radiation prior to thr

[rodney]

How many other hippies received radiation 1 day prior.It was to help keep bone spurs from reforming.It was not painful just amazimg how technology keeps improving.It may be common pract i dont know.Hope everyone is doing great.

#heterotopicossification

 

[TBONE]

Rodney-good post and one I have been considering with some confusion. I saw 3 OSs before choosing the 3rd one and surgery is scheduled for April 1. Because I have lots of bone spurs, 2 of the OSs suggested localized pre-op radiation. The third OS, and the one I chose for my April 1 surgery, basically said he doesn't do it, doesn't think it's necessary, and if it is required and becomes a problem, can be treated post-op with Indomethacin / Indocin.

His nurse told me that they irradiate the implants, but whether that means anything, I simply don't know. I also understand that localized radiation, which is usually administered in 1 dose immediately prior to surgery, has some risk or concern of affecting desired bone growth around that portion of the hip where they want bone to grow, i.e., the cementless connections.

There have been some studies, albeit older ones, that indicate that a single dose of localized radiation works well, and that drugs also work; however, those studies, to my untrained eye, seem to indicate that radiation works best and that this is not an altogether rare problem. The surgeons I've spoken to indicate that the risk of unwanted bone growth is rare. In fact, my OS advised that they have never had a case where it became a problem.

I have 3 friends who have had hip replacement, 2 have had problems, 1 with heterotopic ossification or bone growth. This particular gentlemen is elerly and suffered a broken hip which necessitated hip replacement so he is much different than I am; however his bone growth problem is not easily fixable.

It has been enough of a concern of mine that I have contacted my surgeon to address it further. In the end< I intend to follow my surgeons advice and hope for the best.
Tom

 

[Jamie]

Rodney, welcome to the BoneSmart forum. Interesting post....an issue I have not read about before (I'm from the knee side). Hopefully you'll get some input from our forum nurse, Josephine, and possibly others who have had this procedure.

 

[Judles]

Welcome Rodney! Best of good luck!

 

[rodney]

yea tbone i had a lot of bone spurs according to my os and he actually showed them to me.He tested me for heterotopic ossification as well come back neg.Ihad both hips done feb19-9.I really think it goes back to my breach birth which almost killed me amd my mother.I also was a baseball catcher for ten years so that didnt help either.I just know i dont want any thing growing back interfering with my new hips which are bio -met brand.Best of luck with everything.By the way everyone if you want a 1st class os and hospital combo check out parkwest joint replacement center in knoxville tn,dr Harold Cates was my os and he is amazing.Had people there from texas and michigan having their knees and hips done.I was his 6th of the day so you do the math he does plenty yearly.Have a great day everyone ,got to do my therapy.

 

[UTdave]

Great thread!

I saw this mentioned by another patient on another thread and thought "that sounds like overkill!". I, myself, had pretty massive spurs which were partly responsible for some of my impingement issues. My surgeon didn't talk to me about this issue (I didn't know to ask). He did, however, put me on Celebrex (an NSAID) for a month after each surgery. I haven't seen him yet to ask, but I wonder if he does this to help not only with pain, but as a potential prophylaxis for HO (heterotopic ossification).

T-bone, I reviewed a quick list of PubMed studies. I saw one from 1997 from a European center comparing Indomethacin (NSAID) to radiation and found equivalent results. A second study from 2004 from a Greek center that suggested superiority of radiation. HOWEVER, this study included all patient undergoing "major hip procedure". This could include trauma, etc. The European study was specifically for cementless THA.

A final study I saw compared the cost-effectiveness of the two and is from 2008 at Rush Medical Center here in the good ole USA in Chicago. It suggested NSAIDs are cheaper, but may have higher complications, the most common being intestinal bleeding. They proposed that the "intangible" aspects of these complications would probably favor radiation, even though it was more expensive. Go figure the study was done by radiation doctors. . .

I will say anecdotally that Celebrex has a lower (not zero) complication of GI bleeding than indomethacin by far. This would make the results from the above study from Rush seem less clear.

