Emotionally ready for surgery

I have a date for an NHS total hip replacement early February 2022, but I am struggling to go forward and have the operation. I have variously worried if I should continue to manage my symptoms conservatively without surgical intervention as I manage my discomfort with minimal pain relief medication, although I am no longer walking comfortably and suffer varying degrees of pain when bending to put on my left sock and shoe. I no longer walk the distance of 6 to 8 miles I used to complete and now I probably manage more in the nature of 4 miles with a break mid way. Climbing stiles has become very difficult. My arthritis is therefore causing some loss of function, in particular the ability to walk comfortably and a distance, but I cannot say I am in pain as such, certainly not severe pain, and as mentioned I manage without medication by swimming and exercising regularly in the local swimming pool. My symptoms can also vary between my thinking I need to have my hip replaced and questioning if I do.

Yes I would like to walk comfortably, but as a hip operation is primarily a pain relieving procedure am I right to proceed?

I have consulted 3 surgeons 2 of whom have recommended I proceed and the other that my symptoms and in particular my pain does not warrant surgery at this moment in time.

I would be grateful for observations and comment and thank contributors in advance for their time and assistance.

Comments

  • RogerBill
    RogerBill Member Posts: 123

    Hi @buzzyhornet I was in virtually the same position and faced a similar dilemma. From enjoying regular 8 mile walks I became unable to walk more than about 15 minutes. Also many everyday activities which involved standing for more than 15 minutes became painful. But I was able to do many physio exercises and both sitting and lying down were generally pain-free. I had a total hip replacement 3 months ago. The operation was successful although the recovery process has been more gradual than I'd hoped. I'm now able to walk 2.5 miles at 2.8 mph which is much better than before my operation but not yet as good as I was a year or two ago. I still can't quite manage to put socks on without a sock puller or cut my toenails. The recovery process continues!

    Have you seen a copy of your x-ray report and the x-ray image? I requested copies online via the NHS hospital where I had the x-ray. They showed bone on bone and a diagnosis of severe osteoarthritis. I then realised that physio wasn't going to improve this and recovery should be better if I had the operation sooner rather than later when the hip could have deteriorated further along with my general mobility. As I'm 69 the expected c20 year life of the artificial joint wasn't an issue.

    When I asked the medics and physios whether I should or shouldn't have the operation they all said it was up to me and the quality of life I wanted. I can understand their position but it was a difficult decision for me and I sympathise with your dilemma. I paid for a private operation as I was unwilling to wait 12+ months for an NHS operation. I count myself extremely lucky to be able to afford to have done this. If the NHS are willing to fund your operation I guess that must mean they see yours as a case deserving treatment especially if you haven't already been on the waiting list for a long time.

    Hope this helps and please feel free to ask any further questions.

  • Hi @buzzyhornet

    Thank you for posting on the helpline forum. I’m sorry you are experiencing discomfort and some loss of function in your hip which is affecting your mobility. Given that you’ve had conflicting medical advice, it’s understandable that you are questioning whether to proceed with the total hip replacement planned for early February 2022. You may also wish to post in the Living With Arthritis section so others can contribute their observations and comments.

    You’re right that freedom from pain is usually the main benefit of surgery, and you can expect to have some improvement in mobility as well, although a hip replacement may not give quite as much mobility as a healthy natural hip joint. Ultimately, this is a decision only you can make, based on medical advice and you are right to think carefully about your decision. I'm assuming here osteoarthritis (OA) is the diagnosis you have been given. You may find the evidence-based information below on managing OA of the hip helpful. It includes embedded links to hip replacement surgery and to exercises for the hip.

    The core treatment for osteoarthritis is exercise.  Although you walk and swim regularly, I’m not sure whether you are doing regular structured exercises to strengthen the muscles around the hip joint. Research shows that it is these structured movements that make the difference and can help delay surgery or ensure that the surgery more successful.  

    Although you're not in severe pain, I suggest that you check out the online version of the ESCAPE-pain for hips programme (Enabling Self-Management and Coping with Arthritic Pain using Exercise). It's certainly worth exploring all your options for managing the condition conservatively before going ahead with surgery. You can find out more here:

    You are very welcome to call us on our freephone helpline: 0800 5200 520 so you can talk things through with one of our helpline team. 

    I hope this is helpful.

    Best wishes

    Mags

    Helpline Team

  • buzzyhornet
    buzzyhornet Member Posts: 20

    Hi@RogerBill. Thank you for replying so helpfully in reply to my post.

