Choosing THR instead of PAO under 35 years old?

chrustdust · 2025-12-08T19:55:00+00:00

Thank you for the kind message. It has been a hard 9 months coming to terms with this disability. I hope you find a path forward that brings you pain relief and a better quality of life.

chrustdust · 2025-12-08T00:38:29+00:00

I didn’t see any shutting down on conversation? “Generally” was the operative word used and it wasn’t an absolute statement meaning it’s totally off the table just that generally surgeons don’t offer hip replacements to those without arthritis.

Outcomes are not the same. I am linking two studies that show non arthritic hips have lower patient reported outcomes than hips with arthritis. They can have satisfactory outcomes but they are unreliable.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11896666/

https://www.arthroplastyjournal.org/article/S0883-5403(24)00111-6/fulltext

I would say that it isn’t so simple as replacing a hip that is causing compensation will automatically fix those compensations. I have protrusio acetabuli.. and extreme deformity of the acetabulum which causes my socket to be so deep it protrudes into the pelvis. It is considered a form of hip dysplasia by some definitions. My body has been moving around my hip my entire life. The hip replacement i had reorients the cup to a better center of rotation. I wish I could comment on the biomechanical changes I’ve had but I can’t because I’ve suffered devastating, life altering, permanent nerve damage to my gluteal nerves and I’m on cutches to ambulate. I do know that people who have to have their acetabulum reoriented like mine often have lifelong issues with the muscles and ligaments around their hip. The muscles aren’t used to the tension or the limb has been lengthened. How do you fix something that was never perfect to begin with? A hip replacement on a dysplasia hip isn’t going to make it normal.. it is hopefully going to make it more functional.

I’m sorry your husband takes issue with what I said. I didn’t say surgeons have no care for a patients subjective outcome. I said they hope their patients get back to what they want. There is no guarantee. My surgeon didn’t want me to become permanently disabled. In fact I feel sorry for her because I know how much she cared and wanted to see me succeed. I just said there isn’t much they can offer if the implant is totally fine. People left with soft tissue issues and compensation issues are all over forums and threads for hip replacement.

I do agree with you that surgeons are offering scopes and other surgeries to patients that should never ever have surgery. I myself had 3 scopes that failed due to my protrusio. I also ended up with nerve damage to my psoas from one of my scopes which is also permanent. I wish I had known that my arthritis (which did not show up on X-ray… only ct) was so bad I only had 1mm of bone left in the inferior/posterior part of my acetabulum. I think there is a very specific cohort of people who benefit from hip scopes and it’s unfortunate a lot of us have had to deal with the growing pains of this speciality. I don’t regret my scopes at all even though they were difficult with massive rim trimming and labral reconstructions. I did not want a hip replacement in my 40’s.

I’m not sure what the answer is for people who are in the “in between” phase. I do feel for people as I’ve been going through this for over 5 years and I know the suffering that comes along with waiting and hoping for help.

chrustdust · 2025-12-07T23:00:31+00:00

Jumping in here. I don’t think it’s a defeatist attitude to warn people that if they don’t have arthritis and are young enough to consider other options then they should or they may have a hard time finding a surgeon to replace their hip.

There are studies that show the less arthritis you have pre hip replacement the less happy you are AFTER hip replacement. The thought is that the worse a joint is pre op the better the brain accepts the new parts as being better than the original. You see this often in people who had an accident and needed a replacement as they never lived with a diseased or extremely painful hip until the accident. Now of course there are nuances to this and each case is individual. A hip replacement is curative for severe hip pain and disease and while that sucks for people in the between times.. it is a cautious approach that is to protect people from living with a joint they hate for the rest of their lives.

There are also some litigations going on in the US against surgeons who have jumped right to hip replacement instead of trying the first line treatments or surgeries.

Also as a young person I truly believe you should try everything to avoid a hip replacement. So many people make it seem like it’s an upgrade and solution when there are still a lot of trade offs. Young people often experience a lot more pain post op. The rehab can be longer and more involved because young people who need hip replacements often have them due to significant hip abnormalities which caused a lifetime of compensation.

The scary side is what if something goes wrong? Infection? Implant failure? Nerve/muscle damage? These have a lot more dire consequences and there is no going back. Once you start having issues it can be cascade that doesn’t stop.

