4 months after THR groin and thigh pain - thoughts?

[maxwellmedical]

First @Josephine, I am sure you did not mean to criticize me when you said you can go from surgeon to surgeon and not get an answer, but if felt like you were saying I should just give up. A past experience has led me to do exactly that since and it has saved me once already. Josephine if I posted x-ray at surgery, 6 week x-ray and latest x-ray would you look at them to see what you think about the implant having subsided (it has)? I don't know how to get my name off of them which I think they usually are included.

Frr Josephine and all others, the Mayo doctor and I were not a good match. Without going into detail I did not feel he was really listening to me after I spent half my time speaking to a resident - I did not wait 2 1/2 months for the appointment for that to be the result - it was crucial that there were not miscommunications, that I got my questions in and answered, and that I leave with a plan, none of which happened. He had the resident do a cortisone injection in my knee area and high on thigh - and then had a doctor try to get out fluid out of groin to test for infection (none to get) and inject Lidocane in groin to see if lessened pain in two hours of walking to help diagnose source of groin pain. Surgeon did not think things through since knee injection caused so much pain within an hour after Lidocaine injection that I could not complete two hour walking test. Surgeon just told me to get PT and use a topical anti-inflammation creme since hard time with internally taken version. Surgeon said exercise and PT could not make it worse if bone did not grow into implant BUT did not say if would hasten implant subsiding/moving down faster. SO just as before, I don't know whether to do PT now. Doctor also asked if had bone scan and when I said no he then did not order one. He did not order ultrasound which might have shown scarring? impingement?

Unfortunately, it is not just a matter of waiting and slow healing. I wish I had pressed my initial surgeon to see me again at 3 months and do EVERYTHING which is part of differential diagnosis including set of regular x-rays and groin injection an even MRI with new software just in case it picked up anything more. My implant has unfortunately subsided although unlike the FL surgeon, the Mayo surgeon did not say I had to have revision now. Mayo doctor also NEVER said pain in groin and pain in thigh which started at different times (groin within a week of surgery feeling like catching which morphed into just pain with each step, but thigh for not over a month or two after surgery which evolved from thunderbolt pain into just aching kind of pain after waling for 5 minutes).) Mayo doctor to come back a year after surgery date for more x-rays. What? Can't just sit around for six months wondering if subsiding more or stabilizing. Appreciate help here - if have ANY answers I had hoped for about subsiding please share. Since my initial surgeon would only order one standing "special x-ray" (I wanted a normal set) at my six month check, I was not sure if the new doctor could tell if it stopped subsiding after six weeks (compared to the x-rays just taken) or if the six week standing x-ray was unless for this purpose and he could only compare the x-ray taken at the time of surgery and the one just taken six months later (this week). I was not given the opportunity to ask (1) how much it subsided (I think if it is under a certain amount it might be able to become stable - any info on this would be appreciated), (2) the likelihood that it could still become stable, (3) why it subsided, (4) and whether the growth was just fibrous or some osseointegration seemed to have occurred.

Regarding revision, will only do if have to use narcotic to survive. In which case would not have a "life" anyway - no pension, not married, most assets used to care for dying mother and to live on for years during that time --- U.S. not exactly a kind or decent country in many ways. Surgeon said revision no different than initial surgery - that is when he lost my faith. As you know, it is a complicated often terrible procedure when entire implant has to be replaced with breaking femurs to get it out, wiring, grafts etc and high failure rate afterwards).

Josephine, re groin you said you did not think it could be due to scar but I still feel like it is "restricted"when walk and when pull leg up with knee bent. Why do you not think due to scarring?

Surgeon also said knee not too bad which is completely strange. He even said to bicycle again! I still have AV in my other/right hip which I am sure cycling would hasten. I also had knee swell every time I tried to cycle in 2012 which took months to go back to normal each of the times. (In 2013, just walking caused knee to blow up worst and hunch over and limp which is first time had groin pain which led to AV diagnosis which led to this mess). My knee still hurts with each step - just has not swollen since doing hour of walking a day including walking in apt. rather than many hours of cycling, carrying stuff, many hours of walking etc.

