was like - round and round with this med and that med, this PT and that PT and finally a pain management physician. He suggested a diagnostic joint injection, and from there a surgeon.
The hip replacement was my cure. No more hip pain, disappeared back aches. My gait, posture, and alignment have improved. My body is still adjusting but it's going in the right direction.
My other hip also looks 'not that bad' but it isn't bothering me much. My surgeon told me that when it causes me pain, to see him again. His words were that it's all about Quality of Life, not what xrays or MRIs look like.
Don't lose precious time, suffering. A bad hip robs its owner of so much - ability to work and function effectively, joy in simple pleasures like nice walks and outings, enjoying people we like or love. We can never get that back once each opportunity is gone.
We all have our own parameters as to when enough is enough. Go when you've had enough sacrificing, accommodating, excusing, and trying every alternative. For me, it will be much sooner than later...I won't give a bad hip one more day than I must. It isn't worth diminishing that Quality of Life.
Best of luck to you in making your decision.

 

[Layla]

it's all about Quality of Life, not what xrays or MRIs look like.
Don't lose precious time, suffering. A bad hip robs its owner of so much - ability to work and function effectively, joy in simple pleasures like nice walks and outings, enjoying people we like or love. We can never get that back once each opportunity is gone.
We all have our own parameters as to when enough is enough. Go when you've had enough sacrificing, accommodating, excusing, and trying every alternative.

subie2021 Your words above say it all!

 

[Eman85]

My GP told me I wasn't getting any younger and I was in as good shape as I was going to be going forward. besides in our 60's odds are it's one and done as we won't wear it out.

 

[EalingGran]

Thanks everyone. I think I am going to have one more go at switching off the naproxen ( maybe try long acting ibuprofen) and see if hip pain comes back. I can't face more surgery right now but I guess I could ask to go on the NHS waiting list- apparently about 9 months where I am for my surgeon. I take the point about not getting any younger though.

My GP told me I wasn't getting any younger and I was in as good shape as I was going to be going forward

 

[EalingGran]

I have now been offered an ultrasound guided steroid injection on 17th January. My hip is currently not painful but am going to try and stop the naproxen and see whether the hip pain comes back now my severe valgus deformity was corrected by my partial knee replacement. I apparently don't have to have the injection but they can review the hip by ultrasound anyway.
What are people's experience of steroid injections?

 

[subie2021]

A steroid injection was the last step before my THR, considered a diagnostic tool. It was an easy procedure with a little discomfort of pressure as the steroid/anesthetic solution was injected in the joint.
It gave me great immediate relief for 18 days.
All the hip pain came back after that, over a period of a few days.
I had to wait 90 days from the date of the injection to have my hip replaced.

Several years ago I was having trouble with my other hip and was scheduled for an injection. On the day of, I had very little to no pain. When the nurse asked me to rate the pain, and I answered that it was about zero, she alerted the doctor and he cancelled the procedure. I was told that because it's diagnostic, I needed to be symptomatic to find out if it fixed the problem.
So maybe ask your doctor about that, whether the pain criteria is the same where you are.

 

[EalingGran]

Thanks. It is tricky for me as I have definite pathology in lumbar spine/ hip and knee. Also trying to figure out if straightening my leg has helped the hip.
Ideally I wouldn't stop the naproxen just yet as I am only 10 weeks post partial knee replacement and knee still gets warm and sore if I do too much. But I have review with my surgeon to decide whether to go on NHS wait list for hip replacement and now this offer of ultrasound and possibly steroid jab. So I need to see if pain comes back if I stop naproxen. The hip pain was really bad previously.
I paid privately ( £13,000) for my knee and only actually saved about 3 months as pre- op joint school appointment came through last week! So keen to try and stay within NHS for hip- particularly as currently it is fairly ok.

