I urge all patients to get follow up x-rays done at least every other year, better yet, IMO, one year post op x-rays, then every other year after that.
I am working with patients that are 4+ years out from surgery facing revision surgeries, that only have their immediate post op x-rays and now their current x-rays and there is no way of telling when their cups slipped because they did not get x-rays taken in between. It is always a good idea to keep this info on file for yourself in case heaven forbid anything bad happens with your implant in the future. So please do this along with metal ion level checking.
Hopefully nothing will ever happen, but follow up is extremely important and if your doc is not doing it, then please do it for yourself.
Vicky Marlow
thanks vicky.. sound advice indeed .. 8)
Wow! Any indication of why this has happened? Surgeon error or device failure?
Thanks for the info Vicky.
Danny
Thanks Vicky - Dr. Snyder had me at +3 months, +6 months, +12 months and now on a yearly schedule. Hopefully everything turns out well for the folks you're helping.
Danny,
Each case is unique and I am working with several patients. Ones that have regular x-rays taken annually or every other year, then the doc can figure out what happened. When you only have your immediate post op x-rays and then now 4+ years later, you have an x-ray where the cup is completely vertical, there is just no telling when the cup slipped or why until you have surgery to revise it and see if the cup has ingrown in the new position or not.
Vicky
Thank you , Vicky. Very good advice.
Quote from: Vicky on September 15, 2011, 07:10:59 PM
Danny,
Each case is unique and I am working with several patients. Ones that have regular x-rays taken annually or every other year, then the doc can figure out what happened. When you only have your immediate post op x-rays and then now 4+ years later, you have an x-ray where the cup is completely vertical, there is just no telling when the cup slipped or why until you have surgery to revise it and see if the cup has ingrown in the new position or not.
Vicky
Thanks Vicky,
I see your point. I really hope that the patients your working with are ok and they get sorted out. They will be in my thoughts and prayers.
Danny
I'm returning to Dr. Gross for my one year check-up next March. I figured it was worth the drive down from Ohio to see the doc I started out with. Having said that, I also plan on getting a copy of all my X-rays that his office took this past year and keep them in my files at home. I'm very pleased with my resurface, but I agree with Vicky that we all need to be proactive in our own care.
Mac
Wow, Vicky, those two pictures are very scary. Is Melissa OK? In the second one it looks like there's hardly enough bone left to hold the femoral component. Does something like this require a revision to THR?
I'll definitely be going in for my 1 year followup in February.
Vicky,
Those xrays of the neck narrowing are scary! Is there and theorys as to why neck narrowing happens?
Danny
Quote from: Vicky on September 21, 2011, 06:09:46 PM
Here is an excellent example of why it is so important to have regular x-rays to see what is happening and when to your hip. This patient has a pretty severe case of femoral neck narrowing and she would not know when this started happening had she not gotten x-rays taken every other year.
http://www.hipresurfacingsite.com/X-Rays-Problem-Cases/Xrays-Problem-Cases/menu-id-114.html
Thank you Melissa for allowing me to post these.
Vicky
Vicky, can you tell us, or point to an article, that explains why Melissa suffered from narrowing?
Thank you,
D.
Yeah, I want to know also. Thanks Vicky, that's some very eye-opening info.
BTW - screw sticking out of a femur, hello? Ok, I might not be an MD, or a surgeon, but I think if I were in the OR looking over the surgeon's shoulder, I'd be a little inclined to ask why a screw is sticking out of the bone. When I build things in the back yard, I don't usually leave screws sticking out of things. It doesn't look very professional.
Those are some scary pictures for all of us with a BHR. I will be sure to now get x-rays every year and was looking forward to seeing mine next week at 8 weeks post op visit. I must say I'm not quites as excited now.
I would send this link to anyone who is thinking of picking a Doctor who only does a few BHRs a month. Clearly even with a high success rate it is still something that still can have problems.
Vicky like the others I would like to know what causes the bone loss at the implant on the femoral head? I just took 2 calcium tablets as soon as I looked at that picture.
Matt
Quote from: Tin Soldier on September 25, 2011, 11:30:22 AM
BTW - screw sticking out of a femur, hello?
Yeah, that's what I thought when I saw that one. I would love to know the whole story about that case. I wonder how long that person went like that?
Yes, yes yes. Everyone can see why that one is wrong. Don't go near that surgeon.
But, more importantly, why did Melissa's resurfacing go wrong? It looked right. I thought the femoral neck was supposed to get thicker after resurfacing. What happened there?
Vicky, can you tell us, or point to an article, that explains why Melissa suffered from narrowing?
Thank you.
D.
Here are some links to abstracts of studies done on this issue. It was interesting to note that one study claimed a difference between cemented and uncemented.
http://www.ncbi.nlm.nih.gov/pubmed/21157762 (http://www.ncbi.nlm.nih.gov/pubmed/21157762)
http://www.ncbi.nlm.nih.gov/pubmed/21458396 (http://www.ncbi.nlm.nih.gov/pubmed/21458396)
http://www.ncbi.nlm.nih.gov/pubmed/17785738 (http://www.ncbi.nlm.nih.gov/pubmed/17785738)
http://pih.sagepub.com/content/224/3/427.abstract (http://pih.sagepub.com/content/224/3/427.abstract)
Thanks for posting the articles John C.
