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      02-07-2011, 01:10 AM   #1
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Hip Replacement

Does anyone here have any experience with this ? I was diagnosed with Necrosis in my hips. My right hip is in constant pain and after an MRI, they found that I have this condition in both hips. I see the specialist on Friday. They want to operate on my right one, and eventually , I will need to have surgery on my left one too. Any info from you guys on this would be appreciated !
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      02-07-2011, 01:19 AM   #2
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Good luck with that man!
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      02-07-2011, 01:21 AM   #3
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Good luck with that man!
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      02-07-2011, 01:21 AM   #4
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That is a pretty open-ended question....As an Orthopaedic Surgeon myself, I could give you some very general or very specific answers to questions that you may have, but what you really need is a visit with the surgeon.
In general:
1.) Very common, very safe, very effective operation
2.) OPTIONAL surgery. We are not trying to save your life, but trying to increase your quality of life. YOU DON"T HAVE TO HAVE SURGERY, it is your choice.
3.) You must be comfortable with everything...the surgeon, the procedure, the facility...etc. If you don't like it, don't do it. Go elsewhere. There are hundreds of qualified surgeons out there.
4.) Find a qualified surgeon! There are hundreds of butchers out there. Just like plumbers, carpenters, mechanics, etc....there are good ones and there are bad ones, you do have a choice. The more the surgeon does, the better they tend to be at that operation.
5.) You are already doing the right thing, asking questions and getting informed. You don't have to know everything about the procedure, the indications, etc, but you should feel comfortable (catching a trend here?). On the other side, it is possible to be too wrapped up in it, to over analyze the process and try to micromanage, but that patient is fairly rare.
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      02-07-2011, 01:51 AM   #5
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The more the surgeon does, the better they tend to be at that operation.
Are you saying the more times they have done the surgery or the more they do during the surgery?
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      02-07-2011, 01:56 AM   #6
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Thanks. Currently, I am getting through my days with Ibuprofen , and when I get home I take pain killers. I don't see a way to avoid surgery. The pain is just too much. I am overweight and am currently in the process of losing as many lbs as possible before surgery. My general DR thinks this may also help reduce the pain. I am very comfortable with my general Physician , but will see how I feel about the Ortho specialist. I really appreciate your feedback. I'm 37 years old, and want to keep a good quality of life.
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      02-07-2011, 01:58 AM   #7
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Are you saying the more times they have done the surgery or the more they do during the surgery?
thats what he's implying. some surgeons only do a couple of procedures because they're the shit at those surgeries.
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      02-07-2011, 04:40 AM   #8
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You are doing the right thing by losing as much weight as is safe.

Hip replacement surgery is very successful these days. I had mine done 34 years ago and it's still going strong.
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      02-07-2011, 05:00 AM   #9
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Find out what company your doctor uses then go search the FDA database for radiological devices and study the recall lists. I worked in the industry for 15 years. Some docs (the big cutters) would get paid by one company $200K/yr to use a hip or knee. If we offered them $100K/yr more, guess what? Company B replaced Company A overnight! Sick, really. All of the firms make decent implants. All the firms have had problem joints, too. Hopefully your doctor has done a lot of the same brand over 6-10 years. It takes 18 months for your bone to remodel from the new stresses of the metal placed into your bones and is a function of how the bone is "loaded;" where it is not stressed, the bone will shield (literally, disappear). This is called stress-shielding and reflects Wolf's Law. This is also why people put the surgery out as long as possible. Ask to talk to other patients of your doctor (possible HIPPA issues) and spend time online finding out which implants people seem happiest with over an extended time. If the surgeon is a joint replacement specialist and has been in the same town for over 8 years he is probably using good products or he would be sued too many times. The body is the harshest environment in the world so you should put it off until you do not want to live "this way" any longer. I think if you get 10-12 years out of an implant you are phenomenally lucky.
Take time with your search. It will pay off in the long term.
* www.fda.gov Go here and search for the Center for 'drugs and radiological devices' and start a search for the major orthopedic companies referencing recalls and device failures. Their database just started getting accurate in the last 10 years (after 60 years of performing replacements).
Good luck and God's speed regarding your health.
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      02-07-2011, 07:51 PM   #10
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Wow. I can't tell you how much I appreciate all the info. I'm doing as much homework on the subject as I can. I will get more info when I see him Friday. I'm hoping they put me on disability because I frankly cannot function anymore at work without taking pills like they are Tic Tacs.
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      02-07-2011, 09:25 PM   #11
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Does anyone here have any experience with this ? I was diagnosed with Necrosis in my hips. My right hip is in constant pain and after an MRI, they found that I have this condition in both hips. ...
I'm pretty much in the same position, only older. I went from an annual weekly average of walking 30+ miles a week to less than half that after an impact injury. AVN is the diagnosis, the same as yours, avuncular necrosis; I've scheduled surgery for a replacement the end of March. The advice you're getting here is fairly on point. My surgeon says he has data from his surgeries that his replacements run well into the 30 year mark; he has patients who are doing intensive rockface climbing now. Look for a surgeon who does the least invasive procedure and who does a lot of them (the advice from a retired orthopedic surgeon).

