Revision THR Lookin' On the Bright Side!!
- Thread starter Loz
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Dee205
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Loz,
Sorry to hear about all these ongoing problems! Please keep us informed and know that we are all pulling for you. You have been through so much and hoping things finally get better.
Dee
Sorry to hear about all these ongoing problems! Please keep us informed and know that we are all pulling for you. You have been through so much and hoping things finally get better.
Dee
Thanks to you all for your kind words.
I could not reply yesterday as I went and played Cricket!! I wont let this stop me from doing things I love. (if you know the game of Cricket you can hide a mid wicket and bat a 11, but still be part of it)
Thanks Ruby red, to answer a couple of your questions.
I don't think it is MoM it has 3 parts Zimmer 60.13.28.52 polyethylene. 194.52.19 expansion shell and 19.28.06 Head. So I think, and have seen that the polyethylene is in-between the cup and head.
I am seeing a new consultant one who specialises in revision surgery ( Mr Michael Fordyce) he has been recommended and his CV looks good.
Also I have been to a physo and she bent my leg around and seemed to think the joint seemed OK, stiff but OK!
You also mention inflammation, I have kept banging on about Bursitis but now I am thinking it might inflamed, but it is not red and I feel well in my self?
A question to those who know will my new surgeon contact the last surgeon? as I am a bit afraid of going back in surgery and the new surgeon not being able to remove the stem the same way as the original one....I mean how big will the lump hammer have to be!!!! as last time the surgeon said " I feared I may have destroyed your femur"
Any way thanks for all your help. "Look on the bright side" would suit me Jamie, as I tend to be a half full type of person and many more are worse of than me!! ....its just really frustrating. Grrrrr
I could not reply yesterday as I went and played Cricket!! I wont let this stop me from doing things I love. (if you know the game of Cricket you can hide a mid wicket and bat a 11, but still be part of it)
Thanks Ruby red, to answer a couple of your questions.
I don't think it is MoM it has 3 parts Zimmer 60.13.28.52 polyethylene. 194.52.19 expansion shell and 19.28.06 Head. So I think, and have seen that the polyethylene is in-between the cup and head.
I am seeing a new consultant one who specialises in revision surgery ( Mr Michael Fordyce) he has been recommended and his CV looks good.
Also I have been to a physo and she bent my leg around and seemed to think the joint seemed OK, stiff but OK!
You also mention inflammation, I have kept banging on about Bursitis but now I am thinking it might inflamed, but it is not red and I feel well in my self?
A question to those who know will my new surgeon contact the last surgeon? as I am a bit afraid of going back in surgery and the new surgeon not being able to remove the stem the same way as the original one....I mean how big will the lump hammer have to be!!!! as last time the surgeon said " I feared I may have destroyed your femur"
Any way thanks for all your help. "Look on the bright side" would suit me Jamie, as I tend to be a half full type of person and many more are worse of than me!! ....its just really frustrating. Grrrrr
Josephine
NURSE DIRECTOR EMERITA
Not according to my research. Who recommended him? And why go to TW hospital when you could get the very best of the best at in London in the body of Sarah Muirhead-Allwood who is the hip surgeon other hip surgeons go to! She did the late Queen Mother's hip too! If I ever need a hip done, she also the one I would choose of I could. You do still have insurance, don't you?
Trochanteric bursitis doesn't get red and it doesn't make you feel unwell. It's just horribly painful and limits your activity. As I believe I said previously, my GP sorted mine in a trice with a shot of cortisone. Have you not had this done yet and if not why not!
Probably not. He might have his secretary get your notes from the other chap's secretary but that's about it. They're generally too busy to spend time gossiping about their patients!
When you first said that your surgeon 'feared he had destroyed your femur' I was appalled. Good revision surgeons have techniques and special tools to remove difficult stems and would never say such a thing. I worked with revision surgeons for a number of years and there wasn't much they were intimidated by as they have pretty much seen and done everything - if they are actually revision specialists and not chaps who 'have a go at' a revision from time to time. Sadly there are far too many of them. Ms Muirhead-Allwood is not one of those. Go see her and get it done properly.
