Truth

My appointment was for 2pm on Thursday, December 16th, but having to fly to LA, drive to the heart of downtown and find parking, I left myself a little extra time. I mean, let's face it people, I am a country girl and driving into downtown LA felt a lot like driving to Afghanistan. When I arrived at the Joint Replacement Institute, it was encircled by a large, white, iron fence with a gate that took you to an underground parking area. The building itself was fairly modern, nice, with big glass windows and stone columns. It was your typical downtown doctor's office with one exception. It was also a fortress.

After taking a look around, I had made a few telling observations. One, there were a lot of people on the street for a Thursday afternoon. Two, none of them seemed to be smiling and many of them seemed to be watching everyone else. And if you had to ask me which country I was in, I would not be able to tell you because the features of the people walking on the sidewalks were not characteristic of anyone from a Scandinavian or therefore, Anglo-saxon culture. There was a lot of graffiti and no one really made eye contact. Many of the store fronts had barred windows, and businesses included check cashing services, liquor stores and Asian nail salons. It was just the kind of place I expected to meet one of the best hip surgeons in the U.S. (not really). It was downtown L.A.

I arrived early and had some time to "kill" for lack of a better word. While I was checking out the "wall of implants", a gentlemen "snuck" up from behind me and in a deep booming voice, said "Hi."

Dr. Thomas P. Schmalzried is a tall drink of water at a towering 6'8" tall (or thereabouts). He was smiling like a cheshire cat.....or a car salesman, either way, it was a little unsettling. I felt like Tweety Bird.

"I hear we will be seeing you this afternoon for a hip problem."

Okay, first of all, first impressions aside, I am scared out of my wits because I am about to meet one of the nation's best orthopedic surgeons who could make or break my life by telling me whether or not I qualify for this hip resurfacing procedure. Secondly, Surgeons are not social people. They don't come out to waiting rooms and introduce themselves to their patients prior to appointments. They went from elementary school to High School, top in their class, to College, then Med School, driven and determined to be better than anyone and thus had their noses in books and let's face it, human bodies for most of their life. The extent of their social experience is well, limited.

I stood in Dr.Schmalzried's waiting room, flabbergasted and speechless, with my hand dwarfed in a giant's handshake, trying to make a worthy first impression of my own, unsuccessfully, and asking myself,

"Who is this guy?"

The Hip Resurfacing procedure was approved in the United States by the FDA in 2006. It's a sexy little form of hip replacement that does not involve sawing off the end of the femur. Instead, it preserves the femur by rotoring the ball and placing a metal cap on the end. The pelvis is then prepared similar to the hip replacement procedure with a metal cup. The reason this sounded great for me is the recovery time is short, and, when it would be time for me to have the real deal, a total hip replacement, there would be plenty of bone stock to do it. While the data changes with new materials, new lifestyles of patients, etc. generally, a new hip will last somewhere in the neighborhood of 15-20 years. So let's do the math. If I'm 44 now, and I baby my hip (which we all know is not going to happen), I can make one go as long as 20 years. I'll be 64 when I need a revision. Easy. Most people have their first hip at 60-something. However, this means that I am facing my third....(egads), hip replacement at 84, assuming I live that long. Then again, I could get hit by a bus tomorrow. So preserving bone stock is in my best interest, and this hip resurfacing thing, sounds like it was made just for me.

But is hip surgery the best option?

Okay all of you existentialists out there. Do you live for today? Or do you try to plan for the future? And saying "Both" is wishy-washy. I want answers. This may be the only leg I have to stand on.....On one hand, you could make an argument for holding out a little longer, taking anti-inflammatories, limping along through your daily life, getting a different job that's not as physical, developing a nasty martini habit and sitting on your daughters' sidelines for all their life......Then, wake up in 15 years, assuming the bus scenario didn't play out, and realizing, what a waste. Or, you could roll the dice with western medicine, drink the Kool-Aid, and at least get yourself 15 good years in hopes that 15-20 years from now, hips will be made out of graphite or kevlar and the longevity of your second hip will be 30+ years. As we all know rolling the dice has it's risks. You could lose.

Making this decision as a registered nurse with 12 years of emergency room experience complicates the issue. Never mind the rare unfortunate occurrence of a bad hip implant. Let's talk about pulmonary embolism, sepsis, deep vein thrombosis, drop-foot, malignant hyperthermia, Coma, death.......Yeah, they're all listed on the consent in the fine print under "potentially bad things that can happen", but if you don't know what they mean, hey, ignorance is bliss. Trust me on this one.

And when we all want answers, where do we go? The internet of course! Google: educating the minds of the future. Just type in hip resurfacing or hip replacement and what do you get?

RECALL! RECALL! RECALL! RECALL! Did you or your loved one receive a "company X" XR7 hip implant? Dial 1-976-999-7000.....We can get you the money you deserve!

You can find anything you want on the internet and paint your own picture based on how you view it. If you go looking for bad hip experiences, they are easy to find. The good ones are not so easy to find. Why? Because they are all out playing tennis, and skiing and running and enjoying life and not spending countless hours whining on the internet.

"Well Mrs. Robinson, have you seen the arthroscopists yet?"

"Yes sir."

"What did they say?"

"They can try to fix it, but say that the arthritis really only points in the direction of a hip replacement."

"They are right. They can't fix you. I can."

"How?"

"You need a Total Hip Replacement."

"What about the hip resurfacing thing?"

"It's not for you."

(That loud thud you just heard was my heart sinking into oblivion by the way.....)

Trying to fight back tears and disappointment, I had to ask....

"Why not?"

Dr. Schmalzried, again, a surgeon, spoke matter-of-factly despite my crumbling emotional state. Women don't do as well with this procedure unless they are very tall (like Tanya), with large diameter bone structure and a specific pelvic-femoral orientation. By the luck of the draw, I was born with an acetabular hip dysplasia with anteriorly-oriented femurs and a "short stature", which means if he puts in a metal cap and cup, I will grind it down in 2-5 years "give or take". Technology advances at a rate of every 10 years which means that when I wear out that Hip resurface implant, I will still have today's technology to fix it....with a total hip replacement.

"You need to give us 15-20 years to come up with something better."

Ouch. Total Hip Replacement. Also known as a Total Hip Arthroplasty or THA, the Total Hip Replacement is huge. First, they "remove" the femur from the socket (after slicing through the fattest portion of my body...yep, my ass), then they saw off the end, drill a hole down my femur, drive a large metal spike with a neck on it down the shaft, attach a ball, grind out a hole in my pelvis only slightly smaller than the cup and then "press-fit" the cup into my pelvis. They connect Ball A to Cup B, making sure that both my legs remain the same length, and sew me up with yet another scar that goes up my leg and around my backside.

I sputtered with contrived enthusiasm. "When can we do it?"

This is where being a nurse comes in handy. You have a very finite and limited time with a surgeon, so you have to get all of your questions answered as if you were having the procedure tomorrow, because in fifteen minutes, he will be gone and it will be impossible to talk to him without making another $300 appointment. Fortunately, I knew this going in and nailed him down on every possible scenario that I could fabricate. Again, not acting in typical surgeon fashion, he spent 45 minutes with me. Yes, 45 minutes! THAT is unheard of! What was wrong with this guy?" First, I got right in to see him and didn't have to wait 6 months. Second, he was honorable, patient, forthcoming......Third, his surgery schedule was open to accommodate me within the month. There was something very different about Dr. Schmalzried and I was determined to find out why this guy was so.......admirable. I suspected he was a car salesman only instead of cars, he was dealing in hips. I was going to find out what he was hiding....And I scheduled my surgery for January 24th.