UKC

Hip Replacements & Resurfacing

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 BazVee 10 Nov 2014
I have done a search and seen some older posts but time and medicine moves on. At 51 I have a problem with a worn out hip and just seeing if anyone else has had anything done recently. After having it Xrayed my GP has mentioned replacement and resurfacing. I suppose I am interested to know the pros and cons of the resurfacing approach and also what my limitations will be if I have surgery. I've not climbed properly for a couple of years but my little boy is fast approaching the age when he will be ready to take his first steps and handholds upwards. The other thing I do is a fair bit of mountain biking.

If I go down the route of having surgery will I still be able to do the things I currently enjoy.
 jon 10 Nov 2014
In reply to BazVee:

> If I go down the route of having surgery will I still be able to do the things I currently enjoy.

Yes, but you'll enjoy them more.
OP BazVee 10 Nov 2014
In reply to jon:

I'm concerned about how far I will be able to walk, will I be able to mountain bike (i.e. how robust is resurfacing), range of movement (any restrictions).

What's the basis of your response?
 Bob 10 Nov 2014
In reply to BazVee:

I had total hip replacement last year (actually almost a year to the week), I'm 55 so just a little older than yourself. I wasn't offered resurfacing as the hip joint was severely damaged. I wish I'd been offered it sooner as it's been a real transformation. I'm fairly sure that some on here have had resurfacing - I seem to remember a thread a while ago. Your GP should refer you to a hip specialist and she/he will recommend what's appropriate, like I said I wasn't offered resurfacing so can't compare the two.

Looking back at things I had trouble with or pain, I can see that it had been developing for at least ten years. A friend mentioned the other night that he didn't recognise me as he'd got so used to my gait which had altered to compensate for the disability. Probably the worst thing was my muscles beginning to realign themselves/work properly around the same time as the course of painkillers was coming to an end but this is still angoing process. I'd altered my gait so much that I was using my secondary/stabilising muscles rather than my primary ones for motion.

I was back on the turbo trainer within six weeks (it could have been sooner but my wife insisted I waited until I'd seen the surgeon) and on the road bike about a month later once the risk of frost/ice had receded. I'm quite comfortable with doing 100 mile road rides and have done 65 mile mountain bike rides so I'd say that you should have little to worry about on that score. I don't do gnarly DH type stuff but am quite comfortable on red routes at trail centres.
 Andy DB 10 Nov 2014
In reply to BazVee:

Speak to the surgeon. they know best the potential improvements and likely complications. My Dad had a fairly extensive hip replacement with extra metal work in his pelvis and was recover in 2-3 months and walking so much better than before.
 pneame 10 Nov 2014
In reply to BazVee:

A thread on knees - but it has stuff relevant to hips:
http://www.ukclimbing.com/forums/t.php?t=573761&v=1#bottom

And more on hips:
http://www.ukclimbing.com/forums/t.php?t=561653

Briefly - should be fine. At your age, if resurfacing is possible, that's likely the way to go. Replaced hips have a life of around 20 years and a second replacement doesn't usually go as well as the first. For all sorts of reasons.

Orthopedists regard hips and knees as their crowning glory, and justifiably so. The outcome is usually good. Quality of life is enormously better for a long time (depending on the age of the patient, obviously!).

Personally, I've always been a little skeptical about resurfacing as a short term fix. But that is exactly the point - if it doesn't go so well, you can always do a total hip. My knowledge about resurfacing is a bit dated (~8 years) as well - so don't let that put you off...

[I'm writing as a retired orthopedic researcher, not a surgeon or patient, although my right hip is not in good shape, so there is a bit of self interest]
 Bob 10 Nov 2014
In reply to pneame:

I had a titanium femur insert with a ceramic ball head and nylon acetabulum (the pelvis part). Apparently it means that the parts can be replaced individually, presumably the titanium tang/blade will last longest providing that the surrounding bone doesn't degrade.

