Resurfacing Revision

[JimK]

So I had my resurfacing about 16 years ago and for over 15 years of that was doing great.  But late last year, problems arose, first loud squeaking, then multi-day periods of pain that just would not go away, then finally pretty bad pain whenever I was on my feet for more than a couple of minutes.  End result was that I would need surgery and did not know going in whether the resurfacing would be revised or I would end up with a THR.

I was please to learn that he was able to save my resurfacing, but what I learned may be of value.  I had a BHR metal on metal done by Dr Pritchett.  End result was that metal wear and debris caused acetabulum bone loss as well as a sizeable pseudotumor.  It is  my understanding that this is one of the risks of metal on metal, some of us go 20+years just fine, and others not so lucky.   Apparently the femoral implant was solid and stable.  He was able to do a bone graft and insert a new acetabulum cup with a cross-linked polyethylene liner.  A result I am quite pleased with.  Do not know how long this will last, hopefully the last time my hip is cut open and dislocated.  I guess my point in all this is that while a component failure is possible, it does not necessarily mean that the resurfacing can’t be saved.  I appreciate Dr Pritchetts skill. 

[rburns]

Thanks for posting that Jim. I have bilateral resurfacing done by Dr. de Smet, 2016R/2021L. They were doing fine but over the past year developed pain with the left one below my glutes with lunges/dead lift type movements/external rotation. Physio/docs tested all muscles and all strong, passive movement of joints pain free and good range.
Ultrasound shows a 2”x ¼” collection of fluid under the glute minimus - an MRI is ordered but the system here in Canada is awfully backed up and I doubt they are familiar with the MARS protocol to eliminate artifacts to see clearly around the joint (my last MRI was not very insightful due to artifacts).
So I will likely head to Seattle for an MRI, and I’m considering a consult with Dr. Pritchett. I would appreciate a further discussion about your experience with him, as I also dread a revision surgery, let alone to a total hip (I am early 60’s and very active).
Thanks again.

[tobyskier]

FYI Jim, Mt Baker imaging in Bellingham does MARS for 700 and are great.

[rburns]

thanks for the info on the MARS imaging tobyskier!

[JimK]

My desire was to save my resurfacing and not end up having a total hip done.  Pritchett is one of those people I would trust to do so if it were at all possible.  Going into surgery, I made know my desire to save (in my case) the femoral head.  He was able to do so and just replace the acetabular component.  My understanding is that he has done a pretty substantial number of successful revisions.  So, if it is a possibility for you, I would see Pritchett and get his expert opinion.  I am currently 6 weeks out and generally doing pretty well other than feeling a little stiff when I first stand up.  Understandable as I am quite a bit older than I was for the first resurfacing and this is the second time my hip has had surgery (which I liken to being in something like an automobile accident). 

[catfriend]

I had my right hip resurfaced by Dr. Pritchett in 2016 and my left in 2021. Both procedures were successful. Both of my hips feel like completely normal and natural hips that were never diseased. I can't speak to a revision experience as my hips are doing just fine! I've met with him on a number of occasions, and I had a lengthy conversation with him just a couple of months ago, so if you want to pm me about specific interactions with him I'd be happy to answer your questions to the best of my ability.

[rburns]

Thank you catfriend. I may do a consult with him once I get the MARS MRI (which I am dreading being claustrophobic and having to have it done in a smaller 1.5T machine). One concern for me is that the studies seem to show just as frequent tissue reactions/pseudotumours with metal on poly prostheses as metal on metal. So if I am getting surgery due to a pseudotumour saving the resurfacing by placing a poly cup seems risky…as much as I would like to.

[IRONMAN]

I’m just reading far too many adverse reactions to metal on metal hip replacements and hip resurfacing now.

It won’t be long unitl all MOM hips are banned.

[Pat Walter]

Hi  I don't know what you are reading, but there are very few problems with metal on metal devices when placed by experienced surgeons.  My BHR is 18 year old and no problems.  I believe you are not reading all the information.  The National Registries have great stats and information   https://surfacehippy.info/category/hip-resurfacing/national-registries/    Revisions at 20 years is only between 9 to 11%   That's fantastic.  You will find much higher revisions for THRs.  https://surfacehippy.info/2023-australian-oanjrr-national-joint-registry/