Revision THR Looks like maybe a revision will be needed...

[Layla]

Thinking of you this morning @chalcedonian1
I hope you found comfort through the post of @zinnia
She's been an inspiration and has come a long way.
Sending a hug and wishes for a good day. Please keep in touch.

 

[chalcedonian1]

I can just give you hope that you can come through it all and meet me on the other side. Are you willing to do that?

@zinnia Yes I am willing of course to do that, but I will not be able to rest my mind until I have interviewed and spoken with revision specialists to see what they say.

Your story is just so incredible to me. My current feelings go two ways: the first is shock that I probably need a revision and the second is, well, not quite relief but something akin to that, that I seem to have found the cause of this debilitating and fluctuating pain, so the constant pain appears to have an exact cause. Problem is it isn't going away by itself, or with time, etc., and needs to be taken care of.

There is something to be said for validation that what I physically feel reflects what is actually happening in that implant (I don't know if that quite makes sense, but I guess anyone who has been in constant pain understands that statement!). I would not take kindly to any surgeon or doctor who implied my pain is not real, I haven't had that experience fortunately with this, but it was only recently I fully admitted to myself things are not getting better!

I admit I am now the opposite of hopeful; hope is what kept me going for over 2½ years like this, and I am now quite fearful that pain of some kind or another caused by an implant will always be my normal. I will deal with post-op pains, I will take pain meds as necessary, I will try to handle as best I can post op depression, painful scars etc.-- all that will be "doable", but my mind is overwhelmed when I think about the possibility of this deep, sharp, fairly regular pain when I shift my weight, get up from a chair, sit in a theatre or walk, you know, all the things that make life "a life".

I was so happy that I have only a slight Trendelenburg lean now when I stand on my implant leg, I have worked on my balance which still needs improvement, but when I put my good leg down and shift to two legs or just to the left leg, the pain is so sharp. My lifestyle has already slowed down considerably over the past 2+ years because of this. I just can't move around for long periods of time, I get fatigued and the pain is too much or I am consciously trying to avoid putting myself in more pain.

I will do whatever is necessary to get better, it is just in the forefront of my mind there are no guarantees that I won't be worse, have an LLD, gait problems, continuing bone growth issues (not sure if a cemented implant is the ticket but it very may well be), etc.

Speaking with the revision surgeons may help my fear, I hope it will not escalate too much more. Please trust me when I say I am anything but a person who typically shares, and certainly posting here has already been worth its weight in gold, so thank you everyone who has chimed in, and I do feel less self-conscious now about posting here.

 

[zinnia]

@chalcedonian1 It makes perfect sense and it is what I meant by finally giving up on "recovery" and accepting that something was wrong. You are right, accepting that you actually need the revision is a validation.

After seeing my surgeon of choice for a second opinion and the 2nd revision reared it's head, my husband said, "well, now we know there's a way to get this fixed." And so you are right, absolutely. And that is your first step to recovery.

Now, stop right there and look what you wrote, "I am now quite fearful that pain of some kind or another caused by an implant will always be my normal." You can't accept that something is terribly wrong and needs fixing and feel the pain of a loose femoral implant as normal at the same time.

Which one do you choose, the possibility of a fix or the pain as normal? Get beyond that and your will be ready to travel a new path.

Of course there are risks. And I understand fully the fear when faced with them. I was scared to death myself. So scared. The steps up to the day of surgery I sort of went through in a haze. It helps to have an advocate with you when you go to the OS you choose to do your surgery. It needs to be someone who will be with you through the whole process. Their just being there can be a positive force. In my case it was my husband. He even had his own questions for the surgeon. If you have to go to more than one doctor to get an intuitive feeling of trust then by all means do that.

There is so much information on line and I'm sure Boston has some fine revision surgeons. The morning of surgery I walked through that door alone to check in and get the IVs started like I knew what I was doing and I was there, finally, getting it fixed. No one can promise you that it will all turn out perfectly. In fact, I have a minor LLD because of minor arthritis in both legs. But it is minor and workable. And I have a slight case of scoliosis that had to be taken into account as well. There is, however, more chances that not that it will be a good hip with pain that is controllable during a recovery that will bless you with your life back. Two years is a long time to suffer trying to make a recovery work that isn't workable. I don't think that's hope, I think that's desperation.