He also said AV lesion in right hip still small and in odd place and would not do anything now. There is a brilliant Italian physician in Milan who has new procedure in which looks through arthorscope at lesion since says even MRI not always accurate in terms of haw bad is often being worse than thought and if worse does not proceed with anything but if lesion large enough goes into lesion/dead bone area and makes entire lesion bleed rather than current rather barbaric haphazard core decompression method which just sticks in a rod or two). That brilliant doctors article also includes flow chart showing what should do depending on factors like is pain in thigh static (when resting too) etc.

Mayo doctor also aid lesion in right hip looked similar - which made me sadly feel maybe pain in groin was due to knee being severely swollen being hunched over, limping and listing and that maybe have had AV for years and only got inflammed due to knee and might have stopped hurting if stopped doing PT in pool and rested for a month once knee swelling completely gone - that having THR was unecessary. Also NONE of doctors ever mentioned ice devices which could wrap around knee and used compression which might have eliminated knee swelling quickly when it happened. Ugh! But can't go backwards and get joint back BUT need info about subsiding and PT and walking a lot good or bad under circumstances.

That Milan doctor emailed me back and said if could not see him to see Dr. Buly at HSS - how can I go back to place initial surgeon is? Is it possible Dr. Buly would be fair despite your saying can't go to doctor who would know my initial surgeon? I am only trying to figure out what to do, get my questions answered and have a well thought out plan. Is it possible the initial surgeon will want to really do a differential diagnosis now since he might want to hold up his oath and "do no harm" an cares about his patients who are failures?

Thank you Josephine an anyone else with info.

 

[Jamie]

Maxwell, I can see you are really worried about all of this and I'm sorry about that.

I don't see any problem if you want to talk to a different doctor at HHS. These doctors are big boys and his feelings (and those of your original surgeon's) won't be hurt by you doing that. The only risk is that the second doctor might not change the original surgeon's opinions/diagnosis. But, frankly, what have you got to lose by talking with him? Nothing that I can see as long as you're aware that he may not be much help.

One thing that stood out in your post was this comment:

Surgeon said revision no different than initial surgery - that is when he lost my faith. As you know, it is a complicated often terrible procedure when entire implant has to be replaced with breaking femurs to get it out, wiring, grafts etc and high failure rate afterwards).

I'm not sure where you have received this information regarding a hip revision (certainly not here on BoneSmart!), but it is way, way off base. Your surgeon is correct that a revision is only slightly more difficult for you as the patient than a primary hip replacement. The implant is removed, but the femur is not broken to get it out. Grafts and wiring are not the norm. And there is NOT a high failure rate!

If you have sources for what you've said, I would really appreciate you posting them so that we could take a look and hopefully ease your mind about this fear. Yes, revisions can be more complex than an initial THR, but a trained revisionist is right at home doing this procedure. As long as you're not dealing with infection or bone loss, it's a pretty straightforward recovery that would be much like your original operation.

 

[Tropic Lady/Special Lady]

Maxwell,

So sorry to hear about your trip to see Mayo/Lewallen. I can see him not giving you a chance to even ask questions and not answering any of your questions. When I saw him he cut the resident off, and he did answer all my questions prior to him doing my revision… but then when this last revision failed only 5 months after he did it, his resident called me and when he told me patients can't tell when their hip is subluxing, or that it's failed I kindly let him know he better talk to Lewallen and study some more because he was completely incorrect! Lewallen was fine with me, but I could see that his bedside manner is probably not so great. I have to tell you it really didn't matter whether you walked after the injection or not, the real test is to find out if your pain let up in your hip after the Lidocane injection, I'm sure your knee hurt but if you felt any relief after the injection into your hip joint at rest, or while walking you really need to let Lewallen know… as that is what indicates the pain is coming from your hip. You may have had increased pain in your knee, but the question is how was the pain in your hip after the injection. That injection is simply a diagnostic tool to assist in figuring out if your hip is causing pain.

