BHR Gone Bad....

[23109VC]

I was curious about that Zimmer thing... Wow.. You're right, Dr. Gross did NIT get that tool set at home depot..   :o

http://www.zimmer.com/content/pdf/en-US/Explant_Acetabular_Cup_Removal_System_Surgical_Technique_(97-7255-106-00_Rev_4)(10-2007).pdf

[newdog]

Wow! Just like a mechanics tool. I wonder if it has a lifetime warranty?  ;D

[lori.36]

Magnus, 
I am so happy for you that Dr Gross was able to revise you.  He really seems like a Pioneer and I would love to get an uncemented device.  He just seems brillant.

Lori
Keep us updated
And damn that Zimmer is a pretty cool tool.  Must be one sharp blade.

[Tin Soldier]

Good Job Magnus.

The BHR cup has small holes in the face of edge that are specifically designed for revision.  Seems like a surgeon would want to use the BHR removal system for a BHR vs. the Zimmer.  However, the Zimmer looks like it can be compatable with most cups in that you are clamping a good portion of the cup and not fussing with a proprietery system.  I guess that's why I'm not a surgeon.  My tool set is composed of a few mild steel hammers, pliers, box knives, and a trusty (not rusty) Dremel for sharpening the chain saw.  I really don't think those would be good tools for this sort of surgery. :o       

[Magnus]

I am now 2 weeks out and everyday I feel better and better.  There is still swelling around the incision, but it is steadily declining.....I finally got all the glue off from around the incision.  Not sure what type of tape/glue they use, but I thought I may have to use Goof-Off to get it off.  Another thing that is different from the first surgery is that I do not have any clicking.  I had some clicking for several months when I moved a certain way...so far nothing.

To answer Toby's question from a few days ago....the acetabular component (cup) they put in was the same as the original component, a Smith & Nephew.

I am getting bored doing the 4 simple exercises...looking forward to swimming and riding my bike.  Hopefully, by May 1st.

[einreb]

That's pretty cool... congrats!

What did he do with the old cup?  You bought it originally... you should get to keep it!

-Bernie

[Dayton96]

What did you use to get that stuff off around the incision?  I don't want to rub too hard with soap and water, but it does bug me to see it every morning when I take a shower.

[FlbrkMike]

When I went home I just had some steri-strips, which peel off pretty easily after a while. 

Most medical adhesives come off pretty easily if you use some rubbing alcohol.

[phillwad]

Good update and glad to see the revision went well

Is it good that I saw the pictures of the Zimmer tool  :o !!!!  I have a full tool box (garage) and I am not sure I want one of thoses added to the tool kit

Keep doing the exercises - Phill

[jugrimm]

I'm afraid I'm useless on the computer and finding it hard to find my way round the site.  I posted my problem yesterday, which is almost identical to yours so very pleased to hear that there is a solution other than a THR.  I'm hoping Pat will read this and help me put my original post up here.  Dr Gross sounds wonderful, but he is not an option for me as my UK insurance won't pay for me to go to the US. 
Can anyone recommend anyone in the UK who has done a cup revision?

[jugrimm]

I'm afraid I'm useless on the computer and finding it hard to find my way round the site.  I posted my problem yesterday, which is almost identical to yours so very pleased to hear that there is a solution other than a THR.  I'm hoping Pat will read this and help me put my original post up here.  Dr Gross sounds wonderful, but he is not an option for me as my UK insurance won't pay for me to go to the US. 
Can anyone recommend anyone in the UK who has done a cup revision?

[jugrimm]

I am so glad to hear about your revision.  I have the same problem, ie large tumour full of blood and debris.  It has been there for 3 years.  I had a BHR in Ocotber 2002.  Very successful until now.  Ironically I have no pain with the lump and the hip works very well so I am loathe to go with the advice to have it replaced with a ceramic THR.  Unfortunatley Dr Gross is not an option for me as I am in the UK, but am hoping that someone might come up with a surgeon here who would be prepared to alter the angle of my acetabular cup.  Please keep us informed as to your progress.  Sounds like it is going very well so far.

[Tin Soldier]

Hey Jugrimm -

What about McMinn?  I'd like to think the grandady of the BHR has a few revisions to his name.  It sounds like you actually have a BHR.  He ought to know about using those 3 little holes in the face of the acetabular cup to revise, right?  I think he's in Birmingham.

