Hi Pat, Bill, rboehmer et all:
First I wanted to second, third, etc all the good wishes, thanks and greetings to Pat and this site. I don't post often but check the site almost every night and it is such a wonderful resource and gift. Thank you so much!
I felt very calm and resolved about my own hip issues (high acetabular cup angle and high metal ions), and my hip still feels great. But I was inspired by Bill's post re: his response from Dr. De Smet that all will probably work out, and I thought, why don't I send a note to Dr. De Smet too . So I sent him an email with my metal levels and he replied right back that I need to revise, that the metal wear is destroying the bone and soft tissues. So I have sent him off a disk of my xrays and he will get them within the week.
I knew in some way that this opinion would come eventually from someone. But it's so difficult to make decisions when there is no consistency. I recall Pat putting my question re: metal ions to Dr. Gross in September and I quote his response ": No one knows what safe levels are. These are normal elements in our body. They are elevated after placing metal implants. There is no value to measuring and following levels at this point._"
I think the future of this surgery must include a reliable way to track how the joint is wearing. I guess we are the guinea pigs.
bye for now,
Nancy
rt BHR Sept. 2007
Hi Nancy
There were quite a few discussions about metal ions when I was at the 2nd Annual Hip Resurfacing Course in LA in Oct 2008. This is becoming more of a problem than most thought it would. There is a lot of research going on as to what metal ion levels are safe, how to measure the metal ions and developing reliable blood test to indicate metal ion levels.
I know Dr. De Smet is one of the surgeons most concerned about the metal ion issue. It was explained that if the acetabular cups are not in the correct positon, they could cause the metal bearing surface of the femur cap to rub more than it should. This excessive rubbing causes higher metal ions. The excessive metal ions cause the surrounding tissue to turn back and become pseudoturmors as some have called it. I saw videos of a surgery removing this ugly, back mass of dead tissue and bone around a hip resurfacing - it was just plain ugly. That is what Dr. De Smet is concerned about. There is not always pain happening when this deterioration is taking place. For some reason, this problem is again affecting more women than men.
I was concerned enought ask him if I should get a blood test since my BHR is almost 3 years old. He smiled and told me NO since he had placed my cup properly! I was very lucky to have him do my surgery.
If, however, you have really high metal ions, I would think you need to talk to some of the best doctors to get really good input. I definitely would trust Dr. De Smet since he was my surgoen, but this is a difficult issue. You would not want your tissue and bone to be destroyed around your hip. I am not medically trained and found it interesting that all of this could be happening without pain.
So I could not tell you what to do - or even say what I would do in that situation, but it is becoming more of a problem. I am sorry that you are facing such a problem. I don't know why, but us poor females seem to be getting into many more problems than the men!
There are many doctors and medical facilities working on this problem. Hopefully, there will be a good test and guidlines soon. I guess you are right that we are all guinea pigs when a procedure is fairly new.
Please keep in touch with us and we will give you support.
Pat
I sent Dr. DeSmet my x-ray but do not have any blood ion levels to send him because my Kaiser Dr. told me they do not have a way to check for that ::) Here is what I recieved from Dr. DeSmet, word for word.
Dear Bill,
What size did you recieved ? As long as your prothesis is not wearing high this should not be a problem. Of course flatter would have been better, but if your size is not too small maybe you stay out of problems.
Greetz, Koen.
Koen DeSmet.
I meet with my Dr. and his partner tomorrow afternoon. We are going to discuss ion levels and how to test for them. I am curious to see what they are going to say about the angle, wear factor, revisions etc.
