Revision THR 8wks post op - more pain than before<<

[GrannyC]

I am really at a loss for the right words as I’m sure nothing much will be very comforting at this point. I have been following your thread since I signed up on BS last spring before my surgery. It does appear that your new surgeon is at least listening to you and checking into all aspects of this. As devastating as it may seem now, I feel that they will get this all figured out and this will get resolved. You need to try and stay positive for your children as well as for yourself. Even though you can’t do physical things with them and play outside, you can spend lots of quality time with them inside. Most children enjoy playing games or even stirring up a batch of brownies from a box. They make a mess at times but they enjoy it and it makes special times together that don’t involve physical activity on your part. With the weather getting worse (raining today where I am in NY), it makes it easier to think of inside things to do.

Tomorrow is thanksgiving and I am sure you still have a lot to be thankful for despite all these setbacks. Happy Thanksgiving! Sending positive healing thoughts your way!!

@AMR1879 I should also add this. All these things are easy for me to say because I’m not in your shoes. However, it is meant to give a different viewpoint I think you could say and to try to point to some positives during this rough time. You sound like one tough lady so I am certain you will make it through all this and things will be better!

 

[Marvy]

@AMR1879 I am so sorry you are having to deal with all of this. But, you now have a diagnosis and a plan of treatment. At least it sounds as if there will not be another surgery needed.

I can honestly say that I know how you feel when you say you "feel defeated and a complete loss for words" as I am in a very similar situation.

But, keep your chin up - we will get through this You have everyone here rooting for you!

Sending happy thoughts to you...

 

[AMR1879]

@GrannyC thank you so much for your support. I appreciate you taking the time to send me some words of encouragement.

You’re right, I can find plenty of fun things to do with my kids that doesn’t involve me running around. I just get angry to think I still have to be laid up! My 4 year old asks me way too often if my hip is better yet, he also tells complete strangers that “mommy has a new bad hip.” Which is often followed by a comment from the stranger about how I am too young to have had a THR. I chuckle to myself thinking, “if they only knew the full story behind my ‘new bad hip’!”

Unfortunately surgery hasn’t been pushed off the table, it has just been pushed to the side until we see if rest will heal my femur. I am not sure if my experiences have jaded me or if my gut is right but I just don’t feel rest is going to make it all better. It may help with slowing the progression of the stress fracture and the pain but it isn’t addressing the source or cause of why the stem is pressing against the bone and creating the fracture.

I know the type of hip used for the revision and AML colbalt chronium stem is a harder material and can have some issues with it pressing on the bone causing 1 out of 5 to go through some modeling (which to me is not as severe as stress fracturing) with pain ceasing at around 6 months post surgery. We shall see!

@Marvy, I just read through your whole thread. Did you have the bone scan? I remember you mentioning it towards the end of your thread, but I don’t remember if you mentioned the results (and I’m afraid to go back right now and lose this post!). I feel for you, mentally and physically! You are dealing with different challenges but they are also so very, very similar.

We both are dealing with constant pain, and just that is so mentally draining, let alone not knowing the actual source. I cannot express enough to you to listen to what your body is telling you...I had to be my own advocate and there were many times I had to stand up for myself even when I was being told by experienced medical professionals that my (first) hip looked “text book” perfect. I started bringing a close family member with me just to be sure I wasn’t mishearing things.

I started to believe that I was going crazy or that it was my fault my pain was increasing because I was taking narcotic pain meds - can you believe I was told that it wouldn’t be long that just a strong burst of air on my skin was going to hurt, I kid you not!

I did my research and I read about the super sensitivity the PA was referring to but my situation was NOTHING like what it would have to be to reach that point. It was just a scare tactic which is totally unprofessional and should be considered malpractice, in my opinion.

Unfortunately there were other Drs and medical professionals who tried to scare me by giving gory details of procedures or hinting at the cause of my pain being my own fault. Be aware of these “strategies” and don’t let them get into your head. Stay focused on being your own advocate like you are now and you will get to the bottom of this!

I wish I could offer advice on who to turn to in regards to diagnosing soft tissue vs bone ... this was a challenge I was facing up until the bone scan showed an obvious issue with my femur. I was so certain my pain source was a quad muscle, but unfortunately I was wrong.

Another thing I stopped assuming, “they must have seen this before!” Not true! But you will not find many doctors who will admit it and they will continue to treat you as if it is something they have seen and not a new complication that needs a new diagnostic and treatment approach - that is just too much work for them! (Sense my sarcasm?!).

Please keep updating your posts! I hope you find your answers and relief soon!

