Revision THR Dislocation following revision

[melquist]

Dislocated for the second time last Saturday, 18th. Typing one finger, because when I fell on my fanny, what was thought to be a wrist fracture trying to break my fall ended up being mostly a bad sprain, tiny radial fracture. Have to have another hip revision to replace the cup to help with these dislocations. I am pretty down right now and just sick of 6 years of dealing with this hip. Prior to this set back I was doing fantastic with lots of gardening monitoring my precautions of course. This fall while backing out of my garden toolshed...here we go again.

 

[Celle]

What bad luck! I'm sorry to hear this.

Please let us know when you have a date for your revision.

 

[melquist]

I will thank you.

 

[Mojo333]

Oh, @melquist
I SO hate this for you.
Any ideas from OS why this is a reoccurring issue?
Please know you can come here to vent and hopefully feel the live and concern we feel for you.
Hugsxxxx

 

[melquist]

I needed to vent here with "my people" who know what this is like...the set backs and the victories. My OS had kept the first surgery cup in but replaced the liner. The focus was on the rod, because it was the problem, since it was moving in there like a "windshield wiper" according to the OS revisionist. He feels that the cup is the problem, and he is going to replace it with one that should grab the femoral head to help keep it in. It keeps popping out the front where the original anterior THR was. Thanks for your support!

 

[Pumpkin]

@melquist
Sounds like your original surgeon replaced the liner and you are now seeing a surgeon who specializes in revisions?
Please let us know if this is a correct reading of your post?

a new cup solves the problem.

 

[melquist]

Hi-Sorry for the confusion. The cup wasn't replaced by the revision specialist (2nd surgeon). It is the cup from the original THR in 2015. My current doc is a revision specialist, and he had felt that the original cup would work with the new rod. He didn't want to put me through removing the cup too, because it was a mess in there from the original rod moving back and forth and sinking into my femur. I no longer had any pain with last year's revision, but the now second anterior dislocation indicates a need for a cup that will address chronic dislocations. My original surgery was anterior, and the revision was posterior. Both dislocations were anterior. He is researching this further to make sure he gives me the best outcome. He only does THR and TKR revisions in addition to first time THR and TKR. I appreciated that he felt that twice was enough and wants to go back in immediately. It took me a year to find him, because no other ortho would touch me after the first surgery which to this day baffles me. I had to go a three hour round trip out of the area where I live to get to a revision specialist.

 

[Pumpkin]

Thanks for the clarification, all the best for the cup replacement.

 

[Jamie]

@melquist ... so sorry to hear that you are facing yet another surgery, but it does sound like this procedure will finally get you the result you want. I'm thankful you were tenacious enough to keep searching until you found a good revision surgeon. That's sooooo important in cases like yours. Please let us know how you're doing. Sending (((HUGS))))

 

[melquist]

Hi Everyone: I wanted to post to help anyone else who goes through revisions. I had my second revision procedure on August 25th, 2020. The cup and rod were not changed. The surgeon put in a constraint liner to the cup to help prevent further dislocations (2 to date). I am having a much tougher time this time post op. I am not able to put as much weight on it as before due to pain, weakness, and a general feeling of wobbliness. I am using my walker faithfully. I stopped the tramadol yesterday and switched to ibuprofen, because of the expected constipation from narcotics despite doing all the recommended bowel recommendations. I am finding that the ibuprofen is working much better with pain and inflammation as I would have expected. I do alternate it with tylenol staying within the recommended limits. I have found myself going up and down emotionally, but I knew that could happen from the last time. I have been reading about constraint liners for repeat dislocaters. They are having good results, and hopefully I don't end up being one of the statistics that continues to have issues. I am worn out from 6 years of surgeries, dislocations, and just having your life turned upside down. Those of you on this forum know more than anyone what that is like. I keep coming back to this website, because without it, I would mentally and emotionally have more issues. I know it will all get better, but I also know that I don't know what life will look like after getting through this. It won't be the same. You just can't go through multiple hip replacements/revisions, dislocations and surgeries expecting to go back to life as usual. I know I sound down, but that is part of the healing process too. Thanks everyone for being there.

 

[Pumpkin]

melquist
Glad to hear you had your revision and it is behind you.
I suspect your weakness is due to muscle inhibition that can happen after surgery, even a primary THR.
As you move around your muscles will wake up and you should feel more stable.
Hope you start feeling better soon.

Here is another copy of the Hip Recovery Guidelines, so you will not have to search your thread for previous copies.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

​

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

​

Activity progression for THRs​

6. Access these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Care In Hospital​

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

 

[melquist]

Thank you Pumpkin. Your post is very helpful, and I will go back through the articles. They will help a lot.

