Metallosis: Revision LTHR in 3 weeks

[tapan]

Hey guys! It has been a while since I have last visited! I am excited and nervous to start off a new year with a revision left THR on Jan 22. Hoping for a good positive outcome post op. I have researched extensively about revision procedures and their success rates.

Let's just say there is a lot of info out there (great and not so great) but I try not to analyze it too much for the sake of my own positivity! I would love to get some opinions and experiences from you folks about revision surgeries, metallosis, recovery times to help me get through this process as smoothly as possible.

Alright, so to give you a bit of a context, here is a timeline of events related to to my left hip:

Age 4: Diagnosed with avascular necrosis (AVN)
Age 4-21: Pain with daily activities. Developed osteoarthritis closer to 18 that became unbearable by the time I was 21
Age 21: Got a left THR in July 2009. I was cane free by Sept 2009 (2 months post op)
Age 22: Received a call from my surgeon's office that my hip implant had been recalled! (DePuy Acetabular Pinnacle system). Was put on a close supervision by my surgeon to monitor my X-Ray progression and everything looked great. No pain and no signs of complications.
Age 29-30: Started experiencing complications, intermittent pain in my groin area, hip clicking/popping, some leg shortening, hip and thigh pain, feeling of instability. Xrays and bone scans checked out fine and showed no indications of implant loosening or bone loss. Blood serum test suggested high levels of cobalt, almost 2.5 times the normal amount, and chromium was on par. Also had an ultrasound that showed a small sac of fluid build up near my prosthesis. My surgeon (different from the initial one) said these are signs of metallosis and it would be best to get a revision hip replacement. He said only the liner and/or cup would need revising as the stem looks to be in excellent shape.

I am now 3 weeks away from surgery but lately, after last speaking with my surgeon, I have been experiencing some numbness in my thigh and calf whenever I sit down, even if it's for brief periods of time. I am assuming this could be because of the pressure put on my nerves by the pseudotumor.

Have you heard/experienced this before?

My surgeon suggested I should be able to resume my routine activities 3-4 weeks post op. What are your thoughts, opinions, experiences with revision surgeries? Are a lot/most of these symptoms reversible post op?

If you can share any helpful information, that would be greatly appreciated!

 

[Jaycey]

@tapan Welcome back - sorry you need a revision!

My surgeon suggested I should be able to resume my routine activities 3-4 weeks post op.

Recovery from your revision will be just like recovery from your original THR. It may be longer depending on how much work the surgeon must do to access and replace the joint. 3-4 weeks is very aggressive as you know. Best to plan on anywhere from 8-12 weeks and then be delighted if you are progressing faster.

 

[Josephine]

He said only the liner and/or cup would need revising as the stem looks to be in excellent shape.

That's right. We have a few articles in our Forum Library you might be interested in
Metal-on-Metal Hip Replacements: Solving The Uncertainties Dec 2011
Metal on Metal ion levels: safe upper limits for MoM hip resurfacings set by scientists
Metal-on-Metal issues and DePuy recall: regulation of joint prostheses in Australia
Metal on Metal warning (old but ongoing news) (thread in hip pre-op forum)
Metallosis: what is it?

I have been experiencing some numbness in my thigh and calf whenever I sit down, even if it's for brief periods of time. I am assuming this could be because of the pressure put on my nerves by the pseudotumor.

Yes I've heard of it before but what the cause may be is anybody's guess!

 

[Mojo333]

I hate that you've had such struggles, but glad you are on track for a great new hip for a great new year!
We will all be rooting for an uneventful recovery...work on your patience muscle in the meantime! You know you will need it!
Hope the next few weeks fly by!

 

[prairienut]

I'm curious. What were your cobalt and chromium levels? I had those tests as well to rule out metallosis. They are calling my situation aseptic loosening. My metal levels were low but not zero. New prosthesis will not have metal bearing surfaces.

 

[tapan]

Just going to hope and pray for a speedy safe recovery! It sucks to be in this situation but positivity is extremely key!