 

[Marvy]

@AMR1879 Unfortunately you are so right in that we have to be our own advocate and fight for what we think is right. My bone scan is Monday afternoon. Even though I don't want anything to be wrong, I hope it shows "something". All I keep hearing from the doctors are "people would love to have a hip that looks like this". Umm...if they only knew the pain that is associated with this so-called "perfect" hip they would think differently. My original OS is totally out of the picture. His last words to me were that "I was demanding". For what? Wanting to know what is wrong with my hip? Wanting to get back to an active life?

Revision OS #2 is taking a "wait and see" approach after the psoas injection. I am not convinced that OS#1 is correct about the screws (which is what Josephine had said as well).

I keep thinking that there is a stem issue as I have alot of thigh pain-pretty much constant. Revisionist #1 said that the type of stem I have is "supposed" to flex at the tip (I cannot find anything to verify this) so that is why the x-ray looks as if the stem is loose at the tip. I keep asking if my body just can't handle this "flexion" going on, but all I get are blank stares...

 

[Josephine]

Can a stress fracture still fall under the "modeling" umbrella? Or does it jump into a classification of its own once it turns into a stress fracture?

Modelling can and will turn into a fracture if it breaks through the bone. Look at this xray

It rather depends upon where he thinks this fracture is. I'd not be at all surprised if it was around the trochanter.

Sadly I never kept your emails so your images are lost to me. Perhaps you could post the one I sent back with the red arrows and dots on it!

I just don’t feel rest is going to make it all better.

Most definitely it's not!

It may help with slowing the progression of the stress fracture and the pain but it isn’t addressing the source or cause of why the stem is pressing against the bone and creating the fracture.

'slowing down the stress fracture' is impossible. A stress fracture is a fracture, a broken bone and therefore a done deal.

And I did tell you a while ago that your stem was loose which is why it is 'pressing against the bone and creating the fracture'. Actually, knocking against the bone would be a better description!

some modeling which to me is not as severe as stress fracturing

Remodelling is just a stage of the beginning of a fracture. It may not be a severe pain at the start but once it starts making an impression on the bone - as in the xray above, see arrow - it will gradually get more and more painful and when it breaks through it will be just as painful as if you had fallen down the stairs and broken your leg.


So you have two issues here which are pretty much the intertwined - the fractured bone and the loose stem. I'm very much afraid that neither of these can be fixed without a revision.

 

[AMR1879]

It rather depends upon where he thinks this fracture is.

So you have two issues here which are pretty much the intertwined - the fractured bone and the loose stem. I'm very much afraid that neither of these can be fixed without a revision.

The fracture is mid thigh, exactly where you see the dark area on the bone scan.

And where you marked it on your grid a few posts back.

I think the loosening you’re referring to is before my revision, I had a loose stem that you noticed before and of my OS’s did. It took an exploratory surgery to figure it out. The stress fracture is now after my revision in June. This is an AML stem that seems to have a 1 out of 5 remodeling rate...with pain ceasing after 6 mo or so. But I have a stress fracture...according to the radiologist who read the bone scan and my Dr...

Here is the X-ray you we’re referring to with the lines and dots...

Sent from my iPhone using broken link removed: https://r.tapatalk.com/byo?rid=75543

 

[Horseshoe]

@AMR1879 sorry to hear of this development but it's good to get an answer to the source of
pain. Did the latest OS indicate how the fracture happened.. maybe during revision surgery?

Probably a question for Josephine -if you wish to tag her- but does having a fracture prevent the necessary bony in-growth into the new implant which could then cause loosening?

An xray posting tip.. I copied the image from the drs CD onto my desktop, right clicking or can do a screenshot. From there I edited it for size and then uploaded to BS.

Anyway, AMR, you are a trooper and wish you the best, I admire your persistence.

 

[Josephine]

But I have a stress fracture

Well one other possibility is that the bone was giving way from the earlier loose stem and it wasn't noticed during the revision and they replaced the stem with one of the same length which has allowed the fracture to worsen when they should have used a much longer stem which would have reinforced the fracture and prevented it from progressing. But one thing it is not is a 'stress' fracture.

 

[AMR1879]

Even though I don't want anything to be wrong, I hope it shows "something". All I keep hearing from the doctors are "people would love to have a hip that looks like this". Umm...if they only knew the pain that is associated with this so-called "perfect" hip they would think differently. My original OS is totally out of the picture. His last words to me were that "I was demanding". For what? Wanting to know what is wrong with my hip? Wanting to get back to an active life?

