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iron
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iron
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PostTue Apr 19, 2022 9:09 pm 
my wife had hip dysplasia which she first learned about around age 30 after starting to get pains. she was very strong, and a PT, so knew all the right things to do and stabilize. by the time she was 33, she could still do big days and lots of offtrail travel (pickets traverse, for example), but the flat trails killed her. she also clearly started compensating for the pain by leaning. this in turn created SI-joint issues. she had both hips replaced at 34 and was out doing 8k gain days in 3 months post-op. she has had zero issues since surgery. in terms of wearing out the hardware: our understanding is that the intended failure mechanism is the HDPE liner in the socket. when this goes, it sounds like you take that out and put in a new one. no actual bone surgery. the embedded rod in the femur and the metal socket that's screwed into the hip are permanent and should never fail or loosen. i'd call this a pretty reasonable long-term pain/activity management plan

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ArthriticHipster
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PostWed Apr 27, 2022 5:06 pm 
It's me again, your friendly neighborhood Prematurely Old Person. I saw the new hip surgeon this week and asked him about "hip resurfacing." He said that it's the best option for a very small subset of people, and I'm not in that subset. (I guess I should have asked why not.) He said that 10-15 years ago, resurfacing had more advantages compared to "normal" hip replacement; but the normal version has gotten so much better that the potential advantages of resurfacing are outweighed by the disadvantages — which include a greater chance of needing a revision down the line. But he confirmed that surgery is the next logical step for me; he doesn't think there's much point in trying cortisone shots. Either I deteriorated very quickly, or this has been going on for years without me realizing it. So, the good news is that my insurance will probably cover the surgery because the arthritis is starting to affect my daily life; it's become Medically Necessary. The bad news is that I'm getting my hip replaced at age 49, which is just depressing. (The other slightly bad news is that my insurance doesn't cover robot-assisted surgery yet, so the HipBot 5000™ will be sidelined.) I told them I'd like to get it done in September or October. That will let me keep hiking all summer, but will give me plenty of time to recover before next spring.

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ArthriticHipster
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PostSat Sep 03, 2022 2:11 pm 
An update, in case anyone is interested (or if some future hiker with a bum hip finds this)... Surprisingly, I've been able to hike almost as much as I would in a normal non-arthritic summer. I've had a handful of 3000' days, I've scrambled up a few Class 3 peaks, and I've gone as far as 12 miles. I had my pre-op appointment at the orthopedics place yesterday, and the P.A. seemed almost shocked when I told her how active I'd been. The problems are still mostly limited to AFTER the hiking. I frequently have to do a little dance when I get up out of my car, waiting for my bad hip to "click into place" before I can walk on it. (I've found The Twist to be the most reliable dance move for this purpose.) Sometimes I have the same thing happen after just sitting on a chair indoors for a while, especially a low chair or sofa that causes my legs to be bent at a strong angle to my torso. (By the way, running is way worse than hiking. An hour of softball — even with a pinch runner taking my place on the basepaths — causes me more post-activity difficulty than a full day on the trail.) Oh, and naproxen sodium (Aleve) works way better than ibuprofen, both during physical activities and afterward. For me at least. Surgery is in about two weeks, and then I'll have the whole wet season to recover. I'm getting a ceramic-on-polyethylene implant.

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Songs2
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PostSat Sep 03, 2022 10:22 pm 
ArthriticHipster, Good luck with the surgery! Your description of symptoms is a close match for mine, preop. I could climb (walk up, not technical), both in nature and using a StairClimber, but sitting was lethal, and I staggered around on transitioning from a seated to a standing position. And as iron relates about his wife, my hip problem was so severe it aggravated an existing spine problem. The operation is a good one, for both surgeon and patient (I had both hips done, 3 months apart). The newer hardware components simply don't have a long enough history in situ for a reliable replacement estimate. It's possible you will not need any hardware replaced -- and should it happen, probably the liner, as iron indicated. I was extremely grateful to have had the operation, which solved 90-95% of my back issues. Have been backpacking, kayaking, and so forth. I have not tried ice skating because loss of native skeleton in the hips bilaterally reduces balance and proprioception. And, per the surgeon's instructions, no hopping or jogging. I hope the op proceeds uneventfully and you are back on the trails soon.

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ArthriticHipster
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PostSat Sep 03, 2022 10:51 pm 
Songs2 wrote:
It's possible you will not need any hardware replaced -- and should it happen, probably the liner, as iron indicated.
I've been reading some medical literature this weekend, and it looks like the new materials they use (HXLPE for the liners, aluminum-zircon ceramics for the heads) really don't wear down much at all — the "X3" plastic has a wear rate of about 0.01mm per year! From what I can tell, the most likely hardware problem going forward is loosening of the stem in the femur. And because half of that equation is old-fashioned human bones, the technology can probably only go so far.

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Cascades98225
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PostSun Sep 04, 2022 8:32 am 
I went through the same thing in my early 50's. Got a hip resurfacing from James Pritchett, one of the best in the country. Would recommend looking into that. As others have said, this preserves the bone and while this should last the rest of your life, if you do need a revision in the future, it will be far easier and more effective given that the original bone was preserved. Was backpacking on this thing just a few months later and 14 years going as strong as ever. Good luck.

