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

[Josephine]

not think about how all the components align

they don't decide on treating a loose stem and ignore the cup.

Actually this comment was really referring to the likelihood or not of the cup also being loose. It was nothing about the alignment.

one can understand my desire to understand as much as possible,

Of course I can and you must feel free to ask as many questions as you like. It would be my please to reply and explain them all. We've long since had a saying on here "there's no such thing as a stupid question"!

 

[zinnia]

Hello again, @chalcedonian1. I am impressed with how calm but resolute you sound in your posts. Your experiencing almost my exact situation beginning in 2015, except my 1st revision was immediately after the primary surgery. But I suffered with it even though it never felt "right" either. And then it began to deteriorate in about a year's time and I went down hill until I could not do much of anything, including drive. So the fact that you need a revision is a given and you are moving on. Good for you. I am so sorry all this is happening to you, very, very sorry. That you are being so thorough in deciding the course of events toward, during and following your surgery is such a good thing. It's a hard diagnosis to bear with; the frustration and the disappointment in the original surgeon was almost too much to buck up under. Thankfully you have the heart to hold up under the strain of it all and I admire your resilience. I think you will be fine; your recovery, I hope, will be successful. It will, under the circumstances, be its own thing, but has all the promise of the real thing.

The questions about the cup are real, I think. I also looked at the x-ray and though I'm not an expert, I can see what you are talking about as I saw my own and it was much the same. Thankfully, I didn't have a problem with the stem, just the cup.

All that addressed and aside, I am hoping things will proceed in an easy fashion for you. I will continue to watch for your posts so I know where you are going and when. There is an end to this in sight. I am sure of it. You have been through enough. It is time for things to go well. Good days ahead are due you.

 

[chalcedonian1]

@zinnia I think I have the ability to hold up because I have an extremely wonderful and supportive husband who would do anything to see me get better. He is most definitely my anchor. I also see so many worse off than myself, though on the the day of surgery, I will not be calm inside, I can assure you! As you have experienced, when there is no alternative, there is nothing to do but move forward, and you are an example of one who does it with grace.

I can't even begin to express my thoughts about the original surgeon, it is a very dark space indeed to go to in my brain so I am trying to avoid it as much as I can for now. I do care about finding out if the same thing can be prevented from happening again, and this forum and @Josephine have been quite informative in that respect. Having it be an issue with the surgeon's skill is a double edged sword in that it makes me furious on the one hand, but hopeful on the other, because at least there would be a sound reason(s) for the loosening, and I would hope my new surgeon will put in a new implant that is bigger, that fits better and not make the same errors.

But if it is idiopathic, e.g., for an unknown reason my body can't grow enough bone into the implant, well, I just can't even go there...the original surgeon worried me greatly because he said anecdotally he has seen many people, particularly women, who are on thyroid medication (which I am) with this lack of bone growth problem, though he said he couldn't prove it scientifically -- it is just his observation. I note that he also never "observed" that the implant he put in might be the wrong shape, not big enough or with a long enough stem, etc, though he said he would recommend using one with a longer stem in a revision, "one that he uses in older people " --70-75 year olds, which comment @Josephine roundly called out in another posting. He said they could use a cemented implant, but he would recommend against it, and all the other surgeons I am seeing likewise recommend against it and in fact will not do a cemented implant.

My ability to do things is greatly limited by this very strange hip -- there are days when I can walk on it somewhat, but most of the time now I just don't want to walk very far because it gets painful quickly and feels so odd. I also don't want some emergency with the hip because I slip, or step in a pothole, etc., so I am trying to be very very careful. I hope to schedule surgery sometime in late April/May, which gives me time to prepare in all kinds of ways. I sure hope things will change after my recovery, but I honestly can't imagine what that will feel like. I have an appt. tomorrow with Surgeon #4, it will be interesting to see what he has to say about the Xrays.

