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    Old 02-28-2008, 06:30 PM   #1
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    Please help...I'm 31, what material is best for a new hip replacement?

    Hi,

    I am new to this site and I am very confused as to the best choice to make for a new hip. I am 31 yrs old. I was born with hip displasia, and had an osteotemy at 8mo. old. After I had my second little boy, who is now 4yrs. (1st was a crash C-sec) 2nd V-Bac; my hips started hurting more than the normal arthritis pain that I had experienced in the past. I had taught water aerobics and weight training before and during my pregnancy, so was in good shape for his birth, but my hips haven't felt the same since. Although, I wouldn't give up that natural birth for the world...it rotated my hips into a new position. After 3 yrs of limping and pain, while finishing up at night school, I finally couldn't take it any more and went in for fluoroscopic injections (I will highly recommend them for pain), however, only the first one lasted longer than 8 mo. (which was well worth the pain relief) The next one wore off in about 3 mo.

    I went in to an orthopedic specialist in Nov. I learned that I had a cyst on the head of the femur. All of the ligaments are torn up or gone. The bone is deterating fast, and he said that I needed a THR but was too young. He wanted to put in a metal on metal replacement, because I was so young and active, but scared because I am of child bearing age. Well, I have 2 boys 8 and 4 and explained that we are pretty much done. He still seemed unsure, and sent me to an osteotemy Dr.

    The osteotomy Dr.said that he could help, and felt that my bone deterioration and arthritis wasn't to the point that the osteotomy wouldn't work. This was Nov. 26th. Sorry this is so long, I am very confused. I was scheduled for a GANZ osteotemy on Feb. 25th, 2008. Jan 29th, I came down with pneumonia and have been on antibiotics ever since. We had to reschedule the osteotomy for April 1st. Anyways, the pain in my hip has been so severe, worse everyday, it pops in and out while I am asleep, and the pain wakes me up and I have to pull it back into place, very painful. So I went in two days ago, to talk about possibly getting another shot to hold me over, and after he looked at the X-ray (he took that day) --all of a sudden he explained that I m pretty much out of luck now. My bone has deteriorated so much in the past 6 weeks since my last X-ray that he doesn't think that the osteotomy will give me complete pain relief. Well 80 to 90% for 2 yrs guaranteed 4 to 5 yrs max, and then I would prob. have to have the THR anyway. But, my hip is so screwed up due to the previous osteotomy, bursitus, etc., the surgery is difficult to begin with, let alone, I would probably have problems after the surgery due to all of the large scars from all of the other surgeries that I had as a child. OK, this Dr. said that I should get a ceramic on plastic hip replacement.

    I'm not sure which one to get. I have been trying to find out which one is the best for my age, but it's really hard to choose. I am wondering if anyone has any suggestions about what materials are the best for 30 something, active people, who don't want to under go multiple revisions. The first hip guy said that if I start a THR now, I could end up in a wheel chair at an early age, and now due to the bone deterioration, I am being forced into it. We have already talked about hiip resurfacing, it will not help all of the various problems that I happen to have. My sockets are way to shallow and square. I have been told hat they would be very hard to operate on. Any suggestions about what type of hip replacement is the best?

    I keep reading that the metal on metal gives a wider range of motion, but has the metal on draw back...any feedback on this? I have read that some people have had reactions to the ion debris left in their bodies, has anyone experienced this?

    Then, I am concerned about the ceramic. I have read that they do not get good range of motion and can break easily. Does anyone have a ceramic on plastic that can give me feedback? Ceramic on ceramic? I have also been wondering about maybe metal on ceramic? Is that possible? Any other choices? Anyone have any ideas on what would last the longest with the best benefits all around? Any input would be greatly appreciated.

    Thank you,
    Melissa

     
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    Old 02-28-2008, 08:58 PM   #2
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Hi. I'm a little older than you (50) but have been reading up on some of this stuff in preparation for visit with orthopedic surgeon. Others here have loads of practical experience, but I thought I'd share what I've read and then maybe they can give you the real practical advice

    In the traditional metal and plastic hip replacements, the plastic wears out slowly over time. As the plastic wears out, small particles of plastic debris are generated. This plastic debris triggers a response by your body which can lead to loosening of the implants over time. BUT Plastic wear is very slow--an average of 0.1 millimeters each year. Overall, the doctors have most data about these kinds of replacements as these have been used the longest and have successful history.

