THR Crash and burn

[lncrwley]

I live in Prescott, Arizona. The doctor that did the surgery is an orthopedic surgeon who specializes in hip trauma. His website is here: broken link removed: https://www.sonoranorthotrauma.com/ The doctor's name is Dr. Miller. I have to travel 2 hours to get to see him as there are not many good orthopedic doctors that take my insurance where I live.
He told me that I would be in pain for a while. He said he removed some extra bone from the front of my pelvis. I asked him how much is some? He held out his hand, palm up and open like he was holding a grapefruit.

 

[Poppet]

Hi Lynne

Dr Miller's bio reads very well. Let's see what further light Jo can shed.

 

[Josephine]

Sounds like a trauma surgeon who specializes in pelvic reconstruction which is a whole different ball game to doing hip replacements. Trouble with orthopaedics is that there are specialities upon specialities upon specialities and it's a veritable jungle for the average person. It's a bit like having a high performance car with a faulty gear box but you take it to a repair place that specialises in fuel systems. Maybe he can deal with the gear box too but you can't be sure of it. I'd like to know a bit more about this surgeon so I'll go have a look at the website.

As for your surgeon, the lead-in to the website says "dedicated solely to the treatment of complex fractures" which confirms my comments above, also that they do anterior hip replacements. This does not convince me that it was the right place to have dealt with your situation as you needed a hip arthroplasty revision surgeon.

And I am afraid the resolution of the xrays is still too low quality. If the original image is good, I would imagine that your scanner needs to be set to a higher resolution.


btw, the operation you had on your femur years ago was called a derotation osteotomy.

 

[lncrwley]

Dr Miller also has another website: https://www.sonoranhipcenter.com/ that is run at the same place as the other web site that I gave to you. I did have the hip replaced using the anterior approach.
You keep saying that I needed a revision. Is a revision done when you already had an artificial hip or is it called a revision when you have your first artificial hip placed? I am confused. This was my first hip replacement.
Derotation osteotomy? I will have to remember that! Thank you. I didn't know what it was called.

 

[lncrwley]

I noticed that someone put the THR next to the title of this message. Does THR mean total hip replacement or total hip revision? I didn't know which so I never put anything.

 

[Jamie]

The acronym THR means Total Hip Replacement. It would indicate that you have had a hip replaced and no revisions of that procedure. A revision is a subsequent surgery to repair problems. And that may be what is needed in your case. At any rate, you do need to get an opinion from at least one revision specialist not associated with your original surgeon (the only way to get a truly independent opinion). Let me see if I can find a couple of options for you in the Scottsdale/Phoenix area.

 

[joaniec]

I am 6 weeks post op (thr-l). 2 weeks post op x-rays confirmed femur fracture. No surgical remedy was suggested. I am told it will heal on its own. I am experiencing considerable pain and soreness but I went off narcotics. My doctor thought I should. I still need another hip replacement on the other hip. I am treating pain with ice packs and over the counter meds. My recovery is far slower than I had anticipated. I too have pain down the back of my thigh...burning. I also have had pain that feels like an abscess right in the new joint. Doctor said this week that it will eventually go away. He is a board certified orthopedic surgeon specializing in joint replacement..practicing 32 yrs. I am just hanging in here to begin therapy in a therapy pool tomorrow. Good luck and keep your chin up.

 

[Jamie]

joaniec.....I'm curious as to why your surgeon thought you should stop taking prescription pain medications even though you are still in pain. I have to say I'm not particularly impressed by his "go home and wait for it to go away" recommendation.

Why don't you start a thread of your own and tell us a bit more about yourself and your situation. Maybe we can provide some additional options for you. Josephine

Whoops!!! I see that you DID start your own thread!!! I'll take a look there for more information.

 

[Jamie]

Lynne, I have done a little searching for you and here are some options for additional opinions:

Dr. Mark Spangehl (first choice)
Dr. Christopher Beauchamp
Both are at the Mayo Clinic, phone: 800-446-2279

Dr. Neal Rockowitz
Rockowitz Orthopedic Center, phone: 602-957-1233

Dr. Janet Wirlow
Scottsdale, phone: 480-767-0711

If it was me, I'd go with the Mayo Clinic if for no other reason than the fact that there is a team of orthopedic surgeons available....two of which specialize in complex revisions.

Good luck and let us know how you're doing. Please try not to worry. But at the same time, you do need to get to the correct surgeon as quickly as possible so that your problem can be addressed. The "let's wait and see" approach isn't what's needed.

 

[lncrwley]

Jamie, Thank you for searching out the doctors for me. What criteria did you use when you were searching? I'm just curious. I have an appt with Dr Miller next week. I will wait to see what he says. I will keep the names of the surgeons you suggested. I also have an appt with my PCP in 3 days. I want to see what he has to say about the whole thing. I trust my PCP and would do what he suggests.

