Total Hip Replacement 2: Diagnosis

I had an MRI on my left hip at the suggestion of my physical therapist.  I also made an appointment with an orthopedic surgeon specializing in hips.

I got a written report from the MRI people.  Here’s what it said:

• joint effusion with synovitis
• degenerative osteoarthritis
• joint space narrowing and chondromalacia
• subchondral cystic change
• exuberant osteophytosis

OK, then.  I spent a lot of time with the online dictionary and learned that my joint was inflamed, there were cysts forming in the fluid parts of the joint, I had bone spurs forming, and greatly reduced space in the joint.  All of it was “moderately severe.”  At least my bone spurs were feeling exuberant.

My tendons were all intact, so the pain I’d been having was not an injury there, but some part of the arthritis complex.

I pretty much freaked out.  I was hoping for a nice little tear to the labrum fluid sac that could be fixed with a micro-surgery.  Or maybe just some inflammation that would respond to more PT and dietary changes.  This sounded much worse.

After fretting over the list of ugly words, I finally got in to see the orthopedist.  Of course I’d been on Google, so I had a list of treatment possibilities to ask him about.  PRP injections, where my own plasma would be concentrated and injected into the joint.  Arthroscopic surgery to do tiny touch-ups.  A thing called a partial hip replacement, that simply put a smooth metal helmet over the femur.

I’m sure doctors love patients who have been on Google.  I know I love it when my legal clients come in knowing all about the law applicable to their case.  Luckily, he was very patient, and luckily he showed me the X-rays first.

I don’t spend a lot of time looking at X-rays, but my left hip looked awful.  There was no visible space between the femoral head and the hip socket.  Everything looked jagged and chaotic.  He showed me another angle, where a bone spur the size of my fingertip was sticking out.  My questions about non-invasive measures dried up in my mouth as the doctor said there was nothing to do but replace the whole thing.  I believed him.

I asked him why this was happening.  I’m young for this.  I have not been an intense athlete.  I am a medium-sized person of healthy weight.  He showed me around the X-rays a little more, pointing out that my hip sockets are too shallow, and more vertical than they should be.  Hip dysplasia.  It was inevitable, he said.  It may have come a little faster because you’re an active person and have fallen from rollerblades and snowboards and horses.  But it was unpreventable.

I left in a bit of a daze.  I had still been hoping for some minor procedure.  I made an appointment for a second opinion.  Doctor two said the same things and reached the same conclusion.  I had few options but the total hip replacement.

The modern technology on this is called the anterior approach.  The incision is made in the front of your hip and your muscles are just pushed aside, rather than being cut.  This makes healing much faster and less painful.  He showed me the prosthesis — a very neat contraption with a titanium stem that gets inserted into the center of the femur and a ceramic ball on top that sits into a nice smooth cup made of plastic and metal.  They are expected to last upwards of 30 years, although there are some failures sooner than that.  If I’m lucky I’ll get into my 80s doing OK and then deal with what comes next in a new era of medical technology.

I didn’t wait very long before scheduling the surgery.  I couldn’t accept the grave limitations on my life.  And if I did it before the end of the year, it would cost me very little as I’d met my deductible and almost my out-of-pocket maximum.  Once I had absorbed the reality on those X-rays, why wait?