Thank you @zinnia for all your truly inspiring and helpful posts and comments. More to come from both of us!

 

[Krista]

@chalcedonian1, I am sorry you need a revision, and that you will be very prepared for it. I, too, had two hip surgeries, and I was ultra-prepared for the second one (which involved soft tissue injury tendon repair and a look-see of my hip implants), which went much more smoothly for me.

Just wanted to let you know that I have been on thyroid medication for many years and have had no problems with lack of bone growth around my uncemented hip implants. Everything is perfect in that regard with my hip, and I hope it will be that way for you, too. It must be so difficult to have to be so very careful with your iffy hip, never knowing quite what to expect. After winter is over and you have your revision surgery and it is spring and summer, you should be feeling much better!

 

[chalcedonian1]

@Krista Thank you so much for your post. I don't know what to make of the thyroid comments, the surgeon couched his remarks quite properly by saying it is anecdotal and only his observation, but I though almost immediately after I left his office that he knew before surgery I was on thyroid medication and could he have made any adjustments as a result? Of course the answer is no because this is only anecdotal, not scientific, and I would imagine there are many more people on thyroid meds whose implant surgery succeeds than the 2-4% whose original surgery fails because of loose implants.

I also asked Josephine a number of posts ago if she had ever heard of this, and she said she never heard of any such contra-indication with thyroid medication. I am very glad to hear of your success, and thank you so much for the encouraging words. I do want to be ultra prepared for this revision, and will do anything and everything necessary to make it a success--I followed the Bonesmart protocol the first time around, but even then had trouble walking long distances because the hip never felt "good", in fact I always can "feel" the hip in some odd way, and am surprised when I read about people who don't feel theirs after a year or two, when all has settled in.

Ironically, I actually have developed a very good gait, I limp only when I have overdone the walking and moving around (but one day a certain amount is not overdoing, while the next day it could be overdoing). I limped for a long time when I got up out of bed or a chair but managed to overcome that. It took a lot of hard work to achieve this. But again, I do this always in some kind of pain or discomfort! So, any improvement would be a good improvement... and I sure hope you are right. You give me hope that I too might fall into this wonderful category of feeling better.

 

[MammaT]

@chalcedonian1, I have been on thyroid medicine, technically suppression therapy due to thyroid cancer for 21 years. I have read that long term suppression therapy can cause us to need extra calcium, but had no problems with hip replacement because of it. Most importantly I checked with my endocrinologist about it, and he Afro is not aware of a relationship.

 

[chalcedonian1]

@MammaT Glad to see you are home and thank you for taking the time to post to me. I don't have a thyroid at all anymore, it was completely removed over 20 years ago. I do think there must be many more successes than failures with people on thyroid meds, or I would think other surgeons and scientists might have also taken note.

Josephine and one revision surgeon so far have told me the implant is the wrong size, way too small, (perhaps the femoral stem is not shaped properly with the bone), and that may be the most likely reason why it is loose. There may also be looseness in the cup, not sure.

I am glad to hear you weigh in on the thyroid issue, thank you for your experience, glad for you that all is well in that department with your hip. I hope you are feeling better each and every day!

 

[chalcedonian1]

@Josephine My revision surgery is scheduled for July 3rd at the New England Baptist Hospital and I am beginning to prepare my home and what I need to have on hand when I come home from the hospital etc.

I am very interested in what you think about Cold Therapy Systems (e.g., with a hip pad where ice water is constantly circulated around the wound site) or a Cryo cold cuff/compression cuff system wich also compresses the area every minute or so. I used a Cryo-cuff when I had shoulder surgery, and it was very, very effective.

When I had my first hip implant, the gel ice packs moved around a lot, they were rather heavy, and I had to keep readjusting them, and then replacing them with new ones. I know one can use a large pillow case and fill with ice bags, but I am looking for something that is easy to use and not messy. I would like to try one of these units, but am curious if you, or anyone else on this site has ever used one while recuperating. Also please let me know if you would use the cryo part but not the compression part. Thanks much.

