acetabular cup / metal ions

[woodway2]

Hi Pat, Bill, rboehmer et all:
First I wanted to second, third, etc all the good wishes, thanks and greetings to Pat and this site. I don't post often but check the site almost every night and it is such a wonderful resource and gift. Thank you so much!

I felt very calm and resolved about my own hip issues (high acetabular cup angle and high metal ions), and my hip still feels great. But I was inspired by Bill's post re: his response from Dr. De Smet that all will probably work out, and I thought, why don't I send a note to Dr. De Smet too . So I sent him an email with my metal levels and he replied right back that I need to revise, that the metal wear is destroying the bone and soft tissues. So I have sent him off a disk of my xrays and he will get them within the week.

I knew in some way that this opinion would come eventually from someone. But it's so difficult to make decisions when there is no consistency. I recall Pat putting my question re: metal ions to Dr. Gross in September and I quote his response ": No one knows what safe levels are. These are normal elements in our body. They are elevated after placing metal implants. There is no value to measuring and following levels at this point._" 

I think the future of this surgery must include a reliable way to track how the joint is wearing. I guess we are the guinea pigs.

bye for now,
Nancy
rt BHR Sept. 2007

[Pat Walter]

Hi Nancy

There were quite a few discussions about metal ions when I was at the 2nd Annual Hip Resurfacing Course in LA in Oct 2008.  This is becoming more of a problem than most thought it would.  There is a lot of research going on as to what metal ion levels are safe, how to measure the metal ions and developing reliable blood test to indicate metal ion levels.

I know Dr. De Smet is one of the surgeons most concerned about the metal ion issue.  It was explained that if the acetabular cups are not in the correct positon, they could cause the metal bearing surface of the femur cap to rub more than it should.  This excessive rubbing causes higher metal ions.  The excessive metal ions cause the surrounding tissue to turn back and become pseudoturmors as some have called it. I saw videos of a surgery removing this ugly, back mass of dead tissue and bone around a hip resurfacing - it was just plain ugly.  That is what Dr. De Smet is concerned about.  There is not always pain happening when this deterioration is taking place. For some reason, this problem is again affecting more women than men.

I was concerned enought ask him if I should get a blood test since my BHR is almost 3 years old.  He smiled and told me NO since he had placed my cup properly!  I was very lucky to have him do my surgery. 

If, however, you have really high metal ions, I would think you need to talk to some of the best doctors to get really good input.  I definitely would trust Dr. De Smet since he was my surgoen, but this is a difficult issue. You would not want your tissue and bone to be destroyed around your hip.  I am not medically trained and found  it interesting that all of this could be happening without pain.

So I could not tell you what to do - or even say what I would do in that situation, but it is becoming more of a problem. I am sorry that you are facing such a problem.  I don't know why, but us poor females seem to be getting into many more problems than the men!

There are many doctors and medical facilities working on this problem.  Hopefully, there will be a good test and guidlines soon.  I guess you are right that we are all guinea pigs when a procedure is fairly new.

Please keep in touch with us and we will give you support.

Pat

[B.I.L.L.]

I sent Dr. DeSmet my x-ray but do not have any blood ion levels to send him because my Kaiser Dr. told me they do not have a way to check for that    Here is what I recieved from Dr. DeSmet, word for word.

  Dear Bill,
What size did you recieved ?   As long as your prothesis is not wearing high this should not be a problem. Of course flatter would have been better, but if your size is not too small maybe you stay out of problems.
Greetz, Koen.
Koen DeSmet.

I meet with my Dr. and his partner tomorrow afternoon.  We are going to discuss ion levels and how to test for them.  I am curious to see what they are going to say about the angle, wear factor, revisions etc.

