Revision THR Has anyone ever heard of late onset metal hypersensitivity in a ceramic on ceramic hip
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Z15
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Cardie,
I'm doing great ...thanks for asking. Off crutches and off pain meds and getting around just fine. The thing limiting me at this point is not wanting any stumbles, strains or falls to compromise the stitches. That's the weak link for me now.
During the surgery my doc did a few things that he and I had discussed.
He went with the shortest possible neck and angle that worked. The kit has a variety of angles and lengths...if you haven't seen what these modular units look like you can see them here (Stephen Murphy happens to be my doc): https://www.stephenmurphy.org/cv/Steppacher Managing Leg Length and Stability 2008.pdf
That did 2 things. Shortened the moment arm from a torque perspective given that I am now stressing the less strong titanium neck rather than chromium cobalt. From a physics perspective, the shorter the "lever" the less torque is applied to the neck and hopefully the better durability and longer life (of the part). But he had to do that without shortening it to the point that I would be at risk of dislocation. Still no precautions imposed post surgery but I did enquire as to what actions/movements would make me vulnerable.
The other thing it did was help me with my LLD. I can feel the difference in a good way....
He took out all the previous scar tissue on the skin. My first surgery left a "nice" 3.5 inch scar. The second left a fairly lumpy 6 inch scar. I think that yours truly gets credit for the lumpiness. Without the bone discomfort I started sleeping on preferred side really quickly and I think that stretching on the skin as I rolled on it did nothing good for the cosmetic aspect of the scar. (I was probably sleeping on it after a week) So he took out all the superficial scar tissue which required him to make this incision slightly larger than the largest scar so as to taper the tissue removal. We'll see if it is an improvement but I am going to try to hold off on my precious left side sleeping position for as long as I can.
He did give me the bag of blood during surgery which is his general practice. If Lance Armstrong can benefit and be stronger from some blood doping then so can I when I am enduring surgery!
I am not sure if I mentioned this before and since I can't find it in my thread I will tell it again...
In the 2 prior surgeries I remember being IN the recovery room...I remember talking to people...I remember hearing other patients...but I could NOT picture the room...at all. The anesthesiologist said they weren't surprised...the amnesiatic effects can do that and really play with your memory even though I was liking having fairly normal conversations with folks. So i REALLY TRIED to concentrate on the appearance of the recovery room this time...and it worked. Not sure if the concentration made the difference but I do have a pretty clear memory (that I think is real). Anyway...that was the my fun little game that I played. I'm easily amused...
Be well,
Z
I'm doing great ...thanks for asking. Off crutches and off pain meds and getting around just fine. The thing limiting me at this point is not wanting any stumbles, strains or falls to compromise the stitches. That's the weak link for me now.
During the surgery my doc did a few things that he and I had discussed.
He went with the shortest possible neck and angle that worked. The kit has a variety of angles and lengths...if you haven't seen what these modular units look like you can see them here (Stephen Murphy happens to be my doc): https://www.stephenmurphy.org/cv/Steppacher Managing Leg Length and Stability 2008.pdf
That did 2 things. Shortened the moment arm from a torque perspective given that I am now stressing the less strong titanium neck rather than chromium cobalt. From a physics perspective, the shorter the "lever" the less torque is applied to the neck and hopefully the better durability and longer life (of the part). But he had to do that without shortening it to the point that I would be at risk of dislocation. Still no precautions imposed post surgery but I did enquire as to what actions/movements would make me vulnerable.
The other thing it did was help me with my LLD. I can feel the difference in a good way....
He took out all the previous scar tissue on the skin. My first surgery left a "nice" 3.5 inch scar. The second left a fairly lumpy 6 inch scar. I think that yours truly gets credit for the lumpiness. Without the bone discomfort I started sleeping on preferred side really quickly and I think that stretching on the skin as I rolled on it did nothing good for the cosmetic aspect of the scar. (I was probably sleeping on it after a week) So he took out all the superficial scar tissue which required him to make this incision slightly larger than the largest scar so as to taper the tissue removal. We'll see if it is an improvement but I am going to try to hold off on my precious left side sleeping position for as long as I can.
He did give me the bag of blood during surgery which is his general practice. If Lance Armstrong can benefit and be stronger from some blood doping then so can I when I am enduring surgery!
I am not sure if I mentioned this before and since I can't find it in my thread I will tell it again...
