Resurfacing and hypermobility?

[whyme]

Hi,

This is my first post 
I'm a 46 year old male, and will need a hip resurfacing this year. The arthritis in my case is apparently due to the combination of three factors: developmental dysplasia (mild I guess), femoroacetabular impingment (FAI) and joint hypermobility.
This process was accelerated (inadvertently) by practicing sports all my life (swimming, then basketball, mountaineering / climbing, running, cycling, and lately back to swimming -the most forgiving of them all-), until I found out about the arthritis 5 years ago. I've had a hard time accepting this...
Fortunately, as I'm a light weight (62 kg), I kept going for longer than my bad mechanics would have suggested.

The first two factors (dysplasia and FAI) are probably quite common among us "hippies", but hypermobility is a little bit unusual, even for the general population.
Only 2 years ago I found out that some rhematologists in consider the joint hypermobility syndrome as a mild version (i.e. not life threatening) of the Ehler-Danlos syndrome, in particular type III. As this is a connective tissue disorder, it affects not only tendons and muscles but also skin, veins and organs.
In my case I've noticed for many years poor scarring, soft skin (easier to break), slightly fragile veins, bleeding that tends to keep going for a little longer, being prone to suffer muscle and tendon injuries and overload, so this was an eye opener.

Maybe someone in this forum has experienced something similar, or might know if hypermobility could have any effect (positive or negative) on the outcome of a resurfacing procedure. My surgeon (Dr. Ribas, Barcelona) plays it down and is very optimistic, and I wouldn't disagree with him, but having a bit of reassurance surely wouldn't harm, particularly if it's backed up with data / statistics 

This is a great forum, fantastic support. Thanks for reading!

[imgetinold]

Hi Pablo.

I know nothing of hypermobility, but there are several of the most experienced doctors that will do a free phone consultation.  Dr. Bose in India is one.  Dr. Gross from Columbia, SC, USA is another.  If anyone would be able to give a second opinion, they will

Good luck!

[Tin Soldier]

I'm with Imgetin.  I know nothing, yet some of the really surgeons might have some expereince with this.  From a really gross level, it seems to me that if hypermobility doesn't affect bone density, then it might not play much into the long term success of HR or THR for that matter.   If its an issue that remains mostly in the soft tissue world, then maybe all you need to worry about is the surgery and initial recovery.  I said "all you need to worry about", that sounds kind of stupid.  Surgery is a big deal.  Anyway, I'm probabaly not helping much, just yammering on.  I haven't heard much about joint hypermobility here much. 

Hope you get some answers. 

[Dee Dee]

Pablo,

Awhile back when I was looking for answers about my hip and back pain I asked my general dr if I coud have Ehlers-danlos iii and he said it was not definitive.  My physical therapist says I have hyper mobility. I can touch the floor with flat palms and straight legs.  I can bend my thumb to touch my arm.  I used to be able to "pop out" my right hip before the arhritis.  I dont have soft loose skin or bruise that easily, no bowel issues, or dislocations.  I did have some orthostatic intolerance(dizzy when i stand up quick) ever since i was little. So I am a mystery - not enough of the markers to be considered Ehlers-Danlos iii.

Since then I was diagnosed with degenerative disc, spondilolisthesis and mild hip dysplasia( which caused my hips to wear out).  I got my new hips and dr. Gross said I may never get my full range of motion back but that I should come close.  The shallow sockets of dysplasia gave me that flexibility. 

As far as my recovery,   I do not have pain free range of motion yet, but the weight bearing pain from arthritis is gone! With time and hard work I hope to get that flexibility back. 

I hope you get some answers concerning your condition. 

Dee

[whyme]

imgetinold (we all are) and Tin Soldier (I'll probably join your army soon),  ha ha good nicknames :-) .
Yes I'm trying to get a second opinion, we'll see how it goes.

There is risk of reduced bone density in some forms of E-D, but is not my case. I did a bone density scan recently and it was all good.
I was more thinking about ligaments / tendons laxity, and how it could affect the hip function after surgery.

Dee, you hit the nail...
I've a long history of sport injuries: plantar fasciitis, repetitive ankle sprain, achilles tendonitis, shin splints, calf strains, patellofemoral syndrome, knee pain, iliotibial band syndrome, throcanteritis, bursitis, hip pain, lower back pain, finger tendonitis, shoulders dislocation ... Most of these injures are common among athletes, what is uncommon is to have seen them all (but not at the same time!).

