50yrs - Hip OA - too fit for surgery?

OliverT

Hi there, I'm prompted to join this forum in the hope of having some understanding ears to whinge to!

50 yrs old, but looking younger, cycling every day, eating mostly (ish) an alkalising type diet, and taking no meds. Been in pain for the last 10 years or so I guess, quite major loss of cartilage and bone loss, spurs etc. Been excercising on and off for the last few years, but found it hard to keep up.
LAst Easter I suffered a major 'thing' and was immobile for 3 days, unable to sit or bend at the hip at all. Wound up on morphine and valium for a week, and been recovering from that and gaining strength ever since.

As a result of the increased pain and (perceived?) suffering I decided that this year I needed to get the hip replaced, and having an appt with osteo consultant lined up (yearly for past 4 years) I announced that I'd had enough and it was time. It's quite a mental and emotional leap to elect to have ones body chopped up and this was no little thing for me.

Short story long, but the chap I saw (consultant's registrar) was utterly keen to convince me that I am too fit for a hip replacement, and that I should suffer on for another while until I am far more broken.

Now he could be right, but the idea of living through my 50's with this is not a happy or pleasing thought and brought on a good solid depression which I am now dealing with on top of the chronic pain - win win then.

So...this is fun. I used to be uber fit, cycled 300 miles a week and disco-danced another 300 miles, now I cant walk more than a mile (and that's once in a blue moon) much less go for a walk in the woods to see the leaves turn brown or sprout anew. The idea of being stuck to the paved world is depressing beyond words and I'm now throwing every energy into physio and working to improve my fitness so as to prove this registrar right! Hopefully the by-product will be less pain and more mobility, but if you've read this far, you will know how exhausted I am by it. That's almost the hardest thing - the sense of having no extra energy for enthusiasm or excitement, the 2 words I used to have through me like a seaside location through a stick of rock.

Phew - well, there's more to me than that, but I thought I'd set out my apple cart.

Sorry for ranting, but I'm going to use this place for just that, catharsis and all! My partner doesnt need to hear it that's for sure!

Cheers!

ITLSusan

HI Oliver,

Getting rid of pain would help you to feel a LOT better. I've had a couple of types of pain - both of which I was able to get under control.

The first was trigger points. That can cause anything from DOMS like soreness to severe and excruciating pain. It's often mistaken for joint pain. It's also very easily managed - as in eliminated - through self massage.

Hip OA might make you prone to nerve pain. The muscles supporting the pelvis become weak and over-stretched and this can put strain on the sciatic nerve. In my case I used to be OK during the day but at rest or during sleep I'd get terrible pain. The pain would sometimes be deep in my glutes (like bad toothache) - other times it would run all down my leg to my foot. It wasn't true sciatic pain - initially it wasn't constant. And it varied where I felt it - sometimes hip, sometimes foot, sometimes knee, sometimes all of them! Over time it got worse and I ended up with 6 months of 24/7 pain. I was on every drug known to man and nothing even touched the pain. The doctors said I just had to learn to live with it. No one had a clue why I had the pain and no one could help. Yet that too was sorted out completely.

If either of those pain patterns fit then I can tell you more.

I totally get how you feel about loss of an active life. If your life has always involved being fit and active it's not something you easily give up. Things may well look a lot less bleak if you can get some respite from the pain. It's hard to see a way forward when you're constantly hurting.

stickywicket

Hello. Welcome to the forum and please don't apologise, OliverT. We all get (in every sense :roll: ) chronic pain on here. We understand how frustrating and debilitating it is and how we want to spare our family and friends from fully participating in it

Coming from a very fit background will make it all more of a challenge for you. I've had RA since I was 15 (over 50 years). I've always done my best to keep as fit as possible and I exercise daily but this is a far cry from your experiences.

I have two hip and two knee replacements. All very successful. Your fitness levels will stand you in good stead for the recovery from such an op. However, it's true that it can be hard to get replacements if you're 'young' and 50s is regarded as young. I think the main aim is to avoid further replacements later as these are a much longer op with ongoing risks of infection. Having said that, I've had a replacement knee replaced. It's known as a 'revision'. The original TKR lasted 27 years and the revision, despite being a very long implant requiring bone grafts, has never given me a moment's trouble in 5-6 years.

