Revision THR An Incredible Journey

[HappyHippy]

Well, just after I was feeling discouraged about getting a solution for the chronic hip pain, the revision OS called and said he wanted to work me in soon - June 6th. I've been having the test results sent to both Orthopedists - the local guy who's good, but from the same practice as the original surgeon, and the revision OS who's from a larger metro area (where I'm moving).

Then I have that sick feeling from the idea of more surgery. I want to be out of the levels of pain I'm in, and Jimbo's thread was very encouraging - I'm feeling like I've been put through the same round of unsatisfactory results, but won't have someone make the finite decision that this is loose. And I am afraid I could end up worse than I am. I'd give about anything to have the month back immediately after my Psoas release, because I was pain free, but don't know what went wrong to cause it to come back.

So it's good news I got into the best OS for evaluating this, but now may have to face the consequences, for better or worse. After over 2 years I am one tired hippy.

 

[Josephine]

don't know what went wrong to cause it to come back.

It got loose! :wink1:

 

[HappyHippy]

Guess that was a big "duh"

Perhaps I should caution the few people here contemplating Psoas releases not to be as crazy as I was. Within a week of the surgery I was trying to walk 3+ miles and generally make up for lost time. I'd been stuck at 1 mile at most without severe groin pain before the release.

I don't think I loosened it 14 months after the first surgery though - I only had x-rays and Psoas injections without a Cat Scan for diagnosis. The injections worked for about 10 days, so the Dr. went ahead with the release. At that time I had 2 mm of lucency around the stem. I suppose one is action packed with anesthetics for a little while after surgery, and that's why I went dancing ...

And I WILL dance again.

Thanks for the reality reminder, Josephine

 

[Josephine]

Points to remember:
1. Properly implanted implants can take almost anything the patient throws at them and 99.9% of the time it's not the patient that causes it to come loose, it's the way it was put in
However ...
2. walking one mile within a week of surgery was TOTALLY INSANE!

 

[Poppet]

Hi Tiredhippy

I am pleased you have a surgery date, best to get it over and done with. As Jo says, it is loose.

Just project yourself forward a month and think that you will be on the road to recovery... good luck, I will be eagerly waiting to hear how you have gone.

 

[HappyHippy]

Thanks Sandy!

I actually just had an appointment with the revision OS. That was today. He confirmed what Josephine was saying - that at least the stem is loose. He said the placement of the cup looks good, so he's not sure that will need revision. We'll see when he gets in.

He also said it wasn't urgent that I had surgery- the hip is stable enough to take everyday stresses as long as I don't lift. I'm moving soon, but hired out the heavy work. So, one thing at a time.

I do want to let @josephine know that she was right, but she already knew that! I want to thank everyone for their kind words, and especially Josephine for reviewing all my medical info and providing advice. I've always thought the best people for knowing what to do were the experienced nurses. Unfortunately, when I've been in the hospital lately, I seem to get younger, inexperienced ones - and they're worthless. The trend seems to be to get rid of the older nurses with higher salaries and better benefits, and replace them with young ones at my local hospital, but I am getting treated at the larger metro area north of here, which is a good thing.

 

[Poppet]

Hi Tiredhippy... I so understand 'one thing at a time' with the moving.. We moved about 6 weeks before my surgery. So pleased you are getting help in.

Also good news that the OS does not think it is urgent, urgent.

I will stay tuned xx

 

[HappyHippy]

I wanted to see if anyone has experienced new and/or increased popping in their good hip after surgery. Mine has gotten quite bad recently and I worry about increasing arthritis in the good hip. I'm in the middle of moving, so I'm sure I'm overdoing it. I've hired a neighbor girl to help pack, but there are just some things one has to do themselves!

I have a loose stem, and need a revision, but am trying to wait until Jan. when I can change to a better insurance plan. I want a few months to settle in before surgery too, and take better care of myself in preparation. My appetite is terrible at the levels of pain I'm in and the stress of a major remodel then a move. I should be dancing for joy at getting a home I really wanted, and a loan that allows me to finance my updates so I can make it mine - but am struggling just to make it through the day.

So I'm whining, but I am curious about the hip popping - mine has me concerned.

Thanks everyone!

 

[Poppet]

Hi TiredHippy

I can't comment on the popping sensation however; we recently did a major restructure at work and had to move buildings 100+ people. I managed my own gear, and was very careful because I know that previous exercises like this have produced odd pains and aches.

