THR New hip 3/7/12

[sharonslp]

Hi Cathy. It does sound like you have to do something! The partial dislocations must be scary enough....the risk of a full one would be terrifying. It must feel like you're damned if you do; damned if you don't at this point. I'm with Jamie though....depending on what Jo says, maybe yet another opinion.

Just want it all to work out for you finally....

Sharon

 

[VThereandnow]

@djklaugh hey pal, I wish I could be more like you and keep bouncing back. You know I really was thinking I was on my way, and I was, but when I started resuming my normal life it became clear that even though I was getting stronger in other areas, the glutes were not and when they fatigued, they gave out. Thx for stopping by.

@sharonslp it is always comforting to hear from you, not sure why, but it is. I just cannot even believe I am still trying to get better since march of 2012. You've already had two. Crazy, but life sure can be sometimes, so I try to keep pulling myself back up and pushing forward.

I will tell you all though, after it happens it take me almost a week and a half to start feeling normal again and even more to be out and about not thinking "what if it happens here?" I hate being afraid. I swear it feels like a mild PTSD when I get a certain sensation in my quad, I freak. The one thing I am glad about (well many things) is that I had the period of good recovery up till now because it helped me get on a more positive mental course and I started to feel more like my old self. Now I just need to hang on to that. Another surgery can't be taken lightly and the lock thing has some iffy outcomes out there.

Thanks all, you too @Jamie

 

[Josephine]

2 screws partially sticking out the back of my cup

I don't think that's anything to worry about. Some models of uncemented cups are designed to be secured with between one and three screws for additional stability.

Would have thought muscles would have come back by now, they have not. Why have muscles not come back? it is going on 8 months. Could be because ...

Could be because of almost anything. Sad fact is, the why is largely irrelevant now. And at 8 months it's actually quite early yet. These things can take 1-2 years to regain normality.

I do know he is a surgeon and surgeons suggest surgery

Actually no they don't. It's estimated that around 60% of the patients a surgeon see don't need surgery, just reassurance and/or non-invasive treatment such as PT.

Your surgeon sounds to be on point about locking rings getting bad press because they get used inappropriately. If he's aware of that he's a good'n!

 

[VThereandnow]

@Orthodoc I was wondering if you could take a look on page 25 of my posts and weigh in on my post of Wenesday. It describes the timeline of my surgeries (THR & Revision) and current issues. Wondering if the logic of surgeon recommendations make sense to you. Thanks in advance, Cathy

 

[Elizak]

Hi Kathy,

I am so distressed to read of your many complications. And the pain and fear.

I think that maybe another opinion would be appropriate before agreeing to the locking/constrained ring addition to the cup, particularly as you are so active.

Would it be possible to consult a revision surgeon completely outside of your area ???

Best wishes and thinking of you


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[Elizak]

Sorry for misspelling Cathy.
I see Josephine has replied, suggesting that the "locking or constrained rings" do have an appropriate medical use.

Still thinking of you. So disappointed that you have had all of these complications.

I always imagine you on your kayak. Soon, I hope for you.


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[Orthodoc]

Wondering if the logic of surgeon recommendations make sense to you

Your timeline does give a good account of your history. After reading through it, I do feel that your surgeon is making logical recommendations. He talks about using a constrained line which would decrease the chance of dislocation and subluxation in the future. The two down sides of using a constrained liner is that:

1) if the cup is not well fixed then the forces placed on the liner can get transferred to the cup and pull the cup out of the socket (much less likely with a well fixed cup).

2) there are increased stresses placed on the plastic at the end range-of-motion due to the nature of how the constrained component is designed. This can lead to stress loading on the edge of the plastic.

You mentioned that you still feel a little "short." This can be easily fixed by placing a new ball on the stem that has a slightly longer neck length. This has the added benefit of increasing soft tissue tension and decreasing the chances of dislocation.

DePuy Pinnacle Gription

I have extensive experience with this acetabular component. It has an excellent track record for osteo-integration (when the pelvic bone of the "cup" grows into the metal).

Good luck.

Orthodoc

 

[Poppet]

How lucky are we to have orthodoc - hi there Cathy, just stopping by to give you my support - hugs and love to you my friend x

 

[VThereandnow]

Thanks Poppet and yes, totally lucky to have ortho doc and Jo and you and Sharon and Z and Cardie and ... Need I go on?

 

[VThereandnow]

Thanks @Elizak , so nice of you to stop by, my first surgeon was here in VT and my revision surgeon is in NH so I am already out of the area. I really like my surgeon, but the 2nd opinion is always a good thing. I really want to make sure another surgeon feels the cup is perfectly placed as that is one of the complications of the ring. One day at a time is all I can do. Actually just got back from the Adirondacks for our vacation and it is the first summer I could not kayak. The 2nd sublux was only 2 weeks ago and it seemed kind of risky. Otherwise I have still been kayaking in the summer. Cheryl just has to help me in and out. I keep that picture to inspire myself though I must tell you I wonder if life will ever feel normal physically again-- Thanks again, Cathy

 

[VThereandnow]

@Orthodoc thank you so much for response-greatly appreciated, cathy

 

[Elizak]

Hi Cathy,

I know that you will be back to your favorite activities. You have a very strong spirit that will see you through these troubled times.

I don't have medical advice to offer. I do hold you in my thoughts and prayers. And, always see you on your kayak, in some incredibly beautiful place otherwise inaccessible, totally at peace and in sync with your environment.

Best,

Courtney


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[VThereandnow]

@Josephine @Orthodoc -One of the things I forgot to ask you both, was about something in my CT rpt results. It said the following:

2 of the acetabular fixation screws noted to penetrate through the
posterior cortex of the supra-acetabular iliac bone projecting into the gluteal
muscles, of uncertain clinical significance.

My osteopath feels this might have something to do with the muscles not getting strong.

My surgeon says he sees this all the time and it is not my problem. He says when the screws are put in they are fully IN the bone and when the bone grows into the cup things compress and sometimes stick out the back, especially if the bones is a little thin.

Have you seen this before and is the surgeons explanation a valid one? I do trust him, but obviously not 100%. My first surgeon tainted me. Thank, Cathy

 

[Poppet]

Hi Cathy, just dropping by to say hello and looking forward to reading a response from orthodoc

 

[VThereandnow]

@Josephine @Orthodoc I know, especially you Josephine, addressed the screws sticking out the back, but what about penetrating the muscle? Is that something to be worried about?

 

[Orthodoc]

2 of the acetabular fixation screws noted to penetrate through the
posterior cortex of the supra-acetabular iliac bone projecting into the gluteal
muscles, of uncertain clinical significance.

This would depend on how far the screws are sticking out and exactly where they are penetrating. Remember that many time when screws are used there is a small portion that will stick out of the of bone on the other side. This is frequently done to increase the "purchase strength" of the screw into the bone. Orthopaedic screws typically do not have threads that go to the very edge of the screw (like a bolt screw). Rather they are sometimes kind of blunt at the end and small section needs to penetrate the bone to grab the bone with the thread.

Orthodoc

 

[Josephine]

Something like this ...

In addition to which, such a 'foreign body' will quite rapidly develop a little envelope of fibrous tissue over it which will protect nearby tissue.

 

[VThereandnow]

@Orthodoc @Josephine thank you both again, extremely helpful -Cathy

P.s. Is saying thank you just adding to your over abundance of tags?, should I just be adding a "like"?

 

[Josephine]

No, that's perfectly okay and thank you.

 

[Orthodoc]

I "like" the tag.