Hi fellow surfachippies,

Some of you my remember my hip saga from Bionic's Bone Blog.  I am very happy to report that my resurfaced hip is working fantastically, thanks to Dr. Gross and to the forum here for helping me to find him.

Well, three years have passed, and, lo and behold, it turns out my hip wasn't to be my only problem joint.  For the past several months, I have noticed a steady deterioration of function and increasing pain in my left shoulder (hips, shoulders--sort of the same thing, right?).

The problem isn't really bad at this point, but "I've seen this movie before," and I know where this is going.  I figure I have about 5 or 6 years, max, before the pain and stiffness become hard to manage.

I've just started researching shoulder surgery, and the parallels to hip surgery options are striking.  Replace "femur" with "humerus" and "acetabulum" with "glenoid," and you're looking at very similar issues.

There's talk of total shoulder replacement (TSR), hemi-surface replacement, and problems with plastic wear.  There's also a resurfacing cap for the humerus, which avoids the big spike down your arm. What pulled me up short, though, were the restrictions.  After TSR with a plastic glenoid component, most exercise is out of the question.  It is recommended that patients never lift more than 25 pounds with the affected arm!  If you've read my blog, you know that's not my thing.

I tried to find metal-on-metal options for the shoulder.  They do not seem to exist, however.  Perhaps this is due to the slight difference in the shoulder versus the hip, where the shoulder has to actually translate as well as rotate within the joint.  So it's not possible for the ball to perfectly match the socket, if normal anatomy is to be maintained.  I surmise that one of the components has to have some "give," so MOM is out of the question.  I'm not sure, though.

So, being a demanding surfacehippy, who does not want to settle for the restrictions associated with a plastic joint, I'm looking for other options.  The good thing is I still have time, although I doubt I'll wait as long to fix my shoulder as I waited to fix my hip.

Does anyone here have any experience in this area?  Do you know of any websites like this where better options for shoulders are discussed?  Do you want to talk about it here?

So far, I've found two things that look mildly promising:

1) The "ream and run" procedure  (http://www.shoulder-convention.org/mac2011/presentations/Friday_01-14/16.30-18.00/04_Warme.pdf)

2) Biologic glenoid resurfacing (http://www.shoulderfractures.info/Data/Biologic-glenoid-arthroplasty-for-young-shoulders.pdf)

Both of these are "hemi" solutions.  DON'T YELL AT ME PLEASE.  I know hemis have terrible outcomes for hips. 

With ream and run, the procedure reams the glenoid (similar to acetabulum) to bare bone and lets "nature take its course" in healing.  The bare bone regenerates fibrocartilage over time, on its own.  Voila, new joint.  Sounds good, but so far I've only found one guy who does it (Matsen).  He appears to be close to retirement, and I'm not sure he'll still be practicing by the time I'll need surgery.  Maybe there are others.  He's the pioneer.

With biologic glenoid resurfacing, the procedure inserts some cartilage (like a knee meniscus from a cadaver) into the joint and allows it to reattach.  Nice idea, but it has a very high failure rate so far.

At any rate, I wanted to share this with you (perhaps it will generate some discussion about hips?) and also see whether anyone can point me in a good direction here.  The good news is there's time.

Thanks!

http://forum.hip-replacement-and-recovery.com/viewforum.php?f=10&sid=8bf4464ebb7ab30771139bde4cddd9ec

Here is the address if it is of interest.

Hay bionic,
               I know how you feel. I'm 9 months post op with a BHR and now a old injury is coming back to haunt me! I fear that I will need to have reconstructive surgery on my shoulder in the near future.

Bionic, nice to hear from you again, good to see your hip's doing fine. Pat's suggestion is excellent, Dr. Bose would be a great resource for options and maybe tell you how far away you are from surgery. If you check the link Pat included, you can see there are resurfacing options for the shoulder now, which have the same benefits (conservation of bone, etc) as in the hip.

Good luck, and again, good to hear from you.

Hay Bionic,
               Ill let you know what a specialist says when i eventually sort out an apointment. Ive just sorted a private med plan so i need to leave it just a little while before i start a claim. But i no within myself i need an op. Ive done some research and i n my uneducated opinioni have a grade 3+ AC joint seperation with both shoulder ligaments snapped and a step deformity to the shoulder(my right arm is 2'' longer than my right!).But as i say thats just my own diagnosis!

The reem and run seems interesting but whats the data on it? I would have thought if getting cartilage to regrow was as simple as reeming it out and letting it grow back it would be routeenly used?

Keep us updated mate and ill drop you a PM when i actuallly start my insurance claim
Danny

Bionic I've not actually sat down and read the report yet I will try and do so tomorrow though. Sounds interesting!
Danny

I am starting to think the best thing to do would be to put us lot down. It seems like we are falling apart all over the place. I hit a bit of big wave on our Inshore Lifeboat and got knocked off my seat and bent my wedding ring finger the wrong way so I had to take ring off before it got too big. Starting to go down a bit now though. Another potentially buggerted up joint.

I don't think it's the years Jason, as much as the mileage. I know I've put a lot of miles on my body with all the things I've done, and it has recovered as much as it could.

Would never change that though, not built for a low mileage life.

I hear that.  I'm thinking the most important is to find a cure that keeps you going.  I'm not interested in plastic parts that wear out.

"You'll feel great!  No pain," they say.  "Just don't lift more than 20 pounds.  Ever."  No thanks to that.

I have the same attitude toward my shoulder I had toward my hip.  Give me something that lets me keep adding the miles.  Eventually, I might run out of good options, but I sure as hell don't plan to start by compromising.

While we're on the subject of choices for other joints besides the hip, have you seen the artificial discs?  I sure could use one or two of those in my neck!

But, once again, the medical device companies turned first to plastic.  The De Puy "Charite" total disc replacement device has a UHMWPE core, allegedly to absorb impact while providing movement in all directions.

But, what do you know, pathology reports show that the devices shed plastic!  The result is osteolysis and revision.  Revision of discs can be damn near impossible, so the the consequence of a failed artificial disc is usually fusion.  Which sucks.

Luckily, there's a metal-on-metal artificial disc, too.  I'm not sure it's FDA approved, though.  The FDA really seems to be dragging its feet with regard to orthopedic implants.  There's lots of artificial disc activity in Europe, though.

My own experience has been similar in that the shoulder opposite of my resurfaced hip started causing problems. Although the doctors thought it may have been time spent on the cane that aggravated this, I had actually had symptoms before the surgery. I think proper diagnosis is key; my x-rays revealed no OA and a pretty normal joint. Although it would take an MRI to be sure, examination led the Dr to tell me though he thought I probably had no major rotator cuff tear, the RC was inflamed and likely deteriorated. I had a predinisone injection a couple months ago and so far it has felt much, much better.

That's great to hear, and suggests I should probably get this checked out by a doctor, instead of self diagnosing.

Even since first posting, this problem has gotten more persistent.  I'm hesitating to see a doctor, though, as I'm finding that the more problems one has, the harder it can be to get insurance.  Sometimes it's better to suffer in silence and keep your record clean, sorry to say.