    While I am pre op I can understand your wish to recover as soon as possible, yet it does sound as if you are making steady progress and I suspect it may be a question of ploughing on and congratulating yourself upon the recovery you have made to date, while looking forward to walking a distance again comfortably.

    I say comfortably because while I can still walk a reasonable distance I can only walk at a studious pace and recently this has caused some back pain. As such if you are returning to walking with good form and without any or diminished pain this may be a cause to be optimistic.

    My first x ray taken April 2019 revealed severe degenerative arthritis with bone spurs around the femoral head and a cyst. The weight bearing aspect of my hip was described as almost non existent, but at the time I was functioning really quite well and suffering only a niggle in my groin.

    This was not then explained to me, but latterly I understood you might have quite shocking x Ray's, but function quite well and I thought that's me! A year later a second x ray showed little change.

    My function and mobility have however declined, although perhaps imperceptibly. I now also suffer more discomfort. I tend not to use the word pain as it is generally manageable and there are many days when I can manage without medication.

    At the moment however, I find lifting my leg, say to get over a stile, almost impossible, difficulty putting on my sock, sitting for any length of time when my hip stiffens and the same with driving after an hour.

    It is however primarily my inability to walk comfortably or at least as comfortably as I used to that has been niggling away at my hope to manage my arthritis conservatively.

    I agree it is harder to make a decision given this is elective surgery. I also think it is hard when there is no consensus as to how arthritis may develop. The NHS say it may stabilise and may not necessarily deteriorate, but other opinion paints a much less optimistic picture.

    It seems therefore that unless you wait for a hip to deteriorate where you are crawling up the stairs or in abject pain, there is uncertainty and risk in electing to have a hip replacement or continuing to manage the symptoms conservatively.

    Strangely while quality of life is oft mentioned it is generally accepted that pain relief is the primary reason to have the procedure. Yet everyone of course experiences and processes pain differently and for that matter avoids it differently, sometimes at the expense of quality of life!

    I suppose therefore I may have to accept that save when you suffer excruciating pain and medication provides no relief, there can be no absolute certainty?

    You kindly offered to answer any further questions and I wonder if I can take you up on your kind offer as follows

    1. I am also fortunate to be able to pay for private treatment, much as I support the NHS. I have been waiting on the NHS list knowing this might be some wait, but now I am being offered a date I am wondering if private treatment might be preferable.

    I say this because private treatment will allow me to choose my preferred surgeon. Unfortunetely I have not felt reassured by my allotted NHS surgeon who is less inexperienced, although friends have offered the reassurance that the overwhelming majority of surgeons working in the NHS are technically completely competent. Sadly I lost a loved one after an operation carried out by a surgeon who seemed to have little time or apparent empathy, and this may be causing some unnecessary worry on my part.

    2. I live alone and wonder if I can recover at home or if it is better to go into a convalescent home say for a week. The former is the more appealing, but I suspect I may be in pain and immobile after the operation, although it seems some mannage quite well. While I appreciate everyone's recovery is different I wonder how you fared and what you might recommend?

    Thank you again for your message and in anticipation of your comment and reply to this one.

  • buzzyhornet
    buzzyhornet Member Posts: 20

    @RogerBill ..less experienced ..of course.

  • RogerBill
    RogerBill Member Posts: 123

    Hi @buzzyhornet

    At the moment however, I find lifting my leg, say to get over a stile, almost impossible, difficulty putting on my sock, sitting for any length of time when my hip stiffens and the same with driving after an hour.

    It is however primarily my inability to walk comfortably or at least as comfortably as I used to that has been niggling away at my hope to manage my arthritis conservatively.

    Before my operation this was exactly my position except, as it was my left hip and I have an automatic car, driving wasn't much of a problem.

    For the hip operation, even though I fully support and very much appreciate the NHS, my decision to go private was easy due to the NHS waiting time. Other than dentistry, it's the first time I've had private treatment.

    Seven years ago I had a prostate cancer operation and, as I wasn't happy with the first NHS surgeon I saw, I went back to my GP and, after some difficulty and delay, was able to get referred to another NHS surgeon who had much more experience and was excellent. However, I suspect the situation with hip replacement is very different to cancer treatment, especially given all the added pressures the NHS has suffered in the past decade plus Covid (for the past three years I've served on the committee of a voluntary group for cancer patients which is run from a local NHS hospital so I've some insight into pressures under which the NHS is working).

