Revision THR Lookin' On the Bright Side!!

[Loz]

Re: Looks like a revision for me then!!

Well just had a call from the OS secretary, "he has just recieved the results of my bone scan taken monday the 6th and would like me to come in for a follow up apointment.....Monday the 13th at 8.15 in the morning" !!

I should not read too much into the speed of that...should I??

all though it sounds a bit funny, the last thing I want him to say is that there is nothing wrong!! because there is.

If any of you have any pre planned questions for this event please let me have them. Thanks.

 

[Z15]

Re: Looks like a revision for me then!!

Loz,

I'm glad the wait won't be long. You know your body so be sure to firm about what you know, regardless of what he thinks...

Keep us posted, and good luck,

Z

 

[thelandlady]

Re: Looks like a revision for me then!!

Hi Loz,Good luck with your revision surgery, I had mine revision done in May last year. I am not absolutly painfree but better than before cos i think the damage with the MOM had already been done.

 

[Jaycey]

Re: Looks like a revision for me then!!

Sound like your OS popped you into the top of his clinic list for Monday. Fingers crossed for you Loz! We will all be anxious for your update.

Be sure and take a list of questions and write down everything while you are asking. These visits are alway nerve wracking. Better to write down the information so you can think about it all later.

 

[Josephine]

Re: Looks like a revision for me then!!

He's probably seeing you before he goes for his operating session or a clinic. They usually start at 8.30 or 9am

 

[Loz]

Re: Looks like a revision for me then!!

I keep raeding that a revition is a lot more complicated and the risks are greater...I can see that in a older patiant where the bones are softer and prone to fracture, but is this the same with a 1 year old joint?

Also is the incition a lot bigger?
and the recovery longer ?

I will ask the OS but if any of you loverly people have a imput please say. xx

 

[MarkC]

Re: Looks like a revision for me then!!

Loz, keep us posted on your results. I have been through a lot of tests concerning MOM and none of mine have turned up any psudotumors or really any sign of trouble from the MOM. So far, the illiopsoas tendon is thought to be the main culprit. I ran into a snag with my thyroid condition so I am sort of on hlod until I get that corrected. I am hoping for the best for you. I have pain in the goin and also side and back at times. My OS is waiting for thyroid to get sorted out and then says we will see where we are pain wise and wht next steps to take.

Do you know what your metal ion levels were?? I can tell you mine were elevated but not very much. Of thjey were much higher, my OS would have probably recommened revision right off the bat. Anyway, I do hope that you will get an answer and get relief.

 

[Jamie]

Re: Looks like a revision for me then!!

I keep reading that a revision is a lot more complicated and the risks are greater...I can see that in a older patiant where the bones are softer and prone to fracture, but is this the same with a 1 year old joint?

Also is the incition a lot bigger?
and the recovery longer ?

I will ask the OS but if any of you loverly people have a imput please say. xx

Loz.....a revision is no more complex than the original surgery and it can be easier on you since there is no cutting of bone (or very little). The age of the patient is not a factor either.

The surgeon will remove the old implant and cement (if it was cemented). The bone will be "freshened" up to provide a good bonding surface and the new implant placed.

They will follow the old incision line and it should be about the same scar as before. Recovery will be about the same length of time as you must get muscles strengthened again. But pain levels should be less.

 

[Dee205]

Re: Looks like a revision for me then!!

Liz,
Good luck and our thoughts will be with you! Great advice to write the questions and answers down......I know with some of my previous surgeries, I would get so nervous, I forgot half of what the dr said. With the TLHR, I went in armed with a pad and pen. Best wishes! It will get better.
Dee

 

[Loz]

Re: Looks like a revision for me then!!

Right, next installment.

Just got back home and yes I will need to have a revision.

The NB bone scan has revealed an anomaly in the stent. My OS seemed pretty sure that that means the stent is loose, and with the thigh pain and limping he thinks this make sense. There were no Ions shown in my blood and the readings are normal. So he seems sure there is no ARVAL effect.

I am booked in for March the 1st and will have a new stem and cup, he would like this time to put a smaller head and smaller cup in so it means the full hip operation again.

The OS has said that a MOM hip is his preference because of my age and lifestyle and the fact he has done 100s of them without fail! But he knows I am a bit concerned with the MOM hip, as I have read the papers!! And if I wanted a plastic insert I can have one.

He was also reassured me that as this was a straight forward revision that there will be no “bone work” to speak of and neither the x-ray nor NB bone scan shows up any fractures.


A few questions
Why has the stem gone loose (OS said this is only his second out of 100s)
Will this happen again?
Why is his preferred hip MOM. and should I have one?

Thank you all for your concern :Thank You:

 

[MarkC]

Re: Looks like a revision for me then!!

My OS gave me MOM becasue of my age (40 at the time) and my activity level. I have the depuy pennacle with the oversized cup. My metal ions are indeed elevated but not by an alarming amount. I can tell you this, if I had it to do over again, I would demand that we not use the MOM. I do understand the theory behind them (less wear and more durable), however, I have spent the last 6 months getting tested and discussing pain with my OS and not knowing if the metal is causeing some of it or not. We suspect that my illiopsoas tendon is the prime culprit but we also do not know. If I had ceramic or something different, then the metal would not even be a question. Also, I have to now be tested once every 6-8 months for ion levels. If they spike up to a certain point, revision would be recomme3nded.

Here is the kicker, I think that many OS's that used MOM are backing away from them now. I have done a ton of research and the bottom line is that people have had problems and they do not know why. some suspect a sensitivity to metal causes inflamation of the surroinding tissue but not enough to show damage...just enough to give chronic pain. I have friends who have metal on poly and ceramic on poluy and they are doing great. In my sitch..the metal is still at play and I have one of the best OS's around (at Duke University) and he is not sure. My orignal OS totally blew off any "scare" of metal and I wonder now if he still uses it as much.