I haven't been posting much lately. After I posted my x-rays that thread pretty much went nowhere except for Nancy who sounds like she is in the same boat and a comment on how it would be good for bronco busting or whatever, I rolled with it and made a joke..... but kinda got over talking about it honestly. I figured I'd just do all my pt, eat better, try to dump 30 lbs. and move on with my life. Guess I just wanted to go back to a semi-normal life and stop dwelling on it 24/7. Well it is working better with less pain, I ride my bike 30 minutes a day, and do about an hour or more of pt exercisises everyday and am back to doing some work, but it's always there in the back of my mind that it is not right, even with the "maybe you stay out of problems" e-mail from Dr DeSmet. A good night's sleep is rare and I get kinda dizzy now and then when I sit up real fast. Nancy keep us posted and I wish you the best on this, and I will let you know what I find out as well. Sorry it's not all peaches and cream ha ha, it is better than before, but I would LOVE to be 100% confident it's right, I am a little jealous of those who got theirs right, human nature I guess, Enjoy it !!!!
See Ya, Bill.
Hi Bill
Good to hear from you. I am glad you are trying to get on with your life the best you can. Hopefully, things will remain OK for you.
There are not any standard blood tests for the metal ions yet. None of the few labs that do testing, do it the same way - as far as I understand. That is what they are working on - a good standard test for metal ions and also knowing what the various levels mean.
At least most men with the large hip device sizes have less problems than the ladies do. So let's hope that is in your favor.
I just wanted to say HI and wish you the best for 2009.
Pat
Hi Pat and Bill
Thanks so much for your responses. Bill I have to say you made me laugh, as I had decided as well to just get on with life, enjoy my hip and stop thinking about it so much. Anyway, I will wait until I hear from Dr. De Smet, see my Doc in February and go from there.
Nancy
Just got back from my 2nd opinion with a different Dr. "The angle is 65 degrees and will fail in 2 to 3 years" The good part is he thinks he can preserve the bhr (femur side) and luckily there is a thicker cup available so I should wake up with a bhr not a thr, Revision scheduled for 2-23-09. ::) Kind of in a weird mood.
I think I'm going to get shitfaced starting right now.........Bye bye, Bill
>:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:(
B.I.L.L.
Well that's good and bad news. Just remember if your doc can take care of it that will be fantastic. So you will have some more rehab, but, because you know what to do and expect I bet this time around will not be so bad. Who is gonna do your revision? Good luck.
Wayne
Hi Bill
Just wanted to say Hi and I will keep you in my thoughts and prayers. I am so sorry that you are going to face another surgery.
Please keep in touch and we will all give you support the best we can.
Again, I am so sorry about your difficult situation.
Pat
Quote from: B.I.L.L. on January 09, 2009, 10:20:37 PM
Just got back from my 2nd opinion with a different Dr. "The angle is 65 degrees and will fail in 2 to 3 years" The good part is he thinks he can preserve the bhr (femur side) and luckily there is a thicker cup available so I should wake up with a bhr not a thr, Revision scheduled for 2-23-09. ::) Kind of in a weird mood.
I think I'm going to get shitfaced starting right now.........Bye bye, Bill
>:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:( >:(
Bill,
I wish I could join the party with you. I am bummed out it did not work out for you, I hate to see any fellow surface hippy have to go through another surgery, but the good news is that it sounds like you'll wake up with a resurfaced hip.
I'll be praying for ya and sending lot's of good thoughts your way.
Take care, heal fast and rehab even faster.
Chuck
Hi Bill.
I know how you are feeling. I had revision surgery in Nov 08 from a BHR to THR. My hip resurfacing only lasted 6 months. I had all sort of emotions going on when I was told I needed a revision but I can tell you now 6 weeks after my revision that it feels great.
Bill I think that there seems to be a small percentage of people where malpositioning of components by surgeons is a problem however you are lucky and it sounds like the cup may just have to be replaced.Thats really good news Bill. Even if you have a THR it is not bad news. I had a MOM THR and the cup & femoral component are now the same size as my original BHR.
Bill it is hard news to swollow that you need a second surgery but trust me you will be OK. I really wish you the best. Try and be as positive as possible, next summer you will be walking and pain free.This will become a memory.
Keep your chin and head up Bill.
