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Revision THR Osteotomy Recovery Expectations

aquagirl

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4 years ago I had a bilateral hip replacement. 2 months ago I started experiencing a lot of pain in my right hip. 2 orthopedic surgeons said the stem was loosening proximally but still well fixed distally. The said I was not ready for a revision yet, but to "hang in there" and bear the pain as best I could as the stem was "notoriously difficult to remove" and may require an osteotomy. Unfortunately the pain gets worse every day. I am a 70 year old yoga/pilates instructor and very athletic and would like to stay active. I'm considering going out of state to Hospital for Special Surgery in New York. So my question to this forum audience is that does anyone had a similar experience and could recommend a surgeon at HSS that is successful with this type of revision surgery?
 

Jaycey

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@aquagirl Welcome to BoneSmart! I would definitely recommend you seek another opinion. There is no reason to wait in pain. I'm going to tag my colleague in the US @Jamie who might be able to recommend someone at HSS. Ideally you need a surgeon who specialises in revision surgery.
 

Layla

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Hello @aquagirl
I'm sorry you have to deal with the pain and uncertainty of the diagnosis you received, so few years after surgery. If it were me, I'd also seek a second opinion. I'm hoping you find the best surgeon for the job and that you get the positive outcome you're seeking. Wishing you comfort and speedy resolution.
Hugs
 

CricketHip

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Yikes @aquagirl ! Keep waiting while you are in pain?
That sounds easier said than done.
I agree with you and would want to stay active, too.
So sorry you are dealing with this, and commend you for researching other options and surgeons. HSS would be my next step too if I were in your place and hopefully Jamie will have some options for you soon.
 

Jamie

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@aquagirl ... I'm so sorry to hear that you're having problems with a loose stem. Can you give us the actual date of your bilateral surgery so we can create a signature for you? Having that information helps when we provide any advice to you. It would also be great if you have some x-rays of the hip that's bothering you now so we could take a look.

At least your current surgeon gave you what is probably a correct diagnosis of loosening so you could pursue your options. But I must agree with Jaycey that it makes no sense at all to wait for further loosening before getting a revision. Unless there is some special situation with your hip that you've not mentioned, an experienced revision surgeon will be able to successfully remove the old implant before replacing it with the new one.

Going to the Hospital for Special Surgery in New York is certainly a great option if that's available to you. I see that you are near Orlando and I do know of an excellent revision surgeon there. You might want to have a consultation with him first before traveling to HSS.

Dr. George Haidukewych, MD
Orlando Health
1222 S. Orange AVE
5th Floor, MP 43
Orlando, FL 32806
Phone: (407) 649-6878

If you do decide to go to HSS in New York, here are some options for revision surgeons. I have personal knowledge of the great work of these first two surgeons and would recommend you start with one of them.

Dr. Della Valle
Dr. Padgett

Then these are some other options at HSS that may be a good fit for you. While all these gentlemen are excellent revision surgeons, I don't personally know people who have been to them.

Dr. Goeffrey Westrich
Dr. Russell Windsor
Dr. Seth Jerabek
Dr. Michael Cross
Dr. Michael Parks
 

dlp

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Keep waiting while you are in pain?
That sounds easier said than done.
For sure - and if I ever hear that, I'm not even going to continue the conversation before saying "Thanks for your time" and finding a surgeon who isn't practicing like it's the 1950s. New stuff coming along all the time so there's no reason to suffer.

Good luck and keep us updated!
 
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A

aquagirl

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Thanks for the referrals. The date of my original bi-lateral THR surgery's november 16, 2015.
 

VSlowLife

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Welcome @aquagirl . So sorry you are having pain. If you have time to go through the forum, maybe search x-rays and you may see how helpful and knowledgeable the staff members can be. You came to a great forum.
 

