When is the right time for THR?

Hi All,

My name is Brent and I’ve been visiting this site for over 5 years now ever since I was first diagnosed in Aug 2015 with Stage 2 osteoarthritis in my right hip. Thanks to Brother Tom for his inspiration and foresight to create this forum. I recently turned 50 and like so many in this community I’ve chalked up my fair share of marathons and ultras. No need to be specific except to convey that I love the dirt, endorphins and sense of freedom running provides.

Here’s the scoop – I finally set a surgery date for March 23rd. Honestly, I still don’t feel 100 percent that I’m ready. I guess does anyone really feel ready to have their femur lopped off? At this point I’ve been steadily going down hill the past 4 months. I have been running 18 – 24 miles a week but literally grimacing through the pain. And yes, like everyone else the pain shifts from the hip, to the butt, to referred lower leg pain. My off days I bike or use the elliptical and that still produces some discomfort, but, nothing compared to running. Long story short – I crave the need to get my heart pumping daily. My concern is that it has grown increasingly more painful to flip over in bed at night and deal with the referred leg pain during my daily routines. Ironically, some days are just fine – others painful and full of limping.

So herein lies my conundrum. Do I hold off doing the surgery until I can’t run anymore and am down to biking, elliptical and short walks? That sounds depressing or do I be somewhat preemptive and stick to my surgical date? I fully realize it will be months before I will even consider running again until the implant has properly fused with my femur. I know I will go back to running regardless. I’m just curious to know from anyone how they knew it was the right time?

Thoughts anyone . . . .???

Home Forums When is the right time for THR?

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    • #19238
      Brent
      Participant

      Hi All, My name is Brent and I’ve been visiting this site for over 5 years now ever since I was first diagnosed in Aug 2015 with Stage 2 osteoarthriti
      [See the full post at: When is the right time for THR?]

    • #19240
      jimmyc
      Participant

      Not all surgeries are 100%. You won’t hear about them, because this site is for people who run again after THR; it is not a representative sample. I ran multiple times after my bilateral, but it didn’t work to my favor. When you can no longer work 40 hours, or walk 5 miles, then get your surgery. Running is very, very important, but at some point, we all must give it up. Sadly.

    • #19242
      Brent
      Participant

      Thanks for your input JimmyC. I certainly empathize with your experience after surgery. I fully realize that running may no longer be in the cards. I’ve researched and read so much over the past 5+ years to gauge realistic expectations. But, as Tom points out, everyone is different and will have varying results. That said, I’m cautiously optimistic. I’m hoping to get perspective from both sides and make an informed decision based on my pain levels and quality of life.

      Anyone else have input on their decision/timing?

    • #19246
      Hoppie
      Participant

      Hi Brent,

      I had mine when I could no longer walk for exercise. I had to conserve steps to have enough left to do routine things like grocery shopping. Walking more than a short distance provoked horrible muscle spasms. It also hurt to lift my leg to get on a bicycle and the amount of riding I could do every week was declining rapidly.

      -Hoppie

    • #19247
      WedgeC
      Participant

      Brent-your story IS LITERALLY MINE!!! SO MANY OF THE IDENTICAL SYMPTOMS AND THOUGHTS!! I’m 49 y.o. I had the exact same questions as of December 20 for my December 22 procedure!
      How did I know??? MANY of the same reasons you gave but cemented in my mind this fall when a 10-mile race (that I was prepared for) left me barely able to walk the next day due to hip pain and when older heavier non-athletic parents can move faster than me during a parents-kids soccer game 😉 I don’t know that I’ll answer “for sure the right decision?for another 6 months but I can tell you today-22 days post-op, I’ve hit 2 big milestones: I can walk up stairs pretty normally with just a slight muscle stiffness at the incision and can walk briskly with ZERO JOINT PAIN. I hiked a hilly 3 miles on day 20 post-op (avg. 3.6 mph) and biked 8 miles easy on a road bike at 15mph on day 21! THERE IS BRIGHT HOPE and I plan on running again; God willing by May.

      • #19249
        Brent
        Participant

        Thanks for you thoughts WedgeC. It’s reassuring to know there are so many others out there in similar predicaments. As I mentioned I’ve been dealing with this for 5+ years so I’ve had a lot of time to adapt and adjust my thinking about running. For me it’s no longer an end game or a need to be competitive – I’m at peace with my accomplishments. My main concern is to be able to run post surgery 2-3 times a week without expediting the need for a revision prematurely. From the sound of you’re thinking it seems like you’re OK waiting until New Years if need be. I think that’s really smart to ensure the post and acetabular cup have had an opportunity to really fuse with your bones. I’ve read many posts on this site about runners that jump back to running 8 – 12 weeks after surgery and I think that’s insane. But, then again, everybody is different.

