Orthopaedic referral

Whiskey26

I have OA in both hips ( right severe, left mild) and recently had an x-ray on my right knee, as it has been painful and swollen for a while and my nurse thought OA may have spread. I've had the results back and thankfully it hasn't spread. They think it's just referred pain and I'm speaking my physio next week about it. In the meantime, my GP has suggested a referral to see an orthopaedic surgeon to see what my options are regarding my hip. He's suggested this because I walk with a stick and have difficulty bending and carrying things and I'm only 57. Truth is, I'm not sure I want to speak with a surgeon right now. Although I'm in pain most days at some point, I do manage to keep it under control with painkillers and have various aids to help me, ie: sock aid, step to get into bath etc. I would prefer to speak with my physio, to see if she can help me do some exercises or hydrotherapy etc, both for my knee and my hips, before I see a surgeon. The thought of any injections into the joint, terrifies me, as I hate needles and I know from people on here, the pain relief is short lived and it's painful to have done. Apart from having two children and a few rounds of stitches as a child, I've never been in hospital. I would rather try and manage/live with the pain and try and carry on as long as possible, than go in for a replacement. Despite the severity of the OA in my right hip, I'm hoping if I can sort out some exercises and keep mobile, it won't get any worse. Am I being a big baby? I just can't face the thought of going into hospital. I am so frightened and the thought of it has increased my anxiety. My GP says I don't have to be referred if I don't want to, at this stage. Thoughts please?

Lilymary

Hi @Whiskey26 , it's perfectly normal to be apprehensive about hospital procedures. You're not being a wuss. Prior to my THR the only surgery I'd had was tonsils out when I was six and a few stitches here and there. I'm only 4 years older than you. I have another very fit and active friend of your age who is having her new hip later this month. And while I haven't had children, but I'd far rather go through hip surgery than child birth!

I really do think it would be worth at least seeing the surgeon to review your options. He is a specialist in arthritic hips, your GP isn't, so he can discuss with you what can feasibly be achieved without surgery, and what to expect from your hip in the months/years to come. Surgeons aren't desperate to replace our joints for the sake of it. He will only offer it if other options have been exhausted, or if it's already beyond the point of no return. But if he does suggest surgery then it's well worth being put on the waiting list, since in 12-18 months when your turn comes (hopefully much sooner) , you may be more than ready for it by then. I suspect you could defer at that stage if you still felt so inclined. But tbh, from what you decribe, I'd say you're more than ready for it already. While the pain was horrendous and very limiting, I didn't have the same level of immobility that you describe.

I had the steroid injection, and I wouldn't honestly say it hurt. It was a pretty uncomfortable yes, but it was over very quickly. I was almost disappointed, all that build up for a sharp poke with a needle. Sadly I was one of those for whom it didn't work at all, but if it had done, then I would have been happy to keep having them until the damage to my hip was so bad it was time for surgery. Just lie there, look the other way and think happy thoughts. (I usually dig my nails into my palm if really worried, as the pain in my hand takes my mind off what the doc is doing! 😅)

But if and when the other options HAVE been exhausted, then surgery is probably your only and best course, as the OA will continue to deteriorate however much exercise we do and pills we pop (although they may slow it down a bit). The purpose of this surgery is to manage pain and restore mobility when all else fails. Do keep up with the exercise though, the better your muscles that support your hip, the faster you will recover from the op, plus it will help manage the pain now, and equally important, it will help your mental health - this is a tough time for you.

While my recovery has been disappointingly slow, I am in a minority in that regard, and I am immensely grateful for my new hip. The relentless 24/7 pain in the joint has gone (yaaaay!!), I need no pain relief at all, it's just that my muscles and tendons just need to get over themselves and start toeing the line, which is a bit hard work, but hey, I'm getting there.

Look at it this way - without surgery the pain and immobility is only going to get worse. After surgery, the only way is up. The docs do this day in day out, the nurses will look after you immediately in the post op, and if you've been battling along with the various aids for this long, there won't be many surprises for you in how to cope when you get home. The OTs will give you all the extra kit you need, the physios won't send you home till you're mobile, and your family will help out with the day to day stuff.

