This is a great page that covers a lot of the things they measure in hips.
https://miles4hips.org/hip-dysplasia-whats-with-all-the-angles
Do you have a standing, weight bearing radiograph that still has joint space showing? That will be easier to compare.
No question at all that that joint needs to be replaced, but in my (non expert but rather obsessively informed layperson) opinion, there’s been clear pathology there for a long time, and it absolutely could be contributing to your back pain.
Whew - thank you, I am going to try to make sense of all this.
There was another view taken, but DH did not take a picture of it.
Radiographs are often available in your patient portal. If you have an old film, pre all this arthritis, it will be easier to look at it and compare to the pictures at that link. You’ve really got nooooo space there, that really must be painful, I’m sorry 
You can always request your imaging on a disk when you have stuff done. Usually, you can get it right there, for free. Sometimes you have to go to medical records, and rarely, there’s a fee. It’s really useful to have your own copy of everything. Really very highly recommend.
I do have past disks - the most recent of just my hip is from last July, I also have lower lumbar films from seven years ago that might include some hip stuff.
No idea how to evaluate them myself, of course! This is SO much detail, and I would have to do a lot of careful step-by-step reading to understand any of it (I have some “deficits” lol!)
(ETA I always ask for the disks!)
This one is a good place to start, it’s just so clear. FAI is short for femoroacetabular impingement–when there is bone overgrowth along the neck of the femur and/or the rim of the acetabulum. See how the “ball” of your femur isn’t a ball at all? There’s a giant bump along the “top.” Like in this picture, look at the bump that’s outside the circle. That’s cam FAI:
The sphere-icity has been totally lost. Looking at a radiograph like this, you might be like “so what”…but you can’t see the labrum, which sits on the edge of the acetabulum, and just gets hammered by that extra bone on your femur, especially as you close your hip angle. The labrum is well innervated (it can hurt!) but isn’t vascular, so it can’t really heal. Impingement like this shreds the labrum over time, which causes pain, but that damage also really alters the biomechanics of the joint, which leads to early wear.
None of this is to say replacement isn’t the path forward–it clearly is. But I do think you’ve been a bit let down here in the past, with what seems to be (from this one film, anyway) some clear pathology that has perhaps been a problem for awhile. Unfortunately, it’s just not uncommon, doctors are so siloed.
I’m going to need to see some diagrams so I can have some idea of what all of this means. (I also have to look at comparison x-rays on my computer, hard to see all of this together and compare/contrast when I’m on my phone!)
I’ve never had any hip issues up until a year ago – so there would be no reason to get x-rays specific to my hip(s) – unless the doctors suspected something else? I have the usual lumbar arthritis, degeneration, stenosis – particularly bad between L5 and S1 so I’ve had injections there - radio frequency ablation, etc.
Without any hip pain, there was no reason to suspect that there was an issue - but it sounds like there was a gradually worsening “pathology” that might have led to this. My spine docs just zeroed in on what was causing me pain, thinking “horses”/spinal issues (because that would seem to be the most obvious thing!)
While it’s certainly possible to have a lot “wrong” in your hip and not have it really bother you much until the cartilage tips over into “serious” wear territory, it’s also pretty possible this has been contributing to pain that you’ve not identified as hip-based. Hip stuff is weird that way, it’s all so central and connected, that problems can cause pain in places you might not expect.
Hopefully you get even more relief than you expect with the replacement!
I think? @BUSY had checked in here a day or two ago for an update, but I don’t see any posts from her?
Less than a month now (26 days) until surgery - which is on May 4th, and I am now actually counting the days because the pain has gotten so bad. 
I was riding a student’s horse for her (she is on vacation this week) but was only able to ride him on Tuesday - since my painkillers had worn off by that time it was pretty ouchy, but I was able to get a decent schooling done. Alas, I can no longer ride my mare because she is too wide, and my saddle has a wide tree and twist (plus dressage saddle high cantle, UGH!) - so she is on vacation, again. (I gave her two full months off over the winter.) I am going out several times a week to see her, groom her, etc. - but really can’t even do groundwork or longeing at this point, so have had to be okay with just hanging out with her and doing stretches and bodywork.
I’m still doing my dog classes - and this has been rather exhausting and painful if the pain meds have worn off (doing two evening a week and Saturdays, but am “easing off” a full boat and finishing the bulk of the classes in about two weeks thank heavens.) I’m also still teaching (horse) lessons and coaching my one competing student at competitions - but I have been using my cane and trying to take it easy-ish. (She’s good at setting fences for lessons under my tutelage, and my DH has pitched in once or twice when he’s available.)
MRI (needed or not) is at the end of this month, and is not only pre-approved by insurance, but per the insurance company it’s completely covered (Hallelujah!)
I have a consult with the doc about 9 days before surgery and have set up the surgery at the surgery center where he will go over everything (had to pre-register and all that jazz one month before the surgery date), and have had the pre-op PT approved - I just need to call and make an appt.
