Hi Gang !! How are you guys ?? I hope everybody is doing well. I have a few questions about acetabular cup placement, hopefully you can help me out. I have read that improper placement of the acetabular cup is probably the most common mistake made in hip resurfacing, my questions are:What are the symptoms of an improperly placed cup ?What are the mistakes made ? I assume the only ways to get it wrong would be it was placed to shallow, placed too deep, the wrong size, not tight enough or placed at the wrong angle, wich brings me to my next question.What is the range of the angle ? (viewed from the front)Is there a set standard range of what would be considered acceptable ? or is it strictly patient to patient ? And finally is there a place in this site where we can post and compare x-rays ? If there is I must have missed it ? If not, maybe start a topic for that ? The reason I'm asking is because I have been having some knocking/pain issues and wanted to know why. So I started poking around and found some x-rays on line and quite frankly they don't look anything like mine. The cup angle on mine seems much steeper (more vertical) than the other shots that I have found on line, and I'm curious to know how big an issue that is (if at all). I'm a little upset my Dr. would not let me keep the x-rays so all I have is a few pictures of them on my cell phone, but they show it pretty clearly. It looks to me like the outer edges of the cup are just about flush with the outside edge of the pelvis top and bottom, (maybe slightly countersunk on the top) but the angle seems pretty steep to me ? If my spine is straight up and down, the angle on the cup is way less than 45 degrees toward vertical. Anyway I thought if I had some examples to look at I could see if anyone elses is that steep. I am going to get new x-rays after the holiday and will get a good enough picture to post them on here, and will probably send them to the big name guys as well.Any thoughts or links on this subject will be greatly appreciated.Pat I know you just attended the Dr. workshop, your thoughts on this ? Thank you very much !!, Bill
Bill,
From what I've read, acetablular cups when placed incorrectly the symptoms were pain, snapping and popping in the hip area. Sometimes the pain can be really severe. Everyone will have symptoms that differ from other folks.
If you look at Pat's main home page you'll see what I believe is a perfect installation of our hardware. That is what I used when I got my 6 week x-rays to use for comparison.
I have a Internet friend who I will ask if he will talk with you about the symptoms he had. His name is Brett.
This may not be anything Bill, some people have strange pains well into and beyond 4 months.
Chuck
Thanks Chuck, I think your talking about the little picture of someones right hip where it says advertisements ? If so I have looked at that picture and mine is steeper than that. I hope it's nothing but for whatever reason I still need a cane at 9 weeks or I have pain on the outside of the hip when I walk without it and I feel unstable. I don't know man.....I wish I had more faith in the Dr. to be honest with you, I thought it was weird that he wouldn't let me keep the x-rays for one thing, I was able to keep the ones of the hip before the surgery, why couldn't I keep the ones from after ? And why can I not find an x-ray anywhere that looks like mine ? Every single one I've looked at shows the cup being more "on the top" of the ball, where mine seems to be set to where it looks like its more on the side, like the top of the cup bareley goes past the very top of the ball, it looks to me like all the vertical force would be placed on the very top outside edge of the cup, rather than spread across the whole cup. I wish I knew where I could find a good cup placement vs poor cup placement section, and what the differences are between the two, with x-rays of both. Maybe it's all good and I'm just a slower healer than most, maybe when I read about people having no pain and cruising around like normal weeks before where I am I shouldn't get my hopes up ::) ::), maybe I'm being a sissy drama queen ha ha :D, I don't know but wondering about it is driving me nuts. Either way I am going to go get new x-rays and demand to keep them, or at least get some pictures with a decent camera so I can e-mail them out for a couple other opinions. My biggest fear is that if it is wrong I want to fix it ASAP, I don't want to invest 6 months of healing time to start all over again. I just want to KNOW that it is installed correctly. My wife says don't worry about it the Dr. says the x-rays look good, but I feel like well yeah what else is he gonna say ? I mean if there is an "optimum placement" and then "acceptable" placement, where doe's mine fit in on the scale ? Am I closer to optimum or borderline acceptable ? I would like to know as many facts as I can gather before my next appt. Hopefully all is well and you guys can all say "Jeezus that B.I.L.L. cat sure is a worry wart, what a goof" Just not knowing why I seem to be behind pretty much everyone elses story in here is eating at me and I need to know its right, sorry I'll stop rambling, I really am an optimist I swear...
Hi Bill,
Sorry to hear you're having so many problems. Can you get your PCP to order an x-ray and then take it to different Ortho Dr for a 2nd opinion?
I hope it's not what you're thinking and that things start to improve for you soon.
