Bilateral THR Tony2hips Recovery

[Layla]

Hi @tony2hips
I found this article for those who are reading and unfamiliar with heterotopic ossification, as I was.

https://bonesmart.org/forum/threads/heterotopic-ossification-in-the-hip.8407/

I'm in agreement with Mojo. Have a discussion with your OS about the benefits of therapy
before you begin engaging with physio.

Best wishes as you move forward. Please keep us posted!

 

[tony2hips]

Thank you for that Layla. Having read through it I think I need to think hard before considering the surgery as it sounds as if recovery could be longer than the from the THA or Revision with a high risk of infection or possibility of it reforming. I really thought while laying in recovery from the simultaneous THA two years ago that my problems were over, not just starting

#heterotopicossification

 

[Mojo333]

I don't have any sage advice..but loads of sympathy, Tony.
I had BTHR to get better and get on with life also and I hate that you are still struggling.

 

[tony2hips]

Had another meeting at hospital. Asked if I would be 'happy' to have another operation which may involve anything from removing the bone growth to a full replacement. Happy is not a word I would use. I have also been placed in a Post Operative Physio Class, not bad considering it's now 2 years 2 months since the original op and revision.

Later that day I get a phone saying that want to book me in for an 'Examination under Anaesthesia' which evidently requires me to have a general anaesthetic even though no surgery is involved. I have no idea what is involved or why the risk of going under a general is required, especially when my bilateral and revision were performed under an epidural and sedation. Have to admit not keen on a general. Does anyone know why this would be necessary.

Also found out from NJR website that..
1) My revision surgery was not reported
2) My surgeon specialises in Hip & Knee Replacement, Knee Revision but not Hip Revision.
Why on earth would they have allowed someone who admitted making a mistake in original surgery, perform the revision if he doesn't specialise in that procedure.
Have also now been referred to rheumatology over pain in feet, ankles and hands.
Feel like I am on a downward spiral and struggling to stay positive. All the hope I had of returning to full health before the original operation now seems a distant memory and while my pain is much reduced starting to wish I hadn't started on this journey!

 

[Jaycey]

@tony2hips I would definitely ask for a referral to another surgeon! You are absolutely correct - it this OS does not specialise in hips or hip revision you don't want him touching you. And I also agree - why the examination under GA? We see this for knees all the time but not hips.

I can recommend a surgeon in your area if you would like me to.

 

[tony2hips]

Thank you Jaycey.
I am actually on my 3rd OS but if you can recommend another that would be great. Unfortunately it was original surgeon who didn't specialise in Hip Revision but didn't find that out until after he performed the procedure that hospital have subsequently said was not a success.

 

[Jaycey]

Do you happen to have an x-ray that you could post here? I'm going to tag @Josephine and see if she has any recommendations.

 

[Josephine]

Asked if I would be 'happy' to have another operation which may involve anything from removing the bone growth to a full replacement.

This might be inevitable. As you can see from my article on HO, the basic procedure would be just removing the HO overgrowth but this generally isn't recommended as it tends to encourage the growth of it.

Later that day I get a phone saying that want to book me in for an 'Examination under Anaesthesia' which evidently requires me to have a general anaesthetic even though no surgery is involved. I have no idea what is involved or why the risk of going under a general is required, especially when my bilateral and revision were performed under an epidural and sedation.

Tony, what that means is that they want to put your leg and hip through a full range of movement, maybe even with some force applied. It would seem this is something they are unable to do to you while you are still awake. It should only be a short anaesthetic, about 5-15 minutes at most and probably with the aid of xray. Don't fear it. It should tell them more than they can get without.

 

[tony2hips]

Hi I don't have a recent x-ray unfortunately. I had a CT Scan in January but do not have access to that. Does anyone have any info on the after effects of MUI as have read that after a shoulder examination you cannot drive for 2/3 weeks. Is it same after hip examination?
Also would anyone have any idea why my revision surgery appears to have never taken place according to NJR reports

 

[Josephine]

What do you mean by "MUI"? I am unfamiliar with that acronym.

Also would anyone have any idea why my revision surgery appears to have never taken place according to NJR reports

I also don't understand this comment .... for what reason should it have taken place?

 

[Josephine]

I've just read your thread through from the start and do apologise for my absence from it.

which strangely shows numerous primary but zero revision for the year that he performed mine. How is that possible, are hospitals reporting successful surgery and omitting the failed operations?

That's because there is lots of data in there which is not available to the public. And the year of no surgery might be for various reasons such as he was on a year's study leave or sabbatical, or things like that.

I am starting physio on Wednesday but again do not understand why.

I advise you not to do this. Not advised.

BTW, earlier in this thread you commented several times about your having had a revision only 7 days after the primary surgery and were you the only one to ever need that. Well I can tell you that I have seen numerous patients with a history very similar to yours (but different!) who had dislocation or similar and had to be opened up again. I've even known patients have to be taken back into theatre from recovery because their hip got dislocated coming off the table. So it's rare but not, in this old nurse's experience, unknown!

 

[tony2hips]

Josephine
Thank you for your reply and apologies for delay in responding but had a mad few months. I am now on my 3rd different consultant (excluding the original OS who performed the simultaneous bilateral THR and Revision).

With regards to the non reporting to NJR of my revision surgery, the surgeons hip and knee replacements procedures for the year are recorded as are his knee revisions, but according to NJR figures he performed no Hip Revision Surgery during the year, which is strange as he performed mine. In fact Hip Revision is not even listed as a procedure he specialises in, which begs the question why he carried out mine, having already made a mistake on original surgery a week later. I would have honestly thought that the hospital would have made sure a surgeon who specialises in Revision Surgery performed the surgery.

