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Bilateral MoM heading for revision

Triker

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Back in 08 I had bilateral hip replacements. I was only 49 at the time so my surgeon decided to go with a pair of Biomet m2as.

Well, three weeks ago I got a severe pain in my left hip and a less severe ache in my right. I was seen by the PA in the office who examined me and sent me for blood work. My cobalt level is 5 times the limit and my chromium twice the limit. I went for an ultrasound and have fluid on both hips, nothing but good news.

Over the last five years I have developed a back ache, hearing loss , tingling hands and feet and was diagnosed with familial tremor which I now believe may be caused by the metal toxicity.

I just got a call yesterday and the PA said the surgeon wants to see me about getting a revision. He said the doctor wants to replace the ball while preserving everything else if he can. Does anyone have experience with this kind of revision? How bad is the surgery? Recovery? I am emotionally as we as physically sick over this.
 

alexthecat

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That's really rough! I'm sorry you are going through this. We've have a few members, over the years, who have had to have revision surgery for metallosis. Here are a few of their threads:
https://bonesmart.org/forum/threads...ensitivity-in-a-ceramic-on-ceramic-hip.20813/
https://bonesmart.org/forum/threads/revision-of-7½-year-old-hip-post-op.38552/
https://bonesmart.org/forum/threads/surgery-completed-i-have-crossed-over.25822/

Here's some info from the Bonesmart library that may be useful:
https://bonesmart.org/forum/threads/metallosis-what-is-it.8254/


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dapplega

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@Triker - that is a tough hand to be dealt... Don't have any experience that can help you other than to say you are in the right place for support... Hang in there...
 

Jaycey

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@Triker So sorry you are suffering due to your implants. Has your surgeon suggested bilateral revision?
How bad is the surgery? Recovery?
It's basically THR but no one can predict how you will react to the procedure. This will also depend on what your surgeon finds once he accesses the joints.
 
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Triker

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Well, I can't get in to see my surgeon until the 12th of next month, and if I have anything to say about it I'm getting both hips taken care of although it will be two separate surgeries. I'm not going to keep a ticking time bomb in my right hip just because it has a little less fluid than the left.
 

Jaycey

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@Triker Can you go to another surgeon. Perhaps someone with no connections to your original OS? You really need a revision specialist.
 
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Triker

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My doctor is part of a group Orthopedic Associates of Rochester, there is a revision specialist Dr. Klotz who is one of the best. The doctors routinely pass patients to another doctor when something isn't their specialty. I will inquire when I get in for my appointment.
 

Layla

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I'm sorry to read this. My heart goes out to you. This is news none of us wants to hear.
Thankfully there is a solution, I'm just sorry you have to go through this. We'll be here to offer support and encouragement as you move forward.
Wishing you peace and comfort as you wait.
@Triker
 

Josephine

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Over the last five years I have developed a back ache, hearing loss , tingling hands and feet and was diagnosed with familial tremor which I now believe may be caused by the metal toxicity.
And you would be right. Those are listed side effects of Metallosis.
I just got a call yesterday and the PA said the surgeon wants to see me about getting a revision. He said the doctor wants to replace the ball while preserving everything else if he can. Does anyone have experience with this kind of revision?
If I were in your shoes, I'd prefer to have a completely new device. There is more than one site where metallosis can arise from from. Best not take any chances.
 
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Triker

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Thank you, lots of good advice here. I thought the metal particles came from the West of the ball and socket rubbing,they can come from elsewhere also?

Geeze! Auto correct stinks, I meant I thought the particles came the ball and socket rubbing not from the stem.
 

Jaycey

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@Triker If you click on the link in the post Jo left you, you can read an article about Metallosis that indicates there can be corrosion of the metal stem (trunnion).
 

prairienut

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I just had a revision (aseptic loosening, no metallosis) and was surprised they did find some corrosion between the metal cup and its metal liner. The OS simply cleaned up that corrosion and inserted a new PE liner. He also replaced the ceramic ball and femoral stem which was the part that was loose. My original prosthesis was ceramic on metal and was done back in 2009. Happy to have new bearing surfaces along with a well-fixed femoral stem.
 