Take care
Barbara
Bill,
I had my 4 weeks post-op x-rays taken at the local hospital, since I had my surgery out of town. I had a prescription for the x-rays and could have them taken anywhere. I choose the hospital because they put the x-rays on a CD and gave me the CD. I then made copies of the CD. I sent the original CD to the Dr. for his review and he said they look great. I copied the CD on the hard drive of my home computer so I can review them or send them via email attachment to anybody I want.
The placement looks great because I had a pelvic x-ray which shows both hips. The new implant on the left side looks symmetrical with the natural hip on the right side. I was laying down on the table in the supine position. They also took a cross table lateral where I bent my right knee and they took an x-ray through the space below your bent knee at the left hip. In this case the socket is more vertical as the femoral cap (and leg) has rotated within the socket.
I have been reviewing the x-rays because I have a leg length discrepancy and the Dr. says it should even out in 3 to 6 months. He knew about the shorter leg prior to surgery and placed the new implant accordingly. The new implant looks even with the right hip, so I'm working with the physical therapist to strengthen and stretch the left side pelvic and hip muscles so my leg length evens out. My physical therapist says I should have a pelvic x-ray taken in the standing position rather than supine position to verify if the hips are symmetric.
I will wait about six months and work on exercises and stretching, before adding a heel lift or foot insert, if needed.
Quote from: Barbara on November 26, 2008, 11:45:56 AM
Hi Bill,
Sorry to hear you're having so many problems. Can you get your PCP to order an x-ray and then take it to different Ortho Dr for a 2nd opinion?
I hope it's not what you're thinking and that things start to improve for you soon.
Take care
Barbara
Thanks Barbara, I hope it's right too. I guess I'm looking for some kind of diagram that shows whats good, bad, and in between.
Hey Stevel, Can you post your X-Rays on here ?
Bill,
I'd rather not as the x-rays have my patient information (identification). Check out the x-rays shown on Dr. Bloomfield's website for difficult hip resurfacing patients. They are located under "Hip Information" at the bottom of the page. Go to the home page of this website to access "Hip Information." Go to Dr. Bloomfield's website to view the photos as a lot of them were not viewable on this site.
Bill,
I emailed you my x-ray.
Check your email.
Chuck
Quote from: B.I.L.L. on November 26, 2008, 01:20:28 PM
Quote from: Barbara on November 26, 2008, 11:45:56 AM
Hi Bill,
Sorry to hear you're having so many problems. Can you get your PCP to order an x-ray and then take it to different Ortho Dr for a 2nd opinion?
I hope it's not what you're thinking and that things start to improve for you soon.
Take care
Barbara
Thanks Barbara, I hope it's right too. I guess I'm looking for some kind of diagram that shows whats good, bad, and in between.
Hey Stevel, Can you post your X-Rays on here ?
Bill,
I sent you an x-ray of my LBHR at 4 weeks post-op to your email address. Check your email.
Hi B.I.L.L.
I am sorry I did not get back to your sooner.
The perfect angle for the acetabular cup is 40 degrees. It varies a little each way sometimes. Also the doctors will purposely change the angle for people who need more ROM or doing certain sports or activities. This is not an exact science and depends on the doctors experience as to how it should be properly placed for each person.
I would not be able to tell anything by looking at the x-rays since I am not a doctor. There are also other angles and placement involved too. It is very complicated. I have 3 studies I will post in a few days about the angles and computer assisted surgery to make the angles correct.
I don't know what to tell you since I would not be able to read your x-rays to tell the angles, etc.
If you start having problems or pain, then one of the really expirenced surgeons will read your x-rays and give you an opinion. If you are not in great pain, then they would not be very willing to take time to read you x-rays since they are so busy.
I have to look at the settings on this discussion group to see if I can let you post photos. If you have an url where they are already posted you can use that. I have a photo section, but have not let people join due to all the porn and problems.
Let me take a few days to figure out how I want to give you a place to post photos.
Pat
Hey Bill,
First of all the doctor can not keep the x-rays from you. You have a right by law to have a copy of them and anything else that is in your medical file.You can call his office and demand a copy of anything in your medical file be sent to you or for you to pick up.Also I will send you a copy of my x-rays after surgery but I'll have to have my wife do it cause I'm not to computer savy. Also when you get your new x-rays ask them to convert them to a cd that way you can send them to Doctors around the world if you need to.They did that where they took my x-rays and they didn't even charge me for it. Hang in there bro we're all pulling for ya.
