Revision THR Revision

Bogey26

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Aug 16, 2020
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72
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I had a right hip revision in 2017. Original hip replacement was in April 2006. It was discovered about 3 years later thru routine X-rays that the allograft failed and the implant was migrating. I am still mobile and able to walk although there is discomfort in the hip area and achy pain. My surgeon is not pushing me to have surgery (yet) since I’m able to walk. Quite honestly, I’m nervous about having a re-revision. My surgeon did both my left and right hip replacements as well as hip revisions after 10 years for both. All successful except for my right hip revision. I am a 70 year old female and overall healthy and pretty much active but this bout had slowed me down. Has anyone experienced similar outcome where the allograft failed?
 
@Bogey26 I can't remember any members who had a graft failure - but obviously it does happen. So sorry you are facing more surgery.

What does your surgeon say about this? Is there a solution so that this does not happen again?
 
Hi @Bogey26
What does your surgeon say about this? Is there a solution so that this does not happen again?
This was my question also. Has your surgeon related to you a strategy to give you assurance they can overcome the problem of the allograft's failure to fuse.
Just for others info:
Allografts are commonly used to restore the host bone stock and to provide sufficient stability for the new prosthesis. Different techniques and types such as morselized (“chips”) and structural (“bulk”) bone allografts can be used depending on the defect size and configuration.

From what I read, good to excellent short- to long-term clinical and radiological outcomes and survival rates of acetabular and femoral revisions using allografts have been documented, the underlying factors for the success of allograft incorporation are not completely understood.
It seems the information cites that likely that the defect size, the surgical technique, the type of allograft, the use of bone cement and host-related factors influence graft incorporation.

Was cement used with your procedure?

I know I would like the Surgeon who has intimate knowledge of my anatomy to be the one to have the answers, and I don't know what his experience with bone grafts is... but would you consider an opinion from another revision specialist to see if there are options?

I know the thought of another surgery must be horribly daunting...
 
Thanks for your responses. My surgeon says that he would not use bone graft (cadaver) again since my bones did not incorporate into it, but instead use a bigger ball and cup. He could not use the same procedure as my left hip revision due to the defect size. The issue for my right hip revision was discovered two years ago (three years after the revision surgery) and while the implant migrated, my surgeon said it could stabilize. Pain comes and goes, but for the most part, I am mobile and able to walk which is positive for me. Hence, my surgeon is not pushing me to have surgery. Yes, the thought of having another revision surgery to correct this is daunting, but have a long relationship with my surgeon and my other surgeries have been successful, and with that, I would agree he has an understanding of my anatomy. He is highly regarded and considered one of the best in our state.
 
After a year of anxiety having to face another revision surgery, I’m glad to report that it’s done. Due to my hip taking a turn for the worse with the implant migrating into the pelvic area and broken screws, it became necessary to have the surgery done. Two and a half weeks post op and all is well and on the road to recovery. Prior to the surgery I had several acupuncture sessions and I can’t help but feel that the sessions is helping with the recovery and low pain levels.
 
@Bogey26 Welcome to the other side again! What was the actual date of your surgery. We will update your signature for you.
 
Thanks for the info, @Bogey26
I am so sorry this hip journey has been so long and difficult.
I am glad you are feeling confident in this surgery and am sending you all good healing thoughts...
Your rough road can be another member's inspiration one day.
Hope your week is Sweet!
 
I'm so glad that you're on the healing side, again. Let's hope that this is the final chapter of your hip saga and a new chapter of healthy living has started. Blessings as you move forward.
 
I’m so glad it is behind you. I wish you the very best of recoveries and hope everything will get better from here on.
 
Hi @Bogey26
Stopping by to say :hi:and see how you're doing at this one month post op milestone?
Hopefully you're doing well. Please update as time allows, we'd love to hear from you.
Wishing you only the best!
 
I’m in my 5th week post op and getting stronger each day. For the most part, feeling really good except dealing with the slight leg length discrepancy, trying to walk with a normal gait. My surgeon says that my brain will help to work that out. I guess it’ll take time as there is still mild pain in my hip, and having to remind myself to take it slow since this is the 3rd surgery on my right hip.
 
@Bogey26 Five weeks out is still very early days - especially since you have had multiple surgeries. Sounds like you are doing well.

Yes, the body does adjust to leg length differences. Try heel/toe walking:

This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.

It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.
1619184824963-jpeg.83076
 
Thanks for your response Jaycey, especially for the reminder of the heel/toe walking. I’m trying it and it does make a difference and will be sure to make a conscious effort to continue every day. As you say I’m in my early days of recovery, what would you say is the average recovery timeline to get to a state of normalcy for an individual as me who’s had multiple surgeries (in one hip)?
 
what would you say is the average recovery timeline to get to a state of normalcy
There isn't any "normal timeline". Literally every recovery is different, even on the same person. In general recovery from THR takes one year or more.
 
Hi @Bogey26
Wondering how you're doing at this four month post op point? Hopefully you're feeling much stronger and steadier on your feet than when you last posted. Best wishes for a happy holiday season and a fantastic 2023.
Happy Four Month Anniversary!
 
Thanks Layla! Overall I am doing good. I’m able to walk up to 7,000+ steps. I just recently returned from a trip and experiencing aching pain in my right side above my hip/lower back. I have a followup appt in a few days and hopefully it’s just muscle pain. My gait has improved and the leg length discrepancy seems to have settled although there is a slight length discrepancy. I’m also wondering if this is causing the lower back achy pain. It feels tight and as if it needs a good stretch.
 
@Bogey26 Did you do more walking during that recent trip? Or climbing stairs, walking on uneven surfaces? The body usually adapts to a slight leg length discrepancy. But if you still feel this is an issue, see a good podiatrist and get measured. You might benefit from a small lift in the shoe of the shorter leg.
 
Thanks for the update, Bogey26. It's good to hear you're doing well overall. Jaycey's questions are good ones to ponder after your vacation. Hopefully the hip / lower back pain you're experiencing eases soon.:fingersx: Let us know how your follow up appointment goes.
Take good care.
@Bogey26
 
Hi there….i’m back! Headed for another revision, now for the left hip. It’ll be the 3rd surgery for that side…the acetabular lining is wearing out. Original hip replacement was done in 2005, revision in 2015, now re-revision scheduled for 5/2/24. This time it’ll be with a different surgeon! I’m a little nervous being he is a new surgeon but trusting him with his skills. He trained with well renowned orthopedics at JIS Orthopedics and sub specialty is hip revision. This will be my 6th surgery for my hips, three on each side! I had a re-revision surgery done in August 2022 on my right hip. I sure hope I’ll be fixed for good with the new surgeon! I’m 72 years old and want to make the most of my remaining years!
 

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