· Which implant is the best?
This is about as difficult a question to answer as “Which car is the best?”. There is a certain amount of individual preference to this decision and will affect your back pain after. With new materials and stem designs now being introduced, there is a matter of judgement about risk of taking on improved designs that may be unproven in the human body. By trying something that is new and improved you may need to take on some of that risk. That said, even the “old devices” seem to be constantly changing so it may not be as clear-cut to accept past record as an indicator of future performance as it may seem.
· My doctor said he is going to use a titanium implant, is that a good one?
I’m not sure why it seems many doctors are telling their patients this. Perhaps because titanium sounds high tech and they feel the patients will be reassured he is using the best metal for golf clubs. Titantium can be used in hip implants in the stem and on the backing of the acetabular component to create a rough surface for bone ingrowth. When used in a stem it has the advantage over cobalt-chrome in that is more flexible, so it will flex more with the bone. As for longevity, the metal of the stem is probably less important than other details such as the composition of the articulating surfaces (junction of ball-and-socket). Titanium is never used for the articulating surfaces because it is too soft.
· When is the right time to stop waiting and have surgery?
For me I was having significant pain in certain situations more than 4 years before I had surgery. I waited until it had advanced to where I had severe pain and joint stiffness after any exertion (such as doing yardwork or a lot of walking). My range of motion had been affected so much that climbing stairs was a problem and I could no longer ride a bike. The decision came down to one of quality of life — in order to avoid situations with a lot of standing or walking I was passing up a lot of activities to the point I felt my life had become one of only avoiding pain. Although I wasn’t in pain all the time, it was enough that at times I felt it was affecting my personality.