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

[Josephine]

Good members, can I please ask you not to make your posts one huge block of text? They are very difficult to read. @chalcedonian1 and @zinnia you will notice I have edited your posts into several paragraphs. Please follow this pattern when you post. Thank you so much!

 

[zinnia]

Thank you @Josephine for the "caging" clarification; I referenced it to illustrate how worried I was about cemented or un-cemented.

I will also remember to paragraph my entries. Sorry about that inconvenience.

 

[chalcedonian1]

@Josephine I only meant that I can't indefinitely keep this implant in my hip when I said I can't "use it" -- obviously it needs to be replaced.

Has HA coating been found to contribute to aseptic loosening? I have read a few studies in which it seems the HA coating didn't have a certain influence on the risk of stem revision, and therefore HA coating of stem components was not associated with relevant effects on the survival of stems, but I hadn't read it contributes to stem loosening either.

I can deal with temporary LLD, I meant it will be difficult to deal with it if it is permanent, I was talking about a lift only if it never settles on its own. I will read through your link, thank you.

Your comment on the difficulty of the surgery is immensely comforting! I didn't think about it this way and I appreciate you straightening my head around that one; of course I will be asleep, so how will I know? I have also assumed the longer the surgery, more misery will occur on the recovery side-- and that I dread at the moment, probably because I am in such pain, and the contemplation of even more pain is almost unbearable. But when you have to do something, there is no choice to be made, the surgery must happen.

@zinnia Thank you for your thoughtful commentary! I don't know yet how I feel about this surgeon, what my intuitive feeling is about him, or maybe any surgeon for that matter at the moment. I had full faith in my original surgeon, he answered all questions, had a terrific bedside manner, is smart and highly regarded, came well recommended, I felt great about him, etc etc. but my implant has still failed. Yes, this new surgeon told me the risks, and he is a leading surgeon at a world class hospital but I didn't feel one way or the other about him, maybe I am still processing the fact I need a revision and hearing his responses was just too hard for me to understand in full, much less get a feeling for/about him. I don't have confidence in myself yet about choosing a surgeon, I know I have to have full faith going in -- just not there yet on any count. Interestingly, I had VATS lung surgery 8 years ago; that surgeon had a rather sour bedside manner, was imperious and somewhat arrogant, but he was THE GUY: the surgery was incredibly successful, I had an amazing recovery, virtually no pain, while a friend of mine who had the exact same surgery in a Canadian hospital was in an induced coma for three weeks thereafter with a breathing tube, she barely recovered and almost died! Obviously we are all different and respond differently to the same surgeries, but her problems were shocking when I just sailed right through it. Yet my VATS surgeon was not someone I would say I connected with either, but I did have faith he was the best around. You are right, I need to get myself there with a surgeon who is willing to own the revision.

So, I have two more surgeons to see, by that time I should have a better feel (I hope!). For me, knowing more information will help, but then the information can get to a huge, critical mass and I just have to go on sheer faith at that point to make the decision of who should do this.

You said you are living in recovery with no pain 3 weeks post op and walking on a cane easily though still for short stints. I am so impressed having read through your entire thread. I can't imagine what you have been through, but I love those words. and I love your spirit that shines through even more. I have had constant pain in one form or another since my surgery, and can't remember what it feels like to have none at all. To be able to walk with no pain is a dream. And yes, I would give up this pain and discomfort for a longer recovery with controlled pain, so long as I could feel it will end at some point! So thank you, I will tolerate whatever I need to here after I get over the terrified part and into the more hopeful frame of mind. I really appreciate your logic, it will help me immensely to get to a mind set I need, thank you.

And the best news is that I do NOT have an infection, the cell culture came back this afternoon and it is definitive, so no immediate hospitalization. I hit the lucky lottery on this one for sure.

I hope everyone that has responded or who may be lurking just to read the threads has a wonderful holiday season. I will stay connected here, it is a relief to be able to express my concerns and again, I am so grateful to all.

 

[MammaT]

Have a good holiday @chalcedonian1. you seem to be researching everything thoroughly. Living in Boston you should not have a lack of choice. Great news about no infection.

 

[zinnia]

@chalcedonian1 So happy to see you back and I detect a more calm approach to your dilemma. You are going about your decision of a surgeon in a very sensible manner I think. I applaud you on your approach.