As far as the cup size, sounds like your OS is on top of things. The oversized cup can lead to problems with the illiopsoas tensonconstantly bumping over it (my case) and causeing pain so at least that will probably be taken out of play. The reson for the oversize cup (theory) is greater range of motion. I have greater range of motion for sure but can feel that tendon pop over the dup (can heaqr it too) every time I raise my knee.

bottom line for me (just my uneducated opinion) is that if I had it to do over, I would demand the most durable non MOM replacement out there and I would find a surgoeon who used it.

Now, having said all that, if I get this tendon released and my pain goes away, and if my metal ions go down over the next year, I will be the first to come back here and say so. That is my hope for sure.

 

[Loz]

Re: Looks like a revision for me then!!

Thanks Mark,

I must admit the thought of a new MOM hip even though a smaller size does get me questioning the OS, but he seemed to be sure its the way to go being that my blood tests showed no metal irons.

What to do??

 

[dectjc]

Re: Looks like a revision for me then!!

Hi Loz
Sorry to hear you need a revision. I hope it goes well for you and you can get on with your life after its done.
Mark brought up some excellent points in his post. Keep us informed of your choice.
Best of luck to you

 

[Jaycey]

Re: Looks like a revision for me then!!

Hi Loz, so sorry you need this revision. But it's great you are having it done so quickly.

I'm tagging Jo so she can comment on your questions. @Josephine:

Frankly I agree with you. From what I've read about MOM I would not let any OS near me with that implant.

And 2 out of 100 - :skeptical: - not sure if I would stick with this one.

Hard decisions I know Loz. Hope you can get the information you need to make the choice.

 

[Josephine]

Re: Looks like a revision for me then!!

Here is the kicker, I think that many OS's that used MOM are backing away from them now.

In droves ... I attended a conference on this topic a couple of months ago and the evidence emerging is chilling - with certain devices. Some surgeons are insistent that they are finding no problems with MoM as such so why are many others?

I have done a ton of research and the bottom line is that people have had problems and they do not know why.

Well, they are gradually finding reasons why. Here are a couple which have only recently been identified and reported
1. misalignment of the cup and/or stem causing a) uneven wear of the head or b) other issues like iliopsoas impingement
2. use of stem and ball from different manufactures and the addition of a sleeve on the trunnion (or taper) to make them fit resulting in a mismatch of materials and microscopic corrosion which is not revealed on xrays or scans

It was stated in the meeting that there are an awful lot of questions that should have been asked since the beginning of hip replacement when MoM was the standard but who knew they were even there to be asked? Science was so undeveloped 60 years ago - even 40 years ago. And the sciences with which to identity the problems, things like electron microscopes, weren't even being imagined much less the scientists to explore and identity these issues. Who knew we even had to ask the questions then?

Consequently, things have to change and now the questions will be asked but a whole new protocol has to be evolved with a whole new data base to collate and interpret results. Tragedy is, we know from past experience that such data doesn't actually provide any real substantive evidence to alter practice until there is about 20 years worth!

 

[Loz]

Re: Looks like a revision for me then!!

Hi Loz, so sorry you need this revision. But it's great you are having it done so quickly.

I'm tagging Jo so she can comment on your questions. @Josephine:

Frankly I agree with you. From what I've read about MOM I would not let any OS near me with that implant.

And 2 out of 100 - :skeptical: - not sure if I would stick with this one.

Hard decisions I know Loz. Hope you can get the information you need to make the choice.

No No, He said I have done Hundreds and hundreds.

So Jo should I ask to see him and request a different type?

 

[Josephine]

Re: Looks like a revision for me then!!

Why has the stent gone loose (OS said this is only his second out of 100s)

Actually it's the 'stem' not the stent. A stent is a tiny tube they put in places like blood vessels in the heart to prevent a heart attack!

Stems get loose for a variety of reasons:
1. if they are cemented, the cement hasn't been put in well enough, if uncemented, the same but for a slightly different reason. You could read this if you are interested Cemented and uncemented hips
2. if the patient has osteo-porosis (softening/thinning of the bones) then it can happen
3. if there is an infection which causes the bone to die around the stem (don't worry - you have none of the symptoms of infection!)

Will this happen again?

We can never say never but provided the implant is put in properly and securely, which I am sure he will do, it should last you the rest of your life!

Why is his preferred hip MOM. and should I have one?

I have no idea but were I in your shoes, I would opt for either ceramic on ceramic, ceramic on plastic or metal on plastic. Certainly NOT a metal on metal. Far too many unanswered questions about just now.

 

[Loz]

Re: Looks like a revision for me then!!

Thank you Jo, I will book an opointment to have a good chat with him about another joint.

My OS is very well respected and when his name is mentioned most people say (who are in the know) how lucky I am to have him. But like all of us, and I am an engineer, we all have are favoured ways of doing things...even if they have been userped by newer methods.

 

[staffsknot]

Re: Looks like a revision for me then!!

Hallo,Loz,

I don't have any technical information to offer, but I have read your story with some anxiety and can appreciate how concerned you must be. You can rest assured, at least, that I and a good many others will be rooting for you at the beginning of March.

This time your recovery can grow as the warm weather arrives, and I hope that you will be back in some sort of action by midsummer.

One possible consolation is that you are not a Nottingham Forest supporter.

All the best, Alan

 

[Loz]

Re: Looks like a revision for me then!!

Thanks Stafsknott (Alan)

No Not a Forest fan but a Palace fan, it looks like this year I will miss the no nothing games at the end of a rather boring league season.....but I bet you wish you could do that!!

I will call the OS tomorrow and ask to see him, and point out why I dont want a MOM joint. x