I totally agree with you as far as flying out to the Mayo only to find out that some residence that is far from a revision specialist is whom you ended up speaking to, and asking all your questions… Lewallen is the expert there, not the resident. He will move on in another 4 months or so to another area of orthopedics, and shadowing Lewallen is simply a small part of his residency in orthopedic care. My guess is that when Lewallen did my revision not even a year ago, he allowed the resident screw in the shell/cup and where he placed two of the screws are protruding into the muscle and a nerve… not good! He probably has the resident open, and he places the cup, etc, then allows the resident to do a lot of the work, after all that's how they learn… but in my case it didn't turn out well and I really believe that's part of the problems I'm dealing with now. I'd say get an appt, with the Docs in NY or get yourself up to see Dr. Maale… you can get into see him within one week of calling. They will work you in if you want him to take a look at all your reports, and do a physical exam…but if you do plan on staying for a week so that if he wants to order bone scans, or CT scans, etc. you can have them done while your there, he prefers you have them done there, as he knows their equipment at the Baylor Reg. Hospital, and simply said it's not that he doesn't trust other facilities to do them or their expertise, he just knows all there. Keep us updated, and I sincerely hope you get all your questions answered.

 

[Tropic Lady/Special Lady]

PS. I have to agree with @Jamie because I've had several revisions and not once did they break my femur, and the reasons for my failed revisions has more to do with the broken greater trochanter the bone structure changes after the very first sugary, and multiple recalled implant parts, that have, and are causing big problems.

 

[maxwellmedical]

First thank you all for your continued support. I would like continued input from all of you including Tropical Lady and Jamie - would appreciate Jamie your tagging Josephine if not doing correctly by doing the following @Josephine. I know Josephine, you thought was too soon but now sorry did not see doctor 3 months after surgery when I knew something wrong. Surgeon I went to here after five months just to see if anything wrong while waiting for m Mayo appointment was surprised I waited so long. Do not know why surgeon who did LTHR did not tell me had subsided if could be seen at 6 week check on single x-ray done then. Surgeon who did surgery would not do full normal set of x-rays at 6 week check --- really upset about it now if NOT able to see it on the "special" single standing x-ray taken but could have seen it on normal set of x-rays. I think Mayo surgeon I just saw said he could see it on the 6 week special x-ray taken by surgeon at HSS. IF have to have revision would not be as awful if had done it months ago since from what all of you said it is not as big a deal a I thought unless have infection(there was no fluid to aspirate so doctor who did that said very unlikely have infection - don't know if should believe). Scary revisions were mostly if had infection since often two part with use of spacers and need antibiotics for months maybe for life which would destroy my stomach - trust me. However would wind up bankrupt - would have to wait at least 6 weeks for surgery and then another many months of recovery. and who knows when my left hip with osteonecrosis will proceed rapidly. DISASTER for me. Notice lots of women on your site teachers who have summers off, time off after surgery, and just have to get to school and around school.

SO here are the questions:(1) Is subsiding same thing as loosing? I believe Mayo surgeon like local surgeon said partly or all bone growth into both my pressed cup and pourous cementless stem in implant is fibrous growth rather than regular bone. I read elsewhere on your site that there is a danger to waiting too long that micromotion can damage bones (and maybe muscles or ligaments?) - is this for subsiding as well as loosening if they are different things?

(2) Does anyone know if implant that has subsided if can stabilize and not drop more? Read some research saying could especially if only subsided certain amount and stopped. Anyone using Bonesmart have had subsiding soon after surgery? If so, did any of you have it stabilize?

(3) Couldn't groin feeling of tightness/pain be unrelated to subsiding? And thigh pain also be unrelated to subsiding and be due to muscle weakness/tendonitis not micromotion - thunderbolt pain in thigh now just aching/pain after walking for a little while.

(4) Can't have three surgeries in the next year (right hip if osteonecrosis speeds up and ball collapses, knee if worsens although now think will live with pain and wait for stem cells).

(5) Surgeon insisted cement not used much anymore (maybe just at HSS) - two years ago was still very active so maybe did for that reason. How much different is it if have cement (less ROM?)

(6) Lastest Mayo doctor said to do PT - could cup and stem move down faster due to PT?

(7) Could it interfere with any further bone growth into implant, or is it true that after 6 months no one gets more bone growth into implant?