Wayne-0
Hi Bill,
I just emailed my x-ray to you, but as Pat said, each case can, and probably should, be a little different. My best advice is to do whatever it takes to have someone you trust look at your x-rays as soon as possible, so that you can put your mind to rest. In the past, I have emailed phone/photos of x-rays, and most docs have found them to be sufficient.
John
Pat.... I think Bill wants the porn on here ;D Don't mess him up, ok?
Chuck
Quote from: Pat Walter on November 26, 2008, 04:24:30 PM
I have to look at the settings on this discussion group to see if I can let you post photos. If you have an url where they are already posted you can use that. I have a photo section, but have not let people join due to all the porn and problems.
Let me take a few days to figure out how I want to give you a place to post photos.
Pat
Quote from: obxpelican on November 26, 2008, 08:45:38 PM
Pat.... I think Bill wants the porn on here ;D Don't mess him up, ok?
Chuck
Quote from: Pat Walter on November 26, 2008, 04:24:30 PM
I have to look at the settings on this discussion group to see if I can let you post photos. If you have an url where they are already posted you can use that. I have a photo section, but have not let people join due to all the porn and problems.
Let me take a few days to figure out how I want to give you a place to post photos.
Pat
:D ;D :D Hey now........Ha Ha.
Quote from: B.I.L.L. on November 27, 2008, 02:52:58 AM
Quote from: obxpelican on November 26, 2008, 08:45:38 PM
Pat.... I think Bill wants the porn on here ;D Don't mess him up, ok?
Chuck
Quote from: Pat Walter on November 26, 2008, 04:24:30 PM
I have to look at the settings on this discussion group to see if I can let you post photos. If you have an url where they are already posted you can use that. I have a photo section, but have not let people join due to all the porn and problems.
Let me take a few days to figure out how I want to give you a place to post photos.
Pat
:D ;D :D Hey now........Ha Ha.
I am just trying to keep your spirits up Bill ;D
Chuck
Ha Ha I'm ok thanks. Sounds like theres no real set rule so I'll stop stressing and post my X-Rays when I can. Thanks to you guys that sent me your x-rays for comparison, actually none of them look the same, but none are as steep as mine. Have a great Thanksgiving 8)
Bill,
The two laws that I was talking about are called the erisa law and hippa law.I think you have Kaiser if I remember correctly. Call Kaiser and demand from them those x-rays that you want.If the person on the phone doesn't give you what you want demand to talk to their supervisor,talk to the supervisors supervisor if need be.Keep going up the chain until you get what you want.Also ask for every persons name you talk to and have them spell it for you and write all this info down and ask for a reference # to every call you make.Bylaw they have to give you this info and they know it, don't let them tell you otherwise.By the way remind them you know that every phone call is recorded (that is the reason you ask for the reference # so you can have it brought up if you need this firepower for later).Stay strong and talk to ya later.
Wayne-0
Everyone is entitled to have access to and copies of their medical records, however there is a process you have to go through to access them. Hipaa is a law made to protect your health information and give you control over who has access to this information. It also gives you rights over your health information and you can request that corrections be made to your records if you feel it necessary.
Call the medical records department of the hospital or Doctors office. You have to fill out the relevant paperwork stating what parts of your records you actually want and might have to pay a small fee. Doctors do have the right to keep some of your records private from you if they think the information could be harmful to you. This would only happen in extreme cases though. I would think you would have the right not only to your x-rays but also to the dictated x ray report, pre and post op report and surgical report if you wanted them.
Good luck
Barbara
Hello Bill, Pat et all
Getting back to the acetabular cup angle......I have a high angle but my hip works great. If you check some of the studies that Pat has posted, there is one that includes xrays of high angles, in the section on metal ions. At my 3 month check-up I noticed that my xrays did not match the other patients, and asked my doctor, who confirmed my high angle. He thinks it's around 59 degrees. I don't know if it slipped or was always like that.
My doc is great, a very caring and compassionate man. He has allowed me to take specialized blood tests for the metal ions, and, they are very high. I have worried about this all fall, and have recently decided it's time to enjoy my hip and stop obsessing on the ions. My doc is surprised I have no pain or metallosis and is going to take new xrays in February. He is also going to discuss my case at an upcoming conference. I feel very cared for, and know that he is concerned as well. But I have a hip that is working great! I had my surgery 14 months ago. I am fully active and don't restrict myself at all. I do, by the way, follow the regime by Keith Brewster, with vitamin C, NAC, and (when I remember,) selenium. I can't remember the URL but if you google him you will find it.
I wonder, am I the only surface hippy out there who has had my blood tested?