    In a ceramic on ceramic hip replacement, both parts (the socket and femoral head) are ceramic. Ceramic articulating (rubbing) against ceramic exhibits lower friction than metal on plastic or ceramic on plastic. This apparently leads to less wear of the liner and possibly to a longer-lasting implant. Because of the limited wear, sometimes a larger femoral head can be used, which would decrease the risk of dislocation. These implants haven't been in use as long as the traditional metal and plastic ones and so there's not enough data to tell how well they will work 10, 20, or 30 years after they have been implanted.

    One of the most concerning complications of ceramic hip replacements is that they have demonstrated a small rate of so-called 'catastrophic failure.' Because the ceramic hip replacement material is hard and brittle, it can crack, much like a ceramic dish dropped on a tile floor. This used to be more of a problem, but I read that newer ceramic hip replacement implants have been much better. However, I also read that the issue of catastrophic failure is still a concern to many physicians.


    Metal on Metal--again ball and socket are metal and they are precisely machined so that a fine fluid film continuously lubricates ever part of the articulation. According to what I've read, this also allows for a larger head and so risk of dislocation is somewhat lessened. Metal on metal wear out even slower than other types of implants, but the wearing out that does occur with metal-on-metal implants causes the release of metal ions into the body. These metal ions can be detected in blood and urine samples, and the levels tend to increase as time passes. When it was first determined that these metal ions slowly accumulated in the body, people were concerned about higher rates of cancer, and allergy-like reactions to the metal. There have been no studies to show a higher risk of cancer, hypersensitivity, or other adverse effects of these metal ions. This is good news, but it is certainly not the final word. Long-term studies looking into the effects of these metal ions over the course of decades are in progress, but the final results are unknown.

    Hang in there!

    Maggie

    Last edited by Larimergirl; 02-28-2008 at 09:03 PM. Reason: finish incomplete sentence

     
    Old 02-28-2008, 11:53 PM   #3
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Hi Maggie,
    Thank you for such a quick reply. Sounds like you and I have been reading into the same medical journals. I was unaware of the larger ceramic ball though, I thought that it was smaller, and had a more limited range of motion. Thank you for that bit of hope. Unfortunately, I have two Dr.s telling me that both are better than each other, and it is very confusing. One says the metal on metal will last me longer, but is scared to do it, due to my being of child being age (metal ions and all), and the other said ceramic on plastic was better, stating that he didn't want to do a ceramic on ceramic because he had heard that some of them in the field have turned into squeaking hips. However, the wear rate is just phenomenal. Yet, I have read about the catastrophic failures as well, and they don't sound like fun to clean up at all. Do you have a choice that you are leaning towards? Also, if you are going for the metal on metal, which metal were you going to choose, I know there are about three types: titanium, cobalt chrome, and stainless steel?
    Thank you again for the information, I appreciate your time and advice.
    Melissa

     
    Old 02-29-2008, 05:12 PM   #4
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    I don't know how to judge the conflicting information that I read. I suspect each doctor probably trains on a different system/type of implant and then is most comfortable with what he knows best. Don't have any proof of that of course--just seems like human nature. And, it sometimes seems after reading these various articles and books, that the choice is a roll of the dice.

    When do you have to make a decision? Maybe some people who have already gone through this process can give us some insights?

    Maggie

    I'm really interested in hearing what you learn. Hang in there!

     
    Old 03-02-2008, 10:55 AM   #5
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    The last two replacements I have had have been ceramic balls. The previous one had a plastic liner which did fail and this resulted in me needing my hip replaced for the 4th time in '06.

    My new hip is still ceramic with a metal liner instead. The range of motion, from what I have found from one of the foremost best hip replacement doctors and researchers in the US, Bernard Stulburg (sp) is that it is not based on material, it is the size of the ball. The larger the ball the greater the range of motion and the less chance of dislocation.