I haven't been posting much lately.  After I posted my x-rays that thread pretty much went nowhere except for Nancy who sounds like she is in the same boat and a comment on how it would be good for bronco busting or whatever, I rolled with it and made a joke..... but kinda got over talking about it honestly.  I figured I'd just do all my pt, eat better, try to dump 30 lbs. and move on with my life.  Guess I just wanted to go back to a semi-normal life and stop dwelling on it 24/7.   Well it is working better with less pain, I ride my bike 30 minutes a day, and do about an hour or more of pt exercisises everyday and am back to doing some work, but it's always there in the back of my mind that it is not right, even with the "maybe you stay out of problems" e-mail from Dr DeSmet. A good night's sleep is rare and I get kinda dizzy now and then when I sit up real fast.  Nancy keep us posted and I wish you the best on this, and I will let you know what I find out as well. Sorry it's not all peaches and cream ha ha, it is better than before, but I would LOVE to be 100% confident it's right, I am a little jealous of those who got theirs right, human nature I guess, Enjoy it !!!!
See Ya, Bill. 

[Pat Walter]

Hi Bill

Good to hear from you.  I am glad you are trying to get on with your life the best you can.  Hopefully, things will remain OK for you.

There are not any standard blood tests for the metal ions yet.  None of the few labs that do testing, do it the same way - as far as I understand.  That is what they are working on - a good standard test for metal ions and also knowing what the various levels mean.

At least most men with the large hip device sizes have less problems than the ladies do.  So let's hope that is in your favor.

I just wanted to say HI and wish you the best for 2009.

Pat

[woodway2]

Hi Pat and Bill
Thanks so much for your responses. Bill I have to say you made me laugh, as I had decided as well to just get on with life, enjoy my hip and stop thinking about it so much. Anyway, I will wait until I hear from Dr. De Smet, see my Doc in February and go from there.
Nancy

[B.I.L.L.]

Just got back from my 2nd opinion with a different Dr.  "The angle is 65 degrees and will fail in 2 to 3 years"   The good part is he thinks he can preserve the bhr (femur side) and luckily there is a thicker cup available so I should wake up with a bhr not a thr, Revision scheduled for 2-23-09.   Kind of in a weird mood.
  I think I'm going to get shitfaced starting right now.........Bye bye,  Bill
 

[wayne-0]

B.I.L.L.
Well that's good and bad news. Just remember if your doc can take care of it that will be fantastic. So you will have some more rehab, but, because you know what to do and expect I bet this time around will not be so bad. Who is gonna do your revision? Good luck.
                                                         Wayne

[Pat Walter]

Hi Bill

Just wanted to say Hi and I will keep you in my thoughts and prayers.  I am so sorry that you are going to face another surgery.

Please keep in touch and we will all give you support the best we can. 

Again, I am so sorry about your difficult situation.

Pat

[obxpelican]

Just got back from my 2nd opinion with a different Dr.  "The angle is 65 degrees and will fail in 2 to 3 years"   The good part is he thinks he can preserve the bhr (femur side) and luckily there is a thicker cup available so I should wake up with a bhr not a thr, Revision scheduled for 2-23-09.   Kind of in a weird mood.
  I think I'm going to get shitfaced starting right now.........Bye bye,  Bill
 

Bill,

I wish I could join the party with you.  I am bummed out it did not work out for you, I hate to see any fellow surface hippy have to go through another surgery, but the good news is that it sounds like you'll wake up with a resurfaced hip.

I'll be praying for ya and sending lot's of good thoughts your way.

Take care, heal fast and rehab even faster.


Chuck

[revision]

Hi Bill.

I know how you are feeling. I had revision surgery in Nov 08 from a BHR to THR. My hip resurfacing only lasted 6 months. I had all sort of emotions going on when I was told I needed a revision but I can tell you now 6 weeks after my revision that it feels great.

Bill I think that there seems to be a small percentage of people where malpositioning of components by surgeons is a problem however  you are lucky and it sounds like the cup may just have to be replaced.Thats really good news Bill. Even if you have a THR it is not bad news. I had a MOM THR and the cup & femoral component are now the same size as my original BHR.

