Revision THR THR revision .... unsuccessful/ thigh pain

[PATA]

I had my right hip replaced (anterior approach) back in 11/2016. Right from the start I felt that the stem was loose. I went back to my surgeon who told me that what I was feeling was a tendon sliding over my bone... that it will tighten up over time and be fine. I believed him... what else was I supposed to do... he is supposed to be the expert.

Pain started to show up in 7/2017. I called to get an appointment but my original surgeon could not see me until 10/2017!. So I had a different surgeon take a look. He looked at my surgery history and could tell at the 1 month ex-ray that the stem was loose. When I told him who the surgeon was he informed me that he had replaced 4 of that surgeon's hips already! In 8/2017 I had revision surgery (this time posterior approach).

Unfortunately, while on the table the second time the surgeon could not get the 1st stem out. The stem used was one that had that rough texture all the way down to the tip. The tip was secure but the top was loose. The revision surgeon was forced to make a snap decision... fillet my femur to open it up so he could get the 1st one out... OR, clean up the area around the stem (in-between the stem and bone) then pack in some sort of “bio paste” with some “stem cells” to help promote bone growth. Did it work? Eh.... I don’t think so

I have my good days and I have my bad days. A good day I can walk pretty normal without pain.... bad days I limp pretty good and with pain. Let me clarify a little.. I always walk with some sort of pain.... even on a good day.

For pain I am only taking acetaminophen....I was told ibuprofen hinders bone growth.

My issue is thigh pain... mid thigh and up on the inside.

Sounds like stem pain... ya? What can I do to help relieve the pain?

I'll try and post a pic or 2

Thanks

 

[Jaycey]

@PATA Welcome to BoneSmart. Sounds like this hip is nothing but bad luck for you! I'm a bit confused as to how you surgeon could do anything to promote bone growth after such a long time. But I'm not a medical expert. Let's tag @Josephine for her input.

 

[Mojo333]

When I told him who the surgeon was he informed me that he had replaced 4 of that surgeon's hips already!

Oh my stars...what a horrible revelation.
I'm so sorry you are having so much pain.
Terrible that you are having to deal with what sounds like incompetent surgeon considering his track record.

 

[Layla]

Hi and Welcome to BoneSmart.
What a rough road. I'm sorry you're still struggling.
Also sorry I have nothing to offer aside from support.
I will look forward to the response from our forum Nurse to see how she advises.
Just know we're here for you.
@PATA

 

[sharonslp]

Hi PATA. This is indeed a sad story of a surgery and surgeon gone awry. All I can offer is that in my own experience with pain control, I don't use ibuprofen because it upsets my stomach pretty badly. Acetaminophen by itself works for me if I take a full therapeutic dosage.

I have some entrenched pain from soft tissue issues that manifests in the front and outside of my thighs (quads and IT bands). I don't generally take anything on a daily basis unless I'm traveling, or dancing. My first choice when I need good pain control for more than a day or so, is Celebrex. Now that there's a generic form available, it's very inexpensive. If needed, like if i do a full weekend at a dance camp, I can supplement the Celebrex with acetaminophen as well.

And don't forget that icing can still be useful for short-term pain relief too.

I sure hope you get a better outcome when all this settles.

 

[Josephine]

The revision surgeon was forced to make a snap decision... fillet my femur to open it up so he could get the 1st one out... OR, clean up the area around the stem (in-between the stem and bone) then pack in some sort of “bio paste” with some “stem cells” to help promote bone growth. Did it work? Eh.... I don’t think so

Oh my stars! Even I know that the second option was doomed to failure! Opening a window in the shaft of the femur is by far the most successful method.

I was told ibuprofen hinders bone growth.

That would be correct!

What can I do to help relieve the pain?

I'd really like to offer you some structured advice about this but in order to do it, I also need to ask you some questions. Are you willing for me to do that?

 

[chalcedonian1]

Hi @PATA and welcome to this great site. I live in the Boston area too, and am having hip revision surgery on July 3rd. (I had anterior THR as well.) I have also sent you a Private Message too with an important question--please check your Bonesmart Inbox when/if you can. I am quite saddened to hear about your situation.

I interviewed three well-known revision specialists in Boston major hospitals before I decided on my revision surgeon. I also have a loose femoral stem due to insufficient bone growth--I do not have osteoporosis or other bone issues, it is just clear the bone growth was not fulsome enough. @Josephine had a number of things to say about my X-rays/implant and she turned out to be correct, so I would engage with her on this site if you can, it is really valuable and may help uncover what is going on with you to some extent. I have read enough on this site to know also that there are success stories with revisions (and first time implants too, though I can't even imagine what it feels like to have a successful implant), so I have regained some hope that with attention and the right surgeons, problems like the ones we are having can be resolved.

