New revision old prosthesis

[AOC]

After a month of searching, I finally found my surgical records for my 1986 THR. Now I'm trying to find out something about the prosthesis that was used. This may be a little too technical, but you never know when you might get lucky. The records indicate they used an S-Rom screw in acetabulum and an HBS II, no. 3 Long Neck. I know the S-Rom is made by Depuy and they were acquired by Johnson and Johnson. A salesmen told me that he doesn't think liners are available for these older models made prior to the acquisition. Can anyone identify the HBS II? Who made it or what it stands for? While I'm rolling the dice, is anyone familiar with a revision in a similar situation where a new liner is not available for a cup that is still in good condition? I still have some liner left but its getting awfully thin.

 

[Josephine]

I found broken link removed: https://www.jnjgateway.com/home.jhtml?loc=GBENG&page=viewContent&contentId=09008b98801c6c31&parentId=09008b98801c6c31&nodekey= and broken link removed: https://www.jnjgateway.com/public/GBENG/SROM_EMEA_ST.pdf which you might find of interest.

I also contacted the Joint Replacement Services Manager at DePuy in the UK and found that not only is this prosthesis is still current use they also keep a failsafe stock of older types of acetabular inserts specifically for people like yourself. Thus the surgeon you go to will simply need to contact DePuy in the States with the information from your notes and make arrangements for one to be supplied for you.

 

[AOC]

Thanks Josephine. I also had an e-mail in to DePuy Orthopedics asking the same question. Since the acetabulum is doing pretty well, replacing the liner with an original liner would be the best deal for me. I'm Jealous of those folks that can utilize some of the newer materials that are out there today. During your inquiry did anyone identify the femur stem? I couldn't find a reference to the HBS designation anywhere. It would make sense that is also made by DePuy but I don't want to assume anything.

 

[Josephine]

I haven't been able to find that out yet but my early guess is that it will mean something like "Hybrid XXX Stem" as they were (and are) always reconfiguring the specs of the implants and a relatively small change would result in an addition to the name of the product!

But I will find out!

 

[Josephine]

AOC, I just had a conversation with the DePuy Marketing Director in the UK and it seems that the American market is a tad different to the UK one. So, on his advice, I have emailed the US DePuy in Warsaw IN, and asked them if they keep a fail-safe stock of liners for the prosthesis you cited. I'll let you know just as soon as I get a response from them.

 

[AOC]

Thanks, that seems a little more in line with what I was told be salesmen here in the States. He indicated that they probably didn't have a replacement for some of the older prosthesis prior to the acquistition of the the firm by J & J. It's sort of scary that you could be looking at some rather severe consequences if you can't find replacement parts when another part of the company (the UK contingent in this case) may have the required parts. I e-mailed DePuy USA last week and have not received a response to date. I can't thank you enough for your help and insight into this situation. For many of the people that look at this site for answers to their questions concering joint replacement issues, you may learn something from all this by making sure that you think beyond your initial surgery and think about what you may need in the future if you ever need to have something done with your new hip or knee. Who sold it to you, are they going to be there to help when you need them and what are the consequences if they are not. I'll continue to post the outcome of my search so that individuals in the same situation can follow this through my new revision.

 

[AOC]

Well, I tracked down my missing medical records and spoke to the folks at dePuy Orthopedics. I was able to determine that both parts were indeed made by them and, to some extent, are still available. I went back to my surgeon and after some discussion decided that we will replace the acetabulum with a more current model that has a better track record. That should allow the use of a cross linked poly liner. The good news, if there is any, is that there is still some liner left so there is no immediate hurry to go to surgury. I have another appointment in February and, if things seem right, I'll schedule the surgury for about April 1. I don't want to wait too long and find myself laid up for the summer. I definitely would prefer to do this during the late winter when things are slow. Thanks for the input and support. I'll keep you all posted on what transpires.

 

[AOC]

Well, it looks like I ran out of time and had to schedule my surgery for September 22. I just finished setting up pre op appointments to give blood, attend a pre op class and vist with the PT and OT folks. I got 22 years out of this hip and though its no bothering me, my doctor says the osteolysis from the worn liner has thinned the bone along the lateral margin and could affect the muscel attachment if there is a fracture. The liner itself is close to the bottom of the cup. He plans to replace the cup with a newer model, replace the ball and repair the bone along the top of the prosthesis. I'd be lying if I didn't say I'm a little worried. Everything I,ve read indicates a worse outcome for revisions as compared to a new hip. At 56, I still have a lot of things I'd like to do and most of them reqire good mobility. Anyone out there that has had a similar revision care to share their experience (good or bad)and tell me how they're getting along? I don't see very much concerning this issue and I'd really like to hear some first had experiences.

 

[Josephine]

The biggest problem is the healing of the wound a second time in the same area. I hope it all goes well for you, AOC

 

[AOC]

Thanks Josephine. I appreciate the work you did to try and track down a new liner for me earlier this year. My surgeon told me that the old cup has a poor track record so he wanted to replace it with something newer. I think its really important to get a copy of your surgical records with the time these hips last. By the time you need a new one your doctor may be retired and the records my be difficult to find. I actually had this done twice. A TARA in 84 and a total in 86. I was a little too active and broke the glue on the TARA! The two incisions cross to form an X. I usually heal well with no complications so I hope there are no porblems. I was more concerned with possible dislocations, leg length, limited ROM or weakness in the leg itself. Care to weigh in on any of these issues.

 

[Josephine]

I was more concerned with possible dislocations, leg length, limited ROM or weakness in the leg itself. Care to weigh in on any of these issues.

Sure

dislocations - no more than usual, certainly no more than with a primary THR
leg length - the same
ROM - by which, I take it, you mean in the long term, again, should be no more than usual.

 

[AOC]

Thanks again. I still have some time to enjoy the rest of the summer before my surgery so I'm not going to dwell on it. I picked an excellent doctor, I'm very familair with the hospital since I worked there for five years in the ER and I did my homework. I'll put up a post and let you know how I make out.