Revision THR Once more into the breech

[LarryG]

Thanks so much Sharon and Josephine. Your responses are very helpful and much appreciated. So far, my recovery has been a lot of one step forward, two steps back. Based on your pain scale, I would describe mine as 5 or 6. I really don't think it is any better than one month ago. I'll get the Tylenol/ibuprofen cocktail today and make another progress report in about a week. Meanwhile, I'm lying low, resting and using the crutch. Thanks again!

 

[LarryG]

July 4th will mark four months since my surgery and it's time to count my blessings. Fifty years ago, people with arthritic hip joints were forced to live the remainder of their lives crippled and in pain. Now, at least we have a chance to get our normal lives back. I'm very grateful for the Bonesmart forum and especially Josephine and sharonslp and everyone else for their support and advise. They got me through the narcotic phase. I have more questions as I prepare for my followup visit to the doctor.

I've always been a quick healer, but recovery from my hip revision has been very slow. It still hurts to roll over in bed or lift the weight of my leg. I'm walking a little better, but still not without a limp. I worry that something is just not right this time. So here is my question: What can the doctor see on my xrays? Can he see if the bone is growing into the cup as it should? He placed ground up bone in a large cavity behind the cup. Can he see if new bone is growing into that void? I developed a small fracture in that area that I hadn't seen before the surgery. Can he tell me if that has healed properly? My appointment is in two weeks and I want make sure I ask the right questions to make sure my recovery will continue. Also, if the doctor's answers are vague, what additional tests might be helpful? Thanks for any insight!

 

[Josephine]

Fifty years ago, people with arthritic hip joints were forced to live the remainder of their lives crippled and in pain

Quite a sobering thought, isn't it?

 

[Dee205]

Larry,
I hope things start improving for you! Funny thing with this surgery is the recovery is different for every one each time. I would definitely make a list of questions for your visit because I know otherwise I plan on asking all these questions and don't get to half of them. My OS would laugh every time I pulled my "list" out.
Good luck!

 

[sharonslp]

Hi Larry. Good to hear from you. I can hear some frustration that you are not yet where you expect to be. Remember that four months is quite early yet in the giant healing scheme. My OS kept reminding me that full healing takes up to two full years. There's a lot of work going on behind the scenes. And my understanding is that revisions are generally slower to heal than original surgeries.

Hurting when you roll over in bed sounds pretty normal....I'm always amazed at the people who are sleeping on the operated side within the first few months. It took me a full nine months for the first hip; not quite as long for the second. Limping....are you still having pain? Is that why you're limping? And if so....are you taking any pain meds still?

If no pain, then the limp may be so ingrained you haven't been able to retrain yourself to walk without it. Did you have any PT after your surgery? Perhaps a short course of PT can help you pinpoint how to move more effectively to get rid of the limp.

As to your questions about what the doctor can tell from the xray, these sound like reasonable things to be able to see. I think you should ask these exact questions, and ask for very specific answers....not a vague "looks fine." Also ask for a copy of your xrays. If you have any concerns about your doctor's responses, Jo will look at the xrays and tell you what she thinks. When did you find out about the fracture?....I don't remember if you mentioned that before. Perhaps that is what is delaying your progress. Josephine, can you address this part of Larry's questions?

Keep us posted. Recovery is not generally a straight line. We all travel our own crooked path, but it's good to have company while we meander back and forth.

Sharon

 

[Poppet]

You will get there Larry, Sharon's statement about full recovery taking up to 2 years is very true. Certainly I am seeing the light at e end of the tunnel at 19 months, but I always worked on the basis of 2 years, so that I wouldn't get disappointed.

 

[LarryG]

Thanks Sharon. My OS pointed out the fracture while we were looking at the xrays on my first post-op office visit. Neither of us had seen that fracture before, but he didn't appear to be too worried about it. My limp is from pain, not from habit. I'm still taking the Tylenol/Ibuprofen cocktail which helps some. It's helpful (hopeful) to know that a year from now I'll probably feel much better. I will take a thumb drive with me on my followup appointment with thee doctor and try to get the xrays. That's a terrific idea. Thanks again.

 

[Poppet]

LarryG, just curious what sort of fish is that?