As for the stem being loose and still not being able to be removed, this is possible because the tip of the stem can wiggle whilst the top, larger part is still firmly fixed. As the tip toggles within the bone, it remodels the inside in a very particular way as bone doesn't much care to have metal constantly moving against it and dies back slowly. You can see this remodelling in this xray - it's this that causes the pain
Hi Josephine,
Thank you very much for the detailed response. I will give you some answers to the questions asked. But firstly let me say...it might just be me but I always feel a bit intimidated when talking to the consultants, and they all have been very nice.
Not according to my research. Who recommended him? And why go to TW hospital when you could get the very best of the best at in London in the body of Sarah Muirhead-Allwood who is the hip surgeon other hip surgeons go to! She did the late Queen Mother's hip too! If I ever need a hip done, she also the one I would choose of I could. You do still have insurance, don't you?
Who recommended him, well a friend of mine has just had a revision (he is in his 70s and had his first op 27 years ago) he told me what a great job he had done and when I went to the GP (not my own) she looked down her list and mentioned the same name??
TW is very close to East Grinstead and the Horder Centre has a really good name around these parts.
Its about money my insurance company will only pay the "given amount" they say I would have to make up the rest...I don't know, but Ms Muirhead-Allwood might be a bit out of my price range.
Trochanteric bursitis doesn't get red and it doesn't make you feel unwell. It's just horribly painful and limits your activity. As I believe I said previously, my GP sorted mine in a trice with a shot of cortisone. Have you not had this done yet and if not why not!
I meant that I might have a infection, but I think that unlikely.
After you mentioned cortisone, I went to my GP and he said "As your under Mr Parnell I think that he you should ask him" Mr Parnell seemed to think that stretches and Physo is the way to go! Then a couple of weeks ago I saw another GP and she just said she would not do that and referred me to a consultant??? Out of the two GPs and two consultants not one of them has offered this??
When you first said that your surgeon 'feared he had destroyed your femur' I was appalled. Good revision surgeons have techniques and special tools to remove difficult stems and would never say such a thing. I worked with revision surgeons for a number of years and there wasn't much they were intimidated by as they have pretty much seen and done everything - if they are actually revision specialists and not chaps who 'have a go at' a revision from time to time. Sadly there are far too many of them. Ms Muirhead-Allwood is not one of those. Go see her and get it done properly.
I think this was said in a light hearted matter , like "it was in there so tight I might have caused damage getting it out" so really just saying "its not loose" Mr Parnell has a dry sense of humour...and is a highly thought of surgeon around the Sussex area. As a mechanical engineer myself I sort of got what he said and took it in the spirit it was said
As for the stem being loose and still not being able to be removed, this is possible because the tip of the stem can wiggle whilst the top, larger part is still firmly fixed. As the tip toggles within the bone, it remodels the inside in a very particular way as bone doesn't much care to have metal constantly moving against it and dies back slowly. You can see this remodelling in this xray - it's this that causes the pain
From the xray it looked to me that the bottom of the stem was OK but there was a gap about half way up until the head, he also mentioned some bone growth (I can’t remember its name) on the outside of my femur which he said could be caused by a loose stem??
How can I get hold of the new Xrays and bone scans, I would like to go back to Mr Parnell and show them to him...as I have mentioned he is a top surgeon, I really went to Mr Michael Fordyce for a second opinion, thinking he would tell me to carry on with the stretches or even give me a cortisone injection, I was pretty shocked when he came back with a loose stem theory.
One thing that did surprise me after the X-rays taken 3 days after the revision, I have not been asked to have any done over the last 15 months...is that usual??
Again thank for your help it gives me some confidence to lead this rather than being led.
XX
#heterotopicossification
Thank you very much for the detailed response. I will give you some answers to the questions asked. But firstly let me say...it might just be me but I always feel a bit intimidated when talking to the consultants, and they all have been very nice.
Not according to my research. Who recommended him? And why go to TW hospital when you could get the very best of the best at in London in the body of Sarah Muirhead-Allwood who is the hip surgeon other hip surgeons go to! She did the late Queen Mother's hip too! If I ever need a hip done, she also the one I would choose of I could. You do still have insurance, don't you?
