Advice/support

[Johng]

Hi All,    I am a Dr. DeSmet patient.. bilateral, almost a year post op. I have been consulting an ortho here in Ontario in person. as well as Dr. DeSmet.  I still have a lot of leg pain which the doc thinks is caused by a bulging disk in my lower back. The back may be grumpy because my gait is uneven. my gait may be off because the cups could be moving. (maybe not) I just had an xray which shows that the bone has not grown around the edge of the cup. There is a 1 mm space around the cup where bone should be attaching itself. At 11 months this seems like bad news. The doc told me we will xray again in 6 months to see if the metal cup is wearing/rubbing the bone. He also said the Conserve Plus is known for not promoting bone attachment (???).  I asked him if it was still possible for the bone to take hold. He just shrugged. I am feeling pretty nervous. Hoping the bone might attach itself in time. If it doesn't wondering if it can be revised or if I will have to have THR? I am going to send Dr. DeSmet my xray and ask him about bone attachment and future options. I will post to the group and see if anyone has had a similar experience. Any advice appreciated . Best regards,  John

[catfriend]

Bummer if the HR isn't working out for you :-[ A resurfacing revision doesn't necessarily have to be revised to a THR. I suspect only a limited number of surgeon perform HR/HR revisions, and you'll probably need to look around. Dr. Pritichett (Seattle) does them. Here is a link to a scholarly journal article he wrote on this very topic: http://www.pritchettorthopedics.com/articles/resurfacing_revision.pdf  The reason for these revisions was metal wear debris, but as you can see he does them. Dr. P http://seattlejointsurgeon.com/

Air Canada flies nonstop daily between Seattle and Toronto :D

[Johng]

Thanks. I am hoping that the bone will attach. If not, onward. I have heard good things about Pritchett. Best regards, John

[vonhouser]

I believe catfriend is correct, you can sometimes revise just the cup. I've never heard of the Conserve having this issue.


You might also consider Dr. Su. He's in NYC which I would think would be closer, and I know he's done some training with Dr. De Smet, so they could consult.


I'm so sorry you are in pain!

[blinky]

I am sorry to hear you are having problems.


Absolutely gather some opinions about what is going on and what can be done. Talk to local guys, but also consult with docs who do revisions, especially those who can save your resurf.

[Pat Walter]

Hi John

I am sorry to hear you are having problems.  I definitely would ask Dr. De Smet about why there has not been much growth into the cup surface.  Also what he would suggest you do.  I would definitely talk to him before making any other decisions.  I do think a very few have had just an acetabularrevised. I think Dr. Su and Dr. Pritchett are two that have done that. I would make sure I would email other surgeons and ask their opinion too.  Best to have as much info as possible before making any decisions.

Pat

[Johng]

Hi All, Dr. Pritchett has advised me to "give it time" unless the bloodwork shows a problem. So...the question I am left with is at 11 months post op is it still possible for the bone to attach itself to the cup(1mm gap)? If not, is there some means of revision, some way to cement the bone to the metal cup? Still waiting to hear from Dr. DeSmet who is the expert on Conserve Plus. Thanks for your support. John

[vonhouser]

I wonder if platelet rich plasma might be an option to help the bone growth. I know Dr Gross does it as part of the surgery....

[catfriend]

It sounds like you need to ask Dr. P some follow up questions. How much time are you supposed to give it? Can the bone still grow into the device? It it only considered a problem if it causes you issues? Re: your cementing idea, is that a possibility? Would that work? It would require surgery. If having an additional surgery, what is your best option? Are there any studies on late bone growth, esp. with the Conserve+? I think you need to keep pushing. Have you heard from Dr. DeSmet yet? If so, what's his take?

[Johng]

I have not heard back from Dr. DeSmet. Thanks for helping me shape the conversation. I was somewhat shocked to hear that the bone is not yet attached itself. I will look into Dr Brooks bone growth technique and keep pushing for the full picture. Your support means a lot. john

[horse doc]

in comparing your xrays, does it look to you like the cup has shifted?  Were and are the cups still symmetrical?

[Johng]

Hi Horse Doc, nothing appears to have shifted, cups appear to be symmetrical. The bone is one mm from the edge of both cups, even gaps.

[karlos.bell]

 :) 8) Hi Johng. the edge of the cup?? if the bone was not attaching I assume you would have massive amounts of issues. There is a proper test that they do and that injects radioactive into your body and they put you through a scanner this is what you need I assume. It shows up all the new bone. I doubt whether the conserve plus does not promote bone growth idea this is without facts ask him (your doc) to prove this. Or change your Doc.
Leg pain can definitely be caused by bulging discs at L4 - L5 L5 - S1 the normal. You have got some hard work ahead of you to figure it out rather than guessing.
My advice as you do not specify age is to look at the western diet as well. It is massively poor in proving nutritional value to aid you in promoting bone growth and low order inflammation.
Wheat and grains for example contain phytates and lectins these are anti nutritional foods that will not allow absorption of good minerals from green leafy vegetables which are the building blocks and importation of calcium.
Leg pain can also be a lot of issues especially with old crook worn hips on a western diet the muscles contract and compensate for all issues especially bilateral. Can also be muscular.
My first stop would be the bone scan. Next would be diet crack on with that rather than the knife again, then if some improvements start some exercise. Then again diet, exercise get that blood circulating.
If the cups have not moved I doubt it whether there is a major issue with this that is causing the pain that is only my opinion as there are so many other factors to look at. 8)
Hope this helps Cheers K