To the OP:

Before the op I would walk with my head and eyes down watching every step even on smooth interior floors. Within three weeks of the op I was able to walk a couple of miles (with crutches obviously), this year I've been up Munros, been ticking off Wainwrights - walking isn't a problem
 jon 10 Nov 2014
In reply to BazVee:

> I'm concerned about how far I will be able to walk, will I be able to mountain bike (i.e. how robust is resurfacing), range of movement (any restrictions).

> What's the basis of your response?

The basis of my response is that I had a total hip replacement in November 2010. I'd initially been interested in having a resurfacing (and indeed started a thread on here asking various questions: http://www.ukclimbing.com/forums/t.php?t=412496 ) but I live in France and resurfacing here is definitely not popular among orthopaedic surgeons. I ended up having a 'double mobility' THR, the advantage of which is that it's almost impossible to dislocate. I don't have any reduction in range of movement, in fact I might have slightly more than before - that includes drawing my knee up to my chest. Recovery time was astonishingly rapid and return to climbing took a fraction of the time I was expecting. I'm now climbing harder than I was in the few years before the operation and have zero pain. I can't comment on mountain biking and running - Bob can - but I can walk easily as far as pre op.

You will benefit enormously from a hip replacement. It's important to have it done before you lose muscle - after all, your convalescence is 100% about the muscles (the hip doesn't need any running in). The hardest thing is actually making yourself do it if you can still function almost normally!

Have a read through the six threads that pop up when you search on here. Lots of interesting and useful advice.
 pneame 10 Nov 2014
In reply to Bob:

Impressive recovery - one advantage of surgery in Europe is that you are likely to get something that has a good track record. There have been issues with metal-on-metal (wear debris) and ceramic-on-ceramic (squeaking). In the US, there is a tendency for some surgeons to be pushed into using the latest tweak as these are more profitable for the device makers (and, coincidentally, the surgeons are often consultants for them!). My impression is that this is much rarer in Europe.

To the OP - if you do get a THR, definitely do your homework. You want a surgeon who does lots of them and a device that has a proven track record. I think the current thought is that anterior surgery (coming in from the front) results in much better recovery times, but the surgery is trickier.

To Jon: A good refresher course in anxiety pre-surgery!
 pneame 10 Nov 2014
In reply to BazVee:

Nice, not too dated, overview of the squeaking issue:
http://www.aaos.org/news/aaosnow/jun10/clinical6.asp
 Bob 10 Nov 2014
In reply to pneame:

Having had time on my hands here's my blog postings from the time http://bobwightman.blogspot.co.uk/search/label/hip%20replacement The scar is actually closer to 15cm not 25cm, I don't think I could look at it properly at the time.

Interesting about you saying about the surgeon - they do three a day at our local general, presumably he's quite practised by now.
 jon 10 Nov 2014
In reply to pneame:

> To Jon: A good refresher course in anxiety pre-surgery!

Too right!
 pneame 10 Nov 2014
In reply to Bob:

Amused at how the blog started - my rate-limiting point will be when I can't cut my toenails on the right. Then I will HAVE to get something done. So far I haven't even talked to my GP about this! Although her approach is usually "what do you want to do about it?" - she regards me as capable of making my own decisions for some reason.

I've just read a couple of interesting books by a general surgeon - he is much concerned about the wimpy sort of training that surgeons get these days (being allowed to sleep occasionally, for example) and whether this will turn out a bunch of people who don't have cat-like reflexes when something goes pear-shaped in the OR. Of course, he is of "a certain age" (i.e. 50s) where he got the hard training.

