Advice on having hip surgery

Deeryx

Hi, I’m new to the community and would welcome any advice. I had a slip on a wooden floor at home in 2019 and banged the side of my left hip. It never resolved and the the orthopaedic consultant said I had advanced osteoarthritis on outside of hip joint. I find some of the online information confusing. I have discomfort in the outside of the hip especially after walking. I can walk 3 k reasonably ok but very uncomfortable to walk after that. I can normally go up and down stairs unaided except when I have a flare. It is sore when I sleep on my side but I don’t have any deep ongoing pain in groin. Internal rotation pretty ok but external rotation very limited. I go to gym and swim. I can’t hillwalk or do heavy gardening. I’ve tried all the alternative treatments and some give partial relief for a short time. The consultant initially said not to have replacement surgery yet as “I would treat new joint like a new motor’. A second opinion I received almost the opposite advice- “it’s a lifestyle choice so don’t wait’. I’m provisionally booked for surgery in March but am confused as to whether it is sufficiently bad yet, although I know I will need a replacement sometime. The issue takes up a lot of mental energy.

any advice welcome thanks

Ellen

Hi @Deeryx

Welcome to the Online Community. I see from your post that you have advanced Osteoarthritis of the hip following on from a fall in 2019.

You have been given some contradictory advice from two different surgeons. One said to get it done ASAP the other implied you might wear it out(if I understand his/her implication?). You also seem to be querying the idea of surgery as some of your symptoms do not meet the 'classic' ones that we all hear.

While you wait for some of our members to come along and share their experience I am going to attach a couple of links one is about hip replacement surgery:

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

Not everyone show all of the obvious signs that it is necessary.

and secondly a link to a thread from earlier last year (now) which is so worth a read for someone facing a THR. Many of the members who have posted are still around.

I can well imagine how you might be ruminating as to what to do in your position obviously it has to be your own decision whether or not to go ahead, but hearing other people's stories can really help.

Best wishes

Ellen.

frogmorton

Morning @Deeryx nice to meet you and welcome you to the online community.

I am wondering having read your post whether you are perceived as 'too young' for hip replacement?

Is that why you are expected to wear the joint out? Just wondering and don't need you to post your age or anything!

I can imagine your worrying about what to do I did too when my youngest (at 19) needed her shoulder replaced. I was so worried as obviously it won't last her whole life starting so young, but in the end we all made the decision based on her pain levels (HUGE) and lack of mobility (RT handed RT shoulder). I continue to worry even though it's great and she has full range of movement, but we'll cross the bridge in the future if she needs it revised.

Like you hers was trauma induced - high dose steroids due to cancer while still growing.

Best of luck and do let us know how you get on.

Toni x

Deeryx

Many thanks for the input. And sorry I should have said I am a 66yo male (no spring chicken😊). I think the fact that I do lots of fitness, used to run etc made one consultant think I may have unrealistic expectations about going back to all that post op. Also I only occasionally use NSAIDs and in the warm weather last summer was able to play / walk 18 holes of golf a couple of times per week. The winter and damp weather lead to greater stiffness and discomfort. I wonder should I look to use NSAIDs more before going for op- but consultant who seemed to be encouraging a tHR said they don’t recommend using nsaids for long. I think there is competition between the private consultants and I sometimes worry that they just want to operate- my Gp said ‘ if you go to a butcher they’ll try to sell you sausages’. So my dilemma is whether I am at the point yet when I need a THR or maybe wait until the pain or discomfort or inability to do even the short walks and exercise I currently do makes the decision for me.

Lilymary

Hi @Deeryx , I had a new hip in 2021 at age 61 after mine, like yours, suddenly reared its ugly head after a fall and it was downhill fast after that. The xray showed the damage was already so bad I was put straight on the list for a new hip. I had the same problems with pain and rotation that you described before I had the fall. I was also a fit fell walker etc beforehand but could barely get round a supermarket a year later. I'm back out on low hills/field walks, but taking it carefully, as I had a few unusual soft tissue complications. A friend had her new hip around the same time at similar age - she was still walking her dogs daily pre-op but had to stop her job as ski-instructor/mountain guide. As far as I'm aware she's now skiing again, although she's had other medical issues to contend with.

I can see why you're getting conflicting advice. I'll try to pick through it.

