No offense to your sister in law but that is quite a pronouncement to make. As Krista wrote, doing nothing will definitely not change anything. You have some hard decisions to make, gather opinions and then I wish you the best on making the best decision for you.
THR Grannyhippy's Recovery Thread
- Thread starter Grannyhippy
- Start date
OP
OP
Grannyhippy
senior
Thank you so much @Krista. Your words give me hope of a good recovery if I have corrective surgery. I forgot to mention in my last post that the reviewing surgeon showed me one of my x-rays and said the stem was in varus position. I think he said varus and not valgus and to me it was pointing outward on the x-ray. When I had viewed these same x-rays some time ago I thought the stem was at an angle and I mentioned it to my GP and sister-in-law. He did not comment and she said that it can appear to be at an angle because of the way I am placed on the table when being x-rayed. She has not seen the x-rays.
And don't worry I certainly will go ahead and have a revision hip replacement if it is required. I can't go on with this hip instability for the rest of my life.
I mentioned to the reviewing surgeon that my pedorthist was worried I would have a fall and the surgeon said he was also worried I would have a fall. The pedorthist built up one orthotic and gave me rocker soles on my shoes to help prevent me tripping.
Keep up the good work with your strength building exercises Krista. It is good to see you are getting positive results.
And don't worry I certainly will go ahead and have a revision hip replacement if it is required. I can't go on with this hip instability for the rest of my life.
I mentioned to the reviewing surgeon that my pedorthist was worried I would have a fall and the surgeon said he was also worried I would have a fall. The pedorthist built up one orthotic and gave me rocker soles on my shoes to help prevent me tripping.
Keep up the good work with your strength building exercises Krista. It is good to see you are getting positive results.
Last edited by a moderator:
OP
OP
Grannyhippy
senior
Thank you @leejaa. I will have the surgery if the surgeon I am seeing in a few weeks says it is necessary. I agree I cannot go on the way I am.
To be honest my sister-in-law has never seen any of my x-rays or scans, only copies of some of the reports and she is making comments from those and observing the way I walk. We don't really see each other face to face except at Christmas time and occasionally on other family get-togethers such as my 70th birthday last October and often we just socialise then and don't always talk about my problems. I don't know what her abilities are as a physiotherapist and my husband has only ever had a couple of sessions with her over twenty years ago when she used to have her own practice. On Christmas day last year we were sitting together at the table and did start talking about my hip. She said then that maybe the damage is already done and my may never get back to normal. She asked me which exercises my physiotherapist had give me, I told her some of them and she said to keep on doing them at home but not to do the straight leg raises. I had told her I got pins and needles around the ankle when I did that exercise. I noted that @Krista had a problem with that exercise as well even when she used something to pull her leg up. I don't really bother with physiotherapy any more but I do some of the water exercises in my neighbour's pool.
My sister-in-law is my husband's younger brother's wife. She did offer to treat me but she lives too far away and I don't like to take advantage of the offer for two reasons. I don't want to use her and also if I did have her as a therapist and was not happy with the treatment it could create an awkward situation. Many years ago we found out a friend of ours was going to her for treatment. She was having problems with her shoulders from working in cramped conditions and lots of keyboard work. She had plaster taped across her back in a x shape and other strapping but she said my SIL's treatment did not seem to be doing much to help her but not to tell her she said so. I kept quiet about that.
To be honest my sister-in-law has never seen any of my x-rays or scans, only copies of some of the reports and she is making comments from those and observing the way I walk. We don't really see each other face to face except at Christmas time and occasionally on other family get-togethers such as my 70th birthday last October and often we just socialise then and don't always talk about my problems. I don't know what her abilities are as a physiotherapist and my husband has only ever had a couple of sessions with her over twenty years ago when she used to have her own practice. On Christmas day last year we were sitting together at the table and did start talking about my hip. She said then that maybe the damage is already done and my may never get back to normal. She asked me which exercises my physiotherapist had give me, I told her some of them and she said to keep on doing them at home but not to do the straight leg raises. I had told her I got pins and needles around the ankle when I did that exercise. I noted that @Krista had a problem with that exercise as well even when she used something to pull her leg up. I don't really bother with physiotherapy any more but I do some of the water exercises in my neighbour's pool.
