Revision THR Continuing thigh pain from failed osteointegration?<

[TerryB_TX]

@Jamie, just sent you a PM with the info you requested regarding my original OS. Thank you for your help.

 

[chalcedonian1]

@TerryB_TX Thank you for your well wishes!! I am beginning to feel better this afternoon and my logical mind is dominating instead of my nerves and fear, so I am going in to packing and how-to-recover-mode, or at least what to do during the recovery when I am awake...

I absolutely went through the stage you are in, and it is a very familiar feeling -- I veered between being angry, fearful, unbelieving, and then wrestling myself down with logic, with an overlay of "this is just a bad dream, this isn't really happening, right?".

I found out quickly enough on this site what Josephine just posted to you above: it is not likely you will know what caused your implant loosening. That may feel maddening right now, but I know I wasted some energy trying to figure it all out, and months later, to this day I still do not know precisely, though there have been some comments about my femoral implant being too short. If I can help you stop wondering about the cause even a little bit here, that will make my day!

I was told late last year I need a revision, but I took my time finding who and where to do it. I have been on limited activity since that time, working from home, not doing a lot of walking as I didn't want to become an emergent care patient in the ER if I overdid it! I actually KNEW somewhere in my brain before I was diagnosed with a loose implant that something was very wrong, but I put up with a lot of pain over the last three years--probably too long. So I when I heard the words leaving the original surgeon's mouth that I needed a revision I was shocked but perhaps not totally completely flabbergasted in full, but still in part, if that makes any sense--again that "bad dream" feeling but also an explanation other than "it's just me, I am not supposed to hurt, it must be me!".

I'm not sure if any of this resonates with you, but whatever you are feeling, I can reassure you that eventually you will feel more calm and collected and you will get through this, as I have so far, and others here have as well.

One coping method might be to ask and research a lot of questions you might have, maybe type up a long list of questions and observations before you see the revision surgeon(s). My pain skipped around in my thigh and groin, and I could never quite pin-point it when it didn't hurt a lot, so I had to really pay attention and write observations down to be able to explain--yet the X-rays were pretty clear when they were finally taken.

If you can have someone go with you to the doctors' appts. to take notes on their responses that is really helpful too--I was at first in such a fog I couldn't remember accurately enough what was said, so my companion's notes were critical to add to my own. You don't get much time with many surgeons, but by my third try, I did spend enough time and had my questions well formed, and I felt he actually gave me the time of day and then some. I also very quickly stopped hoping one of them would say "Oh, you don't need this surgery, you'll be fine"! Another pipe dream eliminated very early on in the process by this site, and just as well.

Doing research on my own behalf kept me sane and focused. I am not a whiner by nature, and I was able to contain my emotions to a degree which helped me ultimately understand and feel that the sky wasn't falling, although the first few days/weeks it certainly felt that way. As I said before, this site is priceless, and I think you have done the best thing for yourself by joining it--I hope you will be able to have something of a weekend now that you have found it! Your feelings of anxiety and confusion will recede into the background as you make a plan for yourself which will unfold as quickly or as slowly as is right for you. I needed to get my work life in some order first, which I took a few months to do, perhaps you have the luxury, or the need, to have this done right away, or not -- all part of the planning. I have been very calm for months, but this last week, I feel like I can't believe it will happen so soon! I think nerves, and suddenly feeling a lack of courage, will simmer down to a calmness and an acceptance again before the surgery (it is happening already today as I research my recovery plan--there is my Type A personality going into full gear) --- and then voila, I will wake up after surgery and I hope it will all be worth it.

I hope for you that the shock begins to wears off, and you begin to see that this will be a pretty good shot at getting some quality of life back. The odds are still very much in our favor, just remember that point when you feel most down. I would take the surgical odds and percentages of success with a revision if I had any other serious illness happening in my body for sure! Until then, keep asking your questions and expressing your concerns etc. on this site -- we all understand, better than even the most beloved people in our lives who can't possibly know no matter how hard they try!

