My husband has recently been diagnosed with Avascular Necrosis. This is when blood flow stops and bone dies. He has it in his right hip. The doctors say that arthritis and a hip replacement are in his future, but do not want to do anything yet because he is too young. He just turned 31. The way it is now is that he has a lot of difficulty walking and is in a lot of pain.
He can’t be on any kind of pain meds, because of his prescription pill problem, that helped lead him to his alcohol problem, which is what probably led him to the hip problem. (Hip Bone connected to the - Whiskey Bone?) The good news is he is not using anything anymore. (Dry as a… ! too much? sorry.) We are going to see about having the surgery anyway when we see the orthopedist on Monday.
They say replacement hips wear out in about 15 years, and he’ll be only 50 or by then. What happens then? Does anyone have any experience with this? Aren’t there bionic parts yet? We were wondering about recovery time and such things.
Sorry to hear that meow meow.
You need to make sure that you let everyone know that he CANNOT take pain meds, and is finding it hard to cope with things as they stand, this needs to be factored in to his treatment plan.
Unfortunately avascular necrosis is not good, and could lead to separation of the top of the femur and crumbling of the bone.
Although it involves major surgery every 15 years or so for the forseeable future, it may be better for them to act sooner, while the bone is relatively healthy, rather than to wait until it deteriorates further.
Make sure you know why they want to do what they want to do, and that it is in your husbands best medical interests, rather than for financial or other reasons.
Good Luck, and best wishes.
With regards to the “bionic implants” and “why 15 years” part of the OP:
I am not a doctor, but I did work in an Orthopedic Biomechanics lab where we did research on (among other things) some hip implants. The basic problems with any kind of implant fall under three (greatly simplified) categories:
-
The implant is too strong or two weak compared to the surrounding tissue. If you take a super strong titanium hip and put it into weaker bone, you’ll eventually wear down the bone. Similarly, if you put a weak implant in strong bone, the implant becomes weakest link and will break first. For someone under 50, breaking an implant is entirely possible depending on how you behave.
-
Man made materials don’t “heal.” Bone is continuously repaired, replaced and remodeled. Steel, titanium and plastic don’t heal. Once you start wearing down the material, it slowly wears down until it breaks. Until we have something like nanites that can repair metal and plastic, or truely organic implants, this will be a problem.
-
Man made materials tend to be toxic. In order to get a hip joint that won’t sieze up and gives the right mechanics and cushioning, you have to use materials that may be toxic when they break down. In conjunction with point 2, you will see this problem with a “plastic” called High Molecular Weight Polyethyelene. HMWP is primarily used in knee replacements, but you’ll find it in some hips as well. Without it, you have too much friction between the parts. With it, you have wear and tear that leads to small particles which may cause other problems (lots of ongoing research).
The real issue with any kind of implant is that 15 years is an awfully long time for medical science. If I have to wait 15 years to find out what the latest model of hip does in an actual human study, I can’t make many products. So the results of the ongoing “implant experiments” are rarely in before the next generation of implant is developed. The current implants are heavily tested in the lab, modeled with computers and the 15 year life is an estimate based on material properties and what’s happened since the first implants.
With regards to the meds problem, make sure your husband lets the doctor know and that the doctor explains how it’s going to be factored into treatment. Some docs have said things as stupid as “Nah, this med won’t affect your drinking.” Others will look for the meds that seem to be less addictive and work through the problem.
Last point from me. Before you decide who gets to do the surgery, make sure you ask how many times they’ve done it and who EXACTLY is going to do the work. One of the top 10 factors for success is surgeon experience (more important with knees, but still important with hips).
A question that is maybe not quite on topic, but if he cannot take pain meds what are y’all planning on doing after the surgery. My wife woke up on a morphine drip (knee surgery) and NEEDED pain meds for a time afterwards. If it weren’t for the meds it would have been torture so I’m wondering what y’all are going to do after the surgery to control pain?
Anyone have any idea on how they work around that kind of stuff? What have your docs said they will use outside of the what seems to be the standard morphine/vicodin combo. I know my wifes pain was exquisite to say the least.
It seems you may be between a rock and a hard place so I wish you the best of luck with whatever choices you make.
As someone with an allergy to morphine and a bunch of related drugs, there are techniques that can be used to help you deal with pain while using other painkillers.
Talk to your doctor. Possibly epidural anaesthesia could help over the period of hospitalisation, then NSAIDs? This doesn’t usually involve any addictive substances. I know that they use this in dogs at the veterinary teaching hospital at my uni that have had hip replacements.
Acupuncture and visualisation work pretty well for me, as well.
I know a number of younger folks who, either because of degenerative bone problems or, in one case, a severe auto-pedestrian accident, have had hip replacements, and some have gone 20+ years with no problems. Others need a replacement in 10-15 years. It really varies with the person. But I know people as young as in their teens who’ve had the surgery and find it changes their life drastically. Also, recovery time is usually surprisingly short because of the decrease in overall pain level once the immediate post-surgery pain passes in a few days.
NameAlreadyTaken has the best advice, though – find a doctor who’s done it a whole bunch of times. I had a thumb joint replacement (for severe osteoarthric degeneration) three years ago, from a surgeon who’s done it over 600 times with zero bad results, and I can tell you that if all surgery went as well as this one, I’d let 'em hack me to bits. Zero pain, full use of my hand, full reach, full strength. Amazing. So the right doctor can produce some good results.
(Of course, I also let a doctor try a very experimental surgery on my foot last year – for the first time ever for him – and it’s turned out almost as successfully, but in this case I trusted him because of the recommendations of another doctor whose judgment of her peers I trust implicitly, so YNK!)
NSAIDs aren’t really pain killers but they do help reduce the need for heavy pain killers in some cases. One of the NSAIDs (Non-Steroidal-Anti-Inflamatory drug) that is actually very powerful is called Toradol. While I was working at the hospital, one of the othopods was doing some clinical trials and it greatly reduced both the need for and duration of use of the heavy pain meds. I’m not sure how well it would apply to your particular case, and I know it is/was expensive and not always covered under medical insurance. However, anything that reduces hospital time or need for narcotics is woth talking about with your doctor.
Again, best advice is to talk things through with your doctor and make sure that both of you are comfortable with the problem and the intended solution. If the doctor is unware of substance abuse issues or how to work with them, then you should definitely get another opinion.
(I am not a doctor, your mileage may vary, ask questions of your physican. If your doc won’t talk to you intelligently, get another)
Thank you all very much for your thoughts.
The doctor we see now is aware of his addiction problems. As far as drugs after surgery, this IS a dilemma… In my suspicious and painful minds eye I can see him faking out the nurse, palming a pill and injecting it through his IV. Now THAT would be the straight dope. I realize he will have to be on something for pain. I appreciate the suggestions for the non-narcotics…I have pretty good medical insurance and the hospitals and doctors available to us seem to be very qualified. I’ll make sure they are.
Too bad about the unavailability of bionic/cyborgial parts.
Oh, and because I didn’t notice the first time:
Welcome to the boards Meow Meow!
I hope you and your husband make it through this and have a long and happy life as SDMB contributors. For future reference, you might skim the General Questions forum (or do a search there). There were a few artificial joint related threads there not too long ago.
My father had it done on one side about 5 years ago and has to get his other side done next month. He’s 63.
My dad as a healthy 57 year old man was in the hospital for about 3 days after the surgery, then on crutches for about 3 weeks, if memory serves.