I'm wondering what your usual surgeon's views were on your hip. Did he ever suggest a replacement? Sometimes registrars are more inclined to go strictly by the guidelines whereas the men in charge are more flexible. (No pun intended ) I guess you could have asked the registrar to check things out with his boss but hindsight is always 20/20 vision.

When in doubt on such stuff I go and have a natter with my GPs. They are brilliant at explaining and understanding and yours would be able to advise on whether or not they considered it worth you asking to see the orthopaedic guy again – but this time the head honcho.

Doing your best to prove the registrar right is a good attitude but bear in mind that overdoing things will be as bad as 'underdoing' them. I can't walk far at all (My feet are rubbish and the other - 34 yr old TKR - is now giving up the ghost) so, for country walks with the family, I use a wheelchair – walk a bit and ride a bit. Being used to high fitness levels you will probably balk at the idea of a wheelchair but what about a scooter? Some of them look fun. And, with good planning, there are some lovely country walks around.

As a footnote, we all try not to whinge daily to those around us and that is one of the strengths of this forum that we can whinge away here to the – reluctantly – initiated. However, we must keep a balance between not overburdening them and not making them feel shut out completely. It's a tricky one. I'm still learning

dreamdaisy

Hello, I have read your post and truly cannot understand your view point. To be rendered immobile for three days must have been horrifying for you, gym bunny that you are, but what's three days in the greater scheme of things? Yup, I speak as a practiced and seasoned arthritic, I have one of the auto-immune types and that has led to OA in a number of useful joints. I recall the bad old days of one affected joint with some affection because its now around forty. Now I'm not sure what constitutes a good day arthritis-wise but I have not resorted to valium and only used morphine post-operatively.

I hope you find the forum to be of interest but I'm not sure if we can help. We are used to people being refused operations on the grounds of youth or other troubles. not because they were too fit. You buck the trend! DD

ITLSusan

DreamDaisy might not be able to help but I can! I know EXACTLY where you are coming from. As do very many others. Typically we're driven out of support forums for not being deemed to be in enough pain. But I know only too well that just because you're strong and you're a fighter doesn't mean you don't need a bit of support sometimes. You can count on me

I'm also putting up a HUGE fight to get the researchers etc to start giving a little consideration to those that are able to help themselves. We're willing and able to do what it takes to avoid becoming a strain on the health system. If they'd just provide a tiny bit of support and do a bit of research it could save the NHS a small fortune in the long run.

OliverT

Thanks for the greets, I understand that many readers here are here for the sense of shared experience and communities form from that, and I'm aware that my situation will be different than many others here.

I didn't say I was a gym bunny, and not too sure whether to take offence at the use of the term, I'm more of your racing-snake variety than the muscle-mary type though so no offence taken.

I'm not here expecting help as such, more seeking some understanding folks as I dare say there must be some shared experiences between us, no matter how alien mine might seem to yours. As for the valium and morphine - if you ever find yourself unable to sit, perch or in any other way hover on or over a toilet for 3 to 4 days and are then forced to defecate into your own hand (a latex gloved hand) then you may find yourself reaching for them, as the valium is a very powerful muscle relaxant. Doc said he'd only give me 7 tabs as they're a bit more-ish, and they are! So instead of being terrified as suggested I was actually in bliss most of the time.

stickywicket

Oliver, everyone's situation is different. We are all individuals. We don't really even share the same disease(s) as 'arthritis' is an umbrella term. The meds, for those of us with autoimmune versions, are broadly the same but the diseases differ quite widely.

We share the common denominator of pain and so we try to support each other as we all understand how it isolates and alienates. We each go, alone, through our own personal trials and tribulations (many of which are lavatorial ) but at least here we can attempt to empathise or at least sympathise.

I would dispute ITLSusan's claim that she knows 'EXACTLY where you are coming from' as I doubt anyone can say that of anyone else. I hope no-one feels driven from this forum for 'not being deemed to be in enough pain'. Indeed, many of us regulars wish that those in less pain, or who have regained a better quality of life by surgery, would stick around more to support others like them and give a different perspective. There is room for a wide variety of opinions and, hopefully, they can be voiced amicably.

frogmorton

Hello Oliver

and welcome to the forums from me too

I am sorry to hear that you are suffering with OA in your hip Must have felt a bit of a downer to find that, after 4 years of seeing an orthopod, when you finally felt ready for your replacement they say you are too young

We understand that on here too well. Some are made to wait due to their age and some have to loose weight first.