 

[Josephine]

I am very interested in what you think about Cold Therapy Systems. Also please let me know if you would use the cryo part but not the compression part.

For my TKR (both - and two shoulders) I used the Cryo-cuff. I thought they were aces!

 

[Mojo333]

@chalcedonian1
Just a few weeks away..wondering if you were doing well and ready to get it all done and dusted?

Will be glad when you get on the healing side for good !
Sending good Mojo your way!

 

[chalcedonian1]

@Mojo333 Thank you for asking. I have had my pre-op appointment and am fairly ready for July 3rd. I try not to think of the day itself but the healing process afterwards, no need to heighten my already existing anxiety. I hope it turns out better than what I have, but I don't want to get my hopes up too high. I will take all the good Mojo you can provide me!

 

[Mojo333]

Oh yes ma'am, this is going to turn out much better. Of course you know of the tough first days, but then you have being tough down by now, eh? (It can really be the pits being tough)

I'm going to believe it!!!!

 

[Gypsy]

I agree with Mojo. It will be better.

 

[Layla]

Hi @chalcedonian1
July 3rd will be here before you know it and you'll be on your way.
Happy for you to finally get it right.
By the way, which leg is it? Let us know and we'll add it to your signature.
Wishing you comfort as you await July 3rd.

 

[chalcedonian1]

It is my right hip/leg. Thanks.

 

[chalcedonian1]

Well my revision surgery is about 10 days away (July 3rd). For the most part things are falling into place. I am getting extremely nervous, I hope to get most of the nerves out of the way before surgery, but fear when my husband leaves me right before the operation that I will lose it. I have been quite strong for the last three years, but facing this surgery is testing me right now.

I have ordered clothing that will not hurt the wound, but will be comfortable. I have almost wrapped up work, and will finish it next week. Crazily, I am stuck on what toilet riser to order -- I hate them. The PT person said they will have some at the hospital to purchase if I feel I will need one, so maybe I will wait until then. She said there are actually few restrictions re: the 90 degree rule, even though it is a lateral posterior cut. This was news to me and can't quite believe it. (I had anterior surgery the first time around and there were no 90 degree restrictions at all.) I know I will be using crutches and be non-weight bearing for a period of time, all that is fine. It is the toileting part that makes me crazy, I am a very independent and clean person and don't quite understand (or remember) "the logistics" -- but I am sure I will figure it out. I am going to cut down on my eating of solid foods for a few days pre-surgery and start taking Colace-- OMG, the constipation from anesthesia and the meds hurt more than the last surgery itself and really incapacitated me. I am always so surprised that no one forewarns you about this.

I just wish I could feel more optimistic about the outcome. I am generally not a negative person, but I am feeling quite cautious about what lies ahead, and saying to myself "I hope I am no worse off afterwards than I am now, and hopefully it will be better than that". I have put the anger I've felt about needing a revision into a pocket of my brain and am not touching it in these critical days before surgery, I know better than to go into surgery with an angry mindset (thanks to those of you who wrote me, especially @zinnia.) Of course I am very concerned that if the bone did not grow around the implant the first time around, it will happen a second time, or perhaps worse. But I won't know that for some period of time after surgery. @Josephine has suggested it takes at least 12 weeks I think for new bone. I wondered before if I didn't do enough walking, or maybe I did too much walking, and/or could I have done something to make myself better, did I do something to make myself worse (because this time around I will do WHATEVER it takes), yet it seems like I don't have control over this part either (I didn't fall down on my hip, or have other any issues, so whatever caused my bone to not to grow enough around the implant still seems a mystery, and I simply can't know if the surgeon cleaned the area out well enough, right?). One's mind can think of all kinds of bad things happening ahead, for sure.

