Collagen Disorder + DJD + Congenital Hip + Trauma = Possible Resurfacing?

[MNHippyChick]

Hey everyone -- what a great place for information.  I am seeing the surgeon tomorrow and am hoping that he'll do a resurfacing surgery in the near future. 

A quick summary of my ortho history is:

   
• Congenital Hip Dysplasia - my entire right hip was not formed; not dislocated NOT FORMED
• Ehlers Danlos Syndrome, Type 3 (faulty collagen production); I am extremely flexible and hypermobile
• Degenerative Arthritis bilaterally
• Coxa Profunda bilaterally
• Bilateral Spldylolysis at L3
• L3-4 Disc Bulge
• Anterolisthsis L3 on L4
• L5-S1 DDD; HIZ right posterior aspect of disc
• Spina Bifida Occulta

So that's a brief look at what is going on lumbar spine through the pelvis. The same types of issues are seen throughout my thoracic and cervical spine.



Most recent imaging shows:

   
• Labral tear of the anterior aspect of the anterosuperior labrum
• Full-thickness chondral defect posterosuperior femoral head

So, on top of all of this I had a right hip arthroscopy s/p downhill skiing accident involving a dislocation of my right hip + 7 broken bones; labral tear found and debridement done in 1998.  Most recently have been receiving hip injections with lessening results with each injection.
My question is based on the options for the repair of the labrum and chondral lesions -- I can't realistically have a procedure that will facilitate regrowth of cartilage, since my body only produces faulty collagen.  With the bone issues -- it's likely the recent tears are from structure rather than trauma --

I'm hoping for the bone-sparing joint resurfacing for many reasons, those of you that have experience or similar issues as me -- what procedures have you had and what were your outcomes?


I guess I should add that I am, or was, a quite active, smaller frame female, age 40... I've read the recommendations for having a joint resurfacing done in women -- BUT, I don't want to give up that much of my femur quite yet if I don't have to :)

Thanks!

[Pat Walter]

Hi. Welcome to Hip Talk.  I am sorry about the problems you have and had with your hips. It sounds very complicated.

I would suggest to start to email some of the top hip resurfacing surgeons and attaching a x-ray to see what they suggest. 

Since you are a female, you choices in the US a fewer than they use to be.  Dr. Pritchett, Dr. Gross and possibly Dr. Su are  you main choices for hip resurfacing. Dr. Rogerson is closer to you, but does not do women any longer.  He would still be a great source to see what is involved with a hip replacement.  I am not a doctor, but with the complicated problems you have, I think it could be possible that they would suggest a THR.  You might still want input from the hip resurfacing surgeons before you considered a THR.  With your complicated problems, I would make sure that any surgeon you use is very, very experienced. The hip resurfacing surgeons are very experienced since hip resurfacing is a much more difficult surgery than a THR.  So they are an excellent source of information even if you can't have a hip resurfacing.

I wish you the very best in finding a solution to your hip problems.

Pat

[karlos.bell]

 :) Hi Hippy Chick. yep sounds like you have some stuff. Yep one can understand it if they go through it. Does any of the other stuff cause you pain??? if so what is the biggest issue?? Your hips or your back?

From looking around there is less  era in a person with Dysplasia and if your small frame it is even harder so I am not sure which one you would be.

Not sure how you would approach a Doc with the list I would be cautious about that and only look at the resurfacing.

Cheers K

[Dessay]

Hi Hippy Chick-


I'm in a similar situation, perhaps not as serious, though. I am hypermobile. I have not been tested for EDS, but my Beighton Criteria score is 7, which is very high and could indicate EDS. I don't have any back problems, but I do have mild dysplasia in both hips and poor cartilage quality on both sides. I did have 2 large subchondral cysts on my right hip that precluded the possibility of my having a successful PAO. I was pretty devastated when I found that out- I wanted so badly to keep my hips if I could.


They don't do arthroscopy on patients like us- it only destabilizes our hips even further. Any ethical surgeon would say no to that right away because they know it doesn't work. If you have a surgeon offer to do arthroscopy on dysplastic hips, run away. Far away. 


I had a right hip resurfacing with Dr. Gross on March 30th. I have osteopenia at 42, perhaps in part because of being hypermobile and not having great collagen. So I am on the slow recovery program- crutches for 2 months and a cane for another month after that and big time restrictions with walking and activity until 6 months. So far, my hip feels fabulous and has since the moment I woke up in recovery. But I have not put much weight on it yet, and won't for some time, so I can't report any success stories yet. But I am similar to you, and have had good results so far. It's REALLY frustrating having to crutch around for so long, but I'm determined to have a good result, so I'm going to do this right.


Dr. Su uses the BHR and won't do smaller femoral sizes, so don't waste your time sending him your films. You have 2 choices- Dr. Gross here in the states and Dr. DeSmet in Belgium.


You have some confounding factors, but Dr. Gross kind of likes the challenge, and he's very well-researched- hips and knees are all he does, and he's a resurfacing specialist. He's done over 500 women with dysplastic hips and is undeterred by that aspect. He's probably your best bet. Send him your films and see!


Best of luck to you!
Cara

[catfriend]

Dessay13 (and MNHippyChick) As Pat mentioned in her response, Dr. Pritchett (Seattle) is also an option (as well as Drs. Gross and and DeSmet). He does resurfacings on women, and plans to continue doing so. He did my right hip and January, is willing to do my left when it fails in a couple of years (or whenever, since one never really knows). He does do out of state patients, and welcomes complex cases. You might check out his website and consider him for a consultation.

[blinky]

Hey MNHippy Chick!


Send your X-rays off to one of the docs listed and see what he says. Even if you get a no, you can ask about what you should do, what you should think about going forward. With such a complicated case, it wouldn't hurt to get a second opinion.


How did the meeting with the surgeon you spoke to in early May go?


Dessay, how are you doing?