Young people these days... etc etc....
 jon 10 Nov 2014
In reply to Bob:

> Having had time on my hands here's my blog postings from the time

Jeez, Bob... no general anaesthetic? Out the next day? I wanted all the anaesthetic I could get. And certainly will again for the left hip which, judging by pain levels over the last few weeks, won't be long now. I can identify absolutely with 'I can't remember a time in my adult life when I have been as frightened.' Me neither.
 Bob 10 Nov 2014
In reply to jon:

The anaesthetist was very persuasive! Seems that current thinking/practice is to avoid general anaesthetic wherever possible as monitoring the patient is much more involved and the post-op recovery is much longer requiring constant attention. The anaesthetic that they did use on my lower half was very effective though and I genuinely felt nothing - a bit weird watching your legs being lifted and moved around without any sensation whatsoever.

The "get 'em out of hospital quick" mode seems to be partly freeing up beds (though the ward is ring-fenced for orthopaedic surgery) and getting you back in to your own environment which you are used to rather than having lots of ill people around you. Also mentally better I suppose.
 Chris_Mellor 10 Nov 2014
In reply to BazVee:

I have had both hips resurfaced in c2001 and 2003 and climb twice a week, thankful and very glad. Don't hesitate for a moment; the results should be outstanding. Check out the Yahoo! Surface hippy website/group - https://groups.yahoo.com/neo/groups/surfacehippy/info - it's a totally brilliant resource and full of helpful, encouraging and knowledgable people.

Best wishes
 Skol 10 Nov 2014
In reply to BazVee:
With total hips(postero lateral approach) there are dislocation risks that apply according to consultants for 16 weeks. In reality, this should be forever unless a large femoral head is used.( frequent dislocations include tying laces, twisting)
Resurfs are great if you are suitable. Minimal risk of dislocation.

Best speak to a consultant. You will need X-rays.
Another good approach, that some consultants use is DAA. Less invasive and less risk of dislocation in positions that you may need, such as cycling and tying laces.
OP BazVee 10 Nov 2014
In reply to BazVee:

many thanks for all the responses and links to other threads, Lots of interesting replies there and many things I can identify with. It seems that everyone I have heard from almost without exception has said if its causing that much grief get it done for the better. My mum had the same one done at 61 so I was always expecting this to hit me at sometime.

I've struggled with this for sometime, typically when climbing my right side has been stiffer and probably about 8 years ago, where it was at all possible, I started to swap my feet so that my left foot did all the high steps, I sort of gave up four years ago. It has come to the stage where I do a 3 mile walk and I am stiff & aching so much that I have to take painkillers, this and the inability to sleep comfortably has brought it all to a head

As suggested I will try and keep fit, I must get the rowing machine back out and perhaps return to doing some short one hour cycles.

Can anyone who has had this done tell me how soon after surgery I would be back driving and able to go to work, I am a self employed surveyor so I need to inspect commercial properties and I also do the school run which involves a short 5 minutes walk from the school to the village car park and back again.
 pneame 10 Nov 2014
In reply to Skol:

Isn't the DAA approach slowly displacing (sorry...) the posterior approach due to much better recovery times?

Which did you have Jon, Bob? I'm guessing front given that you both were out and leaping around quite quickly.

The anterior approach involves a lot less cutting of muscle although it is technically more demanding
 Skol 10 Nov 2014
In reply to pneame:

> Isn't the DAA approach slowly displacing (sorry...) the posterior approach due to much better recovery times?
We aim for 1 day post op discharge, although realistically it's second day, mainly due to intrathecal anaesthesia.
The major hip stabilisers are spared, and the dislocation risks more amenable to daily function.
Op times no different at our hospital.

 jon 10 Nov 2014
In reply to pneame:
Posterior but minimally invasive, only a 7cm scar. That said, the bruising afterwards was spectacular, one can only guess that the smaller the incision the more wrestling that has to be done. It'll be interesting to see if the surgeon still favours this approach... when the time comes!
Post edited at 21:09
 Bob 10 Nov 2014
In reply to BazVee:

I was having physio for several months before I got my GP sent me for an x-ray to check on any structural problems - the physio could not believe how stiff and inflexible my hip was. To give an indication of the level of pain, 20 months ago I slipped on ice and broke my ankle and walked around on it for three weeks before thinking that it wasn't just a sprain. The Fibula was properly displaced, not just a hairline fracture. That was in no way comparable to my hip which would have me in tears and nearly blacking out. I could just about tie my shoelaces on the right side; putting gaiters or overshoes on was nearly impossible; I couldn't stand on my right leg without holding on to something.