My sister-in-law is my husband's younger brother's wife. She did offer to treat me but she lives too far away and I don't like to take advantage of the offer for two reasons. I don't want to use her and also if I did have her as a therapist and was not happy with the treatment it could create an awkward situation. Many years ago we found out a friend of ours was going to her for treatment. She was having problems with her shoulders from working in cramped conditions and lots of keyboard work. She had plaster taped across her back in a x shape and other strapping but she said my SIL's treatment did not seem to be doing much to help her but not to tell her she said so. I kept quiet about that.
Yes, family makes it difficult to be a patient at times. The same obligations/feelings can happen in work settings also. I work at a small community hospital who has some excellent surgeons but no real joint replacement specialists so I chose to go to a different surgeon who specializes in joint replacements and have the surgery at a larger hospital with a dedicated joint replacement center. I chose this for the surgeon's expertise but also I wanted to have the freedom to be a patient - to be demanding if necessary, to be cross and in pain and not necessarily to "understand how things are". I am not saying that my hospital would do that but staff when they know you expect you to understand and administration to understand if you have a complaint. I spoke to my PCP about my choice and he totally understood as he had some procedures done elsewhere also- he said he could not see the nurses who he works with as a physician having to take care of him and putting in or taking out his catheters plus we both wanted to limit visitors and even when you say you do not want any- people you work with assume it does not mean them.
I wish you the best on your path to a full recovery and will keep an eye on your postings. Some have longer roads than others to reach the promised land, it seems.
I wish you the best on your path to a full recovery and will keep an eye on your postings. Some have longer roads than others to reach the promised land, it seems.
OP
OP
Grannyhippy
senior
A few weeks ago I mentioned I sort the opinion of another orthopaedic surgeon regarding my THR and he gave me a referral to yet another orthopaedic specialist to get his opinion.
I saw that doctor yesterday and he agreed that I do need revision surgery. The stem is too short, there has been subsidence even though the prosthesis is not loose and the acetabular cup although at a good angle is sitting too low. He could feel some sort of defect when he pressed on the trochanteric area and it also felt like the muscles had parted and he thought he could feel a hernia in the scar area. He could just replace the stem but ideally the acetabular cup should be higher up in the pelvis. So as far as I am concerned if he is going to fix the problem he may as well do it properly and replace the lot which is what he suggested. There is a 1.5 centimetre leg length discrepancy.
I asked whether my replacement hip would be ceramic on ceramic which I have now and he said it would most likely be polyethylene because there is a greater chance of dislocation after revision surgery. I did not ask why polyethylene would be better but I wished I had.
He cannot guarantee a complete recovery but maybe an eighty to ninety per cent recovery because of the previous muscle atrophy and fatty deposits. He thought it odd that the nerve conduction tests done in 2015 showed partial denervation in all the lower extremities but the tests to the gluteus muscles in 2016 showed nothing remarkable. He said because the muscles are working that is a good sign and yes there is hope of a reasonably good recovery but if I do nothing I will not get any better. So, even if I only have an eighty to ninety percent recovery I will still be better off than I am now. My limp is very bad. He also said that I am an "interesting case".
Another thing this doctor said was that he could not understand why the surgeon who did the initial surgery had not had an MRI done on my hip since the surgery. I have only a an MRI of my lower back since then because of my back problems and that only showed the top of the hip prosthesis.
This doctor was quite willing to do the surgery but since the referring specialist only asked for his opinion on the referral he was not sure whether the intention was for this doctor to do the surgery or just give his opinion. So he suggested I make an appointment to see the referring surgeon to discuss this matter and he would also write a letter to that doctor.