 

[maxwellmedical]

PLEASE NOTE ADDITIONAL QUESTIONs TO ONEs IN OTHER POST I MADE AN HOUR AGO! Josephine you said if have loosening ask WHY!!! (1) Don't know if subiding and loosening the same but will ask the question if have subsiding quickly after surgery (within first two months) was it due to something being done wrong during surgery!!! I have not seen any other explanation anywhere. Groin hurt starting a week after surgery and thunderbolts in thigh after only a month or so after surgery. Would go back to surgeon who did surgery at HSS since hate not trusting doctors anymore but if likely cause surgeon error, he would not be likely to tell me! (2) It was computer navigated so could that be what caused it? Nothing said in operating report about any problem but maybe did not say anything. Don't know if lawsuits related to Mako and subsiding - Fed Gov't website on errors showed lots of computer navigated problems including software problems and Mako has failed to report things reported to them and now company sold. (3) I had the cross ploy Smith and Nephew - surgery report mentioned something being "locked" - hope not stem and neck since Australia report said that kind had significantly higher problem.

 

[maxwellmedical]

The replies said no difference wih revision surgery - finally found what sacred me - HSS by well regarded ortho there about "regular" revision THR not due to infection that scared me (after the info about the two part surgery if infection found). https://www.hss.edu/conditions_revision-total-hip-replacement-overview.asp

 

[Poppet]

So sorry to hear you are having these issues @maxwellmedical - scary time for you I am sure - thinking of you

 

[Josephine]

First @Josephine, I am sure you did not mean to criticize me when you said you can go from surgeon to surgeon and not get an answer, but if felt like you were saying I should just give up.

Absolutely not! No way! Never give up trying to get answers.

Josephine if I posted x-ray at surgery, 6 week x-ray and latest x-ray would you look at them to see what you think about the implant having subsided (it has)? I don't know how to get my name off of them which I think they usually are included.

I'll sort that out if you post them.

Surgeon just told me to get PT and use a topical anti-inflammation creme since hard time with internally taken version.

Even topical anti-inflams get to the stomach and I am very surprised that your surgeon suggested this.

He did not order ultrasound which might have shown scarring? impingement?

Not necessarily. MRI is better.

Appreciate help here - if have ANY answers I had hoped for about subsiding please share.

Is subsiding same thing as loosing?

Sorry I never answered you sooner. My Bad! "Subsiding" is actually a situation where the stem may sink down in the femoral shaft as the patient bears weight on it. Generally this isn't a bad thing as it's impacting the stem tighter into the bone. Loosening or micro-movement is when the stem is not a tight fit in the bone and can move slightly from side to side. This can be at the bottom tip with the mid-stem still held fairly firmly in the bone. But this means that when weight is put on the ball at the top, the bottom of the stem can toggle back and forth causing pain and eventually remodelling of the bone where the tip is knocking against it. Eventually this can even cause the bone to break out. You can see the remodelling in this xray

As you know, it is a complicated often terrible procedure when entire implant has to be replaced with breaking femurs to get it out, wiring, grafts etc and high failure rate afterwards).

Under certain circumstances this can be the case but usually when the patient has had a complicated replacement to begin with. From what you've said thus far, your replacement wasn't complicated.

Josephine, re groin you said you did not think it could be due to scar but I still feel like it is "restricted"when walk and when pull leg up with knee bent. Why do you not think due to scarring?

Scar tissue doesn't usually occur in a hip and these kinds of problems are therefore more likely to be caused by tendinitis.

Surgeon also said knee not too bad which is completely strange. He even said to bicycle again! I still have AV in my other/right hip which I am sure cycling would hasten.

Cycling won't endanger your other hip. High impact activities like jogging will though.

There is a brilliant Italian physician in Milan who has new procedure in which looks through arthorscope at lesion since says even MRI not always accurate in terms of haw bad is often being worse than thought and if worse does not proceed with anything but if lesion large enough goes into lesion/dead bone area and makes entire lesion bleed

That is an extremely old technique. I remember assisting at many of those as a young nurse back in the 60-80s! They were also remarkably effective. However, we usually did them on teenagers and young adults who were still in the bone growth mode. At your age I would question the chance of success.

Milan doctor emailed me back and said if could not see him to see Dr. Buly at HSS - how can I go back to place initial surgeon is? Is it possible Dr. Buly would be fair despite your saying can't go to doctor who would know my initial surgeon?

You can only try! But it's a big unit so quite possibly, the doctors aren't as close knit a community as in smaller hospitals.

