Jim had a colt wreck in 2005 resulted in broken pelvis and other damage. Plated pelvis at that time. 2011 right hip replacement. Now as they warned him, his left hip may need replaced. We are going next Thursday to ortho surgeon.Has anyone here had hip replacement while on ADT and HT? Wondering if it makes the surgery or recovery more difficult. I'm also concerned about his past staph issues, but thats not cancer related.
Thank you
Hi there. From ChatGPT:
Androgen deprivation therapy (ADT) and hormone therapy (HT) can impact recovery from hip replacement surgery in several ways, including an increased risk of complications such as infection. Here's a detailed explanation:
1. Bone Health and Implant Stability
Osteoporosis Risk: ADT can reduce bone density, potentially complicating the process of implant integration (osseointegration). Fragile bones may also increase the risk of perioperative fractures.
Delayed Healing: Poor bone quality can extend the recovery timeline.
2. Muscle and Functional Recovery
Sarcopenia: ADT-induced muscle loss can impair strength and mobility, making it harder to regain independence after surgery.
Fatigue: Generalized fatigue from HT can reduce the patient’s participation in rehabilitation programs.
3. Risk of Infection
Immunosuppression: ADT may modulate immune responses, potentially increasing susceptibility to infections post-surgery.
Delayed Wound Healing: ADT can impair tissue repair, making the surgical site more vulnerable to infection.
Infection risk is particularly concerning in joint replacement surgeries because a prosthetic joint infection (PJI) can require additional surgeries or prolonged antibiotic therapy.
4. Cardiovascular and Metabolic Risks
Cardiovascular Effects: ADT is associated with higher risks of cardiovascular events, which could affect perioperative care and recovery.
Metabolic Changes: Therapy-induced metabolic syndrome may contribute to chronic low-grade inflammation, impacting recovery and infection resistance.
Strategies to Mitigate Risks
Bone Health:
Pre-surgical evaluation and treatment for osteoporosis with medications like bisphosphonates or denosumab.
Ensure sufficient intake of calcium and vitamin D.
Infection Prevention:
Strict adherence to surgical sterility and perioperative infection control protocols.
Consider prophylactic antibiotics tailored to the patient’s health status.
Rehabilitation and Mobility:
A prehabilitation program to optimize muscle strength and overall fitness before surgery.
Structured physical therapy post-surgery to rebuild strength and mobility.
Monitoring and Support:
Close monitoring of cardiovascular health before and after surgery.
Engage a multidisciplinary team to manage potential complications.
Summary: ADT and HT can impair recovery from hip replacement surgery by increasing the risks of poor bone healing, reduced muscle recovery, and infection. Addressing these risks proactively with a comprehensive care plan can help optimize outcomes.
Thank you for that information. Appreciate that.Will make sure his surgeon is aware of all these things. And of course will notify Jim's MO after the ortho consult.
Fortunately, Jim has stayed active. Works out daily on his total gym, and works around our property. His Dexa scan last year indicated good bone health still. The infection part is worrisome, considering his past staph infections the last couple years. A lot to think about. Trying not to worry as he's already apprehensive.
Hoping that others have had successful outcomes. Jim is adamant that he must be able to continue riding his horses.
having given you the info from AI, I would suggest the following and note, I'm not a doctor. Whatever you hear from the ortho surgeon, get a second opinion from another cutter. Surgeons want to do surgery. I assume he's in pain?
Ask for a dexa scan to view his current bone health. Take the information to your medical oncologist for his/her opinion. Include all non cancer related medical information.
Note that once you've had a staph infection, it is considered easier to get another one so when asking a question here, it's important to include complications and comorbidities.
Thank you!Yes his pain has increased significantly the last week. He's been saying since it started bothering him, he absolutely won't have a surgery. So that fact he's willing to do that now tells me it's unmanageable. It's gotten where he can only ride his horse for a short period of time and thats unacceptable. Also gets worse when he's digging post holes, the bending I would think.
The staph is the scariest part to me. So I will be addressing that up front. This surgeon has done all of Jim's musculoskeletal surgeries the last 20 years and is brutally honest. He works limited days, limited clients now, and will absolutely not do anything unnecessary. I'm truly hoping its something less invasive than total replacement. He does have osteoarthritis in that hip.
