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  1. #1
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    Am I ready for a Hip Replacement?

    I'm on the waitlist (Canada) for hip surgery and am going on 9 months now. I really am not looking forward to this surgery as I fear a big loss of my way of life. I ski pretty hard, dirtbike (trail), windsurf (poorly) and just got into Mtn Biking (including downhill). I'm 52. The Doc says my left hip is end of stage arthritis. I ache during the day but don't limp. Nights are the worst and the lack of sleep was getting to me but I just started taking a small amount of sleeping pill so am finally catching up on sleep and feel human again. I take small amounts of pain killers.
    So, the clincher is, I get out on the hill and after a bit of warm up I can still ski hard- trees, bumps, whatever. I take breaks each run and I feel a bit awkward compared to normal and definitely am not up to my old level but no way am I handicapped.
    So, the question is- is it possible to need a new hip when you can ski hard?? When the pain is less I definitely don't think so but then I'll have a few bad days. It's amazing though how I so quickly forget the bad times and pain/throbbing when I'm having a good time, even if it was just the day before. I seem to have no pain memory or is it that I'm just not ready yet?
    Anyone else been there, done that? If so, how mobile were you and how much pain did you have before you finally got your hip done? Did you wish you waited longer? (i'm a total hip- they won't resurface me)
    Thanks for any input
    Carol
    Last edited by CarolB; 03-19-2014 at 08:25 AM.

  2. #2
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    Try a full spectrum approach, stretching, massage, rolfing ,acupuncture, & using natural anti-inflammatories like turmeric .Perhaps Chiro if you know a trusted one. The interrelation of structures is mysterious & it's surprising how many problems are symptoms of something else
    Calmer than you dude

  3. #3
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    I was in pretty much the same situation as you, maybe a little worse. Had my right hip replaced last april. The only things my dr. recommends against is running and jumping. I have around 50 days on skis this season. I'm not sore after I ski, glad I had it done.

  4. #4
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    Quote Originally Posted by CarolB View Post
    So, the question is- is it possible to need a new hip when you can ski hard??
    Yes, I could ski fine. Getting out of the car and sitting at a desk was my problem. I had my THR 2/12/13 and have about 80 days of Nordic, 30 Alpine this year so far.

  5. #5
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    Hi and thanks for your replies. Especially for the ones that have said they're still getting in more ski days than I could anyway. I usually only manage ~20/yr between other sports (we go to Baja for 6 weeks/yr). Those 20 days make the rest of my week so much better though
    When I originally though the pain was in my back (small ruptured disc) i had lots of physio, accupunture, massage, stretching, you name it. Nothing worked except massage for temporary relief and, strangely enough, days when I did more intense sport activity. My take is that my muscles are so tight around the hip to help support/react to the situation that they're impossible to loosen without first doing major movements that normally hurt like hell in Physio but that I can trick myself in to not noticing when having fun outdoors. Once I'm looser than I try to stretch more (laterally) but then the viscous circle catches up again during the work week. Stress makes it worse.
    Thanks again to those who responded so far and keep it coming in with your person experiences. I talk to an older person on the waitlist who can't hardly walk and I feel bad for being on the list. But then flip flop and think that just because i have a high pain tolerance and am strong/working at it doesn't mean I should feel guilty, and then i do another flip and wonder if I try to keep going like this.... argh

  6. #6
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    I'm not real familiar with the Canadian Health Care system. When your on the list, do you still get to choose your surgeon and the type of procedure?
    I would choose the best surgeon available, one that's done hundreds of procedures a year.
    I got hung up on the procedure, Anterior Approach, instead of finding the best surgeon. My surgeon ended up chipping off my greater trochanter and now I have more pain than I should.

  7. #7
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    And get a spinal for your anesthetic. There is a small body of literature to suggest better outcomes after surgery. My 3 cents
    I rip the groomed on tele gear

  8. #8
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    2nd the stretching/massage/dry needling approach. Yoga is a good way to commit to regular stretching. Like anything worth doing, you really need to commit to see results.

    The latest evidence I've read suggests that tight, hypertonic muscles are more likely the cause of hip OA rather than the result. Like a lot of medical research, the answers aren't clear cut. Once you have a total hip there is obviously no going back. You cannot stretch those tight muscles with an artificial joint like you can with a real hip. The standard medical approach these days are to immediately go the THA route if your xrays show nearly bone-bone contact, but there are many active people out there with bone-bone contact and no pain.

