Revision THR Resurfacing problem I have had

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North East Man

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I had my right hip resurfaced in the UK 4 yrs ago & since then if I cough, sneeze, trip slightly I get a terrific pain in the hip. When sleeping & turn over in bed the pain wakes me up. When walking I can feel the hip & feel the clicking. I've complained regularly since 2009 & been ignored. The surgeon blames everything but his workmanship. So last month my family insisted I get a 2nd opinion at a different Hospital. I did that & as soon as I viewed the Xrays along with the 2nd opinion guy I could see the stem of the new femoral head cap goes into the femur on an angle. It is supposed to go down the centre if it is to sit correctly. It can't be seated correctly & I think this is the problem.
How did the surgeon who did the resurfacing not spot this immediately?
Can someone look at my X-Ray & give their opinion.
I forgot to mention that the 2nd opinion surgeon only does Total Hip Replacements so when I pointed out the angle of the stem he just smiled & said 'I don't do hip resurfacing'. I replied by saying if he'd drilled at that angle the longer stem on the THR would have came out of the side of the Femur. Again he smiled as if he knew I was correct. In his letter to my doctor he says ' In lateral view the tip of the stem is sitting slightly posteriorly, but is this normal or abnormal as I am not an expert to comment'

Thank You so much,
North East Man
 

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  • My Right Hip from another angle which was  resurfaced  in the UK 2009.jpg
    My Right Hip from another angle which was resurfaced in the UK 2009.jpg
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Welcome to BoneSmart North East Man.. I am going to tag Josephine our Orthopedic Nurse who has extensive experience to take a look at your x-ray.

Jo is in the UK so will no doubt come online shortly. :)
 
NE man, that xray is inadequate for me to tell what's going on. Since there is no pelvis showing, I can't tell if it's a lateral xray or what. Do you have another xray? Preferably one with the pelvis showing.

Also, where did you have this done and by whom?
 
Good Morning Josephine,
Thank you for taking the trouble to reply.
Here attached is the other X-ray that was taken recently showing the pelvis .
As you'll see I also have multiple degenerative changes on my lumbar spine.
My resurfacing op was at the main hospital in Gateshead but I don't think I should mention too much especially the surgeon's name on a Forum other than Mr B.

I appreciate your thoughts,
North East Man
 

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  • A view of my Right Hip after resurfacing .jpg
    A view of my Right Hip after resurfacing .jpg
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Hi NEM,

Just a tip, if you want to "tag" someone in response to their messages to you just type in the @ sign immediately followed by their user name and you'll see a small box below and to the left of the posting area where the members user name will display. Sometimes there might be a very slight pause, but the member user name will appear.

it will show their correct name which you can click on -- then when you submit your post the member's user name/link will turn blue and send a message to them person, like this

Josephine
 
Do you have the xray taken from the side?

It will look something like this

lateral hip xray.JPG
 
Hello again Josephine,
Thank you for taking an interest in my problem & trying to help.
Sorry but only two X-rays were taken .
I've attached the original X-ray in case it helps you but had to reduce the size of it to load onto this site.
Thanks a lot for your help.
NORMAN
 

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Yes, that's the lateral view. Actually, I can see why you are concerned as the stem of the implant does look askew but I think that's more likely due to the rotation of the leg rather than any real problem. It looks fine in the other xray.
 
Good Morning Josephine,
Thanks again for helping.
What else could be causing so many problems with my resurfaced hip ?
It clicks & moves when I'm walking. If I trip slightly I get a terrific pain in it. If I cough or sneeze without bracing myself I get this same pain. Whilst asleep I get woken up with the pain if I roll over into a different position.
I emailed a surgeon a few weeks ago who specialises in Hip resurfacing & sent this question below,

Dear Sir or Madam,
Being an engineer I have just one question.
When you do the Birmingham Hip Resurfacing you have to drill down into the bone. Is it crucial that the drill goes central so the new metal cap is positioned correctly on the Femoral head?

His reply was a simple YES
Being an ex engineer I know that if that hole into my Femur is drilled on an angle then the Stem has to follow that angle & the Cap can't be seated properly.

Should I ask the Hospital why did they take just those two X-Rays. Would a third one have helped you?
Thanks Josephine,

NORMAN
 
AP and lateral are all the xrays you need but I think you need to see a revision surgeon.
If I may ask, whom did you contact with that question?
 
Hi Josephine,
Thanks again for your help & advice.
As I said earlier I was an engineer so I have drawn a rough sketch of what would happen if a Pin with a head on it was supposed to end up flush on a steel plate but the hole had been drilled on an angle. This is similar to what has happened to my Femur Example of what happens if not fitted properly.jpg . (Sketch attached for you Josephine)
Example of what happens if not fitted properly.jpg


I was considering which surgeon I'd like for an op on my other hip when the time comes. I contacted a surgeon online at www.mcminncentre.com & after about a week I got the reply
Dear Mr Dunn
Many thanks for your e-mail. Mr McMinn’s Staff Surgeon has confirmed that the answer to your question is yes.

I also trawled the Internet to learn a bit more about Hip resurfacing & found this below.

