Paula’s Revision ASR to THR 2010
ALVAL, PSEUDOTUMOUR, HYPERSENSITIVITY … WHATEVER YOU CALL IT, IT’S A REVISION TO THR Having visited this site numerous times over the last few years, I thought it was time that I shared my experience with other past and future hip patients. I have recently undergone revision of my ASR to a THR because of a reaction to the metal on metal bearing. I know this issue is in the spotlight of the orthopedic hip community internationally just now as more patients emerge at the 3-5 year post-op mark with unique reactions. I am a female and was diagnosed with osteoarthritis in my left hip when I was 33 years old (I am now 42). At the time I was an amateur triathlete competing at local events but struggling to meet training goals because of pain. Once I had the diagnosis at least I knew the cause, and also knew that heavy use of anti-inflammatory eased the symptoms. Ultimately however, whether I was resting or training the pain continued. In addition to the OA, I had some bone spurs and when I was 35 I agreed to have the spurs removed (“femoro-acetabular debridement”) in the hope of alleviating impingement and delaying serious OA. My first major surgery. After 12 months it was apparent that the debridement was unsuccessful and in fact the OA had worsened to the point where I was ready for a resurfacing. My second major surgery. The resurfacing was wonderful in that it got me back to pain-free life; walking, sitting, sleeping, cycling. In fact I became a strong cyclist, riding over 100 km every Friday morning at a strong pace in our local peloton, and going on a number of international cycle-touring holidays. I kept trying to run – that was my ultimate dream. Once or twice over the years I managed to belt out 5 or 6 km, but usually I would start experiencing enough discomfort to make me walk after just a few hundred meters. I was still taking anti-inflammatory off and on for general aching in my left leg. Range of motion was definitely improved, although not to the point where I could, for example, sit with my legs crossed. I saw my orthopedic specialist quite regularly – both professionally at his clinic for follow-ups, and also socially as he is also a keen cyclist and we spent many hours chatting whilst spinning along at 30+ kph. My x-rays looked perfect. At about the 3.5 year mark, I started to notice weakening in my hip flexor. I was dropping off the back of the peloton and couldn’t do anything to get stronger. I saw my physiotherapist and concentrated on strengthening the surrounding muscles for six weeks before confessing to my doctor that I was really facing problems. The only anomaly that was apparent on x-ray was re-growth of bony spurs, which we discussed removing. Before another major surgery however, we decided to run a battery of tests … bone scan, bloods, MRI, CT, ultrasound. All these tests were inconclusive, except for the ultrasound which showed some fluid in the groin. It also showed that the tip of one of the screws remaining from my resurfacing procedure (“trochanteric flip”) was protruding into my groin so we agreed to first try a less drastic approach of removing the screws. My third surgery. I was only on a crutch for a few days, but the swelling and limping continued for months. My range of motion improved almost miraculously – it felt like a brick had been removed from my groin and I was sure this was a success! By three months though I still had a strange half-golf-ball sized lump over the trochanteric wound site and I still had pain. Back to the doctor, where alarm bells started ringing again. He excised the lump that same day … expecting to drain fluid but in fact finding dead tissue. My thigh was finally flat again but not for long … by the next day the lump was back. Infection, cancer and loosening were all ruled out. A metal-ion test was requested of the pathologist, but seemingly there was nothing apparent. Things were not looking good but a definitive diagnosis was difficult. Around this time there were a couple of European conferences which my doctor was attending, dealing specifically with hip resurfacing. He was able to talk to the presenting pathologist as well as a colleague of his who represented the European Advisory Committee for adverse reaction to MoM implants. Now the diagnosis was conclusive … classic symptoms and the only option was revision to a ceramic THR. Surgery number four. (It turns out that the fluid – actually necrotic tissue – had drained from my hip joint and down through the holes left by removal of the screws to present on my outer thigh. An incredibly unusual scenario! I think if this hadn’t happened our next step would have been needle aspiration of the hip joint to get a sample of the fluid/tissue. I have a whole new appreciation for ultrasound.) I am now at six week’s post-op. Again the surgery went perfectly (6.5 hours) and the x-rays look great. Definitely it has been the most difficult of all the procedures I have had, with a slower recovery. I am walking on one crutch, but thankfully can get in the pool and swim with the squad using a pull-buoy instead of kicking. I’m still taking pain meds and imagine I will need them and the crutch for another couple of weeks. For a semi-revision surgery though I think I am doing okay; I am at work and am planning on joining a gym this weekend to start getting some strength back in my legs. In a couple of months I will get back on the bike (maybe not in the peloton) and there is a surf-ski endurance race at the end of the year that I would like to train for. Whilst I breezed through the previous surgeries I found this one very traumatic emotionally as well as physically. Over the months I have spent loads of time surfing the web for stories and information and experiences. I thought it was time to share mine. If anyone has been through this I would love to hear how your recovery is; and if anyone is facing this I would be absolutely happy to talk about it more. Paula |