 

[subie2021]

I sympathize with you going through all the sorting out of what hurts where.
I went through the same thing and it's very frustrating when there is never a definitive answer. When my right hip was giving me grief, I was sent for xrays and then an MRI of my lower back and hip. Hip looked ok, but my back is a train wreck. My doctor said "How in he** are you walking around with that mess?"
But my back rarely hurt, and if it did, it wasn't very painful.
Then when I fell and hurt my left hip, more imaging and because the hip didn't look all that bad, but my back is a mess, all the therapy etc was focused on the back problems.
After more than a year I saw a pain management doctor who diagnosed a bad left hip in about a minute. The hip replacement cured the pain.
My younger sister saw a spine doc for pain, and she wound up with a rod, screws, and heaven knows what else in her backbone. Guess what fixed her pain? A hip replacement!
It's a mess to try to untangle all these inter-related muscle, nerves, tendons, and bones. I wish you the best in figuring out what will work for you

 

[EalingGran]

Thanks!

 

[Caison113]

Pre-hip surgery, I started developing sharp lower back pain anytime I took a walk longer than 5 minutes (leaving aside my hip pain and terrible gait). Post-surgery, that back pain was gone. It was all due to my posture affected by my terrible hip. Not guaranteeing anything, but hips affect everything. Sounds like your knee/hip alignment really did a number on the rest of you. Certainly worth looking at the THR if your x-ray supports intervention.

 

[Layla]

Hello @EalingGran
If you're still on schedule for the injection today, I wish you all the best and hope it brings you speedy relief. With the time difference between us, possibly you already had your appointment. A peaceful rest of the day to you!

 

[EalingGran]

Thanks.
After discussion with the doctor I decided not to have the hip injection. I really don't currently have hip pain despite stopping all painkillers for 2 weeks. My knee is not great though and my lumbar spine is worse since stopping naproxen.
The doctor in the ultrasound guided injection radiology dept thought the hip MRI I had pre knee surgery wasn't that bad and I might go for years without needing a replacement. Straightening my knock knee on the right does seem to have cured the hip pain. Just wish it had cured all my knee pain as well...
Seeing my surgeon tomorrow to review both knee and hip. I am worried that the medial knee pain is due to the unoperated compartments and I should have had a TKR instead of just a half knee.

 

[Layla]

Hi again,
Great news that your hip is no longer hurting, but I am sorry you are struggling with knee and spine pain. I hope your appointment goes well tomorrow and your surgeon has some advice, or a solution other than additional surgery that will bring you relief. Keep us posted, we're here for you.
@EalingGran

 

[zauberflöte]

Hi @EalingGran I'm sorry you're having such a complicated mess of pain. It sounds like you are really keeping track of what hurts when/where/why and in my book doing that is a very good thing. I hurt all over if I don't take tylenol regularly-- OA seems to like me... but no hip joint pain, so I count that a blessing.

I knew somebody who had a partial knee, and her recovery took longer than just a few months-- you probably have a ways to go on the knee recovery marathon. Do you still use ice? I loved my ice!

 

[EalingGran]

@zauberflöte Yes thanks I am still icing at least a couple of times during the day and resting the cold water pack on it at night. It really does help.
I even had to superglue back on a couple of the velcro pads which had come loose through so much wear.

 

[EalingGran]

Keep us posted, we're here for you.

Thank you so much.
I had a really positive appointment today with my surgeon who did my PKR and who specialises in knees and hips.
I put the full update on my knee recovery post. But the upshot is that he thinks my hip is too good for surgery and could be fine for many years now my valgus ( knock knee) deformity has been corrected with my lateral PKR. He has given me another NHS appointment in 6 months though to follow up the knee and hip- so if there is a problem and the hip pain comes back I don't have to either go privately or go back through the GP.
He is also convinced that my residual knee pain is soft tissue/ medial collateral ligament and will settle gradually. It was stretched and " unhappy " pre operation and is now having to get used to a realigned straight leg.
He spent ages talking me through my pre- operation MRIs and thinks the unoperated side of my knee was " pretty pristine" with too much cartilage to be causing pain.
He has also given me the name if the back specialist he recommends in case the lower back pain doesn't improve with exercise or the sciatica comes back.
So feeling pretty good- just need to clear this awful chest infection and keep up the pilates/ physio exercises....