When I suggested that an intuitive approach may be helpful I am really thinking about your sense of his abilities and willingness to answer questions with an easiness. I didn't mean "having a connection" because I'm not sure what exactly that would be. So, therefore, your experience with the lung surgeon was actually an intuitive approach in my mind.

But that is really just playing with words. . .what's important is how you feel about the surgeon. I wouldn't try to get too fancy about it. Does he have a good history with revision surgery? Is he handling your questions with what I consider to be an easiness and an attention to your concerns? When you interview the next surgeons you'll get a better feel for it. And I think "interview" is a good way to think about it. You are interviewing them for this job of fixing your hip. Which one would you hire?

Continue on doing what you are doing. You are doing it so well. I understand the long term pain. I was in pain for 2 years. Now that I look back on it, it surprises me that I waited so long to get help.

It sounds to me that you need this revision as soon as you can manage it. We will all be following your progress to that goal. I wish you the very best and look forward to watching your thread as you move in that direction. There are many people here who wish you well and will be at your side as you move forward.

Have a very :merryx:. Best wishes to you and yours.

 

[Layla]

Continued prayers for resoulution @chalcedonian1
I'm thankful for @zinnia and her loving attentive care to your situation.
She's a great example of how all of this can turn around.
I hope you're able to spend some quality time with loved ones over the next days.
Sending a hug and warm wishes for a very Merry Christmas and prayers that you're blessed
immeasurably in 2018!

 

[Josephine]

Has HA coating been found to contribute to aseptic loosening?

To the best of my knowledge, no. Most loosenings are caused by improper site preparation just prior to implantation.

I have also assumed the longer the surgery, more misery will occur on the recovery side-- and that I dread at the moment,

Absolutely not! When you wake up, it will be pretty much the same as the first time!

 

[Mojo333]

@chalcedonian1
Just wondering how things are for you?
Have you gotten a date for getting that miserable hip fixed?
Thinking about you.

 

[chalcedonian1]

@Mojo333 Thank you for asking. I am still seeing various surgeons, asking questions, trying to figure out who might be the best alternative for me, and hear what they have to say as to what makes for the best outcome etc. The lapse of time is helping me cope a bit better. It was very shocking when my hip problem was confirmed by the scan and xrays, and it was so hard to think straight at that time. I also wound up with a bad cold and have been in bed for the last week so there's that too. But thankfully it is not the flu, and I am beginning to feel a bit better, though still sick.

Laying in bed puts no stress on the hip so not much pain, that develops the more I use it, like walking around in a store: all of a sudden I will have a huge burst of excruciating pain and then it will subside but I can't walk "right", both out of fear that it will happen again, and pain because there is always some residual pain there, most especially after an "episode" where the stem wobbles in the femur and I cant put all my weight on the leg.

So I know what lies ahead, it is just a matter of getting my life together to accommodate the surgery and recovery period after I pick where I will have it done. I am following all the current hip revision people on the site and am hoping to see good outcomes for everyone. Thanks so much for checking in with me, I will stick with the site and post as things move forward.

 

[Mojo333]

I know it has to be super tough.
Everyone in our neck of the woods head been sick..flu, colds..
I imagine I would also be super paranoid about too much walking around.
I'm certainly happy that you aren't dealing with an infection.
Please let us know how you are doing...I know that this was not the way things were supposed to go.

 

[Layla]

Hi @chalcedonian1
Prayers for insight and your comfort as you continue to research.
Hope your cold eases soon. It seems every other person is suffering with something
during this nasty cold and flu season. Rough year!
Only saving grace is the pain relief you're getting for your hip, while on your back.
All the best to you!

 

[zinnia]

Well, @chalcedonian1, nice to have you back. So sorry you've been sick. This has been a hateful season for colds and flu. I have not escaped but it didn't put me in the bed as it has you.
The fact that you have been without pain while resting in bed must be a bit of a relief for you. Sort of proves, does it not, where the pain is coming from. . .the femoral loosening, which as you have found can be a monster of a pain. No one who hasn't been through pain like that can understand it. Luckily, you have found BS and those of us who do understand. So keep hanging around and we'll be there by your side the whole way.