I know Josephine, you thought was too soon but now sorry did not see doctor 3 months after surgery when I knew something wrong.

Yes I did because at 3 months there is still a lot of post-op pain in the picture.

local surgeon said partly or all bone growth into both my pressed cup and porous cementless stem in implant is fibrous growth rather than regular bone

That's not entirely true! Bone goes through various stages before it becomes mature bone but those stages should be mostly expired by around 3-4 months out.

And thigh pain also be unrelated to subsiding and be due to muscle weakness/tendonitis not micromotion - thunderbolt pain in thigh now just aching/pain after walking for a little while.

Surgeon insisted cement not used much any more (maybe just at HSS) - two years ago was still very active so maybe did for that reason. How much different is it if have cement (less ROM?)

No difference to ROM at all. But he is dead wrong about it not being used any more. Data from the National Joint Registries have shown that not only is it used in about 65% of cases but it has much better stats for longevity. In fact, for those reasons it is recommended as having better outcomes and being more financially sensible!

Could it interfere with any further bone growth into implant, or is it true that after 6 months no one gets more bone growth into implant?

This is true because bone healing is complete after about 3-4 months. But there are reasons where the process of bone growth might be interrupted at any time due to, for example, movement (not all kinds of movement though!) or infection.

Latest Mayo doctor said to do PT - could cup and stem move down faster due to PT?

In theory you could say so but actually the opposite is true. Loading (weight bearing) actually increases bone growth and density. Obese people often have ridiculously dense bone!

was it due to something being done wrong during surgery!!! if likely cause surgeon error, he would not be likely to tell me!

Well no - it's been my sad observation on here that surgeons rarely tend to 'fess up to such things!

It was computer navigated so could that be what caused it?

Wouldn't have thought so.

surgery report mentioned something being "locked"

This could mean one of several things. Can you tell me the actual phrasing he used?

finally found what scared me - HSS by well regarded ortho there about "regular" revision THR

That article includes a huge range of reasons for a revision and the comments regarding it are quite muddled up at the end. I think it's not a good article for you to have read - somewhat misleading.

Groin hurt starting a week after surgery and thunderbolts in thigh after only a month or so after surgery.

This comment has me thinking ... both those were within the post-op pain period. So I am left wondering how you managed your pain meds in that period?


1. what pain medications were you prescribed, how much did you take (in mg please) and how often?

2. what was your activity level in the first few weeks? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

6. what kind of PT/exercises were you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

 

[maxwellmedical]

@Jamie @Josephine. ALL members help please. I think Josephine still OK to tag you - please let me know if not. I think I did it correctly this time as Poppet explained it in past. I welcome thoughts on revision orthos in South FL - ones good experiences and ones bad experiences (although one of your members loved the ortho who did my original left THR which has had bad result).

Although one kind member has given me suggestions for Florida revision specialists, I checked your clinic tab and just a long list of ortho groups for area. Perhaps I am missing something but it appears you do not have a list of revision specialists. So many of the orthos claim to do revisions although baloney. Although you have said revision not big deal if primary was not complicated, the first ortho saw here (who was suggested to another member and my hand surgeon here also suggested) talked about trying his best although not primary so harder and would wash out and hope no infection -- he is supposed to be known for revisions but did not even suggest doing test to draw out fluid to see if infection shows - why wouldn't he do this if not just rushing me into revision prematurely? Jamie kindly gave me a list of revision orthos in South but perhaps you could suggest ones for South Florida and if you think they are as good as ones in Boston, Philly, and NYC. A kind member who I have been privately communicating with gave me a few recommendations but like to see who you think highly of - she went to see the TX one that is highly recommended on this site but he recently had back surgery and she thought he seemed to be unfocused (according to her). I am also VERY afraid of getting an infection in the joint and just MRSA and C-diff in general in hospital - its part of why went to HSS in the first place although that has led to a "disaster" in probable need for revision. Since now will likely need revision in left hip and primary in right in near future, it would be nice to use one surgeon. thanks you for your continuing help.

