Assessment for hip replacement/AF/Nocturnal Asphyxia

[Fib36]

Hi Everyone,

Well I went yesterday for my full assessment for hip replacement which took in total almost four hours involving blood test, ecg, blood pressure, 2 sets x-rays, allergy tests, short time with surgeon also with anaesthetist (who thankfully gave me the go ahead to continue taking my Flecainide 150mg x2 up to and including the morning of the op also to use my oxymetazoline spray to clear my occluded nasal passages) BUT my problem is this-- I went with the full expectation that as my RIGHT HIP was giving me all of the extra excrutiating pain when sitting, walking etc. that it would be replaced HOWEVER the surgeon said from seeing my x-rays that my left hip was now bone-on-bone and had to be done first despite my trying to stress how much pain I was getting from the right hip - his explanation was that due to the bad wear in my left hip, this was putting extra strain on my right hip even though there was less degredation in the right hip and that was what was giving me all of the constant pain. When I walk I get little to no pain or discomfort from the left hip and only from the right hip including a throbbing pain hip/knee in tune with my pulse yet I am now booked in for a left hip total replacement next month. My fear now is that after the op surely I will place even more stress on my right hip thereby making the pain even worse during the recovery period.

Has anyone any comment or any similar experience they can share with me to help alleviate my extra worries please??

Fib 36

[BenHall1]

Hi,

Not sure how to explain this ... its all about geometry ! Think about the steering geometry of your cars front end. If you get one part out of alignment it can stuff up an opposite component of, say, a tyre. Its about stresses and strains AND geometry. I've had right knee replacement, great, now I'm starting to have issues with left knee, after 8 years. The right knee geometry alignment spot on .... BUT ... now the left knee is having to compensate. Sorry, don't know how else to express it.

John

[Fib36 in reply to BenHall1]

Hi,

Very many thanks for your reply and though hard to accept I do understand the logic so the simple answer is "just get on with it...!" (Only just over 3 weeks to go -just hope evil Mr A F doesn't rear his ugly head..and my usual stress levels of 1000% dont jeopardise the procedure!!

[CDreamer]

What your surgeon says makes perfect sense and John’s explanation is as good as it gets - all about geometry and spinal alignment. As soon as we favour one side over another we will go out of alignment. Where we feel pain does not always correspond with the site of the origin of the dysfunction.

Hope it all goes well for you - make sure you do the physio exercises to the letter - and yes it may hurt but you will benefit in the longer term.

[Fib36 in reply to CDreamer]

Hi,

Many thanks for your comments and for endorsing John's explanation. I will do my best to survive and come out the other side to face the physio too!

[Desanthony]

Yes. absolutely this makes absolute sense. I was getting more pain from my right hip which was compensating for the left hip and like you the left hip was bone on bone and was causing the problem. I had my left hip replaced back in 2010 and thought I would have to have my right hip replaced within 3 to 5 years. Good news is that once my left hip was done all the pressure was relieved and I have not had my right hip replaced - though I did have my right knee replaced back in 2019 and right hip still going strong! I am not saying this is what will happen to you but it is quite astounding.

[Fib36 in reply to Desanthony]

Hi,

.Many thanks for the words of explanation & encouragement - I hope I have a similar outcome to yourself though must admit the stringent rules about not bending the torso beyond 90 degrees etc etc is a bit scary for someone who lives alone (except for my cat!)

[Desanthony in reply to Fib36]

The 90m degree thing is a b***er! However I managed. Make sure they know you live on your own so that they can tailor physiotherapy on coping in your situation and also furnish you with any particular raised seats or handles and bars to help you get up from a sitting position. The worst for me was washing myself during that time and I had help and had fixed up handles and bars around the house to help me get up and was pretty fit - apart from the hip problem but everything was just so tiring and frustrating at times. My wife said it was like having a houseful of children again and seemed to take hours to do just one thing. By the time i had done my morning exercises - managed to get to the loo, had breakfast and had a good wash it was often 11 0'clock and time for her to start lunch. Because for the first 6 weeks you can only walk on the flat I had a problem because we lived on a hill so had to either walk up or down to get anywhere. My son bought a treadmill for me which they put in the utility room for me so I could exercise on there when we were too busy or too tired to manage to bundle me into the car and take me down to the old docks to have a walk around - sometimes the weather was too bad to walk around the old docks as my operation was at the end of March so still a bit "breezy" and rainy.

Am sure you will do fine. all the best.