[Johng]

Hi Karlos, Thanks for the time and thought you've given my posts. I am 53 and my diet is whole foods. I have been told by my PT that slipping cups would cause exteme pain. I will definitely explore dietary adjustments to max calcium uptake...thanks. I hope the bone will ingrow over time. I will ask Dr Desmet about bone scans . I am still waiting to get Dr Desmet's interpretation of my X-rays . Much appreciated Karlos!

[horse doc]

Is there a thread here pertaining to what an optimum post surgical diet would look like?   I'm pretty sure my diet is far from ideal, might as well do everything thing I can to help my implant etc.

I wonder if Fosamax would help or hurt your cup ingrowth issues

[karlos.bell]

 :) Thanks John. Books I have read many books and had many issues.
The 2 I found the best information and will work with any situation with scientific facts is by your author Loren Cordain. The Paleo Diet and The Paleo Answer. It would only be my opinion with no scientific evidence that a bone and cartilage disorder - disease could be attributed to what we eat as we are not all the same. Absorption of certain minerals cannot be absorbed due to our western diet. IE. Zinc.

I would not be worried about the 1mm gap I am assuming that this is on the edge of the cup. It may never grow but I would be concerned if the cup was not bonding to the bone now and for the future. The device relies on your bone density and therefore your health to keep it well. And the same for all other joints in our body. Pict of mine is attached I do not know what the difference is?

Grains, wheat, dairy, salt, sugar, beans,High lectin producing vegetables in these books scientifically  have been proven by this scientist to be non beneficial for some if not all persons and do create disease in others and some cultures are rife in it.

So whole foods? specifically I understand but some whole foods I would not touch now. I have now completed 4 1/2 marathons in 4 months getting the strength back in my hips due to the FAI and cartilage issues, but overall I am heaps better. I would not attribute this just to my hip change. I am no gold medal winner but life itself is a hell of a lot better and I am now beginning to enjoy it so be the diet but its simple.
My wife still has not got her head around it but she has seen me run an that in itself is amazing for her due I was on crutches for 8 years.
Be honest its not really a diet just plain simple stuff and we over complicate eating habits and foods.

My advice Horse Doc is read those 2 books get out of it what you can, give it a crack and there is no thread or link to the internet on the ideal diet.....? wow now that would be cool. What I can tell you though I am now jumping 2 feet both legs up and down on a box. I can jump and land over a 3 1/2 - 4 foot fence (hands first so that is cool) so if my hips are not bonded in by now I would be in deep pooh.

Those books now are getting harder to get so probably for under 100$ I would get them regardless as they have now saved me and given me back some health I had lost.
I am 51 as well. Good luck.

Cheers K

[vonhouser]

I am also a big fan of the paleo diet, although I do sometimes incorporate gluten free grains, but I try to really limit them. Sugar as well, I have it sometimes but am cautious.


Another resource you might like is Chris Kresser. Not strictly paleo, but close. Lately he focuses a ton on gut health, but read some of his older stuff too. I like his scientific approach.


Also Mark Sisson has some good stuff. Again, not as strictly paleo as Cordain, I think he is ok with dairy or at least says try it and if it doesn't bother you include it.


I think the important thing is to try different approaches and find something that helps you personally to look, feel, and perform better.


Totally agree with Karlos that the standard american diet (or standard western diet, but the U.S. version is the worst) is very inflammatory.


You also might consider bone broth...

[Johng]

Thanks I will check out these sources. I hope you are doing well post-surgery. I had great care under Dr. DeSmet; don't miss Belgian hospital cuisine though.

[Johng]

Hey Karlos, A local Dr. who has some experience with HR and has kindly agreed to do my physical exams.  He has looked at my last xray, seen the I mm gap at the edge of the cup and said it may indicate loosening. Dr DeSmet has not replied to me yet. Wondering if you could elaborate on the 1 mm gap not being a worry and the cup not bonding to the bone now and for the future. Thanks again. John

[blinky]

For horsedoc:


My husband was in charge of meals for a few weeks post op, so I tried to eat to heal, but had to keep it simple. I ate protein at every meal, lots of eggs, fish, and lean meats. I was on iron pills to get my heme back up, but if I had not been, I would have sought out red meat and liver to get those iron levels back up. I ate lots of fruits and vegetables. Those were important for vitamins, but even more important for fiber! My appetite wasn't too good at first, so I tried to eat the protein first then the fruits and veggies. As I felt hungrier I added other foods. For me that meant yogurt and cheese.


As time went on and I got hungrier and more active, not to mention more independent, I started eating peanut butter smeared on apples or whole wheat toast or veggies dipped in hummus. Those foods were easy for me to get myself and helped tide me over if I got hungry between meals.


My son brought me Thai food from his job, especially seafood soups.