Who recommended him, well a friend of mine has just had a revision (he is in his 70s and had his first op 27 years ago) he told me what a great job he had done and when I went to the GP (not my own) she looked down her list and mentioned the same name??
TW is very close to East Grinstead and the Horder Centre has a really good name around these parts.
Its about money my insurance company will only pay the "given amount" they say I would have to make up the rest...I don't know, but Ms Muirhead-Allwood might be a bit out of my price range.
Trochanteric bursitis doesn't get red and it doesn't make you feel unwell. It's just horribly painful and limits your activity. As I believe I said previously, my GP sorted mine in a trice with a shot of cortisone. Have you not had this done yet and if not why not!
I meant that I might have a infection, but I think that unlikely.
After you mentioned cortisone, I went to my GP and he said "As your under Mr Parnell I think that he you should ask him" Mr Parnell seemed to think that stretches and Physo is the way to go! Then a couple of weeks ago I saw another GP and she just said she would not do that and referred me to a consultant??? Out of the two GPs and two consultants not one of them has offered this??
When you first said that your surgeon 'feared he had destroyed your femur' I was appalled. Good revision surgeons have techniques and special tools to remove difficult stems and would never say such a thing. I worked with revision surgeons for a number of years and there wasn't much they were intimidated by as they have pretty much seen and done everything - if they are actually revision specialists and not chaps who 'have a go at' a revision from time to time. Sadly there are far too many of them. Ms Muirhead-Allwood is not one of those. Go see her and get it done properly.
I think this was said in a light hearted matter , like "it was in there so tight I might have caused damage getting it out" so really just saying "its not loose" Mr Parnell has a dry sense of humour...and is a highly thought of surgeon around the Sussex area. As a mechanical engineer myself I sort of got what he said and took it in the spirit it was said
As for the stem being loose and still not being able to be removed, this is possible because the tip of the stem can wiggle whilst the top, larger part is still firmly fixed. As the tip toggles within the bone, it remodels the inside in a very particular way as bone doesn't much care to have metal constantly moving against it and dies back slowly. You can see this remodelling in this xray - it's this that causes the pain
From the xray it looked to me that the bottom of the stem was OK but there was a gap about half way up until the head, he also mentioned some bone growth (I can’t remember its name) on the outside of my femur which he said could be caused by a loose stem??
How can I get hold of the new Xrays and bone scans, I would like to go back to Mr Parnell and show them to him...as I have mentioned he is a top surgeon, I really went to Mr Michael Fordyce for a second opinion, thinking he would tell me to carry on with the stretches or even give me a cortisone injection, I was pretty shocked when he came back with a loose stem theory.
One thing that did surprise me after the X-rays taken 3 days after the revision, I have not been asked to have any done over the last 15 months...is that usual??
Again thank for your help it gives me some confidence to lead this rather than being led.
XX
#heterotopicossification
Josephine
NURSE DIRECTOR EMERITA
Well, my xray was just an example of how a stem can be loose in one place yet firm in another. The term you are looking for is probably Heterotopic ossification or he could just have said 'ossification'. It happens in the presence of movement. In fact, if you look at that xray again, just below the tip of the stem you can see a bridge of bone spanning the medullary canal which is bone created by the movement. A good example in a different place. Here's another example of extreme ossification on the trochanter (outlined in yellow). It can certainly mess with a surgeon's attempts to remove the implant.
Unwise at least.
Very simply, actually. You contact the hospital where they were taken, speak with the xray department and ask them what is their protocol for you getting copies of your xrays and scans. You will need to provide your details plus dates when the xrays were taken and there will be a small fee for it. The information is usually supplied on a password protected cd-rom.
Josephine
NURSE DIRECTOR EMERITA
btw, I looked up your two surgeons on the newly published NJR surgeon profile site.
For your information, the two surgeons you have mentioned did the following numbers of surgeries in 2012
Mr Edward John Parnell: 159 primary THRs and 16 revision THRs
Mr Michael Fordyce: 259 primary THRs and 60 revision THRs
No prizes for guessing which one is the 'specialist' and the one I would go to if I were in your shoes!