I am now seeing the referring surgeon on 7th March to discuss the conversation which followed between the two doctors. I was under the impression he wanted the doctor I saw yesterday to do the surgery but that surgeon did not want to operate without the approval of the first doctor. Ultimately of course the final decision on who does the surgery is up to me and looking at the two doctors' profiles the surgeon I saw yesterday does about 400 operative surgeries a year including 50 hip and knee revisions so he has plenty of experience.
@Josephine, When I eventually have the revision surgery do I have to start a new Bonesmart thread under revisions or do I just continue on with this thread? Also would you have any idea why a polyethylene replacement would be better than a ceramic one for a revision THR because I did not ask the doctor why he made that choice.
I saw that doctor yesterday and he agreed that I do need revision surgery. The stem is too short, there has been subsidence even though the prosthesis is not loose and the acetabular cup although at a good angle is sitting too low. He could feel some sort of defect when he pressed on the trochanteric area and it also felt like the muscles had parted and he thought he could feel a hernia in the scar area. He could just replace the stem but ideally the acetabular cup should be higher up in the pelvis. So as far as I am concerned if he is going to fix the problem he may as well do it properly and replace the lot which is what he suggested. There is a 1.5 centimetre leg length discrepancy.
I asked whether my replacement hip would be ceramic on ceramic which I have now and he said it would most likely be polyethylene because there is a greater chance of dislocation after revision surgery. I did not ask why polyethylene would be better but I wished I had.
He cannot guarantee a complete recovery but maybe an eighty to ninety per cent recovery because of the previous muscle atrophy and fatty deposits. He thought it odd that the nerve conduction tests done in 2015 showed partial denervation in all the lower extremities but the tests to the gluteus muscles in 2016 showed nothing remarkable. He said because the muscles are working that is a good sign and yes there is hope of a reasonably good recovery but if I do nothing I will not get any better. So, even if I only have an eighty to ninety percent recovery I will still be better off than I am now. My limp is very bad. He also said that I am an "interesting case".
Another thing this doctor said was that he could not understand why the surgeon who did the initial surgery had not had an MRI done on my hip since the surgery. I have only a an MRI of my lower back since then because of my back problems and that only showed the top of the hip prosthesis.
This doctor was quite willing to do the surgery but since the referring specialist only asked for his opinion on the referral he was not sure whether the intention was for this doctor to do the surgery or just give his opinion. So he suggested I make an appointment to see the referring surgeon to discuss this matter and he would also write a letter to that doctor.
I am now seeing the referring surgeon on 7th March to discuss the conversation which followed between the two doctors. I was under the impression he wanted the doctor I saw yesterday to do the surgery but that surgeon did not want to operate without the approval of the first doctor. Ultimately of course the final decision on who does the surgery is up to me and looking at the two doctors' profiles the surgeon I saw yesterday does about 400 operative surgeries a year including 50 hip and knee revisions so he has plenty of experience.
@Josephine, When I eventually have the revision surgery do I have to start a new Bonesmart thread under revisions or do I just continue on with this thread? Also would you have any idea why a polyethylene replacement would be better than a ceramic one for a revision THR because I did not ask the doctor why he made that choice.
Krista
post-grad
@Grannyhippy, terrific news! They can never guarantee 100% recovery, and an estimate of 80-90% is a very good one. And, who knows, maybe you will be surprised with a better result than that. Looking forward to hear about your progress to the revision and repairs. If I were you, I would also want them to fix it all!
Josephine
NURSE DIRECTOR EMERITA
Polythene has a much greater track record than ceramic but truth of it is that there really isn't much to choose between to two as far as functionality and performance are concerned.
I'm not so sure. 50 hips and knees are actually low numbers as it could be 25 hips and 25 knees including revisions. Personally I'd want to see hip 20-30 revisions alone before I called it 'plenty' of experience. Sorry to cast a blight on it all but you need to know these things. I'm also quite bemused at all the things he discovered as I've never heard of some of them before! For instance ...
If there has been 'subsidence' then chances are that it's loose!
I have NO idea what he meant by this!
Nor this.
Continue with this thread and we'll change the prefix for you.