Revision
Hi Bill,
As I recall Dr. DeSmet reviewed your x-rays and said the implant could be OK if the wear was OK. This is more encouraging than the report from the second Kaiser doctor. Is your second Kaiser doctor, Dr. Klug of Roseville, CA? He is on Pat's list as having done over 200 hip resurfacings. I'm surprised of the difference in opinion as Dr. DeSmet is one of the best in the world. As I recall, Vicky tried to steer you to Dr. Klug back in July before your surgery. I recommend sending your x-rays to several other top hip resurfacing surgeons that do hip resurfacings and interpret x-rays for free e.g. Dr. Mont, Dr. Bose, Dr. Su and Dr. Gross. If you need to stay in California, then Dr. Amstutz in LA is the most experienced, but he charges $300 for a pre-op exam or interpretation of your x-rays.
Hi Bill
Wow - well you are certainly decisive.
Here are a couple of questions I would ask:
Is the new cup metal? If so what assurances can you have that the new Doc will get the alignment correct. You don't want a repeat of the previous situation. I wonder if it is possible to get a cup lined with something.
Will you also choose a plan B if he can't get it correct and has to revise to THR? And again, if that is MOM, can you get assurance that the angle on that one would be correct.
I only keep dwelling on the metal issue as I get the impression from Dr. De Smet that metal wear leads to tissue damage and bone loss. Of course there is much wear from plastic as well, which is why they use MOM in the first place. I don't know.....now I'm really confused. Pat, can you help???
Nancy
Hey Nancy you are right about me making a snap decision. I have this bad habit of thinking people (Like doctors) are always 100% honest
and craftsmen at there trade, positive thinking gone bad I guess.
Anyway if it needs to be done, wich it does if I want it to last,( we all know it's wrong), then the sooner the better right ??
I was glad this guy was honest enough to tell it like it is,
And I have 5 weeks to get more opinions, and I will check out this guy, believe me. And knowing what I know now, if I have any kind of doubt, I'll pull the plug.
Check your pm's. Bill
Hi Bill
I've just read through this thread. I'd like to add my best wishes to you for a successful outcome.
Ed
Quote from: bothdone on January 11, 2009, 08:56:21 AM
Hi Bill
I've just read through this thread. I'd like to add my best wishes to you for a successful outcome.
Ed
Thanks's !! ;D
Hi Pat, Bill et all
Not sure whether I should have moved to the new metal ion subject, but here goes anyway.
I've been so so calm, maybe too calm. Now I'm getting pretty stirred up.....
I am still waiting for my report from Dr. De Smet re: my high acetabular cup angle, but today I talked on the phone to Hena Ziaee, the researcher at the McMinn Centre in Birmingham, England. I had sent her the xrays as well. She was not able to put the xrays through their software to determine exact angle as for that they need an xray of the whole pelvis (both sides together). But she said the angle looked roughly 60 degrees to her, and on top of the high cup angle there was high anteversion as well. I am not so familiar with that but I know that it's a serious problem also.
Anyway she said just by looking she could tell there was serious edge loading and that I needed to revise.
I asked her about the controversy around the blood tests, and should I take her up on her original offer to test my blood with their lab, and she said my levels were so consistently high over a few tests, that further tests would not be necessary.
She also said my femur looked "fantastic" and that I should just get a new cup. I asked her what the statistics were re: the success of that and she said only 3 have been done. I don't want to be a guinea pig anymore. I think I'm going to ask my surgeon to give me what he's good at.
The reality is beginning to sink in and I'm pretty bummed. So I guess I next wait to hear from Dr. De Smet once he receives my xrays.
Bill - hope you see this!
Nancy
Hi Nancy,
I know that this is a tough, and very personal decision, but I would share a few thoughts from a fellow patient's point of view.
If the femoral side is good, I have trouble finding a good reason to cut that off and throw it away. If you choose to revise the cup, I am not sure why that should lead to sacrificing a "fantastic" femoral result. Remember that revising the femoral side will involve additional risks and gambles, when it appears that you have a good result on that side already.
You said that the lady in England said that there had only been 3 cup revisions. I am sure that there are Doctors in this country that have done many more than that; Gross and Mont come to mind as two doctors that I believe have done a number of cup revisions from other Doctor's cases. If you could find a doctor that has done a number of successful cup revisions, it would help you to feel less like a guinea pig.
