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Hip pinned 5 years ago, AVN now

Discussion in 'Hip Replacement Pre-Op Area' started by swimbody, Mar 27, 2012.

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  1. swimbody

    swimbody Junior Member

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    Hi folks,

    I will ask the doctor who is going to work on me (long story shopping for docs here in Texas but eventually found an incredible surgeon that I haven't met with yet but said will work on me gladly) but I'm curious if I will need two surgeries in my case.

    Like I said I had a hip pinning 5 years ago and now the femoral head is collapsing. This was found when I asked to have my screws removed. I'd been running and even completed a full triathlon after the surgery. I actually went skiing over spring break with no issues, no pain, etc.

    Anyways the news is out. Two surgeons say core decompression is a way to buy time but 6 weeks on crutches with no weight bearing for a two month pain filled delay? That doesn't sound good. The stuff I've read (and it's not been a lot) was that core decompression is not usually successful since AVN is just a misunderstood condition (AVN is avascular necrosis).

    I'm thinking that pre op for a hip replacement would mean the screws would come out and I would have to strengthen the hip prior to putting a metal object in the core of it. I've been doing research and I'm pretty enamored with the BioMet M2M. I know the alerts out there for metal on metal but I want to stay active in my life. I'm 40 and will risk the gamble that a new hip will come out in the next 20 years that will last the rest of my lifetime after the Biomet wears out.

    Any thoughts on the pre op planning to remove the pins first to allow the bone to strengthen? I don't want to get dinged for two surgeries costs. Thank god I don't have to wait in some government line to get a new hip.
  2. Juliep

    Juliep Graduate

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    Hi Swimbody,

    I can't help you with answers concerning the screws coming out first, but I can tell you from my experience with 2 hips with AVN that I was advised against the Core Decompresion and the more I had read up on it, I don't think I would have agreed to do it regardless. I haven't heard too many success stories from it and you have so much more restrictions than getting the THR and then end up having one anyways.

    I have the Biomet as well but metal with poly liner. It was funny, the other day I was at a art/craft show and there was a booth with all the Biomet products. I thought that was quite interesting.

    Good luck with your appointment and let us know what gets decided.
  3. Jamie

    Jamie Administrator

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    Biomet parts at a crafts show, Julie? Now that's pretty funny!!! Some marketing weenie must have told them it's a good place to connect with their customer base!:th_heehee:

    Swimbody....welcome to BoneSmart! I think you are wise to think twice about the core decompression. And, you need to consider whether "buying time" is what you really want to do. After all, that DOES mean more surgery even if the core decompression is successful.

    With a THR, you would not have two surgeries. Your surgeon would not remove the screws. There is no need to do that to "strengthen the bone."

    My suggestion would be to find yet another surgeon....one who specializes in younger patients. Don't try to pick your implant....they all work about the same once implanted. More important by far is the skill of your surgeon. You want someone who does 250 hip replacements a year or more.
  4. alexthecat

    alexthecat Forum Advisor

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    I had the pins in my hip removed in the same surgery as my THR and I would not have wanted to do it any other way. One surgery, one recovery, and on with the rest of your life. Has your surgeon recommended removing the pins and performing THR in separate surgeries? If so, you might want to consider seeking a second opinion from a surgeon who is comfortable with more complex cases.
  5. Juliep

    Juliep Graduate

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    I guess that's what living in retirement area of Florida will do. Guess they figured they had a lot of potential customers there. :th_heehee:
  6. swimbody

    swimbody Junior Member

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    Thanks great to hear from you and thanks for the welcome. I just keep thinking that the three monster screws in my hip will leave a huge cavity that will weaken the bone. I'm not excited about that prospect. Oh well.
  7. alexthecat

    alexthecat Forum Advisor

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    The holes left by my screws were grafted with bone harvested from my pelvis. The graft healed to become normal bone. It's not weakened and there are no holes. It is my understanding that holes left by screws are typically repaired by grafting.

    Have you discussed your concerns about the screws with your surgeon? Has he said that he does not intend to graft the screw holes?
  8. DallasSarah

    DallasSarah Post-Grad

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    Hello and welcome to BoneSmart SwimBody,

    Where are you in Texas?

    Julie that was a little scary to see hip parts at a craft show, wow! Funny too...odd!

    I'm not a medical guru so no advice on your situation. Glad you joined us though you will get excellent advice, lots of support and yes some TLC when needed :)

    All the best,

    Sarah
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  9. Jaycey

    Jaycey Moderator

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    Hello swimbody, I agree with the input you have already received. From what I have seen on this site the decompression route is a painful and often only a temporary fix. If it were me I would go straight to THR.

    Don't worry about what implant they use. Typically an OS will choose what they have the most experience with and what give you the patient the best results.
  10. Lindawalms

    Lindawalms Graduate

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    Hi and welcome - please read my threads - some started by me and some started by "nanamac" - please do not consider CD - it is terrible and in my experience did not work and has given me so much more difficulty in my life...although I am just one person that is my advice...THR is AWESOME!!!
    xoxo,
    Linda
  11. Poppet

    Poppet Honourary Moderator

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    Hi welcome to Bonesmart.

