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THR gwenc's recovery

Here is a picture of my leg taken 9 weeks post op. @Josephine what do you think of the positioning of the stem?

[Bonesmart.org] gwenc's recovery
 
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Aye, aye, aye - I think it's loose!

Yellow arrows point to a space all around the stem.
The red arrows show where the inside of the bone is remodelled. This means that the stem is toggling so the tip is knocking against the inside of the bone. Bone doesn't much like this and dies back as a result. The more the stem toggles, the more remodelling occurs and the looser it gets.

[Bonesmart.org] gwenc's recovery
[Bonesmart.org] gwenc's recovery



You need to see a surgeon who specialises in revision surgeries because they invariably deal open-mindedly with such cases. But first, you need a consultation with such a surgeon to see if this really is the case or not.

Please be assured that if this proves to be the case, this was NOT your fault! The cause of it is the failure of the stem to meld with the bone. There can be a number of causes for this but the primary ones are failure of the femur to not have been properly and accurately reamed to take the implant. This is a crucial step when doing an uncemented hip. The other common-ish cause is a poor quality bone such as osteoporosis. In these cases, if the new bone doesn't grow normally or at all, then it fails to meld with the special surface on the implant and thus secure the stem and so far as I can see, there is not evidence of this having happened in this case.
 
Thinking of you as Irma comes on in..Floridians are tough as Texans...stay safe.

No comment on Jo's assessment except to say that might confirm some of your concerns about how you have been progressing. Guessing you didn't need that news and guessing you well decide not to be bouncing around on the horse right now...PLEASE....till you check on it.

Thinking of you:console2:
 
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That X-ray was at 9 weeks?
Need new one now I'm guessing.
 
@Mojo333 I am due to see my O/S on the 21st of this month. I am sure he will take new xrays then, and I will be sure to discuss this with him also.

@Josephine, thank you for your frank reply, although of course this is NOT what I want to be hearing. Is there any chance at all you might be wrong? Please, please, please????!!!!!

Also I am wondering if this does turn out to be the case, is there any harm in waiting to have revision surgery as long as I am not in too much pain? Based on your earlier comments when I asked about whether or not bone can heal itself after a stem loosens I am guessing this does not much matter since if the bone is dead, its dead.

I dread the thought of going through yet another surgery, and by all accounts revisions are much less successful and harder to recover from than the original. Oh dear, dear, dear, I am devastated!!!
 
Hi @gwenc
First....best wishes for your safety as you ride out the hurricane.
I'm sure Jo's assessment is worrisome. I just want you to know you're in my prayers
as you take the next steps to wade through this.
Sending a hug.
 
gwenc said:
Is there any chance at all you might be wrong?
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Worry not! Josephine has just given you information so that you can have a good discussion with your surgeon. Get another x-ray and tell your surgeon you are concerned.
gwenc said:
I dread the thought of going through yet another surgery, and by all accounts revisions are much less successful and harder to recover from than the original.
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Not necessarily! If the revision is done by a surgeon who specialises in revision surgery you should be fine. If your current surgeon refuses to consider all the options do get a second opinion.
 
gwenc said:
Is there any chance at all you might be wrong? Please, please, please????!!!!!
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I really don't think so. The evidence on the xrays is pretty compelling and supported by your history. I have been doing this kind of thing (reading xrays) for years. Over those years, I've always joined in with many experienced surgeons who were teaching doctors, new and experienced, about reading xrays. So I learned a lot.
gwenc said:
Also I am wondering if this does turn out to be the case, is there any harm in waiting to have revision surgery as long as I am not in too much pain?
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Well yes, because that 'remodelling' I mentioned can cause serious damage that could even lead to a crack in the bone. And you do NOT want that! But a few weeks or months might be okay.
gwenc said:
Based on your earlier comments when I asked about whether or not bone can heal itself after a stem loosens I am guessing this does not much matter since if the bone is dead, its dead.
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But the bone isn't dead. If it were, it couldn't get remodelled!
gwenc said:
by all accounts revisions are much less successful and harder to recover from than the original
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Don't know where you've read that but it's never been the case in my experience. Most revisions are not that difficult to perform and so the recovery likewise isn't too different from the original surgery. I think yours would most likely fit into the category.
 
I'm so sorry to hear all you are going through. Not only the worry of the hurricane and your horses but this question with your hip. Hopefully your appointment comes quickly and you can get some answers. Sending positive and healing thoughts your way :flwrysmile:
 
It will only 'definitively' show it if the surgeon or radiographer is knowledgeable enough to see it! As always, in the end these things are in the hands of human beings!

But again, the bone is not 'dying'. It is simply being damaged by the knocking of the metal implant. You can do the same with an apple if you knock it with something metal, eventually the flesh will bruise and die. But the rest of the apple will be okay.
 
@Josephine Thanks for your prompt reply. So here is my plan: I got my appointment moved up to this coming Thursday afternoon (day after tomorrow). I would like to know if you have any suggestions as to what to ask, and specifically HOW to ask so that I don't put him on the defensive immediately. I am open to suggestions thanks so much for your help with this.
 
It this with your original surgeon? Please tell me you're not going to let him within a million miles of your hip again!

But whoever you see, if it helps, print off the pictures I gave you (with the arrows) and take it to show him. He'll either nod or chuck it in the bin!
 
@gwenc oh man...all this and a hurricane too. My prayers are with you for Thursday and meeting the OS.

On the bright side, I'm so glad that saddle is so right for you! Is a saddle like this made to your specs/measurements like pointe shoes?
 
Yes this is the original surgeon. I will not have him do the revision. I just want to see what he says
 
Gwen, You're on my mind.
I'm praying for your peace of mind as you journey through this.
Hopefully you'll get answers soon and be able to move forward.
We're all behind you......as you know.
Hugs
@gwenc
 
zauberflöte said:
@gwenc oh man...all this and a hurricane too. My prayers are with you for Thursday and meeting the OS.

On the bright side, I'm so glad that saddle is so right for you! Is a saddle like this made to your specs/measurements like pointe shoes?
Click to expand...
Yes, ZF, all custom made. Love it. But now afraid to ride lest I damage myself more. I still am hoping against hope that this is all a bad dream....
 
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