Today was my 6-week post-op appointment with Dr. Waddell. I drove the two hours by myself and did not use cane or crutch! He was happy with the incision, my mobility, and the x-ray so won't see me again until June at 6 months out. I still have the 90 degree restriction but he said I could start to "cheat" a little by flexing a little past 90 degrees. I just am not supposed to flex the hips and twist at the same time. I told him I could still not sleep on either side because it causes achiness in the operated side. I have to sleep on my back always. He thought that was normal post-op incision pain for only 6 weeks out. I asked about the fastener for the cerclage cable on the femur. He showed me in the x-ray a smooth, low-profile connector on the backside of the femur, NOT a big knob on the side where it could interfere with tendons and other tissues.
I asked him again what he thought caused the aseptic loosening. The possible causes are number 1, bad luck, and at a distant second, an undersized prosthesis. It is also possible there was some biological reason preventing or interfering with bone ingrowth. Out of pure curiosity, I asked him how he decides to use cemented vs. uncemented prostheses. He said virtually all revisions now are uncemented. Primary THRs can use cemented or uncemented implants, but usually uncemented. My OS knows a surgeon at HSS who does 90% of his primary THRs cemented so the frequency varies with the surgeon. For the bone cement to work effectively, it requires the porous or honeycomb part of the bone to be intact so it can take on the cement and create a solid bond. In a revision, the bone of the femur has lost a good portion of that porosity and so is not a good candidate for using bone cement. There is a risk factor with using bone cement that I had never heard of before. Forcing the cement into the honeycomb of the bone pushes the fatty components of the bone out where they can enter the bloodstream. This has the potential of causing a pulmonary embolism. May not be a high risk, but it's there.
I'm happy with this revision so far. It feels so great to go out of the house without a crutch or cane. I no longer deserve to use the handicapped parking tag. I have my third outpatient PT session tomorrow and am looking forward to it. This therapist really knows her stuff and helps me understand which muscles are weak and what I can do to strengthen them until they are in balance with the unoperated side.