Last time wrote on this thread, my right hip with osteonecrosis was asypmtomatic. Wish could say things better. Worst fear has come true and unoperated right hip now hurts a lot (inner thigh, bottom buttocks, outside thigh and thigh) which started two months ago. At first intermittent so just hoped temporary but not the case. Had hoped would at least get another year with it being asymptomatic waiting to see what happened in problem left hip in which THR done 7 months ago. MRI confirmed osteonecrosis progressing in right hip.

Hoped for a year so could see if in 6 months left THR stem stabilized although only fibrous growth as of 6 months after surgery (and doctor said after 6 months bone won't grow into implant). Even if did stabilize not great but better than needing revision which second doctor said need and third said thinks loosening but wait six more months. Would still have had to try and find out why groin in left operated hip hurt since no explanation found - would still have seen another ortho to see if could figure out why groin hurts. I was still hoping too optimistically that despite stem subsiding abnormal amount (1cm) both orthos thinking probably stem loosening, that stem might stabilize without tip having risky micro motion - maybe whole stem would wedge in enough including tip. QUESTIONS - Don't you think 1 cm drop in stem would force cup down too? And if not, could this be somehow contributing to pain in groin? Wouldn't ball be "pulled" on or not move correctly in cup if stem dropped 1 cm? (which is way over amount considered OK for any type of stem) Ugh.

To think all I had two years ago was a knee which has significant osteoarthritis which swelled a lot and hurt with - no doctor suggested using a device like a Game Ready (compression and cold) a few hours a night when swelled which might have helped it enough for a few years. What I wouldn't give to just have that problem now.

 

[tiona]

@maxwellmedical, You may want to take a look at my thread. I'm currently weighing the pros and cons of a revision and will decide next month after i see my specialist. My issue is chronic and severe tendinitis due to the psoas tendon sitting directly on top of my implant. This can be easily visualized on CT. MRI is not indicated because the implant causes too much artifact, making the structures impossible to see clearly.

 

[Josephine]

Hi Max, sorry I've not got back to you. I've been away on a conference all week.

both orthos thinking probably stem loosening, that stem might stabilize without tip having risky micro motion - maybe whole stem would wedge in enough including tip.

Highly unlikely, especially since you hip is so many months ago. It's loose.

Don't you think 1 cm drop in stem would force cup down too? Wouldn't ball be "pulled" on or not move correctly in cup if stem dropped 1 cm?

I'm sorry but I have NO idea what you are meaning by this.

 

[maxwellmedical]

@tiona - how do I find your thread? Sorry for my delay in responding. I am interested in reading it if you can tell me how to find it.

@Josephine sorry for not being clear. Is man-made stem (press fit impacted in) attached to man-made femoral neck? And is neck attached to femoral head/ball ? And does new man-made femoral head/ball move "freely" in liner in man-made acetabular cup (which has also been impacted in near bone)? Something mentioned a "spacer" - is that the liner?

Josephine, I was thinking since all doctors agree stem has subsided/dropped in femur an abnormal amount of 1CM which has probably has led to loosening and cup has not subsided or maybe only small amount, then maybe area in which femoral head moving around when walk is bigger than should be and maybe fact moving in space larger than should be is that is what is causing groin pain. Especially since biggish man-made femoral head/ball was used.

One of two doctors saw for second opinions thought maybe cup is loosening too. Other one said not sure if cup also loosening but loosing could not account for all the groin pain but no effort to figure out why. No doctor seems to be willing to find out what is causing groin pain - read articles on various things that could be causing it. I will see physiatrist specializing in hips hoping he will be more interested in figuring out why groin hurts. But have to wait three weeks to see him.

My delay is dealing emotionally with confirmation from MRI that osteonecrosis in right hip is progressing. Groin, lower buttocks, and some thigh pain on right side started two months ago. At first came and went - now with each step. Pain progressed. Had tried to be optimistic (or just fooling myself) and hoped maybe pain just be bursitis or tendonitis since problem in left operated hip was causing me to rely on right leg more. I have been leaning forward a bit when walking since pain in groin worst in left operated leg when stepping forward with right leg and and left leg goes back -- when that leg is fully back it "opens" groin all the way which makes it hurt the most (groin pain with each step and now sometimes when sitting) - MAYBE this is clue as to what is causing groin pain.

So now will have to have right primary THR before can do anything about left hip which will probably need revision (unlike osteoarthritis, osteonecrosis progresses fairly rapidly after ball begins flattening).

