I'm wondering if I need to change surgeons.

[mcgaughy]

I am 57 and had a total hip revision almost 4 years ago. Have done great up until about 6 weeks ago and could feel "movement" when I moved my leg a certain way. Couldn't get an appointment with my surgeon until mid September so managed to see another surgeon. He xrayed and said it had loosened in the femur and was working up into the pelvic bone. He sent me back to my surgeon saying that he needed to fix it but told me to not go anywhere without my walker. My surgeon looked at the xrays and said "yeah it's worked loose and you have some bone loss but the top looks fine." He raised his eyebrows when I said the other doc had said I needed to use the walker. I asked "you raising your eyebrows does that mean you disagree?" His comment was "does it make you feel better?" as if I didn't really need the walker. He went ahead and scheduled surgery for Aug. 8th and said if I had too much bone loss he may have to "open up the femur and may need to use cadaver bone?" Of course this means a much longer recovery time. My worry is that he doesn't think the top needs to be replaced and that's fine if he's right but I can't keep repeating this surgery every few years.

 

[mcgaughy]

Also the other doc ordered a ct scan and the results state there is a "well corticated fracture of the anterior acetabulum which extends to the acetabular component" What does this mean? I am not aware of any fracture other than my original fracture of the head of the femur 32 years ago.

 

[Jaycey]

Hi Mcgaughy, the reference of the fracture sounds like your original one to me. It would be right to note it on the analysis.

The main thing is you need to have trust in your surgeon. He will do what he thinks is right. If you have any doubts by all means get another opinion. You are right - you don't want to be having endless surgeries. Please keep us updated!

 

[mcgaughy]

I don't believe this fracture occurred when it broke originally. I had an aneurysmal bone cyst that caused the head of the femur to break but was not supposed to have affected the pelvic area. Do you know what "well corticated" means?

 

[mcgaughy]

Also any ideas as to why this would happen so suddenly. I had xrays late March and everything looked fine. Haven't had any falls or any reason for this to happen. I just don't want to go through this surgery again and have the same thing happen.

 

[Jamie]

I believe that Jaycey is correct that the "well corticated" is referring to an old injury. This is a term radiologists use to indicate that a bony area has a covering on it....like an injury that has healed over. Jo is probably the best person to explain this and I'll go ahead and tag her. But she is out for a week or so and it may be a while before she sees the tag and responds. Josephine

In the meantime, my suggestion would be to get another opinion or two from surgeons that are experienced revisionists. Neither of these doctors you have seen appear to be in that category, based on what you've written about their comments. You may need to do some research to find revisionists in your area. We can help with that if you need it.

 

[mcgaughy]

I would appreciate help in finding an experienced revisionist in my area. I am near Birmingham, Alabama. By the way, both of the docs I have seen are supposed to be experienced at revisions but I agree that I need at least one more opinion since they both differ so much. Thanks so much for your help.

 

[Jamie]

Okay....I'll see what I can find inour BoneSmart clinic locator. Can you please give me your zip code? It would also be helpful if you could tell me the surgeons you have talked to.

 

[mcgaughy]

The zip code for Birmingham, Al is 35203 that is the city nearest me and Herrick Siegel (UAB Highlands) is my current surgeon and Mark Elkus is the other surgeon I saw recently. I liked Dr. Elkus but he said that he could not take over my care and sent me back to Dr. Siegel. Any help you can give me is appreciated. Thanks!!

 

[Jamie]

I did some looking at surgeons within driving distance from you (100 miles). Boy....there really aren't any that I could find who specialize in revisions. Your first surgeon does, but I'm not particularly impressed with his comments to you. Why wouldn't the second surgeon take your case?

If you are willing to drive more than 100 mies, I did find two surgeons who sounded like good possibilities:

Dr. Paul Apyan, University Orthopedics, Chattanooga, TN (423) 267-4585

Dr. Bruce Ziran, Atlanta, GA (404) 265-6991

Part of the problems with doctors and their clinics/hospitals is that they don't feel the need to expand information on the doctors' specialties. They will only make statements such as "orthopedic surgery" which don't give a clue if the person has experience with revisions or not. In addition, I found that most of the links associated with the University of Alabama Medical Center website were inoperative....VERY frustrating!!!