        I’m struggling with waiting or taking the plunge. For instance I ran 6 miles this past Friday and also this morning with acceptable discomfort. (I say “acceptable” but I think I have a really high tolerance of going into the pain cave so often) Sunday, however was not good at all. I also had a lot of pain skiing with my family a few weeks back. So as you know with arthritis – some days are good, others aren’t. I have a solid 2 months before my Surgery date so I have some time to weigh the good with the bad. I do really appreciate all the feedback from others as it helps put things into focus a bit more.

    • #19248
      Petemeads
      Participant

      Hi Brent – have you researched resurfacing (Birmingham hip and variants)? The sort of procedure that Andy Murray chose that allows full activity including impact. Only a few surgeons specialize in the procedure, those that don’t will probably not even mention it as an option, but it offers a younger athlete a more conservative option than a TFR which is easily converted to a TFR later in life if necessary. A well-fitted BHR or its equivalent will last at least 20 years. That said, a modern ceramic THR seems a pretty good alternative and my surgeon was happy for me to carry on running and climbing, saying “you will not be able to break it” when I expressed my disappointment that my second BHR op resulted in my femoral head snapping off,thus requiring THR as second best.
      Whichever you get you should be able to get running again within a few months, I have had a good year despite lockdowns, over 900 miles of running, up to 13 miles, and long days in the hills up to 42 miles. I have just turned 70, my hips are 6 and 3.5 years old.

      • #19250
        Brent
        Participant

        Hi Petemeads – thanks for your thoughts and feedback. Yes, I’ve done extensive research on the Birmingham hip and spoke to a different surgeon about it as well. My concern with the BHR or THA approach is that it is metal on metal. As you are aware this releases metal ions into your bloodstream (metalosis) which some people tolerate just fine and others very poorly. Most clinical research papers in the past 3+ years have orthopedic surgeons steering away from performing BHR at all. In fact the surgeon I met with said because I am relatively short and have a small femur and acetabular I might not be a candidate. That coupled with the metalosis risk factor I ruled it out. The other thing to note, as you pointed out, is that the THR using ceramic on poly is exceptionally strong. The surgeon I am scheduled with also has a brother that still does both THR and THA but rarely THA any longer because of the risk factors I noted.

        I also researched the dual mobility hip which uses 2 polyethylene cups and allow for great range of motion. The Hospital for Special Surgery (HSS) in NY uses this approach for revisions when dislocation is problematic. They also use it in younger patients. It has been around since the 1970’s but the double polethlene cup system is still relatively new. The only drag is that they are still testing it.

        I am really impressed at 70 you’re still cranking out the miles – especially with both hips redone. I’ll look to you as the poster boy that I hope to emulate 20 years from now! Thanks much for your input!

    • #19252
      WedgeC
      Participant

      Hey Brent in reading your last post you once again confirm my experiences pre – surgery. I live in FL so water skiing (for me at a very recreational level) had become painful. And yes with OA, one day is tolerable and the next is real painful. Tempering your expectations is great because the reality of your future is unknown… in addition to what I said previously, I posed this reality to myself: “with OA and the decline in stability, strength, and mobility (all eventually inevitable but in my late 40’s, OA was the main cause), AM I WILLING TO ROLL THE DICE – knowing I may not run again – in order to gain the CHANCE to run like I did 15 years ago?” What’s the chance of NOT running again due to having a THC? For “runners” our age, I estimated that at 20%, so I am rolling the dice. For me, I’d rather take the risk at having a shot at running a 3-hr. marathon (that’s the best version of myself) than “shuffling off into the sunset”. 20 min. before the surgery I’m standing in the pre-op room practicing deep breathing, fighting back fear-tears and praying that I was doing the right thing (for more reasons than stated above I.e. please God no complications”…
      So I made the decision…. and some of the best advice I’ve ever heard… “make the decision, then WORK TO MAKE IT THE RIGHT DECISION!” So here I go out the door, practicing proper form in how to fast hike!