@Marvy I understand that feeling of wanting something "wrong" to turn up on the bone scan, blood work, x-rays, etc... Because it would give you something to go on in solving the mystery of your pain. I never thought I would be so disappointed to receive good news about normal bloodwork! I often have to remind myself to be thankful for the good reports. Keep me posted on the results of your bone scan. Ask to see the images after they do the scan and take pictures of them! If the room is set up like it is at my hospital, you can view everything right there, there isn't a separate room where the tech sits to review the images (like they do for x-rays). Remeber they are your scans! You have the right to see them. you are a paying customer, more or less. Just don't ask them their opinions on the scans, they only operate the equipment.
You should continue being "demanding" until you get some answers. Th OS's job is to be the experts and fix what is going on with your hip, sometimes it seems like their ego's get in the way. I had THREE surgeons tell me that my hip looked "picture perfect" or "textbook perfect" HA!! I sure proved them wrong when it slipped out during my revision surgery! Sometimes I feel like I got lucky with how my revision went, then I feel angry that they were so insistent it wasn't my hip....such mixed emotions. Especially now that I am having even more trouble with the new hip. We have to keep searching for the answers! Your pain is real and debilitating, and you deserve to feel better!!

Probably a question for Josephine -if you wish to tag her- but does having a fracture prevent the necessary bony in-growth into the new implant which could then cause loosening?

@Horseshoe That is a good question. @Josephine what do you think is going on here?

they should have used a much longer stem which would have reinforced the fracture and prevented it from progressing. But one thing it is not is a 'stress' fracture.

You don't think it is a stress fracture? It seems like the only answer is having the hip redone again with a longer stem? Is there something wrong with my bone? I had a DEXA scan and my bone density with normal.

 

[Josephine]

does having a fracture prevent the necessary bony in-growth into the new implant which could then cause loosening?

Horseshoe, you got that back to front. As I said previously, the reason for the fracture is because the first stem was loose and the reason it was loose is because there had not been any bony ingrowth into the stem.

 

[AMR1879]

@Josephine why didn’t I get bony ingrowth the first time? It sounds like from your reply to @Horseshoe you’re assuming I wouldn’t get ingrowth the second time either... why?
So the solution is a revision of a revision, using a longer stem and cementing it in place... right?

 

[Josephine]

why didn’t I get bony ingrowth the first time?

Who knows? Maybe because the surgeon didn't bed it into the bone properly but that's only a guess.

It sounds like from your reply to @Horseshoe you’re assuming I wouldn’t get ingrowth the second time either... why?

I never said that! But it is usual to use a cemented implant when an uncemented has previously failed.

So the solution is a revision of a revision, using a longer stem and cementing it in place.

I also never mentioned using bone cement either. What I did say needs doing it changing the stem to a longer one so it provides the fractured area with a splint so it can heal.

 

[AMR1879]

I thought I’d post a quick update. Still dealing with stress fracture. Waiting to hear back from 3 second opinion Drs. [emoji53]


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[Mojo333]

Gracious @AMR1879 .
What have been your restrictions in the meantime ? How are you feeling, besides completely anxious I'm sure!?
So sorry you are dealing with this...
Were the first two consults unfruitful, or unsatisfactory to you?
Please come here to vent or inform as there ARE people struggling as you are.
I'm guessing a revision my be eminent or are you still trying to get answers.
Piling up prayers for you.

 

[Marvy]

@AMR1879 I am sorry that you are still dealing with this issue. I hope that one of the surgeon's will give you an answer so that you can get this issue resolved and get your life back. I totally understand how frustrating this is. And, of course, nothing in the medical world happens as quick as what we would like. Or maybe I am just a very impatient person.

As Mojo333 has said, please post your ventings here as you are not alone in this journey...

 

[Horseshoe]

@AMR1879 sorry to hear this hip is still not behaving, how frustrating for you!! Hopefully third time's a charm with OS #3 .

@Marvy best wishes to you too, you have been very patient. If I understand correctly, it sounds like the screws can sometimes migrate or if placed incorrectly/wrong size, can irritate soft tissue, how painful, hope the revisionist OS can help you

 

[AMR1879]

Horseshoe, Marvy and Mojo333 Hi guys! I am so appreciative of your replies. I plan to post more details tomorrow, but just a quick one now. My revision surgeon is equally puzzled and is ALSO seeking out opinions from his coworkers, ortho surgeon friends, and he is even reaching out to the manufacturer of the hip I have in now.


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[MammaT]

Wow! I hope between all of them they figure it out @AMR1879. Sounds like you are challenging them.

 

[GrannyC]

So glad to see your update as I have thought of you often and wondered how things were going. It sounds like OS #3 is taking this very seriously and really looking into it. Hopefully he will find some good answers for you. I, too, am very sorry you have had to go through all this. It isn't supposed to be this difficult!! Hang in there though and it will get fixed. I admire your persistence!!

 

[Mojo333]

Will be praying they come up with good solutions.