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40 Yr. Old Guy -- Hip Arthritis due to Slipped Capital Epiphysis


I just turned 40, and I have an arthritic right hip due to childhood slipped capital femoral epiphysis. At age 13, I had both hips pinned; the left hip was a mild slip; the right hip was a severe slip. Over the years, my right hip has worn considerably, although it still has an intact joint space: the joint space is narrowed (especially top center) but is not totally absent. And the funny thing is, I do not have any hip joint pain -- none! But I do have limitations with hip motion, and I do experience chronic back muscle pain and stiffness; and my right leg has always felt somewhat weak and 'troublesome'. And because of my hip history, I would periodically go in for ortho exams just to keep an eye on my hips.

A few days ago, I had a consultation with a very experienced hip and knee specialist here in So. Cal (Dr. Patel). He took fresh x-rays and examined my hips. During the exam, I had no hip pain with any of the hip movements. He pushed and pulled on my right leg and hip, and I experienced zero pain. I have big deficits with internal rotation, but again, no pain with any of the hip movements. But he did say my right hip is 'pretty worn', and he also said that he has some patients with x-rays that look like mine that are using walkers and canes to ambulate -- and that kind of freaked me out. I am a very active guy, and I can still do most physical activities: weight-lifting, cycling, hiking, walking, so I am not close to being disabled. But my x-rays paint a pretty bleak picture. I almost feel like I should be in a lot of pain -- but I'm not.

So, I guess I'm here just to get some feedback from others, either those who have dealt with similar physical problems, or those who might be able to offer some advice or feedback in some way.

I am worried about the longevity of my right hip. As it is, I do very little high-impact activities: no running, no jumping, etc. I do a lot of weight training, and I take great strides to keep the muscles in my legs strong and functional. I am not overweight. Dr. Patel, although he said my right hip looks 'pretty worn', also said that he thinks I still have 'some mileage left' in the joint.

So, I assume that hip replacements aren't done on joints that still have 'some' joint space left???

Since I was in my 20s, I have known that I would at some point in time require a hip replacement, so it's not a big shock that my hip is heading south. And when the time comes, I want to make sure I select the best possible surgeon and the best possible prosthesis; I want to remain as active as I possibly can following total hip arthroplasty. And because of my deformed femoral heads, I am not a good candidate for hip resurfacing, which sort of bummed me out. And I know full well that younger, more active people tend to wear out hip replacements much sooner than older, more sedentary folks. And for a person getting a hip replacement in his 40s, the likelihood of having to receive at least one revision (maybe two) is pretty high.

I know all about the potential pitfalls of hip arthroplasty in the young person, so please don't try to spook me with all the 'doom and gloom' about how artificial joints are not meant for this or that or how you are supposed to baby an artificial implant and not do this or refrain from that.

The only hip implant for me that really looks promising is the new Delta Ceramic Hip, or Silent Hip, which is used widespread in India but has yet to receive FDA approval here in the states. My hip specialist said he would use a ceramic ball with a polyethylene cup liner -- and he would use the anterior approach. But that bearing articulation does not seem as promising as the ceramic-on-ceramic bearing used in the Delta Hip.

Well, sorry this post was so long. But I guess I felt the need to vent a little. These hip issues have dogged me for many years, and even though I was never in much pain hip-wise, my limitations in movement and right-leg weakness have always been more than just a little troubling.

I would love to hear any comments, feedback, or advice anyone would like to share.

P.S: If I could open my hip x-ray file I would gladly share the picture, but I can't open the x-ray disc on my computer.

Thank you,

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replied October 28th, 2014
Thank you for asking

A perfectly pain free limb due to decades old trauma. X rays show the picture advised by surgeons too to go for it. Then go for it. I don't see it necessary and urgent right now.

It's your decision to make. Implants and prosthetics recommended by FDA are all fine. But you may be worse than what you are now. Plus prosthesis is a foreign body and you would need immunosuppressive therapy worsening other troubles.

Nutshell why to go for such risks for just slight motion restriction. Physical Therapies Can Help Overcome It.

Seek an orthopaedic surgeon and let them be the judge of what is est in your favour.

Take care

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