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The Hip Talk Discussion Forum was hacked a few weeks back. It has taken me a long time to fix it. The only backup I could use was way back to April 2020. All members and posts up to that date are available. Anything newer has been lost. I am sorry, but that has been the only way to get things up and running again.

Author Topic: More Thumps and knocks from a BHR  (Read 8671 times)

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Pete C

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More Thumps and knocks from a BHR
« on: October 01, 2009, 03:44:05 AM »
I had a left hip BHR, cemented (Smith & Nephew) in July '08. Prior to that, I was a +25 year regular runner and mountain climber, until the arthritis pain got to be too much. So, I was in fairly physical condition at op time.
Surgeon was Dr. Pritchett, at Swedish Hosp, Seattle. He'd done at least 1200 of these by then. Recovery was slow at first, but then proceeded normally. I was brisk walking and then biking within 1 and 2 months resp. post op. All arthritis pain is gone. Beginning at 10 months post op, I started back to running, slowly......9.5-10 minute miles, for up to 4 miles, 2 - 3 times a week. Hiking and mountain climbing (up to 5000' elev gain), four outings this past summer.

At about 3 months post op i began to notice a thumping effect in some situations. This is difficult to describe, but is is somewhat like a knocking sensation, or similar to the feeling in a finger joint if you crack your knuckle. Usually not painful, although there have been a couple of times when it did hurt, but mostly just uncomfortable.
My hip now does this all the time. Lying in bed when i wake up, if i stretch out my legs, in an outward extension motion, my left hip joint will "pop". Same during excercise, walking, etc. I had thought this was a tendon on muscle, or tendon on tendon thing going on in there, until i had my 1 year follow up, July '09, with Dr. Pritchett.
After I described this to him, he knew exactly what I meant.  He said that about 28% of his BHR patients have this symptom. He then described it as a slight dislocation, follwoed by realignment. At least, that is what I think he meant. He told me that there is something about an "equatorial alignment" of the joint, related to the relative position of the two components. By "slight" he said he is describing only millimeters out. He did say that my x-rays showed everything is completely normal with the new joint. I was so taken aback by this explanation that i didn't have the presence to ask intelligent questions of what I had heard.
 
My concerns are as follows:  What is going on in the joint, metal on metal? To my mind, this is an unusual wear opportunity and I wonder if metal is being worn away, since the smooth surfaces of the ball and cup are not always in complete contact.  Will this shorten the life of the components? Is the joint more likely to "pop out" because of this? Is it going to continue like this indefinitely? Should I be doing the PT exercises again that I did when I had post op PT? It seems like the thumping/knocking in this joint is more pronounced after a period of weight-bearing excercise.

I need to schedule another appointment and ask these questions in detail. However it is over an hour of driving to get up there, plus the cost of the appointment. I would like to get any feedback possible from the group, before I pose these questions to the doctor again. Or, maybe it is quite normal, and I don't need to.

Any ideas on this? Thanks!

Pete


B.I.L.L.

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Re: More Thumps and knocks from a BHR
« Reply #1 on: October 01, 2009, 05:02:49 AM »
I still get that at just over a year but only after really pushing it. On an average day it never happens unless I am on my feet ALL day doing lots of bending, lifting etc.  For me it seems to happen when I push the range of motion too, almost like you stretch the muscles and then they get "loose" for a couple days.  At this point for me I notice it more if I STOP doing pt exercises for a few days, I feel like the more I concentrate on exercising on a daily basis, the less knocking I have.  Thought I read somewhere that the knocking and knuckle cracking sensation is due to fluid sucking in and then getting forced back out from between the two componets when the hip does that slight dislocation. For me it seems that the more I exercise and mild stretch, the less it happens.  Sometimes I'll be just standing somewhere and a slight weight shift will result in a popping or knocking sensation, but it doesn't hurt and I'm kind of used to it so it doesn't freak me out anymore, though it did at first.   It makes sense to me that if it's caused by a slight dislocation then the muscles need to be stronger to hold the two parts together.   But I'm a poolman not a Dr. so consider the source... ;D ;D

bothdone

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Re: More Thumps and knocks from a BHR
« Reply #2 on: October 01, 2009, 08:49:21 AM »
Hi Pete

Sorry to hear about your problems.  Just to give you a bit of different information on this.   Your symptoms are things I've never experienced with either of my BHRs despite lots of physical activity, particularly since my right BHR in March 2008.     I hope you find out what's going on in your hip and get it resolved.