    Hips today should last 20 years, all parts independantly replacement and non cemented with the research I found and the many disccusions I've personally had with my doctor. Trust me having 4 hip replacements by the age of 40 is something I do not take lightly.

    I strongly suggest 2nd and 3rd opinions before rushing out for the surgery itself. Educate yourself on the "after life" of the surgery and amount of pain you may or may not have.

    Like you, I have masses of scar tissues from so many surgeries. Most doctors have reopened the previos incisions and the last doctor, Stulburg, actually cleaned out masses of scar tissue. The problem with scar tissue is that it will regrow back, there's nothing that can be done about this at this time. There is some experimention going on with scar tissue prevention but I am not sure that in the US it's actually being used.

    Lastly, a good ortho will never use a socket with a plastic liner. In fact they are incredibly difficult to get anymore.
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    Last edited by Kissa; 03-02-2008 at 10:57 AM.

     
    Old 03-02-2008, 03:20 PM   #6
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Hi Kissa and Maggie,
    Thank you so much for the information. The more and more that I read, the less and less I want to do this. I keep looking at the limited range of motion. I am a swimmer, and breast stroke is my fav. stroke, Kissa, with your replacement, would you still be able to move your hip into the outward position without dislocating it? My husband and I have definately been thinking about going back to the first hip replacement ortho guy. He seemed to have a bit more insight on the type of ball and sockets that should be used in younger patients.

    Kissa, I am so sorry to hear that you have had to have so many revisions at your young age. I am very surprised that you have still had the ability to have that many. I now that you have suffered, however, you should feel blessed in a way; that you have had the ability to have more than the average amount of hip replacements than most people can in a lifetime. God has definately blessed you. Does your ceramic ball give you a large range of motion? Were you able to get a large size? What about the metal and ceramic rubbing together, was there any concern for fracture or squeaking? How do you like this replacement?

    I have seen at least 4 ortho guys. My husband is Navy, and the military one, took one look and said there was absolutely nothing that he could do to help. The second one that I saw, was after the birth of my second son, and he was the first one to suggest the osteotomy (4 1/2 yrs ago). At that time I decided to deal with the pain by taking 800 motrin. Then after a year passed I finally was limping for over 5 mo. straight and I couldn't take it anymore and got the 1 st injection. The arthritis pain has been there since I was a young child. I have had at least 4 or 5 surgeries as a child.

    The pain now has gotten to the point where it pops in and out while I sleep. This just started. I can be walking and feel the head of the femur twist and I can do nothing to stop it, sometimes it pops in and out...sometimes it just twists, and I have to just stop and wait for the pain to subside. I don't limp constantly, however, it is daily, only when I have been on my feet for more than an hour or so. I also have bad bursitis. I was going to see if I could have the bursa removed while he was doing this surgery anyway. I just keep questioning whether I am at the point where I need a replacement.

    Obviously, my bones are deteriorating at a very fast rate, if they deteriorated to the amount of changing the type of surgery that could be done in 6 weeks. I have been told by all the Dr.s that if I do nothing, I would need a hip replacement in 2 yrs., but that was looking at my X-rays in Nov. not the most recent ones, so who knows. I am scheduled for April 1st...this is a tough decision to make when you still have a lot of revisions to look forward to.

    Kissa, what caused your hip replacement at such a young age, and what was the cause of all of the early failures, if you don't mind my asking?

    I just keep looking at my two little boys; and yesterday we were at a skating party and my oldest fell down and started to cry, I excused myself from the conversation and ran to him, it hurts...but I was still able to run to him. I keep thinking about not being able to run to one of them if they need me in an emergency. How mobile have you been able to be throughout the years?

    Sorry for all of the questions, its really nice to hear from some one who has gone through this before.