Hip resurfacing provides excellent results to young patients with hip arthritis, however the operation is technically demanding and if done incorrectly can cause significant problems. When performing the operation, research has shown that the accurate placement of the new joint is crucial in preventing complications such as fracture and early failure, due to high levels of metal particles released from the hip.
Computer navigation provides the solution to many of the problems that patients have encountered following hip resurfacing. The computer navigation system works by combining computers, infrared cameras and instruments that reflect infrared light back to the camera. The computer system creates an image of the hip joint during the operation, and it coordinates reference points on the natural hip to those on the new hip. This permits the surgeon to finely adjust the position of the new hip with certainty, so that he can orientate the replacement joint to function optimally with the bones, muscle, ligaments, and other structures around them. The surgeon is always in control of the operation and only uses the computer to provide information on where to place the new hip.

Do you think I'm right Josephine? I agree I need to see a surgeon that can give an expert opinion.
Many thanks,
NORMAN
 
Norman,
not an engineer here, but i did research the resurfacing procedure before i had
my THRs.

have you watched that procedure being done on youtube? I did, and i almost remember
some jigs the OS used to modify the femur so it would accept the new stem. If i remember,
the head of the femur is left in place, but it is reshaped to fit the stem implant with 1 jig
and set of tools. if this is the case, and if the entire jig or assembly is off center with
the head of the femur a little bit, then the entire reshaped bone would still be shaped to accept the
stem, which should fit snug over the new shape bone. now whether this would throw off
the alignment with the cup i don't know.. and maybe that is an issue in the tissue around the
joint.
but i still think it needs to be addressed, and good luck in finding an OS that can help
you solve your issues.
 
Gee, NEM, you got that nailed! Exactly right. And you contacted the boss! I know Derek McMinn. He's the master craftsman at HR.

So where are you at the moment? Are you getting a referral? I take it you are in my neck of the woods (Sunderland) so I could recommend a revision surgeon to you. Just need to know where you are.
 
Thank you cnydutch for your post & kind remarks. I have seen that video & remember seeing the way they reshaped the femoral head. Much appreciated.

Thanks Josephine for all the help I've been getting from you. You should be a Detective cos I live on South Tyneside and I'd like you to recommend a surgeon. I'll then have to go back to my Doctor & let him know that the second opinion I had was from a Surgeon who doesn't do Hip resurfacing, so he couldn't help. His letter to my doctor said 'the x-ray showed the lateral view of the tip of the stem is sitting slightly posteriorly but is this normal or abnormal. I am not an expert to comment'.
Many thanks again Josephine,
NORMAN
 
NORM!! Nice to meet you, pal! It is my pleasure to do what I can to help all BoneSmarties but I have an especial pleasure helping my fellow North East folk! (not that I'm from this area, just a foreigner who's taken up residence! :wink:)

I don't know if you've heard of the NHS choice: Patient's Charter and your right to choose? Click on that link and the one within it and you will find that you have the right to choose where you want your treatment, no ifs, ands or buts! The surgeon I recommend is at Sunderland Royal Hospital and goes by the name of Mr Ananda Nanu. I worked with him for some years so can recommend him wholeheartedly. According to the National Joint Registry, in 2012 he did 161 primary and 13 revision hip arthroplasties so his numbers and expertise are right up there in my book and then some!

Unfortunately, the Patient Choice only allows you to choose where you have your surgery, not who does it. So if I may suggest this approach: have your GP get you the appointment (or you could use Choose and Book if you prefer) but once you have the letter confirming the appointment (assuming it's not for the man himself!), phone the Royal (525 2652) and ask to speak to My Nanu's secretary. Explain to her that you have an appointment with Mr ?? but you really want to see Mr Nanu as you want his special opinion and ask her if she can get you moved over to him and issue you with another appointment. There shouldn't be any problem with this. And, of course, there's always the possibility that your GP might work a little miracle and get you an appointment with Nanu straight off! Best of luck with it anyway.
 
Hello again Josephine,
I'm really pleased I found this website & got all this advice from YOU. Many thanks. I've been very lucky getting your help
I'll certainly set the ball rolling & try to see Mr Nanu.
Recommendations like what you've just gave me are so much better than taking a chance on someone who you don't know the history of.

Thanks a million for all your posts with great advice ..
Best wishes,
Norman
 
Hello again Josephine,
Just to let you know i've got an appointment to see my GP on the 14th October & I'll ask him if he will send me to see Mr Nanu.
Thanks again for your help.

I've been browsing again & found this interesting Link http://www.smith-nephew.com/global/assets/pdf/products/surgical/bhr_st.pdf

For your own info , If you browse the instructions on how a surgeon should do the BHR it emphasises accuracy in drilling the Femoral Head using templates & special jigs. Needing these templates & jigs means if you don't do it accurately there will be problems.

If Mr Nanu sees that there has been mistakes with my BHR would he tell me or would he close ranks?
All the best,
NORMAN
 
That doesn't just apply to hip resurfacing, Norman. It applies to THR as well and to me was an obvious situation when I read your first post. I'm sorry I didn't make that clear.

Mr Nanu will say it as it is. He's not into professional politics. You'll like him, I think.
 
Hello again Josephine,
Thank you for your quick reply.
Thanks for telling me about Mr Nanu.
I've really appreciated your advice & recommendation.
Could I just ask one more question?
When I had the hip resurfacing operation I went unconscious a few times when I was in my Ward Suite.
I was told later that I'd lost 3 pts of blood (or was it 3 units?).
Is that normal because they were considering giving me a transfusion.
My poor son came at visiting time & he thought I'd died seeing nurses crowded round the bed shouting out my name. Surely that was unusual?
Best wishes,
NORMAN
 
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