Best wishes

Ed
LBHR 25 May 2004
RBHR 19 March 2008

larry2458

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Re: More Thumps and knocks from a BHR
« Reply #3 on: October 01, 2009, 09:14:27 AM »
i didn't know the percentage of clunkers was as high as 28%.
mine started at 8 months and when i last my consultant i asked him about this clunking and he said it was the device and not muscles as other people have been told.
he asked me did it hurt and when i said never we were both happy.
mine only starts clunking after i've been walking for a few hours or mountain biking but not during these exercises.
           
                                                       larry
lbmh 16th october 2008

B.I.L.L.

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Re: More Thumps and knocks from a BHR
« Reply #4 on: October 01, 2009, 11:42:02 AM »
This thread reminded me of why I stopped posting on this site. Any time you write about a problem the first guys to chime in are the ones with perfect instalations who never had any issues whatsoever to tell us yet one more time how awesome theirs is and yours must be messed up.
 Larry, I was just relaying what I was told and my personal experience with clunking.  Your consultant told you "it's the device" ??   .....and has nothing to do with the muscles that hold it all together (like other people have been told)   That doesn't make much sense to me, no explanation why, that's just how it is ?  Wonder if your consultant and my doctor (who placed my cup at 65 degrees) are buddies, they sound alot alike. 
Good luck Pete C.   Hope you get it figured out. Exercising and trying to strengthen the area seemed to help my clunking, but like I said WTF do I know I'm a poolman not a Dr. 
Best of luck to you.

Pat Walter

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Re: More Thumps and knocks from a BHR
« Reply #5 on: October 01, 2009, 01:06:05 PM »
Hi Guys

The clunking is very common and generally will go away eventually.  I don't know many people years into their recovery that still have the clunking.

I had the clunking. You could feel the two pieces moving in and out of each other.  It was obviously a very small amount, but noticable - not painful.  I had a lot of it early on and then less as time went on.  I was still getting the clunking a year or two out. Generally it was when I was sitting or moving in a certain direction with my leg.  I am 3 1/2 years post op now and just occasionally will feel it when I sit a certain way or move my leg in a different way.  Again, it is not painful.

I was told by Dr. De Smet that in most cases it is the muscles that have not tightened up yet.  Since I was in very poor physical condition, I am sure my muscles were not well used and really out of shape.

From my understanding and engineering background, I could not see how having the two surfaces moving away from each other and coming back together in a gentle manner could possible wear the device out.  Have you ever held a hip resurfacing device in your hand?  They are very well machined, thick and strong.  If you think about bearing wear, it occurs when bearings are in motion and under a lot of loading.  Just having your hip clunk and the device move apart a little is not a large amount of loaded and certainly not a great deal of friction of two parts rubbing together at high speed.  So if you think about it in common sense terms - a small amount of clunking is not excessive wear on the bearing surfaces of your hip device.

Your hip is working well and you are not in pain.  It may take another year or more for all the clunking to go away.  It took me that long, but I was 61 and certainly not as active as you are.  People think they are healed at 6 months, but many surgeons will tell you it could take a year or more.  Remember you had hip problems for a long time before your surgery.  It might take your body as long to get back to normal as it took to go bad. I know people who have been on crutches for a year or more, then expect a surgery to be magic and give them their life back quickly.  You new hip device may be perfect, but few body parts are and they take time to learn how to work with a good hip.  I know some people that had very bad hip problems that are still working on getting back to normal at 3 or 4 years post op. Again, it is not the hip device but our human bodies that are very fragile and slow in learning to work normally.

Good Luck.

Pat



Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

bothdone

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Re: More Thumps and knocks from a BHR
« Reply #6 on: October 01, 2009, 01:10:03 PM »
This thread reminded me of why I stopped posting on this site. Any time you write about a problem the first guys to chime in are the ones with perfect instalations who never had any issues whatsoever to tell us yet one more time how awesome theirs is and yours must be messed up.

Hi B.I.L.L.