Lastly, if you are considering having the original surgeon do a total revision, I would think that you would want a pretty good explanation of why he can assure a better cup positioning this time, as compared to last time.
Best of luck on whatever you decide is best for you.
John
I would pursue getting the cup ONLY revision. No way would I take a THR if I knew I could get my cup revised. Fight to keep your resurfacing.
It's good that they said your femoral cap is good, keep your spirits up, this will work out for you.
Don't get down!
Chuck
Quote from: woodway2 on January 14, 2009, 06:04:18 PM
Hi Pat, Bill et all
Not sure whether I should have moved to the new metal ion subject, but here goes anyway.
I've been so so calm, maybe too calm. Now I'm getting pretty stirred up.....
I am still waiting for my report from Dr. De Smet re: my high acetabular cup angle, but today I talked on the phone to Hena Ziaee, the researcher at the McMinn Centre in Birmingham, England. I had sent her the xrays as well. She was not able to put the xrays through their software to determine exact angle as for that they need an xray of the whole pelvis (both sides together). But she said the angle looked roughly 60 degrees to her, and on top of the high cup angle there was high anteversion as well. I am not so familiar with that but I know that it's a serious problem also.
Anyway she said just by looking she could tell there was serious edge loading and that I needed to revise.
I asked her about the controversy around the blood tests, and should I take her up on her original offer to test my blood with their lab, and she said my levels were so consistently high over a few tests, that further tests would not be necessary.
She also said my femur looked "fantastic" and that I should just get a new cup. I asked her what the statistics were re: the success of that and she said only 3 have been done. I don't want to be a guinea pig anymore. I think I'm going to ask my surgeon to give me what he's good at.
The reality is beginning to sink in and I'm pretty bummed. So I guess I next wait to hear from Dr. De Smet once he receives my xrays.
Bill - hope you see this!
Nancy
Hi Nancy
I hope you don't let all this get you down. Sometimes bad things happen to good people. This is obviously not a good situation - but I think if you can keep your femoral cap and only have your acetabular cup revised, it would be a good solution. I know you have to make up your own mind, but you post here to ask us our opinions. I am not a doctor and can't give medical advice - only my opinion. If I were in your situation, I would want to keep my hip resurfacing if possible. After all, that's why you choose a resurfacing in the first place.
I hope you will see a solution for this problem soon and finally get over a bad situation. You need to be able to get on with your life without worrying about your hip replacement.
Please keep in touch. I will keep you in my thoughts and prayers.
Pat
Hey Nancy, So sorry to hear that. Seems you and I are in the same boat, the obvious negative is we (well me for sure) need an early revision, the positive side is we should come out of it with a resurfacing and not a thr (hopefully) Let us know what Dr DeSmet says, I'm curious since my angle is 65 degrees and he said "maybe you stay out of trouble" but didn't have any ion test results to go with it. I am going to ask for a few more opinions from the doctors on this site and will post their responses when I get them. My new Dr. (Mohammad Namazian out of Kaiser Fontana, Ca.) sounded quite confident he could re-position a new cup and retain the femoral componet. I will try to gather as much info as I can on this subject and post whatever I find here, please keep us informed and I am truly sorry you have to go through this. Nice to talk to you the other day by the way. Try to stay positive, I'm sure it will work out. Bill
Hi Everyone
Thanks for all your kind and supportive thoughts. I am still awaiting a note from Dr. De Smet and will let you know when I hear from him.
Nancy
What ever did Dr. De Smet tell you ? Marilyn
Quote from: MarilynRS on June 08, 2009, 01:49:35 AM
What ever did Dr. De Smet tell you ? Marilyn
X 2
Hi Nancy, any word yet ?
This thread reminded me of the emotional roller coster this whole deal has been. I am due for my 9 month x-rays/checkup in about 2 weeks and am hoping the decision to "Ride it out" and see how it performs was the right choice, hope all is well and keep us posted. Bill.
Hi Bill, Pat, et all
Thanks for your thoughts!
