+-

Advertisements

Author Topic: Surgeon Disagreement  (Read 1020 times)

0 Members and 1 Guest are viewing this topic.

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Surgeon Disagreement
« on: June 23, 2018, 06:29:47 PM »
Greetings,


I had my right hip resurfaced with a MOM Conserve Plus prosthesis in 2006 by one of the most experienced resurfacing surgeons in the US. I won’t mention names for reasons that will become obvious as you read my post.


Background: I am female, 5’3”, 120lbs, 67 years old. The resurfacing has been a complete SUCCESS for me despite everything I have read about metallosis problems for female patients.


In February 2018, I had a total hip replacement on my left hip. I knew I was not a candidate for resurfacing. That has gone well. In conversations with my current surgeon, I decided to have my blood ions tested. They came in somewhat high (7s & 8s). As a precaution, the current surgeon ordered a MARS MRI.


I sent all this info to the surgeon who did my resurfacing. He wasn’t concerned about the blood levels, but when he saw the MRI image, he recommended a revision. He saw some fluid around the joint. I was stunned because I have no symptoms: no pain, no swelling, no anything. In a phone call with him, he said that it would not get better, only worse, and he thought it was wise to do the revision early.


So I emailed the most experienced resurfacing doctors in the USA for second opinions (all are highly visible on the Surface Hippy site). One of the most experienced asked for a packet of info as well as all the images. After review, he called me and adamantly advised AGAINST revision. He stated that the blood ions were not a problem, and the fluid was no more than 10cc. He stated that nearly all prosthetic joints have a minor fluid build up and he is convinced that I do not have metallosis. He also was complimentary about the placement of the resurfacing joint, calling it “perfect placement.” He said he thought there was a good chance that I would never need a revision and it was not good to do one unless medically necessary (which I already knew). He recommended having my blood tested again in 2 years. He offered to email his thoughts to the first doctor and I encouraged him to do so. Finally, he said that he was suprised that he had a differeing view from the first surgeon (because, I assume, they are both top docs).


I emailed my first doctor and told him briefly what the second doctor said. They do know each other and, I believe, have mutual respect. The first doctor thanked me for the new information and told me it was up to me. (Not so helpful). I asked him to please get back to me with his thoughts after he has heard from the other surgeon.


I’m not sure how to proceed. Both surgeons are highly knowledgeable and experienced. I am not eager to do a revision, but I don’t want to ignore a problem that could be brewing.
Any thoughts?

moe

  • Sr. Member
  • ****
  • Posts: 261
Re: Surgeon Disagreement
« Reply #1 on: June 23, 2018, 07:52:48 PM »
If I were in your position I would not get a revision unless multiple surgeons agreed that a revision was needed. I am surprised that your original surgeon recommended one without you having symptoms. Good luck.
Bi-lateral, BHR, Dr Marchand. 7-13-09

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Re: Surgeon Disagreement
« Reply #2 on: June 23, 2018, 08:01:26 PM »
Thanks Moe. In fairness, one other surgeon agreed with my first doc but I had the feeling that he was deferring to the first doc rather than providing a carefully thought through opinion.

karlos.bell

  • Sr. Member
  • ****
  • Posts: 339
Re: Surgeon Disagreement
« Reply #3 on: June 24, 2018, 07:18:34 AM »
 :) Yep
Ask De Smet he uses conserve plus.He may have ideas for you.
My MOM is down to about under  0.5-ppm for 2 hips
0.191 cobalt 0.141 Chrom.

Dr Koen De Smet 29-April-2015 Conserve Plus - HR Left  48mm - HR Right 50mm.
FAI hip surgery failure right side 2011- FAI  right and left failure 2013.

MattJersey

  • Full Member
  • ***
  • Posts: 198
Re: Surgeon Disagreement
« Reply #4 on: June 24, 2018, 03:07:03 PM »
Saddle I would check with another top surgeon but do not brief them. Ask them for their opinion on placement as you had been worried after reading something. Basically get them to take a full review but give them none of your current information so they don't have that bias. (If they say go see your original surgeon say that you didn't want to embarrass due to being a layperson questioning the expert over the quality of his work. You have no pain but had been worried following reading about getting your THR since you were no longer a candidate etc.)



