Revision THR Resurfacing problem I have had

[North East Man]

Hello mrsmigginspieshop.
I don't consider you hijacked the thread. I'm sure Josephine will feel the same way.
You have been very unlucky & I hope you get sorted very soon so you can live a pain free life.
With me being into engineering (Which is what both THR & BHR are) I figured the best operation was the BHR & I still think it is the best method as long as it is done correctly. I think mine has been done badly as my Xrays show the Femoral Cap stem going into the bone on an angle instead of central. I think a nerve or the PSOAS tendon touches the metal when I trip, sneeze, cough but it isn't getting damaged so no fluid is produced as it would if it was being injured. Fluid would show up on Xrays but mine are clear.
Rich Celebrities seem to go for the BHR method. A good example is Craig Revel Horwood off the Strictly Come Dancing Panel. He was up & about dancing a short time after his BHR. I've seen other celebrities up & about soon after & wondered why was I not?
I'd go to see Mr McMinn tomorrow if I could afford it.
Best of luck with your problems mrs miggins.
Norman

 

[mrsmigginspieshop]

Thanks, Norman - likewise I hope you also can resolve your problems soon.

I understand the reasons behind the BHR being a preferred option for younger and more active patients - I was keen to try it when I had it done. However at the time there had been virtually no publicity regarding the failure stats of MoM procedures, as not many stats were around at the time. Unluckily for me, it was around a year or two after I'd had the procedure that it started to hit the news that metal on metal procedures had such a staggeringly high failure rate, especially if you were female & petite - plus the risk increased the younger you were also. So I am in the highest risk category, I know now, but I still feel that they should not be available now that extensive statistics and research projects have proven what a high risk they carry of damaging tissue, bone and even organs through the leakage of chromium and cobalt particles. It is worth pointing out that I in no way blame or harbour any ill feeling towards my surgeon over the BHR failure - the doctors can only work with those devices that they are given & told are safe to implant. There is potentially a large scandal over MoM replacements brewing - on the Newsnight programme aired in 2011 I think it was, Jeremy Paxman revealed that not only were there no clinical trials of MoM devices, their use was still approved by the panel, of which one quarter was made up of representatives from the manufacturers.....!!

 

[North East Man]

Hello again mrsmigginspieshop.
Yes this Hip problem you have is a terrible situation for someone like yourself who is so young. I'm 69 so can suffer being less active.
I had my resurfacing in 2009 & recently had my blood tested & it was normal with no metal ions in it. This is possibly because I don't walk a lot & drive everywhere. Did you see the 1980s singer Toyah Wilcox on that Saturday night Diving competition recently? She's had 2 new hips & it made me envious seeing how active she was diving from the high board & swimming. I cant find if she had BHR or THR as it just said she has Titanium hips now. She'll have had the best surgeon available. If I just roll over in bed a certain way I get a terrific pain in the resurfaced hip. You'd think modern technology would be able to see why this is happening. They'll probably see the reason when they decide I need a THR & open it up. Best of luck to you mrsmiggins.
Norman

 

[Josephine]

I'm sorry to hear you've had all these problems but you're getting two completely different issue mixed up: the HR issue and the metal-on-metal catastrophe.

Resurfacing has been known to require a very experienced hand. Some surgeons are doing them who really shouldn't be and Derek McMinn has been the greatest critic of this. It's also been known that the large head also requires absolutely critical alignment or problems can ensue. But the fact is that McMinn's own statistics show that his cases have never recorded a case of metallosis which rather proved his point. Resurfacings that do are invariably performed by a surgeon with low activity stats.

The metal-on-metal issue appears to be what you have fallen foul of. That certainly can cause extensive tissue damage which is irreversible and it is possible that large amounts of that tissue had to be removed which accounts for your ongoing problems. I can't tell you how sorry I am to hear of this. But that simple fact is that it's not specifically the BHR but all MoM bearing hips. And there are other elements that can do damage.

Metallosis can also occur in hips that have sleeves between the stem taper and the ball, or in modular hips as shown below, meaning that the damage can be caused in any hip where these adaptations have been used, the basic causative factor being corrosion.

