hip joints wear and tear

mandylerwill

Hi,
I'm after advice in relation to treatment for hip arthritis/replacement via NHS in England.

Background

Active life including being in the army to age 40 with less active/weight gain to 16 ST to current age of 58. Had a labral tear and clicking hip 3 years ago and physio/1 x fluoroscopic injection which resolved the pain/has not come back. I now have feelings of discomfort in both hips, worse on the side that had the labral tear. Most noticeable - stairs - climbing over low obstacle - side movement of hip. So there is a restricted range, that is mostly ok - I can 'fast walk' on a treadmill for 3km without significant difficulty. I've had x-ray and they show most of the hip joint ok - but a bit thinner/closer to bone to bone at the bottom. Currently doing slimmers world to at elast try to take the weight down. GP highlights the way NHS works:

-X-ray to monitor - pretty much on request
-Physio to improve supporting muscles
-Othopeadics referral if in pain - hip replacement if pain/loss of function is bad enough - preference to only do it one and hope ith lasts until death.

Questions

- Does Physio give any genuine benefits?
- How much pain/loss of function is likely to result in referral for hip replacement?
- What is common waiting times from such a referral.
- How good is a replacement hip compared to a good working original as a %?

I guess I want to use quite heave excerse as aprt of losing weight, but am worried about the extra damage I may do to myself. I hate the idea of having to go through an extended period of pain/loss of function before replacement.

Apologies if this is very mild compared to many, but would appreciate your thoughts.

Graham

PS my wife has much worse arthritis, hence the username!

Juliew

Hi sorry to hear about all your pain. I had a THR 13 weeks ago at the age of 40. For the past 9 years I couldn't put my sock on, wash and dry below my knee, sit and stand whilst bending knees. For the past year and a half I was on regular medication and that was just taking the edge of slightly. The pain and flexibility started to impact on my driving I could just about handle a 10 minute journey. The pain impacted on day to day living and my work. I had 2 sessions of physio and was referred to my GP and he unturned referred me to a specialist after me doing a tick box questionnaire.
From seeing my GP to seeing a consultant it took 5 weeks, I then had to see another consultant cos of my age that took another 4 weeks (would have been 9 weeks but got a cancellation, then I had my op 4 weeks later, about 12 weeks from GP referral to op. I can imagine waiting times are different. For me the op has been a life changer, the hip pain has gone and I can do things I haven't been able to do for about 9 years, I don't really remember much before the lack of flexibility became an issue. My consultant/surgeon told me in my post op appointment that my hip was a right mess and on the verge of seizing lucky if I got another 4 weeks out of it before it gave up completely
I too am overweight but I joined weight watchers last year and lost 2 and a half stone but managed to put on a stone and 3 pounds since my op, I intend on getting that weight off plus more especially now as I'm more active and I'm back to work so that should help.
I hope this helps

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mandylerwill

Juliew wrote:

Thanks Julie - sorry to hear that you had difficulties so early in life and that the operation has helped you significantly. It sounds like you put up with things for a long time before getting a referral but then it was done within 3 months - may I ask roughly where in the country you live?

I guess I was worried about a couple of years wait once referred.

I wish you all the best going forward.

Graham

Juliew

Probably a fault on both sides I should have probably pushed it myself, I never saw the same gp which probably didn't help, I saw the same gp in February last year and this year which is probably why I got referred. My hip being in such a bad way is probably why the op was done so quick plus my consultant/surgeon put me down as urgent. I had my op done in a private hospital but had NHS funding. I'm Stevenage Hertfordshire
My first consultant appointment was done through the choose and book service where I had a choice of 4/5 hospitals
If they do refer to a specialist and you get your appointment through if it's a long wait I would phone regularly and see if you can get a cancellation
Through my own experience I would keep on at them, I certainly will when my other hip gets worse

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stickywicket

Hi Graham and welcome.

I like your GP's advice. It sounds pretty much spot on to me. I should tell you that I have both RA and OA, the latter arising because of lack of treatments for the former in my younger days. I had two knees replaced in 1981 when I was 35. It's true they prefer not to replace joints until we are old enough to hopefully not wear out the replacement but, after 27 years, one of them was replaced. It's a longer operation, a much longer implant and carries more ongoing risks. Having said that, mine's perfect. I also have two hip replacements.

In answer to your questions:

1. Does Physio give any genuine benefits?

Absolutely. I regard it as essential and so do any worthwhile sites about arthritis. Here is what Arthritis Care says about it https://www.arthritiscare.org.uk/living-with-arthritis/exercise-and-arthritis .

2. How much pain/loss of function is likely to result in referral for hip replacement?

If you mean how much is lost by having a THR, I really can't answer that as I'd hardly any movement left before mine. I guess you're never going to have the full range movement of a natural joint but presumably you no longer have that anyway.

3. What is common waiting times from such a referral.

How long is a piece of string? I guess it depends on your part of the country and your local hospital. Better hospitals (usually teaching hospitals) have longer waiting lists. We wait first for an appointment and then, if offered a replacement, wait for a pre-op and then for an op date. If you can be available at short notice and / or are happy to go in at unpopular times eg Christmas you might get an earlier date.

4. How good is a replacement hip compared to a good working original as a %?

See my answer to 2.

