Early on (after resurf Dec’05) I experienced a lot of clicks pops etc and so had others, so whenever I mentioned it to Dr.. Ure and got x-rays which were just simple straight on AP x-rays he said it all looked fine no problems, but it didn’t really go away although when I did a lot of clams, it did go away for awhile, but it returned, the instability as I had come to realize and it got worse and worse. And became crunches and clunks. And I told Dr.. Ure and he said that he really didn’t know what could be wrong and suggested more physical therapy, which didn’t help and the physical therapist felt that some surgical error was involved. And it got worse so that when I turned in bed at night it would go crunch crunch crunch and I became less and less able to walk and had given up Pilates some time ago and swimming even was difficult except for short bits. But no real pain, except when bending and then there was severe pain from impingement which would take half an hour to go away.. So got in touch with Vicky who sent my x-rays both recent and I think 1year post surgery to De Smet and Bose and Su and all three said that the acetabular cup was malpositioned. DeSmet and Bose said that it had been so from the beginning and Su couldn’t be sure of that. Oh yes, I had in the last two years also consulted a local othopod who does do resurfacing but I don’t think his experience is great, who had said that all looked ok from xrays and best to just live with it. When it got worse I’d consulted him again and had insisted on an xray from another angle – cross table lateral – and when he saw this, and I guess this is also what DeSmet and Bose and Su saw, all did agree that acetabular cup was malpositioned. “Too high anteversion” said DeSmet. And this is quite confusing to me since I had the operative report from my resurfacing with Dr.. Ure, and it described how he’d placed the acetabular cup and then did a fluoroscopic look at it and then repositioned it to 45 degrees and that that was satisfactory. But perhaps he wasn’t referring to the anteversion and perhaps I think that my unusual anatomy wasn’t sufficiently taken into consideration including the bio dynamics of my walking since a physical therapist who specializes in such things would need to work with surgeons pre-surgery and of course that’s never paid for so it doesn’t happen.Anyway, I spoke to Dr. Ure, and when I’d described my symptoms of clunking he said I needed revision and that metal wear is an issue and that were he in my shoes he’d see Dr. Schmalzreid. He also suggested that I come back there, but at that point I felt that I’d better not.
I went in late May to Schmalzreid for consult and he said that he could make me more functional. He also said that the risks of revision surgery were greater than with primary surgery…ie, dislocation and sciatic nerve palsy… I was scared and retreated home for a couple more months and then it became apparent that I couldn’t go on and that metallosis from the 2 surfaces rubbing together and wearing down was obviously getting worse and so I went to LA for surgery with Schmalzreid. And I no longer could do endless research and worry. He said that in my case he would use a highly cross-linked polyethyline cup and a metal stem into the femur. I no longer could go on thinking that under no circumstances would I allow this poly implant. I just went and had it done. LA seemed the closest unless I went with the local orthopod who also said that he could do the revision. I could no longer consider the trip to India or Belgium, mainly because of money but also because I felt that I simply didn’t have the energy to travel. Even NY and Dr. Su seemed too far and too expensive.
But this revision surgery is so very difficult. My resurfacing was so easy. There were no real restrictions. I had no pain after a couple of days and walked without crutches using only trekking poles for couple weeks after surgery, and regained strength and flexibility very quickly. Now I have no pain. Good. And of course I’m very flexible and this is what is so terrifying. Trying to monitor my every move so that I don’t swivel or rotate or bend at the waist beyond 90 degrees. And I cannot put weight on that leg so am on crutches for 6 weeks possibly longer and so am essentially totally dependent and helpless and yet still make wrong moves and get so scared of having a loose hip and forever being at risk for dislocation. And the revision surgery was long _4 hours-he had to chip the acetabular component from the surrounding bone; it was all well grown in as was the femoral component ..too bad..nothing was loose despite my age the bone was good enough …but now of course I no longer have a femoral head.So, I lie on the bed a lot of the time because if I crutch a lot as I could do, then my shoulder hurts because I have a frayed biceps tendon…so that’s where it’s at. Just hoping for the best but it’s impossible to notice every single move one makes especially if one is -or had been, very strong flexible and agile. Aug 5 was my revision surgery. I have reconciled myself to some limitations. But hope I don’t mess it up so that it could dislocate and so that I must watch every move for the rest of my life.Dr. Schmalzreid felt that my structure and my posture and the degeneration of my discs in my spine and the consequent accentuation of my lower spinal curve were contributory to the total situation, that is, the way that I aged exacerbated the effect of the malpositioning ..at least I think that’s what he said as he spoke afterwards to my husband ..I was obviously not quite able to take it all in, but perhaps I was and he just didn’t really bother to explain to me. He also told my husband that the op was very hard work as he had expected–4 hours in surgery. Lots of grey metal gunk around hip, prosthesis with black stains.And I mentioned elsewhere perhaps that in June ’08 I had to undergo Posterior Tibial Tendon surgery which torn posterior tibial tendon was, I believe secondary to the imperfect hip surgery and caused by the torquing consequent to the malpositioned hip prosthesis.
Ok, that’s it…Can’t think of any cheery note to end on. No pain at present is it.Flame