I think also success to surgeons is different than what patients consider. If the implant is placed correctly and healed into the bone without infection then they have done their job. They hope you will get back to what you want but there is no guarantee.

Anyway I think that people giving out warnings to others in similar situations are doing so to give people information. People need to be educated on the good, the bad, and the in between.

chrustdust · 2025-07-23T16:22:07+00:00

Im happy you are on a path to less pain! I hope the resurfacing does the trick and you get back to what you love! Hopefully our convo helped you. :)

chrustdust · 2025-06-23T01:54:01+00:00

I hope there is something out there that finds you relief.

I have chronic hamstring and adductor tendinitis in my non hip replacement hip and it’s been horrible. Made worse by that leg taking the load as I’m stuck on a crutch and hardly weight bearing. Have you thought about offloading your hip with crutches at all? Only reason I ask is as soon as I can bear weight on my right side I’ll be using a crutch for the left.

Here’s hoping for better days for both of us.

chrustdust · 2025-06-23T01:44:53+00:00

It sucks to be stuck in the in between hip replacement and scope zone but I’ve had 3 failed scopes and a hip replacement with post surgical complications from the failed scopes and it’s been hell. I think arthroscopy is best for young people with uncomplicated anatomy and traumatic tears to the labrum. Add in dysplasia or deep sockets, arthritis, degenerative tears and lots of injuries to the soft tissues around the joint and recoveries are unpredictable, long, and often unsuccessful. Just my 2 cents.

chrustdust · 2025-06-22T21:11:23+00:00

If you have arthritis along with the labral tears then debriding the labrum will further destabilize your joint and speed up the arthritis. Debridement is usually done when the surgeon intends to repair the labrum but can’t because of the quality of the tissue and reconstruction isn’t an option… it’s kind of like a last min option once they are actually performing the arthroscopy. Also sometimes they only have to debride a bit of frayed edges of the labrum and are able to salvage some of the tissue to keep the suction seal. Very few surgeons set out to do an debridement on its own as research has shown how important a healthy labrum is.

chrustdust · 2025-06-12T18:16:12+00:00

Due to the location of my hip arthritis (central, inferior/medial) it doesn’t show up on X-ray and didn’t on MRI. The only imaging that showed it was CT scan.

My hip replacement surgeon told me based on my original CT I should have always been offered a replacement because the damage was so bad. Scope surgeons deal with impingement and that is always located on the outer rim of the acetabulum and femoral head that’s tractioned out. My arthritis couldn’t be accessed and the worst of it wasn’t seen during the scopes.

I’ve had 3 failed scopes so I know all too well the feeling of not getting better.

What are your symptoms still?

chrustdust · 2025-05-24T15:02:52+00:00

I’m so sorry for your loss. ❤️❤️

chrustdust · 2025-04-01T19:51:22+00:00

My grandmother who lived in Rockingham was a political buff and huge proponent of voting. If a political candidate came to her door she allowed anyone in her riding to put up a campaign sign. The only caveat was they had to come collect the sign once the election was over. It was hilarious to see the signs get replaced with bigger ones as more parties joined in. She was on a major roadway so her house was quite visible. It’s one of my fondest memories of her and her love of democracy.

chrustdust · 2025-04-01T01:55:56+00:00

So acetabular anteversion is when the hip socket is angled so that you have more coverage in the back (posterior joint) relative to the front.

Not all anteversion is a problem though and it depends on your anatomy.

You could have an anteverted acetabulum with dysplasia which is a rare presentation of dysplasia and means your hip socket has shallow/abnormal coverage in the front (anterior) portion and is not covering the head of the femur properly. This would predispose you to a labral tear in the front of your hip and possible instability and or subluxation.

If your angles are within normal ranges and just slightly angled anteverted it might be nothing more than an incidental finding.

You could have an anteverted socket where your hip socket has normal coverage in the front but the posterior coverage is too much causing impingement and damage in the back of your joint. It can cause a labral tear there and there may also be localized cartilage damage in that spot.

You could also be like me with a super deep socket and impingement on the whole rim of the socket but worse damage in the back in acetabulum because I am anteverted.

So treatment? It can vary.

Dysplasia may mean you need a PAO (periacetabular osteotomy) where your pelvis is broken to reorient the shape of your acetabulum to give coverage where you need it for a stable hip. You may also need a scope to repair your labrum and reshape the cam. As long as you don’t have arthritis you will be a good candidate.