  9. #9
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    Quote Originally Posted by Shredhead View Post
    I'm not real familiar with the Canadian Health Care system. When your on the list, do you still get to choose your surgeon and the type of procedure?
    I would choose the best surgeon available, one that's done hundreds of procedures a year.
    I got hung up on the procedure, Anterior Approach, instead of finding the best surgeon. My surgeon ended up chipping off my greater trochanter and now I have more pain than I should.
    Sorry to hear about your experience. I hope your situation resolves with time. It sucks though.

    I'm not sure what the answer would be today, if I were to go on the waitlist. The system was just changing when I got on it. Another reason I made the decision to get on with it. I did get to pick my Doc and he's got a very good reputation. He was clear in telling me he would not do the Anterior approach. I looked in to it as it did sound appealing but the studies I showed indicated that at 6 months/1 year there were no differences, just a seemingly faster earlier recovery but the Anterior approach had more risks. I decided to play safe and stick with the Doc with the higher chance (keeping in mind that even great Docs screw up once in a while, I'm sure. Just hopefully not on my shift). The risk of Sciatica with the Anterior approach scared the heck outta me as I had that at the onset of my hip issue. Just shoot me now stuff and very glad it's gone. I hope that's not the pain you are experiencing.
    Last edited by CarolB; 03-26-2014 at 08:34 AM.

  10. #10
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    Quote Originally Posted by jma233 View Post
    2nd the stretching/massage/dry needling approach. Yoga is a good way to commit to regular stretching. Like anything worth doing, you really need to commit to see results.

    The latest evidence I've read suggests that tight, hypertonic muscles are more likely the cause of hip OA rather than the result. Like a lot of medical research, the answers aren't clear cut. Once you have a total hip there is obviously no going back. You cannot stretch those tight muscles with an artificial joint like you can with a real hip. The standard medical approach these days are to immediately go the THA route if your xrays show nearly bone-bone contact, but there are many active people out there with bone-bone contact and no pain.
    Yes, my Doc was clear on how pain is an individual situation. He did say that, if you're young, once you go bone on bone you're likely on the way to surgery eventually so it becomes about when you're ready.

    I do think about how my tight muscles could well have been a factor but I think they were tight due to dysplasia, versus not stretching enough. Massage therapists always say they're crazy tight and once they're that tight in the hip it's easy to damage other muscles/joints if you stretch wrong. If I could go back I'd definitely do more TFL stretching. I'll take your advice and try to commit to more, especially once loosened up after skiing. When I was young I tore my Sartorius I was so tight. Add my love of Moguls and dirt biking with all that and I guess I was a recipe for disaster. Too late to ponder all that though and whether I would have given any of it up anyway (well, maybe the icy mogul days, had I known).

    I agree that Surgery seems like the easy fix so often these days and part of me wonders if that doesn't make our ridiculous Canadian waitlists actually smarter. I can definitely say that I've changed my attitude on what I think I'll be doing after surgery now, versus what I would have said 9 months ago. Hopefully that'll translate in a longer life of the fake joint and a wiser recovery.

  11. #11
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    Quote Originally Posted by detrusor View Post
    And get a spinal for your anesthetic. There is a small body of literature to suggest better outcomes after surgery. My 3 cents
    Thanks for the info. I haven't got an actual surgery date yet but when I do they'll setup an appt to discuss that. I hate general as it gives me the shakes so I'm definitely interested in a local, if possible.

  12. #12
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    Quote Originally Posted by CarolB View Post
    Add my love of Moguls and dirt biking with all that and I guess I was a recipe for disaster. Too late to ponder all that though and whether I would have given any of it up anyway (well, maybe the icy mogul days, had I known).
    Wouldn't blame yourself. Osteoarthritis is arguably most influenced by genetics (and if you were to have congenital hip dysplasia this would certainly contribute), so wouldn't dwell on what you could have done differently.

    The one thing I hope to caution, and I've stressed this in past posts, is that a total hip or total knee is a mechanical device. Like a car, how quickly it wears out is very dependent on how you drive it. Orthopedic surgeons I've spoken to would either a) caution against skiing or, b) recommend groomers, etc. I realize there are many out there that are okay with regular skiing, but these are the exception, not the rule, because there are consequences to every action. The two issues are the torque on the prosthesis and, equally important, what happens when you fall down. Fractures around a prosthesis are no joke, so things like aggressive skiing down hard terrain or trail dirt biking do pose a serious concern. Plus, a revision total hip is a completely different beast than a primary total hip - you only get one good bite out of the apple, so to speak.