You are a strong minded woman. I think I can tell that once you make your mind up your are strong willed toward success. BoneSmart is here, I am here in any way I can help. I can carry on a conversation with you until you have made up your mind if you are getting anything out of my feeling about my own experience. Either way, I wish you the very best and I hope you will keep in contact so I will know how you are doing. Meanwhile, I know this is terribly hard. Somehow I know you will prevail.

 

[Layla]

@chalcedonian1
Please continue to post. You will always get feedback from someone here.
I'm so thankful for @zinnia imparting wisdom and sharing her experience as
she's lived a lot of what youre experiencing. It's been a long road to recovery for her
but she's doing it. I have faith you'll do it too. Hang in there, we'll be here for you.

 

[zinnia]

@chalcedonian1 I see you have been back with us for a bit of a check in. I hope you had a pleasant weekend and the week ahead will greet you with some relief from your pain and discomfort. I am thinking of you and how you may be doing.

 

[chalcedonian1]

zinnia, Layla Thank you so much for your comments. I had a hip arthrogram and CT scan today and the preliminary results of fluid drawn from the hip seem normal according to the surgeon's office though the cell culture still needs to grow for 5 days to see if there is bacterial growth.

Nonetheless, I take comfort from today's findings, at least enough to get me through Christmas with my family who do not know this is going on with me (only my husband knows and my sister lost her husband several months ago, so it is a tender holiday this year indeed and I do not want to ruin the joy of all of us being together).

I also have appointments with two hip revision specialists. One on Wednesday at Mass General Hospital who does lateral/posterior and one in February at the New England Baptist Hospital who does anterior revisions. I found a few surgeons who will only do a revision if they were the original surgeon, so they are not possibilities.

Both of the revision surgeons with whom I have appts are highly recommended, though of course my original surgeon was also.

My biggest concern is why the bone has crept away from the implant, and then avoiding this the second time around, Josephine said to look into getting it cemented, along with the constant sense of pain and it just not ever feeling "right". So I am starting to feel a little hopeful I will have some time to figure out the revision, what type of implant next (cemented or non cemented), etc.

Believe it or not, if I don't have an infection I feel lucky indeed and right now at least believe I can deal with this new issue so long as I have some hope that I can avoid the same experience, not yet sure about that. I guess I will only know in the actual doing.

It has been a blow, one I thought I could not surmount, but @zinnia is so inspiring and gives me a sense there may be some hope, truly.

I will post xrays etc when I get them and can download them from the disc, but for now that is the news.

 

[Layla]

There is hope @chalcedonian1 as long as we're breathing there's hope!
Zinnia is a great example of strength and courage and she is triumphing.
It's a blessing the preliminary findings are not pointing toward infection.
Prayers the cell culture findings show the same.....no infection.

I'm sorry for the loss of your brother in law. First holidays in the wake of loss are always difficult.
I hope your meetings with the revision specialists prove beneficial and you're able to make a decision,
then you'll be able to schedule a date and begin the recovery that will give you your life back.
A lot to look forward to in the New Year. I'll bet 2018 will be great for you. But first....
Warm wishes for a wonderful Christmas with loved ones.:merry christmas: :nativity:

 

[zinnia]

@chalcedonian1 So excited to see you are back. I am very sorry to hear, however, about the loss of your brother in law. I understand perfectly why you are centered on your family's well being especially at Christmas. They will know of your situation soon enough.

I am so pleased for you to have found doctors who will discuss a revision with you. I can't tell you about the bone not filling in around your femoral implant. Josephine would help you understand that. What I can tell you is that in my case the bone did not grow around and into the cone placed in my acetabulum either. It did grow around the femoral implant which I hope is an indication that the acetabular implant was not properly placed in the first place so there was never going to be any bone ingrowth. But that's my experience.

The great thing happening for you is that you have appointments to see these doctors. You can ask them all your questions, what their approach to the surgery is and make your decision about who will do your revision. I am excited for you. I understand exactly what you mean about it not ever feeling "right"; I never felt my replacement revision felt "right" either. As it turned out, it wasn't.

I think you can put to rest the thought about history repeating itself in your case. I had the same fear but any surgeon who takes on another's mistake for revision is taking a risk themselves because now they own the situation. That is the way I see it anyway. I can't promise you success, of course. But it is rewarding to hear you say you will only know in the actual doing.

Good for you. You are a brave one. Hang on; keep heading in that direction. All the BS folk are here to help and smooth the hard parts. I will keep watch for your thread so I know where you are with this.

