The old saying "Wait until you can't stand the pain any longer" holds true ONLY if you are going to have a THR.  It is not the case with hip resurfacing.  With hip resurfacing there is a window of opportunity and ONLY a qualified and experienced hip resurfacing surgeon can tell you for sure whether or not you can afford to wait. 

Here is a patient (with his permission) that posted on the surface hippy message board inquiring about hip resurfacing, then waited and posted again, and continued to wait and wait, until unfortunately his hip deteriorated to the point that he no longer qualifies for hip resurfacing.  I am sure Richard will be very happy with his THR's if that is what he ends up getting, we will post updates to his story as it unfolds.  But for those of you thinking that you should wait, you should read this. Thank you Richard for sharing your story.

Richard's Story 

Fri Mar 28, 2008 1:46 pm  Message #134398

Thanks for your reply. I'm 63 (today, in fact) and fairly active (or was). I am getting to the gym three times a week and would like to get back to hiking in the White Mountains which is definitely out till I've got new hips.  At the moment, the pain is pretty tolerable. I was just out shoveling snow without any problem, but I can't stay

upright too long or walk too far (especially uphill), and I don't sleep comfortably, so I'm thinking about moving ahead with the surgery sooner rather than later. Thanks for your cell number and I may call if I get further along and start having more specific questions. Again, thanks.
Richard Backus

Mon Sep 29, 2008 3:57 pm  Message #141413

I sent x-rays to Dr. Su and was told I was a candidate for surgery.  They planned to schedule my right hip which shows greater  osteoarthritis. The problem is I've been swimming and doing yoga and both hips are feeling pretty good (and taking maximal dosages of acetaminophen and ibuprofen), so I'm thinking maybe it makes sense to defer the surgery until I'm actually in significant pain. (I have had considerable pain in the past but never anything I would call excruciating.) The other advantage of deferring is that in a year and a half I'll have Medicare as well as my regular insurance (and thank God for that!) I took my dog for a one and one-half hour hike (on a level rail trail) today and both hips feel good, not perfect but good.  I'm not sure I'll be eligible for hiking Mt. Monadnock any time soon and I'd like to do that kind of hiking, so my lifestyle is affected.  Guess you could say I'm conflicted about going ahead or not. And I suppose the answer is: I have to decide for myself, right? Just thinking out loud, but if anyone has any advice, I'll be happy to listen.

Richard


Thu Jul 8, 2010 7:03 am   Message #159066

Hi, All!

I have been largely "lurking" but benefiting from the discussions. Yesterday, I saw Dr. Su in NYC about my hips which have been hurting to some degree or other for 6 or so years, my right worse than my left. I had come close to simply scheduling surgery a year ago in January 2009, but realized at that time that my hips were hardly hurting (although, admittedly, I couldn't go hiking in the mountains or anything of that nature). Thus, I postponed, but over the course of the last few months, my hips had clearly gone downhill, and I decided it was
time to have surgery.

I anticipated that Dr. Su might agree that my right hip was ready for surgery but that I could wait on the left hip. I also worried conversely that I might have postponed too long. Indeed, looking at the x-rays, Dr. Su started with my left hip, noting that there was some space, indicating cartilage in a large section of the joint but that it was bone on bone in one notable area and that therefore the osteoarthritis was severe. He noted a darkening area under the bone-on-bone section and said it indicated a developing cyst. It reminded me of dental x-rays when the dentist points to an area and says, 'You see that? That's decay.'

However, I was already looking anxiously at the right hip where even I could easily see what looked like a tunnel as though someone had stuck a pinky finger into a rotten apple. When Dr. Su turned to talk about that hip, he noted the large cyst and the general deterioration of the femoral head. He said he could go ahead with a resurfacing but he thought there was a good chance it would lead to a revision, and it was clear he was leaning towards a THR for both hips... at the same time! I knew a bilateral was a possibility but had no idea I would be
a candidate.

I am encouraged that he would use metal-on-metal for the THR which would mean the same larger femoral head component that makes the resurfacing so stable. I could, apparently, go confidently for a resurfacing on the left hip, but I'm inclined to accept the idea of a THR on both sides, particularly as he indicated he could lengthen the left leg a little, noting that it was slightly shorten than the right (something I've long suspected) and probably was since birth.