I have an appt. for all my pre-surgery bloodwork and tests next Friday - and when I go to PT I’ll ask them about “prep” - I got a HUGE binder with all the pre-op instructions, including when to stop my Meloxicam, how to bathe beforehand: use Chlorhexidine to scrub, no shaving below the neck?!? for 5 days beforehand, must “sleep on freshly washed sheets and fresh out of the washer PJs the night before” (I guess they are really worried about infection!), and I “should stop smoking and eat a healthy diet and have a BMI under 40” (check, check, check - and how can people really accomplish all of these lifestyle changes within one month of a planned surgery? 
), but they are certainly thorough!
I don’t remember any of these detailed instructions before my breast reduction surgery (and I’ve had two other surgeries but they were thumb and rectum - ugh - respectively.)
I’m wondering whether this is now standard because of the potential liability??
The pain has been an issue; once my most recent injection wore off (which was awhile ago), it’s been getting progressively worse. Walking up the stairs last night (with my cane, mind you), I was a little too ambitious climbing one step and it was a BIG OUCH!, I had to have my husband throw me up an ice pack which I laid on my hip to help the pain subside so I could sleep; I sleep mostly on my back. Yesterday I went in to my pain doc for trigger point injections (they do NOT use steroids, just Lidocaine), and requested something stronger - I’m already on Tramadol and have been for about 6-7 years, low dose, only in the AM), so she called in a prescription for Percocet. I have some leftover opiods from right before my mother died (she had to have a leg amputated because of a blood clot) so they are 7 years old - obviously have lost some potency but I have been taking small doses when the pain gets so bad that I can’t function - but now I have a fresh supply, thank God! (I have taken opiods in the past after surgical procedures with no issue - have tapered.)
I have been using a LOT of ice when I’m sitting at the beginning and end of the day - heat packs on my low back and glutes which are tight because of all the compensation when I move and walk - and I get deep tissue bodywork twice a month; also chiro adjustments twice monthly - both help, but only so much. I’m still exercising daily, going gently on my elliptical actually hurts WAY less than walking!, go figure! And stretching, though doing my right hamstring is. Tricky. Ouch.
@iberianfan - I Googled some of these cold therapy machines and they are $$$! The ones I found used are not that much cheaper - nothing under about $160. I’m wondering whether they might ? be covered under the many things “for medical use” that our FSA debit card can be used for; will look into that.
Anyway, that’s the update. Struggling a bit with the morale and the negative effects on the old psyche. A bit angry and grumpy and frustrated since I am used to being VERY active and now feel crippled and old. UGH.
“This too shall pass” (repeating this got my dear late father through WW2, after all!)
I stick it under my glute or in my low back (whichever needs it most!) when sitting and driving - though I do have to contort myself in the car seat to keep it “on the right spot”, but boy is it helpful. HIGHLY recommend! 
Yes, I did post but ran into some issues with computer so deleted - all the above from pain to protocol just ‘struggle’ same as ‘lived’ through by friends and family. It’s just so life changing before, during and after but !!! so worth the struggle - get extra rest with ice until and afterwards - afternoon naps will help with the “WTF” - how can I be so inactive ??? but it will pass and life will be so much improved ! You will wonder why you did not have the "event’ sooner. Jingles !
Thank you for all of that, and you are of course right! 
I am unable to nap unless I am completely and utterly exhausted – so maybe once every two or three years? I’ve tried many times without success (I’m just not a napper - neither is my daughter! though my husband can fall asleep in a chair, but then again he has sleep apnea.)
Maybe post surgery I will be able to get some rest during the day, but I am dubious – I don’t sleep soundly if I’m not able to really move around and DO things, and it’s sometimes hard for me to tire myself out enough to shut my body and brain off.
Of course the constant pain I’m in does exhaust me, especially since I’m having to continue to do income generating stuff. “Make hay while the sun shines” until I’m too incapacitated to be able to. Just gotta hang in there!
And good update! Ordered an ice cube system and was able to use the FSA Debit card - score!!!
I am the same way – I’d have to be either ill or way past tired to sleep in the daytime. I’m the daughter, sister, and wife of men who can cat nap at a moment’s notice, then wake up refreshed. I’ve tried so many times to emulate their behavior, without success.
Finally did a sleep study, in which I discovered that my sleep is completely normal and totally apnea free. I spoke to the sleep doctor (board-certified in both sleep and internal medicine) about my lack of the ability to nap, thinking that perhaps it was the sign of some issue. He reassured me, and said that that I’m a “chunker” – I require my sleep ideally in a several hour long chunk – and that there’s nothing wrong with that, it’s one of the varying ways to be, and normal for me.