    • #19253
      WedgeC
      Participant

      Hey Brent not trying to play psychologist here but I had an additional thought in evaluating your last post… it seems you really want to get back to running “soon“ or “quickly“… totally understand this and sympathize, and also don’t think there is anything wrong with having a “calendar goal“ to start running again… But I believe we should plan in our minds first that the return to running schedule is certainly not up to our wants and wishes. Nature, healing, the orthopedic surgeon, physical therapy, stress, nutrition, fate, etc. all will play into determining when this can happen. Put any races or “need to be training by to race“ dates on the shelf for now… and this was another reason I decided to have mine done when I did, three weeks ago. Osteoarthritis progressively gets worse, I turn 50 in six months, racing and the best endurance events are certainly paused and many of them for this year will be open only to those that didn’t get to race last year… and most importantly, I chose the Christmas holiday weeks because it would have the least amount of impact on my work, income, and providing for my family. From about April 2 2020 to December 2021 will undoubtedly be the “darkest“ time for endurance events in my lifetime so no better time to try the replacement, recover, and see if I can come back stronger 💪🏽
      Again, not trying to tell you what to do, just giving you the best background for my decision and I was struggling with so many of the same things that you are currently… once I made the decision, there is no turning back… Only moving forward and making the most of my present situation. Regardless of my long-term outcome, I have made a promise to myself to not be negative and never dwell if things don’t turn out as I realistically expected!

    • #19254
      Batt1b
      Participant

      Hi Brent. I don’t think anyone can really tell you when the time is right for your THR. But I do think that each of us know when the time is right for us, though we may rationalize against that knowledge. In my case I fought hard against it and felt that I could endure whatever pain and discomfort was necessary to keep my old hip and keep running. The deal breaker for me was when the pain affected my sleep. When the pain prevented all but a few hours of sleep at night it was too much. AND it went drastically downhill in a couple of months. When I first scheduled surgery I was unsure, but when the time arrived I couldn’t imagine waiting longer. Now I’m more than thrilled with my new hip. It’s been three years now. I am running again though not to the degree I was before, mainly because the rest of my body resists. Strength has been slow to return but my range of motion is as good as it has EVER been. Speaking for myself, it now seems irrational to try to delay the inevitable a few more months, while enduring the pain of the deteriorating hip. I’m confident you will do what is right for you, when it’s right for you.

      • #19255
        Brent
        Participant

        Thanks Batt1b – I really appreciate your insight. I’ve been at the tipping point for some time – loosing sleep, grinning through pain and basically sucking it up because I really want to hold on to my original parts. It seems many on this forum are unsure when the time is right and when to schedule. I’ve allowed 2 months from now just in case I decide to back out. As it stands I am feeling more confident that the time is right. Thanks again for you thoughts.

    • #19256
      WedgeC
      Participant

      One other confirmation cue as to when I needed THR…this past summer when attempting to mount a horse for introductory horseback riding. Myself (49 y.o. and 150 lbs.) and a heavier woman in her 60’s were the only people in a group of 20 that required the roughly 2’ tall step-stool to mount our horses! And yes the 2-hr. ride was painful!

    • #19257
      AKrunner907
      Participant

      Hi Brent, I ran through most of 2019 and 2020 with pain in my hip. It began as a discomfort over the years and then in the last year and a half became debilitating. I went from running 60-80 miles a week on average to 25-40 if I was lucky. Last year I could still manage runs of up to 100k but by the end of them I was done, my hip would be unbearable and I would have to take a few days off after any High intensity or long run. By the end of September last year I couldn’t run a step without severe pain in my hip and I stopped running. By November I finally went in and had my hip looked at. I have FAI (Femoroacetabular Impingement) bone growths on the femur ball have completely worn down the cartilage in the hip socket and now the socket and femur head are bone on bone. The pain is constant and I can’t walk half a mile without sitting down form the pain. Some days the pain is manageable, then I step wrong, stub a toe, the hip locks up and I’m done. Some days I get the pain radiating down to the knee or ankle, those days really suck. I can still cross country ski (classic only, skate skiing is way to painful) so I can still get my cardio in and still feel somewhat normal, but even then after a hard or long ski over 10 miles I have to take a day or two off afterwards for my hip to calm down. I’m scheduled for surgery February 15th, I’m so sick of the pain now I’m counting down the minutes until surgery. If I knew how bad the pain would get, how fast my hip would degrade over the last 8 months I would have scheduled the surgery back in July when it really was impacting my life.
      I guess what I’m saying is if your hip has caused you to not have the life that makes you happy, that is no longer the life you live, get the surgery. The sooner you’re pain free the sooner you’ll be back to doing the sports that you love. I have wasted 8 months of my life because I wasn’t sure it was the right thing to do. I’m 56 years old and now I’ll have to wait until the end of summer possibly before I can actually begin returning to running. I’m pretty pissed at myself for waiting this long and now my life is on hold.

    • #19261
      Rusty Rathburn
      Participant

      Get it done!I got my first at 49. Just like you, I wanted to hold off. I was scared. Less that a year later I was darn right giddy to get the other hip replaced. The added benefit….. I sleep so much better, No more waking up all night. And I still run! Only advice, find a surgeon that encourages you to continue your running. Don’t wait.

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