    Thank you for taking the time to share your insights with us.
    Melissa

     
    Old 03-02-2008, 05:26 PM   #7
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Hi. I don't have young kids, but I can understand your fears about the rest of your life. I don't know if I'm ready for this either (I'm a swimmer too, but am already limited in the kinds of kicks I can do). I think Kissa has best experience on most of the questions you raise, but I thought I'd put in my two cents too. (So happy to have found another newbie to talk to about this stuff).

    One thing that hit home with me and got me really going down this path was a comment from my internist after my annual physical in Jan (and xrays showing bone on bone in hip): She basically said "It won't get better. Eventually, without intervention, your limitations will increase and be inevitable. " Then she repeated "It won't get better" several more times.

    She then went on to say that while she wouldn't push me towards surgery, she'd hate to have me wait so long that I run out of options for less invasive procedures. Her comments just startled me--I'd been focusing for a long time on just avoiding surgery that it was like a slap in the face--I guess I'd thought if I did everything I was told to do--lose weight, exercise, stretching, physical therapy--that somehow the arthritis would be arrested and it wouldn't get worse. (Magical thinking I guess)

    I had seen one orthopedic surgeon three years ago and he told me to wait till I couldn't stand it anymore--but, frankly, I have a really high pain tolerance and also a push, push, I'm going to be independent attitude-this makes it difficult for me to know exactly if I'm in "too much" pain. So trying to decide if it's time is hard.

    But, I know that while I can cope with routine activities. If something happens, or I have a strong workout at the gym, and I push myself too much I limp for days and am awake at night with pain. Even when I don't push myself, I have pain at night and wake up several times during the night. So, I'm starting to think it's time. If I had to run across a street, I wouldn't be able to do it. If I had to run to help a niece or nephew or even chase one of my dogs, wouldn't be able to do it.

    One of my friends had hip resurfacing when she had younger children. Two years later, she says she sometimes forgets that she had the operation at all--but she will admit it took a good six months to really feel strong and a year before she close to normal. Her kids say they are glad she had the surgery because she's able to do more stuff with them now.

    Don't mean to go on about myself, but just wanted to share my doctor's statement-------------From all that I've read here, no surgeon can guarantee progress but lots of people seem to go on to recover quite a bit of mobility and do lots of activities...but from what I've read too--all this takes time and first six weeks are hardest and adjustments/special precautions need to be taken to avoid dislocation through those six weeks and really sounds like maybe through first six months.....I think this process is really scary and sounds like a lot of people here had the same kind of fears we have before they had the procedure---I am trying to learn as much as I can before going to see my new surgeon at the end of this month--because I have the theory that this will make me calmer when I hear what my options really are. (I'd really like to qualify for resurfacing and my doctor has, I'm told, quite a bit of experience with this procedure and comes highly recommended by some other doctors.) Probably though I'll just worry all over again--fortunately there are some really nice people with experience who respond to questions and comments.

    Take care.

    Maggie

    Last edited by Larimergirl; 03-02-2008 at 05:36 PM. Reason: insert new sentence

     
    Old 03-04-2008, 01:15 PM   #8
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Hi Maggie,

    No don't apologize, please feel free to share...that's what we are here for. I enjoy the conversation. We are all here to learn from each others experiences.

    Have you looked into a possible PAO osteotomy to prolong the life of your hip? That was my only choice due to the bone deterioration. I had asked my Dr. about resurfacing as well, and it doesn't look like I am a candidate because of my bone loss. However, if you are....that would be my first choice, osteotomy second, then THR last.

    I guess I'm at the last resort. Unfortunately, they have told me that mine will not be minimally invasive due to my previous osteotomies and I will take just a little longer to recover. The osteotomy/THR DR. said that it was going to be a difficult surgery, however, he felt confident that he could do the surgery.

    I totally hear what you are saying about the night pain. I have learned to prop up my hip with a barricade on that side with pillows or blankets so that it doesn't turn out so far, and it hasn't popped out of place recently in my sleep. But it does throb, and every ,morning it is hard to get out of bed.

    I felt the same way you did about prolonging the inevitable, I guess. Maybe I could just put it off another ten years of so. Unfortunately, I have been told that I will have to have it done anyway in a year and a half due to the bone loss. There is a small bone, the size of a dime holding the head of my femur in place, and if I loose this piece (due to deterioration) I could possibly miss my chance at having a replacement at all. Due to how shallow my socket is, they need that piece to make a deep enough space for the implant.