I'm no medic but I think you're possibly on the wrong track if you're trying to combine strengthening and range of movement physio exercises with weight reducing ones. See a proper physiotherapist for advice about that. If ever I need to lose a few pounds I just don't buy in stuff like cakes, crisps and biscuits on the grounds that I can't eat what's not there. Not buying in wine is harder but can be done if absolutely essential

Good luck!

mandylerwill

thanks stickywicket

daffy2

Hi Graham
As is so often the case Sticky has given you a comprehensive and informed answer, and I think you will find that others will echo what she says about the piece of string answer to 'how long'(referral etc). It depends on many variables not all of them anything to do with clinical considerations unfortunately. You might find it useful to check on the latest NICE guidelines, which can give you an idea of the 'ideal world' scenario.
If you are worried about 'heavy exercise'(as part of your weight loss effort)causing more damage then think about alternatives, not least because weight loss is possible without such a(at the risk of being sexist) macho approach, as other forumites have proved. Other forms of exercise which might seem to you not as effective might in fact be more useful for building strength and function in supporting joints now and in the future.

dalek

mandylerwill wrote:

Hi,
I'm after advice in relation to treatment for hip arthritis/replacement via NHS in England.

Background

Active life including being in the army to age 40 with less active/weight gain to 16 ST to current age of 58. Had a labral tear and clicking hip 3 years ago and physio/1 x fluoroscopic injection which resolved the pain/has not come back. I now have feelings of discomfort in both hips, worse on the side that had the labral tear. Most noticeable - stairs - climbing over low obstacle - side movement of hip. So there is a restricted range, that is mostly ok - I can 'fast walk' on a treadmill for 3km without significant difficulty. I've had x-ray and they show most of the hip joint ok - but a bit thinner/closer to bone to bone at the bottom. Currently doing slimmers world to at elast try to take the weight down. GP highlights the way NHS works:

-X-ray to monitor - pretty much on request
-Physio to improve supporting muscles
-Othopeadics referral if in pain - hip replacement if pain/loss of function is bad enough - preference to only do it one and hope ith lasts until death.

Questions

- Does Physio give any genuine benefits?
- How much pain/loss of function is likely to result in referral for hip replacement?
- What is common waiting times from such a referral.
- How good is a replacement hip compared to a good working original as a %?

I guess I want to use quite heave excerse as aprt of losing weight, but am worried about the extra damage I may do to myself. I hate the idea of having to go through an extended period of pain/loss of function before replacement.

Apologies if this is very mild compared to many, but would appreciate your thoughts.

Graham

PS my wife has much worse arthritis, hence the username!

I had THR (right side) aged 30.
It is a 'no brainer' really. No different to the original hip. Most of the time I forget I have got it.
Just make sure you do the excercise they give you.
The only thing they tell you not to do is jogging or football, I guess because of wearing it out.

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mandylerwill

thanks daffy2 (and stickywicket)

I just had a look at the NICE Guidelines and saw 'end stage arthritis' defined as pain and disability.

It still seems like 'how bad is bad enough' and the possibility of an extended period of years of decline before action taken.
I don't believe I am a candidate for a replacement hip and probably not for 2 years+

I guess I am just concerned at the thought of spending my 60's getting progressively worse before getting a replacement at 70!

Yes - I am pending a physio appointment - I'm assuming 3 months (bristol) and see where I go from there.

I'm ok with the 'sexist' comment - I may not be comfortable with being one of two men in a room of 30 women at slimming world (but I am there) - I just want to push it a bit by exercising as well to move things along quicker - naturally I do not wish to knacker the hips faster as a result!

Graham

stickywicket

This, from a very reliable site, might help https://www.arthritisresearchuk.org/arthritis-information/surgery/hip-replacement-surgery.aspx

mandylerwill

stickywicket wrote:

This, from a very reliable site, might help https://www.arthritisresearchuk.org/arthritis-information/surgery/hip-replacement-surgery.aspx

Thanks Stickywicket - that's pretty clear - I'll save anything else for the physio appt - whenever it is.

Graham

AliB

Julie you were lucky to get seen and done so quickly in Hertfordshire. I too was due for hip replacement but in St Albans hospital..my left hip was apparently 'very bad' I was never given any other option like you. I had a 10 week wait for my op in June then 10 days before it was due the hospital postponed it untill the end of August which then gave me another 9 week wait... I was devestated as I was in so much discomfort and who was to know whether they would postpone it again come the end of August? Luckily and I appreciate not everyone has the option to do this but I went private and had the operation done within the week of seeing the consultant. Best thing I have ever done. I am now having the right hip done by the same surgeon next month. Have hardly ever had to call on the use the NHS hospitals (apart from pregnancy) in the whole of my 68 years so felt quite let down to be honest .

Juliew

AliB wrote:

Julie you were lucky to get seen and done so quickly in Hertfordshire. I too was due for hip replacement but in St Albans hospital..my left hip was apparently 'very bad' I was never given any other option like you. I had a 10 week wait for my op in June then 10 days before it was due the hospital postponed it untill the end of August which then gave me another 9 week wait... I was devestated as I was in so much discomfort and who was to know whether they would postpone it again come the end of August? Luckily and I appreciate not everyone has the option to do this but I went private and had the operation done within the week of seeing the consultant. Best thing I have ever done. I am now having the right hip done by the same surgeon next month. Have hardly ever had to call on the use the NHS hospitals (apart from pregnancy) in the whole of my 68 years so felt quite let down to be honest .

Hi Alib, it's a shame you felt let down by the NHS and had to go private luckily you was in the position to do that. Glad you've had it done and not in pain like you was previously. I hope your next op goes well


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