Is there ever a right time for surgery?

dcdavies

Hi,

I am 38 years old and was diagnosed 2 years ago with OA in both hip joints although for the last 10 years I have consistently had right knee and lower back problems which are likely connected. My right hip is pretty much sore all the time now and particularly bad after any exercise. This is a fairly major issue to me seeing that I am very sporty and enjoy being active. I was on arthrotech which really helped (and to an extent still does) however my stomach is really not coping with it anymore and I have some of the more rare symptoms such as lethargy, mood swings, etc. So I have come off it and I am struggling. My consultant feels it is time for a total hip replacement and I am finding it difficult to come to terms with this. Part of me feels I should just get this done so that I can get back to some level of normality and that by putting this off I am maybe gaining 2yrs at most, but part of me feels I should stick it out until I cant walk anymore. At the moment I am on a waiting list for the operation which could occur within the next 8 weeks unless I pull out.

The long and short of it is that I feel utterly lost and confused as to what to do. On top of that my recent consultation revealed that I likely have OA in my hands, feet other joints.

Does anyone have similar experience and let me know how they coped/came to a decision on what to do/decided when the right time for surgery was?

Thanks


David.

dreamdaisy

I don't think there is such a thing as the right time but I know there is the wrong one. Speaking as someone who has had to wait three years for two knees (because aged 52 I was three years too young) and is now struggling with OA in both ankles and both hips thanks to the delay (and is honestly wondering if it's worth having done) I say go for it and go for it now. It's best not to leave things too late because that will make recovery harder, you've been offered the chance to improve matters (and hopefully slow damage to other leg joints) so take a deep breath and take the plunge. I wish you well. DD

barbara12

Hello David and welcome to the forum
I have had one THR and the other wants doing, but at 64 I am a lot older... :shock: ..it took me 3 years to make my mind up to get the first one out the way,I saw a lovely consultant and his words were you don't want it to get to the point were you don't have quality of life...
It must be hard being so young and having to deal with this, I do think the pain will help make up your mind,but its never easy even with the pain...no one wants to go through surgery if they can help it..any questions ask away...mine is now 12 months old...

rayray

Hi David,

I had a THR in my forties but wished I had had it done ten years earlier. Have you been told why you have arthritis in your hips? I was told that in younger people there is usually a reason why the hip becomes arthritic. I had hip deformities in both hips which triggered the arthritis - I didn't know I had hip issues until my early forties although I had terrible lower back pain for twenty years before the THR - it went post THR. I had one THR but the other hip was treated in 2010 with an arthroscopy which has delayed the need for a THR.
It may be worth asking to see a hip specialist who specialises in hip problems in younger people. I saw [XXXXXXXX] in Truro (was referred to The Duchy Hospital on the NHS) and he was amazing.

If you decide to go for the THR then you will find that your life is transformed. I was in terrible pain every time I moved my hip - overnight it went and I feel that this hip would allow me to walk as far as I want. It really is a miracle. I would also say that if I had been given the chance to get it replaced before I spent two years on crutches in total misery I would have gone for it.

text edited by Mod YEH. Cannot name Dr's or health professionals

stickywicket

The right time for surgery? Well, when I had my first two TKRs it was because I just couldn't cope with the demands of motherhood. I jumped at the offer. I had my first THR when my left hip broke and the other one when I found I couldn't stand. I had one TKR replaced when the surgeon decided it'd best be asap. So, all no-brainers for me but then I have RA in most joints so I'm always playing catch-up

I'm amazed you're feeling able to wonder about the op as many people on here would give their eye teeth for a new joint but have to wait. Clearly you feel your pain is not unbearable. Maybe all the exercise you've done have helped there.

However, surgeons don't normally offer them when they feel they're not essential – well, NHS ones don't. Might this be a case of the pre-op wobbles?

Have you been given info on what you can and can't do post-op? I don't know which sports you are into but some might not be possible. This is info put out by the NW London NHS :

It is also possible to participate in recreational walking, swimming, golf, driving, light hiking, cycling and ballroom dancing. Activities not suitable include jogging or running, contact sports, jumping sports and high impact aerobics. The reasons for this are that the hip replacement will wear out more quickly or an injury involving the replacement may be difficult to treat.

http://www.nwlh.nhs.uk/services/Resources/20_HIP_-_FINAL_VERSION2.pdf

dcdavies

Hi and sorry for my slow response,

Thank you so much for the replies It is good to hear that there are positive thoughts regarding the THR.

In answer to some of your queries:

I saw one consultant approx 2 yrs ago who didn't even want to consider surgery. His opinion was to take painkillers until i couldn't take anymore. HOWEVER he did then refer me to a consultant who specialises in younger people. He took one look at my x-rays and offered surgery if I felt I was ready for it. At the time I wasn't. I did ask him why I had OA in both hips and he told me it was likely genetic as i have it developing in my fingers/toes and lower back.

My pain varies and it can really depend greatly on what I have been doing and affects my back/knee/hip. If I have been active it can easily stop me doing daily things incl. sleeping. I can however have good spells where I only have minor pain & stiffness and I almost feel normal and I try to convince myself I don't need surgery. I was over ambitious yesterday and went for a long walk with friends and have all of last night and today in agony.