OP
OP
Grannyhippy
senior
Sorry @Josephine I did not explain myself clearly. The doctor I saw yesterday is an Assoc. Professor and he is head of the Bone and Joint Clinic. This is a small excerpt from his profile page on line A/Prof. xxxx performs on average approximately 400 operative procedures per year of which about 350 are joint replacement procedures. These comprise about 120 total hip replacements, 150 total knee replacements, 30 unicompartmental knee replacements and 50 revision (re-do) hip and knee replacements.
Yes I know that could be only 25 hip and 25 knee replacements and I did not ask how many were hip revisions. I don't know of any doctor who does more revision surgeries than that.
How many hip revision surgeries a year would you consider being adequate for the doctor to be well experienced in that area?
I might add that being a professor or associate professor does not necessarily mean they are the best person for the job. The surgeon who did my original THR is a professor.
Thank for the information about the polyethylene prosthesis.
I don't know what he meant by a defect in the trochanteric area either but it hurt with a sharp, stinging sensation when he pressed on that area. It also used to hurt when my physiotherapist pressed firmly when she massaged around that area. She just thought it might be scar tissue causing the pain.
Yes I know that could be only 25 hip and 25 knee replacements and I did not ask how many were hip revisions. I don't know of any doctor who does more revision surgeries than that.
How many hip revision surgeries a year would you consider being adequate for the doctor to be well experienced in that area?
I might add that being a professor or associate professor does not necessarily mean they are the best person for the job. The surgeon who did my original THR is a professor.
Thank for the information about the polyethylene prosthesis.
I don't know what he meant by a defect in the trochanteric area either but it hurt with a sharp, stinging sensation when he pressed on that area. It also used to hurt when my physiotherapist pressed firmly when she massaged around that area. She just thought it might be scar tissue causing the pain.
Josephine
NURSE DIRECTOR EMERITA
Well that looks better!
I would rather say nothing under 20 per year but the more the better.
Well, that's a no brainer to me - it's Trochanteric bursitis
OP
OP
Grannyhippy
senior
I now know the date of my hip revision surgery. It will be on May 12th. The orthopaedic surgeon has booked my surgery for first thing in the morning as it will be a lengthy one. His receptionist said it could take up to 4 1/2 hours and he had to book extra theatre time to allow for this.
The surgeon performing my operation will be the doctor I went to for a second opinion regarding my ongoing problems since my THR in 2015. This surgeon had also referred me to another OS who is an Associate Professor for his opinion.
Both OS's said the stem was too short and needed to be replaced with a longer one. Both said that the acetabular cup was at a good angle and could be left in but the Associate Professor thought that it was sitting too low and ideally should be higher up in the pelvis. He thought it better to replace both the stem and the cup. He was willing to operate but did not want to do so if the referring surgeon intended to. Which he did.
The surgeon performing my operation prefers not to replace the cup because it would make it a longer and more complicated surgery. He will, however, have one available on hand if he finds it does need replacing. The Associate Professor will be available to assist.
The doctor said that I will be 5-7 days in the hospital and then be transferred to a rehabilitation hospital for another 7-10 days approximately. I am to book a pre-surgery consultation and information session at the hospital a week to a fortnight before my surgery. I have been told I will probably have further x-rays etc. done on that day and that the anaesthetist usually attends these sessions so it will give me a chance to ask any questions about anything I am worried about.
This OS is concerned about the fact that I had low blood pressure for two days after the original surgery and needed to have the speed of the drip in my arm increased to help raise my BP. He also said it was not normal to have the drainage tube in for four days until the blood started to separate in the tube. He said I must have bled a lot for that to happen.
The surgeon performing my operation will be the doctor I went to for a second opinion regarding my ongoing problems since my THR in 2015. This surgeon had also referred me to another OS who is an Associate Professor for his opinion.
Both OS's said the stem was too short and needed to be replaced with a longer one. Both said that the acetabular cup was at a good angle and could be left in but the Associate Professor thought that it was sitting too low and ideally should be higher up in the pelvis. He thought it better to replace both the stem and the cup. He was willing to operate but did not want to do so if the referring surgeon intended to. Which he did.