I presume you are referring to my post.    My intention was to let Pete know that I had never experienced clunking and that possibly there might be something that could be done to resolve the problems he has with his hip.   (I don't know if there is something that can be done or needs to be done.)  I just wanted to provide a bit of information and offer a bit of support.   I didn't want to imply or suggest anything else.   I'm sorry if it read like that.

Ed

ps.  I've just read Pat's post which came on while I was writing this.  Her post certainly gave me a lot more information.
LBHR 25 May 2004
RBHR 19 March 2008

Pat Walter

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Re: More Thumps and knocks from a BHR
« Reply #7 on: October 01, 2009, 01:54:31 PM »
Hi

I think we all have to realize the only perspective we have on hip resurfacing and recovery is from our own point of view.  We can understand what other people are experiencing, but if that was not our experience, we can only say that we are concerned and sorry they are having problems.

It is diffiuclt to understand the pain and problems when you have not experienced them. It is not diffiuclt to express concern and to be caring.

I had been criticized many, many times when I told about my recovery.  It was quick and easy with no swelling or bruising. One crutch for a few weeks and none after that.  I only took Advil after leaving the hospital for incision tenderness.  I was moving slow and it took time for my body to heal, but my experience was very good.  So people either assume I am lying or bragging.  It is neither - it is my own personal experince.  That did not stop me from understanding other people's probelms, but again, it was not anything I experienced.

So we all have to remember that we can only report our own experinces while being kind and supportive of other people's experiences. When you are really hurting and in pain - it is diffiuclt to believe others did not feel the same way.  When you have an easy recovery - it is diffiuclt to understand why others are having such problems.  We are all individuals with our own personal stories. This group has many wonderful, supportive folks trying to help others. ;D

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

B.I.L.L.

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Re: More Thumps and knocks from a BHR
« Reply #8 on: October 01, 2009, 03:12:01 PM »
Hey guys.  I came in here this morning to delete my post from last night but you guys get up pretty early and got here before I could.
I suppose I'm jealous of those lucky enough to have proper placement and took out my frustration with my doctor on you guys.  Ed, it was actually Larry's post that basicly said I had no idea what I was talking about and it's not the muscles, even though I just wrote what I experienced, and then failed to give any other explanation of what causes the knocking, just that NO, it's not the muscles.  Anyway I'm sticking to my story, strengthening the area seems to help me, take it for what it's worth I guess.  Sorry to get all bitter on you guys, :-[
Hope you get it figured out Pete,  I'll try not to post when I'm in a grouchy mood in the middle of the night again, Take care, Bill.

larry2458

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Re: More Thumps and knocks from a BHR
« Reply #9 on: October 01, 2009, 03:52:25 PM »
This thread reminded me of why I stopped posting on this site. Any time you write about a problem the first guys to chime in are the ones with perfect instalations who never had any issues whatsoever to tell us yet one more time how awesome theirs is and yours must be messed up.
 Larry, I was just relaying what I was told and my personal experience with clunking.  Your consultant told you "it's the device" ??   .....and has nothing to do with the muscles that hold it all together (like other people have been told)   That doesn't make much sense to me, no explanation why, that's just how it is ?  Wonder if your consultant and my doctor (who placed my cup at 65 degrees) are buddies, they sound alot alike. 
Good luck Pete C.   Hope you get it figured out. Exercising and trying to strengthen the area seemed to help my clunking, but like I said WTF do I know I'm a poolman not a Dr. 
Best of luck to you.
bill

i wasn't having a go at you and what you'd been told.i hadn't read your post so i don't know why you are getting upset.the consultant i spoke to wasn't the doctor who operated on me.i haven't seen him since the morning of the operation.just like you ,bill,i was just relaying what i was told.
                                                     larry
lbmh 16th october 2008

B.I.L.L.