Any suggestions and uplifting messages from anyone who remembers this stage before surgery are very welcome. I have a support system at home, but no one understands my feelings better than those who have gone through all of this as well. My courage can't leave me now but at times I feel it slipping away. Thank you everyone.

 

[Mojo333]

Hi my friend

OMG, the constipation from anesthesia and the meds hurt more than the last surgery itself and really incapacitated me. I am always so surprised that no one forewarns you about this.

Right?! I had a very hard time of it also and I would definitely get all necessary stool softeners, laxatives, and easy to go through the old digestive tract foods I could accumulate.

I can imagine your anxiety, as I was pretty shell-shocked at the prospect of two...but not knowing what exactly caused this hip replacement to let you down, would obviously make things harder to find peace about the upcoming procedure.
I am going to think positively about this outcome, as are you, and your whole fan club. Cant stay this way.
I will be praying you find some peace..

 

[chalcedonian1]

@Mojo333 Thank you for your response. I need all the positive thoughts I can get.

 

[Layla]

Aww, I'm so sorry that pre-op anxiety is kicking in. I understand you don't want to "lose it" but if you can make it all the way up until it's time for hubby to leave your side, you'd be doing well. That will be minutes before "lights out" and then the magic will happen. Your OS and his care team will respectfully, carefully and skillfully FIX YOU.

I'm happy to hear you're still working as it serves as distraction. You will figure the toileting out just as you did before. Check NanaMama's thread for some constipation recipes if needed. Someone this morning shared a natural remedy that worked for them. I'll find it and share. It never hurts to have back up ideas (pun intended)

Try not to dwell on negative thinking. I understand how easy it is..but will doing so really change the outcome? No, it won't. Every person you deal with on the day of surgery wants the best possible outcome for you and will work toward that end. No one will be indifferent. It will be a team effort. Perfectly orchestrated.

You shared that Josephine and one revision specialist have mentioned that the implant is the wrong size, way too small. So go with that. Believe that is the problem and accept that it will be remedied on July 3rd. You have no proof it's idiopathic, or a result of your thyroid medication, so why can't you have your happy ending?
YOU CAN AND YOU WILL

You have tons of support here. It comes in various ideas and beliefs, all well intentioned. Along with that there is prayer. I have a strong faith and know many others here who do also. They will intercede on your behalf. Prayers for comfort, peace of mind and the best outcome imaginable. You just have to believe it can happen.
We're here, we'll be here. We care.

Sending love, a warm hug and best wishes for a peaceful weekend
@chalcedonian1

 

[chalcedonian1]

@Layla Those are all lovely and very logical thoughts, especially about those performing and helping the surgery along. Wish I had thought of them myself, but I have not been able to cast this quite the way you have, and as I read your post, I do believe you are correct. I have been inside my own head for too long and almost can't see the forest for the trees at this point. And there have been some signs of lack of administrative attention, but that may be because I am paying attention to all of the details far in advance of what is expected of me (my need to delude myself and feel in control of something, most likely!).

Yes, the surgeon I am using (and another) did say he would have used a longer implant, so I will remind myself of this too.

Next week will be quite busy so that is a good thing, it will fly by as I have a lot of work to wrap up and people to speak with. I even have a closing the day before surgery in the morning! That was not by choice just how it worked out. I do think I will be ready in almost all aspects,I just need to get my spirits up more than they are right now, and cultivate my sense of faith in the surgeon and his team.

I have ordered an ice therapy unit so that i don't have to keep moving ice packs around, and it can pump the cold from the unit. Just have to figure how to wrap it around my hip with the hip pad that comes with it. Thanks for the recipes, I will do anything and everything to have all systems become as normal as possible ASAP.
I remember the hospital stay as being exhausting, not much sleep because you are woken up every few hours for BP readings etc., but all that is relatively minor in the scheme of things, and I will look forward to coming home for sure, so I want to focus on that too.

I do need to hear these positive and encouraging thoughts from those who have been here. Thanks again.