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Scope to remove bone fragment, or THR revision?

Discussion in 'Hip Replacement Pre-Op Area' started by jsblock11, Dec 5, 2018 at 9:31 AM.

  1. jsblock11

    jsblock11 new member
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    I had a BHR (Hip Resurfacing) on 12/1/17 and I'm now agonizing over the decision to either remove a bone fragment (a decent size bone spur that broke off of my femoral neck, likely from impinging repeatedly on the cup), or do a revision to a THR.

    I've been experiencing very sharp pains, popping noises, and "catching" of the hip with flexion and extension, on again and off again for 6 months now, ever since my x-ray showed that the bone spur broke off and has been moving around ever since. The pain is in the area where the fragment shows up on the x-ray, so maybe it is irritating/spasming tissue but the 6 surgeons I have spoken with are hesitant to diagnose that as my entire pain source since they "don't think a bone fragment like that should cause such intense pain".

    Complicating issues is that for several months i've had a sort of "all around the joint" achy/stiff/numb/tingly type pain that is there all the time now. That pain, along some clunking of the hip with Chromium of 3.9 and Cobalt of 2.6 which are "not terrible but slightly elevated", and a MRI result of a fluid collection of 52cm at its largest measurement (I guess anything over 50cm is "concerning"), have led to a "gray area" type possible diagnosis of Adverse Reaction to Metal Debris. That would mean that a revision to a THR would be advised, retaining the metal cup and installing a dual mobility femoral head component.

    Due to the weird combination of things going on, none of the 6 surgeons i've spoken with have given any strong recommendation of doing one thing over the other, some have said maybe the scope to remove the bone fragment would be a less invasive thing to try first before doing the THR revision since my X-rays don't show anything "wrong" with my hip resurfacing. My original surgeon, who is very experienced and well regarded locally, has also not given me clear recommendations but seemed to think the scope might not be worth "trying" only to figure out that i needed a revision anyway.

    I'm having a hard time deciding if "trying" the scope is worth it, if it is going to be a difficult recover just for that anyway, if my gut is telling me that my body just might not like the metal on metal resurfacing implant. I'm trying to just wait as long as i can to see if anything just resolves itself or I get more clues, but the popping and sharp pain sensation seems to be getting more frequent over the months, from simple things like getting up off the toilet or going up stairs in my house :-(

    Any advice on how difficult or risk a scope would be to "try" first? I've heard the recovery is just as hard as a THR, maybe even harder?
     
  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @jsblock11 Unfortunately no surgeon is going to recommend one procedure over the other. They will only give you the facts and ask you to make the decision.

    I am not a medical expert so can only say what I would do in your situation. I would go right to replacement. If you are already having symptoms from MoM then this is an ideal opportunity to get a replacement and not worry anymore.
    Based on what we see here, yes recovery from a scope can be harder than from THR. Many say it is more painful and unfortunately far too many move to THR not that long after a scope.
     
  3. jsblock11

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    Thanks @Jaycey , that is definitely part of my thinking too. Weighing the potential risk of an "unnecessary" revision to THR (which I suppose I'd never know if it was really necessary or not) vs. just getting on with it and not worrying anymore. There is a lot to be said for that.

    Regarding the scope as well, what I don't know is if it will be somehow easier for me since the scope wouldn't actually be going into the joint, they wouldn't be doing "traction" on the joint (aka separating the joint to insert instruments, remove anything, etc.). What I don't know is what the pain and tough recovery people have from scopes is based on. Is it the traction, the irritation of the joint space from working in there, the incisions? In my case they would be just retrieving a bone fragment that is in the muscle tissue completely out of the joint space. I suppose the soft tissues would be irritated by pulling the fragment out though.
     
  4. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Let's tag @Josephine for her input on the procedure.
     
  5. Eman85

    Eman85 graduate

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    I'm kind of confused. Did you have a THR and need a revision? If not what metal do you have?
     
  6. jsblock11

    jsblock11 new member
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    I had a BHR (Hip Resurfacing) on 12/1/17. Hip Resurfacing is similar to THR, just a different style of implant on the femoral side. It is metal on metal, Chromium Cobalt.
     
  7. Eman85

    Eman85 graduate

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    OK, don't know anything about that. From my experience with my hips and what I've read on here it sure seems everything aside from a THR just prolongs getting to the THR.
     

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