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

Josephine

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I do not want to live with a loose prosthesis and the pain that goes with it.
You could no more live with a loose stem than you could a fractured bone!
So, is anyone familiar with metal sensitivities or allergies? I have never been tested but, I will be getting tested this week. It may be the answer to why both prostheses never achieved complete ingrowth.
This is not the cause of a failed embedded implant. Mostly it's because the site has not been properly prepared at the time of surgery. Read this Cemented and uncemented hips for more detail.
I often had reactions to necklaces or bracelets that were not pure gold, silver, or platinum. If I wore them for extended amount of time, I’d often end up getting a rash in the area touched by the metal.
reactions to cheap jewelry do not necessarily show a metal allergy.
Then I remembered. back in 2009 I got a small red tattoo above my inner ankle. From day one, it itched like crazy.
Some of the inks used in tattooing have metal bases.
 

Debru4

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If you have the option to have some allergy testing to metals, that would probably be good, and would reassure you as well. I have a diagnosed nickel allergy and it has caused problems for me in the past. Before my hip replacement took place, this was something the surgeon followed up on with the company that made the implant, just to confirm that nickel was not part of the alloy. Your situation sounds so complex--kudos to you for remaining so positive and forward thinking!
 
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prairienut

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Back in January, you asked who my revision surgeon was at HSS. It was Dr. Bradford Waddell. He is a young surgeon in his late 30s but skilled and doing a high percentage of revisions. The recovery
from the revision was easier than the primary THR. I had aseptic loosening of the femoral stem after 10 years. Most likely cause: bad luck. Second most likely cause (a remote second): too small a femoral component.
 
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Debru4

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@prairienut ---I appreciate your perspective---
Most likely cause: bad luck.
This comment really resonated with me. I think we all can try to be smart about the things we do when picking a surgeon, preparing for surgery, and recovering. But even then, how difficult, or how easy our recovery is has a lot to do with luck. As do issues that later develop. I think our natural tendency is to want to take all the credit for doing well, which often sets others up when they have issues, into thinking they did something wrong, when in fact, as you said, it may have been plain old "bad luck". (Not saying there never are other reasons related to the quality of the medical care and decisions that were made. Those situations are heartbreaking to hear about. )
 

Leahdp

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@AMR1879
I saw your title and it peaked my interest since I am 13 weeks post op and still in pain. I had a cementless post also and at least my Dr said I am having end if stem pain. He said usually by a year the pain goes away. Unfortunately Josephine looked at my x-ray and said the stem is loose and and this point it will not heal correctly. I am heartbroken. Others suggested a second opinion but I am waiting till my May apt and will discuss this all with my surgeon. After reading your saga and the procedures for a revision I am worried about how long my stem already is and can't imagine a longer one. I am hoping this is the one time Josephine is wrong but not betting on it. My pain is not nearly as bad as yours but I never went off my pain meds so it may be worse without them. My heart goes out to you and I am sending healing thoughts.
 
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AMR1879

AMR1879

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My metal sensitivity test came back positive to nickel. This may be the best news I have gotten in a very long time. All my bloodwork ruled out any autoimmune disorders like Lupus or Rheumatoid Arthritis (thank goodness), but my sed rate and c reactive protein are still elevated, so there is something my body is reacting to and trying to get ride of; so learning I am indeed hypersensitive to nickel, gives a good reason why my hip is just not settling in for the long haul.

This is not the cause of a failed embedded implant. Mostly it's because the site has not been properly prepared at the time of surgery. Read this Cemented and uncemented hips for more detail.
I believe, my revision was set up for failure and this is bc of two things, failure to properly prepare the site, and my body reacting to the nickel in the heavily coated stem, basically treating it like a forgin body.


I am hoping this is the one time Josephine is wrong but not betting on it.
Yeah, I wouldn’t bet on it either... :bawl:Josephine was the only one who said pretty confidently that my first hip was loose. Good luck with your appointment in May. Just a little tip (you may already thought of already) bc there are a number of diagnostics (bloodwork, bone scans, MRIs, hip aspiration, etc that your Dr could order up between now and your May recheck so that you go into the appointment informed and hopefully able to make a concrete plan. This would be much more time efficient approach so you get fixed ASAP. Not to mention and I’m sure you’re well aware, (especially since you are on Bonesmart) that infection is the most important thing to rule out....it all depends on what the diagnostics show—obviously!
 

Debru4

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AMR1879--As someone with a diagnosed nickel allergy I have been surprised at times by how many things contain nickel. Years ago I cut my leg shaving and ended up with a severe reaction. Another time I got a small scratch on my back from a little piece of metal when I got something out of the back of a pick up, and the same thing happened. If there is a tiny bit of nickel in jewelry, I instantly react.

