Revision THR Hip pain 20 months post op

[Dirtynes]

Ok, had my blood results back today and they are all normal so my OS said it is very unlikely that I have a joint infection. He did say that a transient infection from my abscess can have systemic effects so this is probably what was causing the issues with both of my hips.

So things are looking very positive at present for me and I am very relieved. I would like to thank everyone for their support and advice on this forum.

 

[clodaghcov]

@ Dirtynes so pleased for you, well done.x

 

[Josephine]

Wow, what a relief for you!

 

[Layla]

Wonderful news. Thanks for sharing.
I'm very happy for you, it must be a great relief.
I hope you have a nice weekend!
@Dirtynes

 

[Dirtynes]

Hi

I last posted on here about a year ago where I had some complications in my hip (left THR cemented stem and uncemented cup) where I had my bloods taken due to a suspected infection. None of the bloods were elevated and the symptoms subsided.

However my hip has never felt totally right - I had a right THR 7 years ago and this has been fine. The joint is stable but I cannot sleep laying on that side as it is uncomfortable and in the past week I have started to get mid thigh pain and a warmness in my leg. I have had a general feeling of fatigue for some time now.

I still have some concerns that I may have an infection and was wondering if anyone has had issues like this and could give me some advice.on what I should do.

I am in the UK and the procedure was performed on the NHS.

Regards

Nick

 

[Jaycey]

@Dirtynes it has been almost one year since you had your bloods done. I would go to your GP and request another test. Your new symptoms certainly warrant an investigation.

You will notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. I changed the title for you.

 

[Dirtynes]

Thanks Jacey

Fully understand the need to merge threads so there is continuity in the story.

I had x-rays done a few months ago and this ruled out loosening of the prosthetic and my surgeon thought that my discomfort in the joint will reduce over time. He did say it takes 18 months to two years to heal but I would have expected a gradual improvement but my condition has remained static for a long time.

The mid thigh pain has worried me this week as this is a new symptom.

I will consult with my GP this week and take it from there.

Regards

Nick

 

[Layla]

Wishing you comfort and all the best as you consult with your GP next week.
If you feel something isn't right, don't give up pursuing answers.
Please stay in touch and let us know how you're doing. I hope you have a nice weekend and a Happy Thanksgiving!

I think you celebrate it in the U.K. as we do here?
@Dirtynes

 

[prairienut]

When I was having chronic pain in my THR in April of 2018, I had an x-ray taken to rule out a loose prosthetic. I was told the prosthetic was well-positioned and not loose. Well, several months after that, the hip failed entirely, and I ended up on crutches until I could get a revision. When I showed the revision surgeon the earlier x-ray, he said 100% of his colleagues would have diagnosed me with a loose prosthetic! I tell you this story just to make the point that it is possible for a Dr. to misinterpret an x-ray and miss the diagnosis. I'm not saying this is happening in your case, just something to bear in mind. It might be worth a second opinion if the pain persists.

 

[VSlowLife]

@Dirtynes I have seen a few posts, where when Josephine was available, she could point out certain features on a hip x-ray, when up loaded by a bonesmartie, when asked to do so. I found it very enlightening.

 

[Dirtynes]

Hi All,

It has been a while since I have been on here and hope you are all well.

I have had onset pain develop in my left hip. I tis on the upper area of my leg and on the outer side of where the stem joins the femur. I have had x-rays done and the report back is that there has not been any significant changes. I have been sent for physio which has not improved the position.

I am at a loss if what to do next as they seem to have discounted aseptic loosening but I am in pain which has started about 3 years post op.

I feel like I am going round in circles with the NHS and wondered if anyone had some guidance on what I need to do next - clearly something is not quite right.

Regards Nick

 

[Jaycey]

Sorry you are dealing with this pain @Dirtynes ! Sounds like it is time for a second opinion. You need to find a surgeon who has no connection to your current OS - preferably a revision specialist.

If you let me know your current surgeon's name and what hospital you were in, I'll do a bit of research for you.

 

[Dirtynes]

Hi Jaycey

Thanks for your reply. The surgeon was Gavin Hussel who is based at the Spire and Queen Alexandra in Portsmouth. I cannot seem to discuss my situation with a surgeon as I keep hitting the GP/Physio level. I do not even know who has reviewed the X-rays.

How do I get a second opinion on the NHS or do I need to look at private options?

I have bilateral hip replacements and one was done just over 10 years ago and this has been fine.

Nick

 

[Coddfish]

Hi @Dirtynes
With the NHS I think you just have to keep pushing until you get what you need, be prepared for a battle. I had my surgery done privately at Spire Portsmouth. For a private consultation at the Spire you would probably need to pay £200 to the consultant and £160 to the hospital for X-rays. I have no idea what the protocol is around seeing a different surgeon to the one you used before, or how easy it is to get back on an NHS list if the surgeon you see privately recommends a revision. I highly recommend Andrew Langdown, who did my operation and is a consultant at QA as well as working privately at the Spire and at Nuffield Chichester. I approached him directly following a recommendation from my (private) physiotherapist.