[Fib36 in reply to Desanthony]

Hi,

Very many thanks for your reply and for info re 90 degree restriction etc. Ironically I have a treadmill which I purchased recently as I was no longer able to walk down to the village and back again due to the gradual incline. However after using the treadmill a few times at very slow walking speeds I began to wonder if this was in fact making things worse so decided to leave it alone BUT I still have it so maybe it will come in handy after all! Yes it is concerning me that I live alone -have already purchased a raised loo-seat (+4 inches) and a 3 wheel folding walker (also have now got several long-reach grabbers in various places AND a couple of sock-sliders!) however I was wondering if there is anything else I should purchase although as you suggest -maybe the hospital will be able to provide something apart from the usual crutches. Some remarks on this site seem to suggest post-op recovery is a breeze but I do have doubts about that based on my experience 5 years ago with my knee replacement! Anyway here's hoping, Take good care

Fib 36

[Desanthony in reply to Fib36]

A long shoe horn is useful. I was given one at the hospital. Hip replacement is a breeze compared to total knee replacement. I had a total knee replacement in 2019 and believe me I almost wish I hadn't it was so much more painful in every respect. both the actual pain of the op and whilst doing the exercises. Having said that now I am pleased I did as the pain does go and i managed to get a good amount of movement back about 100 - 130 degree bend -on a good day and can now kneel down on said knee - something they said I would never be able to do. So it was worth it but those first couple of months were not easy.

[Fib36 in reply to Desanthony]

Hi,

When I had my right knee replaced in 2018 there was very little physio offered and I remember being given a scrap of paper on which the physiotherapist had written down a few exercises for me to do and that was it - consequently I still have a knee which barely goes past the 90 degree mark so always been a problem to get a sock on or kneel or anything now of course I am to face left hip replacement on 5th Dec even though the chronic pain in my right hip still makes me think "surely they should be replacing that one first otherwise how am I going to cope with trying to depend on that hip after the op to replace the left hip...?" I just hope and pray that the posts received about balance of one side to the other etc will apply to me otherwise total disaster? Even more worried as due to long long waiting times have had to go down the 'self-pay' route and somehow have to scrape up the £10,700 they require.

[Desanthony in reply to Fib36]

Credit where credit is due with both my hip and knee replacements I had brilliant physio. After the hip replacement a physio came out to my home within the first week to measure up for walking sticks and check that I was doing the exercises properly and to do them as often as I could. We have a gym at the hospital and I went there to classes once a week for about 6 weeks - this was on top of doing the exercises from the pamphlet provided at my pre op and walking every day. After the knee replacement I went every week to 10 days to the hospital for physio for about 2 months.

Do they offer easier payment terms for the operation? Its a shame but sometimes we are forced to do this.

I was lucky in that I was going to a chiropractor/physio for my back pain and on one visit I complained about pain in my groin and right hip. He examined me and told me it wasn't my right hip but my left hip and it needed replacing quickly as it was affecting my right hip and back. As he also worked in the NHS he was able to refer me straight away.

Good Luck.

[Fib36 in reply to Desanthony]

Hi again,

So sorry to be a nuisance but based on the information you gave me about more pain in the right hip than the left prior to your left hip replacement may I ask you your opinion about my present predicament please? I am due to have my left hip replaced on 5th December because the surgeon at my assessment said it needed doing due to being bone on bone BUT he appeared to totally ignore the fact that I was complaining about the terrible pain in my right hip AND that I had gone there fully expecting that the right hip would be prioritised and replaced. My biggest fear now is that if the left hip replacement goes ahead I will need to depend on my right hip for support during what appears to be a lengthy process and therefore the continuous excrutiating pain/throbbing in my right hip will become even worse and totally unbearable. Oddly enough my bone on bone hip is virtually pain free! May I therefore ask you to kindly quantify the level of pain and type of pain you were experiencing pre-op and especially in the right hip please and how you fared immediately post-op? - my fear now is that if I question the surgeon's decision I will lose my op appointment, £95 assessment fee and have to go through the whole process of 3-4 hrs of tests etc assessment all over again. I had no option but to go down the self-pay route due to the very long waiting lists despite being a struggle to afford to pay. Please can you help with your advice?

Fib 36 (David)

[Desanthony in reply to Fib36]

