THR Nearly Two Years after LTHR and now a popping/movement sensation

[Suzieslips]

Thanks HappyHippy and it's good to read that you are doing well after your revision surgery.

One thing which has always concerned me about the particular hip replacement system I had fitted (broken link removed: https://www.exac.com/products/hip/acetabular-systems/novation-ceramic-ahs)is that it appears to be a system with unique parts. The 'kit' comes with different size cups, balls, liners, stems, etc, but they are all designed to fit together, rather than with systems manufactured by other companies.
The system is also not available in the UK....

I'm thinking that Jo would probably say that this doesn't matter, but I don't know.

 

[oldyellr]

Available in the UK according to their website. broken link removed: https://www.exac.com/company/worldwide-selector

 

[Suzieslips]

Thanks John.
That website has expanded a little since I last looked at it.
I can't see anything there about uncemented systems for the UK, so they may not be approved here yet.
But at least it appears that there may be something available if needed (and NHS costs allow...).

 

[special lady]

Suzie, was in and out of town for a week... does sound like something's up as far as your answer to when you are feeling the clunking/popping... it doesn't sound like it's actually subluxed to the point of dislocating, getting caught or partially dislocating, but it does sound like it's shucking a bit while ambulatory, and the way you discribed, it would be anterior subluxation. Once they figured it out with me it was easy to semi duplicate... while laying on your back and you being totally relaxed your PT can gently pull on your foot and should be able to feel it slightly come in and out. However, never allow anyone to pull it too hard, or far, because if it is subluxing it could cause it to slip out if it is shucking.

How's PT going, and when do you go back to your Doc?

 

[Suzieslips]

Thanks Special Lady.
I am coming to the same conclusion about what is going on with my hip. The problem is getting medical staff to agree with me!
My follow up physiotherapy was cancelled (my therapist was off sick) so my next session is now on Tuesday morning, hence I haven't much to add to this thread at the moment.
I have been very good doing the exercises, but there is no real difference in the muscle power in my legs, thighs and glutes (it was pretty good anyway) and the hip is still clicking/clunking/popping in exactly the same way as previously. So, I'll tell the therapist, but I am guessing that nothing much will happen until my 6 weeks of 'try the physio first' is completed.....

 

[special lady]

Suzie, hope you do find out exactly what's going on soon.

 

[Suzieslips]

Well, all change on the hip front!
At my appointment yesterday the physiotherapist decided to hold my hip whilst I went through the exercises she had given me.
The result - she stopped me doing them!
She said she could feel 'quite a bit of movement' accompanying the clicking and pops and she wanted a second opinion on whether it was okay to continue.
So she made me an appointment to see the physio who specialises in hip replacement problems and that happened this morning (Wednesday).

The new physio looked at all my x-rays and notes, felt my hip whilst it was in motion, and said that in her opinion, this is a case of misalignment, rather than muscle problems.
She did say, however, that to her it seems more like a problem in that it will cause wear on the joint and eventual pain and failure. She doesn't think there is a high risk of dislocation.
However, she doesn't want to take any chances and is referring me to the hip surgeon she normally deals with when she encounters similar problems.
The only thing is..... there is about an 8 week wait to see him....

I asked if he is a revision specialist and she said she knew he did revisions, but she wasn't sure if that was considered his specialty. She made a note that I wanted to see a specialist in hip revisions, but said that would be up to him to refer me if he thought it necessary.

Her thoughts on what will happen (and she says she could be wrong)....

The Hip surgeon will see me but will be unlikely to recommend a revision at this stage. Instead, he will want to keep a close eye on me.

So now it's the wait for another 8 weeks and see what happens next!

Still clicking and clunking
Suzie ....

 

[Josephine]

She said she could feel 'quite a bit of movement' accompanying the clicking and pops. The new physio looked at all my x-rays and notes, felt my hip whilst it was in motion, and said that in her opinion, this is a case of misalignment, rather than muscle problems.

Her thoughts on what will happen (and she says she could be wrong).... The hip surgeon will see me but will be unlikely to recommend a revision at this stage. Instead, he will want to keep a close eye on me.

And I think it's more a case of a cup loosening than misalignment which is why I asked if you had xrays. And therefore 'keeping an eye on you' is out of the question.

 

[Jaycey]

Hi Suzie, please do keep us updated. Sorry you have that long wait!

 

[Suzieslips]

And I think it's more a case of a cup loosening than misalignment which is why I asked if you had xrays. And therefore 'keeping an eye on you' is out of the question.

Oh dear. That seems a lot more scary!

I have requested the last x-ray, but am still waiting. The system was down the last time I asked, so my request may have gone missing. Will ask again, although hopefully the consultant will pick up on the possible loose cup with a bit of a 'nudge' from me.

So Jo, if the cup is loose, does this mean that the whole thing could collapse?
I'm on my own at the moment in a first floor flat (hubby is working away and we are in the process of moving again). I'm worried now that something could happen when I'm on my own, or if I will soon not be able to climb the stairs!

 

[Josephine]

So Jo, if the cup is loose, does this mean that the whole thing could collapse?

Not at all! People have walked around on loose cups for years - or rather, limped around! And if the stem is still solid then all that needs doing is the cup. However, if it really is a misalignment, then the whole thing needs to be redone. Now which is scarier?