Really appreciate your input!
So his MO said Jim has osteopenia but not osteoporosis. She said she sees no concerns with the surgery, and should proceed with the recommendations we receive from the surgeon. No conflicts with his current treatment. And doesn't feel anything besides the normal fatique and muscle loss, will impact his recovery. And since he's stayed active and tolerates his treatment so well, she feels that will be minimal. So with her okay and the great info from this forum, feeling optimistic and ready to get to the other side of this.Thank you again for the info.
I had a hip replacement before I was diagnosed with Pca, but I can testify that once the pain (from osteoarthritis at least) has advanced to a certain point it’s basically unbearable. It is telling that he is now open about that, and I think it’s a good sign.
I’ve also had blood infections and am no more enthused about more surgery than you two. Yet I’m going to get another in several months and that’s only what’s planned-who knows how many more may follow? I take the risk because moving as well as possible is a top priority for me.
As you well know, we become more and more like old cars. We fix up what we can but can’t trade in, as we are the car itself. He must ride!
THR is fortunately such a relatively easy procedure to do well, and its efficacy surprises new patients each day. Nearly every person I’ve known who gets one wishes they had it done sooner. If it were me I’d absolutely accept the risk despite the understandable concerns. Great luck to you!
Excellent advice. I had a THR as well as a shoulder done. So glad I did. Second shoulder will be done next year.
I had a hip replacement last year which was 3 years into my ADT and Erleada treatment. My doctor had me stop the erleada a month before and a couple after the surgery. This was an over abundance of caution but he said there was no harm in stopping it. I had no issues with the replacement and recovered fast. I was also on Zometa for osteoporosis which the surgeon had me stop 3 months before and 3 months after.
I am 64 and had my right hip replaced on Sept 20 at 16 months in on ADT. I had my left hip replaced in 2019, pre-cancer. I feel like the healing went ok but the recovery of strength and balance is taking a little longer. My whole body paid (I lost some progress on strength) for the downtime of the first few weeks after surgery. I was also anemic after the surgery because my blood counts were already still impacted by salvage radiation and the surgeon had to make the incision longer than he planned. After PT and iron/Vit supplements I am doing fine. I still have some pain but I cross country skied the 5th time of this season yesterday. I pulled the trigger on replacement a little early but I wanted to get it done while my PSA is undetectable. With my pathology I don't know what the future holds. All in all, I would do the hip the same way again.
Cross country skiing is extremely strenuous ! That is amazing and very encouraging. Jim is also undetectable so this is as good a time as any. Jim says he agrees with unknown future, so lets not waste any more time. Thank you!
I’m not much help providing an answer to your question, but I can relate to your husband through our mutual love of horses. I grew up on a family farm/ranch and have spent considerable time in the saddle. I believe it was Roy Rogers that said, “the outside of a horse is good for the inside of a man”. I’ve certainly found that to be true. I can also relate to having a few “colt wrecks” but fortunately I’ve escaped with just a few bad scrapes and bruises and almost lost a few fingers/thumbs from calf roping. Best wishes to you and your husband as we share this painful journey…
Thank you! Jim loves that saying. He grew up with horses and rodeo'd a bit when he was younger. Roped calves briefly and rode bulls. Lost a kidney in a bull wreck at Livermore when was 18, so decided he better get a "real" job and go to work 🤣We love horses and they're our life. His only stipulation through this cancer thing has been, if he can't ride a horse he's not doing the treatment. He's just finishing our last young horse, and from here on out we'll only mess with ones that are well started. We are down to 7 horses now, but 4 are retired. We team rope and I was barrel racing, but have stopped for the last few years. We have an arena we built, so we just rope at home and I keep my old horse tuned up lightly on the barrels.
