Hip replacement under 30

[Hippy]

Apologies up front but I'm an existing member posting under a new account as this is related to someone close to me who I do not want to identify.

Following three operations for Developmental Dysplasia of the Hip before the age of three a young person I know who is in some pain has been offered a Total Hip Replacement privately whilst still under 30. They understand that in all likelihood they will need it at some point soon and therefore almost certainly need another one later but I'm trying to help them understand if there are options at this point even to push the first one out by a few years. Ideally I'd love to connect with someone who has a similar experience or some expert knowledge. They could go to the NHS for a second opinion but I think it would probably take longer than there is before the private operation would be done.

[speedster986]

Hi. The options really depend on the degree of degeneration that has occurred and the amount of pain they are in and its impact on their life. In terms of options there are conservative measures such as weight loss, cushioned shoes, walking aides such as walking poles or sticks and analgesia. Low impact (open chain) exercises such as cycling or swimming may help some people who can manage to do them. The next level can be injections with steroids and or local anaesthetics but this is not curative. Hip replacements are very good for pain relief but do have a finite lifespan and have risks such as dislocation. Hip resurfacing maybe beneficial in active younger males but can depend on the size and shape of the hip which may be a problem in dysplasia.

[Hippy]

speedster986 said:

Hi. The options really depend on the degree of degeneration that has occurred and the amount of pain they are in and its impact on their life. In terms of options there are conservative measures such as weight loss, cushioned shoes, walking aides such as walking poles or sticks and analgesia. Low impact (open chain) exercises such as cycling or swimming may help some people who can manage to do them. The next level can be injections with steroids and or local anaesthetics but this is not curative. Hip replacements are very good for pain relief but do have a finite lifespan and have risks such as dislocation. Hip resurfacing maybe beneficial in active younger males but can depend on the size and shape of the hip which may be a problem in dysplasia.

Thanks for the quick answer. It's a woman so I presume resurfacing is out. I think most of the other options you mentioned have been considered already and are either already being done or dismissed for a specific reason so it seems like she's getting good advice.

[The_Doc]

Lots of very good stuff above, accurate and useful.

I don't do primary hips I do knees, but I am a high volume surgeon

https://boneandjoint.org.uk/Article/10.1302/1358-9...

-is a seminal paper and basically says that a well performed Cemented Exeter total hip could be the last operation you ever have. The paper was written by the Exeter gang though.

A ceramic ball on a polyethylene cup, can be a perfect bearing surface, even if the cup wears out at 30yrs, you can redo the cup only.

Its a very technical discussion, so just find a surgeon who does lots of hips a year.

[martinbiz]

Hippy said:

speedster986 said:

Hi. The options really depend on the degree of degeneration that has occurred and the amount of pain they are in and its impact on their life. In terms of options there are conservative measures such as weight loss, cushioned shoes, walking aides such as walking poles or sticks and analgesia. Low impact (open chain) exercises such as cycling or swimming may help some people who can manage to do them. The next level can be injections with steroids and or local anaesthetics but this is not curative. Hip replacements are very good for pain relief but do have a finite lifespan and have risks such as dislocation. Hip resurfacing maybe beneficial in active younger males but can depend on the size and shape of the hip which may be a problem in dysplasia.

Thanks for the quick answer. It's a woman so I presume resurfacing is out. I think most of the other options you mentioned have been considered already and are either already being done or dismissed for a specific reason so it seems like she's getting good advice.

Not heard that one before

I know a lady who had a re surfacing done 15 years ago and still good. Mine is 18 years and still going strong

[The_Doc]

Smaller anatomy = measured greater risk of revision.

48mm native head as a "line in the sand". Rare for a man to have a head under 50mm. You can template it preop.... Resurfacing is under 1% by patients a year, but it is still done.

Edited by The_Doc on Wednesday 1st April 20:53

[spikeyhead]

The_Doc said:

...

Its a very technical discussion, so just find a surgeon who does lots of hips a year.