I can imagine the 'fun' you had when you were incapacitated for those 3 days. In the years prior to my back surgery I had regular periods like this (being female too not just an issue for number 2s ). I think my back did this to me for around 20 years before 'they' agreed to operate. I am sure meds like valium could be very addictive.

The idea of exercising to try to help yourself is a really good one for two reasons; firstly it might help now to extend the time before you have surgery. Secondly it is really good to be as fit as possible before surgery for post op recovery.

The forums are a great place to come to have a moan - we all do it at times so feel free - as well as to meet other people in a similar position and swap tips. It does relieve our families from some of our 'moans' yes!

If you take a look on the chit chat forum it can be a useful distraction from pain

Take care

Toni xx

OliverT

Thanks Toni - in the middle of it I could walk and sleep, but just couldn't bend in the middle. A most bizarre experience at the time, though if it were to happen more regularly I guess that bizarreness might wear off - to those experiencing it more regularly, I salute you!

I imagine no1 can always be dealt with with a bottle of some sort (as a diver I know of the very fantastic She-Wee - probably you all know of it too) but yes, No2 takes a certain adjustment of personal barriers. You certainly find out a few things about yourself when you cannot sit, and tbh that was a complete surprise - walk into the WC and it's "ah - no! er....think....er....oh god think of something!!"

I find humour to be a godsend, always have. Having had a rather depressing childhood I learnt early on the value of finding humour in the oddest of places - and this serves me in good stead today, though it can be a bit much for some people. My initials are OT, though it has been suggested they should be OTT, so apologies in advance!

frogmorton

OliverT wrote:

Thanks Toni -
I find humour to be a godsend, always have. Having had a rather depressing childhood I learnt early on the value of finding humour in the oddest of places - and this serves me in good stead today, though it can be a bit much for some people. My initials are OT, though it has been suggested they should be OTT, so apologies in advance!

Humour is the very best medicine there is in my opinion a really good belly-laugh is often all I need to set me right even on a bad day

OT eh? Occupational Therapist!!

Get yourself over to chit-chat and join in

Toni xx

TrishaW

Hi oliver,

Whilst my hips are not my main problem, i do have 2 very close friends who have had hip replacements, and maybe their stories will reassure you.

One is a man who used to be a judo expert in his youth, as well as a general all-round sportsman. He basically damaged his hips through the judo, and had them both replaced in his early 50s. He's now 69, looks 55, is incredibly active (just dug a lake in his garden!) and pain free.

My other friend is an esteemed hospital consultant aged 40. She also looks young, lively and is very active. She had an inherited condition where her hips didn't form properly so by her 30s was in lots of pain. She had a hip replacement aged 38. She had a few problems afterwards and later had it re-done age 39 (not sure of the details) but since then has been fine. She just cycled from Sussex to Paris for charity and rides her bike to work each day.

I hope this will be reassuring. Also with my 'nurses' hat on, try and get as healthy as possible pre-op (good nutrition, good muscle strength as your condition allows, no smoking etc etc). Then get a great physiotherapist post op and follow their advice.

Good luck and let us know how you get on

Trisha

OliverT

Thanks Trisha - your post reiterates the dilemma I face with my hip.

Do I insist on getting it done soon, and potentially have a pain-free and active 50's early 60's? Or get and stay as fit and strong as I can be in order to stave of the first replacement, and thus the very likely 2nd and possibly 3rd.

It's a brave person that elects it at an early age because of the likelihood of needing revisions down the line, so I taske my hat off to your Judo chum. I'm another young looking 50 - people kind of assume I'm 43 or something - and folks like us have a good chance of living to quite some old age, and will no doubt really need those 2nd and 3rd revisions, so I wonder what was the thing that convinced him to make it happen when he did. I'd very much appreciate if I could be put in touch with him as I have some decisions to make and will appreciate all possible input. If not then no bother, and thanks again for relating.

I'm getting stronger by the week - and if anything more sore as a result of it. Once I'm strong enough (I reckon 3 months is reasonable) I'll then have the work on learning the balance of just how much I can work the joint itself without wearing it out completely! Ooh I cant wait!

On a different front, I was out at 3am this morning photographing the moon and generally appreciating the Thames at night. I'll be out again this morning but will remember to take a hot pocket and a flask of tea! Beautiful night but coooold......

TrishaW

Hi oliver,

As my friend has now had his hip for about 20 years with no problems i don't think he even thinks about having to have it done again.