At 65, if the THRs last 15 years, I think I will have gotten good service from them, although one grandfather lived to 92 and I aim to beat his record. Of course, it's certainly possible that the THRs could last that long.

So... the bad news is I'm not a good candidate for resurfacing, but the good news is I will have similar stability and range of motion and will get both hips replaced at the same time. Unfortunately, Dr. Su is so popular I can't get
scheduled until November. I hope that my "rotten apple" of a right hip won't collapse entirely before then.

I'd be interested in any thoughts or comments.

Richard, bi-lateral THRs, Dr. Su, pending

Update September 27, 2010

Rosy Hips

When I saw Dr. Su in July, September 24th seemed a far way off, but then, suddenly it was here and time for my wife and me to drive to NYC to have both of my hips replaced. On the drive down, I was called to say I was scheduled for surgery at 2:30 in the afternoon.

I ate the low residue meals they had instructed me to do, and did the rest of the prep work that night, went to bed and slept very well, despite the pending surgery.

At three hours prior to time of surgery, I walked across the street to the hospital and checked in. It was starting to feel real. The only problem was people kept saying, "Now, you're having a bilateral resurfacing," and I would say, "No, that's not my understanding." The P.A. who came in had to get my consent to the surgery and I couldn't consent to one surgery and have another. Yes, I know this group is about resurfacing, but when I finally broke down and went to Dr. Su for resurfacing, I had waited too long. (More about that later.) He looked at my x-rays and said he advised a total hip replacement on my right which was too far gone and thought the left hip would also be better with a THR although he did say if I insisted he would attempt to resurface both. I had counted on a resurf for several years (too many apparently) so I was a little disappointed, but then he said he would use the Birmingham THR system which, like their resurfacing prosthesis, has a large metal femoral head that doesn't require the special precautions of typical prostheses (no crossing legs, no toeing in, etc.) and I was really happy to hear that. We left agreeing to call when we'd made a decision. But, I had liked Dr. Su from the moment I met him, the Hospital for Special Surgery has an incredible reputation (and well-earned), and it seemed to me I should trust the doctor I had carefully picked. So, before we headed back I said yes to the hip replacement.

But back to the question of the documentation that said hip resurfacing. I thought perhaps Dr. Su had decided to make that final decision after he cut me open and saw what my hips looked like. I know from this group that he has on occasion planned to do a THR and then found the state of the hip merited a BHR. But when Dr. Su came in, he confirmed that a THR was what I was getting and the order was changed. As I waited for surgery, I was surprisingly quite calm. I get agitated making decisions but once they're made, I stop worrying about it. (Though I did have a short period of second-guessing after I got home which an anxious posted to this group helped me get over.)

At 2:30 they rolled me into the operating room, the anesthesiologists introduced themselves to me, put something in my IV, and the next thing I knew it was 6:30 and I was in the recovery room.

And I was feeling GREAT! Well, except for the lower half of my body which had no feeling at all. It was 6:30 so the operation (operations) had taken close to 4 hours. My wife came in and couldn't believe how alert and "perky" I was. I'm telling you, not having a total anesthesia is the best!

Patrick, a terrific nurse, kept checking to see if I was having any feeling in my toes, and gradually it started to return. But I felt almost no pain from the surgery at all. Now, admittedly I was on a "morphine drip" (I don't know if it was literally morphine), a pump which gave me a dosage of pain killer on a regular basis and also had a button I could hit every ten minutes for an extra dose.

I had brought two books I was in the middle of reading, plus my e-reader. My wife left me one of the books, thinking I would be wiped out and ready to sleep. Not so. I was awake until 2:30 am, having finished the book at 10:30. I was still feeling very little pain, perhaps a 2 on the scale of 1 to 10. And I'm thinking, "This is a breeze." Of course, I was pumping the pump every 10 minutes. I was NOT being brave about that, and everybody I've spoken to (including personnel here at the hospital) has told me not to be a hero and wait until the pain gets bad, but to keep it under control from the get-go because once its bad, it's hard to bring it back to a tolerable level quickly.