What state are you in? Do you still ride? I read your post to Jim (he doesn't do technology, won't even use a smart phone) and he loved hearing from a horse person 😄
I was born in Wyoming and my childhood was spent moving around the country and Europe as my father was a military officer. I spent my summers helping my grandfather on his farm/ranch and he was an old rugged cowboy who instilled in me a love for horses. After college I worked a 30 year career in the insurance industry and retired to our family farm/ranch in northern Utah which is on the border of Idaho & Wyoming. I’m the 5th generation to manage and own the farm/ranch that was originally homesteaded by my ancestors. I’m still very active and in great shape except for PCA. I can still “ride, rope, saddle and paint” as the song says. I have a daughter and 2 sons that have all grown up around livestock and agriculture. Fortunately, one of my sons loves this way of life and he still helps out whenever he can. I probably work harder and longer now than I did when professionally employed. Tell your husband to “cowboy up” and we’ll ride through this storm together. Best regards!
Wow! Fascinating life!! Thank you for sharing this and your thoughts on this post ... very uplifting. Jim is sooo fascinated by Wyoming. Would move there if circumstances were different.
Best to you, and much appreciated
As the song goes...
Forever a cowboy he defines the word grit
His only bad habit he don't know when to quit
Free as the spirit that runs through his veins
Forever a cowboy he will remain
I had been on ADT for 1.5 year when I fell and fractured my left hip joint in July of 2023. I had total hip replacement next day. Recovered quickly and was back on my bike riding outside just a month after! The healing went perfectly fine and I run, cycle, do resistance training just like before. I've been very active for many years (since 2009) cycling 200 mi/week routinely so likely this helped with quick recovery despite ADT, etc.
Right after my recovery I asked my physician to do bone density scan suspecting I had osteoporosis and indeed, result came up with Z-score of -2.7 in remaining right hip. That explained why I fractured it from an easy fall (I fell many times riding bikes and never broke anything before cancer/ADT ordeal).
Since then I went ballistic trying to find non-drug ways to stop/reverse osteoporosis and came up on a video interview of Dr. Doug Lucas with John Jaiquish and thus discovered Osteostrong. Luckily I have near-by one of the franchise locations (OsteoStrong Los Gatos) and signed up with them. Now, its almost a year since I started weekly osteogenic loading sessions.
My next bone density scan comes up next August (my doc says SOC is do it every 2y for folks like us) so I will see how effective OsteoStrong is then.
To combat osteopenia I started X3 Bar variable resistance training program (another invention of John Jaiquish) in October 2023 and it works fine as evidenced by my regular monthly body comp DEXA scans (these are not zooming in on hip/spine area sadly). Despite beeing on ADT I gained muscle and lost fat!
Great to hear! Thank you for the info. And personal experience is priceless, and encouraging! Jim works out on a Total Gym every day. But not variable which would probably help more. Your activity level is amazing. Thank you for the osteo info, will look into that.
So Jim's MO said that his last Dexa in July 2023 showed osteopenia but no osteoporosis. I'm definitely going to research Dr Lucas and John Jaiquish. Your story is amazing. Thank you again.
My scan in August 2023 showed osteopenia in spine and osteoporosis in right hip.
Here is the link to video interview: youtu.be/YCjGURH2_4A?si=QUt...
And the one on drug dangers: youtu.be/Ov4V1iPtO7U?si=ljg...
What does it mean if you find a horse shoe?
It means some poor horse is walking around in his socks.
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youtube.com/watch?v=Qt0_oPP...
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And Jim, May the horse be with you...
Good Luck, Good Health and Good Humor.
j-o-h-n
It's been a pleasure............................................ all yours................ (That's what I say to a new Doc when I leave him/her for the first time...........They usually laugh)....
Good Luck, Good Health and Good Humor.
j-o-h-n
If he has no cancer in that hip, he should be fine. I had a hip replacement at the same time as my DX and could use another but that’s where my cancer is. The bone is weak ( I do take Prolia which has helped a lot). The combo of Prolia and the supplements I take (gulcosomine, MSM) has gotten me off walking with a cane and being able to walk a couple kms. I do use trekking poles. I also take anti inflamitories.
I sure hope eventually you can get that hip taken care if.Jim doesn't have cancer in that hip, thankfully. He had a suspicious spot on the hip that already has hardware. It was only found on a PSMA scan. He has no trouble on that side.
Thank you for your input, everything I can learn from other's experience is appreciated.
Would hip replacement be a problem with stage 4?
knee replacement
Failing ADT
Surgery while on ADT meds, put off, or ok?