I think he presumes it's for life...certainly he's had no problems with it.

I would have put you in touch but his wife is very ill at the moment so it's not an appropriate time.

In general I would say that if a new hip will keep you fit and healthy (and reduce pain) and improve your quality of life then it's probably the best thing to do.

Maybe get a second opinion to reassure you? And check the crudentials of your surgeon /their long term results and the type of implant used and it's efficacy?

Good luck!

Trisha

ITLSusan

My personal evaluation on this would be as follows:

1. Is there any hope of restoring function in your own hip? If so then pursue that relentlessly before considering surgery. A pain free hip with good function is better than a fake one.

2. Is quality of life suffering? Is it possible that other joints are being damaged due to the movement impairments and muscle imbalances caused by this hip? If so then you could cause damage elsewhere in your body by waiting. Hips can be replaced - spines can't!

The more unfit you get the lower your chances of getting back to full fitness after surgery.

With an aging population it's likely surgery won't be on offer for ever - the number of working people for each pensioner is going to almost half over the next 20 years. If you think you definitely need it then get in sooner rather than later! BUT also consider that revision surgery might not be available on the NHS in the future.

3. How certain is it that surgery will resolve symptoms? It doesn't always. If the joint isn't the root cause of the problem then replacing the joint won't give good results. I believe research has indicated that success rate is higher in the worst cases of OA. More moderate cases have lower success rate. This *perhaps* indicates that the cases where the problem truly is down to a damaged joint will produce the most severe symptoms. Most cases caused by other issues - such as muscle imbalance - don't get quite bad enough to need surgery. It's worth seeing if this is factoring into the surgeons advise NOT to have surgery.

My dad developed hip OA at age 30 (Congenital defect). By 55 he'd had both hips replaced. Both were redone during his life and one needed a third revision surgery - that wasn't possible so they simply left him without a hip on that side. He managed fine - muscle adapted to support the gap and he led a fairly active life like that for 15 years. He had no pain from that hip (obviously!).

SJ66

Hi Oliver, I'm new to the forum too & have OA in both hips.
I would urge you to get a 2nd opinion as your young age suggests that the OA is a result of other injury or condition & if this IS the case, PT won't do you any favours.

If it hasn't already been mentioned or considered, look up Femoral Acetabular Impingement (FAI for short).

My 1st surgeon 2 yrs ago went from saying he would be happy to replace my hip (I was just 47) then within 4mths he changed his mind & said I was too young. At that point I was in constant pain but still fairly active - tap dancing & cycling. I had a cortisone injection direct into the joint last Feb & this gave me almost 3mths pain-free. Incidentally, the PT I 1st saw before any referrals suspected the FAI as she could only get so far manipulating my joint before 'something' stuck and any exercises I tried to maintain flexibility just caused me further pain. Even when I had the injection (it's done under X-ray) the Dr said he could see some lipping that suggested FAI. So, I went back to my surgeon who completely dismissed the FAI and said I had OA (he did concede that it may have been caused by undiagnosed FAI) & I had to 'put up with it' until I got past 50 before he would consider THR.

So, I looked up an FAI specialist in my area & my GP sent me for a 2nd opinion. He immediately confirmed the FAI but as the OA is now so advanced, the only option is THR & he will put me on the list as soon as I want. Due to my work situation I can't consider it until later this year (I'm not 50 until December & also don't look my age so am sooo tired of being told 'ooh, you're a bit young to have arthritis!')

Anyway, I digress... the upshot is that if it is FAI that has caused the onset of OA, no amount of exercise & PT will improve things for you - the FAI causes tears in the labrum & this adds to the joint pain of the OA. Once OA has set in, the FAI can't be treated (if it is caught earlier then arthroscopic surgery can be done).

I am now at the stage where I can't dance, get on a bike (let alone ride it..) my husband has to put shoes & socks on for me most days, I can't bend down to pick anything up off the floor & lying on either side at night causes my hips to lock painfully. If I need to walk further than around the house or from the door to the car, I have to use crutches as my hip gives way & I can't bear any weight without continuous catching & groin pain. I just wish I'd sought help 20+ years ago when I'd dismissed the occasional 'catching' & pinching pains in my groin as mere pulled muscles from dancing - those pains are now constant every day & one of the main symptoms of FAI.
Good luck & sorry for the essay...