28 April 2015, RBHR Mr McMinn

Saf57

  • Jr. Member
  • **
  • Posts: 80
Re: Surgeon Disagreement
« Reply #5 on: June 25, 2018, 05:45:41 PM »
You have no symptoms, and all seem to agree that the ion levels are ok. Why would you get a revision, it makes no sense. If you ever become symptomatic, then the issue can be revisited.

catfriend

  • Full Member
  • ***
  • Posts: 169
Re: Surgeon Disagreement
« Reply #6 on: June 27, 2018, 09:57:29 PM »
Doctors do disagree on things. That's why we seek out medical "opinions". If you aren't symptomatic in any way, and your blood ions are within reasonable limits, I wouldn't rush into surgery. First, surgery always has risks. You should never have surgery unless you really need it. If you're not comfortable waiting two years for blood tests, wait a year instead. If there are no significant changes, then why have surgery? Second, you state you don't have any problems or symptoms. No pain, no swelling, nothing. So why fix something that doesn't need fixing? Since you've been made aware that you could have problems eventually necessitating a revision you know to watch for this. If it were me, I would skip surgery for now and be aware for the future.

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Re: Surgeon Disagreement
« Reply #7 on: July 07, 2018, 11:57:44 AM »
Thanks everyone for your excellent advice. I have continued to seek opinions from the top national and international surgeons on this site. After seeing the MRI images, three of them have advised revision surgery. One said it was unnecessary.
If the three are correct, I don’t want to ignore the problem and the sooner I do it, the less damage there will be. The hope is that I can revise one component of the resurfacing. Am leaning towards going ahead with the revision.

John C

  • Hero Member
  • *****
  • Posts: 793
Re: Surgeon Disagreement
« Reply #8 on: July 07, 2018, 03:31:30 PM »
If I may ask, what brand of components do you have, which half would be revised under the plan, and what would be used to replace that revised portion. It would be great if you could share the options that you have been offered for partial revisions.
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Re: Surgeon Disagreement
« Reply #9 on: July 08, 2018, 12:30:50 PM »
Hi John,
My current prosthesis is a Conserve Plus. 44mm head. The hope is to replace the femoral component only, with a longer stem. There have been problems associated with revising a resurfacing to a Total Hip Replacement, so we hope to avoid that. As we all know, the surgeon will have to see what he finds when he gets in there.

Saf57

  • Jr. Member
  • **
  • Posts: 80
Re: Surgeon Disagreement
« Reply #10 on: July 09, 2018, 03:25:01 PM »
If you are able, can you please let us know the reason(s) for the revision recommendation. Given the perfect placement, and no symptoms, it would be useful for us to know the thinking here. Thank you.

John C

  • Hero Member
  • *****
  • Posts: 793
Re: Surgeon Disagreement
« Reply #11 on: July 09, 2018, 08:11:17 PM »
Sorry to bother again but it would also be interesting to know the articular surface of the new ball. I am assuming ceramic, since you seldom see poly on the ball?
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Re: Surgeon Disagreement
« Reply #12 on: July 10, 2018, 01:18:55 PM »
Saf57,
My understanding is that the MRI shows that the joint is starting to fail. There is fluid building up within the hip capsule and the doctors who advise revision are unanimous that it’s best to address this before the fluid area enlarges (and starts to damage surrounding tissue).  The fact that I have is a small size femoral head (44mm) accompanied by somewhat elevated blood levels suggests that things will worsen. One doctor speculates that cup may be loosening and fretting against the bone. Another doctor believes that my body is no longer able to metabolize the metal ions after 12 years and this is leading to metallosis.


If I wanted to, I could choose to monitor this and wait until I have noticeable symptoms, but after a lot of thought, i am choosing to address this at the early stages with hope that I’ll have a better outcome. It’s obviously a controversial and personal decision. Am hoping for the best.


John C: discussion has been about a “coated titanium head”. If course if the cup is compromised, something different may occur.

karlos.bell

  • Sr. Member
  • ****
  • Posts: 339
Re: Surgeon Disagreement
« Reply #13 on: July 11, 2018, 08:47:32 PM »

 :) Sounds all  pretty logical.
Like everything sometimes it is different when they operate so good on you for finding out and paying attention to the detail.
This was very much so when De Smet operated on me.
Previous operations took away much needed bone he could have used (FAI Surgery) and he had to make do. This was not foreseen before operation. His comments were "you were very difficult"
I am glad you have had specialists to bounce ideas off.
Not everything if life goes to plan and I wish you all the best in your operation and recovery.

Kind Regards K 8)
Dr Koen De Smet 29-April-2015 Conserve Plus - HR Left  48mm - HR Right 50mm.
FAI hip surgery failure right side 2011- FAI  right and left failure 2013.