Do go along to see your surgeon at least, talk through your worries with him/her, and work out a solution between you. You have nothing to lose, and they won't force you into anything.

sunnyside2

I think you have nothing to lose by seeing a surgeon. They are generally keen to NOT do surgery for as long as possible so won't be trying to talk you into having anything unnecessary done. Plus it is your body- if they recommend a procedure and you don't want it you just say no thank you. Thing is a surgeon can tell far more about what is going on with your hip then the GP ever can and knowledge is power. With knowledge you can make informed decisions on how you want to move forward.

ps I have had multiple steroid injections into knee joint- very very brief sting and then blessed relief as the local takes effect followed by a substantial improvement in swelling/pain etc for a good while. I am an utter coward and thought of a needle going between sore bones freaked me but honestly its not that bad. I would not have had more then one if it had been bad

Whiskey26

Hi @Lilymary, @sunnyside2 thanks very much for your message. I am going to have a serious think about seeing an orthopaedic surgeon within the next few months. I need to get my physio sorted and more importantly, my anxiety, before I make any decisions. I think it's fear of the unknown with me and also, I read somewhere (and I don't know how true this is) that hip replacements are done with a spinal block? Now despite having two epidurals when I had both of my daughters, I dread the thought of an operation being done in this way, so I'm awake. I'm afraid if I couldn't be anaesthetised completely, in other words 'put to sleep', I definitely wouldn't want it doing. I realise how silly I sound and I should be ashamed of myself at my age, but fear is fear 😱

Lilymary

I had a spinal block but they also sedate you. They let you choose how far under you want to go, I said I didn’t want to know anything about the op. And I didn’t.

So my experience was that I changed into one of those awful gowns (although bizarrely I don’t remember doing so 😅), they sat me on the side of the treatment couch and I looked down and realised I suddenly had loads of wires attached (!). They used some sort of scanner to make sure the injection went into the right bit of my spine. They then laid me on my side so all the anaesthetic went to the operated leg, and kept checking to see when my leg had gone dead. They kept me informed of what they were doing all the way through, we’re happy to answer questions (like “what’s that beeping noise?” “Your heart beat ....” 🙄😅) and were generally very cheerful and reassuring, but they so clearly knew precisely what they were doing and it was all happening so fast that I just let them get on with it and tried not to think about it. Then when they were happy that my leg had completely left the party, they said “ok, now the sedative”....... And that’s the last thing I remember till what felt like a split second later they were wheeling me out of the operating theatre into the recovery room, and it was all over! I felt delightfully woozy and rather amused that my legs felt like they were floating 12” above the bed. (They weren’t, in case you were wondering.)

but I know some people like to be more aware during the surgery as they’re just interested in the process. One friend had light sedation (at her request as she thought it would mean she recovered faster, but tbh I don’t think it did) and spent the whole time listening to The Archers on her headphones. She said she was pretty much oblivious to what they were doing, but was rather annoyed that they finished half way through an episode. She was so relaxed about the whole process she recommended I do the same, but I’m like you, I really didn’t want to know, and the anaesthetists were more than happy to oblige.

.

helpline_team

Hi Whiskey26,

Thank you for posting on our helpline forum, I am sorry to hear how the possibility of going into hospital is affecting your anxiety, you are not being a big baby, everyone is different, some people would rather go into the hospital than have to go to see a dentist. 

I am so pleased to hear that the OA hasn’t spread to other joints it must have been such a relief for you.

As Lilymary has said, and it is entirely up to you, but by seeing the orthopaedic surgeon and finding out what your opinions are may put your mind at rest, in the end it would be your decision only and no one can force you into having an operation. Surgery is always the very last resort, usually when medication isn’t helping, and a person’s quality of life and mobility is affected. But like I have said it is your body and your decision only.

It is great to hear that you would also like to try physio and hydrotherapy as a way of managing your condition, exercise helps to build the muscles up and helps with the stiffness, I have heard that exercising in warm water can be very beneficial.

If at any point it would help you to talk things through informally and in confidence to one of our Helpline advisors about how you are feeling and other treatments that may be available, you are more than welcome to call our Free Helpline on 0800 5200 520 weekdays 9am – 6pm.

https://www.versusarthritis.org/about-arthritis/treatments/surgery/hip-replacement-surgery/

Best wishes

Chris

Helpline Advisor

sunnyside2

no one would force you to have a procedure awake, When I had knee surgery they did give me a block- but I was asleep throughout - they knocked me out before did anything. It was an opp where they cut the bone of my lower leg and moved it over and then screwed it down to alter how the knee cap moved. The only issue I had when I came round was I was really cold - no pain- and they sorted out the cold by popping a heated blanket on me. I was amazed how well controlled everything was.

