Metalosis type symptoms 2 1/2 yrs after bilateral BHR. Revision?

[glgwettsurf]

 I am a57 year old male,  I had a bilateral BHR in April 2010, at HSS in New York, because of osteoarthritis pain in my left hip. I had the right hip done as well because my surgeon said the right hip was just as degraded as the left, even though there was no pain. I did not want to go through recovery twice. The right hip has always been a source of pain and inflammation, especially when exercising. The right side remains atrophied with restricted external rotation.

I have had two MRI’s and two ion level tests as well as multiple x-rays. My surgeon has maintained the whole time that my problem is not my hip. After a year and a half, I developed back problems and the surgeon's rheumatologist  declared my back the source of my hip problems. After much back work (epidural, RF ablation etc., its on to his referred physiatrist, who upon examination described severe atrophy and dysfunction of the right rotator and gluteus muscles, the deep stabilizers. An EMG indicated normal nerve function. He prescribed more PT, which I have been doing now to varying degrees for 2 ½ years anyway. The right hip muscles do not maintain any strength for any period of time.  This persistent weakness was not as apparent during the first year, only the pain and inflammation. At about the year point, the weakness and malfunction gradually got worse and worse.

Of course, my gait is severely affected, as a result of this weakness.  I was prescribed belatedly for arthritis and torn meniscus in the left knee, this has now become extremely serious and painful, and the right knee now has similar problems as it is impossible to walk with a proper gait. My metal ion blood test levels are low, so my surgeon discounts any possibility of metalosis or alergic reaction, along with the fact that it is only one hip that has the issues.

I have seen Dr. Clarke, Dr. Marwin, several other non-resurface specialized docs, and conversed with Dr.Gross, to no special conclusion, the devices certainly apear to be properly placed. Mr. McMinn refused to "follow up" my surgeon, even afer they had me send all material. I contacted Dr. Pritchett after researching his work on metalosis. He stated that he has done quite a few revisions on people with my symtoms, ie metalosis symtoms without apparent elevated blood levels or tissue/bone damage - and recommends using a femoral metal-polyethyline bearing something he calls a dual mobility prosthesis.

Has anyone had experience with Dr. Pritchett's revisions, or for that matter with him in general? Can anyone share their experience with revisions in general, metalosis or metalosis type symptoms like mine?

Thanks,

Gar

[Tim Bratten]

Hi glgwettsurf
I had a revision (ceramic on ceramic THR) from Dr. De Smet and it is working quite well. My original problem was a poorly placed implant that any competent doctor spot out immediately. It also turned out I had staph infection in the bone that was causing everything to come loose. So I guess the causes of my problems were quite different from yours since the difficulties from my HR were apparent from x-rays (all the experienced doctors that I contacted concurred that my implant was poorly placed and coming loose). At any rate, I'm quite happy with my revision ... it is working a lot better than my resurfacing did so I could definitely recommend De Smet as a possibility if you need another surgery. De Smet told me that in very rare cases people can have allergic type reactions to MOM even with low ion levels and this can cause problems like tissue damage, shrinking of the femur, loosening of the implant and pseudo-tumor. I have no idea if this has anything thing to do with your problems, but you might try contacting him.