Problem is neither doctor really sure about what caused abnormal subsidiing (or unwilling to say) and neither sure what is is causing groin pain (one said maybe cup loosening, other aid subsiding/loosening can't account for all groin pain)

So TERRIFIED that after they do the right THR I will have the same pain in right groin as I have in the left groin eigth months after the left THR (due to something they haven't figured out) AND will right stem will subside an abnormal amount just like it did after the left THR - and this will lead to my needing revision after the right THR just like left hip probably needs.

And TERRIFIED that after doing the right THR when doctor goes back a few months later to do revision to left original THR, will need a second revision because stem will subside after revision and groin will hurt again after revision since haven't figured out (or admitted) what has caused rapid abnormal subsiding or groin pain in the first place. If I showed you the letter in which the well known revision surgeon describes it as "salvage" surgery with a less likely great outcome, often need for transfusion, sometimes fracture and sometimes need for use of cadaver bone which may have diseases (aids? hepatitis?) since it is only washed off, you would clearly know why I have been delaying revision. Doctor from Mayo Clinic says does not know why people make such a big deal about revision BUT his letter about it was similar to the first doctor's letter.

Also not sure if doing anterior vs. lateral/posterior would be better for me. So now waiting for doctor appointments. Don't know if do posterior lateral again but uses cement would make it less likely to subside. Don't know if anterior method is less or more likely to cause subsiding of stem since stem would be shorter - I believe they use a shorter stem. Don't know if can cement shorter stem and if can cement shorter stem and if it makes any difference in preventing subsiding. Mayo doctor did not try to diagnose -- he actually backpeddled and discussion regarding cause of pain.

Any and all thought appreciated.

 

[Josephine]

And is neck attached to femoral head/ball ?

It is attached to the trunion or taper and is stationary there.

And does new man-made femoral head/ball move "freely" in liner in man-made acetabular cup (which has also been impacted in near bone)? Something mentioned a "spacer" - is that the liner?

Yes the ball moves freely in the plastic liner but the liner does not move within the shell which is secured to the bone.

all doctors agree stem has subsided/dropped in femur an abnormal amount of 1CM which has probably has led to loosening

The subsidence of the stem would be the result of the loosening, not the cause of it.

One of two doctors saw for second opinions thought maybe cup is loosening too.

Quite possibly but not inevitably

Problem is neither doctor really sure about what caused abnormal subsiding (or unwilling to say) and neither sure what is is causing groin pain (one said maybe cup loosening, other aid subsiding/loosening can't account for all groin pain)

If the cup is loose, you will get groin pain. But nobody really knows why some prostheses fail to remain secure and others don't.

So TERRIFIED that after they do the right THR I will have the same pain in right groin as I have in the left

Highly unlikely.

If I showed you the letter in which the well known revision surgeon describes it as "salvage" surgery with a less likely great outcome, often need for transfusion, sometimes fracture and sometimes need for use of cadaver bone which may have diseases (aids? hepatitis?) since it is only washed off, you would clearly know why I have been delaying revision.

That's really just a "worst case scenario" kind of statement. But facts are that a revision is a salvage operation of sorts but don't read too much into that. It's just words. And revisions do have good outcomes, many more than have poor outcomes. It mostly depends upon the surgeon.

Transfusions aren't always necessary. The kind of revision this would be, on a scale of 1-10, would be about a 1 or a 2 in terms of risk. It's just a loosening so technically not very demanding. Again, it depends upon the surgeon.

Also the question of donated bone - this has been sued successfully for years with no problems. It's not "only washed off" but held in quarantine for some weeks while it is tested intensely for all manner of bugs including BSE!

Also not sure if doing anterior vs. lateral/posterior would be better for me.

The question of approach is entirely the surgeon's choice. He knows what he can work best with. It's a question of "this is best in my hands". He can only speak for himself.

Don't know if can cement shorter stem and if can cement shorter stem and if it makes any difference in preventing subsiding.

Most shorter stems I know of are uncemented types. If you are having a revision because of a loosening, I know of no surgeon who would be foolish enough to attempt to put in another uncemented implant. It has to be cemented and therefore it has to be a standard type stem. Anything else would be irresponsible.