Revision THR Has anyone ever heard of late onset metal hypersensitivity in a ceramic on ceramic hip
- Thread starter Z15
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ARHip
senior
Z15,
I was directed to your thread. You had already showed up on my post-op thread re: MoM revision after 10 years. I'm now finding you all over the place.
There are many similarities between us. We both have effects of metal - similar but from a different area. Yet then I might be more in your shoes because my metal ball-joint will be replaced with ceramic. As you did, ten years ago I healed quickly and returned to work within a month. I remained active, mainly hiking throughout Arkansas. Running did not work for me. Each stride felt like a jack-hammer. A few years ago, my son and I took a multi-day back-pack trip in the Colorado Rocky Wilderness. Six months later pain began. My son wants to go back to the mountains. I hope my hip will let me. I want to hike into real mountains again.
You are an inspiration. I can hope I bounce back like you have and as I did last time. You are right, when the bone is not hacked on, only muscle, the healing is quicker. Dr said he would remove all the cobalt-effected tissue. I hope it is not too much. But I'm concerned about my Sciatic nerve. Dr says the COLD I feel in my leg is from that nerve. I hope it is just from swelling and not cobalt damage. We will see.
Good luck on your continued healing! Glad you can run, just don't overdo it. Maybe with plastic in my hip, running might be a possibility for me again. Best wishes for the new year.
ARHip
I was directed to your thread. You had already showed up on my post-op thread re: MoM revision after 10 years. I'm now finding you all over the place.
There are many similarities between us. We both have effects of metal - similar but from a different area. Yet then I might be more in your shoes because my metal ball-joint will be replaced with ceramic. As you did, ten years ago I healed quickly and returned to work within a month. I remained active, mainly hiking throughout Arkansas. Running did not work for me. Each stride felt like a jack-hammer. A few years ago, my son and I took a multi-day back-pack trip in the Colorado Rocky Wilderness. Six months later pain began. My son wants to go back to the mountains. I hope my hip will let me. I want to hike into real mountains again.
You are an inspiration. I can hope I bounce back like you have and as I did last time. You are right, when the bone is not hacked on, only muscle, the healing is quicker. Dr said he would remove all the cobalt-effected tissue. I hope it is not too much. But I'm concerned about my Sciatic nerve. Dr says the COLD I feel in my leg is from that nerve. I hope it is just from swelling and not cobalt damage. We will see.
Good luck on your continued healing! Glad you can run, just don't overdo it. Maybe with plastic in my hip, running might be a possibility for me again. Best wishes for the new year.
ARHip
OP
OP
Z15
graduate
ARHip,
I definitely remember your thread and feel bad that these crazy effects of metal have bitten you too. I realize that folks are trying to advance the technology and sometimes they (we) run into unexpected consequences.
Hiking (and I just spotted my avatar as I typed that) is something that I expect to do more of going forward and backpacking especially. My doc suggested not more than 10 miles (running) a week and even at my current pace that does not occupy a lot of my time...so MORE HIKING FOR ME. I hope that you are out there sooner than you think. As far as the loss of some tissue, I have been amazed so many times in my life how the human body will adapt and compensate for a loss. My particular surgical approach does cut the piriformis muscle.
I was F RE A K I N G OUT after the surgery at how little control of my knee I had and how it flopped in when I would stand up. But 2 months later it was like I never had a piriformis. And the fright that I would have in the hospital (first surgery) when I would stand up off the toilet (due to the lack of leg control) was non-existent the next 2 times. Literally, made me chuckle. My body had learned to live without that muscle completely.
I'll offer you this thread too: https://bonesmart.org/forum/threads/for-those-who-really-want-to-run-or-jog-or-similar.15454/ And I would add for you...if you do lose some tissue and muscles are compromised, find a good, curious, Physical Therapist who will think thru some various exercises to help with your bodies adjustment. A good one will be able to help you get to where you want to be with less frustration than doing it alone. And as I say that I'll add, be patient. This is not a 6 month project but hopefully within that time you'll be enjoying some of the rewards of this surgery.