 

[Beckford]

I completely understand how you feel. I had to go through six dislocations before I just couldn’t take any more and found a new consultant. I had my revision on May 16 th this year . It’s been a very hard recovery but I am regaining strength and I walk for about an hour a day with my dog, it helps to keep me sane! I know it’s a bit too much because as soon as I get back home all I want to do is lye on the bed for at least an hour sometimes longer. This makes me feel terribly guilty for literally doing nothing but I simply cannot and all my body wants is rest. I think the accumulation of trauma might have caused a fatigue problem because I can sleep for hours. I was told that this will be a long recovery, a year or more as I had all the components changed and the stem was difficult to get out so he had to break the bone.
I had a restraining acetabulum, my consultant said that it’s virtually impossible to dislocate with this type.
Strangely I don’t really think much about the dislocations any more but I am careful. My groin pain is bothering me , I think it’s the tendons that have had such an ordeal. Ice is brilliant, I get immediate relief and comfort from my ice pad. Anyway I just wanted to let you know you are not alone and I have found great comfort and support from Bonesmart. It’s like a lifeline !

 

[melquist]

Hello Beckford: I cannot fathom 6 dislocations. My 2 were traumatic, and knowing what you went through!!! I cannot wrap my head around that...six!! If I understand correctly your revision with an acetabular cup restraint took place in May. I hope you will let us know how it goes. I am 5 days p/o for my cup restraint, and will be hopeful to see how you progress. Thank you so much for posting and your words of encouragement. I agree Bonesmart is an important life line through all of this. It kept me sane last year, and it is once again.

 

[Layla]

Hello @melquist
Thank you for your kind words in regard to BoneSmart. We’re always happy to hear it’s been a great resource for members. It was for me in recovery also. Wishing you all the best as you begin your journey toward complete healing. Fingers crossed this is the ticket and last surgery you’ll have to endure.
A great Sunday and week ahead to you!

 

[Mojo333]

@melquist
Such a soldier you are.
It is so hard to see the light at the end of the case tunnel when there are so many roadblocks in the way.
Healing hugs and good on you for keeping the faith!!!!
Big healing Hugs coming your way.

 

[Hippielife]

Revision surgery is always a bit tougher to get thru and I am very grateful I had the surgery . I had the left femur implant replaced because it was loose. Also the replacement of the ball joint and the metal cup was replaced with a ceramic cup. Along with the cerclage system to hold the new femur implant In place while the bone heals. This is all designed to prevent hip joint component failure and dislocation.

The causes of a loose femur implant in my case had several effects on tissue as microscopic metal debris builds up . Deterioration in my case called metallosis had caused the femur implant to loosen. Metallosis can cause dislocation of non-cemented implants as the healthy tissue that would normally hold the implant in place is weakened .

i’m not saying that anyone has what I had, but there are many reasons for hip dislocations. During my revision surgery metallosis was found. It did not show up on many MRI’s or X-rays.

The good news is I had the right hip replaced in 1999 and the original components are still in place no issues at all. That’s 21 years on the right hip and it’s still ticking...I garden, ride horses, walking is best exercise...I know that THR is the absolute best option for getting mobility and life back. It can be tricky at times but we all know it’s a better life with mobility and freedom.

Sending many blessing to all the hippies who have shared their stories and the many mods who have been a source of support for so many. Stay happy, healthy and share the love.

 

[Beckford]

Hi hippie life
So interesting reading everyone’s story and journey. So many factors come into play.
Could you please tell me how long it took you to recover from your revision.
I am just over three months. It feels like an eternity and I am still struggling to get full weight bearing.
I do try every day to walk about unaided but then I end up in pain

 

[melquist]

Hi Hippie and Beckford: I am hanging on every word that you both share, because you are both ahead of me in this journey. I am recovering much slower this time that I did after my first revision. My second dislocation was 6 weeks before this second revision, so I feel that it has contributed to it being slow going. I am 7 days post op today, but I have noticed that the last two mornings I have felt better. I am hanging onto my walker as an essential tool which had never been the case before. I am trying to allow my body to show me the pace it wants to go and not push it too fast. I look forward to hearing what you both have to say about your constraint liners, since it is what I have not found a lot of information about other than one statistic which was a 91% success rate. That is a very good percentage with revision dislocations and gives me hope. Thank you!!

 

[Beckford]

I used my walker for at least two weeks but in reality I spent most of my time lying on my bed. Multiple surgeries + multiple dislocations and all the stress and anxiety that goes with that just wiped me out, I was exhausted and even now at three months I get tired a lot. Often I have a couple of hours sleep in the afternoon, it really helps to get me through the day otherwise I am just too tired to prepare a meal in the evening. You do get into a sort of routine, it takes time but eventually you do start to plan your day a little bit and it helps the time go by. As we know, revision surgery is not a quick fix and requires so much patience. As time goes by you will feel less anxious about dislocating but be extra cautious for the first few months to let the hip capsule heal. Just don’t take any risks and I am sure it will stay in position. As each week goes by you will start to feel better and see improvements, that will give you a real lift. I did 15 minutes on my bike today which was 5 minutes more than yesterday, even something as small as that is a good mood booster.