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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: Clunking and Shifting  (Read 12170 times)

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dstphnsn

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Clunking and Shifting
« on: March 23, 2010, 04:11:28 PM »
I had a left BMR October 15, 2009.  Overall I'm doing great.  I'm a fitness walker (almost a race-walker) and at age 61 back to 15-20 miles/week.  I have lots of clunking and shifting, but my 3 mos xray looked fine and I have almost no pain.  My orthopedic surgeon seemed mystified as to what it might be?  I feel shifting when I bend over the sink or sit on the toilet.  Clunking when standing and slightly change position.  Even just shifting position slightly when sitting at the computer.  Not all the time, but many times a day.  I'm reassured by other postings that it's not cup loosening or other bad problems, but what is it?  If it's just "loose" soft tissues surrounding the hip, anything I can do to tighten it up?  Not to worry though, right?

larry2458

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Re: Clunking and Shifting
« Reply #1 on: March 24, 2010, 08:40:17 AM »
I had a left BMR October 15, 2009.  Overall I'm doing great.  I'm a fitness walker (almost a race-walker) and at age 61 back to 15-20 miles/week.  I have lots of clunking and shifting, but my 3 mos xray looked fine and I have almost no pain.  My orthopedic surgeon seemed mystified as to what it might be?  I feel shifting when I bend over the sink or sit on the toilet.  Clunking when standing and slightly change position.  Even just shifting position slightly when sitting at the computer.  Not all the time, but many times a day.  I'm reassured by other postings that it's not cup loosening or other bad problems, but what is it?  If it's just "loose" soft tissues surrounding the hip, anything I can do to tighten it up?  Not to worry though, right?
i get all those clunking and shifing sensations but not when i'm sat down.i don't get them when i'm walking or riding my bikes.i'm on my feet at work and when i shift weight off my hippy side i do get it.we aren't the only ones though.
lbmh 16th october 2008

jackmac32

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Re: Clunking and Shifting
« Reply #2 on: March 24, 2010, 12:50:25 PM »
Hi, I had a LBHR on Oct 1, 2009.   I am also still clunking and shifting...in my hip that is.  I have read on here it can happen even after a year or two....as long as there is not alot of pain when it happens we should be good.

rickg

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Re: Clunking and Shifting
« Reply #3 on: April 06, 2010, 09:59:18 PM »
Add one more clunker. A few days short of a month but doing well over all. Went from crutches to walking with no cane. Heck, I'm a 56 year old Marine. Well put me in the "over doing club" too. Few days ago edged and blew the yard as my wife mowed. Last few days have had lower back pain and more clunking. Got a cain today and taking just that little weight off the hip feels better.  I'm listening to my body and learning.  Sure would like to get my socket set out and "tighten up" the socket! 
LBHR March 10, 2010 Dr. Stocks Houston,TX

Pat Walter

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Re: Clunking and Shifting
« Reply #4 on: April 06, 2010, 10:10:23 PM »
Glad to hear you are doing well.  The clunking won't stop until the muscles around your hip heal and tighten up.  Normal clunking, according to Dr. De Smet, is due to the lose muscles.  As you heal, the clunking should become less.  I am 4 years post op and still get a clunk now and then when I sit a certain way and transfer my weight.  I am 65 years old, so I guess my muscles are about as tight as they are going to get!

Good Luck.

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

phillwad

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Re: Clunking and Shifting
« Reply #5 on: April 12, 2011, 02:28:21 PM »
I am 3 1/2 week post op and when I did my exercises today I got a little clunking, especially on the standing, move the leg backwards exercise (I am sure there is a PT name for it ???)  Good to hear from Pat that it probably a need to let the whole area tighten up - Thanks - Phill

larry2458

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Re: Clunking and Shifting
« Reply #6 on: May 22, 2011, 01:19:26 PM »
my hip will be 3 years old in october and its just dawned on me that the clunking has stopped.must have been over the last few moths.anyway its gone.
lbmh 16th october 2008

sixstring

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Re: Clunking and Shifting
« Reply #7 on: May 24, 2011, 12:31:39 PM »
I got a right hip resurfacing using the Biomet Magnum Recap by Dr. Gross in SC in June 2006.  My clunking/shifting has gotten progressively worse over the years; it is so frequent now (I estimate more than one hundred/day) I often don't think about it.  It occurs primarily when my hip is extended.  When standing, slight shifts in position can set off a series of clunks - almost like a ratchet.  When walking, there is often a clunk as the implanted hip reaches full extension.  The hip does not bother me much other than the clunking; the clunking causes no pain. I am a very active 59 year old male, 5'-8", 163 lbs.