 

[Suzieslips]

Ah that's better!
It was when you said "'keeping an eye on you' is out of the question" with a loose cup that I imagined something really urgent!
Now you have put my mind at rest again. Thanks Jo
So really it is probably a case of - I have a loose cup so there is no need to keep an eye on things because it is what it is and watching and waiting won't change that. It will need putting right (hopefully sooner rather than later).

One further question:
If this is a loose cup, does this mean that the longer it is left, the more damage will happen to the whole system (or at least the top half)?
Because I would imagine that fixing a loose cup would be relatively minor (and less costly) compared to replacing worn parts...

 

[Josephine]

So really it is probably a case of - I have a loose cup so there is no need to keep an eye on things because it is what it is and watching and waiting won't change that. It will need putting right (hopefully sooner rather than later).

You got it!

If this is a loose cup, does this mean that the longer it is left, the more damage will happen to the whole system (or at least the top half)?

Well obviously it will get more loose but the femoral prosthesis will pretty much keep it where it should be. It's just that the looser it gets, moving around in the bone, the more you will feel it. Assuming it is loose in the first place, of course! That's only my best guess as I haven't seen the xrays but am just going on the symptoms. I could be wrong (as the physiotherapist said )

Because I would imagine that fixing a loose cup would be relatively minor (and less costly) compared to replacing worn parts...

I'd say it would be about 45% but no surgery that involves opening up a hip is ever a minor procedure.

 

[Aileen]

Hi Suzie, Jo is right some do walk about on a loose cup for years and you don't fall apart

I managed it for about 3 years, one year of which I didn't do anything about it, more fool me! Strangely, like you it was an accident which caused it. A lady drove out of a turning in front of us and husband had to do an emergency stop. My foot slammed into the floor and OMG the pain. I didn't realise at the time but the cup had been knocked loose, the pain subsided a bit and I tried to ignore it. My other hip had been giving me grief too and to cut a long story short, by the time I plucked up courage to do anything about it that one had gone past bone on bone and had fused.

That was the most painful hip so had it replaced October 2011 but, once fixed and able to use it the other went downhill fast.

So keep at 'em to get something done. I ended up with a really tilted pelvis and my spine has bent the same way. The leg was 1 1/2" shorter and the cup worked it's way up into the pelvis.. I needed two bone grafts. It wouldn't have got so bad if I hadn't been such a coward!! I finally got it sorted last August and it only needed the cup changing. It definitely didn't collapse under me but it did get extremely painful, to the point I couldn't put any weight on it at all.

Hope I helped a bit.

Aileen

 

[Poppet]

Hi Suzie, so sorry that you are encountering issues.. it will be a long 8 week wait, but stick with us, we will help you through, just as with did with the original..

hugs

 

[sharonslp]

Hurry up and wait!!!! Susie, you are remarkably calm about all this....I'm impatient for you! I want this done NOW, so you can stop worrying and get on with a good life. Grr....!!

Sharon

 

[Suzieslips]

Thanks everyone

Jo: Yes I realise that any hip operation of this kind is major surgery, but it was the thought of having the femoral prosthesis replaced that was worrying me the most, so I'm hoping your diagnosis is correct (but won't hold you to it! ).
I was thinking that having the cup replaced may be considered more minor in terms of time and cost by the hospital and that may mean I could get it fixed more quickly.

Aileen: Thank you so much for telling me about your experience with a loose cup. It sounds dreadful what you went through because of the long wait. So glad you finally got it fixed and I definitely don't want to go through that type of pain if I can help it!

Poppet: I'm hoping that perhaps the consultant will get back to me quicker than the aforementioned 8 weeks, but if not, so be it. I'll be ready for him when I get to see him.

Sharon: I'm not really calm - just resigned for the wait. And Jo and Aileen have put my mind at rest about what could occur. Now I just want to get it fixed so that I can get on with my life again and not have to worry about things getting worse and about making people cringe as I walk by clunking!
At least at the moment it doesn't hurt that much (knock on wood and whistle!). But I can tell you now that if/when it starts hurting a lot I will be far from calm and resigned.

 

[HappyHippy]

Suzieslips,

Since I was a revision for similar reasons, I'd encourage you to press on and try to get surgery. My revision OS thought I was fairly safe waiting 6 months for revision because it appeared my stem had better fixation than it actually did. He ended up doing more work to change angles and offset from misalignment, and I had more bone damage than it appeared. I'd gone into pretty severe pain, and you don't want to get that bad.

If they know you'll need a revision, there's nothing to be gained by watching and waiting. My new hip is so much better, that I cried with joy in my first PT session.

That should be you too, so I'd go for a revision as soon as you can get one.

Best to you,

HH

 

[Suzieslips]

Suzieslips,

Since I was a revision for similar reasons, I'd encourage you to press on and try to get surgery.

Thanks HappyHippy,
I definitely will be pressing for surgery once the problem has been determined, as there is no point in waiting and a whole lot of reasons why surgery should take place sooner than later.
My problem, however, may be with the NHS waiting list. But we'll see...

 

[HappyHippy]

Suzieslips,

True, I didn't have the NHS to deal with - just the watching and waiting imposed by several Orthopedic Surgeons. My surgeon couldn't see completely what went wrong until he finally got operated.
My heart goes out to you, as it is hard to know something's really wrong, but can't get it fixed quickly. Having a 3 man band in your hip must be a little unnerving.

I hope your next visits go well, and that you can progress to surgery fairly soon.