BHR FAILED AFTER 16 MONTHS, SCHEDULED FOR THR NEXT WEEK, CONCERNED

[bnickey]

i am 51, had a BHR in September of 08. Complained of symptoms including pain, weakness, giving out. this went on from month 3 post op all the way through 9 months post op. The reply i got was give it time. After 16 months post op, i returned complaining of the same symptoms, the latest x-ray shows a shadow where the cup meets my hip socket. The doc explain this indicates that the boney growth into the metal cup did not occur; explaining my symptoms finally. now i am scheduled for a THR revision, i am concerned about the effectiveness of the revision. i only get one more shot at this. anyone experience similar situation?

[obxpelican]

My first questions is this, why convert to a THR if the cup could possibly be re-set?  I would be concerned as to why the doctor is throwing out the baby with the bath water.

He's going to have to re-set a new cup, is the femoral component damage somehow?

In answer to your question, revisions are normally quite effective assuming you're using a experienced surgeon. 

Before you go for a revision why not send those x-rays for a good look by one of the experienced surgeons in this country or possibly another country?


Chuck

i am 51, had a BHR in September of 08. Complained of symptoms including pain, weakness, giving out. this went on from month 3 post op all the way through 9 months post op. The reply i got was give it time. After 16 months post op, i returned complaining of the same symptoms, the latest x-ray shows a shadow where the cup meets my hip socket. The doc explain this indicates that the boney growth into the metal cup did not occur; explaining my symptoms finally. now i am scheduled for a THR revision, i am concerned about the effectiveness of the revision. i only get one more shot at this. anyone experience similar situation?

[bnickey]

his reason for thr instead of a BHR revision is that the boney growth did not occur with the BHR and he feels that it is very possible that it will not occur again. He feels confident that this will not be the case with the THR.

[B.I.L.L.]

Wow I'm 51 (next week), had a bhr in september 08, have a steep cup, a few concerns and have also been told to "give it time"  Hows that for a familiar experience ?   You mentioned pain, weakness and giving out, I'm just curious , is the pain sharp or more like a dull ache ?   I'm having some swelling and a dull aching sensation after heavy activity or sitting for any length of time, it's not killing me by any stretch but it sure aint like the good side. Was the pain constant or did it come and go ?
Is there something different about a thr cup vs a bhr cup that will allow the bone to grow in better ?
Did he mentioned why he thinks the cup came loose ?
Sorry to bombard you with questions .
Good luck & keep us informed, Bill 

[obxpelican]

his reason for thr instead of a BHR revision is that the boney growth did not occur with the BHR and he feels that it is very possible that it will not occur again. He feels confident that this will not be the case with the THR.

Wait, the THR uses an acetabular cup similar and in some cases exactly like a BHR.

He's going to have to reset a cup regardless---- Pat, am I missing something?

Who is your doctor?


Chuck

[Pat Walter]

I privately emailed him and explained that the acetabular cups for the BHR and MOM THR by Smith & Nephew are the same.  I told him to get second opinions from some of the really experinced surgeons to see if his BHR could be save - perhaps by replacing only the acetabular cup.  I know of one or two patients that had that done.

Again, I am not a doctor and can't say it can be done.  The best course of action is to get the very top hip resurfacing surgeons to give input if it can be done.  Personally, I would want to save my BHR if possible and would travel to the best surgeons if it could be done.  Unfortunately, with either a revision to a THR or revision of the cup - it means another major surgery.

I am sorry to hear about the lack of bone growth into the cup and don't know the reason.  I do know some cups were not set deep enough and there were voids behind the cup.  Dr. Bose and I think De Smet did say that the bone should fill in the void.  I don't know if it did because I am not sure the people ever posted again.

Pat

[obxpelican]

Thanks Pat, I know I've read a number of times where patients merely had their cups re-set (I would assume a new cup) into their acetabular.

I know many inexperienced doctors have troube at first with setting a cup when the femoral component is in the way.


Chuck

[stevel]

Also check out Barbara's posts regarding a revised cup or THR since bone did not completely grow into the cup or socket due to a shallow acetabulum.
And the first surgery was done by an "experienced" surgeon with over 500 hip resurfacing surgeries.

[woodway2]

Hi Pat, BILL et all:
I haven't written in for a while but I guess it's time. BILL, sorry to tell you that next week I am having a revision of my BHR September 07. You will remember I have had very high metal ion test results for some time. I noticed the high acetabular angle myself from viewing xrays on this web site, and requested blood tests. My levels are up over 55 ppb for both chromium and cobalt. It was really hard making this decision as until recently I haven't had any pain. In fact, I had taken up my old sport of horseback riding and was riding better than I have for years!
But what started as an annoying "sensation"  became an ache and now I would finally call it pain. Sitting is particularly weird with a feeling of pressure pushing in at my side. This pain is entirely unlike the original arthritis. More of a leg and thigh pain.
We took new xrays a few weeks ago and the crazy thing is, although the cup angle is still high, the xrays look great. No shadows and it looks like there is good bone growth. So I guess everyone is different and a resurfacing can be unsuccessful in many different ways.
I am pretty depressed but hope things go well . Not much else to say.
Thanks, Pat, for all your support in the past, and for your site. Good luck BNickey!
Nancy

[Pat Walter]

Hi Nancy

Good to hear from you - but the news isn't good.  Thanks for the update.  Please keep in touch and let us know how things are going for you.

We are all sorry and dissapointed to hear about any revisions that are required, but we are here to listen and offer support.

Pat

[B.I.L.L.]

Hi Pat, BILL et all:
I haven't written in for a while but I guess it's time. BILL, sorry to tell you that next week I am having a revision of my BHR September 07. You will remember I have had very high metal ion test results for some time. I noticed the high acetabular angle myself from viewing xrays on this web site, and requested blood tests. My levels are up over 55 ppb for both chromium and cobalt. It was really hard making this decision as until recently I haven't had any pain. In fact, I had taken up my old sport of horseback riding and was riding better than I have for years!
But what started as an annoying "sensation"  became an ache and now I would finally call it pain. Sitting is particularly weird with a feeling of pressure pushing in at my side. This pain is entirely unlike the original arthritis. More of a leg and thigh pain.
We took new xrays a few weeks ago and the crazy thing is, although the cup angle is still high, the xrays look great. No shadows and it looks like there is good bone growth. So I guess everyone is different and a resurfacing can be unsuccessful in many different ways.
I am pretty depressed but hope things go well . Not much else to say.
Thanks, Pat, for all your support in the past, and for your site. Good luck BNickey!
Nancy

Aaaahhhh Crap.    Sorry to hear that Nancy, good luck and keep us posted