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To: Dr. Bolognesi
georgia888 posted:
Hello Dr. Bolognesi,
I will soon be 55 years old & I am facing surgery for total hip arthroplasty. I have a benign lytic lesion in my left femur with a bone-to-bone osteoarthritic status in my left hip. Due to the anatomic abnormality of my left femur, my doctor said it will be somewhat difficult to match the prosthesis to the shape of my femur. In his notes from my last visit, he said he believes he can overcome this with a number of options that would be available. He did not discuss this with me face-to-face.

I have not yet scheduled surgery with this doctor. My PCP was surprised that the surgeon didn't order an MRI or other tests. I plan to seek another opinion in addition to hopefully hearing from you.

Needless to say, I am extremely concerned. Facing surgery under "normal" conditions is stressfull & with this abnormality, I am truly scared.

Please note that I also have severe fibromyalgia in addition to moderate osteoarthritis in my lumbar & cervical spine, right knee, elbows & toes.

At your earliest convenience, would you please comment on this ?

Thank you,
_swank_ responded:
Dr. Bolognesi doesn't answer too often so don't be surprised if you don't hear from him for a while.

Anyway, I would make sure this doctor discusses these "options" with you before doing anything. The next time you see him bring a list of questions so you don't forget anything.

Absolutely get as many opinions as you can from other doctors. Your best bet is to use a surgeon that does a lot of hip replacements, especially if there is some "abnormality" that will make surgery more difficult. Some doctors do nothing but joint replacements so that would be the best choice.

If your x-rays showed a significant problem with the bones in your hip then an MRI is not really necessary. In general, most doctors only order them if it would change the treatment plan. In your case, you've already decided to have a joint replacement so getting an MRI is a waste of money. I'm not sure what other tests your PCP thinks you need at this point. You will have several tests done at your pre-op appointment.
georgia888 replied to _swank_'s response:
Thank you, Swank, for replying & with such good advice. This doctor thinks my next appointment with him will be on the operating table. He never discussed difficulties or options, I read this in his notes that I requested after my last visit with him. He has a good reputation but that won't stop me from seeking another opinion.

Thank you, again.
annette030 responded:
I agree with Swank, you only need an MRI if the information it might provide would change the treatment plan. My husband had AVN of his hip, it showed clearly on the xray, the surgeon did not order an MRI prior to surgery. No need to.

I also have FMS, I strongly recommend you go to and read about it prior to having surgery. They even have an article specific to folks with FMS who are facing surgery, and it lists things the surgeon and anesthesiologist can do to prevent FMS flares post op. Things like proper positioning during surgery, etc. You can print this article out and give copies to your surgeon and anesthesiologist before surgery so they know what to do.

The articles at this site are by medical professionals from the FMS Treatment Clinic at Oregon Health Sciences University in Portland, OR. I happen to live near Portland and have attended some seminars put on by these people. Excellent.

Take care, Annette
georgia888 replied to annette030's response:
Thanks so much, Annette. I believe I have read every bit of literature on line about FMS including the website you mention with regard to surgery. I intend to do just as you suggested in making copies of the article(s) & passing it(them) around. When I shared the fact that I have FMS with this surgeon, he just gave me a blank look as if to say "so what."

Thanks again,

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