Whiskey26

Hi @Lilymary Thanks so much again for your words of advice, which I have saved, so I can refer back to them at some point in the future. I'm wondering when you say you had the spinal block, then a sedative.....did they not give you any sort of anaesthesia before they did the spinal block? Otherwise I'm sure you would feel that surely?? I remember when I had both of my epidurals when I had my daughters, they gave me a local anaesthetic first ( I think it was in the form of a spray, rather than a needle). To someone like yourself who's been through it, I must seem like an extremely cowardly, silly person who should be ashamed at my age. And in truth, I guess I am. I am so pleased to read that you are recovering well from your operation in March. Can I ask how you feel post op? Has your pain disappeared? How is your mobility?

Whiskey26

@sunnyside2 many thanks for your words of reassurance. As I said to @Lilymary, I will keep these conversations safe, so that I can refer back to them should I need to.

Lilymary

Hi @Whiskey26 If I'm honest there are some parts of the procedure that are rather fuzzy, which is probably normal. It's possible they did give me a small local anasethetic before the spinal block, but I can't remember. What I DO remember is that nothing hurt more than any normal injection or fitting a canula from beginning to end of the anaethesia and actual operation. The recovery was more painful, but the nurses were happy to give me as much pain relief as I needed to keep it bearable. As one of them said to me, a big part of your recovery is managing the pain, and if I felt I needed more pain relief, I should simply ask for it rather than wait for them to come round with the drugs trolley.

I don't know whether you've seen it already, but this is the blog I kept about my journey from the day before surgery to (almost) current day. I promise I'm not blowing my own trumpet, but you might find some bits of it useful and perhaps have a giggle. A well developed sense of humour certainly helps get through this sort of thing!

https://community.versusarthritis.org/discussion/54075/new-hip-day/p1

But please note, I am not a typical patient in terms of recovery, and had quite a lot more soft tissue pain, muscle reaction and a slower recovery than most. Basically the hip abductor muscles sort of switched off, and they're the ones that move your leg out sideways, and also help you stand up straight. A tendon in my groin, which helps raise your knee, also played up, and took a while to settle down. All this meant that without my stick/crutches, my torso lurched off to the left over my operated hip all the time. My surgeon is still not quite sure why all this happened, as they didn't do anything to these muscles (!), but he said on rare occasions it does happen. I was just one of them. He's not worried, I think he's just monitoring me more out of curiosity than concern. It's a bit frustrating for me, but it's getting much better. I'm just getting on with whatever my body will allow me to do, but the main thing is, No More Pain.

Where I am now? My op was April 17, I'm getting round the house and garden without a stick, and not needing any pain relief (after about 10 pills a day pre-op). I do my physio 2-3 times a day (only takes about 5 minutes). At the moment I tend to take my stick with me when going into town etc as my hip muscles get tired and achy quite quickly, but I did a short shopping trip without it for the first time today. It probably looks like I'm still limping a bit while my muscles get back to normal but it's loads better than it was and is visibly improving all the time. I can stay on my feet for 2-3 hours at a time, again without pain, and can walk about 2 miles with my stick. That's much more than I could pre-surgery, and I know it's going to keep improving.

Finally, You Are Not A Coward!! You have battled through your arthritis for years, you have endured pain, depression and fatigue, and kept your life going despite all that. That makes you A Warrior, not a "silly person". And you certainly shouldn't be ashamed. It's completely normal to be anxious about surgery. My way of dealing with it from the day I was told I needed a new hip was to go into a state of total denial about what someone was going to do to my leg. That's why I asked them to knock me out completely. Does that sound like someone brave to you? No. I'm no different to you. I did have a bit of a wobble when the anaesthetists got stuck in, but I thought "well it's too late now, they seem to know what they're doing" and I sort of mentally blocked out what was happening. Afterwards, I didn't even have the courage to look at the wound when the nurse took out the stitches. Every now and then I have a peak, but there is an emotional disconnect about it being part of my body. I just make sure it's healing ok in a rather detached way, as thought it's someone else's leg, and get on with life. That's not brave or cowardly, it's just a different coping mechanism. So don't think your anxiety is anything to be ashamed of. At least you're honest about yours, I just hid mine better.

Every time you look at yourself in the mirror, tell yourself "I'm an arthritis warrior. I'm still standing despite everything my hip has thrown at me. We can fix this." And believe it.

Whiskey26

Hi @Lilymary Thank you so much for sharing your experience and your kind words of advice. As I said before, I have kept hold of these messages, put them in a file, so that I have them to refer back to as and when. I hope you continue to recover and improve, albeit slowly but surely.