That's right. We have a few articles in our Forum Library you might be interested in
Metal-on-Metal Hip Replacements: Solving The Uncertainties Dec 2011
Metal on Metal ion levels: safe upper limits for MoM hip resurfacings set by scientists
Metal-on-Metal issues and DePuy recall: regulation of joint prostheses in Australia
Metal on Metal warning (old but ongoing news) (thread in hip pre-op forum)
Metallosis: what is it?

Wow these are really helpful. Thank you for sharing!

Yes I've heard of it before but what the cause may be is anybody's guess!

I really do hope it's temporary :( From my first surgery experience, my entire leg from knee down was completely numb right after the surgery for up to 2-3 weeks. I am assuming it's because of the trauma my soft tissues and nerves went through. In which case, if the pseudotumor is removed completely in the revision, I can expect a similar outcome. I am no doctor but it makes sense...I think...

@Mojo333 thank you! I am undergoing pre-op physio which my surgeon highly recommended. I hope I am on my feet aid free in the first couple of weeks post-op!

@prairienut I am really sorry to hear this! Looks like you're having your revision in a few days. I really wish you a safe and a speedy recovery and would love to hear your progress and experience!

My cobalt levels were 10 (normal range is <= 4). Anything over 5 I believe is considered toxic BUT doesn't necessarily require a revision, just frequent monitoring. If the cobalt level is higher than 20, I believe that's severely toxic and revision is required even in the absence of symptoms. However, in my situation, my surgeon recommended surgery as I am already experiencing symptoms.

My chromium levels were 13 (normal range is <= 13.1).

Did you get a bone scan test done to rule out the possibility of aseptic loosening? The dye that's injected pre bone scan should reveal any signs of aseptic loosening. My surgeon ruled out the possibility of loosening based on my bone scan results.

 

[Mojo333]

. I hope I am on my feet aid free in the first couple of weeks post-op

Now why would you want to put that on yourself?
Aid free in the first couple of weeks?
I am all for optimism, but that is truly setting yourself up for unrealistic expectations in my opinion.
Your new replacement will tell you when you will walk unaided, if you will let it.
A few months of easy does it will be worth it, believe me.
This is a major surgery!
I know you will do well...just try to work on that patience muscle.
Read this from or library.
https://bonesmart.org/forum/threads/activity-progression-for-thrs.13187/
This recovery time is an investment in a hip pain future and well worth it.

 

[prairienut]

@tapan, I never had a bone scan. The three surgeons I consulted could see the loosening in the x-ray, and it was confirmed by an MRI. I had a raft of blood tests and a hip aspiration to rule out infection and metallosis. Looks as if I will have both parts of the prosthesis replaced. Surgery is only 4 days away -- trying to avoid anxiety by staying busy getting the house ready for my return. I have severe symptoms so really have no choice but to go for the revision.

 

[tapan]

I must not be thinking and typing straight Sorry I meant in the first couple of months. Based on my first procedure 10 years ago, I was off the walker in about 1-2 weeks and then switched to a cane. I was then cane free about 6 weeks post op. I realize I am a decade older than my first procedure, so recovery may be a bit slower but I got my fingers crossed!

Thank you for your advice and kind words! Patience unfortunately is not my virtue haha.

Based on your experience, how long did it take you to start climbing stairs post op?

 

[tapan]

My situation was the opposite. My xrays indicated a perfectly healthy hardware and the bone scan did not show any signs of aseptic loosening. My blood test revealed the high levels of cobalt. I know how you feel and I understand your anxiety even though I am still 3 weeks away. But I heartily wish you all the best for a safe and speedy recovery! Just focus on the positives and look forward to the pain free life!

 

[Mojo333]

I could climb stairs..with railings, like toddler...one step at a time...the day after.
I didn't do stairs much after that for a few weeks as I recovered at my sister's one story home and her outside steps had no railing...so if necessary, husband would lend an arm.
Probably was a month out before I could go up and down by myself but another two months or longer before I could walk up them properly.
I did do both of my hips at once so..
Do work on your patience...the time spent doing this slowly will be well worth it!
Not much longer now!
2019 will be a good year!

 

[Josephine]

@tapan - it's unnecessary to quote a post just to reply to it. Just scoot on down to the bottom of the page where it says "write your reply" and start typing! Unless there is some specific phrase you want to address, of course - like I just did! Then do it like this How to quote a post.

Thanks for understanding!