The main inhibitor to driving is insurance: often the insurance company will only let you drive again once the surgeon says it's OK; the surgeon will say it's up to the insurance company However, in my case I asked him at the six week post op appointment and his response was: "sit in the car in a car park with nothing around and slam on the brake with your foot, if it hurts don't drive, if it doesn't then you can drive". It didn't hurt (I had the right hip done BTW). I think I could have driven a week or two earlier if I'd had to. Walking was pretty soon after the op, in fact once I got going on the crutches in the hospital I'd be wandering around the ward for fifteen to twenty minutes at a time, this is within 24hrs of surgery.

pneame:

I had a lateral incision, the scar is about 15cm long, I can just span it by spreading the fingers of one hand, though rather cleverly (well novelly to me since I don't make a habit of having major surgery on a regular basis) is that the sutures were all subcutaneous so I don't have the Frankenstein stitched look. The location and size of scar is not too dissimilar to shot 2a here - http://www.orthopaedicsone.com/display/Cases/Use+of+Spare+Parts+in+Musculos...
 jepotherepo 11 Nov 2014
In reply to jon:

Have a look at http://www.rcoa.ac.uk/system/files/PI-ACHKR-COL-2014.pdf or http://www.rcoa.ac.uk/node/3324 for information on what we do and the risks.

A spinal anaesthetic can make you so comfortable you can watch a film on your ipad whilst the surgeon gets doing some DIY on the other side of a curtain but its not for everyone.
OP BazVee 11 Nov 2014
In reply to Bob:

Bob, well I start the physio next week, but I am not sure what it is likely to achieve, I think I sort of wanted it rather than surgery but reading all the posts it now seems I'd be better of biting the bullet and getting a replacement sooner rather than later. I also think the deterioration seems to have picked up speed although that might just be a mental issue.

I have had my hips Xrayed already, I had started to limp very badly especially after any exercise and after a mountain bike ride earlier this year one of my mates nagged me to go and see someone, as a result I went to see his chiropractor/sports injury specialist, it was him that wrote to my GP and said I needed an Xray. He also saw the Xray (as the hospital is across the road from his practice) after that he said you are in replacement territory and to give him some credit he said there's nothing else I can do for you. I then went to the GP who talked very briefly about replacement and resurfacing but it was very brief. Now armed with a bit more information I can perhaps get this moving in the right direction a little quicker.

I read a lot of similarities between where you were and I am, aching nagging hip for a lot of the time, on my right side I struggle to tie my shoe, put my sock on and cut my toe nails, it was your blog that I read where you said about your knee muscles I seem to have that as well. I'm also starting to drink a brandy or something else every night just to take the edge off it (although I did manage sober three weeks of october).

I used to think I was a fit young rock climber and mountaineer, over the last six months I have turned into an old bloke with a bad limp.

Thanks for all yours and everyone else's advice. By the way when you are going to have something done on the NHS how much choice is there when it comes to which surgeon does it?

Barry




 Skol 11 Nov 2014
In reply to BazVee:
You need to play the 'loss of function, inability to earn, high level of pain' card.
The best money(£200 ish)you can spend is to pay privately for assessment by the consultant of your choice, and say you need it done on the NHS.( God Bless It).
 Darron 12 Nov 2014
In reply to jepotherepo:

Someone I know had a spinal anesthetic and was listening to her walkman whilst the op was going on. She suddenly started giggling and the anesthetist asked why. She had realised she was listening to the Saw Doctors (an Irish band) whilst they were hack sawing away at her hip

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