Keep us posted, Sir,
Z
I definitely remember your thread and feel bad that these crazy effects of metal have bitten you too. I realize that folks are trying to advance the technology and sometimes they (we) run into unexpected consequences.
Hiking (and I just spotted my avatar as I typed that) is something that I expect to do more of going forward and backpacking especially. My doc suggested not more than 10 miles (running) a week and even at my current pace that does not occupy a lot of my time...so MORE HIKING FOR ME. I hope that you are out there sooner than you think. As far as the loss of some tissue, I have been amazed so many times in my life how the human body will adapt and compensate for a loss. My particular surgical approach does cut the piriformis muscle.
I was F RE A K I N G OUT after the surgery at how little control of my knee I had and how it flopped in when I would stand up. But 2 months later it was like I never had a piriformis. And the fright that I would have in the hospital (first surgery) when I would stand up off the toilet (due to the lack of leg control) was non-existent the next 2 times. Literally, made me chuckle. My body had learned to live without that muscle completely.
I'll offer you this thread too: https://bonesmart.org/forum/threads/for-those-who-really-want-to-run-or-jog-or-similar.15454/ And I would add for you...if you do lose some tissue and muscles are compromised, find a good, curious, Physical Therapist who will think thru some various exercises to help with your bodies adjustment. A good one will be able to help you get to where you want to be with less frustration than doing it alone. And as I say that I'll add, be patient. This is not a 6 month project but hopefully within that time you'll be enjoying some of the rewards of this surgery.
Keep us posted, Sir,
Z
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charlie cyborg
senior
Hi John @Z15 ,
It's Charlie (Cyborg)!
I was searching for some info on the forum yesterday ( I suddenly realised it's excellent diary) and couldn't resist reading some of the old posts, it was then that I noticed under your avatar mention of your revisions!!
I feel terrible that I hadn't known that you'd been going "through the mill" which is entirely my own fault for dropping out of the forum for so long. It's like when you lose touch with a good friend, the longer you leave it to get back in touch, the more difficult it becomes! Actually it's not "like" that .....it IS that!!!
I feel especially bad when I remember how truly supportive you were when I had my setback!
I haven't seen any posts from you this year but as the forum layout etc. has changed I'm not sure I'm looking in the right place!
Anyway I'd REALLY like to know how you're getting on, if you've got the time and the willingness to let me know I'd be grateful.
Your old cyberfriend (in absentia)
CC
ps I'm busily catching up on your thread ........not pretty reading!
It's Charlie (Cyborg)!
I was searching for some info on the forum yesterday ( I suddenly realised it's excellent diary) and couldn't resist reading some of the old posts, it was then that I noticed under your avatar mention of your revisions!!
I feel terrible that I hadn't known that you'd been going "through the mill" which is entirely my own fault for dropping out of the forum for so long. It's like when you lose touch with a good friend, the longer you leave it to get back in touch, the more difficult it becomes! Actually it's not "like" that .....it IS that!!!
I feel especially bad when I remember how truly supportive you were when I had my setback!
I haven't seen any posts from you this year but as the forum layout etc. has changed I'm not sure I'm looking in the right place!
Anyway I'd REALLY like to know how you're getting on, if you've got the time and the willingness to let me know I'd be grateful.
Your old cyberfriend (in absentia)
CC
ps I'm busily catching up on your thread ........not pretty reading!
Last edited by a moderator:
OP
OP
Z15
graduate
Charlie,
No worries at all! Hopefully you were off enjoying your life with a happy hip.
As for me, I got thru the questions and testing and now enjoy a hip that seems even happier than pre-inflammation. I think (in hindsight) that I was always dealing with some inflammation from early on and it just took 18 months to get bad enough to fix.