    I had multiple bone grafts for reconstruction and THR four months later, can't even tell I have a replacement. My bone is forming well around all the bone grafting.

    Good luck and once again welcome to Bonesmart :)
  12. swimbody

    swimbody Junior Member

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    Once again, thanks everybody. Sarah in Dallas, I live in Austin. I've gotten a little more clarification with all of this but not anything from the surgeon. I saw two surgeons here before finding the third and best one for me; thank God I did my due diligence. Anyways the surgeon who I'm scheduled with for a consult is seeing me in two weeks on Friday the 13th of April. After that I'm sure its scheduling time for the THR. I have only spoken with the surgeon's scheduler and assistant and she was partially helpful. More answers in two weeks.

    I have a friend who works for Stryker. He doesn't sell to my doctor so there is no conflict of interest although he recommends the Mobile Bearing Hip. My doc uses Smith and Nephew hips and Stryker knees. I asked my friend if I could request a hip since the reviews are so strong about the MBH. If you go to Smith and Nephew's site it's like a maze. Stryker is straight forward and informative. I'm in sales so Stryker gets a big gold star for customer service and that reflects back to the quality of their products. I'm looking for a joint comparison chart. I've found pricing for each hip and I want to be totally educated with this process when I go in to his office in two weeks. I understand anatomy so I realize there are two incisions one can use in THR and I want to be moving again as fast as possible. Only issue is the three screws and I don't see how those can be removed without cutting through muscle. I fear a long recovery and I cannot afford that. I just cannot. I'm really stuck. If there is a doctor or nurse here who can confirm my fears I would really appreciate it as I can start planning for the down time.
  13. DallasSarah

    DallasSarah Post-Grad

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    Happy Friday Swim,

    Glad you have a new appointment, Jaycey was right don't focus on the equipment find a great surgeon he or in a rare case she will know what is best for you, based on lifestyle goals, age, bone structure.

    I know more about AVN since joining our website, just not enough to give advice. When you have time bounce around here and find stories you connect with we have many men in your age group that have had hips replaced and have bounced back to a normal way of life very quickly.

    Its good you have a friend with Stryker it's a good brand, again find a brilliant surgeon first and let them figure out what's best for you. I'm a firm believer in trusting your own decision you will know once you find right person. Read, read read this will give you education so you won't be nervous. I found great comfort even now knowing the actual hip joint is a very simple function just a ball and joint not complicated the work is the surgeon getting it in placed.

    All the best,

    Sarah
  14. DallasSarah

    DallasSarah Post-Grad

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    I forgot to add. All your questions like the cutting of the muscle for the screws write them down for your appointment, start a list now, print out and take with you! I find handing them the sheet always helps get quick answers instead of talking :)
  15. alexthecat

    alexthecat Forum Advisor

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    There were no muscles cut in order to remove the pins from my hip prior to THR. The muscles were separated in order to access the joint, just as they would be for any THR. That was actually a very minor part of the surgery and it did not interfere with my recovery. Also, like Sandy, the bone grafts caused no problems with my THR.

    There is a link to my recovery thread in my signature if you are interested in reading more about that. Understand, however, that every recovery is different and happens on your body's timeline, not yours. Setting deadlines or trying to hurry things along can be counterproductive.

    I agree with previous comments that implant selection is best left to your surgeon. He is the one with the training and experience needed to make that decision.

    Have you discovered the Library forum yet? It's a real treasure trove of information about preparing for and recovering from joint replacement.
  16. swimbody

    swimbody Junior Member

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    Thanks Alex. Great to go back and see the dates when your surgery was and how quickly you improved. My surgeon is an incredible doctor. He has a 6 month waiting list since he's so talented. He recently replaced both of Earl Campbell's knees and Earl is now walking. Amazing that I get the same guy. I will relent to suggest a hip and I will take the advice here and let the surgeon choose what he wants...:sigh:

    Alex, after my fracture I healed quickly and then started swimming and running again. Didn't know I had AVN and that the head was dying as I had no pain inside the joint. I'm really curious about the screw canals. It seems to me that it would really weaken the bone so I can't help but think I'd be no weight bearing for a while. Maybe I'm just not understanding the whole procedure in our instance. You keep mentioning crutches. I intend on walking into the hospital before the surgery and I intend to walk out. Were you able to lift any weights prior to surgery? Were any muscles cut? Did you feel like you had to learn to walk all over again like I felt I did after pinning? I was in a wheelchair for three months after the pinning!! Did the doctor know the DAA procedure like what is shown in this movie http://www.aboutstryker.com/hip/procedures/lorre-vid.html?

    My issue is that the screws will come out and the new hip will be going in all at once so I'm assuming no weight bearing due to the holes. I wonder if they will have to graft. I know, I know, take notes and write these questions down. I will I promise to.

    Sorry for the barrage.

    Swimbody
  17. Poppet

    Poppet Honourary Moderator

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    Good idea Swimbody to go with as many questions as possible.

