Is 33 too young for THR?

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Alison82
Alison82 Member Posts: 4
edited 18. May 2016, 09:52 in Living with Arthritis archive
Just joined the forum and after some advice with OA in hip...

I know that my condition isn't nearly as bad as most people on here, but I've been offered a THR and am interested in others' opinions.

I'm 33 and have been struggling with right hip pain for nearly 3 years. I've always been very active, doing lots of sailing, skiing and numerous 1000 mile-plus cycle tours, but recently find myself doing very little, although paradoxically one of the worst activities is sitting still! After many appointments & referrals, I've been told there's nothing wrong / it's a labral tear / it's FAI / Coxa Profunda Protrusio (?) / and finally, Medial Pole OA with reduced joint space at the back. I'm guessing this is the reason why sitting/lying are so uncomfortable?

At a previous appointment I was told by specialist that there's nothing that could be done until I'm old enough for THR, but was then referred to his colleague who yesterday said he would go ahead with it. He seemed very confident that it's not that rare at my age and that modern materials will last long enough.

Luckily I don't suffer from too much stiffness so can still do some gentle activity, I just find the pain afterwards excruciating. Recently I tried taking up kayaking as I thought this would have less impact, but the pain afterwards meant I couldn't sleep for 2 nights. I teach 4/5 year olds so usually don't have time to think about pain during the day, but evenings and nights are worst - and after several sleepless nights I become a very grumpy teacher.

I've been taking ibuprofen, along with paracetamol during the day and Cocodamol/Solpadol at night. Added to anti-gastric upset, anti-depressants, anti-anxiety, Glucosamine....feels like half a pharmacy each day.

Though I've begun to deal with the depression, I still feel that my life has been on hold (currently single and have found the pain to be a barrier to relationships). I've been offered a solution which sounds like a great fix, but is it 'Buy Now, Pay Later'?

So, do I jump at the chance to be pain free and get on with my life now? Or do I delay, try stronger/different painkillers and keep plodding along?

Your thoughts are appreciated
A

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  • [Deleted User]
    [Deleted User] Posts: 3,635
    edited 30. Nov -1, 00:00
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    Welcome to Arthritis Care Forums Alison82 from the moderation team

    As mods we are here to help with any problems you may have on the message boards.

    There are lots of lovely people here with a wide range of experiences with arthritis and the problems of living with the condition. Just join in wherever you like you will be made very welcome.

    I look forward to seeing you posting on the boards.

    Best wishes

    Mod John
  • frogmorton
    frogmorton Member Posts: 29,618
    edited 30. Nov -1, 00:00
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    Welcome to the forums from me too Alison :)

    I am very pleased to meet you. Sorry about your poor hip though :?

    I don't think 33 is too young for a hip replacement if that is what your consultant recommends and you want it too.

    My own daughter has avascular necrosis of her left femoral head, (thigh- bone and Rt shoulder too) - due to treatment for leukaemia - she is 18 and having a core decompression this summer - there is every likelihood that she will need a THR sooner rather than later.

    If she asks my opinion I would think she ought to go ahead as life is for living as much as possible and I would hate for it to stop her enjoying her life to the full.

    There are a good few people who use this forum whose hip replacements have lasted over 20 years so far so...

    At the end of the day it is very much a personal decision Alison, but do let us know what you decide to do. Everyone here is so nice and supportive we will be here for you every step of the way.

    Love

    Toni xxx
  • stickywicket
    stickywicket Member Posts: 27,730
    edited 30. Nov -1, 00:00
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    Hello Alison and welcome from me, too.

    I can see your dilemma. I have R.A. And have had it since I was 15. By the time I was 35, with two small boys, my knees were shot to bits and I was given new ones. I was told they only lasted 15 years or so but, for me, it was a no-brainer as my kids needed me there and then. With care, they lasted much longer than 15 years. One was replaced after 27 and I still have the other (albeit in a very rubbish state) but I should emphasise I have used them sparingly. (Definitely no skiing :wink: ) The RA everywhere else means I was never able to do things that might shorten their lives but I have always exercised to keep them in good nick.

    A revision operation (a replacement of a replacement) is a bigger op than a straight joint replacement. There is more can go wrong and there are ongoing risks of infection.

    What would worry me in your situation is that there seems to be little agreement over the actual problem - 'nothing wrong / it's a labral tear / it's FAI / Coxa Profunda Protrusio (?) / and finally, Medial Pole OA with reduced joint space at the back'. Is a THR the answer to all the potential problems? Or could you get a new hip only to find the problems are ongoing? I know I'd want to be sure of that before going in for any joint replacement. I'd also, in your case, want to know which physical activities I could resume afterwards.

    Generally speaking, on here, those who have only had OA in one, or two, joints and are well-motivated to get back to an active life, do very well. I'm pretty sure skiing and running would be out (Basically, anything twisty) but cycling and swimming are good as is walking.