I'm currently enjoying regular mountain runs...hoping to be fit enough for a 5k (mountain) trail race in town this summer. But here is the good news...if I'm not, it will because of a finicky old Calf/Achilles issue on the other side and not the hip. At the moment I am doing fairly well with that but it often feels like one mis-step away from setting me back. I lost a full month at one point back in March where it really laid me up.
So anyway, I'm quite fine and it's very nice of you to check in. I read in your thread about your biking...and I agree with you, it is very good exercise for us hippies...just wished that I loved it like running....
Keep it up my friend,
Z
No worries at all! Hopefully you were off enjoying your life with a happy hip.
As for me, I got thru the questions and testing and now enjoy a hip that seems even happier than pre-inflammation. I think (in hindsight) that I was always dealing with some inflammation from early on and it just took 18 months to get bad enough to fix.
I'm currently enjoying regular mountain runs...hoping to be fit enough for a 5k (mountain) trail race in town this summer. But here is the good news...if I'm not, it will because of a finicky old Calf/Achilles issue on the other side and not the hip. At the moment I am doing fairly well with that but it often feels like one mis-step away from setting me back. I lost a full month at one point back in March where it really laid me up.
So anyway, I'm quite fine and it's very nice of you to check in. I read in your thread about your biking...and I agree with you, it is very good exercise for us hippies...just wished that I loved it like running....
Keep it up my friend,
Z
Mikeb
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Z, I feel sorry for you and hope all the best to you. You sound like a person who loves his sport and doesn't want to stop. I know what my surgeon told me before I had the operation, I would have to curve some the things I do and which sport is a no, no. I know what I would like to say but take it easy buddy. All the best.
Poppet
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Wahoo... Is that cousin CC popped back in to visit? @charlie cyborg xxx
OP
OP
Z15
graduate
Mikeb,
I appreciate the concern, but my surgeon gave me the green lite for 3 miles of trails 3 times a week. I've seen him many times since and he is very comfortable with his assessment. I know he has patients who are doing a lot more...but I'll stick with the 5K's....
Z
I appreciate the concern, but my surgeon gave me the green lite for 3 miles of trails 3 times a week. I've seen him many times since and he is very comfortable with his assessment. I know he has patients who are doing a lot more...but I'll stick with the 5K's....
Z
charlie cyborg
senior
HEY JOHN!!!!!!
I'm so pleased that you're doing your 5k's .....hopefully on soft pine needles? I used to run back in the old days with my Perthean hip (even did 5 & 10k races) .... it always hurt like Hades but it was the most efficient way of exercising when I was travelling! To be honest I guess I always loved biking even as a kid 'cos it didn't hurt!
You were always one to play down things, a model stoic my friend, so much so you could be a BRIT........ that's meant to be a compliment btw!! Reminds me of a Monty Python sketch where a British soldier has lost his leg and when questioned "how does it feel?" he replies, ".... It stings a bit!"
It's really great to be chewing the fat with an old friend!
Charlie
ps
How's the soccer?
How's the shoulder?
pps Yes Poppet it's me you've changed your name!! I didn't recognise you!!! xxxxx
I'm so pleased that you're doing your 5k's .....hopefully on soft pine needles? I used to run back in the old days with my Perthean hip (even did 5 & 10k races) .... it always hurt like Hades but it was the most efficient way of exercising when I was travelling! To be honest I guess I always loved biking even as a kid 'cos it didn't hurt!
You were always one to play down things, a model stoic my friend, so much so you could be a BRIT........ that's meant to be a compliment btw!! Reminds me of a Monty Python sketch where a British soldier has lost his leg and when questioned "how does it feel?" he replies, ".... It stings a bit!"
It's really great to be chewing the fat with an old friend!
Charlie
ps
How's the soccer?
How's the shoulder?
pps Yes Poppet it's me you've changed your name!! I didn't recognise you!!! xxxxx
OP
OP
Z15
graduate
Charlie,
Not pine needles at the moment but more like ankle deep mud. REALLY makes a workout that much workout-ier.
