bad news today

[Barbara]

I will be 1 year post op on my rt side next week and 10 months post op on the left.
I have had no pain or problems with the rt side but continuous pain on the left. I thought it was soft tissue and muscle pain, though a couple of times I have been scared because I thought the pain was in my joint. I have had a lot of clunking on that side that is not associated with pain and ignored that as normal also.
I went for my 1 year check up today and found out that the cup has loosened on the left. There is quite a space there between the cup and the bone. My choice is a complete hip resurfacing revision or a Total hip replacement.
I was so devastated that I forget a lot of what the Dr told me. I don't feel ready to go through more surgery at this time even though I had a very normal surgical course and quick recovery. I need to psyche myself up and decide what to do.
Has anyone else had the same problem? I don't know at this moment what to do. It's a lot to take in.

[wayne-0]

Sorry to hear that Barbara. If it were me I would still go with resurfacing. Your other side is doing really good and if you can get the left side fixed up you should do really well in the future. I know surgery isn't something we look forward to, however a little more surgery and recovery/rehab will be worth getting a normal life back. Good luck to you and whatever decision you make all us hippies are pulling for you. Keep us posted.

Wayne

[bothdone]

Really sorry to hear that Barbara.    My inital reaction, given the choices of resurfacing revision and THR, would be to go with the resurfacing.   However, I'm sure there must be a lot of questions you'd want to ask - chief of which, for me, would be how successful is the re-surfacing likely to be?  It is something I would have no idea about.  Perhaps someone on here can help with that?

My main suggestion would be to prepare a written list of questions and follow-up questions for doctor.  Take someone with you who you trust and who would understand what is being said.  You can then discuss the options more fully afterwards.  Maybe allow them to ask the doctor questions during the consultation, if that's allowed.

Very best wishes

Ed

[obxpelican]

Barbara,

Hey, I am sorry to hear you're having a problem but if it were me I would go with the HR revision, it will be the least invasive as he can go in and re-set the cup which is not as major as cutting bone and inserting a THR device.

Cups are one of the biggest issues with hip surgery.

I wish you well.


Chuck

I will be 1 year post op on my rt side next week and 10 months post op on the left.
I have had no pain or problems with the rt side but continuous pain on the left. I thought it was soft tissue and muscle pain, though a couple of times I have been scared because I thought the pain was in my joint. I have had a lot of clunking on that side that is not associated with pain and ignored that as normal also.
I went for my 1 year check up today and found out that the cup has loosened on the left. There is quite a space there between the cup and the bone. My choice is a complete hip resurfacing revision or a Total hip replacement.
I was so devastated that I forget a lot of what the Dr told me. I don't feel ready to go through more surgery at this time even though I had a very normal surgical course and quick recovery. I need to psyche myself up and decide what to do.
Has anyone else had the same problem? I don't know at this moment what to do. It's a lot to take in.

[Tekka]

Hi Barbara

Really sorry to read your post, I can appreciate you not wanting more surgery, its traumatic at best.

I would want a re-surfacing, but we are all pro re-surfacing here, if the cup can be fixed then I would consider going for it. See what your surgeon thinks !!!

Hope you can works things out.

Best wishes

Terry

[dw]

It stinks either way, but I guess the way to look at it is - no matter which way you go, the cup is replaced, might as well save as much bone as possible!

[John C]

Hi Barbara,
Very sorry to hear about your report. Here would be my thought on it. If I understand correctly, the femoral cap is still doing well, so you would only be revising the acetabular cup. With that in mind, I cannot think of any reason to do anything to the femoral side, like converting the resurfacing cap to a THR type stem, if it is doing fine.
Your post mentioned a "complete resurfacing revision", but if it is possible to only revise the cup and leave the successful cap in place, it would seem to be just a partial revision, and much less traumatic and bone conserving than a total revision to a THR.
Good luck in whatever you decide to do.

John

[Pat Walter]

Hi Barbara

I am sorry to hear about your slipped cup.  That seems to be one of the problem that keeps happening now and then.  It use to be femur neck fractures, but now loose cups and misplaced cups are the biggest problem in hip resurfacing.

If you forgot what your doctor told you - call his office and ask the nurse to explain it to you again.  You paid for the appointment and deserve to know everything that is wrong and what he suggests be done.  This is your hip and requires an important decision, you are in control.  Ask for the information again.

