Advice for meeting with orthopaedic surgeon?

Hi everyone, I’m a 62 yo male runner with severe AO in the right hip. After a year on the wait list I finally will have my pre-op meeting with my surgeon in a couple of days (Apr 11). After that it will probably be close to a year before the surgery takes place. The surgeon is highly recommended by the sports medicine clinic that referred me – as a surgeon who understands the needs of athletes. However, I am wondering if there is any emerging consensus about the best type of hip implant for someone like me who hopes to remain active at a number of sports, including running. What do I need to be sure to ask the surgeon to ensure that we arrive at the best solution for my particular circumstances?

I’ll definitely continue reviewing posts and links on this site, but meanwhile please let me know if you have any advice for my pre-op meeting. ¬†Thanks!!

Alan

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    • #9463
      Doug A.
      Participant

      Hi everyone, I’m a 62 yo male runner with severe AO in the right hip. After a year on the wait list I finally will have my pre-op meeting with my surg
      [See the full post at: Advice for meeting with orthopaedic surgeon?]

    • #9464
      liz
      Guest

      Hey Alan!
      Where do you live? It sounds like you are not in the US. I am really only familiar with US choices and procedures, but I’ll try to offer some questions for you to ask.

      1) Would you be a candidate for hip resurfacing? It is a great option for active people if available.
      2) If you are only a candidate for regular hip replacement (THR), ask what device he will use. Press for details, like what it will be made out of and how large the ball will be and who the manufacturer is. (Google it all when you get home!)
      3) Ask if you have any choice in the device used. (Sometimes you do.)
      4) What short term limitations will be placed on you post op. Short term is like the first six weeks.
      5) Ask which approach he will use, anterior or posterior. This will affect your limitations in the short term.
      6) Ask about long term restrictions. Will you be able to cross your legs? Squat deeply? Run? Do yoga?
      7) Ask how many THRs he does a year and how long he has been doing them. Practice makes perfect.
      8) Ask about complications. I’d press him what HIS rate of complications is. Examples include infection, dislocation, thigh pain or numbness.
      9) Can he connect you with some former patients of his? I think it helps to talk with someone about what he went through in detail. Every doctor has little peculiarities.
      10) Before going in, I’d think about what you want to be able to do post op. Run? Garden? Lift weights? Hike? Play basketball or soccer? What is your job and what physical requirements do you have there? Ask the doctor about those specific activities.

      Good luck! Depending on where you live, there may be other questions. Some countries have a hip registry and track the performance of various devices (and maybe doctors). Can you get a second opinion if this doctor is unsatisfactory?

    • #9465
      Doug A.
      Participant

      Hi Liz, thanks very much for the quick reply! Yes, I live in Canada and we probably have longer wait times than the USA, but the timing isn’t terrible for me – I can still run (a bit), walk/hike (with a limp), and ski (need to avoid falling!), but I’m definitely starting to feel ready to go for the op. I think I may be a candidate for resurfacing – although the joint has been bone on bone for a few years apparently that doesn’t matter. I am about 5′ 9″ tall, 155 pounds, and generally in excellent health. Are there other considerations? Do you know how much of a concern the metal ion issue is for resurfacing options?
      Thanks again! Alan

    • #9466
      Petemeads
      Participant

      Hi Alan,
      I have a resurfaced hip (3 years old) and a ceramic THR approaching its first birthday. I’m 67 and still running/climbing/biking etc and substantially without pain, although the THR leg is not completely recovered yet. I chose the resurfacing route initially because it is mechanically superior and allows an easy fallback to THR if it wears out. Bone quality let me down with the second operation and my femoral head broke off during the fitting, hence the THR.
      Metal ions will not be a problem if the device is fitted perfectly or if one of the newer alternatives is available (metal on polythene or all ceramic) but getting a good surgeon with lots of experience (ideally over 1000 resurfacing ops) is important, not sure if there are any in Canada. My metal ions were tested at 3 years and are absolutely fine despite all the exercise I have been doing.
      Having said that, there is a lot to be said for a ceramic THR – an easier op, little fear of wear or breakage, large diameter ball will not dislocate any more readily than a resurfacing, and probably cheaper. And easier to find an experienced surgeon. At our age there is a good chance that both types of device will outlast us, despite our best efforts to wear them out!

