Hip replacement worries - analysis paralysis

Posted by Mamie @mamie, Aug 3, 2019

Just bringing back my topic in a new way to ask for your thoughts. I need a hip replacement — not for pain but because joint is so stiff I have to use a cane (sometimes two), am bending forward more, and getting more limited in function. At 68, I would really like to get back to walking since it has been 5 years of decline. Five ortho docs I saw in years past said without pain in hip, they would not replace. Now I found two docs (one does 2x more knees than hips — 60 hips a year) and the other is a trauma surgeon who each say they would do it.

Since people on this forum have said: "If I knew then what I know now" — I would like to know more now so I pick the better alternative. One says posterior with lots of PT after. The other says anterior with no PT. Since no docs before even wanted to do surgery, now having two with opposite opinions is keeping me up at night worrying. I could do nothing but I want to have a life — just don't want it to be worse than it is now. I've talked with others about their docs but they were ones that did not want to do mine because my joint is so stiff/stuck – joint is welding itself to the cup – so apparently would take twice as long as "normal" hip replacement. Any thoughts anyone can offer so I can move beyond "analysis paralysis" and get on with life? Thanks.

Liked by shashana11

Hi @mamie – I'm 68 too, but I have only had knee replacements so I don't have advice to offer regarding the hip replacement methods, but I feel for you struggling with this dilemma. I can't imagine how difficult it would be if two doctors had two different approaches and I needed to decide which way to go. I'm going to tag some people who I believe have had hip replacements and see if we can get some experienced insight into your questions: @katepitt @klouis @beatricefay @mariemotte @laura1956 @scottb32. Meantime, are you able to walk at all? Are there any exercises that either of the doctors have recommended – or PT?

Liked by shashana11

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Hi, @debbraw Thanks for responding. Yes, I can walk but need cane because one leg is shorter because of the collapsed and fusing joint. If I try without it, I wobble badly and leg has little ROM to let me catch myself if I start to fall. When the weather cooperates, I go about a half mile sometimes using one cane, sometimes two. I do about 15 minutes of floor exercises — and then straight-leg-it-to-get-up using my arms on couch like doing a push-up. My hip does not hurt — just my back and knee — which, I'm told, is fine and not causing the pain. I can go use stairs but need a handrail and cane. Can't lift leg up much higher than a stair. Some days worse than others and get more bent over leaning on cane. Had been taking only one ibuprofen a day for more than a year and then found it was affecting my kidneys. Now take nothing but Tylenol once in a while. Just worried that stuck joint will make for complicated surgery and I will end up worse than I am. But as I am now, I feel more like 88 than 68. Tried PT a few times after last docs said they wouldn't operate. But PTs say I can't exercise properly without getting the hip replaced – Catch 22.

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@mamie

Hi, @debbraw Thanks for responding. Yes, I can walk but need cane because one leg is shorter because of the collapsed and fusing joint. If I try without it, I wobble badly and leg has little ROM to let me catch myself if I start to fall. When the weather cooperates, I go about a half mile sometimes using one cane, sometimes two. I do about 15 minutes of floor exercises — and then straight-leg-it-to-get-up using my arms on couch like doing a push-up. My hip does not hurt — just my back and knee — which, I'm told, is fine and not causing the pain. I can go use stairs but need a handrail and cane. Can't lift leg up much higher than a stair. Some days worse than others and get more bent over leaning on cane. Had been taking only one ibuprofen a day for more than a year and then found it was affecting my kidneys. Now take nothing but Tylenol once in a while. Just worried that stuck joint will make for complicated surgery and I will end up worse than I am. But as I am now, I feel more like 88 than 68. Tried PT a few times after last docs said they wouldn't operate. But PTs say I can't exercise properly without getting the hip replaced – Catch 22.

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@mamie You mention that the surgery would be complicated but then that the doctors said they would not operate. I hope you can find a really good doctor who is confident and can do it and relieve you of your pain and inability to do many things. It does seem as if hip replacements are less troublesome than knee replacements on people with normal hip problems so hopefully it would work well for you too.

You really do have a dilemma with PT.
JK

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I had the anterior approach and have found it has worked fantastic. I'm 7 months out and just returned from Europe where I walked extensively every day all day. Major hills and rugged terrain that I would have never been able to do last year. I did feel sore several evenings but the soreness was gone in the morning. Prior to my hip surgery I had a kidney transplant 2 1/2 years earlier so I had been very concerned about the hip surgery. I could afford to lose some weight and make it easier on my new hip and kidney. I had both operations at the Mayo Jacksonville and couldn't be happier with the results! I didn't realize how much pain I was in until after I received the new hip. For me the anterior approach was the way to go and shortened my recovery time. I found the hardest decision was to make the decision and move forward. Good luck on your path

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@contentandwell

@mamie You mention that the surgery would be complicated but then that the doctors said they would not operate. I hope you can find a really good doctor who is confident and can do it and relieve you of your pain and inability to do many things. It does seem as if hip replacements are less troublesome than knee replacements on people with normal hip problems so hopefully it would work well for you too.

You really do have a dilemma with PT.
JK

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Hi, @contentandwell Thanks for your thoughts. Actually the doctors I saw several years ago did not want to do the operation because I had no pain. I just recently (about a month ago) saw two orthos and each said they would do it but had opposite opinions on what approach as well as PT. So I went from no one wanting to do it because I had no pain/joint was fusing to now two docs willing to do it but giving me opposite advice. I guess nothing is simple.