The surgeon performing my operation prefers not to replace the cup because it would make it a longer and more complicated surgery. He will, however, have one available on hand if he finds it does need replacing. The Associate Professor will be available to assist.
The doctor said that I will be 5-7 days in the hospital and then be transferred to a rehabilitation hospital for another 7-10 days approximately. I am to book a pre-surgery consultation and information session at the hospital a week to a fortnight before my surgery. I have been told I will probably have further x-rays etc. done on that day and that the anaesthetist usually attends these sessions so it will give me a chance to ask any questions about anything I am worried about.
This OS is concerned about the fact that I had low blood pressure for two days after the original surgery and needed to have the speed of the drip in my arm increased to help raise my BP. He also said it was not normal to have the drainage tube in for four days until the blood started to separate in the tube. He said I must have bled a lot for that to happen.
Krista
post-grad
How good it is that the revision is scheduled, and you have so much information for preparation, @Grannyhippy. A little over 7 weeks to go...and then on to recovery! 
Horseshoe
graduate
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I'm glad you have a date to get this painful hip sorted out @Grannyhippy. Your new surgeons sound very experienced and confident. I had low BP following both thrs from anesthesia meds and had a drip for just one day following my first thr, believe it helped reduce swelling. Didn't have a drain for the second and it felt like a big log, I couldn't flex my knee at all.
I hope this revision goes well for you
I hope this revision goes well for you
OP
OP
Grannyhippy
senior
Yes @Krista, not long to go now. I am both looking forward to and a little apprehensive about the surgery but my OS assures me he has a good anaesthetist.
@Horseshoe, I know it is not unusual to have low BP after surgery but my anaesthetist at the time did think I might need a blood transfusion before I went home. I didn't require one though. I think you are right about the drainage tube preventing swelling as I cannot recall any swelling on the operated leg after the surgery. Just bruising. I also never needed to ice the leg for pain or swelling as everything seemed to be under control.
I forgot to ask this surgeon if he was going to give me ceramic on ceramic which I have now or change the head to polyethylene which the Assoc. Prof. was going to use if he did the surgery. I will try to remember to ask on my information day. I guess it does not matter what he uses anyway as he will be the best judge of what suits my case.
@Horseshoe, I know it is not unusual to have low BP after surgery but my anaesthetist at the time did think I might need a blood transfusion before I went home. I didn't require one though. I think you are right about the drainage tube preventing swelling as I cannot recall any swelling on the operated leg after the surgery. Just bruising. I also never needed to ice the leg for pain or swelling as everything seemed to be under control.
I forgot to ask this surgeon if he was going to give me ceramic on ceramic which I have now or change the head to polyethylene which the Assoc. Prof. was going to use if he did the surgery. I will try to remember to ask on my information day. I guess it does not matter what he uses anyway as he will be the best judge of what suits my case.
OP
OP
Grannyhippy
senior
Only three weeks to go until my revision hip replacement. Counting down the weeks.
@Josephine, I have a question for you. I started to fill out the Bonesmart survey which came through my email address but when I typed in the number of months since my latest hip replacement surgery as 22 months, it would not accept that. I then typed in Twenty two months and also tried 22. None of these answers were accepted by the survey and I could advance no further with it. How am I supposed to answer that question?
@Josephine, I have a question for you. I started to fill out the Bonesmart survey which came through my email address but when I typed in the number of months since my latest hip replacement surgery as 22 months, it would not accept that. I then typed in Twenty two months and also tried 22. None of these answers were accepted by the survey and I could advance no further with it. How am I supposed to answer that question?
OP
OP
Grannyhippy
senior
Thanks, @Josephine. I followed your advice and just typed 22 in the survey and it has accepted that answer.
OP
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Grannyhippy
senior
Only two days till my pre-admittance appointment. @ Josephine if I remember correctly (and I can't find your thread) you are going for your shoulder surgery on 3rd May? If so I wish you all the best and hope all goes well on the day.