For your information, the two surgeons you have mentioned did the following numbers of surgeries in 2012
Mr Edward John Parnell: 159 primary THRs and 16 revision THRs
Mr Michael Fordyce: 259 primary THRs and 60 revision THRs
No prizes for guessing which one is the 'specialist' and the one I would go to if I were in your shoes!
Yep, Loz.....you want Mr Michael Fordyce, as he has done many more revisions and would most likely be more experienced in dealing with your particular situation.
Than you all for your help, it means so much. I know there was something wrong but seemed to have been pushed from pillar to post, and in my rather nieve way have just gone with the flow....I wont get cross but thinking that every step I have taken in the last 3 years has caused me mild discomfort to 10 out of 10 pain has worn me down a bit.
Anyway with all your help, its onwards and upwards
Anyway with all your help, its onwards and upwards
Hello again,
Just got this letter from the consultant..it is to my GP with me on copy.
I must admit I never had these before.
Here is the crux of the letter, if anyone could say what it all means that would be great.
In December 2010 he underwent what sounds like a metal on metal total hip replacement (that's correct) which was complicated by a deep vein thrombosis. The hip remained painful and a bone scan appeared to show loosening of the femoral component. He therefore, underwent a revision operation but at the time of surgery it was felt that the femoral component was not loose and left in situ. The hip was revised with a metal on polythene hip replacement.
On examination, he walked with a antalgic gait. Rotating his hip reproduced his hip pain. There was some mild trochanteric tenderness. His x-rays show a spotorno type acetabular component and an uncermeted stem. There appears to be a lucency around the proximal half of the femoral component and a marked cortical hypertrophy on the lateral aspect of the femur.
These radiological findings usually indicate loosening of the femoral component which I feel is probably responsible for his continuing symptoms.
As I said that the meat of the letter.....any help in putting it in simple term for a simple man???
Thanks
Loz xxx
Just got this letter from the consultant..it is to my GP with me on copy.
I must admit I never had these before.
Here is the crux of the letter, if anyone could say what it all means that would be great.
In December 2010 he underwent what sounds like a metal on metal total hip replacement (that's correct) which was complicated by a deep vein thrombosis. The hip remained painful and a bone scan appeared to show loosening of the femoral component. He therefore, underwent a revision operation but at the time of surgery it was felt that the femoral component was not loose and left in situ. The hip was revised with a metal on polythene hip replacement.
On examination, he walked with a antalgic gait. Rotating his hip reproduced his hip pain. There was some mild trochanteric tenderness. His x-rays show a spotorno type acetabular component and an uncermeted stem. There appears to be a lucency around the proximal half of the femoral component and a marked cortical hypertrophy on the lateral aspect of the femur.
These radiological findings usually indicate loosening of the femoral component which I feel is probably responsible for his continuing symptoms.
As I said that the meat of the letter.....any help in putting it in simple term for a simple man???
Thanks
Loz xxx
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Loz, I'm just catching up on all this. Oh for the days when you only worried about bursitis! I do hope you get situated with a revision date soon and get it all sorted out so you can move on with your life.
Sharon
Sharon
Josephine
NURSE DIRECTOR EMERITA
antalgic gait a limp adopted so as to avoid pain on weight-bearing structures, characterized by a very short stance phase. IOW, the patient is adopting this type of gait to spend minimal time weight bearing on the affected leg. Here's a YT demo
This is EXACTLY what I described in post #187. (she knows, y'know!
) 'Cortical hypertrophy' just means there is new bone growth showing which in turn means there is something going on - in this case, the movement of the tip of the stem which has probable broken through, or is about to break through, the bone. This does NOT mean your bone is about to fall apart, just that there may be a small hole or crack.
'Hyper' means more ('hypo' means less), trophy means growth or development (e.g., 'atrophy' means less growth or tissue mass as in muscles 'atrophy' when they are not used) and cortical is the hard bone.
'Lucency' means there is a gap showing between the stem and the bone which there shouldn't be.
'Spotorno' is just the name of your new cup and is a product marketed by Zimmer
Anything else you want interpreted?
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