Nancy/woodway
I reviewed my 4 week post-op pelvic (both hips) and left side (LBHR) hip x-rays and measured some angles with my protractor. The x-rays were taken in a supine (laying flat on my back) position with my legs fairly evenly spaced although I believe the technician did not adjust the space much. The angle between the longitudinal axis of my femoral neck and the longitutinal axis of the femoral shaft is 135 degrees on the left side. I've read where this angle is normal. The angle between the longitudinal axis of the femoral neck and a vertical line (matches spine) through my pelvis is 30 degrees and matches my right side (unoperated). I'm not sure what a acetabular cup angle of 59 degrees is referenced to?
BILL,
Hang in there. I believe you have a right to be concerned and ask questions, especially when you feel you are behind the recovery curve and information is hard to get. If I can get a copy of my x-rays on CD after my post-op 12/4, I'll send you a copy to add to the others you've been getting. I know they won't answer any specific questions for you, but you have several for reference.
Good luck my fellow hippy.
JohnS
Stevel
Sorry, I've been looking on the web for the xray that I once found with angles marked out on it, but I can't find it. The study that is on Pat's surface hippy is http://www.surfacehippy.info/metalionstudy.php. It was this study that alerted me to the angle issue. I do know that my cup angle is not as high as the 3 outliers in
this study.
nancy/woodway
Nancy,
Thanks for the reference. Those are steep angles! It appears that the acetabular socket angle is measured from the horizontal, so a steep angle is over 55 degrees.
My cup angle is similar to the ones in those study pics. I"ll let you know what the Dr. says when I see him. I have made a lot of progress in the last few days. I'm off the cane for quite a bit during the day now but still using it on longer walks. I feel the last few days have been a turning point and really hope the steep angle will not be a big issue but we will see... Thanks everyone for all your pm's. Any info on steep angles I get I will let you know. Thanks again, Bill
Got a message from my Dr. on my cell phone (he's never sent an e-mail, always a call on my cell with a restricted #, I was in the shower and missed the call). Anyway he said yes the angle is much steeper than he prefers, "It thought it looked ok after surgery but the last x-rays show the cup angle being very steep" "We can wait an see if there are problems 6 months down the road" F-that, if its wrong I'd rather not waste another 6 months wondering. I'm not 100% sure there are x-rays from right after surgery, I got the impression the x-rays at 6 1/2 weeks are the only post op x-rays. I have an appointment with him to get new x-rays and I will have my digital camera with me and post them here when I get them, as well as get 3 or 4 other doctors opinions. Awesome huh ?? Right about now I wish I still had the original eguipment..... If you are new in here and haven't had surgery yet, LISTEN TO PAT AND USE ONE OF THE DOCTORS ON HER LIST. Thats all I got, later, Bill.
Oh I do have one question, I can't seem to find exactly what are the downsides to high metal ions in the blood ? Does it lead to loosening of the components ? General health issues or what ? Just curious. I googled metalosis and all it has is some lame video that shows some guy turning into the terminator. What do the metal ions actually do ?
I'm gonna have to weigh my options, thanks.
I'm so sorry to hear about this. I guess there's little consolation in knowing you were right all along.
I suggest you get a guru's opinion on what to do. You've given this doctor his chance, and he's blown it.
Find one of the renown resurfacing docs, send him your x-ray, and tell him your story. He might recommend operating again, in which case the metal ion issue will go away, and, more importantly, you'll have an overall more successful outcome.
Do not wait.
Hi Bill,
I would be very surprised if x-rays were not taken right after surgery. I think that it would be valuable to call ahead and make sure that these are available at your appointment, so that they can be compared to the new x-rays. Whoever you talk to in the future, it will be critical to know whether the cup is still where it was originally placed, or whether it has moved. From there, just get some opinions from Drs that you have a lot of trust in.
For what it is worth, I have had three different procedures done on my hip over the years. One that was done earlier this year, was a total disaster. It was after that event that I went to Dr. Gross, and his surgery has put me back on the positive track. I now look back on the previous experience with the other Dr. as an unfortunate side trip, not a dead end.
I am sure that you will find a way to feel that you are on track.
John
Hey Bill,
Sorry that you were right about the diagnosis.
This is my opinion, take it for what it is, I am not medically trained, but if you're having pain to me it's obvious that it's an impingment issue or something related to how your cup is seated. I would get those x-rays (the originals), ask for them on a CD if possible, tell them that you are getting a 2nd opinion.
As far as the metal ion issue, Dr. Gross has a good whitepaper on it. http://www.grossortho.com/forms/MetalIonWhitePaper.pdf
I'm sorry that it did not turn out correctly, but that does not mean you won't be perfect soon. Be the best patient advocate for yourself. Find a doctor with experience that lives close to you and get a 2nd look.