This time, even though I was extremely careful, making sure boxes were at waist height and not lifting too many heavy files at once etc. I am still suffering two weeks down the track.. pain around the joint area which I think is a muscle attachment and muscle pain just above my knee which again I believe is attachment strain. Also, it has aggravated my lower back where I have three prolapsed discs... so from my experience, I would suggest that all the extra tiny little twists, bends or stretches seem to wake up muscles still not fully functional.

I do hope it settles down with some rest, elevation and try icing/heat which ever helps..

Great that you have your dream home now though.. enjoy the little pleasures of it, but rest as well

 

[Jamie]

Tired Hippy.....can you describe the popping a little more? When does it happen? Can you feel it in your joint as well as hear the noise? If so, where do you feel the popping happening? I'm going to tag Josephine so that she can comment. Josephine;

 

[Josephine]

TH, truthfully, you shouldn't be putting off getting that loose implant sorted. It is an uncemented stem, I take it? As it joggles around in the bone, it will be causing damage and could even break through. See here to see the kind of thing I mean

It's not that I want to scare you but you do need to understand the consequences of waiting too long.

As for the popping, it seems pretty clear to me that this is the result of doing too much on an already diseased hip. I wish I could tell you to take it easy but considering what you have going on, that's hardly a reality, is it? But please just do take care.

 

[TracyW]

Good morning Tired Hippy, I have been experiencing popping in my good hip since my surgery. Maybe it was there all along, but I wasn't so focused on the pain of the dying hip I didn't notice. I just got new x-rays and there is minimal joint space in the good hip. There is a slight burning if I sit with poor posture which is more annoying than painful. My OS says I can wait if I want as my knees will most likely need attention before the hip will. No harm in opening up a conversation with your OS about the good hip. I did so we could make sensible decisions together instead of me waiting in pain too long as I did with my first hip.

Good luck with the move into your dream home. I know it’s very hard to be in pain and have to concentrate on anything else. It was great that you hired the neighborhood girl to help. Be as careful as possible, rest often as possible and keep the ice handy.

 

[HappyHippy]

I'm starting this thread because I became aware through posting on other threads that I'm really afraid of revision surgery and if will take care of my pain.

This really happened when I met with my OS Wed. Some of my worst pain is burning around the top of my tensor fasciae latae. I also have groin pain and pain around the cup, as well as stem pain. My OS told me that the surgery would only correct the stem pain, unless he finds other problems. But what if most of the problem is from the nerve and muscle damage from the Anterior approach?

I don't want to go through a revision if it takes care of 25% of my pain. I'm diagnosed with Meralgia Parasthetica which is thigh numbness and nerve pain. After 2 years I'm not sure if I should ask if a surgeon should be going through the front again to repair muscle and nerve damage, or replace the prosthesis. I've had a Psoas release that helped some, but the first surgeon made a lot of mistakes. In fact, my OS said he quoted my case to another patient to talk them out of an Anterior hip. I'm a great example of what can go wrong. I feel sad.

Just what are realistic expectations?

 

[Jamie]

Tired, a couple of questions for you.

Is the surgeon you are now talking about in regard to a revision the same one who did your hip replacement? (If it is the same doctor, I suggest you get several other totally independent opinions)

Have you had a couple of opinions? (If not, I would see another doctor or two to get their take on what you could expect from a revision)

It sounds to me like you still have a number of questions that you need to have answered satisfactorily before you agree to a revision. It is important that you are comfortable with the surgeon who will be doing the operation, the risks involved, and the expected success. That may take discussions with one or more additional revision specialists to get you to that point.

I'm also going to tag Josephine so that she can comment.

 

[Josephine]

Honey, I can fully understand your reservations about yet more surgery. But you should take it on board that it's perfectly normal to feel like that.

My OS told me that the surgery would only correct the stem pain, unless he finds other problems. But what if most of the problem is from the nerve and muscle damage from the Anterior approach? I don't want to go through a revision if it takes care of 25% of my pain.

I can also understand this but let me ask you - if there was only 25% improvement, surely that would be better than nothing?

After 2 years I'm not sure if I should ask if a surgeon should be going through the front again to repair muscle and nerve damage

On the one hand, if his objective is to explore nerve and muscle damage, I don't really see how he can do that without going through the original incision. Just not doable, I'm afraid.