      Just thought of another point – resurfacing will not change leg length, THR might do (mine is about 4mm longer). This should be undetectable but I suspect some of the residual twinges in this leg are due to tissues getting used to the difference…

      Have you found the SurfaceHippy website yet? Lots of good info on there for both sorts of device, although mainly aimed at BHR. Cheap operations available in Europe and India if Canada cannot oblige…

      Pete

    • #9467
      Doug A.
      Participant

      Very interesting Pete, thank you! I visited the surfacehippy website a couple of years ago but will take another look to refresh my memory. Cheers!

    • #9468
      Run4Fun
      Participant

      Alan,
      We are very similar… like to run distance, same age, same height and weight, only for me it was my left hip with OA.
      I choose the resurfacing route and had it (BHR) done Last August shortly after I ran Boston, Eugene and Seattle Marathons.
      I remember my first meeting with my Orthopedic surgeon, sitting in office and testing him out . I dropped the “R” word (this sometimes will cause these guys to hit the ceiling) … I didn’t get much of a reaction , so I went deeper…. and tried the “M” (Marathon) word….the guy hardly flinched….so I then mentioned that I was a member of the “MM” (Marathon Maniacs) club. This is a club where you become a member by running multiple marathons, in quick succession. and they give you a membership which proves that you are certifiably insane.
      The short of it is, that he was not worried or concerned about the amount of running I was planning to do. He even told me once that I would not be able to wear it out ( from running too much) in my life time ….. so …I run!. At 6 month post op, I am up to about 6 miles, if I manage manage to Qualify to run the Boston Marathon again.. it would be my 4th time, I plan to give him my medel in appreciation.

    • #9469
      liz
      Guest

      Ah! You may well be a resurfacing candidate. One issue will be if you are large enough, if there is a device that fits you. One major manufacturer doesn’t make smaller sized prosthetics anymore, so small men and women find it tougher to get HR. But if you are a candidate, that’s the way to go.

      I agree you should check out surface hippy. There is a comprehensive list of questions on the site.

      Metal ions? Yes, that is a concern, so ask if your doctor will be monitoring and ask if he has cases in which metal levels have been an issue. (Full disclosure: I have two metal HR hips and at 2 and 1/2 years out, my metal levels are normal. Metal can be an issue, but these days it isn’t often a problem.)

    • #9470

      Hi Alan

      I had a THR 14 months ago at age of 52. Ceramic on ceramic – its the hardest wearing and as I understand it there is little history of any wearing out. (very rarely they get a squeaker !!) Don’t have metal on metal.

      I have been careful about getting back into my running – 6 months none at all then a bit on an anti gravity machine and then I walked a half marathon in just over 3 hours. Been slowly building my running since and did 10k this weekend in just under 48 mins – and no hip pain at all – muscles a bit sore!

      re leg length – both mine are the same length now – they weren’t before !!

      best wishes

      simon

    • #9471
      Doug A.
      Participant

      Thanks everyone, there is great info and inspiration in each of your replies! I leave before dawn tomorrow (Wednesday) for the 4 hour drive to the surgeon’s clinic and I feel pretty well-prepped for it. Good luck to all of you in the future!

      Alan

    • #9472
      ForceD
      Participant

      Liz’s list above is pretty good. Here are a few other things I’ll add:

      – Ask about the company that manufactures whatever device you’ll receive. Do some research on that company, and the device.
      – Medications that you’ll be required to take both before and after the surgery. For how long, and if you have any choice in them (particularly pain meds). Including: Anti-blood clot meds; stool softeners, and antibiotics. I didn’t realize until afterward that artificial hip recipients are required to take antibiotics before dental procedures for their remainder of their life.
      – Besides the surgeon, who all will be in the operating room?
      – Ask about pain from residual injuries inflicted on the operating table (I didn’t realize this beforehand either). To begin his work, the surgeon has to dislocate your hip. That can cause injury/pain in other parts of your leg. In my case the knee, and I had to treat for that with ice and elevation before I could try walking normally. And then before he closes you up he purposely tries to dislocate the artificial hip…so that he can fix any potential problems before closing. Again, that twisting of the leg can cause injury/pain throughout the leg.

      Bottom line is just to ask lots of question in order to get a good dialogue between you and the surgeon. If he knows you’re interested, he’ll volunteer info you may not think to ask about. My surgeon gave me his personal email address so that I could ask questions in the couple of months prior to my surgery. I got to the point that I felt I was annoying him, and I told him so. His response: “I wouldn’t have gotten into this business if I didn’t like talking about it.” He then told me “You’d be surprised how many people go into a doctor’s office and just say ‘replace my hip’ and never ask a single question about what’s being done, and what’s being put inside them.”

      Good luck

      Dan

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