Chuck
Quote from: B.I.L.L. on December 03, 2008, 12:40:49 PM
Got a message from my Dr. on my cell phone (he's never sent an e-mail, always a call on my cell with a restricted #, I was in the shower and missed the call). Anyway he said yes the angle is much steeper than he prefers, "It thought it looked ok after surgery but the last x-rays show the cup angle being very steep" "We can wait an see if there are problems 6 months down the road" F-that, if its wrong I'd rather not waste another 6 months wondering. I'm not 100% sure there are x-rays from right after surgery, I got the impression the x-rays at 6 1/2 weeks are the only post op x-rays. I have an appointment with him to get new x-rays and I will have my digital camera with me and post them here when I get them, as well as get 3 or 4 other doctors opinions. Awesome huh ?? Right about now I wish I still had the original eguipment..... If you are new in here and haven't had surgery yet, LISTEN TO PAT AND USE ONE OF THE DOCTORS ON HER LIST. Thats all I got, later, Bill.
Oh I do have one question, I can't seem to find exactly what are the downsides to high metal ions in the blood ? Does it lead to loosening of the components ? General health issues or what ? Just curious. I googled metalosis and all it has is some lame video that shows some guy turning into the terminator. What do the metal ions actually do ?
I'm gonna have to weigh my options, thanks.
Hi Bill
Proper placement of the acetabular cup is one of the most difficult problems in resurfacing. You are correct in encouraging people to use the really experineced surgeons.
The high metal ions can cause a number of problems from pseudo tumors, to metallosis which is high wear if the bearing with the generation of lots of metal wear particles. It is usually a result of sub-optimal component positioning.
You can get fluid build up making it seem like an allergic reaction or just pain. I saw videos of surgeries removing hip resurfacing devices which had the allergic reaction. There was an ugly mess of dark black tissue all around many areas of the hip. Some called them pseudo tumors. The surgoen would not want to leave that kind of tissue in your body and would do a revision if they suspected such problems. Very high levels on metal ions in the blood will usually make the surgeon suspicious. There are not many very good reliable blood test developed yet to test metal ions. That seems to be one of the biggest problems.
I have a handful of stories of people with metal allergies requiring revisions here http://www.surfacehippy.info/hipresurfacingproblems.php (http://www.surfacehippy.info/hipresurfacingproblems.php)
I would guess you surgeon would try a blood test if he suspected problems if he can find a lab that can do a decent job of it. People have problems and don't have pain. Dr. De Smet and other surgeons were talking about it at the LA resurfacing conference. Only the blood test tells them there is a problem. Dr. De Smet said the only way to have peace of mind is to know you used a really good surgeon who placed the acetabular cup properly. Years ago patients thought the femur neck fractures were going to be the big problem, now it has turned out to be loose or improperly placed acetabular cups.
Normally they take x-rays right after surgery so they can see the placement of the hip device.
Wish I could help you more, but don't know what else to say at this point. See what your surgeon has to say.
Pat
Thanks for the encouraging words you guys ! My appt. is next thursday the 11th. I keep you guys up to date and will post the X-Rays when I get them.
Hi BILL
Well....sorry to hear your news but it is good that your doctor called you and is giving you some attention.
Here are some thoughts....It sounds like you are recovering well but slowly. My surgery was Sep 19 07 and I was not really physically confident until Christmas. Now my hip is great. Some of the discussion around metal ions at the course Pat went to in LA were because of me, as my surgeon was there delivering a paper and asked a few colleagues their opinions. Everyone had a different take on the angle and metal ion issue. The only surgeon who said he would redo the surgery based on the ions and xrays and not based on pain, said he would do it only if the angle was 70 degrees or more. My angle as measured by my doctor is 59 degrees.
Can you find out what your angle is?
RE: the metal ions. Pat is right, nobody knows much about this. I went to Dr. Gross's link and the problem I have with it is the same problem I have with all the "don't worry about the ions" articles. These papers never talk about those of us who have high ions - the outliers. It is hard to get accurate tests, and very confusing as all over the world different units of measurement are used. I am hoping that 10 times tiny is still tiny. The lack of information is because all that is known about metal in the body is from industrial applications, ie inhaled metals. And so most of the problems are lung related.
So maybe there is no problem. Wouldn't that be nice. I'm in denial right now......next test for me is in Jan.
best,
Nancy
I read an article where Dr. DeSmet's comparied the BHR device to the Conserve Plus device. At the end of the article, he summarizes the problems with sockets placed greater than 50 degrees for the BHR device.