That last paper suggests that larger heads will reduce the potential for narrowing, if I am reading it correctly.
Interesting and a little disconcerning. Thanks
John, am I right in saying that the study which summarised on the cementless cemented device found more thinning with the cementless device? That's what I understood it said.
Is this neck thinning exclusive to HR I wonder or do devices like the bmhr have the same problem?
Quote from: Dannywayoflife on September 27, 2011, 08:59:38 AM
Is this neck thinning exclusive to HR
No. A major problem with THR is 'stress shielding', where the bone gets weak. In a well placed and
sized resurfacing, this should not happen.
I still would like to know more about the Melissa x-rays.
Quote from: Dannywayoflife on September 26, 2011, 04:00:37 PM
am I right in saying that the study which summarised on the cementless cemented device found more thinning with the cementless device?
I did not get that.
The difference between the immediate post-operative ratio and the most recent radiograph was statistically significant in patients with cemented femoral components (p=0.006), but not in the group with uncemented components (p=0.173).
The number for the uncemented is defiantly bigger. I'm not sure if I'm miss understanding the data or not. As I am no surgeon that's the way I interpreted it.
As far as I've read the neck thinning in HR isnt like the stress shielding as ive read that the bone density returns to normal but the stress shielding in THR it gets less.
I suppose it could be the bone addapting to the way the force is transmitted with HR as opposed to the natural joint?
I do agree that 0.173 is a bigger number than 0.006.
But the article says:
The difference between the immediate post-operative ratio and the most recent radiograph was statistically significant in patients with cemented femoral components (p=0.006), but not in the group with uncemented components (p=0.173).
So I do not know what the numbers refer too, but it seems as though narrowing is greater for cemented.
I have read it a few times, and now I am not sure.
By the way Danny,
Here is a picture of Mr. Treacy's implant device. You will appreciate the beautiful setting of the suburbs of Birmingham.
(http://sitelife.aviationweek.com/ver1.0/Content/images/store/7/7/47d97610-f691-4b2a-9775-e528abf5402b.Full.jpg)
Ha I like it lop Ronan treacy international rescue at your service!
Why carnt these medical types just put it in laymans terms!?
I wish I could just say "right doc put me back to normal and I want it to out last me!"
(http://image.ec21.com/image/fidaintl/OF0006332642_1/Sell_Acetabular_Reamers_Reamers_Orthopedic.jpg)
Those reamers look knarly!!
Hi Lop; A thought on your question about femoral diameter getting larger after resurfacing: if I understand it correctly, it is the bone density that eventually increases after resurfacing, not the diameter, which sometimes decreases. Like Danny said, this is likely due to a change in how the load forces are transmitting through the bone. An analogy that works for me is the change that we went through a few years ago in windsurfing masts. We went from a larger diameter mast, to a smaller diameter with thicker walls, which worked out to be stronger for an equivalent weight. So, a slightly narrowed femoral neck with increased density might be viewed as similar to the narrower and stronger windsurfing masts that we have switched to.
I am attaching a web site that includes on page 5 an interesting visual portrayal of stress transfer through a femoral resurfacing. I don't mean for this to be a battle of the brands, but an interesting portrayal of how the load transfer shifts with any prosthesis. Note the tension forces that show around the lower edges of the prosthesis, which corresponds to a common area of neck thinning. Since bone grows in response to compression forces, this might be relevant. http://www.biomet.com/orthopedics/getFile.cfm?id=1165&rt=inline (http://www.biomet.com/orthopedics/getFile.cfm?id=1165&rt=inline)
Hi Danny; Like you, I am no doctor of statistician, but I am pretty sure that the study states that there is less neck narrowing in the cementless group, and that the p number does not refer to a measurement of neck narrowing, but is a statistical reference number.
Vick Once again thanks for the info and please do keep up the good work and let melissa know shes in our thoughts and prayers.
Danny
I'm just glad I was asleep when they reamed my acetubulum.
Lop - you sure those reamers weren't from the Thunderbirds, it's all starting to look the same to me.
Quote from: Tin Soldier on September 27, 2011, 05:39:13 PM
I'm just glad I was asleep when they reamed my acetubulum.
Lop - you sure those reamers weren't from the Thunderbirds, it's all starting to look the same to me.
Both pictures came from the same web-site.
Here are pictures that show Mr. Treacy's clinic for private patients, followed by the NHS facility.
(http://davidszondy.com/future/Thunderbirds/cap025.jpg)
(http://www.birminghamroundabout.co.uk/wp-content/uploads/2009/04/spring_road_from_springbank_rd_03.jpg)
Normally I'd agree with you lop the NHS facility's are normally dire but the ROH is like a private hospital mate!
Once again thanks for the Gen info Vicky.