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Replace or inject

Posted , 13 users are following.

steve_1
steve_1

Hi all, my 92 year old mother in law has arthritis in the hip and has considered a replacement, however whilst the NHS say yes a private consultant says ...well...maybe or maybe try a cortisone injection.

Any body got any ideas on this?. Maybe somebody has had the same decision to make and has first hand experience and knowledge they can impart.

3 likes, 22 replies

22 Replies

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  • SJCabes
    SJCabes steve_1

    Posted

    Hi

    I was unsure whether to go with the injection or replacement. My consultant suggested that I try the injection first to see whether it worked and for how long.

    It did work but not for that long so as I was only 40 he thought it wasn't a long term solution.

    I have since had a replacement. It's been hard going but 6 months down the line I am now seeing the benefits.

    Good luck with your decision.

    Sarah

  • bini31328
    bini31328 steve_1

    Posted

    Am 57 and started with OA in my mid 40's - had about 4 x steroid injections prior to surgery - can be effective for months or more -and i know someone who said his laasted a year . My last one only lasted 3 weeks after which i went ahead and had  surgery so my advice us it,s well worth trying - no surgical risks for your poor mum - easy day case procedure etc - if it works then may prevent her needing surgery at all which would certainly be a better option at her age . Mine were all done on NHS so prob worth asking NHS consultant if a viable option - dont know if her age means they could be less effective ( dont see why) but well worth asking the question - hope this is helpful x
  • linda38528
    linda38528 steve_1

    Posted

    Wow .. tough one. I know two people in 80s and 90s who received new hips successfully. I dont have any experience with (? Cortisone? injections).

    But THR is a traumatic operation and recovery process and the use of anaesthetic used can have serious implication for elderly patients.. There are several factors to weigh, but my guess would be that health of your Mom and her sense of ideal activity levels would be key. I would be very reluctant to venture an opinion as you, your Mom and the docs involved are better placed to judge these.

    Good on you for reaching out though ... it is good to into this type of situation with your eyes fully open.

    Good luck and please let us know what you and your Mom decide ... it may well help us with future discussions as so many if us care for our parents s well. Bless you for being careful and supportive..

  • debbi1949
    debbi1949 steve_1

    Posted

    I'm 67 and my surgeon said to try the least invasive first. My shot lasted about 6 months. Still haven't had the actual surgery yet.
  • Chris8968
    Chris8968 steve_1

    Posted

    I tried cortisone injections in both of my hips but it only lasted for about a week. I have talked to several people who have had good results with it though. I think it is definitely worth a try. My surgeon wouldn't do my hip replacement until I tried the injections first.
  • barb31596
    barb31596 steve_1

    Posted

    Steve,

    the fact that surgery was even suggested tells you a lot; but what would she have to lose if she tred an injection first. She might be pleasantly surprised by the outcome. That being said, I wish my 102 year old mother in law had had her knees replaced about 10 years ago when the injections did not help. She has had fabulous health all her life; but now walks with so much pain. I wsh you both well.

  • AnnieK
    AnnieK steve_1

    Posted

    I would think that it all depends on how advanced the osteoarthritis is and how much pain/debilitation she is having. Do her x-rays show bone-on-bone OA? Is your MIL in lots of pain? Does she need to use walking aids because of the pain and lack of mobility in the joint? 

    Any relief obtained from cortisone injections is always temporary. Some people don't even get any relief, for others it lasts only a short time. No more than 3 can be given in a year's time. 

    My father-in-law had a partial hip replacement at age 95 after he broke his femur, and he recovered quite well and was able to walk with a walker, which he had needed before the break anyway.

    Does your MIL have an opinion about what should be done?

    • barb31596
      barb31596 AnnieK

      Posted

      She is 102 now and has just been put on hospice. My point was that at 92 we could not convince her to go ahead with total knees so she has had 10 years of decreased mobility when the injections did not work.
    • AnnieK
      AnnieK barb31596

      Posted

      Bless your MIL's heart! Recovering from THR in the very elderly is harder than for any other age group, so who knows how her recovery would have been from that. It is difficult and painful either way. Sorry the injections didn't work better for her. My FIL lived to be 100 after his partial. 
    • barb31596
      barb31596 AnnieK

      Posted

      Good point. I have had both knees done and it was an ordeal; but certainly not as bad as this THA has been; but then don't get me started. 🙄
    • AnnieK
      AnnieK barb31596

      Posted

      Barb, I have always heard that recovery from total knee replacement was more difficult and painful than from total hip. I assume you've had complications (as have I), so remind me about your problems with hip surgery? My sister may have to have her knee replaced in the next few years, and I am wondering how that recovery compares to THR.
    • barb31596
      barb31596 AnnieK