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Re: Surgeon Disagreement
« Reply #14 on: October 03, 2018, 06:03:32 PM »
Well folks, I did it. Flew back to Seattle to have revision surgery with Dr. Pritchett on Sept 18. I had gotten opinions from several other doctors before I made my decision: Dr. Raterman and Dr. De Smet recommended revision; Dr. Gross recommended monitoring the situation. I decided to go forward with it because I was convinced that a revision would be inevitable at some point and I was afraid that my condition would deteriorate and possibly complicate the procedure.
All went well. Dr. Pritchett ended up replacing the acetabulum cup with a cross poly liner. Surgery was at Swedish Orthopedic Institute: high recommendations from me. I was discharged the next day. Walked too much on crutches to the extant that the foot on my “good” side developed a bit of plantar fasciitis, but recovery has generally gone well.
Dr. Pritchett noted that the metal reaction was in early stages, but it would have gotten worse in the future.
Spent 2 weeks at the Baroness Hotel, sort of like Grandma’s house, but affordable and walking distance to the hospital. Not fancy but ok for our needs.
Glad to have this over with.

catfriend

  • Full Member
  • ***
  • Posts: 169
Re: Surgeon Disagreement
« Reply #15 on: October 03, 2018, 06:16:43 PM »
I'm glad the revision surgery went well for you. Hopefully this will be your last surgery. For women especially I think it's a fine line between wanting to put surgery off, because you should never rush into major surgery, and waiting until it's too late and the procedure will be even worse. As you say, the metallosis would have gotten worse and you would have eventually needed surgery no matter what. Continued good luck with your recovery.

John C

  • Hero Member
  • *****
  • Posts: 793
Re: Surgeon Disagreement
« Reply #16 on: October 04, 2018, 04:17:10 PM »
It is great to hear that your revision went well. Dr Pritchett seems to have developed a great deal of expertise at revising resurfacings. I appreciate that this was a tough decision, and congratulate you on the courage to move forward.
You mentioned that he replaced the cup, but did not mention the femoral component. What was done on that side?
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Re: Surgeon Disagreement
« Reply #17 on: October 09, 2018, 11:39:41 AM »
Hi John,
Yes, Dr. Pritchett has really studied the best strategies for resurfacing revisions. In my case, he left the femoral component alone. I have osteopenia, so we are going to put me on bone growth meds for a few months in order to strengthen bonding to the prosthesis.

Saf57

  • Jr. Member
  • **
  • Posts: 80
Re: Surgeon Disagreement
« Reply #18 on: October 09, 2018, 02:41:07 PM »
I'm glad the revision went well. From one of your earlier posts, it seemed as though you were talking about a revision to a THR, since you referenced going to a longer stem femoral component. It's encouraging to know that, as in your case, a revision that maintains the resurfaced femoral component is possible.

Saddlepal3

  • Newbie
  • *
  • Posts: 25
Re: Surgeon Disagreement
« Reply #19 on: October 09, 2018, 04:59:40 PM »
Hi Saf57,
You are correct that there had been discussion (by 2 docs) of replacing the femoral head; however, it was assumed that the cup would stay put so it wouldn’t have been a full THR. To be honest, I didn’t really care, since my other hip received a THR in Feb 2018.
Just glad to have it over with and hoping that no infection comes along. Revisions statistically have a higher rate of infection that initial procedures (up to 10%). I’m washing my hands a lot:)

 

Mission Statement
Surface Hippy presents information about hip resurfacing. It does not provide medical advice.
It is designed to support, not to replace, the relationship between patient and clinician.
Advertising - Revenue from this site is derived from commercial advertising and individual donations. Any advertisement is distinguished by the word "advertisement"
Privacy - Surface Hippy does not share email addresses or personal information with any group or organization.
Content - Surface Hippy is not controlled or influenced by any medical companies, doctors or hospitals.
All content is controlled by Patricia Walter - Joint Health Sites LLC © 2005 - 2018 Web design by Patricia Walter.

Hip Talk Moderation

Authority 

The Hip Talk Discussion Group or forum is moderated on a Daily basis by Patricia Walter.

The moderator and forum members are not regarded as health professionals. 

Complementarity 

The information provided on this forum is designed to support, not replace, the direct relationship between patients and health professionals. 

Privacy 

We remind you that this forum is public and any message can be read, used, reproduced and cited by all. 
You do have the option to delete your messages. However, under exceptional circumstances, you can contact the moderator to do so. Thus, please take care regarding the information that you post. 

Messages 

The moderator and members should conduct themselves at all times with respect and honesty. 

By using our forums, you agree to post information that is true and correct to the best of your knowledge and is of your personal experience. If the information you post is not personal experience, we request you to provide sources (references, links, etc..) whenever it is relevant and possible. 

You are not allowed to post advertisements, whether in the form of text links or banners, for example. 

Please keep your comments positive and polite. If you have a disagreement with another forum member, moderator or the site owner; please use the the private message feature of this forum or email the member. We try to avoid emotional conflicts on the discussion group and we will do so by removing posts and banning those that cause problems.

The moderator reserves the right to delete any messages deemed inappropriate without notifying the author. In cases of abuse, the moderator reserve the right to ban a member of the forum. In both instances, an explanation will be provided if user requests.

Advertisements






Powered by EzPortal