My best to and your family in this Christmas season. It will be a hard one I know but I hope the season can brighten it for you and yours. :merryx:

 

[Mojo333]

Glad you are getting some answers and are on your way forward to getting this resolved. I know another surgery was not the plan...but we are keeping you in our thoughts and prayers.
You seem like such a beautiful person and mindful of your family's first Christmas with the absence of your BIL.
Wishing you the peace you need to get through the holidays and still be joyful for all the blessings you DO have.
They are killing me this week at the Food Bank, so if I don't get back by...Merry, merry Christmas.:tree:

 

[MammaT]

@chalcedonian1 I am also glad you are getting answers and will soon be getting a plan. The first Christmas without a loved one is indeed a tender moment. This will be my third without my husband and I know I will have moments. It has shown me how brief this life is and we need to do what we can to treasure our time here. In a weird way, it gives me motivation to do things like take care of theses hips so I can live as fully as possible. There are inspiring stories on here and @zinnia is remarkable. This is the season of hope and I hope you can focus on that. We surprise ourselves at what we can surmount. Wishing you a good Christmas and brighter New Years.

 

[Josephine]

zinnia, Layla

chalcedonian1, please read this Multiple tags or alerts in posts

I too am glad you're finding a choice of revision surgeons.

My biggest concern is why the bone has crept away from the implant, and then avoiding this the second time around

Small correction here. The bone didn't 'creep away' from the implant. It never 'crept in' to begin with!

Usually this is because the surgeon never prepared the inside of the bone correctly. This includes flushing out excess blood, blood clots, fat (marrow fat) and loose bit of bone. We have special devices a bit like a power washer, which we use to clean out the bone both in the femoral shaft and the acetabulum. When done, the bone should look white and clean. It then additionally has to be carefully dried with swabs because where there is any fluid or material, the bone will probably be obstructed from laying down baby bone cells into the hydroxyapatite on the implants. You can see more about this in here Cemented and uncemented hips

 

[Descant]

You are going through such a hard time @chalcedonian1 . I’m not surprised that you’re in such turmoil. I think that now you have found 2 recommended surgeons and you decide to go with one of them, then psychologically you will feel better and more able to accept the surgery which is almost certainly going to be successful in relieving you of this pain.

Here in Buckinghamshire UK it is policy to do cemented hip replacements on all patients 70yrs and over because of the risk of non cemented not getting established well enough. I know that you’re younger than that, but I am quite happy 3 weeks post cemented replacement.

 

[chalcedonian1]

@Josephine the link you sent about tagging is not working, but I think I get it now and will try to do it right, thank you and sorry.

I understand what you are saying about the bone not growing in the first place, I did misspeak. When I was looked at after 4 months from the original surgery, he said the bone looked great, the implant looked great. He never told me to come back months later to see if the bone kept growing or if I felt certain pain. (Hence my trying to work through all this pain, and thinking it would all get better with time, that I must be super sensitive to the pain, or I slept wrong, or I got up wrong, or I did too much exercise, not enough massage, etc. I had a lot of hope I guess that I would be fine.)

I saw a revision specialist today who did not or would not say much about my implant or the other surgeon; it is a brother/sisterhood for sure here in the States where drs don't want to speak against another doctor unless they are actually your witness in malpractice litigation.

No one has said anything to me about why I have aseptic loosening, not a word about the site not being prepared right -- in fact, the lack of bone growth seems quite the mystery to the original surgeon and today's surgeon. I am absent infection as of now, nor has anyone said it is an obvious botched implant job. The revision surgeon would only say the implant was not put in "upside down or backwards". He was trying to be wry, I didn't laugh though. He added he has seen all kinds of bad implants and at first glance mine didn't seem to be put in incorrectly but I did NOT ask him if he would have used a different kind or size if he had done the original surgery.

He said this loosening happens in maybe 2-4% of surgeries, lucky me. He also said I was absolutely too young for cemented. He would put in a longer implant which is more cylindrical, and he doesn't believe in an extra HA coating on the implant to promote bone growth as that can also have detrimental effects. No guarantee I will not have LLD either, and in fact if that is what I need for more stability, those decisions are made on the spot during surgery, so that was sobering. I walk barefoot often enough, having a limp is not something I want when I wear shoes, I know a lift will help but would like of course to avoid all this but apparently there is no way of knowing??

