THR One year anniversary THR

[Eman85]

Just my opinion, I would get plenty of opinions before I went for a revision. I got opinions about my THR's and I pretty much knew it was coming for over 30 years. Paying out of pocket would be well worth it to me. I've paid out of pocket to doctors when I wanted a non biased opinion.

 

[Sohowarrior]

It’s difficult. I just tried this with another doctor at HSS and as expected, no appt until June for consult. My surgery is scheduled for 3/26 with surgeon payment due 3/15. I still don’t feel as if I have enough info to make an informed decision. And I sent an extremely detailed email to him yesterday after calling the office, no response yet. I know I’m repeating myself but he’s chief of hip practice at HSS. He’s done thousands of these. The question is do I need this now? And why? But I still have no answers.

 

[mendogal]

Just my opinion, I would get plenty of opinions before I went for a revision. I got opinions about my THR's and I pretty much knew it was coming for over 30 years. Paying out of pocket would be well worth it to me. I've paid out of pocket to doctors when I wanted a non biased opinion.

It's one thing to pay out of pocket for a second opinion (have happily done so).
It's totally different when the scheduled surgeon no longer accepts Medicare and needs up front payment for doing the surgery.
That would be a deal breaker for me.

 

[Sohowarrior]

Easy to say, unfortunately. know, it’s outrageous. Fortunately, I can afford it. Still not sure what I’ll do. I cannot imagine having this surgery anywhere but HSS. Della Valle is top of the heap. If I don’t go with this schedule it will take me months to find another doctor. I’m waiting another day or so and then will consider other options.

 

[Sohowarrior]

I should clarify my predicament. I’m currently in Northern California. The ER doctor here who did my closed reduction suggested I see an OS here. There are two of them and no appts till May and June. Per my other comment, the alternate choice for me at HSS similarly is not available. If I cancel my 3/26 to shop around, I will likely have burned that bridge. And if I were to dislocate again, then what? If I don’t get to speak to Della Valle by Friday I’ll try NYU Langone. My point is that it’s not so simple to seek a second opinion when time is of the essence and I cannot even get an appointment. If I do go forward, at least I know I’m in very good hands.

 

[mendogal]

@Sohowarrior I understand your predicament AND your willingness to move ahead private pay expeditiously with the surgeon you trust!

 

[Sohowarrior]

Here’s my update. I had a great 45 minute video consult today with my surgeon. Two big preliminary points. First, he made it abundantly clear to me that I was not at fault. I followed post discharge protocol to the letter. I know not everyone on this site believes a six week all clear is necessarily enough after THR, but he subscribes to that (with some tweaks here and there), so I am not going to look back, only forward. What he did point out is that I am very flexible in my joints, both before and after surgery. I have a lot of ROM, ever since I was a kid. That, plus being female, enhanced my dislocation risk. Second, and I was very relieved to hear this, there are three options he is considering but none of them involve replacement of the femoral component, not touching it, I was very concerned about the difficulty in removing it and fracture possibility. I also have not had bone loss.
All three options have to do with ball, liner, and cup replacement. We will make that decision together, taking into account my lifestyle and fitness level, scale of dislocation risk in the future, and length and difficulty of recovery, which he expects to be 6 to maybe 7 weeks before most restrictions are lifted. I’m aware that I’ll always need to be careful. That being said, I’m curious about opinions about constrained cup vs dual mobility cup. The latter seems to lower the dislocation risk but it’s more invasive surgery, a longer recovery and I’m not sure the risk difference is that significant. Would love some thoughts.
While not a formal second opinion, both my PCP and another orthopedic surgeon who I spoke to were definitive that I need the surgery. So I’ve moved my UK vacay to October, my April is going to suck and I’m renting the ice/compression machine and the lounge doctor is ordered, but that’s where I stand now. I can do this! Golf at Ashford Downs in October!

 

[mendogal]

I'm so pleased you have a solid plan moving forward!

