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9yr old hip has loosened - revision required

Discussion in 'Hip Replacement Pre-Op Area' started by prairienut, Nov 27, 2018.

  1. prairienut

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    I am returning to Bonesmart after 9 years and looking forward to the informative and supportive community here. I am 68 and had a right THR back in April 2009. The new hip served me well until this summer when I had a few instances of instability in the joint. Then I started getting mild pain off and on.

    I had been doing light workouts in the gym twice a week and felt I was getting better and stronger but then something changed where the pain was worse and more persistent. An xray and MRI scan shows the prosthesis has loosened and I need a revision to replace at least the femoral prosthesis. I am anxious about this unexpected re-do. I have a ceramic-on-metal joint which I was hoping would serve me for the rest of my life. I have received little in the way of explanation for why the THR has loosened. "Maybe, wear and tear." "Bad luck."

    I have appointments with the local ortho practice where I had the primary THR with the surgeon who specializes in revisions. They do about 2 per week in this practice (that may include knee revisions, not sure). I also have an appointment with Dr. Brad Waddell at the Hospital for Special Surgery in NYC. If I like Waddell, I am inclined to go with him because our local hospital does not have the best rating and HSS has a top rating for orthopedics. He is a young surgeon, has been with HSS for a little over a year but already received an award as an outstanding clinician. He has done about 1200 total surgeries, including hips, knees, primary and revision. About half of those are revisions.

    Does anyone have any advice or tips for me as I navigate the pre-surgery maze of appointments and tests? I am on crutches at the moment. Not in a lot of pain but just wanting to keep full weight off of the THR leg.
     
  2. Pumpkln

    Pumpkln FORUM ADVISOR Forum Advisor

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    @prairienut ,
    Welcome back to BoneSmart!
    Were you a member of BoneSmart for your previous surgery? If so, post your former username, an administrator will merge the two user names.

    Sounds like you have some good choices for your upcoming revision. In the articles below you will want to read "Choosing a surgeon and a prosthesis" and "Pre-OP Interviews: What's involved?". Lots of good questions to ask during your appointments..

    If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:
    Score Chart: How bad is my arthritic hip?
    Choosing a surgeon and a prosthesis
    BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
    Longevity of implants and revisions: How long will my new joint last?

    If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
    Recovery Aids: A comprehensive list for hospital and home
    Recliner Chairs: Things you need to know if buying one for your recovery
    Pre-Op Interviews: What's involved?

    And if you want to picture what your life might be like with a replaced hip, take a look at the posts and threads from other BoneSmarties provided in this link:
    Stories of amazing hip recoveries
     
  3. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Hi there prairienut. Have you created a new account for yourself? If you would tell me your previous username, I can merge this new one with the old one and then I can read your previous record which would be helpful.
    That's usual because, quite simply, we generally don't know why these implants loosen so late in their 'life'. However, don't worry about it. It will be pretty much the same as the first time around, whether they take out one or both devices. Another reason why I'd like to merge your accounts, then you can read your previous posts and remember what it was like!
     
  4. prairienut

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    I believe my previous screen name was Amelia, but not sure. I've changed email servers since then and cannot check back to see what I used. I had my THR in April of 2009 at age 58.
     
  5. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    It's okay, we found it, it was GailW!

    Next question: Your accounts have to be merged because members are not allowed to have more than one account but with username do you want to keep?
     
  6. prairienut

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    OK, just use GailW but with the password I just defined for prairienut. Thanks!
     
  7. prairienut

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    I have moved up my 2nd opinion with Dr. Waddell at Hospital for Special Surgery to be Dec. 5 (a week earlier) Followup with the Dr. here in Kingston is Dec. 6. I found out the Dr. here uses Vassar Medical Center in Poughkeepsie, NY, which has a much better reputation than the local hospital in Kingston. Trouble is that for both places, surgeries are being scheduled for January now and even February. Argh! I cannot wait that long. I am getting around with two crutches putting hardly any weight on my right leg. The blood tests ordered back on Nov. 9 (yes, 3 weeks ago!) were not complete. The lab failed to do the chromium ion test and the second test for infection. Cobalt ions are at a low level and the first test for infection (I think white blood cell count) was negative. The additional test results should be available tomorrow. Let's hope there is no infection!

    I'm wondering if I should just cancel the 2nd opinion and schedule surgery immediately with Dr. Lombardo, the local guy. He does 700 surgeries a year, half on knees, half on hips. Because he is a regional focal point for hip revisions, 20% of his hip surgeries are revisions. That means about 70 revisions per year out of 350 total hip surgeries. These sound like good numbers to me, and I'm tempted to just make my decision on that basis. It will be oodles more convenient to have the surgery in Poughkeepsie rather than NYC. And if I commit to him, I can book the surgery tomorrow. I hope the scheduling takes into account the suffering of the patient. My life is basicallly on hold until I get this thing fixed. I'm getting better on the crutches, though. I also worry if I am doing additional damage to the bone during the long wait for surgery.

    Any words of wisdom are appreciated.

    Gail W.
     