So I know what lies ahead,

Well, not exactly. When you say that what do you mean? What you have already experienced is not what you will have after the surgeon of your choice fixes the problem. Yes, there will be a recovery period and there will, no doubt, be some pain involved, but if the Bone Smart agenda is addressed and the pain is controlled it will be of no consequence. Your recovery will progress in the proper fashion as a repaired and improved hip revision. That it is a revision is of no real consequence either. I've had 2 revisions, one improper one and one improved and repaired one. I choose the latter, obviously. They couldn't be more different. It was apparent with my first step. . .my hip felt "there" for me, solid and with little to no pain, I took that first step. . .on the walker to be sure. . .but a step on a "new" hip. And it felt "right". This will happen for you. That trip to the grocery will not happen with those horrific instances of functional failure with the resulting pain.
So I wish you wellness as you make the trip to that goal. You have a plan. Proceed! We will follow you as you move toward that necessary revision, holding a hand if need be, cheering you when things go well and commiserating when they do not go as planned. But success is waiting.

 

[Mojo333]

Smart determined lady, that Zinnia!
Keep the faith.

 

[chalcedonian1]

@zinnia I am wondering if you ever felt those shotgun bursts of pain when your hip implant was loose?Of course there were always other pains too, but it is the sudden giving way that is so scary and painful.

You ask what I meant about what lies ahead--and that what I already experienced is not what I will have after the revision surgeon fixes the problem. I certainly hope you are right. It took about 9-10 months for much of the tissue, sciatic problems and other internal muscle pains to diminish to a dull roar after the THR, but there was always some pain traveling around in my leg, to this day. I have had massage, lots of it, but the relief was only temporary, and as I have said before, my hip/thigh never felt pain free. So I guess you are right that I hopefully will experience something I haven't experienced before. BTW, I followed the Bonesmart protocol, never did anything to excess. I took the pain meds when needed right after the surgery, and while recuperating and had no problems weaning off of them. My recuperation was fairly uneventful, I had a pulled stitch, I stumbled slightly once and had an xray to make sure I didn't do anything to the hip. Other than that, a textbook recovery and the hip looked very good, "textbook" on the xray at 4 months according to the surgeon!

The first revision surgeon I've seen said I had an 80% chance of a good result with the revision. I am still skeptical since I fell into the 2-4% of failed implants the first time around. But I understand I must have the revision, and I think that is what I mean more than anything when I say I know what lies ahead.

I have a meeting next Wednesday with another surgeon and one more the week after that--a trifecta. Then I will decide. I am assuming the operation will be some time in the spring, depending on the surgeon's schedule. I hope my second hip feels "there" for me, solid and with little to no pain, when I take that first step. . .of course the apprehension is still there that it will not. I am not a whiner by nature, I tend to be a problem solver and have been able to do many difficult things in my life without hesitation. Intellectually, I feel it would help to know WHY the implant loosened so then the revision surgeon could adjust to take that into account. I think that is why I am still apprehensive: when there is no known cause, how does one do all one can to make sure it doesn't happen a second, or third time? That is what has driven me a bit crazy more than anything. But I have to move forward.

 

[MammaT]

@chalcedonian1, I can’t imagine what it is like to be in your situation. I do think you are taking the right approach by seeing several doctors. You need to find one you trust and feel comfortable with. I don’t know if docs can really answer why or not. Moving forward is difficult at times. You are using your problem solving skills to the best of your ability.

Carefully evaluate what they tell and ask them each the same questions. Your instincts will tell you who to go with.

 

[Layla]

Hi @chalcedonian1
Sadly, I can't relate to your situation as Zinnia can, but my heart goes out to you in your pain and longsuffering.
You're living what many of us fear and for that I am sorry. I'm clinging to Jo's words above that when you wake up your recovery will be pretty much the same as it was the first time around. The odds you received from one revision surgeon of an 80% chance of a positive outcome are pretty good. I'll be curious to see what the others predict. I understand your skepticism. I'd be the same way. It's saddens me to think of the emotional burden you carry in addition to the physical pain. I pray you are led to make the right decision on the best surgeon to do the revision. Then, that you're able to move forward with hope and a feeling of peace in an effort to regain your life.
All the best to you!