Liked by shashana11

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@scottb32

I had the anterior approach and have found it has worked fantastic. I'm 7 months out and just returned from Europe where I walked extensively every day all day. Major hills and rugged terrain that I would have never been able to do last year. I did feel sore several evenings but the soreness was gone in the morning. Prior to my hip surgery I had a kidney transplant 2 1/2 years earlier so I had been very concerned about the hip surgery. I could afford to lose some weight and make it easier on my new hip and kidney. I had both operations at the Mayo Jacksonville and couldn't be happier with the results! I didn't realize how much pain I was in until after I received the new hip. For me the anterior approach was the way to go and shortened my recovery time. I found the hardest decision was to make the decision and move forward. Good luck on your path

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Hi, @scottb32 Wow, that is wonderful. What a great outcome. You must be thrilled. I am curious about the losing weight part, if you don't mind me asking. I am at the upper limit of the BMI for anterior – 35. What was yours when you had your surgery? I thought it was a little odd that the one doc said that because it would be an unusually large incision that it would probably gap open and I would have to go to wound care. Did yours do that? The incision apparently needs to be large to finesse the femoral head out. Apparently they will have to piece mine out since it is fused.

Liked by shashana11

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@scottb32

I had the anterior approach and have found it has worked fantastic. I'm 7 months out and just returned from Europe where I walked extensively every day all day. Major hills and rugged terrain that I would have never been able to do last year. I did feel sore several evenings but the soreness was gone in the morning. Prior to my hip surgery I had a kidney transplant 2 1/2 years earlier so I had been very concerned about the hip surgery. I could afford to lose some weight and make it easier on my new hip and kidney. I had both operations at the Mayo Jacksonville and couldn't be happier with the results! I didn't realize how much pain I was in until after I received the new hip. For me the anterior approach was the way to go and shortened my recovery time. I found the hardest decision was to make the decision and move forward. Good luck on your path

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@scottb32 That’s great that you have had such a positive experience and are doing well. I feel the same way about my TKR. I generally walk and exercise a lot with no significant pain. Recently I’ve been sidelined due to having fractured my femur.

@mamie My husband had a similar dilemma a long time ago – two surgeons with different opinions. You will probably hate this suggestion, but I would get a third opinion. My husband actually consulted with my doctor who was a dean at Harvard Medical. His case was a bit different, both surgeons were going in but what they did when they got in (ankle) was different. My doctor hold him that when they opened his ankle up it would obvious what the next step should be, and apparently it was, he very rarely has pain in his ankle now.
I will be interested in hearing how you proceed.
JK

Liked by Scott, shashana11

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As someone that considers themselves a "hip replacement expert"…lol, I would say, go for it ! I had my first two hip replacements at the age of 33 . Arthritis is hereditary in my family, but hit me the youngest. I had immobility at first, like you, but then the pain set in because I waited too long.I was also misdiagnosed for a long time, since most doctors could not even fathom that I could possibly need a hip replacement at my age of 33 ! I eventually found a fantastic Orthopedic , and had them done in 1987.Four months apart. They lasted me exactly 10 years , ( I was told that at the time I had them done ) I then had a revision on both. Also a few months apart. These lasted me 14 years . I am on my 3 rd revision now. Had them done in 2011. These , I was told should last me the remainder of my lifetime. Of course that`s if I don`t beat up on them too intensely. But all in all, the therapy was quite bearable and far less painful than a knee replacement. ( which I also had about 4 years ago ) It was well worth it in my opinion. If I had to do it all again, I would. I was back in the swing of doing everything I once did after a few short months. And best of all…..no more pain and mobility back ! And the last ones were even better than the first or second, since medical technology is improving yearly . Less invasive procedures, better therapy , and determination on your part make for a successful end game. Good luck to you !

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I suggest you keep searching for a surgeon who will do your replacement and has the knowledge of handling the welding in the hip. No posterior. Anterior, please. Everyone I have spoken to who had the posterior have had much longer recovery.

Liked by shashana11

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Fascinating dilemma. You have not found the right surgeon. Note the comment about going to Mayo Jacksonville and the good result. You need to go to a major medical center and get your operation. Recommend Mayo most convenient to you. There are other possibilities, but work with someone who does many hips, hopefully a reasonable number of fused hips.

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I fought a similar battle with both knees – I weighted too much (300+ lbs) and I was "too young" at 50; 3 surgeons flatly turned me down. BUT… I was to the point I was in level-9 pain to walk 10 yards, and I was on a cane. I finally found the right surgeon for me who told me the only reason he wouldn't do the surgery was because it hadn't been scheduled yet. His argument was one of quality of life versus age and weight. I couldn't exercise the weight off, and I was headed toward confinement to a wheelchair; what sense did that make to delay the surgery for 10 years just so I would be "old enough"??

I'll echo others: 1) find the RIGHT surgeon for you, and 2) GET IT DONE. Your quality of life is paramount, and you are worth not having to live in excruciating pain and/or limitations. Expect 4-6 rough weeks of PT following (it will pay off in the end), TAKE THE PAIN MEDS THEY PRESCRIBE, and get it done.

Good luck finding a good ortho; I have one here in Lexington KY I would recommend to ANYONE if you can't find anyone in your neck of the woods. GOOD LUCK!!

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