 

[LarryG]

LarryG, just curious what sort of fish is that?

The English name is Bluefin Trevally.

 

[LarryG]

Hi everyone. It's good to see that most of us are gradually, but steadily recovering from our surgeries. I'm worried because all of my friends and family as well as myself can plainly see that I'm getting worse, not better. I'm hoping those more knowledgeable than myself ( like Josephine ) can suggest possible causes to look for. After three months, I could walk around the block. Not anymore.

My surgeon took xrays and declared that everything looked fine and there was no apparent movement or loosening. That was two weeks ago and, since then, I've only gotten worse. There are no apparent signs of infection, so I don't know what to do. Can anyone suggest other diagnostic procedures I should ask for? What are my options at this juncture?

 

[sharonslp]

Hi Larry. Sorry to hear that you still aren't improving as expected. Can you get VERY specific in regard to where exactly and what kind of pain or problems you're still having? Jo will probably post a chart for you to pinpoint areas. She'll also want to know what your daily activity is like....exercise, recreational activities, stuff around the house, etc.

In the meantime, many of us find that our THR did a great job at eliminating the bone-on-bone pain of arthritis, but we still have various aches and pains for other reasons. Here are some common ones.....read these articles and see if anything resonates with you:

Trochanteric bursitis with THR
ITB (ilio-tibial band) issues and treatments
Piriformis syndrome - a pain in the butt!
Iliopsoas impingement after THR
Iliopsoas syndrome

My own issue is the IT band syndrome, with subsequent bursitis. I've been trying PT; so far it's helped a lot with the bursitis; the IT bands are still problematic. Seems like we can develop a chronic tendinitis just about anywhere!

Anyway, give us more details while you wait for Jo to find you. Also, are you still taking any pain meds? If so, what and how much and how often. (I would have almost zero pain if I still took Celebrex, but I'm willing to take the trade-off most of the time....a little pain to be drug-free is important to me. A lot of pain......not so much!!)

Sharon

 

[Josephine]

Oh this is not good, Larry.

First I have some questions to ask you:

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

4. what kind of PT are you doing, if any? How much and how often?


Can you also tell the the exact location of any pain using this chart? Each square needs the number for the row (horizontal) and the column (vertical) to identify it. When you've done that, I'll come back and talk with you some more.

 

[LarryG]

Great questions sharonslp and Josephine !

I don't have much pain sitting or lying down. It only hurts to move. I'd say about 5 or 6 when standing up, taking a step or lifting my leg to get in the car or turn over in bed.

I'm taking 15 MG of Meloxicam daily. Yesterday I took 1000 MG of Tylenol two times and 50 MG of Tramadol two times. We were going out to the movies and dinner and it still hurt so I took 10 MG of oxycodone before we left and another 5 MG of oxycodone about 3 hours later.

It does seem like any kind of extended activity makes the pain worse. We are looking for a new boat, so four days ago we walked around the marina looking at boats for about an hour. I have that strange gait that dips every time I take a step and the farther I walk, the worse it gets.

The following day, we drove to another marina and we walked around the slips again but I was really sore, so we sat on the beach for awhile, had lunch and went home for a nap. The following day, I felt the need to just say home. It hurts a lot just getting around the house. We have stairs (12 steps) and I hate to forget my glasses as I painfully climb from one level to the next. Lately, after taking 2 or 3 50 MG Tramadol tablets, I just sleep in the afternoons.

I'd say the main area of pain when I try to lift my let is DL3 or CL2 (red). If I put weight on the leg, the pain is more generalized to the hip cup area which I think is DL3.

During the surgery, the doctor didn't remove the 22-year-old femoral stem; he just changed the ball. I wasn't having thigh pain and he felt it was very firmly grown in to my femur. Even now, my thigh doesn't seem to hurt. On the cup side, he filled a large cavity with ground up bone and placed a lot of screws. I think I see four or five screws on the xrays.

As my pain increases, there is less and less activity I can to. I took the boat out for a couple of light weight fishing trips earlier, but I don't feel up to that now. Shopping trips are hard. I try to use the shopping cart as a walker so I can appear normal. I still wash the dishes.