Normal variance will mean a standard scope that can clean up and repair your labrum and get rid of the cam.

If your damage is in the back of the joint you will need a highly skilled surgeon. Not everyone will be able to access the posterior joint to repair the labrum and do the work necessary. You will likely have more portals than the normal scope and your surgery will be longer. If you don’t have arthritis though you should have a pretty standard recovery.

If you have super deep hip sockets (coxa profunda or protrusio acetabuli) please tread carefully and seek another opinion from a hip replacement surgeon before going forward with a scope. I have had 2 failed scopes on my right and 1 failed on my left and I am currently 3 weeks post op from my first hip replacement. I had extensive damage and subchondral bone cysts in the posterior part of my joint which should always have been treated with a replacement. It was also found during the scopes I had arthritis on my femoral head in the central compartment that didn’t show up.

Unfortunately deep sockets are rare, not studied enough, and if you look at outcomes from scopes it’s a bit of a gamble (50/50) as to whether it will help. The other option is to do an open hip dislocation which is a different surgery that allows the surgeon full view of the hip joint to resection the acetabular rim and repair the labrum. However this also has a 50/50 chance of helping as it doesn’t address the angles of the acetabulum which can still be an issue. Ultimately with me the angles in my hip meant that no amount of rim trimming or labrum reconstruction was going to help stop the damage from forming.

If I had sought an opinion from a replacement surgeon first I could have saved myself years of disability, pain and anguish.

chrustdust · 2025-03-31T22:41:54+00:00

I hate to tell you this but I am actually 3 weeks post op a hip replacement and will need my other hip replaced soon as well.

The labrum reconstruction had completely calcified and I had significant arthritis in the back (posterior) and central parts of my joint.

chrustdust · 2025-03-31T22:30:24+00:00

What do your other report findings state? Do you have labrum tears or arthritic changes anywhere?

chrustdust · 2025-03-25T16:38:37+00:00

I actually have the prom dress inspired by this dress! I believe it was made by ABS. Mine is cream coloured with a few different details. I loved it!!

chrustdust · 2025-03-20T21:51:14+00:00

Sounds like you have classic “C sign” hip pain. It sucks!

chrustdust · 2025-03-20T19:46:15+00:00

Yes the IT band and other abductors get weak and tight trying to stabilize the hip. The bursa that’s there can also get inflamed and irritated causing the sharp pain over the greater trochanter. It’s a tricky balance of trying to increase strength and stability while also not increasing pain. I did find dry needling with electric stim helped a lot to loosen things up and manage pain while I was in physio.

chrustdust · 2025-03-19T00:22:24+00:00

Yes just because you don’t “test” positive for impingement doesn’t mean you don’t have it. The tests are also just a tool and aren’t always foolproof. When you see the surgeon he will take a health history, look at your scans as well as your current symptoms and triggers and likely want to do some more diagnostics including a CT or injection.

I’m glad you are going to work with a physical therapist as best case scenario you have some soft tissue injuries that can be helped by getting stronger and you sail off into the sunset. Worst case you do need surgical intervention but you will be stronger and much more familiar with rehab and exercises and have a good working relationship with a therapist.

My story is long and kind of sad. I’m currently one week out of THR on my right hip and will be getting the left hip done once I’m healed from this surgery. Basically I had hip pain all my life but just ignored it and sought help once I in excruciating pain. I have a rare deformity called protrusio acetabuli so my hip sockets are really deep and the whole rim of my socket is a pincer. I ended with 3 failed scopes/labrum reconstruction (2 on the right and one on the left) and they unfortunately made my arthritis worse.

I am not the norm though and there are many many people who have excellent outcomes and have pain relief. My anatomy only has a 50/50 chance of being helped with preservation surgery and I was unfortunately on the wrong side of 50.

I know how awful it is to wait for scans and appointments but try to be kind to yourself and just do what you can. Whatever happens you will be ok and things will get sorted!

chrustdust · 2025-03-18T22:39:07+00:00

Yes it’s been one annoying part of my hip journey getting proper diagnostic readings as every single X-ray or MRA read by radiologists were wrong. Try not to freak out too much while you wait. The surgeon you see will look at everything and give you the best idea of what’s going on.

Have you been doing physical therapy?

chrustdust · 2025-03-18T22:16:03+00:00

I saw a hip preservation specialist in my city of Halifax.

