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Revision THR An Incredible Journey

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Ah, well you mentioned your pain was connected with a psoas impingement so I fell into the common trap on only looking at the cup! My bad! My reply is a bit involved so I am sending you a pm.
 
No worries. I think I have problems with everything, honestly. Both cup and stem placement. I see a dark area above the cup in the CT scan that looks like it still didn't meld with the bone, so you were right. I don't think I've had good in-growth anywhere. I appreciate your taking the time to do a good look/see of everything.
 
So sorry for you, I looked at your scans etc.. Jo will come back to you when she has studied them .

Keep us updated, I think you are very brave ...

p.s. I edited my signature with all the bad news in it, too depressing and history now :). I am trying to learn Spanish, so am jazzing up my signature (and posts):)
 
I had a bone test scan today and it looks like I'm still trying to grow bone into the prosthesis, so it appears that it's loose, as Jo said. Hopefully, I can wait for at least 2-3 months before surgery, as I'm moving right now.

I still hope that somehow a few nerves could be deadened and take care of the pain. I'm not eager to have pain forever. Are there stories here of people who did much better after having a revision?
 
There certainly are! I'm on my phone now, so I can't give you a link. If you know how to search the member list, look for "jimbo". That poor guy had a horrible time with his THR, but he came through his revision just fine and returned to a very active lifestyle. Start with his "pain, confusion, uncertainty" thread to get his whole story.
 
Thanks for the referral to Jimbo's story. That man went through hades finding out what was wrong. I'm glad he has a happy ending. I have hope the same is possible for me.

I had a Bone Scan last week and just got the results. I have diffuse uptake all over the implant area, just like the scan a year ago. It's now about 28 months since surgery. The scan also mentioned a photopenic defect in the hardware.

I studied my CT scans and noticed an uneven area that may be a crack in the liner? I'd like Jo to take a look/see and tell me if these are normal artifacts. I meet with my Orthopod tomorrow to see what his opinion is. Hopefully he has a few ideas.@Josephine:

[Bonesmart.org] An Incredible Journey


[Bonesmart.org] An Incredible Journey
 
Well, I met with my orthopod today and there's no magic answers. He's referring me on to a Pain Management clinic. He does think I have micro-motion, but my tests aren't conclusive enough to go to a revision (he says). He wants me to come back in 6 months to monitor the bone loss and stress shielding.

I do have a bad back and an L4/L5 radiculopathy down my left leg. The nerve pain from the Meralgia Parasthestica (numb left thigh) gets pretty bad too. It's hard for me to tell what part is causing the most pain because I have a fair amount of soft tissue damage, and bad arthritis in my back.

Sometimes there aren't easy answers.
 
Thanks for posting your CT images. I am sure Jo will be along soon to comment. I am not a medical expert but sure looks like a problem in the area you highlighted.

Bad backs and THR - tough one. I have been through that same thing. My recovery from THR was not at all straight forward due to back issues. I do hope you get some resolution from the Pain Management area. But do keep pestering your OS if you continue to feel the pain from your hip.

Please keep us updated!
 
Hi Tiredhippy

I am so sorry that you are having these problems - I do hope that you can get some answers soon.
 
Sandy,

Thanks for your words of support, I appreciate them.

I'm feeling a little discouraged from making the loop of lab tests, CT and Bone Scan and again getting results that say everything doesn't seem to be quite right, but just not "wrong enough" to do anything.

Except go back to the Pain Management specialist.

Nerve damage is a big part of my problem and I know my Dr. doesn't want to risk making things worse. And I'm buying a house and will be moving in a month or two, so this isn't a good time for surgery.

I just want to be more free of pain, like more than a few people here. I'm hoping a few nerve blocks work to help calm things down and help me be more active.

I am curious about hearing how others manage their pain, and success with nerve blocks and using RF to stop nerve signals.

And best of luck to you Sandy - you've been very kind!
 
I'm going to tag Josephine again. @Josephine: She is away from the forum for a few days, but I want to be sure she gets back to you as soon as she returns.
 