    Anyways, something to consider. Everyone has to do their own risk-benefit analysis and this is an intensely personal process. There isn't a "right" answer. Best of luck in your decision-making process. Thankfully, après ski tastes just as good regardless of how you ski beforehand.
    Originally Posted by jm2e:
    To be a JONG is no curse in these unfortunate times. 'Tis better that than to be alone.

  13. #13
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    Orthoski:

    We appreciate your input! What is your opinion on the BHR Hip Resurfacing? The main benefit, being able to have a regular THR revision at a later date.

  14. #14
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    Quote Originally Posted by Orthoski View Post
    The one thing I hope to caution, and I've stressed this in past posts, is that a total hip or total knee is a mechanical device. Like a car, how quickly it wears out is very dependent on how you drive it. Orthopedic surgeons I've spoken to would either a) caution against skiing or, b) recommend groomers, etc. I realize there are many out there that are okay with regular skiing, but these are the exception, not the rule,.
    Thank you for that post as this is my big dilemma. My logical side gets the fact that although you hope to return to the same level of play, and might even be able to following recovery, it's potentially a ticking bomb. Hence a life changer. How much of a life changer is up to me and luck. The Doc too but I think I have a good one. Hopefully the model of "car" I'm getting will be more suitable for my lifestyle and not wear out too quickly (ceramic/poly, I think)

    When I think about about the life changing then I go back to am I really needing it yet? Can I wait longer? I pretty much torture myself over this when coming down from the exercise euphoria. During this weekend I came up with the answer to my own question "can you ski that hard if you have a bum hip" (in other words is my hip really that bad?) The answer is yes. My brain, when high on exercise and assisted with real drugs, can definitely ignore a lot of discomfort. Unfortunately in Canada if you wait until you are pretty much disabled before getting on the wait-list you're in for a long 9-12 months of big time suffering, so you try to get on it when you're pretty sure you'll be ready by the time your turn rolls around. If I could have picked the exact surgery date, I'm not sure if I would have already have done the surgery but I don't think I'm too many months away from that chosen date and that surgery is inevitable. If not for my sports lifestyle I would have happily done it already.

    I understand that I have to make sure I do everything I can to make recovery as successful as possible so I have less chance of loosening and fracture. I read stories about people Mtn biking 10 days after surgery and I'm pretty sure that's not a smart move so I won't be that person and will try to be patient and following Rehab advice. When I'm ready to go back to sport I'm going to have to make sure I'm in really good shape and as strong as possible and stay that way. In other words, if I want to be the exception you mention I'm going to have to work smart for it. Fortunately I stay fit year round now and I think that's a big positive on my side for the future. Fractures do worry me although I rarely fall skiing or, so far, Mtn biking. I try to stay within my skill level. Even so, I'm going to have to think more in terms of getting smoother at sport versus the goal of going faster and doing harder terrain. Dirtbiking will be the biggest concern and I haven't come to terms with how to deal with that one yet as this is the sport I do the most and have the most friends due to.

    My Surgeon told me that most patients tell him that by the time they get to surgery they've downsized a lot of their original bold plans so I guess time will tell. Maybe that's the next topic... "How much did your Sports lifestyle change following Total Hip Surgery? (and how well did you cope with it?)"

    Thanks all.

    Carol

  15. #15
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    Quote Originally Posted by CarolB View Post
    My Surgeon told me that most patients tell him that by the time they get to surgery they've downsized a lot of their original bold plans so I guess time will tell. Maybe that's the next topic... "How much did your Sports lifestyle change following Total Hip Surgery? (and how well did you cope with it?)"
    I may have changed some things, but I didn't downsize at all. Low impact is good! I still ski at a very high level, I just don't charge in shit fuck conditions. Ski hard when it's good and do something else, when it's not.
    I still bike everyday. I mostly ride a fat bike now and probably won't be doing any DHing. I've always been into watersports and I'm finding myself in the water even more now that I've had the THR.

    I highly recommend rehabing as much as possible in the pool. Swimming and doing a lot of ROM work really helped me the most.

  16. #16
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    Quote Originally Posted by Orthoski View Post
    Wouldn't blame yourself. Osteoarthritis is arguably most influenced by genetics (and if you were to have congenital hip dysplasia this would certainly contribute), so wouldn't dwell on what you could have done differently.

    The one thing I hope to caution, and I've stressed this in past posts, is that a total hip or total knee is a mechanical device. Like a car, how quickly it wears out is very dependent on how you drive it. Orthopedic surgeons I've spoken to would either a) caution against skiing or, b) recommend groomers, etc. I realize there are many out there that are okay with regular skiing, but these are the exception, not the rule, because there are consequences to every action. The two issues are the torque on the prosthesis and, equally important, what happens when you fall down. Fractures around a prosthesis are no joke, so things like aggressive skiing down hard terrain or trail dirt biking do pose a serious concern. Plus, a revision total hip is a completely different beast than a primary total hip - you only get one good bite out of the apple, so to speak.