Well......I can't remember what my previous update was. I come in and out of worrying about it and for a couple of months there was having a good time not thinking about my hip at all! Partially inspired by Bill....thanks!
So, a little background. I have a high acetabular cup angle, the first measurement was 55 degrees and every time I get measured the xray reader gets a little more careful and now we are up to somewhere between 60 and 64. There is no doubt that there is serious impingement and that is the reason for my high metal ions. Levels have been taken 5 times and have risen from a 3 month level of 57 nmol/l (2.99 ug/l) to the most recent, shocking result I just got of chromium 1065 nmol/l or 55 ug/l, sometimes expressed as ppb. My right BHR was September 2007. I am Canadian, noticed the high angle myself after finding this web site and getting educated (thanks, Pat!) and asked my surgeon for blood tests, which he kindly agreed to to.
I have had several opinions, and my surgeon has now referred me to a surgeon in Ottawa who has more experience with resurfacing and is doing a metal ion study.
I have had several opinions. Dr. De Smet wanted me to revise immediately but that was based primarily on the ion levels (at that time Chromium was 798 nmol/l). All the North American doctors (including Dr. Su) suggested waiting until xrays or ultrasound revealed any bone damage or fluid buildup. All these opinions were based on those levels around 798. So when I got the new levels a few weeks ago I immediately arranged to go to Ottawa again ( a 5 hour trip for me). My Ottawa doctor is concerned but still not eager to rush me into surgery when I still have no pain and no symptoms except the blood tests.
But we did start to have the "revision talk". I am going back in August to do a complete new set of bloods, xrays and ultrasound and we will make a decision.
Here are some other thoughts:
I think we all need to be pushing doctors to do blood tests. It's only with more information doctors are going to find out what the true norm is. What is high? Nobody knows. There needs to be much more research on this. I'll bet there are hundreds of resurfaced people out there who have levels like mine and don't know it. There seems to be this attitude that what we don't know won't hurt us. Well, I think that must change. The problem is that once we know about our metal levels, there is so little research that the doctors don't know what to do about it, if anything. All that is known about what high metal levels can do to the body is based on inhaled or ingested metal, not directly blood born as in resurfacing. And, by the way, these very same issues occur with the MOM total hip recipients.
I really like my hip, am back horseback riding, hiking, everything I want in life. But.....what are these high levels doing to me???? Nobody can tell me. I would so like to hear from someone else who has levels like mine! I research constantly on the internet but not much comes up. I did come across this little article, though, which I found very interesting. I've attached it - hope that works!
Thanks all
Nancy
Vicky Marlow has released the results of metal ion tests arranged by Dr. Su and the results are very very low. Chromium was 2.1 parts per billion (ppb) and cobalt was less than one ppb. She said Cory Foulk levels were also very low and he runs marathons, iron man triathlons and ultra man triathlons. Both had their BHRs installed by Dr. Bose in December 2005. So at least two properly placed devices do not shed ions much since the synovidal fluid lubricates the surface (See results on her website).
On the other hand an improperly placed device (see Jane's story on this website and Vicky's website) does shed a lot of ions and Jane eventually needed a ceramic THR revision by Dr. Su in September 2008.
Thanks Stevel
One little correction...Dr. Su's opinion to stay the course as long as there is no pain is based on my new levels at over 55 ppb. Xrays sent to him by Vicky (thanks Vicky). So there is a calming opinion...
Bill, I ranted on without saying good luck to you and I hope all your tests go well and you continue to surf and ride!
All the best,
Nancy
Quote from: woodway2 on June 08, 2009, 02:19:15 PM
Thanks Stevel
One little correction...Dr. Su's opinion to stay the course as long as there is no pain is based on my new levels at over 55 ppb. Xrays sent to him by Vicky (thanks Vicky). So there is a calming opinion...
Bill, I ranted on without saying good luck to you and I hope all your tests go well and you continue to surf and ride!
