Hi All:

I'm wondering if anyone has any comments on postop patient issues as related to inclination angle of the BHR cup?  Specifically, I have had concerns since surgery (now 9 weeks postop) that in addition to typical muscle healing weakness and anticipated soreness, I've felt an intermittent 'impingement' type sensation when I move my leg with even subtle angular changes such as putting on socks and shoes, getting in/out of car, turning in bed, etc.  Slight angle changes of my leg, especially adduction/rotation trigger this quick and sudden pain.  When I have the hip loaded such as walking and on the bike there's no pain; it's basically when the leg moves in certain positions and NOT loaded.  Turns out that on a plain xray and now a CT scan, the cup inclination angle is only 22 degrees.  The AP film clearly shows that the cup is rotated in the old acetabulum and not straight on with the femoral head aspect of the Smitha and Nephew device.  Everything I've read, including the S&N brochure talks about a planned and postop angle of 40-45 degrees.  So, I'm wondering if the rotated cup edge is impinging on a nerve or muscle as I make these slight movements with my leg.  Thanks for any wisdom anyone can provide!  Thanks, Ken

It would help if you discussed this with your surgeon, and also send your CT Scan and X-rays to an alternative surgeon for a second opinion. The gentlemen advertising on this website will welcome your approach.



Best wishes

Yes, that's exactly my plan, but I was wondering if anyone either personally encountered a low inclination angle and/or knew of a published reference on the topic as I can't seem to find one.  Thanks....

Hi KenLeftHip, take a look at this paper by Dr. Gross: https://www.grossortho.com/patient-education/scientific-publications?download=56:prevention-of-metallosis-in-hip-resurfacing-confirmation-of-the-rail-guideline-in-2466-cases

Dr. Gross goes into detail on why he follows the RAIL guideline for cup placement.

Hi BBhip: Thanks for the reference and I read through it just now.  The paper by Dr. Gross says, "We use 25 degrees as our lower limit to prevent impingement" with a reference to a very early paper (1996-1998 patients) by Gruen.  I pulled that paper too showing the lowest inclination angle of any of those 20 patients at about 22 degrees for only 1 patient; the other patients centered around 40 degrees.  Interesting that Dr. Gross makes that low inclination statement about impingement.
I saw my surgeon on Thursday and he acknowledged my pain as probable impingement related to a notch on the femoral neck and more the angle of the femoral head part of the implant, but we'll see what happens.  We're going to try a steroid/lidocaine injection into the psoas muscle just to see if that eliminates the pain, but I'm not holding out much hope.  We discussed the possibility of replacing the cup part of the implant with concerns that such a revision surgery may be difficult because of having to go with a larger cup size and mismatch with the femoral implant component.  If that were the case, an intraoperative decision to switch over to a traditional total hip replacement would be made.  Yikes!!! Ken