To think my bulging disc won't improve unless I have hip replacement?

[UncertainWife]

Using AIBU for traffic, health is too quiet!

I have osteoarthritis in my right hip (confirmed by several x-rays, most recent in Oct showed moderate with bone spurs, feels worse since then).

Since Sept I've had lower back pain on my left hand side, just had MRI results, they show bulging disc touching nerve root/s at L4&L5 plus herniated disc (not touching nerves) L1 & L2 and wear and tear of facet joints at L3 & L4.

The back pain has been on and off, but worsening when it is 'on'. It feels like my back is trying to fix itself but can't. In Sept I could walk 45 mins and banish the back pain, now I can barely walk 15 mins before I'm in too much pain from both hip and back and the walking makes the back pain worse and not better.

The hip arthritis is making my gait different and I saw a back exercise specialist who thinks my back pain is caused by my hip problem.

The GP suggests physio for the whole situation, but based on what the back exercise person said, and from research on hip arthritis forums, I'm considering a private hip replacement so I can have better mobility and gait to do the correct walking and physio to improve my back.

Anyone got any knowledge or experience of this? Anyone know if you could improve your back with physio while your hip is messed up from OA and causing wonky gait?

Hopeful bump

Hi OP. I'm not medically qualified so please take all this with a pinch of salt. I do however personally have years (and years) of 'dodgy back' experience and have several permanent back impairments that require constant management.

I think that regular physio could help with the symptoms of back pain, but it can't do much more than this if your gait is permanently off.

In your shoes, and if you can afford it, I would pay and go privately. I paid privately for an MRI and that showed exactly why the physio was never going to work! (collapsed vertebrae as a starter).

Thanks for posting @FinallyMovingHouse sorry you've suffered with back problems for so long.

I wish I could find a good medical professional capable of assessing and advising me holistically.

Where are you based OP? If in NW, I know of some excellent physiotherapists.

Pay to see a specialist hip & knee surgeon for a consultation. Should cost around £250-£300. They will tell you if a hip replacement will cure your back issues (if you've had all the scans won't cost you more than that, if you've need scans will cost more) but I work in that field and it's a reason we undertake them regularly.

@RedBlueDotDotDot alas I'm in the SE! Thanks though!

@JanefromLondon1 really? That's good to know. I thought the hip consultant would only be interested in my hip pain. So others do have hip replacements to help back problems? Any idea what type of back problems can or can't be fixed by hip replacement?

Are you near Gatwick OP?

I have hip pain and bulging discs - the hip surgeon did scans of my hip and back as he did not want to replace the hip if the pain was coming from the back and vice versa. If I put my weight on my hip and leg it is very painful and if I walk with an odd gait it is better but I suspect that's why the discs are bulging.

I have hip steroid injections as the surgeon wanted to know if making the leg pain free would ease the back pain. Trying steroid injections into your hip or back may help your doctor work out if it is the back or hip that needs treatment?

My physio says to use crutches to try and even out my gait

No one will operate on you until they have done a full assessment of your lower back and hip to see why the pain is occurring. It could be arthritis in your back, you could need a disk replacement, could be arthritis in your hip making you walk off centre and that putting pressure on your spine causing the disc to bulge,

The hip surgeons at the Wellington are v good.

Thanks everyone.

Not near Gatwick unfortunately!

@JanefromLondon1 I know from my back MRI that I have a bulging disc, and know from the hip x rays that I've got hip arthritis.

Hopefully a hip surgeon can assess this info and advise best course of action. I'd get new hip x rays as previous ones were early Oct and hip is worse since then.

Any idea what the process is to get the back MRI images from the NHS to the private hip surgeon? Does the consultant request it from the GP? I asked GP's receptionist but she had no idea.

The private hospital will request all your scans from the NHS before your appointment. Tell the secretary when you book that you've had them done and at which hospital.

I'm going to get flamed for this but how's your weight? I was diagnosed with arthritis of the hip around 12 years ago, since then I've lost 4st 7 and it's really helped with the the pain. I'm not as bad as you as I'm still fairly mobile but I get pain in my thigh if I overdo things.

My BMI is 22.9, in the healthy range. But I have no problem with you asking!

I'm seeing a private hip consultant this coming Weds, looking forward to getting his view.

I'm still not sure how anyone could be 100% confident of best course of action when you have both a spine and a hip issue though!

Looking at some facebook hip groups and some research on google it looks like the general consensus is to fix hip first and then address the spine, though of course there are some people who say the opposite!

To me it makes logical sense to start with hip replacement to give a stable base and alignment to then do physio and walking for the back.

But I'm very nervous of rushing into a hip replacement if it's the wrong thing to do. It is hard to work out which pain is caused by what!

@JanefromLondon1 I saw the hip consultant but he was not very interested in much discussion about my back. He told me a hip replacement would fix my hip problem and hip pain, and said it might address my back pain ("some people find a hip replacement solves their back pain but there are no guarantees").

I wish there was someone who could properly assess me holistically ie someone who might say 'I can see the hip is impacting your gait which is impacting your back'.

I feel like it's more 'have this op if you want your hip fixed, your back problem isn't my problem'

I know everyone is different and I can only speak from personal experience. I had a hip replacement at 52 years old and it changed my life. You don't realise how much pain ages you until it's gone.
I thought I had back problems too and resolved to tackle those after my hip, but after I had my hip replacement, my back was instantly better too.
If you have OA in your hips and you are bone on bone with boney spurs, I'd say go for the THR. It might not completely cure the issues with your bulging disc & back, but it will certainly help with relieving the pressure on your back from your impacted gait.
Also, why are you considering paying privately as you should be able to select a hospital near you with the shortest waiting list on the NHS.
I just queried about my other hip in September and am down for another new hip on the NHS in February, I can't wait to get my life back.

Thanks for sharing your experience @Antisanctimonious

I'm in the NHS process as well as private. I chose the hospital with the shortest wait time but was then referred to a surgeon with a 10 month wait. Privately it's a 4.5 week wait. I haven't yet decided which one.

I know it's more £ but can you afford to book on and see a spinal consultant? I can recommend a few good ones if you're anywhere near London.

A good hip guy should refer you to a spinal surgeon to review imaging and then you can decide after getting feedback from both.

I did wonder about this @JanefromLondon1 - when I first had back pain I saw a spine surgeon who suggested it would be a minor disc issue and suggested I get an MRI. He moved my legs around and said he thought I had years left before needing a hip replacement, but my hip has deteriorated a lot since I saw him in October.

He said the treatment for my back would be physiotherapy, if that didn't work then injections and as last resort surgery, but he said all that without reviewing my MRI as I hadn't had it yet.

I could have a follow up with him but feel he'll just say the same again, get physio, I can't imagine he'll have a view on whether I should get a hip replacement or not.

My experience of private consultants is that they're in their body part silos and never care about the holistic picture,

I could get to London so do share recommendations, I wish I felt confident that someone would look at me holistically though, it's a lot to spend to have a back surgeon say 'try physio'.

One thing to try with your physio is asking for exercises you can do lying down. This might mean your hip doesn't impact on their efficacy. They were all I could do when I first started going, and they've made a difference.

A bit left field, but perhaps you could get a gait analysis like runners do? Obviously they will spot your dodgy hip but the ones who are really good at this stuff should be trained on what the impact is up and down the chain of spine, joints and fascia.
I can’t recommend anyone but maybe try searching Runners’s World UK online for articles that they have done in the past, as periodically they cover this and list/ interview people.
This might give you the holistic view you’re looking for, to add to the medical one.