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Re: More Thumps and knocks from a BHR
« Reply #10 on: October 01, 2009, 04:38:54 PM »
This thread reminded me of why I stopped posting on this site. Any time you write about a problem the first guys to chime in are the ones with perfect instalations who never had any issues whatsoever to tell us yet one more time how awesome theirs is and yours must be messed up.
 Larry, I was just relaying what I was told and my personal experience with clunking.  Your consultant told you "it's the device" ??   .....and has nothing to do with the muscles that hold it all together (like other people have been told)   That doesn't make much sense to me, no explanation why, that's just how it is ?  Wonder if your consultant and my doctor (who placed my cup at 65 degrees) are buddies, they sound alot alike. 
Good luck Pete C.   Hope you get it figured out. Exercising and trying to strengthen the area seemed to help my clunking, but like I said WTF do I know I'm a poolman not a Dr. 
Best of luck to you.
bill

i wasn't having a go at you and what you'd been told.i hadn't read your post so i don't know why you are getting upset.the consultant i spoke to wasn't the doctor who operated on me.i haven't seen him since the morning of the operation.just like you ,bill,i was just relaying what i was told.
                                                     larry


No worries. Didn't mean to come off so defensive,my bad.
Buy you a beer ??? :D

bothdone

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Re: More Thumps and knocks from a BHR
« Reply #11 on: October 01, 2009, 07:53:28 PM »
Hi Bill

No problem.

Best wishes

Ed
« Last Edit: October 01, 2009, 07:54:01 PM by bothdone »
LBHR 25 May 2004
RBHR 19 March 2008

John C

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Re: More Thumps and knocks from a BHR
« Reply #12 on: October 02, 2009, 12:39:04 AM »
I will throw in my two cents worth on the clunking issue, with the caveat that it is totally subjective and unscientific. I have experienced two kinds. Over the first month or so, it was very pronounced and disconcerting. The doctor said that it was because the muscles were not yet tight enough to hold the joint tightly in contact, and the clunk was as it made and lost contact. This fit with my experience, and it has gone away over the past year. I still experience a slightly different, and much more minor clunk, which I picture as follows. Though they are all different, many of the prosthesis are designed so that the contact is not the same all the way around the surface of the cap. Many are designed so that there is polar contact (around the top), and some space (micro) around the periphery to allow fluid to enter the joint space and lubricate it. This polar contact is the reason that you see the great demonstrations of the cap spinning almost frictionless in the cup, like a top. If there were contact all the way around, it would not do this. The fact that it is spinning on the polar contact like a top is what allows this. Sometimes when I shift a certain way, the polar contact point hangs up for a millisecond before shifting against the inside of the cup. When it does shift, this is what I feel. For me, it is usually when the joint is not well lubricated, because I have been lying or sitting for awhile. This polar contact point is always moving against the cap, but when well lubricated, it moves smoothly so that we do not feel it. Pete is correct in thinking that this wear point of the polar contact against the inside of the cup would normally be the primary source of wear. However, this is offset by the importance of allowing space around the periphery for lubrication to enter the joint and minimize this wear.
Bottom line for my experience; 1. Keep the muscles around the joint toned and tight, to keep things tightly in contact. Specific exercises are needed, since daily activity is not enough. 2. Keep moving to keep the joint lubricated; it is especially important to get it warmed up and lubricated before any heavy weight is moved on the joint (weight lifting, hiking with packs, etc.)
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

larry2458

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Re: More Thumps and knocks from a BHR
« Reply #13 on: October 02, 2009, 07:40:50 AM »
This thread reminded me of why I stopped posting on this site. Any time you write about a problem the first guys to chime in are the ones with perfect instalations who never had any issues whatsoever to tell us yet one more time how awesome theirs is and yours must be messed up.
 Larry, I was just relaying what I was told and my personal experience with clunking.  Your consultant told you "it's the device" ??   .....and has nothing to do with the muscles that hold it all together (like other people have been told)   That doesn't make much sense to me, no explanation why, that's just how it is ?  Wonder if your consultant and my doctor (who placed my cup at 65 degrees) are buddies, they sound alot alike. 
Good luck Pete C.   Hope you get it figured out. Exercising and trying to strengthen the area seemed to help my clunking, but like I said WTF do I know I'm a poolman not a Dr. 
Best of luck to you.
bill

i wasn't having a go at you and what you'd been told.i hadn't read your post so i don't know why you are getting upset.the consultant i spoke to wasn't the doctor who operated on me.i haven't seen him since the morning of the operation.just like you ,bill,i was just relaying what i was told.
                                                     larry