It's an honor to be envisioned into that lovely Monty Python bit!
As far as kicking goes, I wonder if my kicking issues were an omen of the lurking inflammation. I plan to get back to that "test" once things dry out a bit more here. We had a "deep" winter and Spring is going long. I'll let you know if the knew parts are better suited to kicking than the last.
I won't chat about my shoulder other than to say that i HOPE it is ultimately better than it was pre-surgery. At the moment it is not...
Be well my friend....I'll keep you posted on the kicking!
Z
Not pine needles at the moment but more like ankle deep mud. REALLY makes a workout that much workout-ier.
It's an honor to be envisioned into that lovely Monty Python bit!
As far as kicking goes, I wonder if my kicking issues were an omen of the lurking inflammation. I plan to get back to that "test" once things dry out a bit more here. We had a "deep" winter and Spring is going long. I'll let you know if the knew parts are better suited to kicking than the last.
I won't chat about my shoulder other than to say that i HOPE it is ultimately better than it was pre-surgery. At the moment it is not...
Be well my friend....I'll keep you posted on the kicking!
Z
waterman1
graduate
OK Z15... I am sitting on the side here reading and without ever speaking, you know I am feeling your pain as I embark on my brand new titanium/plastic insert hip of 5 weeks, while waiting on the second THR in June. We kinda hold our breath with brand new hips when reading your story. I feel your pain because I know activity causes wear and increases risk with our prosthetics, right? There are gobs of great, compassionate hippies all here pulling for each other. For the record, I am an active offshore CG Captain, freediving to 50ft, cattle farm, hay farm, horses, hunt, fish, walking and swimming is my life. Gave up all impact sports a few years ago as my hips let me down but continue passionately with freediving. I am so sorry to hear about your degrading hip, so I ask for your advice; why did you not go with hip re-surfacing originally? My reason is I was told my femur ball was too far gone from the AVN. Should I be demanding resurfacing in June? Next question: what should I be asking for in latest technology for THR in June? I am sorry, but is there anything learned from what is happening with you, please? Thoughts and prayers are with you and any advice you have is appreciated...
OP
OP
Z15
graduate
waterman1,
I'm not sure what I said that sounded like resurfacing...but I had a full THR in Jan 2012.
Here is a (fascinating) animated video of the procedure for the hip i got.
As you'll see on the video, I have a modular hip. If i were to do it again I would skip the modularity and go with a monolithic femoral stem.
Here is an article on the issue...and why I'd go a different route next time. As I mentioned before, my aggressive use of the hip exacerbated the condition for me....My surgeon stopped using the modular hip except in rare cases about 15 months after doing mine
Z
I'm not sure what I said that sounded like resurfacing...but I had a full THR in Jan 2012.
Here is a (fascinating) animated video of the procedure for the hip i got.
As you'll see on the video, I have a modular hip. If i were to do it again I would skip the modularity and go with a monolithic femoral stem.
Here is an article on the issue...and why I'd go a different route next time. As I mentioned before, my aggressive use of the hip exacerbated the condition for me....My surgeon stopped using the modular hip except in rare cases about 15 months after doing mine
Z
waterman1
graduate
Z15,
No sir, you said nothing about resurfacing. All I know, is that if you are young and active, there is supposed to be advantages of re-surfacing ahead of THR, so I wonder what you learned about re-surfacing vs. THR in your hip journey. I am consulting about re-surfacing next week ahead of my second THR in June. I think I would be speaking for many when I say 'we patients with brand new hips would benefit from any advice you have regarding plastic cups vs. ceramic cups' and/or any word you have regarding why you chose not to have re-surfacing as active as you are...
No sir, you said nothing about resurfacing. All I know, is that if you are young and active, there is supposed to be advantages of re-surfacing ahead of THR, so I wonder what you learned about re-surfacing vs. THR in your hip journey. I am consulting about re-surfacing next week ahead of my second THR in June. I think I would be speaking for many when I say 'we patients with brand new hips would benefit from any advice you have regarding plastic cups vs. ceramic cups' and/or any word you have regarding why you chose not to have re-surfacing as active as you are...