A discussion here made me curious about how the differences between men's and women's pelvic structure affects hip replacement outcomes.

It does seem like there are more women here with poorer outcomes than men. Our pelvises are subjected to child birth and are also not as straight as mens. They have small straight pelvis, where ours are deeper and wider.

Then there's the effect menopause has on bone and muscle growth. I'm already getting osteoporosis in my back and hips. Seems like this can have an effect on how fast and well the prosthesis melds with the pelvis. Testosterone helps men maintain muscle and bone better than post-menopausal women. There is "manopause" too, but the hormones drop off more gradually and later in life.

I'm curious if the moderators or anyone else has discussed this topic.

Thanks
 
I don't recall this topic ever being discussed here on BoneSmart. I'm going to tag Josephine so she can address it. @Josephine:

Jo is away at a conference for a few days, so she will not be able to respond until she returns.
 
Hi Tired Hippy,
That's a very interesting topic you've highlighted. Look forward to hearing what everyone has to say
Jyoti
 
Tired Hippy,
Interesting, I would love to know the numbers as far as men to women breakdown. For the past few years, I have worn Merrell (Merrill?) Q-form shoes and their ad really illustrates the difference between the sexes hip angle.
Dee
 
Me too - my surgeon noted an odd shape to my pelvic bone and did an immediate revision (3 hours after the first surgery) for the new joint wasn't in place to his satisfaction.
 
I'm not so good at reading CT and MRI scans, but the irregularities you see are probably the modelling on the outside of the cup as they show up the same on the xray. It's often difficult for the eye to adjust to seeing the entire prosthesis, front, middle and back, all at the same time.

However, I don't agree with your surgeon about not revising the hip. It's loose - or probably loose, even is there is 'only' micromovement, it's still movement and still causes pain. It needs to be revised and I strongly urge you to seek out a revision surgeon who will crack on and get this done after which you can deal with any issues that might be arising from your spine.
 
Interesting topic.

Actually the reason there are more women than men represented here is because overall more women have hip replacements than men! Strange but true! Other than that, most of the other things you cited are not generally impacting on outcomes. But it is true that women are more represented in issues such as the current metal-on-metal controversy and, since they also suffer more from developmental dysplasia of the hip (DDH) or Perthes disease, then the number of young women with hip problems and replacements are obviously much greater.

Do hormones affect the need for replacement or the outcomes? Probably not. Nor have I seen it cited as an issue in any medical articles. Generally speaking, men and women have a fairly level playing field when it comes to hip replacements. Why some women more often suffer from poor outcomes and problems than men is not clear but doubtful it has anything to do with anatomy!
 
I agree with you Josephine, but am not able to gain agreement with any Orthopedist yet. I have the original I fired long ago, my normal ortho guy whom I adore, but is only working part-time and not eager to risk being a "bad guy" and have a less-than-perfect outcome. My last Orthopod is well thought of, but from the practice where the first OS used to be, but has since left (the new hot shot didn't last very long here - think he's off setting bones someplace).

My last OS was leaving for 6 weeks of Dr's w/o Borders work while on vacation, and that may have played a role in his decision. I'm in the middle of buying a house and moving 40 miles away over the next two months too, so I didn't present as the most eager surgery patient. The OS does want me back within 6 months to re-check the bone loss. Until then, I'm scheduled to see the Pain Management Dr.

I am meeting with my Primary care Dr to sum up everything we found so far - he can refer out to another OS if we're not happy with the results. I am frustrated with the "not bad enough" line I've been getting all along. On the other hand, my back has been my most painful area lately. I'm hiring people to do most of the lifting for my move, but it's still work, and I have to pace myself.

Am I at risk if I take a watch and wait approach and use my meds and perhaps some RF treatment to control pain? I think the Lat Fem Cut nerve is only giving me pain with the numbness, so I'll take numbness alone. Otherwise, I feel I'm being forced to watch and wait. If you don't think so, I'll pressure my PCP to go to another revisionist expert.
 
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