NSAIDs do seem to help the pain and reduce the periods of pain I am in. However they are really affecting my stomach so much so my doctor is trying to urge me to go down the surgical route. I have recently been taken off arthrotec and put on Naproxen (might be spelt wrong!). I am however concerned what long term effects these are having on me. Some of the side effects seem pretty nasty!

Regarding activities post-op, I was given info on what I cant do. Really the only one really highlighted was running which is a shame as that was one of my favorite past-times. However I cant run now anyway!

So i guess my decision is have the surgery and hopefully all my hip/knee/back pain is gone, or continue trying to manage it for another year, two years or how ever long I can last. However that said, I don't want to leave it so long that my quality of life is completely diminished and / or I damage my other joints. I also have a 3yr old girl who is noticing daddy is in pain and cant always play. Also, I am sure that the consultant would not be offering me this solution if my joint was not that bad....

I just keep fluctuating from one decision to the next.

David

dreamdaisy

I hope you are also taking a stomach protector such as omeprazole or lanzaparole with the naproxen, that is very important. If not please see your GP asap and ask for one or the other.

There is no right time as such, although I can understand your reluctance to have surgery when you feel as though things can be managed. The truth is that they can't and other joints may well become affected. Any form of arthritis is degenerative and progressive but for you surgery may halt that in its tracks. I no longer have better days and in the three years I've spent waiting for new knees (I had to be 55 which I am now) both my hips and ankles have gone for an arthritic burton. I still say go for it because you have very little to lose and maybe a great deal to gain - but that gain will take time. DD

stickywicket

You really are finding this difficult, aren't you? Mind you, with two different specialist opinions I'm not surprised. I wonder why the one specialising in younger patients was happy to do it while the other wasn't :? Maybe he just has a shorter list.

I'd guess you've kept your knee in as good a nick as possible by doing the the things you advocated to SirLimpalot. This is maybe why the joint has deteriorated but the pain is, to some extent, tolerable.

If you look after a prosthesis it will last a long time. I have a 33 yr old TKR but I exercise it daily and don't do stupid, heavy duty stuff with it partly because none of my other joints will allow it and partly because it's now well and truly knackered

The way I saw things when told, aged 35, I needed two new knees was that my ability to care for my two young sons was deteriorating alarmingly and impacting on everyone. Despite RA in most other joints I opted to try to sort out those two. I reasoned that, if they wore out by the time I was 50 so what? My sons would be adults by then and my needs less. I've never regretted my decision though, at 68, I no longer see my useful life as being entirely over and done with

dcdavies

Thanks for the replies.

Yup, I am finding this very difficult and as you say, very confusing as I have two specialists giving me completely different advice.

wrt the Naproxen, I am also taking lanzoprasol twice a day. Although I think my stomach has been damaged from 2 years on Arthrotec because the slightest thing gives me indigestion/heartburn regardless. until recently i had never experienced indigestion/heartburn! The drug does seem to manage the pain with regards to recovery period (i.e. excessive pain to manageable pain).

It looks like I may have to come off the Naproxen. Today I have been feeling light headed, dizzy, upset stomach and ringing in my ears. i am just waiting for a call from my doctor to discuss.....

Thanks again,

David.

dreamdaisy

I have tinnitus thanks to twelve years of sulphasalazine so I can empathise with that; it's not pleasant. Arthrotec is another name for diclofenac, yes? That too is an anti-inflammatory, were you also taking the stomach protector too?

One thing to remember: they may be the 'specialists' but are they living with your trouble? Docs deal with theory, we with the reality. DD

stickywicket

I hope your doc was able to help. Like many other meds NSAIDS can vary in how they help and how they hinder individuals.

dcdavies

Hi!

The doctor has prescribed me Gabapentin 300mg which seems to be a drug originally developed for epilepsy and i think is based on blocking the pain as opposed to getting rid of the inflammation (which i thought was important?). The list of very common and common side effects is huge and not very nice.

I'm not keen on the idea of this drug and probably wont take it. Does anyone have any experience of it?

Thanks,


Dave

PS I tried the naproxen again today and the side effects are worse.

dreamdaisy

Quite a few on here take gabapentin (amitryptiline and pregabalin are other options) but it's not a route I have explored because I am on a shed-load of other junk for my PsA. Many meds are cross-overs i.e. they are used to treat a range of conditions in a variety of doses; one of my more interesting ones was a drug designed to prevent rejection after a transplant and I grew hair all over my body. My approach to new meds is this: read the side-effects leaflet once then put it away. The only things they don't list on them is growing a second head or one or more limbs turning into Battenburg colours - the manufacturers have a legal duty of care to warn about what might happen so they cannot be sued.

Unlike you I have a lifetime of entertaining doctors and challenging their knowledge so I have no fear of any medication because what matters is the quality of my life now (such as it is with around forty affected joints and not being able to do that much any more). Get that hip of yours sorted and your life will be a damn sight better in terms of pain and being able to do things - and you may not need the gabapentin. DD

stickywicket

dcdavies wrote:

Does anyone have any experience of it?

I think you'll need to start a new thread, Dave, to get many replies on that. Quite a few on her do take it though not me. If you enter it in the little pink search engine at the top of the page a few old threads come up.

It seems to me you're now entering a situation where either you have the joint replacement you don't particularly want or you take the meds you don't particularly want. I know which I'd opt for