OP
OP
Z15
graduate
Waterman1,
At the time of selection my main reason for considering resurfacing was to allow me to continue running. When my surgeon said he supports his THR patients running it gave me the confidence to go with the full THR. I had heard (don't know the stats) that the shorter pin involved in a resurfacing may be more prone to femoral fractures.
I really liked the information I found about the latest ceramic surfaces. I believe that they produce less debris than other materials and what they do produce is quite inert (unlike metal).
The down side is that if they fail, they fail catastrophically, but with the latest generation of ceramics that is incredibly rare.
At the time, I liked the logic behind modular hips. As seen in the video it provides the surgeon with a better means to properly fit a neck length and angle to the patient. With the growing issue of ALTR (adverse local tissue reaction) from the corrosion of these unlike metals I can see how these may largely fade into the history books.
Z
At the time of selection my main reason for considering resurfacing was to allow me to continue running. When my surgeon said he supports his THR patients running it gave me the confidence to go with the full THR. I had heard (don't know the stats) that the shorter pin involved in a resurfacing may be more prone to femoral fractures.
I really liked the information I found about the latest ceramic surfaces. I believe that they produce less debris than other materials and what they do produce is quite inert (unlike metal).
The down side is that if they fail, they fail catastrophically, but with the latest generation of ceramics that is incredibly rare.
At the time, I liked the logic behind modular hips. As seen in the video it provides the surgeon with a better means to properly fit a neck length and angle to the patient. With the growing issue of ALTR (adverse local tissue reaction) from the corrosion of these unlike metals I can see how these may largely fade into the history books.
Z
waterman1
graduate
Z1,
I feel sorta selfish to ask questions when you are really in a time of need. Thanks again for sharing your experience during a time where surgeon's choices have somewhat let you down. Without the technology we all agree to implant within us, I guess we would end up in wheelchairs. With that said, you deserve the right technology the first time. I am not sure if you were given that, or if any of us are given it when those like you honestly share what is happening to you in real time. My thoughts are with you. Let's all join this club for the long haul to keep up with each other and how these implants take care of us. Again, thanks and take care of yourself and let us know if there is anything we can do for you...
I feel sorta selfish to ask questions when you are really in a time of need. Thanks again for sharing your experience during a time where surgeon's choices have somewhat let you down. Without the technology we all agree to implant within us, I guess we would end up in wheelchairs. With that said, you deserve the right technology the first time. I am not sure if you were given that, or if any of us are given it when those like you honestly share what is happening to you in real time. My thoughts are with you. Let's all join this club for the long haul to keep up with each other and how these implants take care of us. Again, thanks and take care of yourself and let us know if there is anything we can do for you...
charlie cyborg
senior
Hi JZ,
MUD MUD MUD!!!
Seems like your neck of the woods in Vermont and my neck of the woods in Buckinghamshire has it in common!!
About six or so weeks ago after the wettest Winter in the UK ever the trails were starting to dry out beautifully. We even had ones with dust!! After the soggy muddy Winter it was like biking should be, firm and fast. Then the rains came again about a month ago... not really torrential or anything but as the water table remained high after the Winter deluges it didn't take much to get back to swampy mud. I suppose one consolation might be that it's harder to push through the mud so, like you, I am getting "more" bang for my bucks!
Are you looking forward the the World Cup? (Soccer that is!)?
CC
MUD MUD MUD!!!
Seems like your neck of the woods in Vermont and my neck of the woods in Buckinghamshire has it in common!!
About six or so weeks ago after the wettest Winter in the UK ever the trails were starting to dry out beautifully. We even had ones with dust!! After the soggy muddy Winter it was like biking should be, firm and fast. Then the rains came again about a month ago... not really torrential or anything but as the water table remained high after the Winter deluges it didn't take much to get back to swampy mud. I suppose one consolation might be that it's harder to push through the mud so, like you, I am getting "more" bang for my bucks!