At 2:30 am I finally dozed off for about two hours. I woke up to a pain level approaching 6. Ouch! I suppose it was the pain itself that woke me. I hit the magic pain relief button, and waited for what seemed a half-hour for the 10 minutes to elapse so I could self-administer again. There seemed to be no countering the pain which was increasing. I called out to a passing aide or nurse, and got pain pills.

The only other excitement that night was hearing strange sounds from the morphine pump and becoming paranoid that I was getting an overdose. Not so, of course, and just the anxiety of someone who had never had any surgery before.

The next morning, Dr. Warschauer stopped by to check on me. He had given me medical clearance for the surgery, and I had liked him and trusted him immediately (even if he did say his favorite movie was Texas Chainsaw Massacre). He said he was a little concerned about my blood pressure which had been low at times. Earlier, he had said I wouldn't need a transfusion (I was glad since I hadn't banked any of my own blood), but now I wondered if he would change his mind. He didn't. I drank plenty of fluids; my blood pressure came back up.

Two PTs arrived, one for each hip. They asked me to sit up in bed. Merely doing that was excruciating. They asked me to scootch over and dangle my legs over the side. Excruciating. They helped me into a standing position. Excruciating. They had me walk two steps forward and two steps back. Everyone had told me that doing PT can be more painful than the surgery itself and that the first session of PT was by far the worst, but it was now Saturday and I couldn't imagine going home on Tuesday as they had suggested I might.

Through the day I kept waiting to be sent to a semi-private room. I saw patient after patient moved out of the PACU, but I was never one of the chosen ones and the hospital happened to be full to the gills, so finding the bed was proving difficult. I began to anticipate another night in the PACU which, admittedly wouldn't be terrible, since it was now quite quiet and I would have a whole PACU staff to myself and all of them very nice.

Finally, someone came and announced, "We found a room for you!" I cheered. They said, "No, not you", turned to the other man and said, "You." Time passed. Patrick came back on duty. Imelda said good night to me and left. Finally, someone came in and said she had a choice for me. There were absolutely no semi-private beds available, period, so I could either stay in the PACU which would stay pretty quiet or... I could move into a private room just for the night at the same rate as a semi-private room and then move again the next day when a semi-private became available. Did I want two moves or just one? I took the private room, and when I moved into it, it proved to have windows to the west and north where I had a spectacular view of the East River. I couldn't believe my luck, even though it was only for one night.

That night I slept wonderfully. Though people came in to check my vitals and to give me pills a number of times during the night, I fell right back to sleep again. My wife came by at 10:30 am and enjoyed the view. My son arrived at 11 and also enjoyed the view. Friends visited in the afternoon. No one came to kick me out. In short, I am still in that private room with the spectacular view.

And I am feeling great. Exercises that seemed incredibly painful became relatively easy to do. Relatively. PT got me up and walking to the door of the room and back. Going home tomorrow now seemed possible. And best of all, my wife said she had never seen me standing so straight. And the pain, such as I had, was only from the surgery and not at all from the hips.

Dr. Su called and asked how I was doing and said he was pleased with my progress. He also told me my hips were really bad. Resurfacing is still relatively new and many places don't offer it and doctors in those places think it's safer to stick with the tried and true total hip replacement. Consequently, the word is to put the surgery off for as long as you can until the pain so bad it drives you to surgery.

My experience is that that is not the thing to do unless you have special reasons why surgery might be especially dangerous for you. When I was originally diagnosed, I had gone to my doctor and said that I thought I was having some kind of sciatica or pulled ligament or something. I was just having a slight range of motion issue, not a lot of pain, but when the MRI was looked at, the diagnosis was "severe osteoarthritis." It was not "shows signs of osteoarthritis" or even "moderate to severe osteoarthritis." Yet my pain was quite manageable. What I now know I should have done was to get x-rays sent to some of the doctors, world-wide, who will read your x-rays and give you a opinion. And some of the best do it for free. Then, if you have done your research and have found the right doctor, follow their advice. If they say, you don't need resurfacing quite yet, put it off. But keep checking in because, to quote Hamlet, "if it be not today, yet it will come." There is of course some risk with any surgery, but I spent six years, mostly having my lifestyle very cut back and the last 9 months, I was hobbling around in pretty solid pain. I am looking forward to a new day.

Richard Backus