Normally, there is no way to keep a resurfacing with a loose cup.  There have been a few cases where they surgeon was able to go back in and place the cup again.  That is very rare and is usually done failry soon after surgery.  Since you are in pain, the pain is going to control your life.  Also if the cup is loose, you are going to experince a high level of metal ions because the surfaces of the metal bearing made between the acetabular cup and femur cap are not mating properly.  That is causing excessive wear and an excessive high level of metal ions.  That is not a situation that any surgeon I know will want to allow to continue to happen.  Psdueo tumors and many other problems will start to occur around that area of the hip device.  The tissue will turn very black and will need to be removed.

It is just bad luck that you have the problem.  No matter the reason - it is now a resurfacing gone bad.  It is very sad and upsetting to have such a thing happen to anyone, but you will have to make a decision to have a revision sometime soon.

If you are not sure about what your surgeon is telling you, you can send your x-rays to some of the other top surgeons to get a second opinon. The top surgeons that do free email consultations are Dr. De Smet, Dr. Bose, Dr. Mont, Dr. Su, Dr. Gross, etc.  Normally the very expeirnced hip resurfacing surgeons will give you a second opinon.  If your acetabular cup is loose - you don't really need a second opinion.  YOu know you are having pain and can't use your hip properly.  That alone is the main reason to have your hip revised.  The situation is bad and you need to get it fixed.  You are not alone since there have been a few people with problems with loose cups and their hip resurfacings.  You can read some of the other stories of people with lose cups here  http://www.surfacehippy.info/hipresurfacingproblems.php

Again, I am really sorry to hear about your problem.  I hope you are able to make a decision and get your hip fixed properly soon.  Please stay in touch.

Pat

[stevel]

Hi Barbara,

Unfortunate to read about your slipped cup.  Very unusual for a BHR installed by an experienced hip resurfacing Dr.  Did he explain why it slipped and will he cover the costs of fixing it?  Otherwise if you have lost confidence is his ability to fix it, consider going to the other experienced hip resurfacing surgeons that Pat has mentioned, as they do revisions.  I know Dr. Su did revisions for two slipped or misplaced cups by other Drs. last year.

[Barbara]

Thanks for your responses and support everyone. I have compiled a list of questions and am planning on contacting my surgeon on Monday. I've been feeling sorry for myself and very weepy the past couple of days. The pain has become more significant now that I know what's going on and that it's not going to get better.
I'll probably wait until after christmas to have whatever surgery we decide on. I'll let everyone know how I get on 

[Barbara]

I spoke to my surgeon, Dr Pritchett,  yesterday and he says my acetabulum is very shallow but he thought he had good enough contact per xray immediately post op. The xray 2 months later also showed good connection and some ingrowth of bone. However now, 10 months later there has not been any more ingrowth of bone and in fact it looks worse on x ray than it did. The right side was equally as shallow but had adequate ingrowth of bone and it has been perfect with no problems whatsoever.

I continued to have pain on the left side but I thought it was muscular and now in hindsight realize I should have known something was very wrong. The femoral component looks good however may also need revision depending on what we decide to do for the acetabular cup. The quality of my bone is not a problem the problem is the quantity.

The success rate is approximately 70% for a revision from BHR to BHR. The success rate is higher for revision to THR but there is the problem of a future revision when the joint wears out, it is possible but difficult.

If I decide to go for a revision to another BHR (which is what I am leaning towards) my surgeons first choice would be possible bone graft and larger cup. If that was not working he would use the dysplasia cup with screws. He doesn't like that cup and hasn't used it often. He says patients complain of less range of motion and more pain with it. He has only done a few and has spoken with Mr McMinn, who invented it, and has himself only used it approximately 100 times due to the similar reasons.

He told me about the possible problems of Metallosis caused by increased metal ion concentration and the horrible side effects it can cause. I hope I am not there yet!!!

I have some decisions to make and he will do whatever I decide, when I decide.

Has anyone on the forum had the dysplasia cup with screws placed and can you give me your input??? Pat do you have any numbers of people who have had that cup? Has anyone had a revision to a THR and what are their thoughts?

Thanks again everyone for your input and support so far.
Barbara

[wayne-0]

Hi Barbara,  We are all a big family here and every one of us is pulling for you. Hope it all works out for you.

Wayne

[Pat Walter]

Hi Barbara

I do know of people that had the acetabular cup with screws from the start and I think at least a couple that were revised with it.  I can remember seeing the photos of the x-rays.  I am sorry, however, that I can't remember which patients since I read thousands of stories.  Unless it was just recent, I have a difficult time keeping all the stories and names in my head.