Bill it is hard news to swollow that you need a second surgery but trust me you will be OK. I really wish you the best. Try and be as positive as possible, next summer you will be walking and pain free.This will become a memory.

Keep your chin and head up Bill.

Revision

[stevel]

Hi Bill,

As I recall Dr. DeSmet reviewed your x-rays and said the implant could be OK if the wear was OK.  This is more encouraging than the report from the second Kaiser doctor.  Is your second Kaiser doctor, Dr. Klug of Roseville, CA?  He is on Pat's list as having done over 200 hip resurfacings.  I'm surprised of the difference in opinion as Dr. DeSmet is one of the best in the world.  As I recall, Vicky tried to steer you to Dr. Klug back in July before your surgery.  I recommend sending your x-rays to several other top hip resurfacing surgeons that do hip resurfacings and interpret x-rays for free e.g. Dr. Mont, Dr. Bose, Dr. Su and Dr. Gross.  If you need to stay in California, then Dr. Amstutz in LA is the most experienced, but he charges $300 for a pre-op exam or interpretation of your x-rays.

[woodway2]

Hi Bill
Wow - well you are certainly decisive.
Here are a couple of questions I would ask:
Is the new cup metal? If so what assurances can you have that the new Doc will get the alignment correct. You don't want a repeat of the previous situation. I wonder if it is possible to get a cup lined with something.
Will you also choose a plan B if he can't get it correct and has to revise to THR? And again, if that is MOM, can you get assurance that the angle on that one would be correct.
I only keep dwelling on the metal issue as I get the impression from Dr. De Smet that metal wear leads to tissue damage and bone loss. Of course there is much wear from plastic as well, which is why they use MOM in the first place. I don't know.....now I'm really confused. Pat, can you help???
Nancy

[B.I.L.L.]

Hey Nancy you are right about me making a snap decision. I have this bad habit of thinking people (Like doctors) are always 100% honest
and craftsmen at there trade, positive thinking gone bad I guess.
Anyway if it needs to be done, wich it does if I want it to last,( we all know it's wrong), then the sooner the better right ?? 
I was glad this guy was honest enough to tell it like it is,
And I have 5 weeks to get more opinions, and I will check out this guy, believe me. And knowing what I know now, if I have any kind of doubt, I'll pull the plug.
    Check your pm's. Bill

[bothdone]

Hi Bill

I've just read through this thread.   I'd like to add my best wishes to you for a successful outcome.

Ed

[B.I.L.L.]

Hi Bill

I've just read through this thread.   I'd like to add my best wishes to you for a successful outcome.

Ed

Thanks's !!       

[woodway2]

Hi Pat, Bill et all
Not sure whether I should have moved to the new metal ion subject, but here goes anyway.
I've been so so calm, maybe too calm. Now I'm getting pretty stirred up.....

I am still waiting for my report from Dr. De Smet re: my high acetabular cup angle, but today I talked on the phone to Hena Ziaee, the researcher at the McMinn Centre in Birmingham, England. I had sent her the xrays as well. She was not able to put the xrays through their software to determine exact angle as for that they need an xray of the whole pelvis (both sides together). But she said the angle looked roughly 60 degrees to her, and on top of the high cup angle there was high anteversion as well. I am not so familiar with that but I know that it's a serious problem also.
Anyway she said just by looking she could tell there was serious edge loading and that I needed to revise.

I asked her about the controversy around the blood tests, and should I take her up on her original offer to test my blood with their lab, and she said my levels were so consistently high over a few tests, that further tests would not be necessary.

She also said my femur looked "fantastic" and that I should just get a new cup. I asked her what the statistics were re: the success of that and she said only 3 have been done. I don't want to be a guinea pig anymore. I think I'm going to ask my surgeon to give me what he's good at.

The reality is beginning to sink in and I'm pretty bummed. So I guess I next wait to hear from Dr. De Smet once he receives my xrays.