The stem cells and biopaste are not sounding familiar to me -- but others on the site may know more than me. No surgeon has said stem cells would promote bone growth, but I am aware that my original surgeon talked about a coating on the stem. Is your stem now cemented as well? I think I have read that normally 4 months is what it takes to have sufficient bone growth after the surgery/revision, and you are 8 months out. Have you been back to the revision surgeon and had x-rays etc. to see what is going on? If so, what has the surgeon said to you about the pain, etc? I know for too long I convinced myself pain I was feeling was "normal" for me, and since it shifted around (groin, mid thigh, upper thigh), I thought it must all be a part of the process, but it wasn't, I was fooling only myself (until an incident happened, and I couldn't walk on my leg for a good two days, which is when I knew for sure things were not right.) I use acetominephen (or ibuprofen, even though there are deleterious side effects, I can't stand this pain sometimes it becomes too much) regularly so I can function somewhat, but it never eliminates the pain, and icing is extremely helpful too, but these seem to be only temporary solutions in my case as I need the revision and no amount of exercise, massage, ice, advil etc work in the long term. I would love to hear more about your post surgery visits, what you are being told about your course of recovery/healing. I know it is tiresome to never feel well, and to wonder if it will ever get better so my heart goes out to you, but discussing your situation on Bonesmart might enable you to see a path forward.

 

[PATA]

I have been busy so I apologize for being non existent! I’ll get on here on Friday morning and answer any questions posted. Thanks!!!

Chalcedonian... I’ll also respond to your PM....

 

[Josephine]

Thank you

 

[PATA]

A couple of pics... These were taken from the CT Scan about a 2 months ago. There are other xrays that i need to find the disk for. When I do I will post them.

Notice how the flange of the device does not fit snug. I am certainly not an expert but ou would think that would bottom out. Otherwise there is that space that might cause problems later. Just saying...

 

[Mojo333]

I certainly am not a medical professional...but I'm seeing what you are seeing @PATA .
Looks like alot of space at the top of the stem.
Josephine shall be back around.

 

[Josephine]

I don't understand the two images, PATA. Are they both of your hip? Because they have different implants!
I think I'd prefer to see a straight xray.

 

[PATA]

Same hip... same implant. I am trying to find the xray disk I have.

What are people's thoughts on bone growth generators? I have been given this thing made by a company called exogen. It uses ultrasound to promote bone growth. Here is a link to the device...

 

[Josephine]

Yes, they're good though not always 100% effective. They've been in use for ages. I first saw one used as far back as 1984!

 

[PATA]

Here I think is the 1 month xray from the original surgery.
I mean.. sheesh.. the pic posted before this post looks even worse!

 

[Antnee334]

I am posting a photo of my successful revision in 2009, it is my left hip, right side of xray and I believe it looks like yours where the flange is above the femur. It took some time for me to feel like me bone wasn't going to shatter. It felt like I had a wedge trying to push down in my femur. I ride a heavy touring motorcycle and once when stopped was leaning a little to far to the left due to road angle and felt like my bone wanted to break. I had to let the bike roll onto the crash bars at that point, that was in 2010, since then its been great. I wish you the best.

 

[Josephine]

Notice how the flange of the device does not fit snug.

I believe it looks like yours where the flange is above the femur.

It's not crucial for the flange to fit snugly. Most femoral implants don't.

I mean.. sheesh.. the pic posted before this post looks even worse!

Which photo is that, PATA? The only other image I see is of your CAT scans.

 

[PATA]

I disappeared and I apologize. My hip issues have been nothing but a problem. I’m going to summarize it quickly.

1. THR done in November 2016 - was loose very quickly. I could feel it move.
2. REVISION #1 August 2017. New Dr couldn’t get stem out so he cleaned it up and did something to promote new bone growth. Didn’t work
3. REVISION #2 September 2018. Dr got stem out and replaced it.. Result felt very good, solid. I was optimistic
4. REVISION #3 coming up this March (3/27). Hip started to hurt and I thought it was a flexor. I noticed my leg felt shorter. Mid February I went to the Dr and an xray was taken. The stem is sinking into my femur, my leg is noticeably shorter and I’m in pain all the time.

Soooo has anyone heard of this? It must have happened to others. I can’t be the only one. I want this next revision to be successful. Thoughts? Advice? Questions I should ask my doctor?

Thanks

 

[Jaycey]

@PATA Are you seeing a revision specialist? If not I would suggest you try and find one. So sorry you are going through all this!

 

[Josephine]

Well, sadly it's not rare. Was the stem cemented? if not, it should have been. All revisions should be cemented because you really only get one shot at using an uncemented.