If the OP finds one, should he shout "hip hip hip hooray?"

[markiii]

only if he finds 3

[martinbiz]

The_Doc said:

Smaller anatomy = measured greater risk of revision.

48mm native head as a "line in the sand". Rare for a man to have a head under 50mm. You can template it preop.... Resurfacing is under 1% by patients a year, but it is still done.

Edited by The_Doc on Wednesday 1st April 20:53

Yes seemed to die a bit of a death in recent years for some reason, seems strange when it gives you the chance of a THR in later years if needed which would to all intents and purposes almost be a primary rather than a revision

Any reason for this Doc?

[speedster986]

Resurfacing hips have been traditionally made of metal. The metal on metal debris can cause a reaction which can have a catastrophic effect on soft tissue and bones. This has been called metallosis, pseudotumour or ALVAL. This means the revision can be very difficult. Due to this the MHRA, who regulate health devices have restricted who it can be used in. That’s why it has become less common and niche. A new variant made out of ceramic may bring it back if successful in trials.

[The_Doc]

Well put. (did an AI wrote that ? )

Basically it became obvious that you couldn't predict who was going to get a metal ion problem. And a well performed Total Hip Replacement with an expensive bearing might do just as well, particularly the stem.

But Resurfacing still goes on, I have a friend who had one a few years ago. It's just niche not mainstream.

My dad had one done 28 yrs ago (a Birmingham) and it is faultless and essentially perfect

[speedster986]

Hi The-Doc. Not AI. I m a primary and revision hip surgeon. I have to discuss this often with patients.

Edited by speedster986 on Friday 3rd April 10:22

[The_Doc]

Ha !
It just seemed too proficient, but now I see why!
I don't even do primary THR. I did a lovely V40 44-2 with a Unitrax head on the other day. The NOF tricked me into opening our generic Thompsons, but the canal said no.

[INeedAHero]

Hi,

Just creates an account.

Following years of not being able to walk correctly, I have just had an MRI scan.

I've sent this to a couple of physics and they can't see anything wrong with my knee.

A had a MRI scan on my hip a couple of years ago and it was also reported the same, no damage or anything tol report.

Am I being to wonder if I have just a neural or adverse thought process which is causing me pain?

What I'm experiencing, is that when I walk and land my foot, I get a pain at the top off left knee (runners knee). However no amount of rest resolves this at all.

Oddly when I run and land on my fore foot (toes) I don't experience and pain. Very similar to cycling, although there is no pain, there does seem to be some balance between muscles not completely correct.

Any help would be greatly appreciated.

[LosingGrip]

speedster986 said:

Hi The-Doc. Not AI. I m a primary and revision hip surgeon. I have to discuss this often with patients.

Edited by speedster986 on Friday 3rd April 10:22

Who is the coolest person in a hospital?

Nope, not thr ultra sound guy. The hip doctor .

[Autopilot]

speedster986 said:

Resurfacing hips have been traditionally made of metal. The metal on metal debris can cause a reaction which can have a catastrophic effect on soft tissue and bones. This has been called metallosis, pseudotumour or ALVAL. This means the revision can be very difficult. Due to this the MHRA, who regulate health devices have restricted who it can be used in. That s why it has become less common and niche. A new variant made out of ceramic may bring it back if successful in trials.

I was hoping to have the newly authorised for use, MatOrtho ReCerf ceramic resurfacing done due to age and desired outcomes. The surgeon I chose who is one of the few UK surgeons to be authorised to use ReCerf thought otherwise as I'd utterly destroyed the femoral head ( I don't know if they are supposed to look like an orange gnarly pork scratching but mine did!) and no good bone to work with so had a complete replacement.

[Autopilot]

Hippy said:

Apologies up front but I'm an existing member posting under a new account as this is related to someone close to me who I do not want to identify.