No indication that this is the case with me, but he would not say I wouldn't have one leg longer than the other, more than normal that is, he said, as our legs are usually slightly different lengths anyway. He said it is a longer and more difficult surgery than the original implant surgery and he would not go through the anterior scar as I would be left with a very deep valley/puckering in a very big scar AND going in laterally/posteriorly allows them to see more and have more access if needed.

It is a much longer recovery than I had with the anterior original surgery and I will not be able to drive for at least 2 months which isn't really a problem if I set my schedule properly, so that is OK. The last thing I want to do is damage to the hip during recovery.

There is loosening around the entire stem, there is a halo on the bone in the xray that travels around the stem. I will upload pix when I can find my DVR drive. I also have bone modelling at the end of the stem. I must say I am worried about having to go through this again, only it seems it will be worse this time, more serious longer surgery, longer recovery time, but I have no choice. He suggests I schedule surgery within the next month or so which would mean it would happen in Feb or March. That is all I can remember right now, I just picked up my recently widowed sister from the airport and am really tired. Thank you again to all.

@Descant The revision surgeon I saw today will not do a cemented implant. It was a flat out no as he said I was too young. And I certainly can't use this implant for the next five years. The original surgeon said cementing might be an option but that the downside of that is that cementing can fail in time but Josephine countered that with information of her own where she has seen many cases of cementing being just fine for many years!! It is all very confusing at this point to me, and I am still in the being-afraid-but-doing-a-lot-of-research-mode.

 

[danabanana]

How stressful for you...but some good answers. No infection being the best news!!!! YAY!!! I'm no expert but this business of not being willing to use a cemented implant because you're too young I think is false. I'll be interested in what Josephine has to say. The other thing is try not to fret about longer surgery and longer recovery. First, you won't notice because you'll be asleep. Time won't matter to you! Second, while posterior leaves you with some more muscle and tissue soreness but honestly, I think you'll find with a proper fitted prosthesis you'll heal up better and faster because you'll be in less pain! All you've known to this point is pain and struggle...a revision is to eliminate all of that. Big hugs!!!

 

[Mojo333]

Wishing you well. Hoping you have some peace today

 

[MammaT]

Well @chalcedonian1, you now have some answers. I don’t know cemented from non-cemented so I am no help there. Fears are normal, especially after what you have been through. I’m getting right hip done in early February- we will go through recovery together.

 

[Layla]

Hi there @chalcedonian1
I'm so sorry you continue to bear this burden. It sounds like you're getting answers, and formulating
a plan. Hopefully all of this will be behind you soon and you'll be onto recovery. Please have faith it will all
work out. Consider @zinnia i know you're familiar with her story and recovery. That will be you very soon.
Praying for your comfort and peace of mind as you navigate through the holidays awaiting your surgery.
Please stop by for comfort often.....the lights are always on here.
Sending a warm hug!

 

[zinnia]

Hi @chalcedonian1 Glad to see you back. My first thought is that you can't expect another surgeon to tell you what the original surgeon may have done wrong. So I would back off that expectation. You are obsessing a bit about that and making yourself very nervous about that which you probably can never know.

That being said it seems to me that it is enough that the new surgeon is willing to take the revision on because now he will own the surgery and you as his patient and he is answerable for your recovery. In fact, what difference does it make at this point what happened in the primary surgery? It is enough that it has caused you major distress and pain and you definitely need a revision.

So here you are speaking with another surgeon, good job! and asking your questions. My question is, do you have an intuitive feeling about this guy? Does he make you feel comfortable? Is he handling your questions to your satisfaction? As far as the question about the cemented or uncemented, I think that is a surgeon's choice.

My surgeon uses uncemented as he did on me even given my age and the fact that there was no bone ingrowth to the acetabular implant but was to the femoral. I went with his protocol. I asked in pre-op exam about "caging" and all sorts of other ways to ensure the implant would not loosen this time and I was reassured by the PA that the OS had done many revisions of other docs but few to none of his own and he would use the best of his ability to make this right. Given that I had already checked on his credentials as best I could, what more could I ask for? And after surgery he explained that they had to use a fixture to replace the fractured piece that had never been fixed and was lost, in order to augment and stabilize the whole implant.

So what I am saying is, if you feel good about this OS, does he in the end put you at ease. His telling you about a possible LLD and a longer recovery, is telling you the risks and being honest with you. Can you feel hopeful, if not entirely confident, that he is the one you want to be making decisions as only he can? If all of that is true but you have more questions, by all means ask them.