The Consultant I was under until recently wanted to carry out an Examination Under General Anesthetic to ascertain the movement /rotation on the hip and then carry out a procedure to remove a prominent osteophyte and hetertropic ossification and replace liner and femoral head. I wasn't happy about going under a general anesthetic for a non surgical examination added to the fact the consultant has limited experience. It would have also meant going back to the hospital where the original surgery was carried out which given my history with them was never going to happen.

My new consultant is well respected and specialises in hip replacement and revision and has said that at present the ossification is not causing a problem, but the osteophyte is causing impingement, restricting movement and could cause a dislocation. He has also said it was there and should have been removed during the original surgery. Fortunately he thinks he may be able to remove it through keyhole surgery as he advised that opening up the hip for a 3rd time will create more problems than it solves with increased scar tissue, the possibility of further bone growth and further weakening of the hip. He also said he was surprised I had simultaneous bilateral as he stopped performing them years ago due to increased complications.

As far as the case against the hospital they appear to be claiming that malalignment of acetabular liner is a recognised risk of THR. This may be the case but it wasn't on the consent form and if a surgeon asked me to sign a form accepting that they may fit one of the components I would not have signed it and am sure I wouldn't be alone in that. I am a gas fitter and a gas leak is a recognised risk of an installation. It doesn't mean it's acceptable or is an excuse if I created one. Really not sure how they can use that as a defence.

The only thing that seems clear is I now face further surgery because of the original mistake and it is becoming harder to stay positive. I really wish that when I was in pre-op and a surgeon assisting with the operation spent 5 minutes telling me why he would never have a simultaneous bilateral THR, I had listened and cancelled the operation.

 

[Hip Hip Hooray!]

Hi Tony, I am very sorry to hear that you have had so many problems with your original hip surgeon. It doesn't sound like things were done professionally. What a shame. I just wanted to say that I had bilateral surgery, and it was very successful. If you have an excellent surgeon, it can make things easier. I hope that this new doctor can help you and that you get the results you desire.

 

[Mojo333]

I hate that you have had problems and are suffering

I really wish that when I was in pre-op and a surgeon assisting with the operation spent 5 minutes telling me why he would never have a simultaneous bilateral THR, I had listened and cancelled the operation.

Whatever the issue is...it had,nothing to do, in my opinion, with "both at once"
I had bilateral last year in May and have been shocked at how
my life has improved and how well my recovery has gone.
There most definitely must be issues...but I am doing well​

 

[Mojo333]

So, wondering what, if anything you have been able to get sorted?
Wishing you all the best!

 

[tony2hips]

I'm glad that both your surgeries went well. Believe me if my left hip was even half as good as the right I would be the happiest man alive. The only time I get any discomfort in the right is when my left flares up and affects my walking, otherwise it is spot on. As for recovery from original simultaneous op, the hospital physios actually wrote in my notes that my recovery was 'obscenely good'. I had the bilateral on a Thursday, returned to ward on Friday and told I could go home at 9am on Monday, would have been day earlier but don't discharge on a Sunday. It was only after being told I could go home that surgeon looked at x-rays and discovered his mistake. It has all just gone downhill since then. Rehab stopped due to fear the liner may fracture. The two hospital physios (who were superb) actually told me after my revision the following Thursday, that didnt know what to do with me as they had never encountered a patient who had simultaneous bilateral THR followed by revision 7 days later. All they could do was walk with me and try and get me moving.

The movement and rotation on the revised left side is about half of the right and is permanently uncomfortable and the area looks swollen and feels solid. Having since researched simultaneous bilateral THR, according to NJR figures, of 768,000 patients to have had replacements since 2003, only 4,300 (0.6%) had simultaneous. That paints a very different picture to the one given by my surgeon who told me it was common and performed regularly. My mistake seems to be putting total trust in what I was being told. Had I realised this forum and NJR existed before my operation I would have viewed my procedure differently.

 

[Mojo333]

I suppose the only thing that I wonder is would the mistake have been made had they done them one at a time?
I am sorry you are still having to deal with a Bad Hip.
My OS was very nonchalant about bilateral surgery, but it became apparent quickly to me, that most folks acted like I was a unicorn.
When will you have the keyhole surgery you mentioned? Is that still on?

 

[tony2hips]

I am hoping to have the procedure carried out this autumn. I fully agree with your unicorn comment, experienced the same, even from staff, which is disconcerting.

 

[Mojo333]

I'm sorry you still have some surgery to deal with...but will be praying this will be what gets this seen about and that it allows you to finally get back to life with no hip pain.

I am hoping to have the procedure carried out this autumn.

Keep the faith, Tony!
(So happy you followed unspoken hippy protocol...we wish for autumn...not Fall!)
I hope today is a Good Day for you.

 

[tony2hips]

Just an update.

Had an MUA (Manipulation Under Anesthetic) last month with x-rays / scans that showed impingement due to bony osteophytes that appear to have been there before replacement and revision the following week in 2016 . I'm now having surgery on the hip in couple of weeks time, hopefully keyhole but with consent for invasive if required. Another 2/3 nights in hospital - not the original one thankfully - and possibly 6 or 8 weeks off work depending on the surgery. Being self-employed it's a nightmare. Not related to the hip but also confirmed this week I have RA. At least next week can only get better.