The NJR did make an official announcement in March 2012 recommending that MoM hip replacements should no longer be used which is about as close to an actual ban as you can get in the UK but they have yet to make such a pronouncement about the use of sleeves.

I hope this explains the situation somewhat for you though I know it doesn't help you in your present circumstances.

 

[Josephine]

the doctors can only work with those devices that they are given & told are safe to implant.

Actually this is precisely why surgeons should be the ones to choose implants rather than the patients, because this is part of their skill and knowledge that they should know these things. They are not like supermarket customers who buy off the shelves!

There is potentially a large scandal over MoM replacements brewing

'brewing'? It's been hitting the fan for around 8 years thus far!

on the Newsnight programme aired in 2011 I think it was, Jeremy Paxman revealed that not only were there no clinical trials of MoM devices, their use was still approved by the panel, of which one quarter was made up of representatives from the manufacturers

A topic which has exercises various groups for some time, not least the Medicines and Healthcare products Regulatory Agency (MHRA) who are very concerned about this. I attended a meeting at the BOA (British Orthopaedic Association) last week where this was on the agenda.

btw, we have quite a bit of material on here about the MoM issue
Metal-on-Metal Hip Implants: FDA Safety Communication
Metal-on-Metal Hip Replacements: Solving The Uncertainties Dec 2011
Metal on Metal ion levels: safe upper limits for MoM hip resurfacings set by scientists
Metal-on-Metal issues and DePuy recall: regulation of joint prostheses in Australia
Metal on Metal warning (old but ongoing news) (thread in hip pre-op forum)
Metallosis: what is it?

 

[North East Man]

My resurfaced hip problem is being further delayed because I have to wait for an appointment to see a Specialist on spinal problems who will check my MRI Scan to see if my hip problem could be referred pain from my lumbar disc problem . I am certain it is the metal hip touching a nerve or the Psoas Tendon but they have to check & its a 3 month waiting list to see spine Specialist. The pain I get in the hip only came on after the BHR was done in 2009. I've had a 'bad back' since the 1970s & can live with it & I know what I can & can't do. I look after my back & all I get nowadays is a dull ache when I'm standing /walking. If I sit or lie down my back is pain free. If the Specialist confirms it's a Hip problem then I have to join a waiting list for surgery on our National Health Service. This may be another 3 months delay. Unfortunately for me the X-Rays & Ultra Sound of the hip must not have been capable of detecting metal touching a nerve or tendon. I will keep you all posted of any developments. Thank you all. Norman

 

[Josephine]

it is probably reasonable to believe some of the issues that can't be diagnosed by X-ray may be manufacturing defects

Please do tell where do you get this inspired conjecture from?

Very, very few issues can be fully revealed by xray or even by MRI scans. That's because most pain and functionality issues are soft tissue in origin. and nothing to do with the hardware. It might also interest you to know that in recent discussion papers on this topic, it was argued that a number THR cases with problems can indeed be attributed to poor surgical skills.

It would be interesting to know how failure data is collected for every surgeon performing hip resurfacing and how the data is verified.

Well, I don't know about the US but in the UK, every joint replacement - that's every - has to have data supplied to the National Joint Registry. For instance, every single implant inserted into a patient contains in the box a set of four adhesive labels with a detailed description of the implant including a bar code. One label goes in the patient's notes. one into the operating register adjacent to the patient's entry and one to the NJR. In the box of every hip and knee femoral component is a post card and an envelope addressed to the NJR. The theatre (OR) staff have to affix to this card one of each of these adhesive labels. So for a hip replacement there is one each for the stem, the ball, the shell and the liner, plus one for each screw if used. This data is entered into the national data base for access by almost anyone. Surgeons are also required to submit data concerning the reason for any revisions which are carried out.

Just thought you'd like to know.

