YANMD/YANML, but can you offer advice on my osteoarthritis situation?

February 28, 2013 6:18 AM

Following some intense pain I felt back in August, I began going to doctors to figure out the cause. I've been diagnosed with osteoarthritis. I am in my mid-twenties. I could use some help figuring out my next medical and legal steps.

Medical
I've seen 3 specialists (1 sports medicine/orthopedist and 2 orthopedist/surgeons).

The SM noted I have a bone spur, and seemed to think that my August pain was due to a hip impingement caused by the spur. Recommended surgery to shave it down. One of the surgeons basically agreed with the SM (bone spur, hip arthroscopy to shave it down). The last surgeon (supposedly one of the best in the nation) told me that my cartilage is too far gone (plus I apparently have cysts on the femur bone), so that a full hip replacement is my only real option. His opinion is the August pain was likely due to a cyst exploding, causing inflammation.

I would really like to avoid surgery- I've had it before for another part of my body, and the surrounding areas now hurt almost daily. The hip is not severely hurting me (only when I overdo it do I flare up, and nowhere near as bad as August). What should I do? Do I see another specialist? Is it a bad idea to avoid the surgery? If not, how can I make my hip better/avoid making it worse?

Legal
The doctors all seemed to agree this was caused by trauma. The most likely culprit was a fall I took 2 years ago on a giant patch of ice (flew through the air, smashed hit the ground with my hip) that was on the sidewalk in front of the stairs that lead into my building. I got up (hurting pretty bad) and went to the super to tell him about the patch, and he went to break it up with a shovel. I tried going to class, but the pain was too much, so I went home and spent the next two days in bed (possibly more? Can't remember 100%). I do not think I went to the doctor (stupid me, but I think I figured it was just a bad bruise, and that it would heal). Everything seemed fine afterwards, so I forgot about it until all this went down. Might I have a viable complaint? I usually just let these things slide, but since I now have irreversible damage...

Sorry this is so long, but I am really concerned about my future health and well-being. Any advice is welcome. Thanks!

posted by Sakura3210 to health & fitness (6 answers total)

2 surgeons said you could get away with minor arthroscopic surgery and one said you need a total hip replacement, which is obviously a big deal. You definitely need a second opinion prior to getting the total hip replacement, as a young person with many active years left.
posted by treehorn+bunny at 7:11 AM on February 28

I'm not a medical doctor, and my knowledge on this is a bit dated. You probably want to talk to a medical doctor about your concerns.

That being said, my understanding is that joint replacement for osteoarthritis is generally done when the pain is too much to bear. Part of the reason for this is that total joint replacements will generally eventually fail due to wear (~20 years?). I think you can get one more replacement, but after that it's not really easy (because of the way the replacements are fixtured into the bone). Since you're in your twenties, and it's only really bothering you occasionally, I wouldn't rush into a joint replacement -- what happens when you're in your sixties?
posted by Comrade_robot at 7:34 AM on February 28

A hip replacement in someone so young is not something to be taken lightly, although it could be the right thing. I'm an othopaedic surgeon and I only do upper extremity in my practice so this is not expert medical advice. I would go back to each surgeon and ask about what the other said (without naming names, to try and avoid bias). What does the joint doctor think about arthroscopy and it's chance for success, success in this case being avoiding the need for a joint replacement for some period of time. Ask the joint doctor about expected longevity in someone your age and what kind of activity level can you expect once recovered. Bo Jackson had his hip replaced and went back to pro baseball and ruined the thing within one or two years. Ask him or her what the downside to delaying surgery would be. Is an intra-articular steroid injection worth a try? Why or why not? Ask the arthroscopist what they think about arthroplasty vs. arthroscopy. What are they treating? FAI- femoro-acetabular impingement, or something else? FAI wasn't even a diagnosis when I was a resident, but neither was hip arthroscopy so I'm not sure how I feel about that diagnosis, but like I said, this is not my area of expertise. If they both disagree with each other, then I would recommend a third opinion by another surgeon. I would not recommend reevaluation with another non-surgical sports med, since their knowledge of surgical treatment is somewhat limited, but I'll admit their knowledge of non-surgical treatment is usually superior.

And just in general, ask both of them if they are board-certified. How many of these surgeries do they do a year and how many have they done in practice? I've been practicing for 10 years and only a handful of patients know to ask this. Post-traumatic arthrosis in the hip can have myriad causes, a fall being only one. Ask them if this is Legg-Calve-Perthes (LCP)disease. Could this be secondary to a slipped capital femoral epiphysis (SCFE) that has remained asymptomatic until now? Any chance this is osteonecrosis? Have you ever been on steroids for any reason? Definitely not a lawyer, but I would imagine that without a medical record from the time of the original fall you would be hard pressed to prove this is secondary to the fall you describe. Lastly, if you want to PM me your location, I can see if I know anyone near you that I can personally recommend. Can you tell I'm bored since I had a short OR day? :)
posted by karlos at 10:11 AM on February 28 [6 favorites]

I had a very similar situation in my mid-twenties. Osteoarthritis, bone spur in my hip, very sharp pains that made me stumble on occasion, etc. I'm certainly no expert, but I passed on pursuing the hip replacement and focused on low impact exercise (cycling mainly) and the pain faded over the next couple of years, and is almost entirely gone after a decade. It still aches in the morning and if I spend a lot of time on my feet, but it's totally manageable. Just my experience, YMMV.
posted by skintension at 4:19 PM on February 28

I was diagnosed with OA in my early thirties, and it was a bitch and a half. I can't help you with any legal advice, but I do have some ideas on the medical front.

I would delay surgery as long as possible. That crap is serious, and you don't want to do it if you can help it. They keep saying better joint replacement methods will be available soon... Maybe that's all hype, but you don't want to get some cruddy technology now and then feel like a dope 10 years from now when you've got some failing, obsolete tech in your body. (Seriously, what if they finally figure out that stem cell stuff, and they can just inject new cartilage into your joints? If that happens, you really don't want some rusty old piece of crap artificial joint in there, complicating everything.)

I was in agony for several years after I was diagnosed, and then (knock wood!) it mysteriously got better. Maybe it's total hooey, but I sometimes think that eating dark chocolate made the difference. I got on a big dark chocolate kick a few years ago, I buy these packs of segmented mini Hershey bars and eat one bar (at least) per day. There are some studies to suggest dark chocolate can help with OA, and it's the only real difference in my lifestyle that I can think of. I would definitely suggest trying it. It couldn't hurt anything, and it's an excuse to eat chocolate!

I don't know if my hip pain is really gone for good or if I'm just enjoying a few years off, but I can say that even if it seems like there's no reason to hope you'll ever feel better, things really can turn around. Eat some chocolate, do low-impact exercise and try to stay wrong.
posted by Ursula Hitler at 6:53 PM on February 28

Argh. Wrong is wrong. Stay strong.
posted by Ursula Hitler at 8:28 PM on February 28