I feel better about my inability to nap now, although I still wish that I could. I hope that your surgery brings you pain relief so that you can get a quality night’s sleep. Sounds as though you, too, might be a chunker. It’s tough to heal without sufficient restful sleep!
Infection post joint replacement is a Big Bad Deal. Like, a BIG thing. Yes, definitely, they want to make extra sure that you’re checking every possible box on how to avoid that.
I have a collection of ice machines, and ice packs. The only machine worth it, IMO, is the Game Ready. Your surgeon can set you up with a rental if that’s something he recommends. The small non compressive machines aren’t any better than good ice packs–don’t bother. Look for the extra large Torex ice packs, you can get them on Amazon, and have a few on hand to rotate in and out of the freezer.
Something I also found super useful for my hip surgery was Juven. It’s a supplement that you drink and is clinically proven to improve wound healing. You’ll have a lot of healing to do, and it’ll help. It also totally prevented that post op hair loss for me! Which is super superficial but a nice bonus, lol.
Best of luck!
Understand, I will follow all instructions.
The Game Ready is $$$$$! 3K!?!? I doubt my surgeon would recommend it if there is something else that fits the bill (not sure about rental options?), but will look into the Torex - I need to place an Amazon order anyway so will just add it to that
Good to know about the Juven - I already take L-Arginine daily, but I see that there are other ingredients in it.
Thanks for these insights!! Good to know, LOL (and yeah, that sounds about right 
)
That’s why patients are set up with a rental if the surgeon’s protocol calls for it. Patients aren’t expected to purchase. Rental costs generally run a couple/few hundred bucks–in the ballpark of the little cheap non compressive machines.
That said: they can be sourced for significantly less than new (but still not cheap!) on eBay or Craigslist or Marketplace. I do actually own one, with an assortment of wraps. It’s really nice to have with ongoing orthopedic issues.
I’ve also been given a couple cheap non compressive units, and bought an inexpensive compressive unit for my horse. They just don’t compare to Game Ready!
If the surgeon’s protocol doesn’t call for Game Ready, you’ll do fine with quality ice packs. 
I did fine with the small ice machine. I found it worked better/longer if you put in about 6-8 frozen water bottles. Not sure what is meant by “non-compressive”, but my machine pumps the ice cold water through tubes imbedded in the velcro wrap. Anyway, lasted longer than an ice pack, but I didn’t have one for the first hip and did just fine.
You will feel so much better after the surgery. You will have a couple of days of pain, but will feel better every day. Once the initial pain from surgery subsides, you will be so grateful that your hip doesn’t hurt!! And all the accompanying aches from stressing other muscles and joints will ease up too.
Prior to this latest surgery, I had to scrub with the special soap the night before and the morning of. Yes, PJ’s and sheets need to be sparkly clean.
Please keep us posted. I am sure all will be well. The docs are pretty skilled at this by now.
You are going to LOVE surgery. You’re pain is going to be so much better.
I’m still in awe of how good I feel and what I can do now that I couldn’t before.
I too noticed that my wider horse was much more uncomfortable / painful to ride than my more narrow-build horse. It think it’s just the angle it put my hip at.
Obviously you don’t want to get an infection with any surgery, but you are having a JOINT replaced. We all know how serious joint infections are in horses - they are equally as bad in humans. So that is why every possibly precaution is put into place to potentially avoid a joint infection.
Talk with the nurse when you go through these things. Some things are more flexible than the binder says. (Like my nurse told me it’s find to shave…)
I didn’t have to do 5 days of the chlorhexidine, just the night before and the morning before.
And I remember my instructions said I couldn’t use conditioner in my hair and that was another thing the nurse told me I could actually do. I didn’t know how I would get my hair brushed (snarled) without conditioner!!
So ask lots of questions but YES they do take infection that seriously. With your breast surgery, that’s not a joint.
I did not get an ice machine. I just rotated ice packs in the freezer. Worked fine for me. An ice machine is convenient but not necessary.
You also do not want to OVER-ICE with the ice machine, if you get one. There is such a thing as too much ice. You’ll eventually constrict blood vessels, which decreased blood flow, which slows healing. Ice has it’s place to control inflammation but don’t overdo it!
I would told 20-30 minutes ice on, and then 20-30 minutes ice off. Alternate.
I think the clean sheets, nightwear and towel are pretty common instructions these days, as well as the no shaving. I’ve had three laparoscopic abdominal surgeries since August, and had those instructions. I was able to shower the morning of surgery in each case, so I didn’t bother changing sheets the night before, but did use a fresh towel that day. I knew it was going to be my last shower for weeks, so I enjoyed every minute of it.
Rebecca
Just think Dr. D ~ next Easter you’ll be running & collecting Easter eggs again ~ shoving the little kids out of your way and back to “terrorizing” the neighborhood! 
Happy Easter ~ to you and yours !
You’ll be fine ! Actually a new improved version of yourself ! Canter On !!!
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