-
Old logic--wait as long as possible before THR. New logic do it ASAP before ROM
decrease, cysts, atrophy, etc.
-
Dr. Gross: It is a reasonable statement. If you want Resurfacing, your chances
of success diminish if too much femoral bone is lost with cysts or erosion. Bone
density decrease due to inactivity may also be a problem. However, there is usually
no extreme urgency; XRs every 6 months to 1 year are a good way to follow a patient
who is not yet ready for surgery. None of this applies to stemmed THR.
-
I have to travel 2 months after surgery. Will I be able to do that?
-
Dr. Jinnah: You should be able to travel 2 months after surgery if everything
goes smoothly, but again itis best to discuss that more thoroughly with your
surgeon.
Dr. Gross: No. flying in
two months should not be an issue. My patients fly home 3 day after surgery throughout
the US. I generally advise that they can travel after 6 weeks.
-
How long before I can return to work?
-
Dr. Jinnah: It depends on the nature of your work. You can certainly be doing
desk work within a month or so, driving is again very individualized and you
have to have control of your leg before you can drive. The usual time is between
4 to 6 weeks. In terms of back to sports, my recommendation is between 6 to 12
months. But again it depends on type of sport you participate in and how well
youire doing.
Dr. Gross: You can begin driving in 3-4 days, as soon as you are off narcotics
postop.
Desk work is appropriate after 2 weeks.
Walking work: after 6weeks
Heavy labor: 6mnths
Sports 6months
-
Can arthroscopy be done in the hip and delay need for resurfacing or replacement?
-
Dr. Jinnah: Arthroscopy can be done in the hip and itis particularly useful for
conditions such as a torn labrum or perhaps a surgical dislocation of the hip.
Again this depends very much on exactly what your pathology is and itis best
discussed with an orthopaedic surgeon.
Dr. Gross: Sometimes. Hip arthroscopy is a newly developing field. I do not perform
hip arthroscopy. There are only limited indications for this procedure. In my
opinion, too many hip arthroscopies are being done by surgeons with insufficient
skill and experience on patients who are not good candidates. The selection process
for these procedures is too complex for me to break it down into a simple formula.
Instead I will comment on two common scenarios.
a.) Symptomatic CAM FAI in a patient under 40 with little or no degenerative
arthritis in the hip joint. Probably is worthwhile, but only in the hands of
a select few hip arthroscopists
b.) Mild hip dysplasia (Crowe I) with pain and no significant degenerative arthritis
in the hip joint, but with a labral tear:
Very controversial. Removing the labrum may lead to rapid further deterioration
of the hip joint. There are two other options to treat this problem. Try a cortisone
shot and put up with some pain until the joint deteriorates further, then proceed
with Hip Resurfacing. Or, if you are very young (under 40) try arthroscopic labral
resection combined with a Periacetabular osteotomy. We need more studies to resolve
this question.
-
I am young. How long should I try to live in pain before having surgery?
-
Dr. Kreuzer: Hip replacement type surgery has become a very safe operation but
there are still complications that can occur which may result in permanent disability.
It is because of this that we recommend to wait as long as possible to have a
hip surgery done. Personally, I would recommend to proceed with a hip replacement
type surgery when Anti-inflammatory medication are no longer effective and when
you spend most of your day thinking about your hip or when your wife/husand is
tired of putting on your socks.
Dr. Jinnah: Depends on how young you are. Certainly if you think you can get
5 or 10 years by living with the pain it would be worth delaying the surgery,
but whether itis worth it to delay it for a year or 2 is somewhat controversial.
I think this is something you need to discuss with your orthopaedic surgeon.