There have been a handful of people that had revisions of resurfacings to THRs and I have about 8 of their stories listed here   http://www.surfacehippy.info/hipresurfacingproblems.php

Loose components is one of the top reasons for revisions according to the newly released Australian Registry Report.

I am not sure what I would do in your situation.  I am sorry, but I can't remember if you have written to any of the other surgeons about their opinions.  If you haven't, Dr. De Smet is very good about giving opinions about revisions. He has done way over 3000 hip resurfacings and does a lot of revisions of other surgeons errors.  It might be worth dropping him an email, say I suggested it, and ask what he thinks would be the best course of action. He is one of the best hip resurfacing surgeons in the world and is very helpful to patients that need information.  I would write to him, but I don't know all the specifics or would be able to answer his questions to you.  His English is short, but he definitley will answer.

Dr. Koen De Smet
3200 Hip Resurfacings to date ***
ANCA Clinic
AMC-Gent
Krijgslaan 181
9000 Ghent
BELGIUM
Phone: +(1)32 9 2525903
Fax: +(1)32 9 2526457
+1 for USA & Canada:
E-mail: helpdesk@heup.be
ANCA Clinic Website

Pat

[Tekka]

Hi Barbara

When I had my lbhr in the opposite room was a lady who did have a dysplasia cup fitted and as far as I am aware...all was well.

I suppose it depends how comfortable your surgeon feels with fitting the cup.

Really hope you get things sorted.

Best wishes

Terry

[sneadres]

It looks as i will have to have a thr using the min. inv. anterior approach as depuy hip resurfacing device was denied by bc/bs. My Dr. is a very well respected surgeon that does the anterior method for thr and resurfacing. I am 50 and have been very active as i bike,elliptical train, swim, and lift light weights while sitting. Used to run 30-35 miles a week until diagnosed 7 years ago with arthritis in left hip. Now walking is a problem and quality of life has certainly declined as pain has completely taken hold physically and mentally. My Dr. says that with this thr which is metal/with a ceramic head on cap of femur and a metal socket has shown essentially no wear at all and he has no restrictions on my activities after recovery. Still to have hip resurfacing denied with even an fda  approved device by bc/bs was quite discouraging but with my pain i am looking forward to anterior method thr which i never thought i would say. Anyone who has had this experience, i would greatly appreciate your response as to what thr device was used and how your recovery was and activities after surgery that you could resume. I wonder why i pay anthem 1200/month for health ins. with this type of coverage, will certainly get out next year. THANKS.

[dw]

I have Anthem also, and was approved for a BHR (procedure New Year's Eve 2008).  Did they give a reason? Was it the device, the procedure, the doc, the wrong diagnostic code, etc? (Some surgeons put THR for insurance and do the resurface - Anthem recognizes this as an error) That's a heck of allot for insurance per month!

With the THR, you may not get as much hip stability as with a BHR, IMO, but that's my guess.

[John C]

It sounds like the procedure that you are being offered is a very good choice. However, if you would prefer a resurfacing, I do know that Blue Shield has approved a lot of resurfacings. I think that it just has a lot to do with how the Doctor's office submits the information. Part of the issue in your case may be that, although the Depuy device is FDA approved, I believe that its use for resurfacing is still considered "off label" in this country, which can be a red flag for some insurance companies. There are other brands out there (BHR for example) that are approved for resurfacing use, which tends to eliminate some of the insurance issues. Bottom line; I think that you still have a number of options if you feel that you want to explore them.
Best of luck with whatever you choose.

[Barbara]

Thanks again everyone for the input.
Thanks Pat, I will email Dr De Smet for his opinion.
I have another question- does anyone have any input on a THR using a short stem femoral prosthesis? I am trying to gather as much information as I can before deciding which path to take.
Barbara

[stevel]

A three part video about the BMHR is located on this website.  The device is not FDA approved in the US and you will need to go to Birmingham, England and have Dr. McMinn install it.
In your case, with a failed BHR, for the best outcome for a revision, I would go the best in the world, which is Dr. McMinn, the inventor of the BHR, BMHR and a full size THR replacement.

[John C]

Hi Barbara,
I believe that Dr. Gross uses a very short stem THR for revising failed resurfacings. It is so short, that there is almost no stem in the traditional sense. You could try to contact Gross's office for more information on what they use, or go to the Biomet site to look at the prosthesis.