1. NSAIDS aren't ideal long term, they're not a fix for mechanical damage. But I was on them for over a year pre-surgery. Are you also taking omeprazole to limit damage to your stomach lining? I couldn't take them at all without this. I was also on cocodamol between the fall/referral for surgery and the actual op. Together they just about kept me mobile and the pain bearable, but only just. Have they tried a steroid injection yet? They usually try this before surgery, as if it works, it can stave it off for months, if not longer. Didn't work for me I'm afraid, but some have found it helpful.
2. 66 isn't that young for THR. My sister had both her knees done by the time she was 60 - she's an aerobics teacher, and still teaching 10 years later, carefully. But as my first surgeon was keen to point out, we won't all have the same outcome as Andy Murray, and he was scathing about the damage AM was doing to his surgeon's work and said it won't be long before he needs another one. But as a world class tennis player, his lifestyle decision was that he needed to get the best out of life now and worry about disability in old age later. The harder we pound the new joint, the sooner we'll have problems with it, and they can only replace it again once. He was equally keen to point out that he "couldn't give me my old life back". Unfortunately he rammed that one home so hard I went home profoundly depressed. My second surgeon was more positive, although I didn't chose the surgeon who promised the most - I've always been realistic (there were clinical reasons why I changed to do with the types of surgery they offered). But it was interesting to compare different views. Even doctors will say if you get three surgeons in a room you'll get at least four opinions. While I understand why surgeons get frustrated when their patients then go out and hammer their new joint as though it were a natural home grown one (horse riders, runners and builders are probably the worst offenders), it's not reasonable to assume you will be one of those as justification for making you wait. Your second surgeon seems to have taken a more measured view. To be honest, both of them are right. The reality is somewhere in between. It's up to you to decide how you live post op, but I'd advise moderation to get the best out of your new lease of life.
3. Two very fit friends (including the ski instructor) got over their surgery much faster than me, partly I suspect as their muscle tone was so good. It's important to keep up the exercise as much as you can - swimming is great if you can't manage walking or running anymore. I had been a fit walker most of my life before the hip packed up, and I'm certain this masked the deterioration which, looking back on it, had been going on for many years. Sadly another health issue had kept me off the fells for the last few years, and this almost certainly meant the hip was not so well supported as my muscle tone went for a burton, which meant the rate of decay accelerated and left me compromised in my recovery. I'm back out there now, on low level walks, around 4-6 miles.
4. Some people do return to their former sporting activities, but do manage your expectations, and don't get back to it too fast, and don't assume you;ll get back to the same level. The implant will take a long time to bed in, and the soft tissue damage needs to heal properly. It's not a race. It's important to listen to your body and not set artificial deadlines or compare yourself to others. We all heal differently. Let it do its job.

I hope this is helpful. To sum up, they're both right. Hip replacement is "extreme pain management", for use when all non-surgical options have been exhausted and your quality of life is severely compromised, ie the pain has become unbearable and/or the loss of mobility is severely impacting your daily life. It sounds like you're getting to that point. You'll have good days and bad, but I hate to say it, it's not going to get any better. OA is a bio-mechanical degenerative condition, that natural remedies barely touch. Stave it off as long as you can, THR isn't a pleasant experience and you've got to be pretty desperate to want someone to do that to you, but your life will be very much better after, if not quite where you were before it all went wrong, and you do need to treat it with respect.

Deeryx

Thanks so much for your advice and experience, and for taking the time to provide such detailed comments.

In relation to Lilymary's comments, yes I have had a couple of injections and it gives me about 6 weeks respite from discomfort. When I use NSAIDS it is usually Naproxen, which has the stomach protection. Interestingly, laser treatment on the side of hip was one of the more useful treatments. Lilymary's experience makes me think that I need to be in more pain or discomfort before undergoing THR- right now, in my mind, I cannot just convince myself that I will be so much better afterwards compared to now to justify the surgery. Part of the pressure (self-imposed!) is that given that I know I will have to have a THR at some point, I just want the decision to be out of the way - but I'm not sure that is a good reason. Also as I have had three years of periodic discomfort (rather than full-on pain) since the problem arose, I am worried that I may just be wasting time and could have a better life if I just had the op.

As you can see I am agonizing over the decision but ultimately I feel I should be fully settled in my own mind before going ahead. Thanks again for your help and if there is anyone out there that may have simeilar dilemmas I would be glad to share.

Lilymary

It is difficult. One of my friends who had her new hip last year came on here in a panic a few weeks before the op saying "It's been ok lately, what do I do? Postpone it?" She had been badly immobilised by it up to then. Given that places for hip surgery are rarer than hen's teeth at the moment, we suggested she was just going through a good patch and she should go ahead. As it turned out, we were right. She went back to agony shortly thereafter and was extremely glad to have her new hip.

I'd measure it by the impact the damaged hip, particularly the pain levels, are having on your life. Mine all went wrong during the chaos of 2020, and by the end of the year I could barely get round a supermarket, leaning on the trolley, on max strength pain relief. It took me an hour to get round the village - less than half a mile, in dreadful pain. When they told me in Dec 2020 it would be another 18 months before surgery due to the effect of the latest lockdown at Christmas, I caved in and raided our piggy bank and went private. I simply couldn't have done another 6 months, never mind 18. So for me the decision was a no brainer.

While it's not great having this hanging over you, if you're managing reasonably well at the moment, you might feel comfortable deferring it a bit longer. But given the waiting lists you may be in a very different position by the time the date for surgery comes up. I'm not sure what the waiting lists are atm, (they'll vary across the country) but I'd be surprised if it's less than 12 months on the NHS. It was 4 months even going privately.

I've not heard of laser treatment. What did that entail, out of interest?

Btw, naproxen itself doesn't have integral tummy-protecting powers (I was on this too) - it needs to be taken with something like omeprazole.

Deeryx

Thanks Lilymary

I'm coming to the view that to submit myself voluntarily to surgery (which would be my first ever stay in hospital) the potetnial post-surgery gains over where I am at now need to be more significant than I currently perceive they would be. I'm still going to the gym, climbing stairs, walking (albeit not as long as before) - so I think I will push it out for a bit. I'm in Ireland and luckily I have health insurance that will cover all the costs, and the waiting list for the consultant is about 6 weeks, so not too bad. Interestingly, and as an aside, many patients on the public waiting list over here (which is long) are choosing to have surgery abroad in Spain, France etc and this is fairly immediately available and paid for by the state.

My phsio uses cold laser tretament which research shows to reduce inflammation of both joint and soft tissue and to aid healing. I have certainly found it gives relief and I even invested in a belt/brace that I can use at home that provides infrared heat and laser treatment- 20 minutes per day- also helps with managing symptoms. Laser therapy is defintely worth a look for soft tissue damage/healing. I've also recently taken to winter swimming in the sea- well 'dunking' really- for a few minutes every day. It certainly takes my mind away from any other pain I have☺️