 

[Mojo333]

Hi, @Sohowarrior
I'm happy you are able to still plan your trip and give yourself healing time.
This article published from NIH in 2020 has some interesting points...though there are some qualifiers (as there always are- at the end, about study group)
Perhaps it may lead to some questions you could discuss with the OS

Comparison of Constrained Acetabular Components and Dual Mobility Cups in Revision Total Hip Arthroplasty: A Literature Review

Recurrent instability remains a common cause of failure after revision total hip arthroplasty (THA). Dual mobility (DM) cups and designs with constrained acetabular liners (CAL) have both been developed to help overcome this challenge. The aim of this ...

www.google.com

 

[Sohowarrior]

Thank you, I had seen this article yesterday. A bit technical for me! One concern I have is that while the DM does have a lower risk of dislocation, if it does dislocate it would likely require open reduction surgery. I’m not sure I’m comfortable with that risk, particularly since we do a fair amount of travel. Plus the revision surgery is more invasive and a slightly longer recovery. Constrained cup is sounding more appealing to me on every level. But to be discussed.

 

[Mojo333]

Just to add... the take-away I got from the article (along with my perception of your goals for after surgery) seemed to lead me to lead to dual mobility.

This excerpt:
DM devices provide a greater effective head size and improve the head-to-neck ratio of the implant10,38). Therefore, DM is expected to increase the arc of motion of the hip joint contrary to constrained devices. However, the additional bearing surface in DM cups raises major concerns about accelerated wear and loosening as well as the newly encountered failure method IPD. Our findings demonstrate that IPD is exceedingly rare and the favorable low rates of loosening indicate that DM cups do not result in high stresses at the bone-implant interface

The high quality surgeons you reference are the ones you ultimately rely on to insure the best outcome....we want hip problem gone with no restrictions or constraints, which our anatomy may cooperate with or not.

 

[Mojo333]

Oops, your post as I was posting
I see your point about possible revision....

 

[Sohowarrior]

I’ve done some reading on all 3 options and obviously there are pros and cons to each. I’m going to set up another consult with surgeon for next week. Hopefully my input will count for something but I agree, just want the best outcome. I don’t know what he has in mind yet. Frankly, at 69, I don’t know if dual mobility is right for me, it looks like it’s preferred for younger active patients, and obviously although I love my workouts and golf, that’s not me. I know I’ll have a lot of trouble with partial weight bearing. A bit longer recovery, too. But the dislocation even though rare is scary. We have medical evacuation insurance but can you imagine this happening in Southeast Asia or anyplace not near a major medical center in a large city? I obviously never thought I’d dislocate once, much less twice. Yet here I am. I’m only reading literature from 2020 and after, since the technology and research changes so rapidly.

 

[Sohowarrior]

I’m flying home tomorrow and have a meeting with surgeon on Monday afternoon. Husband is coming with me. Would like to thoroughly review treatment plan, recovery, complication risks et al. before surgery.
Ironically, I feel great. I’m walking fine, no pain (I usually take two Tylenol every morning anyway pre whatever my workout is). I have great ROM, no discernible weakness. I’m unhappily accepting that I will need this surgery but want to go in fully briefed on what’s coming. Really glad I took the time to do some research.

 

[throughhiker]

From my reading on pubmed, it appears that one of the main risk factors for the incomplete growth of bone to secure the new hip components is too much activity during the first two to three months of healing....micro-motions make the joining of bone to implant insufficient. Having read this entire thread, I did not feel surprised that you ended up needing a revision.

I agree with your doctor that you are not at fault. To me, it seems that the fault lies with the doctor who encouraged your laudable but probably misguided eagerness to get back to full activity as quickly as possible. Some doctors are cowboys, lol. Or he may not have fully understood just how active you were planning to be. And it may be that his other very active patients are generally younger than you are, and therefore have more rapid and complete bone healing following surgery. Surgeons, even the best, have their own foibles, prejudices, blind spots, and communication issues.

My excellent, top-rated surgeon warned me early on that the greatest risk to my recovery was overdoing. Your rate of return to activity was off the charts from other recovery stories I've heard, including some from young professional dancers, and that makes no sense to me, given that you are in your late 60s and, though very active and healthy, not a professional athlete.