You might ask your physician for a better NASID, I personally found ibuprofen worthless even at a daily 1800 mg level. AVN is an insidious condition, I have absolutely no cartilage in my right hip and I find myself not wanting to do anything that requires effort. Not much of a lifestyle, hun. I've opted for the surgery without a second thought, even though fairly routine now, no surgery is 100% safe and fault free.

Good luck!

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      02-08-2011, 12:35 AM   #12
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I am currently on Percocet and Tramadol. But when working, I just use Ibuprofen. As you know it's a horrible condition. I am only 37 , so the DR says it must be hereditary. I have it in both hips.
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      02-08-2011, 12:44 AM   #13
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I am currently on Percocet and Tramadol. But when working, I just use Ibuprofen. As you know it's a horrible condition. I am only 37 , so the DR says it must be hereditary. I have it in both hips.
are you doing any PT? Or any type of pre-op strengthening? Going into surgery a bit stronger and stable and/or at least preventing any further atrophy due to non-use and pn can only help speed along your recovery. If land/gym PT or exercise is too aggravating, look into aquatic PT/exercise. The buoyancy of the water can help decompress the hips so you can perform some weight bearing activities and strengthen with less pn. Even some manual mobilizations for hip distraction might help ease the pn a bit.

37 y/o, that's pretty young, I guess due to the hip jt. degen you are not a candidate for hip resurfacing. I think there are only 1 or 2 MD's in your area (San Diego IIRC) that perform this procedure, but my patients that I've treated that have underwent this procedure return to function faster and with less complications. The inclusion factor for resurfacing is more demanding than a THR.

GL with your surgeries...
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      02-08-2011, 01:13 AM   #14
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37 is too young to have a THA...if it can be avoided. Hopefully you are at an earlier stage and can avoid a total hip arthroplasty (THA). Lots of good advice above.
I don't see many doctors contracting with prosthetic companies, but I work in a more academic environment (more teaching, less getting paid). Some of my partners are consultants and real designers of implants, but most of that money goes back to the "Foundation" (the institution that we work for).
The bottom line is that at 37 you will have more than one hip surgery...and likely one infection...in your lifetime.
As for minimally invasive hip surgery...that was a big fad a few years back, lots of studies (some of them ours, so I might be a little biased) proved that there was not all that much benefit of the minimally invasive techniques. The orignal series (out of Chicago, Dick Burger if I recall correctly) included a lot of young men than bounced back from surgery very quickly due to lots of physical reserve and psychological anticipation.
Best of luck!
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      02-08-2011, 02:19 AM   #15
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My general DR said no PT after seeing my MRI results. Like I said, my first visit to the ortho is Friday. I think you guy have educated me more here in a day, than all the other websites I have read up on. I cannot thank you guys enough.
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      03-16-2011, 03:23 AM   #16
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Well, it's been a while. I have seen 2 Dr's who have not really agreed with much. One wants to do a replacement, the other wants to do a procedure where they drill holes into the bone to stimulate blood flow. That procedure requires a longer healing time, and according to the DR, it also weakens the bone, so you have to be careful not to fracture it while it heals. He also mentioned he has yet to see it work on anyone he has done it to. I asked him what the point was, if he's had zero success. He said because of my age he would want to try everything first.

I kept all your suggestions in mind and took notes with me about what to ask.