 

[glynis]

Dear TH

I replied to you once before on the forum. Our cases are quite different, but I am also being advised to have a revision, and I'm a bit scared. Not of the operation, as such, but as to whether I will really see that much improvement.

I am honestly not in much pain. I would describe it more as discomfort. It doesn't keep me awake at night. But I am certainly nowhere near as active as I used to be. And I do miss that.

I have had numerous tests over the last few weeks, and will find out at an appointment on Tuesday whether my consultant definitely advises a revision. I am at a hospital called Wrightington, in the north of the UK, which is acknowledged as a centre of excellence.

After all this time (I had my accident on New Year's Eve 2009) I feel I am ready for the next stage.

Whatever you decide, all the best to you.

Glynis

 

[HappyHippy]

Hi Jamie

First, this is NOT the surgeon who performed the Anterior; I'm using a well regarded revision specialist from a larger metro area. I've had second, and this was actually my third opinion. I had come on the forum asking for answers, and when Jo looked at my x-rays, said it was clear it was loose. I actually had my films sent to this Dr. along with the different Dr. From the same practice that messed up the surgery. This dr. called soon after receiving the films and wanted to work me in, and said I was loose just after Jo did.

And Jo, you're right in that it's normal to be scared. I've been commenting on other people's threads - a few that need revision, and have to admit that when I got back from the OS, I cried my eyes out. We discussed all the various pain patterns and what they could mean, but he hasn't confirmed the cup is loose, although it sure feels like it.

So he told me I may not have great results - only better, perhaps. I am supposed to pay attention to the pain and where it's coming from as a guide.

It hurts all over, especially at the end of an active day. Bone scans show diffuse activity throughout. And then there's the burning pain from the top of the incision, which I think is nerve damage. They've already gone through the incision twice, the second to try and clean up the mess without going into the joint capsule. I have been told they can't go in again.

And I am putting it off until Jan. so I have some time to prepare. Guess I don't like the answers I've been telling others with multiple pain generators ... That nothing may get rid of all the pain.

And hi Glynis, I remember you. I was looking for people facing revisions and the fear it may not help. I am on strong narcotics to get through the pain (ms contin and Vicodin) and sometimes they don't help, except I wouldn't be able to do much without. The lack of being able to walk distances or sit comfortably are the real bummers. But you're right in that I'm ready to move on - just afraid the results won't be as good as I need.

Please let me know what you hear about your tests!


Thanks Jamie,Jo and Glynis for responding. I am having kinda a depressed time and need to get out of my head!

 

[alexthecat]

I think most people go into THR with the expectation of a positive outcome. After multiple failed hip surgeries, I no longer had that expectation and it doesn't sound like you do either. You are asking good questions and you deserve answers to all of them from your surgeon. Keep asking!

Emotionally, you may continue to struggle with the decision to go forward. I know I did. Intellectually, I did come to accept the need for more surgery.

 

[HappyHippy]

Hi Alex,

I remember seeing you prowl around (the cat). Did you have a Psoas release or am I thinking of someone else? I know you had other surgeries. How are you doing now?

Yes, I am struggling because if most of my pain is nerve, muscle I don't want to go through the ordeal again. Then again, Jo said the cup was loose, and I could tell by clicking a button in the CT software that masked all the appliance noise, that my cup had space. It also looks like it moved from the very first x-rays. The revision dr. doesn't have everything, and I don't think radiologists do a complete job always either. I just keep getting "Loosening can't be ruled out."

So I do think I'll end up with a complete do over and have 4 months to watch things before, but will not end up pain free. It's those pesky nerves that won't heal by now. The Gabapentin with pain meds make me feel dopey and kinda ill so I don't know if meds are the best answer either.

Thanks Alex for checking in.

 

[lncrwley]

I guess my patch job could be considered kind of a revision. I was fortunate that I didn't have time to think about it much before the surgery. I was only 3 to 4 weeks post op from getting the new hip when my leg popped and we found out that I split the femur. I was still on the pain meds so I don't think I really had time for it to sink in what exactly was going to be done. I was scared but was more just resigned.

If the surgery will reduce your pain only by 25 %, isn't that worth it? It could bring the pain level down to where it is tolerable or even where you will be able to ignore it eventually. I don't know how much pain I will be left with as I'm sure it won't all go away. I have had pain for as long as I can remember.