    Anyways, something to consider. Everyone has to do their own risk-benefit analysis and this is an intensely personal process. There isn't a "right" answer. Best of luck in your decision-making process. Thankfully, après ski tastes just as good regardless of how you ski beforehand.
    friend of mine broke his femur at the top of his total knee. Had it fixed. Still skiing. As you say risk-benefit is very personal. I had a patient who had iliac artery narrowing from amateur competitive road bike racing. She also had something called popliteal artery entrapment, which was causing her no problems but which has the potential to cause sudden, catastrophic blockage of the artery (loss of leg possible). She refused to have the popliteal problem fixed--it would have weakened her gastroc a little--but she wanted to have the iliac artery fixed so she could keep racing. I referred her to someone who has a lot of experience with that problem in cyclists and she had the surgery. I saw her for something else a few years later and asked her how her cycling was going. Turns out after having the surgery she decided to quit riding. Go figure.

  17. #17
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  18. #18
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    And there insurance companies that will send you AND a loved one overseas for elective surgery, including a hotel for recuperation after you're out of the hospital. From what I can gather the surgical and hospital care is excellent. As far as I know no insurers are forcing people to do this and I don't know what incentives are offered.

  19. #19
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    Quote Originally Posted by old goat View Post
    And there insurance companies that will send you AND a loved one overseas for elective surgery, including a hotel for recuperation after you're out of the hospital. From what I can gather the surgical and hospital care is excellent. As far as I know no insurers are forcing people to do this and I don't know what incentives are offered.
    I wouldn't be surprised if this is the wave of the future for elective surgeries.

  20. #20
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    I think mine was closer to 80k, discounted to 40, with about 6k out of pocket.
    I would consider going overseas if the insurance co. covered everything. But you be out of commission for a while.
    I was back at work in a week, but we have a family business and I had a lot of help.

  21. #21
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    That is an awesome satirical portrayal! Now in Canada I don't pay, well maybe (I might have to pay $1500 for the appliance upgrade as they only do standard stuff now) but we wait (added- and we pay big taxes)
    I did get a quote of $25K for a resurface (in the US) and would have done if I could only have Docs here advise it was a good move for me.
    Having one of my bad days today, and ran out of Tramacet (they only let me have 1/day) so I'm in for a different experience at the mountain this weekend maybe.
    Last edited by CarolB; 03-27-2014 at 09:03 PM.

  22. #22
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    i highly recommend a high CBD marijuana for the pain, the R4 strain is the best i know of. try to keep away from the stuff the old school docs give you, the nsaids and myriad of unknown stuff that may give but take away much more and spirit crushing opiates are to be avoided.
    i had my hip done jan. '13 but most of my pain is/was from my back and shipped down, neuro pain. i still have it.
    there is no reason to wait if you need it, do it. the part of you that knows how to ski will still be there and with a brand new hip it's great. wish i could replace the rest.
    good luck, john

  23. #23
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    Had 2 great last of the ski season days last week and moved on to the Dirtbike today. The Dirtbike absolutely told me that surgery is required whereas the skiing didn't as much (only post skiing, not during). I have my date now- June 25th and I think I'll be absolutely ready. Hopefully back skiing in January?

  24. #24
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    Quote Originally Posted by CarolB View Post
    I have my date now- June 25th and I think I'll be absolutely ready. Hopefully back skiing in January?

    Try to get in as good of shape as possible, before your surgery.

    Jellero: Sorry to hear your still in pain.

  25. #25
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    Quote Originally Posted by Shredhead View Post
    Try to get in as good of shape as possible, before your surgery.
    Absolutely, I am already pretty fit by most standards. I know how to work with/through pain (when it's this kind of pain- versus when you should stop pain) and hopefully won't need to modify what I can do too much, maybe more Mtn Biking and a little less DBiking. Stair climbing and Running are not on the agenda. I'm back in the Gym (bores me- even though I work in an Athletics Dept where people are addicted to the gym) and am getting back in to the pool next week. I have access to a trainer that works with hockey athletes so I can get ideal advise for Glute workouts. I guarantee you I will not get taken out by laziness having said that, afterwards I will have to make my hyperactive personality go slower so I have the best chance at recovery. I actually look forward to being forced to slow down, well so I think now.

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