Nancy,
I think Bill's problem is two fold , one is the possible ion issue, but the major problem is that is that he is having pain down the right side of his leg. The pain that Bill was having was the major concern. The angle issue was found because he was investigating the possible reason why. The ion issue came up post-pain.
Chuck
Quote from: woodway2 on December 03, 2008, 11:31:20 PM
Hi BILL
Well....sorry to hear your news but it is good that your doctor called you and is giving you some attention.
Here are some thoughts....It sounds like you are recovering well but slowly. My surgery was Sep 19 07 and I was not really physically confident until Christmas. Now my hip is great. Some of the discussion around metal ions at the course Pat went to in LA were because of me, as my surgeon was there delivering a paper and asked a few colleagues their opinions. Everyone had a different take on the angle and metal ion issue. The only surgeon who said he would redo the surgery based on the ions and xrays and not based on pain, said he would do it only if the angle was 70 degrees or more. My angle as measured by my doctor is 59 degrees.
Can you find out what your angle is?
RE: the metal ions. Pat is right, nobody knows much about this. I went to Dr. Gross's link and the problem I have with it is the same problem I have with all the "don't worry about the ions" articles. These papers never talk about those of us who have high ions - the outliers. It is hard to get accurate tests, and very confusing as all over the world different units of measurement are used. I am hoping that 10 times tiny is still tiny. The lack of information is because all that is known about metal in the body is from industrial applications, ie inhaled metals. And so most of the problems are lung related.
So maybe there is no problem. Wouldn't that be nice. I'm in denial right now......next test for me is in Jan.
best,
Nancy
Hi Nancy
Your message is right on. One reason I have not written an article about the metal ion issue discussed at the hip resurfacing meeting is - there seems to be no concrete information. THere is a lot of thought about metal ions and the possible problems - but few studies. There are also no good blood tests developed that give good consistent results. Not many labs do the blood tests and from what I understand the ones that do don't do it the same way. There is no industry standard. The final concern is that the doctors and researchers just don't know what to make of the results of the blood tests. There are no guidlines for what are HIGH ion levels.
The researchers and doctors need to do much more study about the metal ion issue. Some suspect it could be a big problem, yet they have very little evidence to go on. Dr. De Smet will opt to do a revision if he finds the metal ions are very high from the blood tests he gets overseas. I saw the inside of the hip showing the ugly black tissue around a hip with an allergic reaction. It was downright ugly. The surgeon had to remove all the black tissue. I am assuming it could cause a lot of problems or even become cancer - no one said what would happen long term except it should not be left inside a person.
So the above would have been my article - no one seems to know much about metal ions and what to do about them if they exists and if they cause problems. I think this was a complication that no one was thinking much about early on and now it is becoming more of a concern. The cups placed at wrong angles seem to be much of the cause of the problem according to the discussions. Again, there are no medical studies indicating that yet.
We are all pioneers with a new type of hip replacement. On the whole, I think all the resurfacing surgeons are very optimistic about the proceedure, but understand they have not yet learned everything about hip resurfacing and metal ions.
Pat
Hi BILL and Pat -
Thanks for that answer Pat. BILL, I got the impression your recovery had turned a corner. Sorry if it is not going as well as I thought. I do hope this resolves well for you. I forgot to mention something re: the ions. that in most normal resurfacers the levels are much reduced after the wear in period of up to 3 years. So my own plan, as my hip feels great, is to wait out the 3 years and see if the metal levels reduce, and if not, address the issue again. Perhaps ask for a biopsy if that's possible to check for the black tissue.
I have an appointment with my doc in early Feb after he has shown my rays at a resurfacing conference in January.
One interesting thing - When I was at the height of my anxiety I sent a lot of emails around. One was forwarded to the researchers at BHR in England. I received a note saying they would be interested in sending for my blood and xrays to look at and test for themselves with their own equipment. But when I wrote to say OK, I never heard from them.
Hey all, ok here we go. My hip is working better and better everyday, the pain is subsiding even though it is still there, so I feel like I have definately turned a corner in that respect. I am off the cane as of the last 2-3 days but still have pain after walking for more than 20-30 minutes, even though it is not extreme pain it is enough to make me limp and head for the pain meds. My ROM is getting better as well.
I guess I really won't know until I have x-rays in hand and 2 or 3 opinions from other doctors what the call will be. I am thinking ahead 3 to 6 months, do I want to be 6 months out and wondering ?, or in 6 months would I rather be 3 months out with a correctly placed cup ? In the grand scheme of life I gotta think I'd rather know its right.