If you go back to your initial doctor, I would have a frank discussion with him about the loosening. It shouldn't have happened in just 4 years. Even though his credentials are very good for revision surgery, if it was me....I'd want to be reassured that he can make the repairs and that t hey will last. @Josehpine

 

[mcgaughy]

I think I will go back to the second surgeon Dr. Elkus tomorrow and tell him that I am making a change anyway and ask that he take over my care or refer me to someone that he would trust. He seemed so much more caring and actually seemed genuinely concerned about me. The other doctor has impressive stats but I feel like I am just that - a statistic rather than him looking at me as a human being that cannot keep doing this over and over. Thank you so much for your help!

 

[Jamie]

I think that sounds like an excellent plan. To me, when a surgeon has a joint loosen in such a short period of time and isn't more attentive than the first doctor was with you, it sends up all sorts of red flags. I wouldn't necessarily expect him to admit that he did a poor job, but he could at least be more sensitive to your worries about it happening again in that short period of time. I sincerely hope the second surgeon will take your case. You have an excellent chance of that if you have a heart-to-heart talk with him. Good luck and let us know how things go!

 

[Jaycey]

Sounds like a good plan! Please let us know how you get on.

 

[mcgaughy]

So Dr. Elkus will not take over my care. They referred me to Dr. Jeffrey Davis at Andrews Sports Medicine and he cannot see me for two weeks and then must review all my medical info from last surgery before he will decide to see me.

 

[Jamie]

Hmmmm....did they give a reason as to why he wouldn't take your case? And....even more important.....is Dr. Davis an experienced revision surgeon???? I'll see if I can find anything on him.

 

[Jamie]

Well, here is a link to his biography and frankly, it doesn't sound to me like he would be the surgeon for you. There is no mention at all of revision experience or that he works on the more difficult cases. His work seems to be primarily in resurfacing and with a variety of joints. You really need a hip revision specialist in my opinion.

It's fine to meet with him, but have some specific questions about his experience in dealing with a case such as yours. If you don't get the answers you want, maybe you should think about driving to find someone who has the skill you need.

 

[mcgaughy]

Hmmmm....did they give a reason as to why he wouldn't take your case? And....even more important.....is Dr. Davis an experienced revision surgeon???? I'll see if I can find anything on him.

They would not give me a reason - that is making me crazy wondering why. Dr. Davis is supposed to be an experienced revision surgeon. Thanks!

 

[Jamie]

He may have that experience, but it sure isn't showing in any of the biographical information I'm seeing. All the more reason why you need to ask a lot of specific questions. Good luck!!! And do let us know how it goes. I know this is frustrating for you, but hang in there!

 

[mcgaughy]

Well, here is a link to his biography and frankly, it doesn't sound to me like he would be the surgeon for you. There is no mention at all of revision experience or that he works on the more difficult cases. His work seems to be primarily in resurfacing and with a variety of joints. You really need a hip revision specialist in my opinion.

You're right he doesn't seem to have the experience needed for my situation. I don't mind driving at all was just worried about having to get someone to bring me back and forth so far if I have issues or for checkups until I can drive, but I'm getting to the point I think I may have to do that. I need someone objective to tell me what's going on. Thanks!

 

[mcgaughy]

I called Dr. Ziran's office in Atlanta and they only require a referral from another doc to see me. Dr. Elkus office is sending that referral and there is a group of three docs that will look over my info and one will call me Wednesday (I think) and set me up an appointment. I looked at the bio for Dr. Ziran and he seems to specialize in revising failed hip replacements and that is what I need. I feel much better about seeing him and they didn't require infor from my current surgeon yet so I don't have to risk irritating him even more because I'm getting another opinion. Thanks soooo much for the info on him I feel more positive about this now!