This surgery is sobering. You shouldn't be entering into it lightly. But you should feel hopeful; hopeful to live without pain, to have your life back. To live without fear. That can happen. Yes it can! You can prevail! I only had to have the one implant replaced. But I am living in recovery with no pain. I am 3 weeks post op and walking easily, not for long, but easily on a cane.

Would you give up the pain and discomfort you have now for a longer recovery with controlled pain or no pain at all and a future that is bright and full of all the treasures you can pack into it? You have to make the choice of a surgeon and it is scary. I admit to you that I was petrified. Ask Layla and Mojo, they know how frightened I was and how I was afraid that nothing would be different. But it is. I am finally in a good solid recovery. It can happen.

I hope for you a successful outcome but as you have said yourself, you won't know until you do it and get to the other side. Whatever you choose, whatever the outcome, we are here. Everyone is hoping for the best for you. Stay with us. Someone will always be here to listen, to commiserate, to cheer you up and urge you on or to be happy for you and shout a cheerful blessing. I look forward to hearing about where you go from here.

Many hugs and a :merry christmas:to you and yours.

 

[Descant]

I really like the sound of your surgeon. He has given you such specific facts and I would find that very reassuring. As I understand it, the posterior approach is still the most common and gives the surgeon the best view. He is concentrating on best outcomes for your surgery rather than an easier recovery. That is what would give me confidence in his approach. Here am I telling you I have cemented in order to reassure you, when I didnt know the difference until I had a good look. If I had been given the choice I’m sure that I would have chosen uncemented.
I hope that your unconscious mind is making a decision underneath the extreme anxiety that you have, and you’ll soon be back in recovery mode again.

 

[Josephine]

it is a brother/sisterhood for sure here in the States where drs don't want to speak against another doctor unless they are actually your witness in malpractice litigation.

While I think that's true they don't like to talk bad about their colleagues, it more a case of "there but for the grace of God go I" than anything concerning legal issues.

No one has said anything to me about why I have aseptic loosening, not a word about the site not being prepared right nor has anyone said it is an obvious botched implant job,

Well you see, they wouldn't! What I tell you here is from my own experience and knowledge but a surgeon wouldn't go into that kind of depth about it to anyone, let alone a patient!

He also said I was absolutely too young for cemented

Well that's not entirely true. It's just his preference, that's all. Back in the days, cementing was all we had. hydroxyapatite didn't become available until around the late 1980s. But even since then, there are those surgeons who still prefer to use cement because of the loosening issues such as you have just experienced. There are also many surgeons who do hip replacements on 20 yr olds or even teenagers and use cement!

he doesn't believe in an extra HA coating on the implant to promote bone growth as that can also have detrimental effects

Yes, like loosening!

The original surgeon said cementing might be an option but that the downside of that is that cementing can fail in time

The stats show quite clearly that far fewer cemented implants fail than uncemented. In all evidence issued by the National Joint Registry (UK) cemented hips are by far more reliable. However, you shouldn't let that spook you as there are still a prodigious number of uncemented that have a long and merry life!

No guarantee I will not have LLD either - he would not say I wouldn't have one leg longer than the other, more than normal that is, he said, as our legs are usually slightly different lengths anyway

Quite true on both counts. Almost everyone has some degree of LLD.

I know a lift will help

One should never use lifts after hip replacement because the LLD is only temporary and must be allowed to settle on its own. Read this Leg length differential - LLD

He said it is a longer and more difficult surgery than the original implant surgery

Don't let this worry you. What he meant was that the surgery will be longer and more difficult for him ! You won't know anything about it.

There is loosening around the entire stem, there is a halo on the bone in the xray that travels around the stem. I also have bone modelling at the end of the stem

All sound evidence of loosening!

I certainly can't use this implant for the next five years

Sorry? You can't USE this implant for 5 years? In what context?

My surgeon uses uncemented as he did on me even given my age and the fact that there was no bone ingrowth to the acetabular implant but was to the femoral. I went with his protocol. I asked in pre-op exam about "caging" and all sorts of other ways to ensure the implant would not loosen this time

Well, a) this had nothing to do with your age and b) consider the acetabular and femoral implants to be two separate entities. It's very rare that both will loosen. Also, the cages you speak of are not used in this situation but for a condition called dysplasia, a childhood condition where the femoral head can wear it's way through the floor of the acetabulum and even break its way through. Such cases do need the additional support of a special cage implant but not to prevent loosening.