My hip is going to get put through the ringer as far as use and wear and tear. I am a self employed poolman wich means I am on my feet and knees all day, carrying a heavy toolbox or equipment in and out of yards all day long, and getting in and out of the truck 30 plus times a day easy. Plus I plan on surfing and riding my dirt bike until I no longer can, (hopefully a long time from now). So its not like I'm going to be in an office and up and about a few times a day, I am on my feet from the minute I get up until I go to bed. So for me I am concerned with wear, and would be even if the cup was perfect, but I know its rubbing on the edge of the cup, because there is no way it can't be, no way.
I won't have an exact number of what degree my angle is until I get the actual x-rays and measure it I supose, but I know from looking at the pics of the x-ray I do have that the angle is close to 67 degrees or more. If straight up and down is 90 degrees, and 1/2 way is 45, mine looks to be 1/2 way between 45 and 90, maybe even a little more. If you figure where the very top of the ball is, the cup barely goes past that, like if you were to tug on my leg from the side, the cup would offer little if any resistance in that direction. I'm probably over explaining it, just picture the steepest x-ray youv'e seen browsing through all these sights, thats about where were at. I know this is a long post so thanks for caring if your still tuned in at this point Ha Ha.
(Don't worry my spirits and sense of humor are still intact 8))
So I meet with the doctor next thursday, here is my list of questions so far, feel free to give me any more, I'm all ears trust me.
Do you personally believe it should be redone ?
Have you ever done a cup revision before ? If so how many ? and why ?
If I do a revision is it a thicker cup due to bone loss when they pop out the old one, or is it the same cup just repositioned ?
How many muscles are cut to reach the cup/pelvis , will it be less than the original operation or will I truly be at square one rehab wise ?
Why in the world would you tell me the x-rays "Looked fine" until I brought it to your attention ? Then tell me yes its steeper than I prefer ? Is it really my job to know this stuff ?
Do you have other cups as steep as mine ? If so how are they doing ?
Can I have their phone numbers ?
Does Kaiser have a way to test my blood for metal ?
If a radically steep cup needs revision, isn't it better to do it ASAP ?
(according to Dr. DeSmet it is)
What would you do if it was YOUR HIP?
Then I guess I need to decide if I want him back in there at all, another Kaiser Dr. or out of my pocket (wich I don't have, so not sure how that could work) for one of the more well known doctors ?
Anyway lots too think about, I gotta go try and make some money, talk to you guys later and thanks for reading this if you made it this far ha ha, Have a good day, Bill
I would just tell this doctor that you want the problem fixed. I wouldn't ask him for his opinion. Maybe I'm cynical, but I think that since he made this mistake, he's bound to try to minimize it, even if it's at your expense.
The implants can probably be saved as long as you act quickly. Six months from now they might have started to wear in an odd pattern which makes them harder to salvage.
Ask him what instruments or surgical guides he has to ensure that the reoriented cup will be correctly placed and you won't have this problem again. Before you let him operate again, make sure you are satisfied that he won't screw it up. If you're the least bit suspicious, or if he seems to be acting out of self interest rather than an interest in your health, say "thanks but no thanks" and try to find a doc who gives you better answers.
In theory, this corrective surgery should be cheaper than the first since no new implants will (probably) be needed. Surgical time should be much shorter.
If you're satisfied that this doctor is qualified to repair this, you might want to talk with him about reducing his fee since you believe this condition was caused by his surgical error.
Hi Bill and gang
This revision stuff is very serious business. If a surgeon did not place a acetabular cup properly the first time - there is no guarantee he will do it right the second time.
If the device is not properly place for either component - there is no guarantee it can be saved at all. These are very difficult surgeries and the components are not easily changed.
I just want everyone to understand that. If the femur cap has any placement problems - it can never be replaced, only a THR can be done.
What makes sense to us a laymen - does not make sense medically. Hip resurfacing is a difficult surgical skill and can't just be tweaked as you do an adjustable mechanical device.
Just wanted to add some input here. I hope to have an indepth surgical video available soon and once you see it, you will reallize how much skill is required to place the components properly. It is an art as much as a learned skill.
Pat
Bill,
Check out Jane's BHR Revision to a THR. Click on "Hip resurfacing problems post-op" on the home page of this website. What a disaster. I met Jane at the HSS. She successfully had a ceramic THR replaced by Dr. Su.
Hi BILL,
A couple days ago I promised an xray of my RBHR after my 2 week follow-up. Unfortunately (I guess) they did not take an xray at this point. In fact I haven't seen any xray of my new hardware yet.