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Triker

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Prairenut ,how is your recovery going? Was it as bad as the first surgery?
 

prairienut

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Surprisingly, my recovery from the revision, now 3-1/2 weeks post-op, has been easier and more comfortable than my original THR. I am walking smoothly with only a light use of one crutch and taking a few steps with no assistance when I'm cruising around the kitchen. The pain levels have been low, too. I quit the narcotics as of the 6th post-op day and now just take an occasional Tylenol at night. I suspect that the anesthesia was handled differently than 10 years ago, and the surgical techniques were probably better, too. Keep in mind that I had no metallosis and no infection. A revision surgery that has to deal with tissue damaged by metal ions may be more complicated and could affect the speed of recovery. Also, my surgery involved swapping out only the femoral stem and ball plus a new lining for the acetabular cup. I believe leaving the acetabular implant in place (it was still tightly fixed) helped make my recovery easier than the first time. As Jaycey said, there are many variables in revision surgeries, and each recovery is going to be unique. I wish you the best of luck. I predict you will be feeling much better after those revisions are done and the metallosis is resolved.
 
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Triker

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I went to my appointment and was very disappointed. I drove an hour and 45 minutes through the great snow, sleet, rain and sleet again storm of NY state to spend an additional hour sitting in the waiting room to get ten minutes with the doctor.

He was clearly agitated and spent the first 5 minutes talking about lawsuits. I never intended to sue him and I told him so, I just want to get better. For reasons I don't want to go into here I don't take blood transfusions so I wanted to discuss blood conservation measures he could use during surgery and he didn't want to hear any of it.

His plan was to replace the ball and if the socket was loose, he planned on replacing that also but would have to transfuse if he felt I needed it. He didn't want to discuss hemodilution, cell salvage argon beam coagulation or anything. If he went in and I refused blood he was going to swap out the ball and call it done whether the socket was loose or not.

Also, for the first time he told me there was bone loss behind my left socket. He said he told me about it at my last regular checkup last April, an out and out lie. My wife was there and neither one of us heard any such thing. And he didn't want to discuss my other hip which by the way is the same MoM replacement and also has fluid showing.

I am not happy with this guy and have an appointment with Dr. Ginnetti of the U of R and he has said he would be happy to discuss my concerns. I wasted 3½ weeks waiting for the first doctor.
 
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Carriemay60

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@Triker What a huge disappointment for you! I'm glad you are seeing someone else; he sounds like a horrible person and not surprising he might be dealing with lawsuits! I do hope this next surgeon is more open to discussing your concerns and respecting your wishes.
 

prairienut

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Good decision to look further for an OS. If he is reluctant to even discuss the specific procedures you are wanting, he is not the right one for you. I'm not familiar with the techniques you list, but it would be best to find a surgeon who is knowledgeable in them and is willing and able to perform them. I wish you luck in your search.
 

Mojo333

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I'm so sorry you had to spend your time and effort to deal with that OS...I'm sure you are beyond frustrated.
Hope your appointment with new OS is soon and he is willing to work with you in regard to the possible transfusion issue.
 
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Triker

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Yesterday I met with Dr. Ginetti of the U of R medical center and he seems to be a good fit for me. He took the time to explain everything to me, what options he's considering and seemed sympathetic to my problems. He believes he can help me but also didn't make any crazy promises. I had to go to my old doctor to get my op notes and have another appointment next week to go over them to finalize everything.

As of right now he's going with dual mobility balls with socket replacement if necessary. He seems confident I can get a good result but also told me that I do have pseudotumors on both joints,5cm by 2.5cm on my left and 2.5 by 0.5 on my right hip that indicate some tissue damage and that will be the deciding factor on how everything will turn out.

So, I have to get another half day off from work next week, but hey, things are looking up. Oh, and by the way Dr. Ginetti called my old doctor and told me my old doctor wasn't really comfortable with operating on me and would rather Dr. Ginetti took over the case. Seriously I wish he had told me this a month ago, I could have been that much closer to resolving this.
 
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Layla

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It's good to read this meeting was better than your last and that things are looking up.
It seems you've found someone you feel you can trust to deal with your situation.
Let us know how your meeting goes next week. We'll be here to support you as you move through pre-op, surgery and recovery.
Wishing you only the best. :)
@Triker


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