I went back to my regular DR, and told him neither DR really satisfied me. Sohe now reffered me to the Head ortho Surgeon at their network. When I called to make an appointment, his next slot to see me was in June....WTF. So my DR spoke to him and mentioned my situation. He will be seeing me the second week of April.

The pain has not died down at all. When I first posted this, I was weighing 280 lbs. I have been on a mission to lose as much weight as possible by eating right. Hoping all this time that the pain would stop. I am currently at 253, and dropping. I would like to get to 200 by early summer. I take 2-4 Percocets a day to get me through with the pain. I can no longer play golf. Work is very difficult. I take about 8 Ibuprofens just to get through a day at work. So my condition isn't getting better. I really just want my hip replaced. I don't want to miss a lot of time at work, because I have very large responsabilities there. So that is my update as of now. Any further suggestions are welcome. Oh, my left hip which does not hurt, is 15% damaged also according to the MRI. I have no pain there. My DR says if I lose more weight, I can prolong the need for that one to be replaced.
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      03-16-2011, 10:51 PM   #17
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Dude, you need to resolve this issue. Long term Oxycodone use plus Ibuprofen at a high level daily. There's side effects there you don't want. Not to mention the NASIDs are not going to promote any bone healing.

I agree you need an Orthopedic Surgeon opinion (more than one opinion if you want) that takes into account your current drug use and pain levels.

I'd be insisting on total hip replacement ASAFP, 37 year of age or not. The younger you are at surgery, the faster you're going to heal it up. Don't limp on a few more years popping oxy every day to manage pain. It's madness.

Quote:
Side effects
Main side effects of oxycodone[65]
The most commonly reported effects include euphoria, memory loss, constipation, fatigue, dizziness, nausea, lightheadedness, headache, dry mouth, anxiety, pruritus, and diaphoresis.[66] It has also been claimed to cause dimness in vision due to miosis. Some patients have also experienced loss of appetite, nervousness, abdominal pain, diarrhea, ischuria, dyspnea, and hiccups,[18] although these symptoms appear in less than 5% of patients taking oxycodone. Rarely, the drug can cause impotence, enlarged prostate gland, and decreased testosterone secretion. Compared to morphine, oxycodone causes less respiratory depression, sedation, pruritus, nausea, and euphoria.[67] As a result, it is generally better tolerated than morphine.[68]
In high doses, overdoses, or in patients not tolerant to opiates, oxycodone can cause shallow breathing, bradycardia, cold, clammy skin, apnea, hypotension, miosis (pupil constriction), circulatory collapse, respiratory arrest, and death.[18]
[edit]Withdrawal related side effects
There is a high risk of experiencing severe withdrawal symptoms if a patient discontinues oxycodone abruptly. Therefore therapy should be gradually discontinued rather than abruptly discontinued. People who use oxycodone in a hazardous or harmful fashion are at even higher risk of severe withdrawal symptoms as they tend to use higher than prescribed doses. The symptoms of oxycodone withdrawal are the same as for other opiate based painkillers and may include "anxiety, nausea, insomnia, muscle pain, muscle weakness, fevers, and other flu like symptoms."[69]
Withdrawal symptoms have also been reported in newborns whose mothers had been either injecting or orally taking oxycodone during pregnancy.[70]
Source: http://en.wikipedia.org/wiki/Oxycodone