All the best,
Nancy
Thanks Nancy. Seems like I have heard a different opinion from every doctor I have questioned, but the one thing they all have said is that if its working good and you don't have any pain or discomfort, then don't mess with it. I go from "Man it's not right, I gotta get it fixed asap before I get a tumor or cancer or it dislocates or comes loose or my tissue gets all black and gooey from the metal ions and my leg falls off etc etc etc......" to "Ahhh screw it as long a its working I don't even want to know, lifes too short already I'm just going to charge and enjoy every pain free day I have and if the day comes when something lets loose I'll deal with it then" If I have to get a thr then I'll get a thr you know, whatever. I'm just gonna wake up and make sure I get some enjoyment out of every day and try to forget about it.........and then I come back in here... HaHa J/K !!!
Anyway I get new x-rays in a few weeks, I'll see what my new doctor says along with a few others and go from there. I wont get my blood tested by Kaiser I'm sure since they told me they don't have any way to test for metal ions yet (thats pretty confidence inspiring huh ?) I'll post the results and any other info I come across, keep us up to date and good luck !, Bill.
Hi. I just read your posting and would very much like to hear what you decided to do. I have what I think is a similar problem: elevated chromium/cobalt levels and and a cup angle of 56. My surgeon says he recommends a THP now because he thinks I could have metal sensitivity. I don't know what to think, although I do believe that the cup angle is due to surgeon error.
I had metal levels done 3 years after a failed Durom cup (constant pain for 3 years), "perfect xrays". The levels were very high pre op and are coming down slowly post op (metal on polyethylene THR) . At 4 months post op the chromium is within normal and the cobalt is coming down but not normal. The new hip feels great. My metal levels had never been done prior to my request prior to my recent revision. I agree that they should be done routinely. I don't know if the metal in my blood etc was causing symptoms but I no longer have night sweats, which used to occur fairly regularly. If I had no pain and normal xrays, I don't think I would want to get a revision just for metal levels (if my renal function was OK). I don't think I'll get a MOM on the other side given all my problems though it was likely due to the faulty, loose Durom cup (never integrated with bone).
I had my 9 month X-rays with the new Dr. who told me "Everything looks fine" I asked about the cup angle (mine is about 65 degrees) and he said "Not all steep cups fail and any problems related to metal ions wont begin to show for a couple years, wait a year and then come back" I asked him what he was looking for on the x-ray and he said if the componets start to show dark spots along the edge where it attaches to the bone then the bond is starting to deteriorate and a revision would be needed. He seemed to think he could do a cup revision only and keep the bhr.
He also said Kaiser Permamente dosen't test for metal ions because there is nothing they can do about it anyway, plus there is not enough data on what is or isn't too high. Needless to say I am pretty fed up with Kaiser, I get the feeling they just tell me what they think I want to hear. 2 weeks ago I had another kaiser dr who wanted to see the x-rays and told me that "They lost them" I had knee a x-ray today and the kaiser down here in orange county had a digital x-ray machine and put them on a disc but the kaiser in fontana where they do the resurfacings still use film.......I guess because there easier to lose ? ::)
Anyway I am going to Hawaii october 7th for a few days and then coming back to San Diego on the Ronald Reagan aircraft carrier. My daughter who is in the Navy is stationed on the Regan and they have a "Tiger Cruise" where family members can spend 6 days on the ship (from hawaii to san diego) Our son (then 16 years old) did it last year but this year my wife and I are going. They wanted a release because of my hip and thats how I found out about the "Lost" x-rays. Luckily the dr was cool and gave me the ok to climb up and down ladders.
I plan on getting the tests done on my own after we get back. I'll post the #'s when I get them. I am curious how high they will be since I am on my feet all day and lift 50 to 100 lbs regularly.
But fun in Hawaii is my priority right now........ ;D
HI Catalina and Bill
Funny, I saw my Doc on Monday, made the decision, and then thought I'd give the internet a break for a while. Last night I went on just one more time and saw your letters. My levels were tested in June and for some reason took 2 1/2 months for the results. I am still way up with levels over 1000 nmol/l or over 55 ppm of both chromium and cobalt. Catalina, do you know what your numbers are??