I'm sure glad to see you've had some progress of late. However, I sure feel for you. You have had a rough recovery and may even need to do much of it all over again. I'll try to send good vibes your way.
JohnS
Quote from: JohnS on December 05, 2008, 03:22:38 PM
Hi BILL,
A couple days ago I promised an xray of my RBHR after my 2 week follow-up. Unfortunately (I guess) they did not take an xray at this point. In fact I haven't seen any xray of my new hardware yet.
I'm sure glad to see you've had some progress of late. However, I sure feel for you. You have had a rough recovery and may even need to do much of it all over again. I'll try to send good vibes your way.
JohnS
Thanks JohnS ! I feel the love around here for sure ha ha. :D :D I hope your recovery goes butter smooth and you can get an eye on your x-rays soon. Thanks again and Best of luck to you 8)
OK here are the x-rays. They didn't have them on a disc so I hung them no the slider and took pics so the quality aint that great but you can get an idea of why I'm concerned.
(http://i188.photobucket.com/albums/z263/kelley124_photos/6monthreturntiger139.jpg)
(http://i188.photobucket.com/albums/z263/kelley124_photos/6monthreturntiger140.jpg)
(http://i188.photobucket.com/albums/z263/kelley124_photos/6monthreturntiger143.jpg)
:o ::) Kinda looks more like the bad examples than the good examples huh ? I feel like I wanted my body to run like a Ferrari but somehow wound up with Hyundai mechanic..... ::) I had about 20 questions for the doctor, his opinion is a revision has too many downsides and to just move on and "Keep an eye on it". But don't know what to keep an eye on because he says Kaiser does not have any good tests for metal ions, but they are working on subbing them out to an outside independent testing lab. A cup revision is only possible if he used the thinner of the 2 cups available, at the time of our meeting he did not know wich thickness he put in........(no comment ::) There is no reason to even think about a revision until I find out wich cup was used. The good news is that it's starting to work better and better so I am encouraged there !! I am going to get a couple other opinions but am finally feeling like it's going to be ok and my life is getting back to normal. I will keep you posted, Thanks again for all your concern, Bill.
Hey Bill,
Thanks for posting the x-rays. One positive sign - the joint looks better for the cross table lateral view, when the hip is abducted. That means you are better aligned for bull riding, bronco busting or motocross (if you have a wide motocycle seat) :).
Hi Bill
Nancy here with the 59 degree angle. Just wanted to say I'm glad you are still progressing. I too have been busy. I am a potter - standing all day with much lifting and heavy kiln work. I took a year off work because of my arthritis and then BHR. Just had my Christmas season show and sale and it went really well. I haven't worked so hard for years. Now everything else hurts - my shoulder, elbow, back etc. BUT NOT MY HIP!
My anxieties are still there re: the angle and the metal ions, but the hip works so well I think it would be crazy to redo it at this point. I will continue to monitor with my doctor. Next appointment and blood results in Feb.
Re: blood tests - the blood lab at your hospital probably knows where to send your blood for chromium and cobalt analysis. Mine is sent to another city where the university has a research lab.
Quote from: woodway2 on December 16, 2008, 05:32:41 PM
Hi Bill
Nancy here with the 59 degree angle. Just wanted to say I'm glad you are still progressing. I too have been busy. I am a potter - standing all day with much lifting and heavy kiln work. I took a year off work because of my arthritis and then BHR. Just had my Christmas season show and sale and it went really well. I haven't worked so hard for years. Now everything else hurts - my shoulder, elbow, back etc. BUT NOT MY HIP!
My anxieties are still there re: the angle and the metal ions, but the hip works so well I think it would be crazy to redo it at this point. I will continue to monitor with my doctor. Next appointment and blood results in Feb.
Re: blood tests - the blood lab at your hospital probably knows where to send your blood for chromium and cobalt analysis. Mine is sent to another city where the university has a research lab.
Thanks Nancy, glad you are doing well ! I got an E-mail back from Dr. DeSmet to day and he said as long as it wasn't wearing excessively it should be fine. So thats 1 vote to leave it and just watch it for awhile 8) I meet with another kaiser doc 1-9-09. So we will get 2 or 3 other opinions and I hope they say the same. But it is looking good at this point and working better. My main concern is if it starts to show pre-mature wear I want to fix it before the femoral part is beyond hope. But having a 2nd opinion say to wait and see definately eases my mind. And stevel my bike is pretty narrow but am looking forward to lots of fun activitys with my legs spread apart. ;D
Get your mind out of the gutter !!!
I meant it should be good for sitting on a surfboard and bodysurfing as well 8)