How bad is bad enough for a THR ?

A question I have asked myself a lot these last few months. After my hip scope in March 2009 my orthopaedic surgeon (OS) started talking about the need for a THR within 18 months - 2 years rather than by the time I was 50. He found 2 patches of bone on bone within the joint where the cartilage has literally worn away with the abnormal presssures caused inside a hip joint with dyplasia. My hip socket on the left is too shallow and doesn't fully cover the head of the femur. Once you have this degree of damage, it cannot be undone and will only worsen and progressively deteriorate over time.

Unlike many people with hip dysplasia, I did get some benefit from the hip arthroscopy - although I was warned it could make things worse or speed up the arthritis in the joint - but I got a lot of pain relief even if I lost some flexibility and range of movement as a result (I struggle to put a sock on the affected leg, never mind paint my toe nails !).

The burning question for me though was how bad does it have to be before I should get the THR done ? My surgeon was of the opinion that it could be up to 18 months or longer and I should hold off until I really couldn't stand it any longer. I'm keen to start a family and my surgeon wanted me to have kids before having the THR but instinctively this doesn't feel like the right option. I don't know that my hip could cope with a pregnancy and I don't want to be having a baby and not be able to crawl around on the floor etc. Having spent 6 months prior to the scope in significant amounts of pain, on and off crutches and swallowing painkillers like they were smarties, I also wasn't in a hurry to go back to letting the pain increase or lose any more mobility. It seems crazy to let things worsen when in reality, the end game would be the same and what does another year or two years buy me ? I'll still be having a revision THR in 15-20 years. I feel like my life has been 'on hold' for the last few years and to be honest I'm done with having to let this hip dictate what I can and can't do. I want to have my mobility now and I'll worry about the future when I get there.

It's such a difficult call and those of you with hip problems already will fully appreciate that you adjust your life to cope with a painful hip - you walk less, you park closer to the shops - or give up shopping - you change your car to an automatic so you can drive with less pain, you give up high heels cause the pain isn't worth it, you have to think twice about going anywhere that involves standing (like concerts, queueing in the post office), I could go on....

...in my case I also work from home most of the time so my definition of what is normal in terms of mobility has definitely changed over the last few years. I think my walking is fine as I get around the house OK but reality gives me a sharp shock when I go out and try and do something normal, like walk round a supermarket or just walk at my old pace... I have been so frustrated by these limitations and just do not want to face a further decline into more pain and restrictions.

So when my right (never had any problems or caused any pain) hip started playing up this autumn I decided it was time to seek the advice of a hip specialist who treats young people with hip problems, and dysplasia specifically. No disrespect to my current OS but he doesn't specialise in dysplasia and to be honest I feel he is definitely in the camp of let's wait and see rather than let's do something proactive. So I had a consultation with a London specialist who agrees my right hip does have dysplasia and bizarrely is worse than the left (go figure !) however as my activity level is nowhere near normal, we can't really assess whether it's symptomatic yet or not.

I explained my frustrations to him about having to wait until things deteriorated further on the left hip and his opinion was that as my activity level is already compromised by the hip, we should probably get on with it. Yippee !! At last, a surgeon on the same wavelength who gets it. This man sees people like me every day and knows how disruptive, wearing and frustrating dysplasia is. So, that same day, I booked my LTHR for 27th Jan. Bring it on !