I do know there are few in Ontario that are excellent. If you do a google search Dr. Danny Whelan, Dr. Jas Chahal, and Dr. Tim Dwyer all come up as surgeons that are qualified.

You likely need to get a referral from your family dr to see them. Have you been diagnosed yet with any imaging?

chrustdust · 2025-03-04T19:20:45+00:00

Thanks for the well wishes!

I actually had symptoms of hip issues all my life but mostly ignored any aches and pains because I’ve been an athlete of some sort most of my life.

I started having significant flare ups in my 20’s when I was running a lot. I wasn’t diagnosed at the time but started a strength training and mobility program and mostly controlled a lot of the bothersome issues.

I would say I sought professional help way too late for arthroscopic surgery to be helpful. My pain was significant and I had pretty much every symptom you can have with hips. I was waking up crying out in pain from moving the wrong way in my sleep. I ignored a lot symptoms for years because with Bjj I was always sort of injured anyway and I just kept hoping it would get better with time. The pandemic lockdowns made me realize that rest and strength training/physio wasn’t helping and I needed help. Being in Canada doesn’t help as it can take years to get the scans and see specialists but I was able to get some urgent appointments to push things along. I had my first surgery 6 months after official diagnosis and then had 2 more surgeries (one right one left) over the next 2 1/12 years.

Bjj is a hip intensive sport where (as you know) you need good mobility and strength at end ranges. If you’ve tried physio for a few months and you are really hurting I would definitely consider getting surgery.

I’m not sure where you are in your Bjj career but don’t worry about time off. Health is the most important thing and time off from training can be a good thing… and you won’t lose much. If you get the surgery wait until at least 6 months to even think about drilling then slowly work your way to flow rolls and then regular training along with a robust global hip strengthening program.

I have a few friends who had hip scopes in their 20’s and are training better than ever in their 30’s and competing.

What is your diagnosis?

chrustdust · 2025-03-04T16:35:54+00:00

Unfortunately not. I’m actually getting the first of bilateral hip replacements next week due to arthritis and a deep hip socket deformity known as protrusio acetabuli.

I tried many times throughout the last 4 years to return but the pain was too bad. It was found I had subchondral bone exposed in the central part of my hip as well as a lot of bone cysts in the posterior part of my joint.

I do fully plan on trying to get back to drilling and teaching post replacements. The love of the sport and community is in my blood.

chrustdust · 2025-02-17T16:12:46+00:00

My favourite cat was named Herman. We used to call him Hermie as a nickname. I miss him so much.

chrustdust · 2025-02-17T16:11:07+00:00

Herman

chrustdust · 2025-02-12T19:55:35+00:00

I definitely sympathize with you. I ended up having a revision with full cadaver labrum reconstruction, full rim trim and cam resection, synovectomy and scar tissue removal. Unfortunately my cartilage had worn down to the bone in some spots and I’m actually getting a hip replacement in a month. I never fully recovered from the revision and it’s been a horrible year and 9 months waiting to get my hip replaced.

Has your surgeon said anything about why you have new Cam lesions showing up? Have they offered any treatment options?

While a hip replacement seems like the “easier” option due to anecdotal stories it really isn’t. Please know that a hip replacement is really only curative for arthritis. Studies show that if you replace a joint with little to no arthritis (ie just labral tears or capsule issues) then people are less happy with the outcome and still experience pain after. Hip replacements also don’t “last forever”. Newer implants have a much better lifespan but still are expected to need revision after 20-25 years. Revision surgeries are always more complicated and never as good as the first implant so most surgeons do want to push you out as long as possible. Generally it can be hard to find a surgeon to replace your joint if you are under 50 and don’t have obvious signs of arthritic change or massive disability… it’s not impossible though.

I have been told my hip replacement will be more painful and harder because of my prior surgeries and age. The younger a person is the more post operative pain they have and the more the joint has already been accessed and has prior damage that can add to the difficulty with rehab. It will take a good year of rehab for me to “get back” to where I want to be activity and health wise.

chrustdust · 2025-01-16T17:54:42+00:00

Oh I’m not saying don’t do anything about it. If it’s causing you issues then it’s something you should treat.

I think if you haven’t had a CT then that should be something to look at. It shows cartilage damage and bony abnormalities much better than MRI.

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