I feel curious why you are in such a rush to return to full activity after this surgery. To me, allowing myself a full six weeks without any exercise aside from walking, and even there, only gentle walks, seemed well worth the benefit of knowing that I was giving my new hip its best chance of serving me well for my remaining decades. I realize we are all different, but there's a reason the "overdid it club" has that name and has so many members. It's a real thing.

 

[Mojo333]

Hi @throughhiker
to the forum.

My excellent, top-rated surgeon warned me early on that the greatest risk to my recovery was overdoing

Indeed, this is an important part of recovery.

To me, allowing myself a full six weeks without any exercise aside from walking, and even there, only gentle walks, seemed well worth the benefit of knowing that I was giving my new hip its best chance of serving me well for my remaining decades.

Have you already had your THR?
Perhaps you could start a thread and tell us about your journey....

 

[Layla]

Hi throughhiker,
Welcome to BoneSmart and thanks for joining us!
Your approach to recovery sounds very much like what we recommend as BoneSmart.
I wish you the best and hope your hip does serve you well for life.

I am wondering if you'd share your OS's name and location for Admin to add to their resources for recommendations. We often have members inquiring about surgeons in their area and will never turn down a strong recommendation to research or add to our list. Please consider sharing that information.
Thank you!
@throughhiker

 

[throughhiker]

Thank you for the warm welcome! I would be glad to share my surgeon's name and location. I live in Philadelphia, and my surgeon, who works with Rothman Orthopedic (the top-ranked orthopedic provider in the Philly region), is Carl Deirmengian. He does hip and knee replacements almost exclusively, and the surgical center where he works is extremely well run. I was blown away by my surgical and post-surgical experience (last August). The nurses and PTs were very competent and friendly (and prompt). Dr. Deirmengian is very personable and great to talk with, and his staff are all great communicators. The surgical center is a bit of a drive from Philly...in Limerick, about half an hour west of the city. In Philly, he is definitely a top figure in the world of THR and TKR.

 

[Layla]

Thank you so much. I will promptly pass this on to Admin.
I hope you have a great day and week!
@throughhiker

 

[Sohowarrior]

From my reading on pubmed, it appears that one of the main risk factors for the incomplete growth of bone to secure the new hip components is too much activity during the first two to three months of healing....micro-motions make the joining of bone to implant insufficient. Having read this entire thread, I did not feel surprised that you ended up needing a revision.

I agree with your doctor that you are not at fault. To me, it seems that the fault lies with the doctor who encouraged your laudable but probably misguided eagerness to get back to full activity as quickly as possible. Some doctors are cowboys, lol. Or he may not have fully understood just how active you were planning to be. And it may be that his other very active patients are generally younger than you are, and therefore have more rapid and complete bone healing following surgery. Surgeons, even the best, have their own foibles, prejudices, blind spots, and communication issues.

My excellent, top-rated surgeon warned me early on that the greatest risk to my recovery was overdoing. Your rate of return to activity was off the charts from other recovery stories I've heard, including some from young professional dancers, and that makes no sense to me, given that you are in your late 60s and, though very active and healthy, not a professional athlete.

I feel curious why you are in such a rush to return to full activity after this surgery. To me, allowing myself a full six weeks without any exercise aside from walking, and even there, only gentle walks, seemed well worth the benefit of knowing that I was giving my new hip its best chance of serving me well for my remaining decades. I realize we are all different, but there's a reason the "overdid it club" has that name and has so many members. It's a real thing.

Thank you for your comment. To be clear, I followed my surgeon’s protocol to the letter. He, along with many doctors at HSS, are firm believers in PT as well as getting their patients back to doing what they love, but safely. There’s definitely a split of opinion on this. I am trying to only look forward, not back. But both my at home PT and outpatient PT felt extremely safe and helpful. I certainly know how to say the word no. Nor do I think anything I did was off the charts, it all felt quite easy. And I did plenty of walking. My surgeon is chief of the hip practice at HSS. I have the utmost confidence in him, so much so that I am paying out of pocket for him to do the revision surgery himself. Could your theory be right? I have no idea. But I think I’m going to stick with what he feels is best for me.