 

[Josephine]

These seem like very large images.

Terry, did you reduce their size? Because I actually need 'very large' images!

 

[TerryB_TX]

These seem like very large images.

Terry, did you reduce their size? Because I actually need 'very large' images!

@Josephine, I didn’t reduce them, but had to use snipping tool to capture them, then make minor edits for privacy. Final pictures I uploaded were about 700-800 kb. Hope that’s adequate.

 

[TerryB_TX]

@chalcedonian1, It sounds like we've been through similar experiences. It took a year for me to really admit to myself that something wasn't right. I left my 1 month post op without any mention of a problem. Perhaps it may not have been apparent at that time. I had mentioned the thigh pain and was recommended IT Band stretches. Some pain early on was intense burning pain at the top/front of my thigh, but eventually that went away. The more modest thigh pain continued. To be honest, it feels almost like quads feel with lactic acid buildup after doing a set of lifts. I kept waiting for improvement that never came. It now seems to be getting worse. It's mostly when I get up after sitting or laying down. Any change in position like that requires me to gradually and gingerly put weight on that hip, but once done it's not too bad and I generally feel better after walking a bit.
At the year checkup, my complaint was primarily psoas tendonitis. I was always having to lift my leg in and out of cars and while putting on pants or shoes and socks. Only at the end of the appointment did the OS mention the femoral implant "held in place by scar tissue" rather than bone. I didn't understand the implications of that statement till I started researching and wound up here. He gave me the recommendation to treat the psoas tendonitis with 2400mg/day of ibuprofren for 6 weeks and come back in three months. No discussion of loose stem or revision surgery. I'm deeply disappointed in his lack of candor.

I can honestly say I'm not angry. Maybe that will come later. Mostly its just disappointment and immense anxiety. Anxiety because my mind keeps taking me to the worst possible scenarios. However, past experience tells me that once I start taking positive, concrete steps toward resolution, this anxiety will recede. At that point I'll feel like I am taking some control over my body and my life again.

Well my leg is aching from sitting at the computer too long, so I'll get up, walk around, and enjoy some of the many good things in life with which I've been blessed. Thanks for listening.

 

[Mojo333]

To be honest, it feels almost like quads feel with lactic acid buildup after doing a set of lifts.

This is totally unnecessary, when you come to round two.
Just chill.

 

[tallguy79]

OS suggested my height (6'4") could have been a contributing factor - but there's nothing I can do about that!

Really? I'm 6'6" and wasn't told anything about my height being a potential problem.

 

[Jamie]

Frankly, that was a really odd thing for the surgeon to say. Height is not a factor in the success or failure of a hip replacement!

@TerryB_TX ... thanks for the PM. I'll start taking a look for you to see if we can get you some options for a different surgeon.

 

[TerryB_TX]

@Jamie , Yes, the OS briefly discussed longer femur and more torque and rotational stress on the bone, etc. Makes sense, I guess, but I'm certainly not the first tall person to have a THR, right @tallguy79 ?
I wonder if his comments could perhaps be signaling that he is second guessing his choice of stem length. This is one of the questions I hope (but don't necessarily expect) to have answered by revision specialist.

 

[TerryB_TX]

@Josephine, Just noticed the X-rays I uploaded are only about 150-250 KB, not the 700-800 KB I thought. Could you take a quick look to see if they are adequate for your use? If not, I'll try to figure out how to get better resolution using the snipping tool.

 

[Gypsy]

OS suggested my height (6'4") could have been a contributing factor - but there's nothing I can do about that!

My original OS told me a number of things that seemed to indicate my postsurgical problems were my fault. I think he may have overlooked mentioning that I was too short! It seems some doctors are inclined to blame the patient rather than consider an "oops" or "I don't know." Good to hear you are seeking out a different surgeon.

 

[Josephine]

the X-rays I uploaded are only about 150-250 KB, not the 700-800 KB

This is not the important 'size' of an image. The one I'm after is in pixels. The size in pixels that I'm after is around 1000-15000 pixels

But looking at your images, it looks to me like your stem is loose!