In the 2 prior surgeries I remember being IN the recovery room...I remember talking to people...I remember hearing other patients...but I could NOT picture the room...at all. The anesthesiologist said they weren't surprised...the amnesiatic effects can do that and really play with your memory even though I was liking having fairly normal conversations with folks. So i REALLY TRIED to concentrate on the appearance of the recovery room this time...and it worked. Not sure if the concentration made the difference but I do have a pretty clear memory (that I think is real). Anyway...that was the my fun little game that I played. I'm easily amused...
Be well,
Z
calikat
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@Kim22 My OS says no, but I am pretty sure there is a LLD. My slacks hit a little higher on that leg etc. I would say it is about 1/4 to 1/2 an inch. My PT did not measure my LL. I have not been back in the past two weeks since I went back to work. I am not limping, but something just feels off or out of alignment, and it definitely causes pain. Certain movements cause a sharp jolt. That is why I was wondering what Z's symptoms were. It is not bad enough that I want to go in and have it surgically repaired. But it would explain a lot of what I am feeling. I am still hoping it will get better, but I still seem to be at a stand still.
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Z15
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Calicat,
My LLD was measured in X-rays at 3/8 of an inch...and that was just looking at the difference in the hip due to the prosthesis and surgery. He went in planning (first surgery) to add "a little length" as I will likely need my other hip done in the future and he was putting things where they are supposed to be prior to the cartilage loss. When PT measured the whole leg, they got just over 1/2 inch. I would feel it mostly when standing straight up, feet relatively close together...like when standing at the sink (and washing those darned dishes). It never caused any pain. I do believe that part of why it felt so pronounced was how I had carried myself prior to the surgery which I think was a bit LOW on that side. So I went from a LITTLE short on that side, to a LITTLE long which felt like a LOTTA tipped. I was getting quite used to it after a year and would never have done anything surgival just to fix this. I tried a heel lift for awhile which I will admit made me feel more level...but I did not like the effect.
Z
My LLD was measured in X-rays at 3/8 of an inch...and that was just looking at the difference in the hip due to the prosthesis and surgery. He went in planning (first surgery) to add "a little length" as I will likely need my other hip done in the future and he was putting things where they are supposed to be prior to the cartilage loss. When PT measured the whole leg, they got just over 1/2 inch. I would feel it mostly when standing straight up, feet relatively close together...like when standing at the sink (and washing those darned dishes). It never caused any pain. I do believe that part of why it felt so pronounced was how I had carried myself prior to the surgery which I think was a bit LOW on that side. So I went from a LITTLE short on that side, to a LITTLE long which felt like a LOTTA tipped. I was getting quite used to it after a year and would never have done anything surgival just to fix this. I tried a heel lift for awhile which I will admit made me feel more level...but I did not like the effect.
Z
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Hmmm. My symptoms are kind of a strange sharp achy pulling sensation and achy stiffness in my low back. When I externally rotate my leg with a bent knee...like getting into the car and rolling over in bed...I feel the pain in my hip, knee, down the outside of my calf to my ankle. So your symptom was that you did not feel level? I don't really notice anything like that. Although I can see that my pant leg on the hip replacement side is a bit shorter. I can walk with a normal gate. I had no external rotation pain prior to surgery. I had sharp pain when internally rotating, but other than that my hip was still mega flexible. I just could not bear my full weight on my right side which is kind of important for walking! Of course I also had constant pain at rest too. Pain was my forever companion.
It seems that it still is...just not to the same degree.
It seems that it still is...just not to the same degree.
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calikat
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Hi John. I hope you had a nice holiday. Your above quote has really resonated with me. I can also jump, walk, run a bit with no pain, but externally rotating my hip is very painful. I have to brace myself to roll over in bed because it really hurts to move my leg like that. It seems like it is getting worse instead of better and I also have a sense of tightness in the hip joint area.
Then about three weeks ago I started getting these weird bright red hot itchy rashes on my hands, arms, legs and chest. I have had to take benadryl to calm things down. The rashes seemed to come and go except for this past week. I have had to take benadryl the past three days because of the reaction. There is nothing new in my diet etc. I have stopped all pain medication to see if that is the allergy. Now I am wondering if this might be a reaction to the metal in my hip. I have always had bad reactions to wearing earrings. My earlobes get hot, bright red, and itchy until I take the earrings out. It never occurred to me to worry about metal allergies or any such thing, nor was I ever asked about reactions to metals before my surgery. I am kicking myself now for not even thinking to ask if this might pose a problem.