 

[zinnia]

My dear @chalcedonian1. Believe me when I say, I do feel your pain and your apprehension. Layla will tell you how frightened I was. It took me a year to admit that I needed to see another surgeon for a 2nd opinion. I had already been through 2 surgeries that failed. I was so far out of the 2% to 4% failure league already; how does that happen? I guess it took a year for it to sink in on me that there was no way I was ever going to heal and carry on without pain. All of those questions were there for me as well. But there is no answer I'm afraid. So what to do?

I have learned to let that go because I want to heal and it won't happen with those questions hanging over my head unanswered. I had to forgive and move on. The surgeon who gave you an 80% possibility is just giving you a number that again, really means nothing much. You know what my surgeon said. . .he crossed his fingers. What can they say really? They don't know, so he gives you a percentage. In reality, and Josephine would have a better answer here, but I think you do have the more difficult implant to fix. Mine was the acetabular implant that needed fixing, the femoral is working just fine. But there isn't much they can't fix and fix well. That's just about all you can know.

Yes, I know the pain of the loose implant giving way. . .what you call a "shot gun burst". Great description! I had a big one when my femur just cracked on me 4 months after the first revision. That was fun. It was a real "CRACK" and I went down. And it was only a hairline crack. Think of the whole rod loose in the femur bone and you know why you are in such pain. It's not an easy road. I admire your strength of conviction and your pursuit for a good surgeon. You are a born executive. That will take you into recovery with the best mind set possible. That you followed the BS protocol with the primary replacement means nothing when you realize that there has probably always been a problem with the femoral implant.

When this is all fixed, you'll have that recovery Josephine is telling you about. A new recovery. Yes it is a revision. Yes your first surgery went wrong. But you can start anew. With a new hip. A new chance. But you will have to put all those questions aside because there are no answers as to why it all happened to you in that way. I am so sorry someone else has to go through the pain, the apprehension, the fright of a revision. So sorry that it is you. But it is and so there we have it. So what do we do? We do our best. And that is what you are doing. You are doing your best to make sure this gets fixed. And it will. You are closer still to another recovery, yes, and that really stinks. I know how it does. It really is a big time bummer. But the best thing is, you'll do it and you'll be telling us all about it from the other side. . .the recovery side and you'll be talking to other people who, unfortunately, have to have a revision. You'll be telling them that it's no picnic but good things do happen after all.

Hang in there. You're a great lesson in perseverance. I am hoping for the best for you; for this recovery to go well. For you to find a place out of the way to put those questions which cause so much apprehension so you can move on with a clear spirit into this new experience. A new hip, really. It can happen. It has happened. Wishing you wellness.

Have a good and peaceful night. I am thinking of you.

 

[Mojo333]

Keep the faith...I'm praying all the best for a great solution!

 

[chalcedonian1]

@zinnia Thank you for taking the time for such a detailed answer. I look forward to the day when I can pay it forward on this site for sure. I have a very inquiring mind, my profession has taught me to ask a lot of questions and to never make assumptions, and most of the time that serves me well, but perhaps right before my surgery I will need to turn off that part of my brain. I did before the first surgery, I will need to do that again. And it helps to know it took you a while to acknowledge you needed to see a second surgeon, makes me feel a little bit better as I am kicking myself for not being able to acknowledge my symptoms earlier, that something is wrong, not just "well this is what having an implant just feels like" and soldiering on, which is what I tried to tell myself for quite awhile. But once awoken, one certainly can't ignore it anymore!

How the surgeon will be able to remove the femoral implant without breaking/shattering/doing harm to the femur is actually quite frightening to me. I am trying not to fixate on that, but it has my attention for sure. I was a bit overwhelmed during the visit to the first revision surgeon, so I actually did not ask how that is done. I am not sure I even should know! I guess the best I can hear is that the surgeon has done this many times before and is highly skilled in doing so. But most surgeons don't say "I am not highly skilled" if they state they are revision experts!

