2 year revision revue - stem cell question for Josephine

[karenoz]

Hello from Australia,

I had my 2 year review on Thursday. I had a revision/bone graft done on my LHR over 2 years ago. My OS was thrilled with the x-ray and said that my own bone had grown really well and everything was looking great. I have just recently found this website so I had lots of questions for him, especially about antibiotics and dental work as I just had a tooth removed a week ago and the dentist did not give me antibiotics, my OS advised that antibiotics are a good idea and recommended the new synthetic type of antibiotic (fluco something ?) as the standard pencillin is not as good at fighting off all the bugs anymore.

As I am only 38 (had my first hip at 23) I asked him about future surgery he advised the new cross-linked poly liner that he used on me last time is much more hard wearing than the original one I had so I should technically get longer out of this hip (first hip lasted 13 years) probably would have lasted longer but I am pretty active and did have two children during that time the extra weight and carrying around babies must have contributed to the wear.

My OS also spoke of stem cell future treatment and that it may just be a case of an injection to the hip area, to grow back new bone very quickly, he did say it was some years away, probably will take longer to get to Australia -Josephine, do you have any information about stem cell treatment for hip replacement patients.

My OS must be in his 60's and close to retirement, he has done all my surgery over the last 20 years - I really trust him and will find it hard to feel comfortable with any other OS - but in 10 or 20 years who knows what great possibilities there will be. I just wanted to share my good news after my 2 year review as I am always very anxious leading up to it.

This site is great, have read lots of threads and feel much better informed.

It is great to hear how everyone else out there is managing.
Karen

 

[Josephine]

Karen, antibiotic cover for dental work - even a cleaning - is not just 'a good idea' - it is ESSENTIAL! Read this thread on the subject Be careful of any signs of infection

This contains a LOT of important information about taking care of yourself vis a vis infections when you have a joint replacement of any kind. Just to emphasise this, my sister - who had both knees done 24 and 18 months ago, has recently had a lot of trouble with a dental abscess and first her dentist said it was "old hat" and wasn't done anymore, the her doctor said much the same though he did reluctantly give he a week's worth of antibiotics.

So I checked with the surgeon for her (used to work with him

) and he confirmed - you need to have plenty of antibiotic cover - for two weeks prior if the treatment is planned, for two weeks minimum AFTER the infection is cleared and/or the socket is well healed.

And it must be a broad spectrum antibiotic (which penicillin isn't) something like amoxycillin or co-amoxiclav.

As for the stem cell research, I am afraid I have heard nothing about that as yet. Sorry.

 

[Karen]

Hi Karen

Glad your 2 review was a good one and that your graft has taken well.

I too am still having problems with my dentist; I posed the question here a couple of weeks back and with the response from Josephine and others I contacted my OS - who said
"The national guidance on this is that it is not necessary, however we do suggest that you do take prophylactic antibiotics which could be prescribed by your dentist."
I told my dentist this but his 'guidance book' stated it wasn't required and if I wanted to take antibiotics I would have to get my OS to prescribe, or get it in writing from my OS as to why I needed it, so I am going to ask my OS on my next check up. Consequently my last clean at the dentist was done wihout any medication.

Not sure what my OS meant by prophylactic, maybe Josehine could answer that for me.

Your note about stem cell treatment sounds very interesting. This last op of mine the OS was going to use the fairly new trabecular metal implant instead of another allograft - that's when I originally joined this forum for any advice. No-one had any experience of it but I did find lots of info on the web at 'Zimmer' the maunfacturer; it looks fantastic. My OS decided against it at this point as there weren't that many statistics on its long ternm performance, did another allograft, and said it could be something worth looking at in the future.

My OS who I had had since early 80's retired 14 years ago & I got a new guy - very wary at first, but tell you what he took a risk 10 years ago. That risk gave me yet another chance of revision, done in November last year, my old OS would never have taken that chance & I'd have been without a hip joint & permenantly on crutches! Don't worry too much about it I'm sure your new guy will do you proud if/when you do need him.

Karen

 

[JenniferG]

Karen, Prophylactic means to prevent. So you take not because you have an infection but to prevent an infection.

 

[karenoz]

Thanks Josephine,

I contacted my dentist and he prescribed a week of amoxycillan anitibiotics for me, even though it was 6 days after I had the tooth removed. When I rang my GP she said it wasn't standard practice. My OS said yes I should have antibiotic. The Dentist forgot to give them to me originally - was I confused !!!!! So thank you for clarifying it for me.

Below is a website address and info from an ariticle on using your own stem cells that was in the UK Telegraph last October. Reading articles like this makes me feel really positive about the long-term future. It mentions John Skinner I think I read you have worked with him Josephine.

I hope it is okay to mention this article.

https://www.telegraph.co.uk/earth/main.jhtml?xml=/earth/2007/10/16/scistem116.xml

A pioneering technique to strengthen the crumbling joints of patients who need a second hip replacement could help thousands of people every year, scientists claim.

As many as 10,000 people a year need to have worn-out hip implants replaced, as life expectancy increases.

In a quarter of cases the new hip does not cement in easily, leaving patients unable to walk and vulnerable to becoming obese and suffering heart disease.

Now British scientists are to test a promising way to harvest a patient's stem cells in the hope it can boost the success rate of "revision hip replacements".

Prof Gordon Blunn and his team at the Institute of Orthopaedics, University College London, together with John Skinner, an orthopaedic surgeon at the Royal National Orthopaedic Hospital in Stanmore, Middlesex, received £130,000 from the UK Stem Cell Foundation and the Medical Research Council.

The grant is for preliminary experiments that will pave the way for a trial next year on 80 patients who need a hip replaced for a second time.

Prof Blunn believes that the quality of bone chips which are squeezed into damaged hip joints to rebuild them — before an artificial replacement hip is implanted — can be improved by first transplanting the patient's stem cells into them.

The cells would be removed from bone marrow and extracted from the patient's hip under anaesthetic.

Stem cells from the marrow are isolated, then grown in the laboratory in sterile conditions and used to seed new growth in the bone chips.

It is hoped this will create a more effective way to fix bone damage and inflammation caused by debris from the old artificial joint.

His preliminary experiments suggest bone formation can be boosted up to 75 per cent by the transplant of a patient's own stem cells – the building blocks used by the body during growth and repair.

Prof Blunn said it was unclear whether the NHS could cope with the demands of having to grow a patient's stem cells, estimating that the cost would be around £2,000 per patient if the method were used routinely.

The chief executive of the Medical Research Council, Sir Leszek Borysiewicz, said: "The idea is to use autologous stem cells [taken from the patient themselves] to accelerate healing and outcome."

I have not yeat searched to see what type of research the United States are doing ?

Bye for now

Karen (Australia)