    If you have significant concerns about your NHS surgeon and you can afford a private operation (mine was robot assisted and cost £16,000) I think in your position I would certainly investigate the private health option. I checked out two local private hospitals and their surgeons. I decided I'd prefer a robot assisted operation and shortlisted consultants who had done and were continuing to do a reasonable number of operations and who weren't close to retirement age. Coincidentally I discovered I knew a guy who had recently had his hip replaced by one of the surgeons on my shortlist and his glowing report made my choice easier. The initial consultation cost £250 and, if I hadn't felt comfortable with the surgeon or his waiting time, I would have been willing to pay for a consultation with the next surgeon on my shortlist.

    My main concern with going private vs NHS was what would happen if a significant problem was encountered. When I raised this, the surgeon simply said that he also worked at the nearby NHS hospital and in the unlikely event of a problem that couldn't be handled in the private hospital he'd get me into the NHS hospital. I was also concerned about what would happen if I needed access to the services of a district nurse, my GP or A&E. I experienced a small problem in this area but maybe that was more due to the pressures of Covid than to the gap between private health and the NHS.

    In the private hospital I certainly got a nicer room and better food. But these weren't important for me. More importantly, as it was a much smaller hospital and as they seemed to have more stringent safeguards, I felt Covid posed a lesser risk.

    I think I would have found my first week out of hospital difficult but not impossible if I'd been living alone. Fortunately I wasn't in much pain and found stairs and general mobility not too bad. But before the operation I'd practiced stairs with crutches and had carefully arranged things to be easy to access without bending and had bought an easy grabber and sock puller. But the cost of a week or so in a convalescent home could be well worthwhile for both practical reasons and to gain confidence. Alternatively I wonder if there are care at home services which could be even better?

    I hope my ramblings haven't muddied the waters for you. Please feel free to ask any further questions.

  • Coddfish
    Coddfish Member Posts: 85

    @buzzyhornet Like @RogerBill, I had my hip replaced in September. I was initially able to manage my problem through exercise but was in denial about it for a very long time as it gradually deteriorated. I never said it hurt, but it was very stiff, and getting to standing from sitting and vice verse was becoming increasingly difficult. Walking distances were declining, but the rock bottom point for me was when I could no longer run. At that point I was able to accept it wasn’t going to get better. I think you can always manage these things for a while - then they go over the edge of a cliff - and you can’t predict when that will be.

    Surgery has been a real game changer for me. At 3.5 months on I am fully recovered and have even returned to running. Life would have been so much easier if I had had it done a year earlier. I have been lucky that I had an easy recovery but am sure part of this was that I retained a reasonable level of fitness up to surgery. I wonder if it would have been so easy if I had left it until I really had no other choice

    The main reasons for doing it now are that it is only going to go in one direction and could suddenly become much, much worse, and that recovery will be easier whilst you are still reasonably fit.

    On the recovery point, I had a 2 night hospital stay and had help at home. I think that was essential for the first couple of weeks but after that would probably have been ok had I been alone. I had my surgery privately, it cost just over £13k.

  • buzzyhornet
    buzzyhornet Member Posts: 20

    @Coddfish Thank you for writing with your thoughts and advice. I really do appreciate others who give of their time and experience to help other travellers along the way.

    I believe the predominant view is that my arthritic hip us only likely to deteriorate, but I find my symptoms fluctuate. As such there are some days when I feel I am managing quite well and others when I struggle.

    The NHS website say that symptoms do not necessarily deteriorate, and this view is endorsed by Dr Jenner at the London Pain Clinic who says that in some case symptoms may stabilise and allow for the carrying on of most every day tasks.

    My big bug bear (I gather not being able to run was yours) is not being able to walk comfortably for any distance and the effect this has on my quality of life.

    I suppose I am looking for assurances that a replacement operation will mean I can walk a distance comfortably, although I wonder that when it comes to function rather than pain reduction if the medics are able to offer any assurance or reason to have the operation.

    As I say I can manage my pain, but I am wary that if I do nothing this may change for the worse and my recovery after an operation may then be harder and less successful!

    Perhaps there is no definite answer and I should accept that is the case and stop searching for one?

    I wonder if you can kindly how you managed your first two weeks of recovery and let me know what took you by surprise. I worry that I shall be changing from an active to a restricted lifestyle, albeit I appreciate this may be time limited, and I am anxious as to how I will cope physically and in particularly emotionally given with the change especially given my current level of activity and movement.

    Thank you.