I guess I ask the question "why did this happen" as I don't yet believe the reason they can't answer me is because "we just do not know" (even after they do the revision, having gone in there to see what is what!). I would like to think it is not because they are covering up possible mistakes by the original surgeon because of a litigious society here in the States. You definitely have accepted WITH AN INCREDIBLE AMOUNT OF GRACE what has gone on with you both mentally and emotionally, I hope to get there. I don't want to be angry, it really isn't about that of course, I am not a person who enjoys a blame game and I don't want to feel "poisoned" by those thoughts. I understand the collegial sense that professionals have for one another, and I mostly respect that, but not if it interferes with figuring out what to do, or not to do, in recovery and thereafter that might help the revision at least be a success (and possibly help others with the knowledge). If there is nothing for me to do with respect to my recovery (other than following the Bonesmart protocol, etc.), does that mean my implant failure is probably a result of a poor/wrong judgment or decision made by, or action of, the original surgeon? If it is not the surgeon, then I want to know if I should be more active than before, or less active, the same as before, or eat differently, or whatever. Or was it just Fate, or bad luck???

The original surgeon said "there is nothing I did or did not do" -- and the revision surgeon seemed to echo that, but he also said after he does the revision, it is then up to me, the patient, "to take it from there". Hmmmmmm. As you can see, I am still processing this, because some of these statements could be internally contradictory! If the science is that one simply cannot prove why implants have failed (@Josephine posted several reasons to me as why they do fail, but how to know any or which of those apply to me?), then I will give up the ghost, and will resign myself to the fact that this will remain a mystery in my life, and I will turn off this part of my brain for my own sanity.

I can barely think of a future where I can walk distances through a mall, or by the beach, or even on a sidewalk without pain and awkwardness, and having some odd sensation that doesn't stop, or just intensifies so fast it prohibits me from trusting myself to keep on walking, waiting for that sudden pain. But I pray for this day, I really do. I am doing the best I can right now, trying to not get overwhelmed too much and trying to prepare my business and personal life for the recovery process, so I am moving forward in that respect. Again thank you from the bottom of my heart for your encouragement and fine example. You are truly a very special person.

Thank you @MammaT!

Thank you @Layla. I do want to recover my life and am willing to do whatever is humanly possible to make that happen.

@Mojo333 Thank you also. I will keep the site informed on what/when I decide. On the one hand, it is a blessing to have a few surgeons to choose from, on the other hand, it can lead to a lot of second guessing. Sometimes I feel I am throwing my fate to the winds...

 

[zinnia]

@chalcedonian1

"well this is what having an implant just feels like" and soldiering on,

This is exactly what I told myself for an entire year. And then when I went and complained to my primary care doctor about the pain I was diagnosed with hip bursitis. So there was the problem after all! But the bursitis hung on and hung on and didn't move on. So I finally gave up, gave in. Sought out the surgeon that my primary doctor suggested; liked him and his PA in the meeting and he made room for me on his calendar as soon as he could. He did not try to protect the original surgeon but he didn't go out of his way to suggest there was a mistake either. But there clearly were mistakes which he did tell me about. There were two screws wrongly placed in the pelvis area, one was completely loose, the other he just lifted out with is hand. The original pelvic fracture had not been fixed, the piece broken gone and had to be buffered with a metal substitute to hold the cup in place. I don't know any more details but questions occur to me as I go along which I will ask down the road.

So a doctor can be candid about what he/she finds in the process of revision but it is not possible to see all the details on X-ray. I don't think I like the doctor saying it is the patient's responsibility

"to take it from there".

I think I'd want to know about his/her plans for follow up. As long as you are his patient he/she is responsible for the job of repair I should think. Or at least be more clear in his purpose for saying it. I don't mean to suggest to you that there is no reason that the surgery failed. It is obviously the fault of the surgeon in some way or a "biological issue" in mine as I was told at first by my new surgeon. That is to say that I did not produce bone ingrowth so the cup didn't "take" or settle into place. At the bottom of that, however, is the placement of the cup itself, the correct % of contact, etc., etc. That is the surgeon's judgement. My femoral implant did well, why not my acetabular? So, of course, there are the questions for which that there are no answers. Did the screws come out because of no bone ingrowth or were they placed wrong or what? Of course the recovery is our responsibility in that we are given instructions to follow. I have some major restrictions for instance. That is a given. But that a surgeon could wash his/her hands of the patient sounds more than a bit cold to me. I choose to place the major responsibility on the surgeon, the secondary on the patient. Or visa versa, which ever fits the timing.

I will finish this later. I have to go to PT now. Glad to hear you are doing so well. I will continue to keep up with you. Take good care and continue as you are. You are doing this so well.