Advanced DJD, no Med's and little discomfort, when to do LTHA(R)?

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Had a LTKA done in 1996 and L. hip was bad then said Rheumatologist and Surgeon @ Rothman Institute. In 1999 Surgeon says that my L. hip was worse than ohers he routinely replaces. I said that I have flare-ups but I'm retired and can rest @ those times. Hot, humid weather is a real problem though. He said that my quality of life would improve. I indicated that I am trying to wait till older-58 now-for a better prosthesis being developed like the BTH or total ceramic. The new LTKA bothers me more than the DJD hip right now!And I'm off all NSAIDS due to a conflict w/ Lithium for depression over this hip.I'm on a cane, overweight and swim for exercise. Hip has 0 flexion to sides and I feel jabs of light pain(like shocks when I bend over or stand erect or spred legs. But I sleep good w/ a pillow between legs. And sex is still no problem thou it was earlier w/ hip pain after or during intercourse. Q. When is the right time for a THA? Surgeon says I'm not doing oher tissue damage as of now.(When there is little or no discomfort I am an optimist that I am special an can continue this way indefinately as a few have done . So I'm told.)

-- James R. Bowen (jimbee@sunlink.net), March 24, 2001

Answers

There is no specific "right" time for a total joint replacement. It must be individualized based upon the risks for the specific patient [affected by health, age, weight, activity level, bone quality, expectation, etc.] and the patient's degree of unhappiness with the current situation. Under most, but not all circumstances, the patient does not risk anything by waiting. In other words, it would be unlikely that the surgeon would ever say, "sorry, it's too late now to do anything." You should ask your surgeon, i.e. "Do I risk anything by waiting?"

-- David S. Hungerford, M.D. (dhunger@jhmi.edu), August 24, 2001.

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