You must have had an X-ray which showed both hips so the consultant will have seen both hips as he did with me. As I said he looked at both hips and said that he would do the left hip first and within a few years - 2 or 3 he would have to do the right - that was back in 2010 and I have still not needed the right hip replaced and no longer get any pain from it. I stayed with that consultant for just over 2 years whilst he kept up with the progression of my recovery from my left hip replacement (I think in that time I had 2 X-rays of both hips and he had been reluctant to discharge me as was sure he would have to replace my right hip within that time. By about 2 years 3 months he could see no reason to carry out the operation on my right hip in the near future and so I was discharged from his care. The pain in my groin and outside of my right hip was so bad that I had stopped going out for my usual walks for months and this was why I mentioned it to my Physio/ chiropractor who I was seeing for severe back pain and he examined me and told me where the problem was and referred me. I would say for up to a year maybe longer I only did things that were absolutely necessary - walking to the car and back was probably the most I did for that time. I may on the odd good day have managed to walk around a shop but that was it. No gardening and no walking for pleasure and no trips to the gym - I normally go at least 4 times a week and still do. I had to delay my op because of my Mother's illness and then her death and actually went into hospital about 10 days after her funeral - that would have been about 18 months since I had been seen by the consultant. I first saw him in around about October time 2008 and eventually had the operation in April 2010. The pain I had was in my groin and that, I am told is where the pain is from the hip not on the outside of the hip - which was where I had the pain in my right hip - I thought it was all the same pain or even referred pain until I saw the X-rays shwoing what a bad state my left hip was in. It seems the surgeon was correct and the pain in my right hip was purely from relying on it to take the burden that I had unknowingly put on it as my left hip could no longer take it's share of the burden, and any other changes I had unknowingly made to my standing position etc. I am not a consultant hip surgeon and this is just my experience. I looked at my X-ray that first time and was absolutely amazed at what I saw - the left hip was bone on bone and had actually slipped to the outside pushing the rest of my pelvic girdle in and slightly out - which it seems was causing the groin pain. I must have totally changed the way I stood and walked and probably even lay down and sat due to this change. There was a nice layer of cartilage and whatever to be seen on the right hip which was thin in places but no way near as bad as the left.

I don't think you will find that you will lose your operation date if you voice your worries but I would certainly call the surgeon's secretary and explain that you are very worried about this and ask to have a chat with your surgeon about your concerns - or ask the secreatary to chat with him and get back to you and explain why he is doing this if it is not possible to speak with the surgeon - that is what they are there for. You are not questioning his expertise or training but worried about how you will cope if you still continue to get pain and maybe worse problems from your right hip whilst recovering from the operation. You are paying for the operation and he and his team are there to answer all your questions and ensure you are comfortable with the decision that both of you should have come to about your hip replacement. He will explain to you why he has told you that he will replace your left hip and not your right - in fact I am amazed he hasn't already done so and showed you the X-rays and explained all this to you at your consultation. It may also be worth your talking to your GP and physiotherapist about this. I don't know about your area but here we can refer ourselves for NHS physiotherapy. - or you could ask about seeing the physiotherapist at the private hospital you will be attending for your hip replacement.

[Fib36 in reply to Desanthony]

Thank you so much for taking the time & trouble to explain your experiences - very much appreciated. I DID see the initial xrays (had to go back for another after he decided to concentrate on the left one) and yes the left hip looked bad despite not giving me much pain at all and yes the right hip looked as though some cartilage left (one reply I have received suggested that an x-ray is not infallible & what looks like a reasonable hip joint could in fact be bad so to be warned "you might end up with a painful hip plus a very painful hip....") It was just such a shock when I turned up describing the excruciating pain in my right hip & expecting the surgeon to say yes ok that will be replaced and then to be told he wanted to do the left one which is bone on bone! The worrying thing is that the surgeon is a little hard to communicate with as he is of a different nationality (as indeed was the anaesthetist) but having tried hard to explain to him my situation his decision was made. My overwhelming worry at the moment is how will my right hip cope post op if it is so very painful now to the point that standing up for a couple of minutes becomes unbearable and especially so as I live alone with no family or relatives close by and that is something I must phone about tomorrow.

Anyway again my sincere thanks to you

[Desanthony in reply to Fib36]

You must talk to someone about this. Maybe a chat to his secretary or a physio at the hospital will help. Have you spoken to the physio department?

[MiniMeGreen]

I've a similar experience as I teared my right Achilles tendon 2 years ago. It was treated conservatively which means just a cast for many weeks. Luckily it worked, however when I eventually got rid of the cast I started to limp heavily on the left side! Even worse, it caused heavy unexpected pain on the left hip but mostly heavy backpain. It took me around 6 weeks to adjust and to walk normally. It was something what I just couldn't influence mentally but had to keep walking until it resolved on its own.

[Fib36 in reply to MiniMeGreen]

Hi,

I really appreciate all of the observations & comments and will try to bravely go forward (complete with acute stress as is always the case in every bit of my life!)

[Physalis]

The x-ray on my right hip showed bone on bone even though it was giving me no pain. I had it replaced. A few weeks after the operation I asked about the left one and he said that would need to be done sooner or later so it was and I didn't have to wait very long.

I had looked online for information and noticed that some hips which were very painful but showed normal on x-rays turned out to be very damaged when they were removed. I wouldn't be surprised if this is what is happening in your case.

It's all very well coming up with reasons why your right hip is giving you excruciating pain but making you wait seems to be unkind. He seems like someone who thinks he is right about everything.

You are stuck, there is no-where else for you to go so I suppose you will have to put up with his decision. After the operation you will have one hip which may be a bit painful and giving you trouble and the other one which is very painful.

You might like to read this

bumc.bu.edu/camed/2015/12/1....

I should add that I have one leg an inch shorter than the other but have had no problems with it.

[Dudtbin]

that is exactly what happened to my husband. They di what he thought of as his ‘good’ hip first - they were right! He had much less pain.