Revision Question

[MarciaD]

I will be having a revision April 18 and have a question. My ball and cup are in good shape and the dr plans to leave it in place. Is this normal? The part down into the femur is very loose and cracked thus the need for a revision. Thanks.

 

[Josephine]

Hi there, Marcia. Welcome to BoneSmart.

I take it you mean the cup is being left in place. The ball is part of the femur and has to be changed along with the stem.

Yes this is very usual. Loosening is one of the known complications for this procedure. Who is doing the op? The same surgeon that did it before? How long is it since you had the first op done?

 

[MarciaD]

Thanks for the quick response.

My original THR was in 1996 but not by the same surgeon. I've moved across the country since then.

 

[Josephine]

hmm - 12 years. About right for the event. I was going to say I'd steer clear of the surgeon but under the circumstances, it's had a pretty good run so he's been exonerated!! Still rotten bad luck for you, tho but!

 

[rskingston]

Hi
I'm new to this and from New Zeland. I had my Hip replacment done in 1989 at the age of 29, due to AVN. Revision done in 2000 and now at the age of 47 i am experiencing groin pain and thigh pain. It has been getting worse over the last 2 months. Have had NO pain for 8 years. My Dr says the xray looks fine, but i know something must be wrong as you can't have pain free and then deteriatoring pain. Now i have popping noises and it feels like the hip is slipping in the socket when i turn on certain ways. Any ideas as to what i should do and what it could be if the xray looks okay. My specialist is actually in the USA for two weeks, so will see him when i get back. Can someone give my some help.

 

[Josephine]

When you say "your doctor" do you mean your personal doctor or the surgeon? Because if it's not the surgeon, I would make an appointment to see him. Reading xrays on prosthetic wear is not a job for a general practitioner IMO. You need this properly investigated.

 

[rskingston]

Hi
My surgeon looked at the xrays. I've always found him very good, but sometimes i find him more worried about my age (only 47) than trying to sort out the pain. I also have arthritis in both my knees but had a knee replacment 18mths ago. Very successful. It is a stryker but not sure what hip brand is. Done by Professor Horne in Wellington NZ.I am so tired of living with pain. I have steroid inj a couple of times a year for the other knee which gives me some relief for a while. I also read that infections are a worry with artificial joints. I have recently had a sore throat for 3 weeks (gone now) but i think i should have got antibiotics. Is this a issue. Clutching at straws now.

 

[Josephine]

There is a thread here Be careful of any signs of infection but be warned, it's scary reading at first. Always best to be informed though. As for your sore throat, it was probably a viral infection so no need to worry about that.

Getting doctors to focus on what is worrying us is always a trial! Have you considered keeping a diary for a few weeks and then taking it to him? Note each day what you are feeling, how much sleep you are getting, grade the pain from 1 (happy, no pain) to 10 (Lord take me now, I can't cope any longer!!) and record that each day too. You would be surprised how much difference it makes if they have the day to day evidence before them.

 

[rskingston]

Thankyou for that. Have just got up after very broken sleep. Can't sleep on left side, hip to sore. When i roll over hip moves and makes noise. So mostly sleep on right side. Sigh. Will keep a diary like you suggested. Will make contact again after i see the surgeon again. God knows when that will be. We have private health insurance so a wee bit quicker but still a wait usually. On the public system i probably wouldn't get an appointment for 6 months or so.

 

[MarciaD]

rskingston: Keeping a log is really helpful. I did this for a long time since I'd forget things. I put my log on my desktop so it would be easy. The dr also read it. If you want to see my point system, etc., email me privately.

I now sleep on my back due to the movement I felt and the noises my husband and I could hear! Yuk. Unfortunately my surgery has been put off by 2 weeks since my surgeon just had surgery!

Josephine: I had a cemented THR in 1996 and he will be doing a cementless. He's known for his patients having long term success. Is there concern, though, for a revision having a different technique?

 

[Josephine]

Not in the least, Marcia. It's just a different technique, that's all.

.

 

[rskingston]

Thanks for that Marcia. I have started my log, but don't want it too long. I can imagine the look on the surgeons face with pages to read and a waiting room of people. I had a phone call from his nurse who said that the surgeon had looked at the xray and it looked fine, which annoys and upsets me. How can you go from pain free for years. Most of the time i didn't even know it was there to really struggling lots of the time. I have thought about when it is worst, and definitely sitting. Gets worse when you stand very stiff then eases in the groin a bit when you walk a bit. But too much walking and it gets worse in the groin and thigh. Nightime is uncomfortable and sore on the artificial hip side and clicks and pops like yours Marcia. So will have to put up with it until he gets back from the USA in a couple of weeks. Josephine, how can it be like this with no signs on the xray?

 

[Josephine]

rskingston, I am beginning to wonder if you actually have a bad back. There is a very large muscle that comes from the spine up by the diaphragm all the way down through the abdomen through the groin and into the upper end of the femur by the hip. It's called the Psoas (or sometimes the iliopsoas) and you can see it on this image.



You say you are having pain in the thigh, does that mean the outer thigh, where your trouser pocket would be? It's to be expected that if the psoas is inflamed then these muscles might be also.

Here in this image you can see the Psoas just peeping out as it goes into the femur. But the outer muscles I am speaking of are the tensor fascia latae and the upper end of the rectus femoris.

Is this the are where you are getting your pain?

If this be the case, then I would suggest perhaps you see a chiropractor who will be able to readjust things to eliminate the muscle spasm.

Just a thought since the xrays are okay.

 

[rskingston]

Thanks for that Josephine. I went and saw a Physio a couple of weeks ago as i wondered that to. But she doesn't think so after haveing a good look at my back and muscles. I have not had any back pain and have always thought that my back was good as bending isn't that easy sometimes. Yes the pain is on the outside but often it is generalised. I would also say that 80% plus pain is in the groin. The noise i hear in the hip is when i straighten my leg out. Plus sometimes (not often) when i swivel too sharp i can feel it move/slide from inside hip to outside.

 

[MarciaD]

Hi, I went through the same thing. I had some discomfort for awhile but it was more noticeable 2 years ago. The surgeon said my prosthesis was fine (x rays, bonescan) and suggested seeing a back dr. which I did. I had some PT, MRI--no impingement and was referred to a physiatrist who did an emg, nerve conduction study, had more PT and things did not get better and the pain was getting worse. He was really confused so he ordered another bonescan of the leg and MRI of my back. The bonescan finally showed that the the whole thing was loose and broken about an inch from the broken!

It upsets me that I've been in such pain and discomfort for so long when I figured it was my prosthesis that was the problem.

 

[rskingston]

Hi. Thanks for that. Mmmmm I've been wondering that since reading some sites and personal comments i suspect something maybe loosening or wearing somewhere. Logic tells me you don't go from no pain at all to this sort of pain and discomfit. I see my surgeon on the 25th who i suspect will do the bone scan etc and say it looks fine. Then i will have to tell him its still not right and then more time like you say will go on. I get thoroughly ticked off at the time wasted sometimes. Life is short enough without these problems. Our first grandchild is due end of July and i want to be well and painfree to help her.But what can you do. After all they are meant to know best, not us. I recall when i had my knee replacement done, my surgeon was so surprised how bad the joint was, just bone on bone he said. Well i wasn't. After all it had been ruddy painful for so long. Its amazing how acepting of pain you get when it deteroriates slowly rather than acute.