 

[TerryB_TX]

Thank you for looking at the x-rays, @Josephine . Is there anything that you can see to suggest a reason for the loose stem? Does the difference between the 1 month and 12 month views suggest an interruption of the integration process, possibly due to over activity? Does the stem size and alignment look as you would expect? I'm asking these questions not to assign blame, but only to understand if there might be anything that could be done differently with the revision to minimize the chance of a second failure.
I also notice what appears to my untrained eye a widening or bulging of the femur bone thickness on the outside of the thigh at the top of the implant. I see this when comparing the 1 month to the 12 month AP X-ray. Could this be evidence of some structural weakening over time or is this just an optical illusion due to radiography perspective or something similar?
I'm sorry to pester you with these questions. If my obsessing on these details is inappropriate or unproductive, please let me know. I recognize there are a lot of members with far more urgent issues competing for a finite amount of your time and attention.

 

[Josephine]

Is there anything that you can see to suggest a reason for the loose stem?

There's rarely an obvious reason for it.

Does the difference between the 1 month and 12 month views suggest an interruption of the integration process

I couldn't say because you haven't labelled the xrays to say which is which. Do that and I can proffer an opinion!

 

[TerryB_TX]

@Josephine, here are the one month and one year x-rays, properly labeled. Any subtle clues that might help explain the failure to integrate, even if only a contributing factor, would give me more hope that a revision could be successful. I understand there may never be an answer, but I trust you to give me honest feedback if there is.

In the 1 year x-ray, I've circled the area that looks different to me. Maybe this is normal. Maybe it's just an optical illusion. I'm hoping it's not some sort of structural weakening.

 

[Josephine]

Well thank you! That's make a great deal of difference.

Where you've indicated the overgrowth of bone, you're quite right. That is an overgrowth which is normally caused by the stem toggling against the bone. It can either wear it away or cause an erosion but my guess is that in your case, it's caused an overgrowth. But lack of ingrowth of bone into the stem is clearly visible on enlargement, specially next to that bony lump.

 

[TerryB_TX]

@Josephine, any clues from these x-rays what may have contributed to the lack of bone integration? My OS mentioned my height as a contributing factor, but I’m wondering if he has could have been signaling that he is second guessing his choice of stem length for someone my size (6’4”).

 

[Josephine]

Terry, the truth is that nobody knows why osteo-integration fails. There are lots of theories and ideas but nothing for certain. However, there are two things that could be contributory factors

1. failure of the device to be efficiently fitted into the femoral canal
2. failure of the femoral canal to have been properly prepared (this would include a power wash to remove bone debris, fat and blood so the stem makes good and secure contact with the bone
3. use of NSAIDs during the post-op period. We know that NSAIDs can inhibit new bone growth

1 and 2 might 'just' be as a result of a short stem in a tall person because the leverage of the body would be counter to the eventual stability of the stem.

Those are my thoughts but as I said - no-one knows for sure. This is all hypothesizing.

 

[TerryB_TX]

@ Josephine, thank you for your comments. I guess I'm still looking for anything to tell me that a revision won't be just another roll of the dice, but maybe that's the way it is. At a minimum, I plan to avoid NSAIDS before and after the revision surgery. I've been on 2400 mg/day ibuprofen for a couple of months to try to reduce the inflammation of psoas tendonitis. It seems to have worked, at least while I'm on the ibuprofen. The true test comes now that I have finished the prescribed course.
Is it likely that the psoas issue is another symptom of a loose stem? My surgeon's nurse practitioner thought it could be due to impingement of the acetabular cup on the tendon and that the cup may need to be re-aligned. This explanation came prior to any acknowledgement on their part of a loose stem.

 

[TerryB_TX]

@Jamie , I sent you a PM with a couple of Houston, TX area revision specialists with whom I've made appointments. Would you mind taking a quick look and letting me know if they would make your short list?
I'm still looking for perhaps another couple of surgeons.