    I had over a hundred questions for my first surgeon, he went to get up at one point indicating that the appointment was over.. I promptly said I haven't finished yet... Needless to say, he didn't do my surgery..

    Take care :)
  18. alexthecat

    alexthecat Forum Advisor

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    I was permitted full weight bearing immediately after THR. I was never non-weight bearing at any point, but some surgeons do ask patients not to put weight on their new hips for a period of time after surgery. You'll need to ask your surgeon about that.

    I walked with crutches for one week post-op and then switched to a cane. If you prefer not to use crutches, a walker is also an option. You will not be released from the hospital until you are competent with whatever device you use to walk. You will not be in a wheelchair after THR.

    As I said above (#15) no muscles were cut in order to remove the pins from my hip.

    I did not have to relearn to walk after THR. I did not have an anterior surgical approach and would not have consented to that.

    If you are comfortable lifting weights now, I see no reason that you shouldn't continue that until your surgery. When or if you will be able to return to that is a question for your surgeon.

    I would also suggest asking him about your concerns about bone weakening. If you have a history of bone density issues, that may be something that he needs to know about. That was not a problem in my case however.
  19. swimbody

    swimbody Junior Member

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    I just want to address a statement that I see over and over and that's "trust your doctor as he knows the best hip for you". I now know that is total baloney. The way a hospital in the US determines the best hip for you is a surgeon groups' recommendation to a hospital board that is to buy a certain brands' hip. If the hospital can get the cheapest price possible for the best hip then that's what they buy. My own doc is now a slave to a certain hip type while he's a slave to a different knee manufacturer. I'm going to fight this as I do not want some grandpa hip. I want a formerly flexible athlete's hip. I'm going to fight like hell for the Stryker hip even though it was just okayed for US use. Absolutely pathetic how slow our FDA is. What a crock it is that there is probably a policy in place to prevent the hospital from using this new hip. Wouldn't you want the most flexible hip on the market if you were young? I'm now angry, sorry for the rant. Just frustrated.

    Alex> I have very good bone density. My father is 72 and has incredibly strong hips after a lifetime of running and basketball. My mother was an olympic athlete and has had good hips all her life. I just made a terrible mistake one night that cost me this misery. The doc will only use the anterior approach method and he tries to do everyone in this fashion. What's funny is that he did a video that is on one company's info site about a hip made by that company that I want and now he's forced to use another company's hip.

    oh well. hope everyone is having a good day. i know the folks in dallas are in terrible shape after a scary afternoon. i'm blessed to only have a bad hip as i have my health otherwise.
  20. Jamie

    Jamie Administrator

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    Swimbody, I'm going to tag our forum nurse, Josephine, so that she can clear up any concerns you have about the removal of the screws. @Josephine: I also suggest you confirm what she tells you with your surgeon when you see him. I really don't feel as though the screw removal is going to be a problem for you.

    I know you are upset with having to deal with all of this. It's a difficult diagnosis for anyone to receive, and especially so for someone of your age. But as others have said, your body will determine how quickly you recover and you would be wise to allow yourself proper time to heal.

    Even though you walk into the hospital, it might be that you need assistance walking out. After all, this is major surgery and you will only be there a couple of days. You should plan for the use of some type of walking aid for at least a few weeks after the surgery. If that doesn't happen and you are okay to walk without an aid, that would put you in a small group of folks who were that fortunate. It is not a factor of your age or your physical conditioning. Sometimes folks who have the direct anterior approach can initially recover a little quicker. But....after a month or so, all approaches will yield pretty much the same result.

    You mention that you now know how implants are selected by hospitals. Might I ask how you came by this information? I really must take issue with your comment. I cannot speak for your doctor and hospital and how they work. But this is not something that is routine throughout all hospitals. In fact, the surgeons I am familiar with make their own selections for implants and the hospitals provide them.

    It takes very specific training to use the implant tools associated with each manufacturer's product. Surgeons become proficient with the tools, the implant and the surgical procedures over years of operations. It would suit no one if they were to change products all the time because of some arbitrary cost factors.

    I also want to assure you that there is no such thing as a "grandpa hip." Manufacturers are in business and employ lots of marketing tools to have customers believe that their implants are the best ever. It's not true. Once in, they all function in basically the same way. In most cases, a surgeon is using a particular hip implant because that is what he was trained in initially. You won't see comparisons of hip implants for that same reason....there is not a noticeable difference in the implant.

    If you are using manufacturer's web sites as a research tool, I suggest you do so with a large grain of salt for just this reason. There is a lot of hype out there and most of it is not supported by any facts or studies.

    What there IS a large difference in is the surgeon's skill. That is why we tell folks to search, search, search for the best surgeon and then follow and trust their guidance. It would appear that you have found such a doctor and I hope you can relax and put yourself in his hands.

    If you have read the success stories in the BoneSmart Library, you will see that people do recover from hip replacements and go on to all types of physical activity. I believe you will as well.

    As I said earlier, I know this is an anxious time for you. I think you will feel much better about everything once you have the opportunity to talk things over with the surgeon one-on-one. Please do let us know how that meeting goes.
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