OP
OP
Grannyhippy
senior
I went to my pre-admission appointment today. All forms have been filled in, new x-rays, ECG, blood tests and urine samples were taken. I am apparently healthy so that is good. The pre-admission nurse I saw today will be in theatre assisting with the operation. I also had a consultation with the anaesthetist so I had the opportunity to ask about anything I was concerned about and also give him my previous anaesthesia history. Both the anaesthetist and nurse were lovely people. I kept getting told by various staff and a patient in the waiting room that I picked a very good team for my surgery. I have the best with both the surgeons and the anaesthetist.
The surgeon who is performing the operation sent me to an Assoc. Prof. for a second opinion. The Assoc. Prof. was willing to do the surgery but not if the first doctor wanted to do it himself which he did. So, the arrangement they have worked out between them is that the first surgeon will be operating and the Assoc. Prof. will be assisting. The nurse told me that the doctor doing the surgery had been taught by the Assoc. Prof. and that they are both excellent doctors.
I have been told that everything will be much the same as with the first THR but will be two or three fold over. I will have both a spinal block and general anaesthesia as I did with the first. The surgery will take at least three hours and could be longer. The cut will be much longer. This time round I will probably not even have a drainage tube or if I do it will only be in for a day or two. The anaesthetist said tranexamic acid will be used during surgery to help prevent blood loss.
When I had my original THR I woke up back in my room post surgery and I was cold and shivering and had low blood pressure.
This anaesthetist said that the operating rooms are cold to help keep them germ-free and that both the patient and the surgical team become cold during the operation. He even gets cold when wearing one of those surgical "space suits". I will be warmed with blankets and hot air during the procedure.
I will probably have low blood pressure again post surgery because of the spinal block and because this is a revision surgery I will most likely need a blood transfusion. Surgery is on 12th May.
The surgeon who is performing the operation sent me to an Assoc. Prof. for a second opinion. The Assoc. Prof. was willing to do the surgery but not if the first doctor wanted to do it himself which he did. So, the arrangement they have worked out between them is that the first surgeon will be operating and the Assoc. Prof. will be assisting. The nurse told me that the doctor doing the surgery had been taught by the Assoc. Prof. and that they are both excellent doctors.
I have been told that everything will be much the same as with the first THR but will be two or three fold over. I will have both a spinal block and general anaesthesia as I did with the first. The surgery will take at least three hours and could be longer. The cut will be much longer. This time round I will probably not even have a drainage tube or if I do it will only be in for a day or two. The anaesthetist said tranexamic acid will be used during surgery to help prevent blood loss.
When I had my original THR I woke up back in my room post surgery and I was cold and shivering and had low blood pressure.
This anaesthetist said that the operating rooms are cold to help keep them germ-free and that both the patient and the surgical team become cold during the operation. He even gets cold when wearing one of those surgical "space suits". I will be warmed with blankets and hot air during the procedure.
I will probably have low blood pressure again post surgery because of the spinal block and because this is a revision surgery I will most likely need a blood transfusion. Surgery is on 12th May.
MyAussieGirl
supremo
Many prayers for you I bet it seems never ending.
OP
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Grannyhippy
senior
Thank you for your prayers @MyAussieGirl. Yes, it has seemed like an eternity waiting for something to be finally done to fix my problems. I can't wait for it to be over and done with and be on my way to healing.
Today after talking with the nurse I stood up and stepped back to turn and open the door. She could see I was unsteady on my feet and she went to grab me but I regained my balance. She made a remark about how good it will be for me after I have the surgery.
I am often unsteady on my feet when not using my cane even when just taking a few steps here and there such as unloading and loading the shopping trolley.
It's less than a fortnight since your surgery. How are you coping now?
Today after talking with the nurse I stood up and stepped back to turn and open the door. She could see I was unsteady on my feet and she went to grab me but I regained my balance. She made a remark about how good it will be for me after I have the surgery.
I am often unsteady on my feet when not using my cane even when just taking a few steps here and there such as unloading and loading the shopping trolley.
It's less than a fortnight since your surgery. How are you coping now?