  • Coddfish
    Coddfish Member Posts: 85
    edited 31. Dec 2021, 18:14

    Hi @buzzyhornet

    I don’t think anyone can give you a definitive answer about this. For me, return to functionality was of the utmost importance and I can now walk any distance I want comfortably on most surfaces. I am not yet great on steep inclines (especially downhill) but that’s mostly constraints in my head, not my hip. Although no longer being able to run was the trigger point, I was also frustrated that walking distances pre-surgery were declining.

    I wrote a recovery thread on here at about 3 or 3.5 weeks, and if you find that and read it, you will see I was already doing well. I spent 2 nights in hospital and had help from my husband at home. The first few days were awkward but not painful and I was able to reduce painkillers after ten days or so and stop them completely at 2 or 2.5 weeks. By painkillers I mean paracetamol and ibuprofen - I learned the hard way that I didn’t get on with anything stronger. Progress wasn’t linear with some days definitely easier than others. I would say 8 weeks was the point at which I got more or less back to normal. If I look at my step counts, I was consistently achieving more at 4 weeks post surgery than I had been able to do in the previous 18 months, and considerably more than I had done in the previous 3 months.

    On the exercise front, I had 3 PT sessions, at 3 weeks, 5 weeks and 8 weeks, funded by my fixed price package. I saw my own personal trainer weekly throughout, initially to improve form on the PT’s exercises, but more recently to train normally. I went back to swimming at 5 weeks, initially front crawl and backstroke but now swim breaststroke too. I went back to parkrun as a volunteer 11 days after surgery and participated as a walker about 6 weeks after surgery completing the whole 5k. I have got my walking time for it down to about 50 minutes now, and have just restarted Couch to 5k as a route back to running. I am currently in the Peak District with family and managed an hour and a half at good pace today round a reservoir on wet and slippy uneven woodland terrain.

    If anything surprised me, it’s that it has all been easier than I expected. I don’t think I ever worried I would not get function back, but I did fear a 2-3 month period of pain and frustration. There was little pain, and the progress has been regular enough to always make me feel it would be ok. If the other hip deteriorates, I won’t hesitate to have it done.

    Female, aged 64, I have an uncemented Smith & Nephew Polar 3 system.

  • Lilymary
    Lilymary Member Posts: 1,544
    edited 4. Jan 2022, 18:03

    The only thing I can add to the excellent advice given above it "it's only going to get worse if you don't have your hip replaced, and will only get batter if you do". In my case the absence of hope of improvement and day on day deterioration, even with handfuls of opiates and anti inflammatories, was crushing.

    My first xray, after a tumble onto my backside, showed such advanced OA that they told me there and then I needed a new hip. I'd had almost no pain up to that point, but the tumble triggered a catastrophic reaction, which was so bad they sent me for another xray 2 weeks later as they couldn't understand why the pain was still increasing at such a rapid rate and thought I must have fractured something. Then followed over 12 months of crippling pain, a pandemic and the meltdown of the NHS. What should have previously been fixed in 6 months on the NHS then had an estimated waiting time of over 2 years. I couldn't do it. We plundered savings and went private. It hurt that we had to do that, but I had no choice. I could no longer function. Everything, even laying in bed, hurt, despite maximum doses of prescription drugs every day.

    After THR surgery in April 2021, my recovery has been less than impressive, (read through my thread "New Hip Day" for more details, but don't let it put you off. It might make you giggle too). When I'm still feeling frustrated 8 months later, I remind myself that I now walk almost entirely pain free, without a stick and at "normal" speed (I can even overtake a few people on pavements now 😁) and don't have to drag myself upstairs at an angle of 45 degrees clutching onto the handrail. I don't have to find the parking spot closest to the supermarket door, (every few feet counted) and only do the essential aisles, leaning heavily on the trolley, in agony. Now I walk from one end of town to the other, and and every extra step from the car to the door is useful exercise. Even with my remaining grouchy bits, I can do a 6 mile walk off road, although hills are still tricky at the moment.

    We recently went to a shop that I last visited just before surgery, and I had a flashback of how much pain I had been in the previous time. It made me realise that even with a few complications and a very slow recovery (and I must stress I'm really not typical), my life is so much better now. Still room for improvement, but we're working on it.

    As to how it will affect your function, everyone's different, which is why they won't make any guarantees. l was 61 when I had mine, previously a fit hill walker and trekker. I had every reason to suspect I'd be back out there post op, but it's been a hard road. On the other hand, a friend who had hers done recently was back on the climbing wall 4 months later, and another is back skiing. I've heard of some who are back on their horse after 7 weeks, but I'm willing to bet that made her surgeon pretty cross. You can't predict how yours will turn out, but every likelihood is that you will be better than you are now, and that's worth going for.

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