Question
Hi Sharon,
I am glad that you are able to answer questions about THR.  I am going to try to condense my question as best I can.

Background:
I was born with congenital hip dysplasia in both hips but was not diagnosed with it until 4 yrs old.  I had several surgeries as a child (which fixed the left hip) but my right hip was finally corrected at age 10 by performing an osteotomy that left me with a big leg length discrepancy (1 1/2 inch).  I have a bad limp which produces back pain and slight scoliosis and my right hip has a limited range of motion.  I have lived relatively fine and without pain until these past three years in which I have noticed my right hip joint getting stiffer and an increased difficulty walking/standing for long periods of time. However, I only ocassionally take pain medication because my hip pain is not that constant or severe.  But I am concerned about the pressure that is being placed on my good hip due to my bad hip and limp.  2 months ago I had surgery to remove metal pins in my right hip that were left there from the osteotomy.  This was done to prepare the right hip for a THR in the future.  My DR. is willing to do a replacement whenever I am ready because my hip looks bad and it basically has no cartilage.

My Concerns:
Is it a good decision to get a replacement when I am only 26 yrs old and will likely need revisions done?  I am aware that revision are more risky and that they can produce complications so is it better to wait as long as possible for the THR until my hip feels worse?  I would like to be able to perform my job as a teacher and be a mother in the future so should I get the THR done soon or wait and risk having pain later?

QUESTIONS for Sharon:
What type of implants did you have and how were the results of your revisions?  Do the particles shed by the plactic cup/lining in the implant eat away at the bone making revisions difficult?  How can bone loss be dealt with when getting a revision?  Can you be healthy and functional after several revisions or is mobility limited more each time it is done?

Thank you so much in advance for your advice and input.  And my apologies for such a long post.
Susie

Answer
Hi Susie

First of all, you have gone through so much and your words and worries are absolutely legit!

I had my first replacement at 16.  Those replacements were cemented in and lasted for 15 years.  I did just about anything any normal person would do.  I got finished my masters degree, got married and had two children and toured Europe with no problem.  The first set is always the easiest.  Remember also, my replacements were in 1976 and the materials used were not as good as today.  So yours should last longer than mine did.

I have since had three more revisions on each side, a total of six surgeries and they were difficult.  The reason why they were so hard was because they had to take out the cemented replacements each time which made the surgery harder. Plus as you say, there was some bone disintegration and I had to have bone grafts with cadaver bone.  My last surgeries (about 8 years ago) the surgeon put in replacements that were ceramic and did not have cement.  As I understand it, the cemented replacements are no longer used and the parts can easily be revised if necessary.

Now to your questions.  

First of all, bone will shed with any replacement you have.  So that is not something you can stop.  At 26 years old, I would assume you would need a few revisions but they should not be hard on you.  As a patient, you won't "feel" the difference between a THR and a revision.  But you may need bone grafting depending on how much bone has worn away.

You can be just about 90% functioning, meaning you can lead a somewhat normal life.  For you, it would be better than the life you are leading now.  I am certain that you are not a very physical person, meaning you don't do contact sports, or heavy duty sports.  The people who are most affected by THR's are those who are very sports oriented.  For you, I would assume, just fixing the leg length discrepancy, and being out of pain will be something you would be looking for.

If I were you, I would do the replacement.  Your doctor sounds like he knows what he is talking about and that you would benefit from the THR.  I know that even with all the surgery I have gotten, I would do it all over again if given the same circumstances.  At your young age, you should have the ability to live a normal life and I feel the THR would give you that opportunity.

I wish you the best of luck with your surgery and if you wish to contact me again, please feel free to do so.

Sharon Davis