    We can't say if a THR will solve your problems or how long it will last. You can, however, check your surgeon's profile on http://njrsurgeonhospitalprofile.org.uk/ That might tell you whether or not to trust his judgement.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • Alison82
    Alison82 Member Posts: 4
    edited 30. Nov -1, 00:00
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    Thanks for the quick responses and warm welcomes.

    My mum has had RA since her early twenties so I know only too well how debilitating it can be. She put off getting any replacements for as long as possible (into her 50s) but now has new knees, shoulder, ankle and knuckles. While still severely restricted, at least she can negotiate stairs normally and without nearly as much pain.

    Both surgeons now agree that it is definitely OA (the list was of all the previous suggestions) but is not that obvious on the x-ray, although apparently this doesn't necessarily relate to the amount of pain. There is a small chance that a THR won't relieve the pain, but the surgeon yesterday seemed fairly confident that it would.

    I guess I need to listen to the two surgeons - one who says go for it, while the other says wait - and make my own decision. I'm definitely very tempted and willing to take a risk, just want to be sure that all options have been explored.

    I know that I'll never be able to do all the things I did before, but currently I'd take any small improvement - there's a lot more life to be lived!

    Alison
  • Alison82
    Alison82 Member Posts: 4
    edited 30. Nov -1, 00:00
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    You can, however, check your surgeon's profile on http://njrsurgeonhospitalprofile.org.uk/ That might tell you whether or not to trust his judgement.

    Does anyone know if there is a similar list for Scotland? I've done a quick search but can't find anything.
    Thanks
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    I was refused new knees aged 53 and now, four years on, other joints are far worse (I am blessed with an auto-immune arthritis which began when I was 37 and the damage that caused has led to OA in some useful joints including my hips). My advice is carpe diem, seize the day. A new hip could stop the other deteriorating and that, believe me, is a good thing.

    Totally apropos of nothing my cousin's wife had her first knee replacement when she was eighteen but that was due to cancer. Age should not be a factor and you are lucky in that this consultant is able to see beyond your youth. I wish you well. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • daffy2
    daffy2 Member Posts: 1,636
    edited 30. Nov -1, 00:00
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    Welcome Alison, I'm sorry you are having to face this at such a relatively young age. The decision about whether to go ahead is a very personal one, once you feel you have enough information. As regards the age issue you might want to look at the current NICE guidelines(ref.CG177 ).
  • barbara12
    barbara12 Member Posts: 21,281
    edited 30. Nov -1, 00:00
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    Hello Alison and welcome to the forum
    I really do feel for you being so young and having to make these decisions...hips are very complicated..and the pain can come for a num of places..I have just had my second THR..and it has gone well and so did the first, but I was still in lots of pain around the hip coming form my back, I was warned that this could be the case even though the MRIs showed bone on bone for my hips..so you make sure you ask lots of questions..
    Love
    Barbara
  • rayray
    rayray Member Posts: 115
    edited 30. Nov -1, 00:00
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    Hi Alison,

    I have had the same situation as you - almost identical. Had years of hip problems from my mid twenties until I was finally completely disabled by them in my early forties. I had the diagnosis of profound CAM and Pincer FAI with severe labral tears and everything else that went with it. I think it was basically hips that were congenitally malformed and weren't going to get better on their own. Sitting became impossible and when they got into the hips all the arthritic damage was on the back of the hips.
    I started with an open debridement on one hip as that was all that was available at the time. I then had the screws removed, an arthroscopy and finally a THR on the same hip, all in two years. The surgeon said in the end that the hip was just so misshapen and I kept getting so much inflammation in and around it that it had to be replaced. I was told it should last about 25 years.
    My other hip was simpler. Although I had a nasty labral tear and profound FAI the surgeon did reshape the bone and clear most of the arthritis (by shaving the bone) during an arthroscopy and the hip is still going albeit with a few flares from time to time.
    At the time of my hip problems my surgeon put me in touch with some other patients via a forum (now sadly closed). They were both in their early thirties and ended up having THR which transformed their lives.
    My life too has been transformed. I am left with a few restrictions as my hip was poorly formed I cannot turn my hip inwards as it could dislocate but this is a small price to pay.
    You are young to go through this but a THR changed my life and I remember getting to the point of thinking should I wait this out now and not have an active life for the next ten years or should I go for it and enjoy life now while I can. I am so glad I went for it.
    My surgeon is one of the UK pioneers in the treatment of young adult hip problems. I had to travel to see him but it was well worth it as that is basically what he deals with most of his working time and he knows what can and can't be done. They couldn't deal with my hips locally as no-one was trained in the problem but he can do a heck of a lot with an arthroscope although as in my case it isn't always the answer. There are other surgeons but I don't know much about them. If you want another opinion PM me I can give you his details as he works out of the NHS and has his own website.
    I hope this helps.