My new doctor (he did not do the resurfacing) is not pushing for revision. He says he treats the patient not the xrays. This is because I have shown him emails from Dr. de Smet and Dr. Bose both encouraging me to revise based on metal levels and high cup angle (which is somewhere between 59 and 64 depending on who measures it). I get the sense from my reading that the North American trend is to revise only in cases of pain. I have had only one instance of pain in 2 years and that went away. My xrays still look good with no sign of damage or changes. But on the other hand he does agree that the levels are high and thinks they will stay high. I get the impression that he thinks the joint will last if we leave it alone.
But, I am just not comfortable with these high levels. As I work with cobalt and sometimes chromium ( I have done a clean test staying out of my studio for a month and the levels are the same) I am aware of their potential hazards and am ready to revise. That said I have been placed on my doctor's "long list" and might wait 6 months to a year for this. I will revise to the old poly/metal.
I am beginning to think this expression "surgeon error" is a bit of a red herring. High cup angles are really common. This surgery is extremely difficult and even the experienced doctors sometimes place the angle too high. I'll bet there are hundreds of recipients of resurfacing and MOM THR's who have high metal levels and are not aware of this. The medical establishment is going to have to come up with better computer guidance (right now only the femoral side is computer assisted) or some other way of insuring better placement of components. I do agree with you, Fedup, that metal levels should be done routinely. But the medical establishment will also have to come up with guidelines regarding what levels are acceptable and what to do if high levels are detected.
So that's my little rant for today....you can sense my anxiety. I hope I've made the right decision....
best,
Nancy
Hi Nancy
Most surgeons are very concerned with very high metal ion levels. While attending the 2nd Annual Hip Resurfacing Course for Surgeons in LA in 2008, I saw videos of resurfacing devices being removed when the ion levels were very high. Very ugly mess of black tissue and gunk. I would not want that in my body. I guess it is the way the body reacts to such high metal ion levels - I am not a doctor and that is the only way I see it as a layperson.
Next week I will be at the 3rd Annual Hip Resurfacing Course in Baltimore and will hear many presentations about the metal ion subject and acetabular cup placement. I will listen and learn - then write a report from a patient's perspective about what is currently happening.
If the top surgeons in the world are worried for you, I would tend to agree with them. They have done many thousands of these surgeries and have seen many revisions - not of their own but from other surgeon's problems. They are the best experts we have right now and I would have faith in their recommendations. You definitely would not want to get into any problems from the high metal ion condition. You definitely need to monitor what is happening in your hip.
I can't tell you what to do since I am not a doctor, but I am happy you are posting your experience for others to read. That is the way we all learn. We are listening and will support you in your decision - whatever it will be.
Pat
Hi Nancy -- Have you considered a ceramic on ceramic THR ? I saw that that is what Dr. DeSmet does when he needs to revise, and I believe I have read that the Europeans are ahead of North Americans with this particular technology.... also that the ball sizes can be quite large, similar to the metal.... Seems like a good possibility for also avoiding polyethylene problems down the road.... Also, is the possibility of just revising the acetabular component still an option for you (and keeping your resurfacing)? I know you mentioned that some time back.
The best to you, Marilyn
Hi Pat and Marilyn
Thanks, Pat for your reassuring words! They help a lot! I look forward to your report.
Marilyn, I did consider the ceramic, but read a horrific report somewhere on the net about one person's experience with a broken ceramic hip. The fragments left behind led to multiple revisions afterwards as the particles of ceramic were impossible to completely clear out of the area. I know Dr. de Smet does them but it's too scary for me! The idea of just revising the cup was brought up, but really I don't want to be having to check levels after the revision. Better emotionally for me to move on....
bye for now,
Nancy
Well, the best to you as you move through this journey. Please keep posting and keep us updated, because I think we all have alot to learn over time from your experiences and about this topic in general. It does seem like a study would be good, and as a group, we would probably be willing participants if a group of doctors or whomever came along to track and do such a study. Goodnight, Marilyn