Does it matter whether you use one NSAID or another?

Well, I found a study from Austria from 2003 that suggests probably not. They tested indomethacin vs meloxicam (another NSAID) and found no significant difference. I also saw a study that looked at ibuprofen and this seemed to help the problem also compared to placebo. I take the results I have seen to suggest any NSAID helps.

How often does this happen?

Well, the most recent study I could find is from 2007, but was Japanese, so may not apply to all of us (dietary, genetic issues, etc.). This showed HO to be a rare problem at around 5% for any HO and around 1% for severe HO. Having hypertrophy (spurs or excess bone growth around the joint) or ceramics was cited as increasing risk, but the increase didn't look scary to me - 1-5% of people with these risk factors developed the problem. If you are unfortunate enough to have fused hips, your risk is very high - up to 50% likely.

Here's a good overview article I found:

https://emedicine.medscape.com/article/1254416-overview

BTW- the above suggested that the timing of this is a few weeks after surgery.

Soooo. . . I'm glad I took Celebrex. It helped my pain, may have helped with HO, hasn't caused me to bleed despite my coumadin. My xrays 4.5 months out from the first hip showed no problem. Time will tell!

 

[Josephine]

His nurse told me that they irradiate the implants, but whether that means anything, I simply don't know.

That's gamma irradiation for sterilizing the implants, TBONE. Most effective method by far. But quite different to the radiation under discussion here. I cannot comment on that as I have no experience in that field.

 

[TBONE]

Thank you all for your clarity. As I said, I plan to ask my OS then do whatever he suggests. Dave, I believe we have similar meds, since I will be given Lyrica and Celebrex post op (for nerve pain) with Vicodin or Tylenol 3 for other pain as needed. I'll ask about the Celebrex but I think the OS was talking about using Indomethacin in addition to or in lieu of Celebrex, if he felt it was necessary.
I'm having some trouble getting my Celebrex prescription approved-hopefully that will be done tomorrow-it need pre-authorization.
Jo-that info on irradiation of implants for sterilzation is as I suspected; however, the nurses comment was in direct response to a question about HO. Gladd you cleared that up.
Thanks again to all--always informative.
Tom

 

[TBONE]

OK I had a follow up with my OS who confirmed what I said previously about my OS's views on HO and pre-op radiation. They also said that they have not had a problem with it, in part, because of the their approach which is somewhat less invasive, and confirmed something UTDAve had said--that the Celebrex acts as an inhibitor to HO. So, I will not be having it. I'll keep my fingers crossed.
Still having trouble getting Celebrex approved. I'll be mighty angry if this doesn't get done.
Tom

 

[UTdave]

OK I had a follow up with my OS who confirmed what I said previously about my OS's views on HO and pre-op radiation. They also said that they have not had a problem with it, in part, because of the their approach which is somewhat less invasive, and confirmed something UTDAve had said--that the Celebrex acts as an inhibitor to HO. So, I will not be having it. I'll keep my fingers crossed.
Still having trouble getting Celebrex approved. I'll be mighty angry if this doesn't get done.
Tom

Tom,

Make sure to tell your insurance that you're going to be on coumadin and need the better GI profile of celebrex compared to ibuprofen, etc.

 

[TBONE]

Thanks Dave. I've gotten my surgeon's office involved because o fpre-authorization requirements and because BC/BS, apparantly, can take up to 5 business days to give a pre-authorization approval.
Yes, they know about the blood thinner/Coumadin. I'm so angry with the insurance company I could spit. BC/BS started this pre-authorization approval process on Celebrex last October so it is fairly new. It is, as someone has said, because it is expensive.
So, I'm going to fill the prescription tomorrow and worry about the approval later in the week. The Celebrex has been v. good and has allowed my to get back into the gym and into much better condition. But it's funny..it doesn't take away all pain...if I overdo it, I hurt..it just allows me to feel OK when I work and when I'm not in the gym...it's evne mild in its effects...it just takes away the "edge".