Following three operations for Developmental Dysplasia of the Hip before the age of three a young person I know who is in some pain has been offered a Total Hip Replacement privately whilst still under 30. They understand that in all likelihood they will need it at some point soon and therefore almost certainly need another one later but I'm trying to help them understand if there are options at this point even to push the first one out by a few years. Ideally I'd love to connect with someone who has a similar experience or some expert knowledge. They could go to the NHS for a second opinion but I think it would probably take longer than there is before the private operation would be done.

I've never had, nor do I really know what hip dysplasia is, but do have experience of pretty horrible hip pain so can comment on that part. I used to get a horrible clicking from my hip in my mid twenties, it only really happened when my left leg was bent slightly inwards but good lord did it hurt when it did it. Luckily it's an instant pain and then gone. I had injections in to my hip which gave me around 6 weeks relief and pretty much 6 weeks to the day it was back to how it was. The consultant said I would eventually need a replacement but to wait until I was really bad. The referring consultant said I was too young to be in that level of discomfort so sent me off to Cambridge (Bupa Lea) to see about having hip arthroscopy. I had the procedure and it helped but never really fixed me. I couldn't tell you if this bought me time or not, but yes, it improved but was never quite fixed.

Over the years, my hip got more and more painful, my legs became stiffer, my lower back became agonising and on some days, even walking short distances was seriously painful. For years I'd been putting my left sock on by putting my left knee on the bed and reaching behind me to get to my foot. Shoes and socks were a nightmare and when I'd been out and about ( I remained active despite being in agony) my legs would seize up so badly that even lifting my foot an inch or two off the ground to remove boxer shorts prior to getting in the shower, required shouting, swearing and much effort!

One day I decided I'd had enough, registered with the local docs surgery....I'd only been here 7 years so figured I should sign up...and got referred to the hospital. After waiting a year and never even getting a date to speak to the MSK team and being told they're still waiting to put me on the list to even speak to somebody, I decided that was it, I'd had enough. I paid to see a consultant and one look at my xray I'd just had done and he asked me if I could see a problem (happy to post all this stuff by the way). My untrained eye could see it all looked a bit horrible on one side and could clearly see an impingment. Resurfacing was out of the question as there was just too much damage and no quality bone, a total hip replacement was the only option.

I once compete in bodybuilding and was a competitive martial artist (kickboxing until my kicking got worse and worse then in to semi-pro MMA) so am pretty tough and quite muscular. He used something called the Corin OPS which I can only describe as personalised treatment based on my individual body mechanics, 3d printed jigs, laser alignment and a comprehensive plan to get the best outcome for me based on loads of xrays and CT scans with me standing, sitting, squatting, lunging etc to get the best position for my body. I had the hip replacement (Spinal block and heavy sedation....I knew nothing, just woke up after) and was home by 11:00am on day three.

The first week or two isn't much fun, mainly mind games as I was convinced if I moved my leg would fall off etc. I had my first physio session at 2 weeks. The physio shoved my knee in to my chest, as good as swung me around by my legs and that was that, I'm not that delicate and moving in bed isn't going to dislocate anything. At 4 weeks I was off crutches and by week 9, even my chronic back pain I'd had for 15 years was gone.

It's been 12 months and life for me is quite different. I can walk as far as I like, cycle of rmiles and miles and while no stranger to the gym, I enlisted a PT for leg days. I started light but now using the linear leg press (the one where you're sat low and press at 40ish degree upwards) and pressing a very strict 150kgs of which my finishing set is 40 reps and allowed to pause 3 times or I get shouted at. A year ago. I'd not have even been able to get in the seat or up off the floor again.

I'm under 50 (just) and will need one, maybe two revisions in my lifetime. My only regret is that I waited as long as I did. I'm pain free, I can do my own shoes up and I'm super active. To answer your question regarding if you can push surgery out until a later date, well, no, not really. I wish i'd had mine earlier and not spent years in agony and living a limited life style. If you need it, you need it and if you're under 30, you're going to need a number of revisions so postponing won't really change that fact even if they managed to hang on for another 10 years. We don't know how long we have, so why spend it in pain and with mobility issues?