| My world was split into two. With medication I was | | | | ceramic is the 2nd hardest substance on the planet - |
| pretty well pain-free but unable to concentrate or | | | | the hardest being diamond. Somehow I doubted that |
| focus on anything at all. Without it I was in serious | | | | would be available on the NHS. Still 2nd hardest |
| pain and my mobility was so reduced that I could | | | | sounded good. How long would that last? |
| barely manage stairs let alone leave the house. | | | | Well the jury is still out on that question, mainly |
| Diagnosis - severe osteoarthritis. My life had become | | | | because these new prostheses are still evolving and |
| focused on my hip and the prospect of surgery. | | | | sufficient time hasn't yet gone by to evaluate their |
| A hip replacement at 52? No! Surely I was too young. | | | | wear rate. It is hoped that they'll last between 25-30 |
| I asked my medical friends, who were unanimous in | | | | years - about double the life of a traditional implant. A |
| their answers; "delay having a hip replacement for as | | | | quick calculation and I realised I'd only need one more |
| long as possible". Okay, I thought stoically, I'll hang on. | | | | (unless I was heading for a Guinness Book of |
| But for how long? How would I know when I'd | | | | Records type of life span). |
| reached "as long as possible"? How could I factor in | | | | I was already beginning to swing to the sooner |
| the length of time I'd be spending on a waiting list? | | | | rather than later approach when I found some |
| How was I going to function until then? And was | | | | information discussing the physiological problems |
| waiting really the right answer? I entered "hip | | | | associated with delaying surgery. Medics have always |
| replacement timing" into Google and started reading. | | | | acknowledged that delaying surgery meant the |
| The first thing I learnt was that all weight bearing | | | | patient would have to endure increasing pain and lack |
| implants have a finite life. As the two surfaces rub | | | | of mobility but the approach seemed to be it just |
| together they shed minute bits of debris. This debris | | | | had to be endured. Now the consequences of |
| sets up a reaction in the body which loosens the | | | | long-term severe pain and limited mobility are being |
| tight fitting implant. A loose implant is a painful implant. | | | | recognised. |
| Sooner or later it will need to be replaced. | | | | Whilst waiting for surgery my hip joint would continue |
| Wear is not just associated with the length of time | | | | to wear away increasing both the amount of pain I |
| we have the implant for, it's also about what we do | | | | experienced and the need for very strong |
| with it. The more active the patient is the greater | | | | medication. Furthermore this wear might also gradually |
| the rate of wear and young people tend to be more | | | | deform the joint itself and one consequence of that |
| active than their elders. From my point of view one | | | | may be that options for less invasive surgery, such |
| of my desired outcomes from surgery was to get | | | | as hip resurfacing, were lost. |
| back to an active life. Maybe a bit more subdued | | | | But it's not just the affected leg that is being |
| than before (no more rock climbing) but still one | | | | damaged. As the "bad" leg become less able to |
| where I challenged myself physically from time to | | | | weight bear the "good" leg must take on more of |
| time. | | | | the work. The danger here is that the additional |
| I learnt also that weight plays a key role in how | | | | stress on the "good" leg's hip and knee joints will |
| quickly a weight bearing joint, such as a hip, lasts. | | | | hasten their decline and may even result in further |
| Heavier patients wear out their hips faster than | | | | joint replacement work. |
| lighter ones. This is true for both the original joint and | | | | And it didn't stop there. All this pain and decreased |
| its replacement. Students of mechanical engineering | | | | mobility would result in weight gain, loss of muscle |
| will understand that 1kg of body weight puts | | | | mass, a deterioration in the quality of life and an |
| approximately 4kg of pressure on a hip joint. | | | | inability to carry out activities of daily living such as |
| But did any of this really matter? If a hip replacement | | | | shopping and socialising. It sounded like a recipe for |
| is a fairly straightforward, routine operation surely | | | | depression as well. |
| they could just change my implant once it wore out? | | | | A survey of younger patients undertaken by hip |
| Sadly that isn't the case. | | | | replacement and - a one-stop information shop - |
| Revision surgery involves taking out the old implant | | | | showed that almost 30% of younger patients felt |
| and replacing it with a new one and is considerably | | | | they should have had surgery earlier and that |
| more complex. Second time around (let alone third) | | | | delaying surgery had significantly affected their lives. |
| there is less bone stock to work with and the tissues | | | | Their most often stated concerns were the loss of |
| surrounding the joint, and holding it together, have | | | | quality of life and further damage to their joints. One |
| lost much of their flexibility. Without that flexibility it is | | | | respondent wrote touchingly about how she had not |
| harder to align the new implant optimally and correct | | | | been able to participate in the lives of her growing |
| alignment is crucial to reduce the rate of wear. | | | | family due to pain and immobility. |
| There is also a higher chance of a serious | | | | There is no simple answer as to what is the best |
| post-operative complications following revision work. | | | | time. I believe it is imperative that all hip replacement |
| These are nasty. They include painful dislocation ( a | | | | patients understand the advantages and risks in |
| trip to A&E), infections (possibly necessitating the | | | | either going for early surgery or delaying it. Such an |
| removal of the new implant to clean out the | | | | understanding will allow an informed discussion with |
| infection) and deep vein thrombosis (potentially fatal!). | | | | the surgeon. If your surgeon radically disagrees with |
| The case seemed to be made - delay surgery - let | | | | you and you don't accept his reasoning, then ask to |
| one implant last a life time. | | | | be referred to someone whose views more closely |
| I was convinced. I was convinced for all of 10 | | | | match your own. |
| minutes which is when I started to think about what | | | | Some pointers as to when it might be time for the |
| that would mean for me. Years more serious pain | | | | operation: |
| and heavy duty medication and an ever dwindling life | | | | - When the pain wakes you at night |
| both inside and outside the home. | | | | - When you are taking opiate based medication daily. |
| I started looking for the other side of the argument. | | | | - When you can't walk a mile or carry a bag of |
| Might the new generation of implants come to my | | | | shopping. |
| rescue? | | | | - When you realise you can't look after yourself |
| With traditional implants the hip side of the | | | | - When you're quality of life is significantly diminished. |
| replacement joint was made of polyethylene, which | | | | So did I wait? Well I tried to put it off a bit. I called |
| wears out relatively quickly. Replacing this to give a | | | | my consultant who explained that I was already |
| metal-on-metal implant worked well and extended the | | | | practically bone-on-bone and the maximum I could |
| life span of the new joint. Better yet was | | | | hold out for was two years. That, we agreed, |
| ceramic-on-ceramic - where both sides of the joint | | | | wouldn't be worth the pain. |
| are made from a type of metal oxide known as | | | | I am now 13 weeks post-op and pretty well |
| ceramic. This has a very low rate of wear and unlike | | | | pain-free. Yesterday I ran up the stairs. I've started |
| its metal-on-metal counterparts isn't associated with | | | | going out - shopping and socially. I've got a life again. |
| potentially hazardous metal ion debris. This form of | | | | I love my new hip. |