Too Young for a Hip Replacement

Whenever I open up about having #hipreplacement surgery, the overwhelming majority response is - "but you're too young for a hip replacement"!

"Too young for a hip replacement" became the theme tune to my experience with hip dysplasia since the day my diagnosis was confirmed.

My last proper road race was the?2016?Great South Run, a 10-miler in Portsmouth. I've done this race many times before and for the first time ever the wind was behind my back on the home stretch along the seafront. It was a beautiful day and a fantastically supported race, but I ran in pain all the way and my times reflected this. I needed to get this sorted.

I was 38 years old when I finally sought GP review for what I was experiencing as stiffness and pain in my right hip joint, which severely impaired my ability to run, jump, squat and lunge.

1) Stop doing what hurts you.

I am dedicated to my fitness. I absolutely love running, lifting heavy and pushing my body beyond what my mind tells me is possible. I have rarely suffered injuries and invested in regular myofascial release and sports massage treatments to keep any potential niggles at bay. This has been a way of life for me for at least 20 years. It is my routine, my commitment, my psychological release from life's challenges. Simply stopping doing what I loved was not going to happen. GP prescribed me strong pain relief tablets (which remained in the medicine cabinet at home, unopened), sent me to have a hip x-ray and referred me to MSK physio.

2) It's hip dysplasia.

I'm seen by a MSK therapist, who brings up my xray on screen and shows me a shallow socket where the head of the femur barely wants to be associated with the acetabulum. In other words, the ball at the top of the right thigh bone is not covered by the pelvic socket sufficiently. This is #hipdysplasia. This is the reason for my pain. Apparently this is congenital, I was born with it. My mother always said I exercised too much as a way of explaining why I've finally worn out my body. Turns out, it's my genetics' doing after all!

An orthopaedic surgeon in MSK office looks over my xray, but does not see me in person. Their message to me is to stop high intensity exercise... wait for it... forever. In my head, I made up my mind - no chance I'm stopping what I love doing, categorically - no way. I quietly nod my pretend compliance.

The incremental options given to me are:

1. Stop high impact exercise and strengthen muscles around the hip joint with physio exercises. Take painkillers when needed. (At this stage that would be daily.)

2. Steroid injection into the hip joint to manage the symptoms, if I want it.

3. Surgical reconstruction of the hip joint, which is not advised or offered at present - because - you've guessed it - I'm "too young for a hip replacement"!

I'm told I can reach out at any time if I feel I need further review.

3) If I were a professional athlete, would these be my only 3 options?

Alright, I know I am no Olympian, but I fail to see how any of the options given to me are actually options. The first 2 will mange (mask) the symptoms but not improve or change the underlying pathology, and the 3rd option is not even on the table yet because of my age. They also happen to completely discount me, my background, history and my motivation for seeking help. I hadn't come here for advice to halt my life in return for pain cessation. I wanted pain to stop so that I could continue living my life. I felt the clinicians seeing me did not treat me as an individual, but as yet another case of hip dysplasia. I was 38 and being told to taper down my life.

My range of movement and strength are unimpeded and I can continue to exercise albeit through discomfort. The decision is mine to make, so I decide in favour of continuing to exercise. I make reasonable adjustments to my exercise intensity, reducing high impact elements and using alternatives like stationary bike more. I still lift, I still jump when I can, but I can no longer run. A small local village run with the kids sends me into days' worth of agony. I definitely can't run. My pain medication intake is directly linked to amount of activity I do. I don't like to take pain killers, so do so rarely and only when I absolutely can't think past the pain. I would hate to have myself as my patient.

4) New job kicks hip dysplasia into overdrive.

I start a new job at a major trauma centre, which requires a long commute and I spend a lot of my time plodding long corridors between multiple hospital wings. I'm finding myself unable to straighten out of sitting position to get walking, I am starting to limp, and my pain is getting worse the longer I spend on my feet, which means it's worse at the end of my working day. And then I have 1.5 hrs to get home. It's tortuous. I get a piercing pain from my groin through to my glutes. I'm also no longer getting rid of the pain during sleep and in fact find myself starting to wake at night because of it. It's a constant dull ache of varying magnitude. It no longer goes away with rest. It severely affects my ability and desire to exercise. I start missing days and at times weeks of training. I reach out to MSK team who tell me it's been over 6 months since my last review and I will need to be re-referred by GP in order to see a member of the team. Oh. It would appear the whole "reach out at any time" thing is conditional after all.

5) Thank goodness I work with orthopaedics!

I work alongside orthopaedic team in my new role and ask for an appointment with one of the pelvic consultants. He is a colleague and soon I'm sat in front of him with a new set of hip xrays on the screen. He confirms that I have hip dysplasia and recommends that I would benefit from a consultation with his colleague at another hospital, who has extensive experience treating hip conditions and injuries affecting young and active people. For the first time in many years I feel like there may be a light at the end of this gruesome tunnel.

The pandemic delays referral and appointment availability as it did for many patients. Eventually I'm invited to attend an MRI, CT and x-ray as part of the receiving surgeon's protocols. I'm super impressed to be having a leg length xray - it's the sort of attention to detail that I appreciate.

Finally, comes the day when I enter through the door of Room #1 of the orthopaedic clinic for an initial consultation with Mr Marcus Bankes , my surgeon. It's the day I hope to get answers.