 

[Jamie]

I used the BoneSmart Find A Clinic tab, typing in the zip code for Scottsdale. When you do that, you get a list of possible clinics. In this case, there were six pages of possibilities. I went down the list, checking each web site. Not all of them are smart enough to have good descriptions of the doctors' specialties. Those that don't are instantly eliminated. But....for the surgeons that DO put something in their bio about what they specialize in, I look for those that work with complex revisions of the hips. This is the type of surgeon you need right now. I appreciate all the work you put into finding Dr. Miller and I'm sure he's a fine man. But if complex hip revisions are not what he does most of the time, he's not the person best suited to help you. You need someone with a lot of experience and who has seen problems like yours that are associated with hip replacements many times. So many of our surgeons "specialize" in a variety of orthopedic areas. That's just not possible. A specialist does PRIMARILY one or two things and that's it. For surgeons doing hip replacements, you may have one that does THRs and the complex revisions. But not hips plus, knees, other joints, or other areas or orthopedics. When you add in that they sometimes do teaching, research, write papers, etc......there just aren't enough hours in the day to become an expert at the actual surgical process when you're not DOING it a lot.

 

[lncrwley]

I'm now 76 days from the first surgery. Boy, this is getting old. All I do during the day is sleep or get on the computer. Come to think of it, that's all I do at night too. Thank God for pain meds!

Josephine, I found a copy of my Xrays. They are about 3 weeks old.

 

[Suki]

Hey Lynne

Sounds like you are struggling some, huh? I am really sorry for the problems you have encountered with the THR surgery. Hopefully you have been able to get an appointment with one of the revision specialists Jamie found for you. Though I didn't have a broken bone I did major damage to my 1999 THR and required a revision. Thank God my OS was very upfront with me that he was not qualified to do the revision, and explained the specialized training and experience a revision surgeon requires. Finding the right doc is a real game changer.

I saw on another post that your GP is suggesting you wean down on your meds, while just beginning your PT. I hope you can change his mind, or find another doc, because you may need to continue with those meds for awhile yet.

In any case, I really just dropped by to say hi, and let you know you are in my thoughts. Keep posting, even on your negative days. The folks here are terrific and I have found they offer so much wisdom, great suggestions, humor, and they are a wonderful community of folks that "have been there".

All the best
Suki

 

[Poppet]

Hi there Lynne, just popped by to send you happy, healing vibes from OZ.

Wish I had the answers for you hon, but please post even if you are down, it gives us all the opportunity to do what we do best -

Support Each Other​

 

[Josephine]

Lynne I edited your images because they were far too big and also a little too revealing! But they're not either any more so not to worry!

All I can say is that this fixation has revealed the true extent of the apparent lack of expertise in the complications of hip replacement surgery. I am surprised anyway that any trauma surgeon would choose this fixation, as such a fracture without the implant would always be fixed with an intramedullary, meaning a rod that goes down the middle of the bone. The fracture is right at the bottom of the implant stem (red arrows) and fixing it with a plate on the outside is the wrong thing to do because the mechanics of the situation all work against the bone being able to heal. A revision surgeon would have know that the correct fixation is with a long stemmed implant, not an external plate and wires which, at best, are mechanically weak and unreliable. Fact is, it might heal and it might not. If the stars are in your favour, let's hope it will; but in the meantime, do get to see a revision surgeon and see what he has to say.

 

[lncrwley]

Josephine, thank you for editing the images! I had no idea how to do that without destroying the picture. I have not had a chance to make an appointment with any of the revision specialists, yet. I am still at the mercy of others as I am a "2 footed driver". I know we all learn to drive with the right foot but have always driven with both feet. With that said, I'm afraid that if I slam on the brakes, I will break!!!! I have an appointment with Dr. Miller on Monday. I will see what the Xrays show and will decide what I will do then. The way you explained it, Josephine, makes so much sense to me now.
Suki and Poppet, thanks for the support. I am always here, reading what others are up to and how they are doing so well. You all have completely changed my mind as to the second opinion with a revisionist. I do think I want that second opinion now.

 

[rider1960]

Lynne, I think the second opinion is the way to go.

Dorothy

 

[lncrwley]

Dr Miller had said that the break was a surface break and didn't go all the way through to the prosthesis. Is that even possible????

 

[Josephine]

Lynne, would you post one of your xrays again? I need the extra resolution I lost when I resized it. The one on the right is the one I need. if you can't figure out which one it is, post them all again, full size.

 

[Poppet]

Oh Lynne, I have so much sympathy for you when I see this large size image.. I do hope you can see a revision surgeon soon.. I will be following your journey, sending lots of warm fuzzies