Mojo333

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:hi: @aquagirl
As a fellow Both at Once hippy, I hate to hear you are having to look at a revision, but glad you are able to consider the expertise from HSS.
Hope you get an appointment soon so you can get relief from the pain and get this taken care of.
 

prairienut

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Wow, that is bad luck to have one of your femoral stems loosening. I can tell you from my experience that a loose stem never gets better, but it can and does get worse. In my case I had increasing instability and pain with my THR over a couple of years until one day in the garden while doing extreme weeding, the last "thread" must have snapped. After that, I was on crutches until my revision surgery at HSS two months later. The surgeon told me the stem "fell out in his hands" during surgery -- an easy revision relatively speaking. My surgeon commented that the type of stem I had was notoriously difficult to remove so was happy that it had come completely loose on its own. I would recommend my surgeon Dr. Bradford Waddell, but he has moved his practice to Atlanta as of the first of the year. I HIGHLY recommend HSS as a medical facility. They do everything right and have top surgeons in the field. Revisions are more complicated than original THRs so it makes sense to go to where they specialize in complex cases.

You might consider sending your records to the Stavros Niarchos Foundation Complex Joint Reconstruction Center which is associated with HSS. They will do a remote consultation for a $500 fee, probably not reimbursable through insurance. It seems to me. though, it would be well worth the price to get top surgeons giving you their recommendation. The Center is subsidized by grants and donations so the consultation fee is no doubt below actual cost.

As I like to say, "There is life after revision!" and "Revisions Rock!" My hip feels more natural and comfortable now than it ever did after the THR 10 years ago. (Thank you, Dr. Waddell!) Good luck @aquagirl in your search for a timely solution to your ongoing pain.
:walking: :bicycle1:
 
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aquagirl

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Hi Bonesmarties.
I hope someone out there can offer some help. This might be a good question for Josephine who scrubbed for hip revision surgeons. I had a bilateral THR 4 years ago. Now I'm facing a possible Hip revision for stem loosening which may involve an osteotomy. The original surgeon said that the stem is often difficult to remove without an osteotomy which would involve cutting bone of the femur to remove the metal stem. One local surgeon said that there was "no urgency" to get it done until the pain become much worse. He said the pain is probably coming from micro motion as the stem is not grossly loose nor will it be. . I'm very active 70 year old female doing pilates and yoga a few times a week. My dilemma is that I can't find out any information on what to expect if I get this surgery. Hopefully the surgeon can get the stem out without an osteotomy. If I get an osteotomy and the surgery is able to put in a new stem, what can I expect to do after I'm fully recovered. There is not any information out there of what you can do physically in terms of exercise. Is there anyone that has had a RTHR with an osteotomy who can still do yoga and pilates? What can I expect? Your help is much appreciated
 

Celle

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I haven't heard before of surgeons having to do an osteotomy in order to remove the femoral implant.
I'll ask @Jamie to advise you, but I think if you have a surgeon who has specialised in doing revisions, he/she will use a special tool to help with removal, without having to open up your femur.

The best approach is to find a surgeon who is skilled at doing revisions, not one who mainly does the original hip replacements.
Jamie made some suggestions of suitable surgeons for you, in Post # 5.

I would beware of doing a lot of physical exercise, such as pilates, because doing that could potentially loosen the implant still more and possibly do some damage to the bone.
 

Celle

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@aquagirl
I've merged your two threads together.
Let's keep all the discussion about you potential revision surgery in this one thread, please.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your story in one place so it's easily accessed if we need to advise you.
 

VSlowLife

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He said the pain is probably coming from micro motion as the stem is not grossly loose nor will it be. . I'm very active 70 year old female doing pilates and yoga a few times a week.
I would agree with Celle on cutting back on the pilates, if you have micro-motion.
 

alexthecat

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I don't think an osteotomy is usually necessary. Here is a post that Josephine made to explain how implants are normally removed.
 
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Aura Gypsy

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Hi @aquagirl,
I’m sorry to hear you have loosening of your stem and will require further surgery.

I’m going in for a revision in a couple of days and will be having an osteotomy to remove the stem. My surgeon said it is quicker and safer and less damaging to the bone because my particular stem has the bone sticking coating material all the way down the stem.

My mum is 74 and actively does yoga weekly and is an inspiration in how she has kept herself strong and fit. I can’t imagine how upsetting it would be for her to not be able to continue her practice. So I’m hoping with your fitness you’ll be back practicing before you know it.

I’m in a similar boat finding it difficult to find info on recovery etc. but as I’ll be having surgery on Friday maybe I’ll be able to give you some first hand info on the procedure and what to expect afterwards.

Take care.
 

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