      Posted

      Annie, I had my knees done 9 weeks apart. The first was more painful than the second; but to be expected since the worst was done first. After 5 weeks I could pretty much do whatever I wanted. The surgeon did need to go in twice over  the first 2 years and clean out scar tissue in the worst knee. I am very happy with the final results and seldom think of them. With those surgeries, I knew/felt I was gettng better. I had a THA on 1/25 and wish I had my old hip back. First I got a quad tendonitis from my PT exercises which was very painful and kept me from doing many of my hip exercises. Then I tripped over a curb and walked on a torn quad muscle for a month before it was repaired 10 days ago. I may have torn a muscle in my hip too; but apparently very difficult to image. I have a boatload of pain and am so frustrated. We have had to cancel our trip to Europe in 2 weeks. We live in North Carolina. I really think the pain is wearing me down. I feel very frayed around the edges to say the least. I hope it is going better for you.🌺

      Barb

    • AnnieK
      AnnieK barb31596

      Posted

      Barb, so sorry for you. I empathize completely. Things are not going well for me at all. I have had a tear in my gluteus medius tendon ever since my THR last July. I have been in pain since then and must always use either a crutch or a walker because my limp is so severe. The pain is getting worse all the time, with more muscles involved. Good news is that I found a new orthopedic practice and two surgeons will be doing hip surgery on me soon - waiting for a date. The tendon will be repaired and they will do exploratory surgery to see what else might be wrong. I can't wait, as I am so sick of this pain and disability. 
    • barb31596
      barb31596 AnnieK

      Posted

      Oh Annie, My issues pale in comparison. I can't believe you had to wait this long to have more surgery. Were they able to do an MRI of your hip or an ultrasound? Was your surgeon just not responsive to your complaints? What was the final straw that made you seek treatment elsewhere? I really believe  I have had way too many steroid injections over the past 6 years and that my muscles have been damaged; which is why my quad muscle tore and perhaps something in my hip. With a half a pain pill I really do not have much of a limp. I use a hiking pole outside to walk around as much for safety, and I guess comfort. The pain does wake me at night. How are you managing the pain and what made you decide to get another opinion? I am so sorry for all that you have been thru, and can only imagine how eagerly you are awaiting surgery. If you do not mind, I will be prayng for you that all will be well.
    • AnnieK
      AnnieK barb31596

      Posted

      Barb, your issues are difficult, too! Regarding imaging for the muscles in the hip, MRI shows them very well! You need an expert to interpret the results though. My first surgeon and two radiologists didn't see my gluteal medius tear, but one of the new surgeons, who has gluteal tendon surgery as one of his specialties, saw it on the MRI scan. I made quite a study of my MRI scans, and compared them with scans of normal hip anatomy that I found online. You can see everything!

      As far as pain, I usually take nothing for it, since I will be having surgery soon, and I just power through it. Sometimes it is just so awful that I take ibuprofen, which doesn't really help, or have a glass of wine! I get that you don't want to have to take pain meds to deal with your limp, since you have no real diagnosis and there is no end in sight for you.

      Here's my story. At 3-months I still had a severe limp and could not balance on my surgical leg even for a second. My surgeon's PA kept telling me that I would be fine, that the X-rays were perfect, so nothing serious could be wrong. Of course, X-rays don't show soft-tissue damage. At almost 5 months post-op I still couldn't walk without pain and a limp, even after 22 out patient physical therapy sessions, so I made an appointment specifically to see the surgeon. He had me see a physiatrist in his medical group, who checked out my back (?) with MRI and x-ray, couldn't find anything wrong and kept wanting to shoot up my sacroiliac joint with cortisone. Tried it once, it did nothing for my pain and limp, so why do it again? 

      From a reply to my discussion here on Patient, I got the idea that perhaps it was a torn gluteus medius or minimus muscle/tendon, and my research confirmed this. Went back to the surgeon at 6 months out and said I thought that was my problem. He said no way, but agreed to the MRI that I requested even though he was sure it would show nothing. Sure enough when he gave me the results, the radiologist had found nothing, and surgeon couldn't see anything on the scans either. He recommended more PT and oral steroids. I have never gone back to him, since I knew something was wrong.

      Went to new doctor in a different practice, one who does surgery to repair torn gluteals and has pioneered new surgical techniques for it, and we had another MRI done. The radiologist missed it, but the new surgeon saw the torn gluteal tendon on the scan! He sent me to another doc in his practice who does revisions to check me out for other problems, such as infection or prosthesis loosening. BOTH surgeons will operate on me soon, first to repair the tendons and second to explore the hip area to see what else might be wrong. I feel like I am the patient again, not being forced to be my own doctor and diagnostician.

      I find serious fault with the ignorance of my original surgeon. He had told me that no way could those tendons tear badly, and certainly they would never need surgery, that surgery is never done on them. He was obviously completely wrong. It remains to be seen if I will have improvement or full recovery after this second surgery, but at least there is a chance of it. With my original surgeon, there was no chance.

    • barb31596
      barb31596 AnnieK

      Posted

      What a journey you have had. It puts you in such an awkward position to scramble around hunting down the possibilities for your pain, and then making things happen. You have the gift of perserverance and obvious intelligence. Good for you. Thanks so much for sharng your story. 
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