    I'm thinking about going skiing in the next week or two, I have never been in my life, we live in WA, and I will probably never have a chance again. So, I thought I should do a couple of things that I may never have the chance to try. Hopefully I won't hurt myself too bad...hehe. I figured I'd stay on the bunny slopes with my 4 yr old. I'll have to talk my husband into letting me go.

    I go in tomorrow to talk to the osteotomy/hip replacement guy. I have an appt with him to have it replaced April 1st. Now, I just have to figure out what type of implants I can talk him into using. I talked to the other DR. that likes to use metal on metal yesterday, and was told that he really didn't like to use ceramic due to their failures and clean ups after a break or fracture. I guess I'm stuck with metal on metal then? What else is there?

    We'll see how it goes tomorrow. Have a good day!!

    Melissa

     
    Old 03-04-2008, 05:22 PM   #9
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    I skiied a lot when I was in high school and college. Then I moved to Tx and found out how much it cost to go skiing in Colorado! Aack. Aside from skiing, though, my favorite activities have always been swimming, riding bikes, walking and exercising in the gym. After my annual physical when I saw the xrays of my hip, I was fretting to a male friend who has known me since I was 20--about all the things I might not be able to do. We had just watched some show about traveling in the rain forest and a woman about my age had hitched herself in a harness to go above the trees on a high wire. I'll never be able to do that, I'll never be able to rappel down a mountain or then went to list a string of things. Ummm, he said, what were your favorite activities when we were 20? What do you like to do now? Ok, what's your point I snarled. Well, you've always liked to ride bikes, swim and walk. When have you ever rappelled, climbed a mountain, and stuff like that? Oh shut up. I'm trying to catastrophize here..............

    If you go skiing, have a good time.

    Maggie

     
    Old 03-04-2008, 10:21 PM   #10
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Glad I am reading the board tonight. Stay away from the plastic. I wish we had known. My hubby had his first set of hips done about 16 years ago. He was about 40 and because he was so young the dr said it is the glue that wears out so they just stapled the hips in and the bone grew over it. We thought they would last forever as long as he didn't run or fall and shatter the hip. His first hips were ceramic. He did great for years. Took up golf. Last year he started complaining of pain. Back to surgeon. The plastic liner in the cup had worn out and he had inflamation all around. The surgeon contacted the manufacturing company and they still made the same joint so they had the parts. The company wouldn't warrenty the cup unless the ball was changed out so titanium was used. The surgeon wasn't thrilled with the this particular hip but his partner had done the first one so he wanted to stay with the same so he could do a revision and not a total replacement. It went very well. We were just shocked though as we were never told about any plastic and we thought the hips would last. We still think it strange at the same time he developed hemolytic anemia but we have been told there is no connection...
    Anyway, last week he was hurting alot. Back to the surgeon. Well, some of the plastic got behind the hip part not redone and now he has to have another total hip replacement. The dr says there is no rush unless the pain is too great. He knows he will feel so much better and after my back surgery and recovery he will probably go get it over with, unless he just can't give up playing golf in the coming summer, then he will try to wait.
    I appreciate having learned about the different types of hips. thanks for the info.

     
    Old 03-05-2008, 05:08 AM   #11
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    HI Mel52,
    When you say they replaced the cup with titanium, and replaced the ball, did he keep the ceramic ball? I have been reading about this procedure lately, ceramic ball and metal lining. Is this a new procedure? I had asked the first DR's sec. about this (OK she is a secretary) but she had said that this guy (we can call him OS1) wanted to shy away from the ceramics due to the fractures and cracks. The OS that I am seeing today (OS2 - I am scheduled for a THR with OS2) likes to work with ceramics, however, he is the one who had suggested the poly lining, but everything I have been reading tells me that I will not be getting that one. I will ask him about the metal lining. He had told me that he didn't want to do the ceramic on ceramic due to the possibility of a squeaking hip. I have been contemplating this, and due to the fact that God might want to give me one more child in the future (plus we don't know the real long term effects) I am kind of shying away from the metal on metal (ions and all). It saddens me though, because I know that the metal on metal gives such a larger range of motion and a lower chance of dislocation.