Two years ago by chance I heard about "connective tissue disorders", and googled a bit. I couldn't believe it! It joined all the dots... Not just the sport injuries, but A LOT of other stuff, "peculiarities" in my body that I was aware of but seemed unrelated.
I cried a lot and felt vindicated: people used to tease me suggesting I was exaggerating or making things up, there was always "something" bothering me... Since then I live much happier.
Here is my subset of symptoms extracted from the best article I found (I can send by PM or post if interested):

- History of recurrent musculo-skeletal problems (tendinitis, bursitis, recurrent sport injuries, frequent ankle sprains), joint pain (arthralgias), frequent cracking noises of the joints.
- Soft skin, lax, pale (permits to see the veins), poor cicatrisation, at times queloids, brown moles, prominent veins on the dorsum of the hands.
- Normal coagulation but prolonged bleeding time.
- Hypermobility of one or more joints, with pain, tendinitis, subluxations etc. Can extend the fingers backward, touch the forearm within the thumb, hypermobility of the wrist and hyperextension of the elbows, can touch the floor with the palm of the hands (not bending the knees).
- Back pain, hyperlordosis, laxity of spinal ligaments.
- Anxiety, poor memory, lack of concentration and lack of energy, at times cramps, poor response to inyectable analgesics, like by the dentist.
- Dysautonomia: chronic fatigue and sleepyness at times (like running out of batteries), cold intolerance (usually quite pronounced), dizziness (when standing up suddenly)
- Early osteoarthritis
- Fibromyalgia (recurrent pain, "trigger points")
- Congenital malformations: hip dysplasia, flat feet, egyptian foot (second toe is larger than the first), hallux valgus (when younger), rotated knees.

Regards,

Pablo

[whyme]

Hi,

Just an update on this, in case somebody in similar circumstances reads the thread and might be helpful to them. Eventually I contacted Dr. De Smet by email, for a second opinion and peace of mind, he was very kind to reply and quite confident that hypermobility shouldn't be a problem for resurfacing, at least not for the symptoms I described.
That gives me more confidence.

On a side note, he also said that the bad hip is now "ready" for the operation, as I had been told already. But De Smet did not agree with the proposed surgical approach (anterior) by my prospective surgeon (Dr. Ribas), and also disagrees about performing a preventative osteoplasty on the "good" hip as he thinks it is too late for that (i.e. it wouldn't extend it's lifespan in his opinion).
I'm happy that I contacted him and for being so frank and it's better to have a second opinion, but of course it will make my decision a bit more difficult.
I will try to learn more about the anterior approach and osteoplasty before committing to anything. I'm sure this has been already discussed here so I will check for posts on this on the website.

Pablo.

[hernanu]

Hi,

Just an update on this, in case somebody in similar circumstances reads the thread and might be helpful to them. Eventually I contacted Dr. De Smet by email, for a second opinion and peace of mind, he was very kind to reply and quite confident that hypermobility shouldn't be a problem for resurfacing, at least not for the symptoms I described.
That gives me more confidence.

Dr. De Smet is one of the best and most experienced in the world, the confidence is merited.

On a side note, he also said that the bad hip is now "ready" for the operation, as I had been told already. But De Smet did not agree with the proposed surgical approach (anterior) by my prospective surgeon (Dr. Ribas), and also disagrees about performing a preventative osteoplasty on the "good" hip as he thinks it is too late for that (i.e. it wouldn't extend it's lifespan in his opinion).
I'm happy that I contacted him and for being so frank and it's better to have a second opinion, but of course it will make my decision a bit more difficult.

I think you want to put it in context. The more information and opinions you get from excellent surgeons, the better your decision will be. One thing that is clear from the existing data on the success of HR's is that the skill of the surgeon is extremely important. That leads to selecting a good device, approach, etc.

I had a lateral approach, many people had others, I don't know of success statistics for approach, but there are known results for the top surgeons.

In my opinion, you choose the most experienced surgeon that fits your circumstances and go from there. Confidence in his or her skill has to be paramount.

I will try to learn more about the anterior approach and osteoplasty before committing to anything. I'm sure this has been already discussed here so I will check for posts on this on the website.

Pablo.

Good luck with your research, all of us went through this, and it is important for you to feel right about going forward.