I know something is not right and that my hip joint should not hurt so much. Unfortunately I cannot even get an appointment to talk to my OS until January 9th. I really wish I had thought to ask about the metal sensitivity issues beforehand, but I did not, and I just have to move forward. I am going to reread your thread and see what steps you followed. I remember that you got an MRI, but I am not sure if that showed anything. Any advice you may have would be greatly appreciated. Thanks in advance.
I am going to tag @Josephine also if you don't mind.
ETA I read in another thread that this third change out of your parts (That sounds a bit odd doesn't it? Yikes!) have yielded the best result so far. I am very happy for you!
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Z15
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Calikat,
Just so to be clear, despite the title of my thread my situation ultimately turned out NOT to be metal sensitivity. It was a reaction to corrosion that developed in the taper where the femoral neck (that the ceramic ball is on) fits into the femoral stem (that goes down your femur).
We had rather hoped it was a reaction to metal which would have been preferable in my case. So first they did a basic blood test to look for metal sensitivity but my surgeon ordered a more advanced metal sensitivity test to Chicago and this facility: https://www.orthopedicanalysis.com/metal-allergy/Pateints.html. Results came back that I was NOT sensitive to metal. What I learned early on was that skin sensitivity to metal is not a good indicator of whether internal parts will bother you. I believe that there is some evidence that exposing you to the metals on your skin can actually initiate an allergic reaction internally which might have not been there otherwise. So your skin reaction may or may not be indicative of something. I had some reaction to nickel on my skin (mostly in watch backs) but nothing on this special test.
So, they did an MRI and saw swelling of the tissue that makes up the joint capsule. That swelling and pressure significantly limited my ROM. Like I said, walking was fine...running was pretty good, but slowly pulling my knee up toward my chest was quite painful.
As I've said before, on my list of things that I was avoiding to protect my hip, bi-metallic corrosion was not on the list. If that is the issue (with anyone) it seems the only option is to remove the second metal which is invariably chromium cobalt, which is used in the femoral necks for their much better strength over titanium. Funny, we all think of TITANIUM as being this super metal but apparently in modular hip it is not a great option for necks. In one piece, monolithic hips there is less risk with a titanium neck as the design does not have to make them as narrow or limit their mass as much to fit the modular connection.
So, chromium cobalt out, titanium in, and it feels great. Good luck with yours and, yes, you do want to find out what is causing the rash.
Z
Just so to be clear, despite the title of my thread my situation ultimately turned out NOT to be metal sensitivity. It was a reaction to corrosion that developed in the taper where the femoral neck (that the ceramic ball is on) fits into the femoral stem (that goes down your femur).
We had rather hoped it was a reaction to metal which would have been preferable in my case. So first they did a basic blood test to look for metal sensitivity but my surgeon ordered a more advanced metal sensitivity test to Chicago and this facility: https://www.orthopedicanalysis.com/metal-allergy/Pateints.html. Results came back that I was NOT sensitive to metal. What I learned early on was that skin sensitivity to metal is not a good indicator of whether internal parts will bother you. I believe that there is some evidence that exposing you to the metals on your skin can actually initiate an allergic reaction internally which might have not been there otherwise. So your skin reaction may or may not be indicative of something. I had some reaction to nickel on my skin (mostly in watch backs) but nothing on this special test.
So, they did an MRI and saw swelling of the tissue that makes up the joint capsule. That swelling and pressure significantly limited my ROM. Like I said, walking was fine...running was pretty good, but slowly pulling my knee up toward my chest was quite painful.
As I've said before, on my list of things that I was avoiding to protect my hip, bi-metallic corrosion was not on the list. If that is the issue (with anyone) it seems the only option is to remove the second metal which is invariably chromium cobalt, which is used in the femoral necks for their much better strength over titanium. Funny, we all think of TITANIUM as being this super metal but apparently in modular hip it is not a great option for necks. In one piece, monolithic hips there is less risk with a titanium neck as the design does not have to make them as narrow or limit their mass as much to fit the modular connection.
So, chromium cobalt out, titanium in, and it feels great. Good luck with yours and, yes, you do want to find out what is causing the rash.