Are you looking forward the the World Cup? (Soccer that is!)?
CC
waterman1
graduate
z15,
I may have an identical hip to the one giving you the problems above - Chromium Cobalt and modular type prosthesis. As I head for my second THR of the right hip, tell me what prosthesis is being recommended for you now, please. I have a couple of weeks to decide what is best after hearing your story... where are the stats on how many allergic reactions are out there among us with Cobalt/Titanium hips?
I may have an identical hip to the one giving you the problems above - Chromium Cobalt and modular type prosthesis. As I head for my second THR of the right hip, tell me what prosthesis is being recommended for you now, please. I have a couple of weeks to decide what is best after hearing your story... where are the stats on how many allergic reactions are out there among us with Cobalt/Titanium hips?
OP
OP
Z15
graduate
Waterman1,
A few things...Ultimately mine was not an "allergic" reaction. I am not allergic to either of the metals, or the corrosion by-product. Mine and others are categorized as an "adverse local tissue reaction".
The issue is that these modular hips are designed with flexible titanium in the stem to bend with the bone, and a much stronger chromium cobalt in the neck where more strength is warranted. Where the 2 metals connect, touch and rub there is a potential for corrosion (read up on galvanic corrosion or bimetallic corrosion). So any non-modular hip will avoid this corrosion issue. Any SINGLE metal modular hip will avoid the bimetallic corrosion (but will have potential other issues).
My hip, the Wright Profemur Renaissance is not normally distributed in the US with a Titanium Neck Option, but they received clearance and got me one. Studies I've seen have not shown a high incidence (or ANY occurrences) of titanium neck fractures in folks under 170 pounds like me.
I have dozens of articles on the topic in folders but here are a few for your perusal.
broken link removed: https://www.healio.com/orthopedics/journals/ortho/%7B903f2596-c0dd-4712-aee7-222d416c8eb4%7D/failure-of-a-modular-hip-implant-at-the-stem-sleeve-interface
https://www.biomedcentral.com/1471-2474/11/3/
broken link removed: https://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_22/52.short
broken link removed: https://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_15/42.abstract
Many of the reports I read require access to medical libraries or charge fees per view. With 2 kids in sciences in college and my wife working at a hospital I had plenty of ways to get them...
I hope that helps.
Z
A few things...Ultimately mine was not an "allergic" reaction. I am not allergic to either of the metals, or the corrosion by-product. Mine and others are categorized as an "adverse local tissue reaction".
The issue is that these modular hips are designed with flexible titanium in the stem to bend with the bone, and a much stronger chromium cobalt in the neck where more strength is warranted. Where the 2 metals connect, touch and rub there is a potential for corrosion (read up on galvanic corrosion or bimetallic corrosion). So any non-modular hip will avoid this corrosion issue. Any SINGLE metal modular hip will avoid the bimetallic corrosion (but will have potential other issues).
My hip, the Wright Profemur Renaissance is not normally distributed in the US with a Titanium Neck Option, but they received clearance and got me one. Studies I've seen have not shown a high incidence (or ANY occurrences) of titanium neck fractures in folks under 170 pounds like me.
I have dozens of articles on the topic in folders but here are a few for your perusal.
broken link removed: https://www.healio.com/orthopedics/journals/ortho/%7B903f2596-c0dd-4712-aee7-222d416c8eb4%7D/failure-of-a-modular-hip-implant-at-the-stem-sleeve-interface
https://www.biomedcentral.com/1471-2474/11/3/
broken link removed: https://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_22/52.short
broken link removed: https://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_15/42.abstract
Many of the reports I read require access to medical libraries or charge fees per view. With 2 kids in sciences in college and my wife working at a hospital I had plenty of ways to get them...
I hope that helps.
Z
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