Bill - hope you see this!
Nancy

[John C]

Hi Nancy,
I know that this is a tough, and very personal decision, but I would share a few thoughts from a fellow patient's point of view.
If the femoral side is good, I have trouble finding a good reason to cut that off and throw it away. If you choose to revise the cup, I am not sure why that should lead to sacrificing a "fantastic" femoral result. Remember that revising the femoral side will involve additional risks and gambles, when it appears that you have a good result on that side already.
You said that the lady in England said that there had only been 3 cup revisions. I am sure that there are Doctors in this country that have done many more than that; Gross and Mont come to mind as two doctors that I believe have done a number of cup revisions from other Doctor's cases. If you could find a doctor that has done a number of successful cup revisions, it would help you to feel less like a guinea pig.
Lastly, if you are considering having the original surgeon do a total revision, I would think that you would want a pretty good explanation of why he can assure a better cup positioning this time, as compared to last time.
Best of luck on whatever you decide is best for you.

John

[obxpelican]

I would pursue getting the cup ONLY revision.  No way would I take a THR if I knew I could get my cup revised.  Fight to keep your resurfacing.

It's good that they said your femoral cap is good, keep your spirits up, this will work out for you.

Don't get down!


Chuck

Hi Pat, Bill et all
Not sure whether I should have moved to the new metal ion subject, but here goes anyway.
I've been so so calm, maybe too calm. Now I'm getting pretty stirred up.....

I am still waiting for my report from Dr. De Smet re: my high acetabular cup angle, but today I talked on the phone to Hena Ziaee, the researcher at the McMinn Centre in Birmingham, England. I had sent her the xrays as well. She was not able to put the xrays through their software to determine exact angle as for that they need an xray of the whole pelvis (both sides together). But she said the angle looked roughly 60 degrees to her, and on top of the high cup angle there was high anteversion as well. I am not so familiar with that but I know that it's a serious problem also.
Anyway she said just by looking she could tell there was serious edge loading and that I needed to revise.

I asked her about the controversy around the blood tests, and should I take her up on her original offer to test my blood with their lab, and she said my levels were so consistently high over a few tests, that further tests would not be necessary.

She also said my femur looked "fantastic" and that I should just get a new cup. I asked her what the statistics were re: the success of that and she said only 3 have been done. I don't want to be a guinea pig anymore. I think I'm going to ask my surgeon to give me what he's good at.

The reality is beginning to sink in and I'm pretty bummed. So I guess I next wait to hear from Dr. De Smet once he receives my xrays.

Bill - hope you see this!
Nancy

[Pat Walter]

Hi Nancy

I hope you don't let all this get you down.  Sometimes bad things happen to good people.  This is obviously not a good situation - but I think if you can keep your femoral cap and only have your acetabular cup revised, it would be a good solution.  I know you have to make up your own mind, but you post here to ask us our opinions.  I am not a doctor and can't give medical advice - only my opinion. If I were in your situation, I would want to keep my hip resurfacing if possible.  After all, that's why you choose a resurfacing in the first place. 

I hope you will see a solution for this problem soon and finally get over a bad situation.  You need to be able to get on with your life without worrying about your hip replacement.

Please keep in touch.  I will keep you in my thoughts and prayers.

Pat

[B.I.L.L.]

Hey Nancy,  So sorry to hear that.   Seems you and I are in the same boat, the obvious negative is we (well me for sure) need an early revision, the positive side is we should come out of it with a resurfacing and not a thr (hopefully)     Let us know what Dr DeSmet says, I'm curious since my angle is 65 degrees and he said "maybe you stay out of trouble" but didn't have any ion test results to go with it.  I am going to ask for a few more opinions from the doctors on this site and will post their responses when I get them.  My new Dr.  (Mohammad Namazian out of Kaiser Fontana, Ca.)  sounded quite confident he could re-position a new cup and retain the femoral componet.  I will try to gather as much info as I can on this subject and post whatever I find here, please keep us informed and I am truly sorry you have to go through this.  Nice to talk to you the other day by the way. Try to stay positive, I'm sure it will work out. Bill