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RumiDude
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PostSun Sep 04, 2022 8:50 am 
Something to consider is this, almost all surgeries cannot be undone. So it is an all'in commitment when you have any sort of surgery, especially a joint replacement. I have come to the conclusion that it is best to try PT and other such solutions first before commiting to irreversible surgery. Not knocking any surgeon, surgery procedure, or whatever, but nothing is 100% sure and sometimes things just go really bad for whatever reason. Not trying to scare you, but that is just reality and you need to consider that. Rumi

"This is my Indian summer ... I'm far more dangerous now, because I don't care at all."
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ArthriticHipster
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PostSun Sep 04, 2022 10:16 am 
Cascades98225 wrote:
Got a hip resurfacing from James Pritchett, one of the best in the country. Would recommend looking into that.
I did look into it. The surgeon I'm using offers hip resurfacing, but he said it's not the best choice in my situation, for various reasons — the main one being that in his opinion, a future revision would be more likely with resurfacing than full replacement.
RumiDude wrote:
I have come to the conclusion that it is best to try PT and other such solutions first before commiting to irreversible surgery.
No amount of physical therapy can restore broken-down cartilage and eliminate weird bone growths. There really aren't any other solutions for a severely arthritic hip.

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Sallie4jo
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PostSun Sep 04, 2022 10:40 am 
Do true..for hips, knees and shoulders. The key is to have a surgeon you feel confident in and that they have been doing the surgeries for awhile. I have been blessed..knee, hip, shoulder and soon the othe knee. Take care and get your knee muscles as strong as possible before surgery. Then work hard in recovery.

I choose to live in a landscape of hope. Terry Tempest Williams
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Sallie4jo
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PostSun Sep 04, 2022 10:40 am 
Do true..for hips, knees and shoulders. The key is to have a surgeon you feel confident in and that they have been doing the surgeries for awhile. I have been blessed..knee, hip, shoulder and soon the othe knee. Take care and get your knee muscles as strong as possible before surgery. Then work hard in recovery.

I choose to live in a landscape of hope. Terry Tempest Williams
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RumiDude
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PostSun Sep 04, 2022 11:32 am 
ArthriticHipster wrote:
RumiDude wrote:
I have come to the conclusion that it is best to try PT and other such solutions first before commiting to irreversible surgery.
No amount of physical therapy can restore broken-down cartilage and eliminate weird bone growths.  There really aren't any other solutions for a severely arthritic hip.
Twenty five years ago my orthopedic doctor told me I would eventually need to have knee replacement given the state of my cartilage which was confirmed through X-ray/CT and MIR. My knees were both painful, particularly my right knee. The pain often would prevent good sleep. I was told I would know when the time was right. I was forty-five years old at the time, in excellent physical condition, and active in many activities all year round. In October of this year I will turn seventy years old. Three years ago in 2019 I hiked the Oregon section of the PCT. I have section hiked all of the Washington PCT. I have hiked extensively in the Olympics for the past two decades. Yet, I have not had the knee replacement surgery, or even orthoscopic surgery. I don't take any medications/supliments, either prescribed or otherwise, to help. I did go to PT twenty five years ago and have essentially kept the PT routine going on my own every since. I am NOT suggesting that everyone would have similar results as I have. But I do offer my experience as a counter to the idea that surgery is the only solution. And since surgery carries risks, can't be reversed, and results vary widely, I always suggest to people contemplating surgery to try PT, dialing it back a bit, and waiting to see the results. One final observation on this whole topic, as we age we will all have to dial it back on many of the activities we did in our prime years. This is a hard pill to swallow. Intellectually I understand it, but emotionally I have often struggled with the idea of diminishing physical abilities. There's a term for this physical phenomenon, sarcopenia. There are lots of things we can do to mitigate sarcopenia, but so far it can't be stopped. And the person who doesn't come to terms with that will only frustrate themselves. Good luck in whatever course you decide to take. Rumi

"This is my Indian summer ... I'm far more dangerous now, because I don't care at all."
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ArthriticHipster
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PostFri Sep 16, 2022 3:04 pm 
New avatar!

awilsondc, RichP
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Anne Elk
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PostFri Sep 16, 2022 4:39 pm 
ArthriticHipster wrote:
Sometimes I have the same thing happen after just sitting on a chair indoors for a while, especially a low chair or sofa that causes my legs to be bent at a strong angle to my torso.
Your comment reminded me of the time I helped take care of an elderly neighbor for a couple weeks post-op, just to make sure she didn't have accidents. I remember her telling me that the doctors told her that with the new hip, it was important to never sit with her hips lower than her knees. I don't know if that's advice everyone gets, or if it was specific to her fitness level, etc.

"There are yahoos out there. It’s why we can’t have nice things." - Tom Mahood
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ArthriticHipster
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PostFri Sep 16, 2022 4:43 pm 
Anne Elk wrote:
I remember her telling me that the doctors told her that with the new hip, it was important to never sit with her hips lower than her knees. I don't know if that's advice everyone gets, or if it was specific to her fitness level, etc.
The physical therapist at the hospital did say to avoid any extremes, which includes bending the hips more than 90°, but I think that was meant as a temporary measure. Hopefully once everything is healed up, I'll be able to sit however I want... but I'll put it on the list of things to ask about at my follow-up visits.

Anne Elk
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ArthriticHipster
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PostWed Sep 21, 2022 10:59 pm 
After 8 days convalescing in a friend's one-room backyard cottage, I'm back at home... where, in order to get to and from my bedroom, I will need to use the — cue suspenseful music here — STAIRS! eek.gif I was grumbling and whining quite a bit on the first couple of days after the surgery, because it's really alarming to have your lower leg just flop over sideways without being able to stop it. But things are moving forward pretty quickly. I ditched the four-legged walker after two days, and now, a week post-surgery, I'm using a trekking pole only when I want to go for a long walk outside; indoors, it feels completely unnecessary. I'm not delusional: I know it's going to be a while before I can cover any kind of distance, and I've still got a big fat incision on my rump that reminds me of its presence every time I sit down, or walk up stairs. But it's hard not to be impressed at how advanced (and routine!) this surgery has become. I'm sure it helps that I was in pretty good shape going into it.

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