Yesterday, I had my 5-1/2 month follow-up with Dr. Bradford Waddell at the Hospital for Special Surgery (HSS) center in Stamford, CT. He said the x-rays of my right hip revision looked "perfect." I am having no pain except for a very mild occasional ache in the front of my thigh. He said this was end-of-stem pain and was common. It usually fades within one year from surgery but not always. It is certainly something I could live with and doesn't slow me down. I am still on restrictions but I can break them "one at a time" i.e. don't bend past 90 degrees AND twist at the same time. I am highly satisfied with my revision so far. The hip feels more natural than it has in years. I can even comfortably jog a little on my meadow walks with the dogs. I did not do this with my original THR. My next follow-up is at the one-year point, January 2020!
I asked what I could do or not do that would affect the long-term outcome of my revision. He said at this point it is fully fixed and the bone ingrown. Infection could compromise the implant so be sure to take the prophylactic antibiotics prior to dental procedures or the removal of a bone spur on my toe. A traumatic injury where the bones around the implant are broken would certainly affect the implant. And finally, bad luck could hit again and the implant loosen for some unpredictable reason. Let's hope my luck holds out this time.
I was also curious about how an uncemented prosthesis bonds the second time around and what is the limit on repeated revisions if they become necessary (of course, I'm hoping they don't!). I know that a revision requires the surgeon to use a longer femoral stem so it extends into "fresh bone." How many times can you do this before running out of femur!? He said I had enough femur for four more surgeries. That sounds like enough to cover my remaining time on earth, even with serious bad luck! Regarding the ingrowth of bone into the prosthesis, in addition to preparing a fresh area beyond the length of the first implant, he reamed out the top part of the femur to create a wider channel until it was "bloodied up." These fresh surfaces trigger the bone to grow into the implant all along its length, both top and bottom.
I have read opinions that you only get one chance at an uncemented prosthesis, that subsequent revisions have to be cemented. This is not the practice of the vast majority of surgeons at HSS. Revisions there are nearly always uncemented. In fact, it is a cemented prosthesis that cannot be repeated during a revision with equal effectiveness as with the original THR. Once the cement has entered and filled the honeycomb layer of the bone the first time around, you no longer have that open, porous area to accept the fresh cement and assist in holding the bond the second time around. It must work well enough for certain situations because surgeons still do cemented revisions, but it is definitely not the only way.
The above information is offered in the spirit of discussion. I do not pretend to be an orthopedic expert. I did feel it was important to relay to others how my questions were answered by my OS. I have learned a lot from him and appreciate his taking the time to explain the concepts and procedures. I'm sure different OSs have different procedures that work for them.
United States
So glad to see your update and wonderful to hear DH is doing well also!