  8. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @prairienut Welcome back to BoneSmart. In my experience your gut feeling about working with a surgeon is the most important aspect of the whole decision making process. Not having to wait is certainly a benefit. And having the surgery where it is convenient is definitely a plus. You will need followup care post op.
    If you are using crutches, probably not. But getting this done quickly before limping impacts other areas of your body will mean an easier recovery.

    Please keep us updated.
     
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  9. prairienut

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    Just got my complete blood work results. No indicators of infection and low chromium and cobalt ion counts. Now that is some good news! Tomorrow I see the NYC surgeon and Thursday the more local surgeon. I am still leaning towards the local surgeon so unless I learn something startling tomorrow, I will go with having surgery only 40 minutes from home rather than 2+ hours. Surgery date will be booked by the end of the week. I'm getting around OK with the crutches and in very little pain. Stay tuned!
     
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  10. Mojo333

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    :wave:I hope you are able to get some peace after appointments ...
    Time to get this recovery show on the road!:ok:
     
  11. prairienut

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    I met with Dr. Waddell today at Hospital for Special Surgery Outpatient Clinic in Stamford, CT. It was an enlightening experience, and the difference between this visit and the one at my local ortho group was like night and day. I liked the place and the staff, liked the thoroughness of the radiology they did, liked that Dr. W, even though a young doctor, does twice the rate of hip revisions as Dr. L., liked his explanation of the possible causes of the loosening, liked the details he offered about what he would do and why, and finally liked that there is a full day of a very detailed workup done at HSS two weeks prior to surgery including a needle aspiration to ensure there is no "hidden" infection. Thus, I've decided to go to HSS for the revision. Both my brain and my gut are comfortable with this decision.

    The biggest surprise is that the most likely cause for the loosening is that the femoral implant used 9 years ago was TOO SMALL. On his computer screen, he showed me how he would size an implant for my unoperated leg, then he drug that image over to the right leg, flipped it, and lined it up with the implant I have. Quite a size difference! He also observed that my operated side is about 1-1/2 cm shorter than the other. He says I've probably adapted to this over the 9 years, but he will consider whether to even me up during the revision. He took an x-ray of my lower back as he likes to view the joint above where he will be operating to check for problems or interactions between the hip and the back. My lower spine showed minor arthritis but I've never had any pain with it, so that looks good. He even checked my left hip which has good cartilage space and smooth, rounded femoral head (thank God). He agrees with my P/T who speculated that my right hip had a congenital anomaly which caused it to deteriorate at a faster rate than usual.

    They will try for a surgery date as early as Jan. 3, but if that doesn't pan out, it will be late January or early February. Dr. W told me that in the meantime, walking around (I'm using one or two crutches) would not increase the damage or make his job any harder. That definitely gives me some peace of mind. I'm ready for this!
     
  12. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi, While it's unfortunate you have to go through this, it sounds like you'll be well taken care of at HSS,
    with Dr Waddell. It also seems you won't have to wait long for a date. Things are looking up and moving forward. Wishing you comfort as you wait.
    @prairienut
     
  13. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    I hope your date will be sooner than later...but it sounds like there is a definite plan to get this right!
    Wishing you a good day @prarienut
     
  14. prairienut

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    HSS called. My surgery is scheduled for Jan.3 with pre-op testing on Dec. 13. I'm pleasantly surprised. The front office person said that if it couldn't be on the 3rd, it was going to be Jan. 30 or later. So pleased to know I will be on the healing side in less than a month! No time to get overly scared.

    I will be meeting with the anesthesiologist on the 13th to discuss my post-op problem I had 9 years ago where my legs were very jittery the day after surgery -- very uncomfortable to say the least. I'm hoping there is some non-drug treatment (hot or cold packs?) that can help calm my legs if needed.
     
  15. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    Yay...New Year Hip!:egypdance:
    Thank goodness not too long to wait.
    Ice was my best friend, but still remember some of that antsy "got to move them" feeling.

    Hang in through the holiday...next year will be sweet!:santaclap:
     
  16. prairienut

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    I have my pre-surgical screening appointments set up for next week at HHS. They include the usual medical screening and interview plus EOS biplanar imaging to determine the extent of my LLD (leg length discrepancy). The EOS imaging is done standing up under normal weight bearing and gives a 3D view, not as much detail as a CAT scan but with far less radiation exposure. A front-to-back 2D image and a lateral 2D image are combined to construct a 3D image using mathematical modeling. The purpose of this test is to determine how much to correct my LLD during surgery. The final screening test is the hip aspiration to detect any "hidden" infections. I am anxious but at the same time eager to have the surgery over with.
     
  17. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Wow - sounds like you are in very good hands @prairienut ! It's very important that you trust your surgeon and the team. They are certainly being very thorough! Glad you can get this done quickly.
     
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  18. Going4fun

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    Hi @prairienut, you can't be HSS for images ... The place has amazing machines ... and surgeons for that matter. Glad you found a doctor you really like and trust. I almost went to David Mayman there ... I was in the New York office ... decided last minute to go local ... Really odd finding, huh, on the small femoral device? Love that your surgeon is deep into planning and imaging well ahead of time.
     
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