I only went to PT once. The guy seemed to think I could do the exercises fine on my own. I went to the gym a few times and worked on the same movements I learned in PT with super light weights. I was also able to do the stationary bike for 30 minutes. I think it's been six weeks since I went to the gym though.

 

[Josephine]

I'm taking 15 MG of Meloxicam daily. Yesterday I took 1000 MG of Tylenol two times and 50 MG of Tramadol two times. I took 10 MG of oxycodone before we left and another 5 MG of oxycodone about 3 hours later.

This isn't a very structured method of pain management. Meloxicam is just an NSAID and therefore a fairly mild pain reliever. Taking Tylenol twice a day is inadequate too as is 50mg Tramadol only twice a day. 5 or 10mg oxycodone occasionally isn't good planning either. You'd be much better off taking 50mg Tramadol and 1,000mg Tylenol 3-4 times a day instead of just now and again.

On the cup side, he filled a large cavity with ground up bone and placed a lot of screws. I think I see four or five screws on the xrays.

Do you have an xray you could post for me?

I went to the gym a few times and worked on the same movements I learned in PT with super light weights

I'm glad you stopped going to the gym. That wasn't a very wise thing to do with that hip!

I would be interested to see the xray though.

 

[LarryG]

Thank you for taking the time to give me such detailed and personalized responses. I'll have to insist on another appointment with my surgeon in order to get a copy of my xrays. I might even have to make a formal written request.

Sharon, your description of surgeons as being single minded about cutting and only cutting describes my doctor exactly. He only looks at the results of his work as shown on xrays and never examines my actual body. I like the guy though.

I'm going to try to get another appointment tomorrow and perhaps a referral to another specialist if he doesn't find anything amiss. Is there any particular speciality you would recommend?

 

[Josephine]

A tip about getting a second opinion: don't ask your surgeon to refer you. Most likely he'll just send you to one of his golfing partners who will be unlikely to go out on a limb for you. Best thing to do is us our Using "Find a Clinic" to find revision surgeons - this article gives you advice how to do that. Specialist revision surgeons are competent and comfortable to be truthful about what they find in examination, history and xrays. He may even want to do his own.

Please don't go to any trouble getting xrays for me. I was just curious about the screws you said he used. A lot of people make a point of getting their films either hard copy or on cd-rom which was why I asked.

 

[LarryG]

Josephine

Hi everyone. Shucks. I was hoping my next post would be about how the dark clouds parted, the sun came shining through and my newly revised hip was finally healing. We all want that outcome. Sadly, my pain started getting worse about 7 months out. I looked through my x-rays and saw that 11 days after the surgery, the day they removed the staples, the film showed a fracture in the roof of my left acetabulum. My problem is that, up to now, this fracture hasn't healed now the doctors are starting to see evidence of loosening in the acetabular cup. Moreover, the fracture looks worse now than ever. So the docs are talking about doing the surgery all over again with a possible repair of my pelvis by a trauma surgeon using Internal Fixation. That is a damn big operation and I'd like to find a hospital and surgical team with experience in complicated surgeries like this. My medical insurance is through Kaiser Permantante and I'm not too sure how I go about finding this, more specialized hospital. My surgeon here said he had no idea how I would find it which wasn't a helpful response. He also said I would have to wait at least six months if he was going to do it. I really need to make good, well informed decisions from this point forward. Any suggestions would be much appreciated. Thanks.

 

[Josephine]

So the docs are talking about doing the surgery all over again with a possible repair of my pelvis by a trauma surgeon using Internal Fixation.

Oh my goodness! He clearly doesn't know much about this stuff! Repairing an acetabular roof isn't that complicated. One uses a special shell along with plenty of bone meal grafting to shore it up. And cement. And quite possibly the stem doesn't need to be touched, just the cup and probably the ball. But the extra device put in under the cup looks something like this

And yes, you do need someone who does revisions to do it. Try this Using "Find a Clinic" to find revision surgeons. But certainly don't let him do it!

 

[sissy46]

Larry, I can only imagine how frustrated you must be, and I'm so disappointed for you. This seems to be dragging on and on. I hope you can get a second opinion from a revision surgeon who is totally unconnected to the one who did your surgery. Why do you have to wait six months?

 

[sissy46]

How are you? Have you found a surgeon yet?