No worries. Didn't mean to come off so defensive,my bad.
Buy you a beer ??? :D
bill
no problems
when i visited my consutant,him saying that the device was the problem was one of the few things that i understood as his english wasn't too good.
when i told him about the problem i was having with my other hip he pointed to the x-ray and told me i had osteophytes on the joint.   
i said
"how come ,even though this hip is aching,since the op on my other hip my non-op hip is freer than its been for years"i didn't get an answer to that one.

when i asked how long it would be before i started having problems with my non-op hip he said about 2 years.so, it looks like i'll be a bothdone too.
bill i don't know how you'll get me beer,but a pint of addisons cider would go down a treat
                                                       cheers
                                                         larry
lbmh 16th october 2008

Jed

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Re: More Thumps and knocks from a BHR
« Reply #14 on: October 02, 2009, 06:33:12 PM »
From what I understand,  hips are very difficult joints to dislocate. So much so that if they do dislocate, there is often lasting problems thereafter. Now to install the two HR parts, the hip is dislocated, albeit as neatly, and in as trauma free manner, as is possible for the  surgeon.
All  dislocated joints are prone to repeat dislocations. Immediately after surgery the swelling keeps things tight. As this subsides there is some laxity in the joint until scar tissue develops and the cut and stretched muscles and tendons heal. That is why you have to be so careful for the first 6 weeks. No different from if you dislocated an elbow or shoulder.
With bad dislocations of the shoulder, another ball and socket, there can be residual looseness which manifests itself like clunking, the bone being drawn slightly out of the joint and then popping back in. In this case there is little noise as the cartillage - which is elastic as well as incredibly smooth - absorbs the shock. Even though the new HR bits are incredibly smoothly machined (indeed the particular alloy is chosen to permit this smooth machining as well as to be inert in the body), there is no cartillage between them. Hence joint laxity caused by a surgeon to install a new hip is likely to cause more 'noise' or clunking than the laxity often present after a normal dislocation, because this 'normal' joint will retain the softening, lubricated properties of cartillage. To help mitigate post-dislocation joint laxity, all sorts of exercises are prescribed. Indeed I am compelled to work my left leg muscles for the rest of my life because of laxity in the knee caused by a  partially ruptured ACL, torn cartillages etc. And even though I have done this for the past 15 years, it still  softly clunks, albeit very occasionally, if I do something unusual or stupid.
I too had clunking in my new hip, starting about week 5. I'm in month 7 now and it is very rare, but some movements, especially if I am tired, can bring it about. As with my knee, I take this as a signal to get back to the exercises that are most important in strenghtening those muscles most citical for joint stability.

Pete C

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Re: More Thumps and knocks from a BHR
« Reply #15 on: October 02, 2009, 11:46:21 PM »
Thanks so much to Jed, John C, and all who replied to this post.  It is great to know that we are not the only one who has issues and questions, and even better to have so many intelligent answers.

John C, your analysis involving the polar contact point, and the gapping around the periphery makes perfect sense. It also corresponds to what my surgeon seemed to be saying about the alignment at the "equatorial" range of the joint motion. The space built in to allow fluid in-flow is probably greatest at the periphery, and yet only millimeters (if that) as my doctor explained.

After reading all this I am much less concerned about long term wear from this clunking. And my faith that it isn't likely to pop out of joint, which is why I went with the BHR in the first place, is fully restored. In fact, I plan to log a few miles of running tomorrow AM, and some climbing next week when the sunshine returns here.

This is a GREAT site! From the guidance of finding resurfacing in the beginning, to patient stories before and after surgery, and the reassurance of all of you, I am really greatful that we have surfacehippy. Thanks Pat for gettting this going!

larry2458

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Re: More Thumps and knocks from a BHR
« Reply #16 on: October 03, 2009, 08:36:37 AM »
pete
i'll bet everybody who clunks has had that "what the bloody hell was that!" moment.
i was at the top of the stairs when when i had my first "moment" and just putting my foot down on the landing.i rang the hospital up immediately(as fast as i could get back downstairs anyway) and the physio calmed me down.
it didn't start doing it again for months and by that time i'd been on here and realised i wasn't alone in clunking
                                                     good luck mate
                                                           larry
lbmh 16th october 2008

 

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