 

[Hippielife]

When we go in for hip replacement surgery we have expectations on how much better life will be once thru the recovery period. Expectations that our quality of life will improve and our mobility without the nagging severity of constant pressure and pain that literally takes our breath away Is gone. We all understand there is a long term and short term healing and recovery period.
It’s very unfortunate that those who suffer severe harm from hip surgery have very little support in the industry and no where to go. This is a world wide issue. We hippies are not alone. Other joints to.
I have hope that some time in the future a protocol will be designed by the joint surgeons to support and specialize with patients who’s joints need revision due to primary surgery. Not everything shows up on all the tests from mri’s , x-rays or Bone scans . There are however variable clues in blood metal tests .
In most cases patients suffering with severe pain months after primary hip surgery experience very real pain and in some cases causes are from hip component failure a long list …or in many other cases only thru revision surgery does the complication from primary surgery finally show … thru a visual …during surgery.
It is very important to me and for everyone if primary surgery is needed or revision to be sure the surgeon is experienced in many hip replacements surgeries a year and not just another treatment included in the surgeons clinic/practice.

 

[Dirtynes]

@Coddfish

Funnily enough Andy Langdown did my right hip at the Nuffield. Unfortunately I was unable to get him to do my left.

I am somewhat surprised that no one seems interested in investigating the issue to understand what is causing the issue so they can learn from it. I regularly get the Spire joint register email to monitor my progress but haven't had anything back about my low score.

Gavin Hussel is an experienced surgeon although he has a different technique to the others in the same hospital (as I found out at joint school) in that he goes in via a lateral cut on the outside of the hip.

Thanks for all your help. I will continue to persevere via my GP until I can actually see a surgeon to discuss/review my situation.

Nick

 

[Jaycey]

@Dirtynes I did a bit of research. First, your problem with the current surgeon is that he does not do any revision surgery - or at least he has no published results for revisions.

I would recommend you travel just a bit and try getting a consultation with Douglas Dunlop. He is based in Southampton General with private practice in Nuffield and Spire. He does 200+ THRs per year and has expertise in younger patients with problem hips.

How do I get a second opinion on the NHS or do I need to look at private options?

First and foremost - be firm. You will need to get a referral from your GP. They may push back saying you can't select the surgeon. This is not true. Ask for a referral to Professor Douglas Dunlop (see step 2) and don't take any flack about going private. It is your right to choose your surgeon and the practice.

Step 2: The approach I have taken (twice) is to book an appointment in the consultant's private practice. You will pay for the consultation and x-ray but I found private appointments gave me the opportunity to have a good discussion with the surgeon. You will have time to discuss all your questions and get a feeling about working with the surgeon.

Step 3: If you like what you hear during the consultation and funds are not an issue for you, then you can book surgery in their private practice. I didn't have that option for either of my THRs so I asked to be put on the consultant's NHS list. The wait times are horrid now. But if you keep following up with the consultant's medical secretary you might just get lucky and be offered a slot if someone cancels.

I hope this information is helpful. Please let us know how you get on!

 

[Dirtynes]

@Jaycey

Thanks for the information. When I first met Gavin Hussell he did tell me that he was experienced in Hip Revision (which is why he recomended a cemented stem due to my age as these are easier to remove - my right is uncemented and he advised this is more complex to remove on revision.

I will go back to my GP and be more firm with my request - they seemed to be trying to pass this off as some kind of soft tissue issue which I am not convinced about as the phsyio hasn't changed the position. Unfortunately I had been getting pain in my knee and it has now been confirmed that I need a knee replacement as well.

I am not in an immediate rush to get any surgical outcome but really want to understand why I have suddenly started getting pain. This generally occurs more at rest than anything else so this is not consistent with aspectic loosening.

I will consider an approach to Douglas Dunlop for a second opinion/X-ray. Many thanks for your guidance/suggestions.

 

[Coddfish]

@Dirtynes I am pleased to hear the uncemented hip Andy did is still going strong. Mine is also uncemented, I find it odd a surgeon would cement in such a young person Especially if the rationale is he might have to take it out. At 64 and female my bone health was good enough to be uncemented. I would definitely try to get Andy for your knee, I thought he was absolutely brilliant.

 

[Dirtynes]

@Coddfish

The rationale was that due to my age I would need to have the hip revised and it was easier to melt the cement and extract the stem on the cemented implant. The uncemented one would be much harder to remove as the bone would have grown into the implant (and may require fracturing of the femur).

It made sense to me but I had two different views from two surgeons at the same hospital. I was trying to get Andy to do the second hip as I was happy with the result with the first and will definitely see if I can get him to do my knee.