Hip Dislocated 6 weeks post-op. Anyone ever had this happen?

[Roboclimber]

It is true that the pain issue I deal with stems from a spine break and associated nerve damage. In that department, the surgeon has done all he can do, although I am going to explore nerve blocks.

Every time I have a hip surgery, the nerve pain I get is crazy. I usually get this in my foot or glute - the totally numb parts of my leg. It lasts for about a week of heavy meds, and they never give me enough. It is one of the big reasons I am anxious to avoid hip surgery.


I suffered this same pain for another week after the last sublex. It is not a new thing, and I have had to manage it for 30 years. It even becomes aggravated sometimes with a bad cold. Weird.


As much as Swedish Medical Centre in Seattle tried to help me when I paid them $50,000 US, I think they now wish I would just go away. The failure is likely an embarrassment that they can't fix without redoing their work. Which they are willing to do, of course. For another $25G's.


The world is a vampire.

[chuckm]

Chuckm: I am wondering if you are suggesting something I might be missing. I have been told I have an unstable hip joint and neuropathy that is affecting the integrity of the joint.

Roboclimber, it could be that you are missing some or part of the hip capsule. Much like a knee missing the ACL ligament. But if it was that way at the time of surgery I think Dr. Pritchett would have put you on a very cautious recovery plan knowing that the dislocation risk was greater for you. I think this was unforeseeable. 


But, considering the nerve damage you mention, it could be possible that you do not feel pain in the capsular tissue. Normally you feel very sharp pain before the hip dislocates. You would have an uncontrollable reflex that would stop you immediately from continuing the movement that you were making. Or, perhaps you did feel that extreme pain before the hip went out, but you had already gotten yourself into a situation that you couldn't reverse yourself despite the pain.


Regardless, once the capsule is compromised, it may not tighten back up. If it is popping out just rolling over in bed, there is definitely an issue with those ligaments not doing the job of holding the hip tight to the pelvis.



A total hip replacement is even worse for dislocation.

But the dual-motion hip replacement is unique. It is the total hip replacement device that does not dislocate because of the way it is designed. And it looks like that device is doing extremely well for low wear rates and durability.


It sucks to have yet another surgery, however, Dr. Pritchett does have a point that the dual-motion will be a good option for your situation.


Chuckm

[karlos.bell]

  Robo climber. Hi. read your stuff not cool. Bugger! an orthopedic hip brace is what you need for a start to stop the hip from popping out. I made one for myself and the specialists had never seen it before. It braced the hip joint due I had FAI and wear in places the hip joint sort of flopped around in the socket, I limped and it was wobbly. The brace pulled the joint in against the pelvis and I was able to walk. When I took it off I wobbled like John Wayne and could not walk in a straight line. From there to propel forwards I used crutches so I did not use my leg muscles at all. Basically the joints were just there to hold me up. It was crap but that's how it went.
The muscles atrophy due to no use.
Ok from my reading of spinal cord damage from compression yep it can happen but the cord below T12 is not spinal cord it is Cordia Equina and they are harder to damage than the spinal cord. they also over years do have better regeneration if the pressure has been removed. So I would not give up. Swelling in the joint can also cause local paralysis as I have experienced.
Best thing I would suggest is brace then try and get walking with that.
I use to wear the brace for years and every where my wife did not like it but I could walk with it and it decreased my pain as I hated pain killers. The end result was fixing the issue the joint. So you have done the right thing try and get the ligaments to heal so the joint does not pop out so much.
Get a brace sorted it goes across the hip joint on both sides and a strap around under the groin.
Joining both on the outside of the hip joint.
I had clips so I could take it off in a hurry.
Hope this is a start to helping. Cheers K

[Roboclimber]

Thanks for your reply, Karlos. in fact I did purchase one of these braces you describe. After six weeks I stopped wearing it. Then it dislocated again. And so on.


A month ago I was working in Toronto and it dislocated again. This time it stayed out of socket for four hours before they put me under (it was a busy night at the hospital). By then it was spasming and I was in a great deal of pain. This makes it the 3rd complete dislocation, and the fifth time it has come out of the joint (it has sublexed twice).


Dr Pritchett feels the writing is on the wall and so I am getting back in line for the medical merry-go-round of surgery. More tests, x-rays, and waiting. Unbelievable. In the meantime, Pritchett feels I need to get on this quickly as it will continue to dislocate, and it will now dislocate more easily. I need a dual mobility implant (or something similar) which reduces the risk of dislocation to zero.


In the past when the joint dislocated I really had little to no pain the following day, but this time it's different. The joint hurts like it did when it was failing and I can't do as much with it without getting pain.


I should add that my spinal chord injury is from a 1982 car accident and that little has changed since then with regards to function and sensation. I have worked hard on these muscles to the point I was climbing hard again (5.13; WI6), but in 2008 this is when things started to go south. In 2010 I had the 5th spinal surgery, and the surgeon performed work to relieve a stenosis and fused L1 to S1. Later that year was when I first experienced the hip arthritis.


I do know that technically the area of my spinal injury is in the spinal chord and is in fact the Cordia Equina, but if I start getting too technical no one will know what I am talking about.


It is important to note that the dislocations are happening when I am relaxed. 3 times when I am in bed rolling over from my back to my left to reach and grab the plug to my laptop. As you can imagine, when I tell someone this happened when I was in bed how many of the predictable jokes I have to deal with. In any event, can you imagine how unnerving things are when you can't even relax without worrying about a dislocation?

[horse doc]

Robo, this sounds so frustrating!  I've read your blog and your thread here and you have my sympathy.

As you wait for the upcoming consultations, maybe we can flesh out the specifics regarding why your hip is unstable.  The fact that you have nerve damage is obviously complicating your scenario beyond the typical surgical damage done to the area during hip resurfacing and the influence of specific implant devices on hip instability. 

I would separate out the potential contributors which might be at play in making your hip unstable. 

1. Nerve damage from auto accident.  Have your doctors given you a specific neuroanatomic diagnosis?  It should be known which specific nerve tracts are damaged.  The fact that you have skin sensory loss is suggestive that you probably have motor nerve deficits as well.  They are separate entities.

The muscle groups innervated by these damaged nerves are what you need to worry about.  Figure out which muscles they are and what their role is in hip stabilization.  It is a complex articulation but you need to understand why certain leg motions are causing enough torque to dislocate your hip.  It's possible that you lack the muscular resistance to certain dislocating movements. These movements might be risky regardless of which implant you have.

Analyze your previous dislocation events though the prism of torque action overcoming your hips resistance to dislocation.  Its possible you can strengthen your specific weakened muscles while avoiding (with extreme prejudice) specific leg movements.

I think the generic post- surgical restrictions and rehab programs are adequate for most cases but yours obviously falls outside the norm.  Its possible that simple walking is the best rehab for all the hip stabilizers and it isn't necessary to know them by name.  I don't know.  Sorry if this seems professorial or implies some lack of understanding on your part, I'm sure you are the leading expert regarding your own situation

[thecynner]

OMG!!!!  This is my story!  I had Dr Pritchett too and on my third dislocation. 

[thecynner]

This is my exact same story!!  I have dislocated it 3 times and Dr Pritchett tells me he does not know what to do next because it has never happened to a patient before!