     
    Old 03-05-2008, 05:12 AM   #12
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Maggie,

    That is so funny that you say that, because I have been saying the same thing to my husband. Especially about never being able to run again, and he keeps saying, "Since when do you run?" Which I crack up and laugh, because it's so true, I have never been a runner, I was always the kid in the very back of the track when everyone was doing their mile in like 6-9 min (we had some fast kids in my class), I did mine in like 10 to 12 min. I could never run, it hurt too much. My hip has always been a problem. I was able to do gymnastics, but not run...hehe.

     
    Old 03-05-2008, 12:44 PM   #13
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Liquidnice, they had to replace the ceramic ball with titanium or the company would not warrenty the parts. He no longer has any ceramic

     
    Old 03-06-2008, 10:18 AM   #14
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Hi all,
    So, I went in yesterday with all if these great questions and now I am somewhat confused. The OS2 now says that I should wait as long as I possibly can to get the hip replacement. I was under the assumption that I was ready now. He said that yes my bones are deteriorating at a fast rate, but they will all be removed anyways, so it doesn't really matter how bad the get. I was not told that by OS1. He had explained that I couldn't loose too much bone or they wouldn't be able to replace the hip. He said that he knows I'm in a lot of pain, he can see it on the x ray in he hears me, I don't have to copnvince him, he said that he would do it whever I am ready.

    So now I'm thinking of not getting it. I am physically fit, somewhat, hehe...except for my bum leg. I was thinking that I am pretty bad (leg pain) from about 7 pm to 9 am, and that maybe I should wait until it is constant all day. I have it through out the day, with popping and pinching, and I was trying to clean house today, but I don't know how long I can stand for. I guess I thought I was OK during the day, but lately, I have spent most of my time in the pool, driving, or on the couch, so I have not been doing a ton of walking around, but whenever I do, I now notice more that it hurts. My husband says that I limp on it constantly, but I don't notice that.

    I'm so confused. How bad should I let it get? The DR. said that was up to me? When did you guys know that it was time? I would like to get back to normal and get a job, but I don't think that I can work standing up for more than an hour without pain. That would be one of the reasons I would go ahead and do it now, just so I can get back to normal, cleaning my house, doing odd jobs around the house, being able to do more with the kids, being able to get out of bed in the morning without pain, and get a job.

    Any input?

     
    Old 03-06-2008, 11:25 AM   #15
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    Re: Please help...I'm 31, what material is best for a new hip replacement?

    Hi. Drs. have said same thing to m--that I would know when it was the right time. I still don't know how to answer the question. I'm getting more and more uncomfortable though and would hate to wait till I need a cane or wheelchair to move around.

    I quizzed one of my surgeon friends at the gym and he said (speaking very generally) that many patients have surgery when one of these criteria are met:

    Pain is constant and interferes with most activities of daily living.
    Pain occurs when you are at rest or interferes with sleep.
    Pain not controlled, even by narcotic analgesics.

    That being said, he says that tolerance is different with everyone. Surgery is the same if you are having THR no matter whether you are moderate or advanced with deterioriation.

    It's so frustrating not to have a clear guideline. I'm not slated to visit my doctor for three more weeks--so who knows what I'll say after I meet with him--but I'm starting to think that the basis for my decision is going to be whether I'm willing to put up with the progressive/ongoing restrictions in my ability to move. I can still cope with day to day activities and do what is needed, but if I go outside comfort zone and push myself, I'm in enormous pain.

    So, question to consider might be how much restrictions are you willing to live with, how high is your capacity to adapt? What I am realizing is that my world is slowly getting narrower and more restricted and I hate that.

    Anyway, keep on posting. I'm so happy to have found someone to talk to about this stuff and who has same worries-even though different circumstances--I don't have little kids to worry about.

    Take care

    Maggie

     
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