Z
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Z15 Thank you so much for your detailed reply. I am just not sure which direction to proceed since my OS is out of the country. I am thinking that I may go to see an allergist next week. Last night I had a new different looking rash over my hip and scar area...nickle size white welts...very strange looking. I took the benadryl and 30 minutes later it started to disappear so I think it is definitely some type of allergy. This morning I have a fine rash all over my torso. When the rashes first started I just thought/hoped that they were stress related, and I ignored them. I really did not think about anything to do with my hip components. But they have progreessed to a point that I really cannot ignore them. I am going to start taking pictures so I can show my OS.
Pulling my knee up to my chest causes pain for me also. My hip joint feels very tight. Also when I turn my hip out, like when I try to roll over in bed or lift my knee and turn my knee out...those types of motions. Oddly enough walking/weight bearing (which was pretty awful pre-surgery) does not seem to be a problem, but there is a strange sensation of tightness. I am not quite sure how to explain it. I am very thankful for your thread, because it really has helped keep me calm. You had such a strong attitude about it all. It is what it is, and stressing about it will not help anything. I just need a plan of action. It is easier to deal with this hiccup because my pain is much less than before my surgery so I feel mentally stronger, and of course I have all of our BoneSmarties to help me. Thanks again for all of your help/info.
Pulling my knee up to my chest causes pain for me also. My hip joint feels very tight. Also when I turn my hip out, like when I try to roll over in bed or lift my knee and turn my knee out...those types of motions. Oddly enough walking/weight bearing (which was pretty awful pre-surgery) does not seem to be a problem, but there is a strange sensation of tightness. I am not quite sure how to explain it. I am very thankful for your thread, because it really has helped keep me calm. You had such a strong attitude about it all. It is what it is, and stressing about it will not help anything. I just need a plan of action. It is easier to deal with this hiccup because my pain is much less than before my surgery so I feel mentally stronger, and of course I have all of our BoneSmarties to help me. Thanks again for all of your help/info.
calikat
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Z15
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If it was an allergic reaction then they would "simply" swap out the metal I was reacting to (QUITE likely the chromium cobalt) and I would be done with it. In the case of the corrosion reaction, there was a much higher likelihood of soft tissue DAMAGE and compromising of the bone connections with the prosthesis. Even without those, the corrosion of the femoral stem has "damaged" the stem with at least surface pitting on the metal. It's not unusual that the corrosion situation can require removal/replacement of the stem, and that may still be something in my future. For now, it feels great...works great...and I may 
have even been running in the mountains a little bit this week. I had to stop back in June when the pain was increasing so if I DID go running this week it was well deserved... 
Z
have even been running in the mountains a little bit this week. I had to stop back in June when the pain was increasing so if I DID go running this week it was well deserved... Z
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Thanks for the info Z.
@Poppet I had itchy rashes develop on the tops of my feet and hands this morning as well as my torso. Benadryl seems to keep it at bay. Just one more thing to deal with. @Poppet despite your problem with jewelry, you had no problem with your hip implant? I am thinking the rashes are here to stay, and I am going to have to be tested. I took pictures this morning so I can show the doctor.
@Poppet I had itchy rashes develop on the tops of my feet and hands this morning as well as my torso. Benadryl seems to keep it at bay. Just one more thing to deal with. @Poppet despite your problem with jewelry, you had no problem with your hip implant? I am thinking the rashes are here to stay, and I am going to have to be tested. I took pictures this morning so I can show the doctor.
calikat
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@Josephine The following is what my surgical report says:
IMPLANT:
Medacta Versafit size 46mm outer diameter acetabular shell with 32 mm inner diameter neutral acetabular liner and Ammos size 1 collared stem and 32 -4 or S-Delta ceramic head.
My OS said it would be metal /ceramic. I am feeling nervous and a little frightened about all of these weird rashes/reactions I am having. Also...I don't want to hijack Z15's thread. Let me know if I need to start another one. Thanks.
IMPLANT:
Medacta Versafit size 46mm outer diameter acetabular shell with 32 mm inner diameter neutral acetabular liner and Ammos size 1 collared stem and 32 -4 or S-Delta ceramic head.
My OS said it would be metal /ceramic. I am feeling nervous and a little frightened about all of these weird rashes/reactions I am having. Also...I don't want to hijack Z15's thread. Let me know if I need to start another one. Thanks.
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