[jugrimm]

thank you for your input.  I have already emailed McMinn, but so far no response.  I am also waiting for Mr Desai's secretary to send me my xrays and scans as jpg's so that I can send them to Dr Gross for his opinion.  I am driving myself mad at the moment reading everything I can about pseudo/aval tumours.  There is quite a lot of conflicting advice out there.

[jugrimm]

Hi Magnus,
Just wondering how you are doing now?  Have you had new blood tests and if so what are your chromium/cobalt levels now?
Did Dr Gross tell you how many cups he has successfully repositioned?
Hope you're doing OK. :)

[t2bones]

I am at my wit’s end because of severe pain which recurs in my left hip which was resurfaced in December 2009.
The key points of the story are this:
•        I am an active 62 year old male in international business.
•        Osteoarthritic hip causing pain which was preventing me from normal activities, especially golf. The origin of this might have been a rugby injury or a chronic injury caused by an arthritic right knee.
•        In December 2009 my hip was resurfaced and an S&N device used.
•        Recovery was good until I stopped taking warfarin, replaced with aspirin, and got 5 pulmonary embolisms, which slowed me down.
•        I persevered with PT and exercise and by June 2010 was playing golf and was essentially pain free and walking well
•        Since that time I have had a number of painful incidents where for no apparent reason my hip has given me considerable pain to where I need to use a cane to walk.
•        In the last few weeks the pain has been intense and more continuous. I can’t play golf without pain killers. I only feel better after long rest periods.
•        I have had fever up to 102F, which I can control with antibiotics, but my hip is now swollen, and sore to the touch from the outside and also in the groin area.
•        According to the surgeon the X rays are normal, although micro-fractures are always a possibility, and he really offers no solutions at this time.

Last week further X Rays were taken and it now seems like I have a compressed fracture behind the cup and the hip is starting to collapse. My surgeon wants to replace the femoral head with a THR, this seemed Ok. However I asked Dr Bose, Chennai his opinion and he came back and informed me that my cup was at much too high an angle - 64degrees. His opinion is cup removal, replacement and a large diameter ceramic ball!
This opinion seems to fit common wisdom....
But how do I get hold of Dr Gross for his opinion?
My thanks in advance for all thoughts.....
Tony

[Pat Walter]

Hi Tony

I am sorry to hear about your pain and hip problems.  You can find all the top surgeons contact information on my doctor's list page  http://www.surfacehippy.info/listofdoctors.php

Here is Dr. Gross's info

Dr. Thomas Gross
2200 Hip Resurfacings to date***
South Carolina Joint Replacement Center
Midlands Orthopedics
1910 Blanding Street
Columbia, S.C. 29201
Lee Webb, MSN, APRN, ANP-BC
Assistant to Thomas P. Gross, M.D.
803-256-4107 office, 803-355-2774 pager
803-331-6894 cell, 803-933-6754 fax
Contact email: Ms. Lee Webb, MSN, APRN, NP
South Carolina Joint Replacement Center

If your cup is placed at the wrong angle, your metal ions are most likely very high.  You need to get a blood test from one of the top surgeons to find out.  The high cup causes edge wear and high metal ions.  If this is the situation, then you will need a revision to a ceramic or other non MOM device.  If the metal ions are not high, then there might be a chance to keep your acetabular cup and match it to a THR femur component.  I would only work with the top surgeons that have done a thousand or more.  Revisons are diffiuclt and you want the best outcome.  Even with a THR, the components must be placed properly or a MOM THR can also cause high metal ions.

Good Luck.

Pat

[Anniee]

Tony,

Please listen to Pat and call Lee Webb at Dr. Gross's office.  If you do not get her immediately, leave her a message and she will call you back.  I can tell you from personal experience that they are both wonderful and will do anything they can to help you.

Best of luck!

[t2bones]

Thanks to everyone for their encouragement and advice.
I have now gathered and received a lot more information about my situation:
1. My cup is at 64 degrees
2. My femoral head has a compressed fracture
3. I have tissue loss around the hip
4. Tests underway for infection and metal ion concentration.

The medical community has offered several different approaches to revision and I appreciate all who have participated.....
1. Replace ball only with large metal ball (THR)
2. Install a ceramic to ceramic large ball and socket
3. Install a metal to metal large ball and socket
4. Install a metal to XLPE device
5. Install a dual mobility metal to XLPE device

I am leaning towards a choice from the last 3 options.....does anyone have any insights on the relative strengths and weaknesses?

My opinions to date have come from Drs Bose, Gross, the original surgeon, and also a hip specialist at Mayo clinic.