It is really challenging, but as you said, a far better diagnosis than RA or Lupus, as it can typically be managed. So do you know for certain your implant contains metal? I'm glad you feel relief at having more information. I know I would.
 

Mojo333

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@AMR1879 :hi:
I'm so glad they ruled out the bad stuff...and you feel as if you are getting some answers!
I will be glad to know when they feel they can safely get this sorted. Any idea when?
Will be thinking of you:loveshwr:
 
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AMR1879

AMR1879

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So do you know for certain your implant contains metal?
Both my first hip and now this hip are fully coated, cobalt chromium hips which also contain nickel. I gave the sticker sheet from both op reports showing the exact components used, so I was able to look it up.

@Mojo333 I am currently researching surgeons in Manhattan who are familiar with metal sensitivity in their hip patients. I was told by the surgeon from the Rothman Institute in Philadelphia to wait as long as I can bc the surgery comes with a lot higher risk of picking up an infection or one of the other million complications that could be the result of a revision of a revision. I’ll keep you posted!
 

Mojo333

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Please do!
Meanwhile, do eat well..
Keep that immune system cranking and no falling down and going boom!:no-fin:

We are rooting for you!:angel:
 

Layla

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Hi @AMR1879
Wishing you luck in your search and only good things to come as you move forward.
We'll be here rooting for you. Please keep us posted.
I hope you have a nice week!
 

Hippielife

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AMR1879... Hello, like your pic... you look very happy. Nice to see another happy face. Even with complications a little sunshine helps and knowing they can be worked out, and by becoming your own self advocate.
In my experience with my last implant there was metal fretting from movement which can cause micro bits of metal fretting into blood and areas around the implant. Ask for a heavy metal blood test and urine metal test. Or a sample of tissue can taken from around the implant for testing. Due to high levels of cr and cobalt revision helped. It was a bit high before my revision. Since revision the levels are back down.
It’s a start to understanding the metal issue you may have. Do you have information on the type and manufacture of your implant? I am curious too. This may also help with more info. Your tag from the implant from surgery report will help identify make and model.
Every once in awhile this situation shows up and with revision the symptoms can be greatly improved . This is a Huge blimp in thr Surgeries and it can be corrected with the correct implant, surgeon and a rehab program designed for you. I had rehab 3 days after revision and took it very slow and in 6 months I was doing well . Best wishes to you.
 

Lyndam

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@AMR1879, Hi, so pleased you have a cause for all your trouble, it's been a long road for you.
I have a similar problem in that I may be looking at a revision of a revision, and my surgeon has previously said he's not going back in there, so I've been thinking, if you had a lateral/posterior previously is it an option to revise anteriorally, and vice versa? This is my thought for myself so I thought I'd share it with you. I'm no expert, but I am under the impression that it is the incision and compromised skin in the area that can be the problem for the increased risks of infection and healing, so if they change the site and method does the 3rd or 4th op carry the same risks as the first op?
Just thought I would share that in case it is of any help, maybe you have already investigated that option and have an answer you can share with me. You will have a lot more surgeons to choose from than we do here, especially the anterior types, anterior is not that big here, if I need it I won't have more than 2-4 to choose from in Auckland.
Best of luck, :).
 

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Hi @AMR1879 , just popped in tonight to see how some of our class was doing. Sorry you're still struggling, I admire your perseverance, you must be so frustrated. I wish you the best of luck getting an accurate diagnosis and treatment soon.

As an aside, I get my metals tested annually for peace of mind, eg., metal debris at the trunnion site.
 
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AMR1879

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UPDATE!!! Almost 1 year later! So my thigh pain has continued to burden me..... I discovered I have a nickel allergy, and now an X-ray taken today shows the revision hip is in-fact loosening.....
@Josephine ive attached my latest
X-ray and would appreciate your input! Has anyone had a gold plated hip?? My surgeon was thinking a cemented stem may (unfortunately) be my best bet...
 

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FCBayern

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I can't add anything to help you @AMR1879 but I can tell you Josephine has retired from the site. I'm sure some of the Moderators will be along soon to help.
 

Jaycey

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@AMR1879 Sorry you are still dealing with the same issues Jo commented on in March. Tough time to need another revision but hopefully things will ease and you can get this scheduled.

We have several members who have metal allergies and their surgeons were able to locate implants that worked. Have you discussed this with your surgeon? You might want to get a second opinion from a revision specialist.
 

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