Quote:
Adverse effects
Main article: Nonsteroidal anti-inflammatory drug
Ibuprofen appears to have the lowest incidence of digestive adverse drug reactions (ADRs) of all the nonselective NSAIDs. However, this holds true only at lower doses of ibuprofen, so OTC preparations of ibuprofen are, in general, labeled to advise a maximum daily dose of 1,200 mg.[18][19]
Common adverse effects include: nausea, dyspepsia, gastrointestinal ulceration/bleeding, raised liver enzymes, diarrhea, constipation, epistaxis, headache, dizziness, priapism, rash, salt and fluid retention, and hypertension.[20] A study from 2010 has shown regular use of NSAIDs was associated with an increase in hearing loss.[21]
Infrequent adverse effects include: esophageal ulceration, heart failure, hyperkalemia, renal impairment, confusion, and bronchospasm.[20]
[edit]Photosensitivity
As with other NSAIDs, ibuprofen has been reported to be a photosensitising agent.[22][23] However, this only rarely occurs with ibuprofen and it is considered to be a very weak photosensitising agent when compared with other members of the 2-arylpropionic acid class. This is because the ibuprofen molecule contains only a single phenyl moiety and no bond conjugation, resulting in a very weak chromophore system and a very weak absorption spectrum, which does not reach into the solar spectrum.
[edit]Cardiovascular risk
Along with several other NSAIDs, ibuprofen has been implicated in elevating the risk of myocardial infarction (heart attack), in particular, among those chronically using high doses.[24]
[edit]Interaction with aspirin
According to the U. S. Food and Drug Administration, "Ibuprofen can interfere with the antiplatelet effect of low-dose aspirin (81 mg per day), potentially rendering aspirin less effective when used for cardioprotection and stroke prevention." Allowing sufficient time between doses of ibuprofen and immediate release aspirin can avoid this problem. The recommended elapsed time between a 400 mg dose of ibuprofen and a dose of aspirin depends on which is taken first. It would be 30 minutes or more for ibuprofen taken after immediate release aspirin, and 8 hours or more for ibuprofen taken before immediate release aspirin. However, this timing cannot be recommended for enteric-coated aspirin. But, if ibuprofen is taken only occasionally without the recommended timing, the reduction of the cardioprotection and stroke prevention of a daily aspirin regimen is minimal.[25]
[edit]Risks in inflammatory bowel disease (IBD)

Ibuprofen should not be used regularly in individuals with inflammatory bowel disease due to its ability to cause gastric bleeding and form ulceration in the gastric lining. Pain relievers such as paracetemol/acetaminophen or drugs containing codeine (which slows down bowel activity) are safer methods than ibuprofen for pain relief from IBD. Ibuprofen is also known to cause worsening of IBD during flare-ups, so it should be avoided completely at those times.
Source: http://en.wikipedia.org/wiki/Ibuprofen
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      03-16-2011, 11:05 PM   #18
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My only advice is to do some serious research on the doctor and ask around. Really try to find the most skilled physician available to you. If you can get a guy that does high profile pro athletes, that is a good bet. Good luck!
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      03-17-2011, 12:54 AM   #19
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MrBlonde, I am totally aware of the danger and I agree with you. I just can't make it through the day without medication. As soon as I see this final Dr this should be taken care of. I am not looking to be on meds for a long time.
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      03-22-2011, 01:09 AM   #20
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MrBlonde, I am totally aware of the danger and I agree with you. I just can't make it through the day without medication. As soon as I see this final Dr this should be taken care of. I am not looking to be on meds for a long time.
Good call dude. You'er already going to need to withdraw from oxy, good luck.
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      03-22-2011, 01:20 AM   #21
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I disagree with the ASAP arthroplasty (total hip). Although core decompression (drilling holes) and even a vascularized free-fibula graft has spotty success, really depending on how bad the disease is, a total hip at 37 is a BIG DEAL...I would say a much bigger deal than 4 percs and a handfull of Advil daily.

As for the recommendation of a "doc that does high-profile athletes"...that is maybe not the best advice. In our business, a physician or group can buy the rights to market themselves as the "team doctor". The players will actually go somewhere else, usually directed by the team/coach/manager. The high-profile surgeons (a la Jimmy Andrews) do SPORTS MEDICINE and not large joint arthropasty.

Best of luck in your quest!
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      03-22-2011, 10:57 PM   #22
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I disagree with the ASAP arthroplasty (total hip). Although core decompression (drilling holes) and even a vascularized free-fibula graft has spotty success, really depending on how bad the disease is, a total hip at 37 is a BIG DEAL...I would say a much bigger deal than 4 percs and a handfull of Advil daily.

As for the recommendation of a "doc that does high-profile athletes"...that is maybe not the best advice. In our business, a physician or group can buy the rights to market themselves as the "team doctor". The players will actually go somewhere else, usually directed by the team/coach/manager. The high-profile surgeons (a la Jimmy Andrews) do SPORTS MEDICINE and not large joint arthropasty.

Best of luck in your quest!
Well that is good input.

In Pittsburgh though, that has not been my experience. All the teams here have doctors the athletes can use, or they can obviously choose to use someone else - which sometimes happens of course. In my particular case, for a knee surgery, I found out who actually did the work on several indispensable athletes and then went to him to have mine done.
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