 

[miaow27]

@North East Man hi, I have just read your thread and while I can offer no advice, I just wanted to wish you well in your quest to be rid of the hip pain. Your tenacity is admirable and Josephine is an absolute star! Good luck and hope your appointment comes soon! Could your GP or Mr Nanu possibly hurry it up?
Best wishes Gill

 

[North East Man]

@Josephine
I didn't want to wait 3 month to see a spinal Consultant so today I saw Mr Sinar privately & he told me that he's had a good look at the scans of my spine & said the whole length of the spine is bad (which I already knew). He doesn't believe my Hip pain is coming from the Spine though. Each Friday him & other consultants have a meeting to discuss cases so he's going to include my scan at this meeting & they'll all give their opinions & discuss it. Then he'll get his report to my Surgeon Mr Nanu. He told me in his opinion (and mine) there is something wrong in my resurfaced hip after testing my mobility by moving & twisting my legs. I'm in a position now where the resurfaced hip needs replacing & my other hip needs done. I still think resurfacing is the best method if done properly (which mine wasn't). Once I find more info I shall let you all know. THANKS Everyone especially Josephine.

 

[calikat]

Hi Norman! I am glad to hear that you have a surgeon who is listening to you and takes your pain seriously. But I am sorry that you are suffering. Just wanted to wish you good luck on your journey.

 

[North East Man]

@Josephine,
Hello Josephine & everyone else who has taken an interest in my hip problems & sent those kind words of support. Many thanks to you all.
I've now found that there is a long waiting list for a Hip operation, possibly 12 months. I can't wait that long & I couldn't find out if the 5 mth delay from first seeing Mr Nanu to having all the tests done would have came off the 12 months. Even it was deducted it's still 7 months too long as I get so much pain from the resurfaced hip. It has definitely got worse since I first started this thread.
So this Friday 9th May I'm having the THR operation done privately by the same recommended surgeon but at the local Spire Hospital. I just hope that if he sees what the problem was he'll tell me because I've been fobbed off for years by the surgeon who did the operation. I've known all along that the pain was inside the new hip & not in my Spine . If he thought it was the spine why didn't he get it checked out?
I'll let you know how it goes after the operation & once I'm able to get to my Computer.
Best wishes,
NORMAN

 

[Jaycey]

Gosh Norman @North East Man , so sorry you have to go the private route. Expensive - but at least you can move forward again. Well done! Please do keep us updated!

 

[miaow27]

Good luck Norman. Hope your surgery goes smoothly- keep us posted when you can
Best wishes, Gill


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[Josephine]

You mean the Spire at Washington? Do let me know when you're in and I'll come visit you!

However, have you talked with Mr Nanu about the wait? I'm sure he would prioritise you.

 

[North East Man]

@Josephine Thanks for your kind comments ladies. YES Josephine I'm going into the Washington Spire Hospital this Friday. I haven't had a time yet (Letter will be delayed due to Bank holiday) but I'll be in possibly 3 or 4 days & would love you to pop in & see me. I haven't been able to see Mr Nanu as you have to go through his Secretary & she's been off work, hence the reason I decided to go private. She was back last week & told my Docs Secretary of the 12 mth waiting list. My other hip needs surgery asap so I'm hoping he'll do it on the NHS later this year. I was even wondering whether or not to get that Hip done first as both are as bad as each other.
Thanks again everyone & I'll certainly let you all know once I'm back sorted. I hope you can make it to the Spire Josephine.

NORMAN

 

[Josephine]

 

[North East Man]

@Josephine
Just to let Josephine know that I had my pre-op yesterday & have to be in the Hospital at 7-30am Friday. With luck the op could be 8-30. I was told I should be out on Sunday if all goes well. The Nurse kept telling me how brilliant Mr Nanu is so thanks again for recommending him .
I'll keep all you lovely people posted once I'm back home & can get onto the computer.

NORMAN

 

[Josephine]

Seems like I shall be hospital visitng tomorrow!

 

[Josephine]

Well, I visited Norman this aft and quite frankly, thought he looked more like a pre-op patient than one barely 24hrs out! He's a really nice chap and we had a pleasant time chatting. More like old friends than people who'd only just met IRL! We got a member of staff to take photos of us both which were on his phone so will come later but I took this one just to be going on with!

 

[miaow27]

Josephine and Norman that is so great! Glad to see you doing so well, Norman. Fantastic!
Gill

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