In February 2011, I had blood levels of chromium and cobalt measured on my own - Dr. Gross did not suggest it.  Cr was 38 mcg/l ("normal" <1.4mcg/l) and Co was 81 mcg/l ("normal" <0.5 mcg/l), both extremely high.  I reported this to Dr. Gross who asked me to have them rechecked with a lab he uses - results there were virtually identical.  (Note: mcg/l means micrograms/liter; one lab measured serum metal levels and one measured plasma levels with very little difference between the two.) 

I talked to Dr. Gross after the elevated blood metal levels were confirmed.  He said my cup inclination angle is to steep ~ 60 degrees (optimum is closer to 40 degrees) which is associated with excessive wear, probably due to edge loading of the cup.  He said steep inclination angles weren't known to be a problem in 2006 when I had the resurfacing, and that he didn't have a way then to set the angle during the operation.  He now uses an intra-operative x-ray to measure the angle at which the cup is placed and now never has cup angles > 50 degrees.  I recommend reading Dr. Gross's article on Acetabular Component Inclination Angle on his website (http://www.grossortho.com/). Given that my hip is functioning well, he didn't feel my blood metal levels were a serious health issue, and said the options were to continue to track metal levels, get an MRI to check surrounding tissues for signs of metallosis, or to revise the cup. 

I opted for a metal-shielding MRI (MARS protocol) (May 2011) to see if there were abnormalities around the implant.  The MRI showed abnormal fluid accumulation around the hip; the radiologist's report concluded it was most likely a "psuedotumor due Particle Disease."   

I met with Dr. Gross in May 2011 right after the radiologist reported the MRI results.  Dr. Gross recommended replacement of the acetabular cup to correct the steep inclination angle.  As a side note, he believes my clunking is due to the temporary loss of "lubricating" fluid in the implant due to the excessive wear on the edge of the cup, causing the hip to catch or stick - he feels this probably accelerating the wear.

Dr. Gross feels that replacing the cup at the correct angle will resolve the excessive wear, metallosis, and psuedotumor. He said that total hip replacement is also an option, but that since the femoral component looks good, he recommends cup replacement.  Even though the femoral component likely also has wear, he feels that when placed in a new cup at the proper angle, it will function well.   He says he has revised 3 HSRs in his patients who had steep cup angles (>60 degrees), one of whom had metallosis.  In one revision he replaced cup only (very recently) and in one case did a THR (about a year ago).  He said the revisions went smoothly and both patients are doing well. I don't recall him mentioning the outcome with the third revision.   

I originally posted this account under the "clunking and shifting" thread to provide some perspective to those who have these symptoms, but want to be clear that the clunking/shifting alone is not significantly affecting the quality of my life and I would not consider surgery to eliminate it.  I am considering the "revision" surgery to address the high blood metal levels and metallosis.  I'll also try to post this under "serious post op problems thread."

I'd appreciate any insights from those of you who have had similar issues, particularly from any of you who have had a cup-only revision due to metallosis.  Thanks.

Brian
Black Mt., NC

bullweenie

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Re: Clunking and Shifting
« Reply #8 on: July 09, 2011, 01:56:11 PM »
"Given that my hip is functioning well, he didn't feel my blood metal levels were a serious health issue, and said the options were to continue to track metal levels, get an MRI to check surrounding tissues for signs of metallosis, or to revise the cup."

I'm a bit shocked by this advise from Gross given off the chart levels. The UK issued a directive to monitor anything above 7 and revise anything above 20. Cobaltism will result at the levels you have and that can damage the heart, thyroid and nervous system. You also should have your kidney function checked. There is a recent study on metallosis that prompted the FDA to require every single implant maker to collect data on metal levels for every implant walking around out there, just this spring. Just google "cobaltism" to find the study by a doctor in Alaska. Titanium levels should also be monitored on the Biomet.

Hip implants take a lot of abuse because they are such a major joint with a lot of weight bearing. In hindsight, it's easy to see why they are shedding debris no matter how well placed. I find that if my activity level is low, no obvious issues. But when I am very active, I get pain in the scar area. I may be in the same boat pretty soon...

Lopsided

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Re: Clunking and Shifting
« Reply #9 on: July 09, 2011, 02:08:30 PM »
Hip implants take a lot of abuse because they are such a major joint with a lot of weight bearing. In hindsight, it's easy to see why they are shedding debris no matter how well placed.

No, good placement is the key factor to good performance. Hip implants are not shedding debris.

You can either freak out at all the bad publicity put out by people without implants, or read all the success stories here.

D.




Proud To Be Dr. De Smet's First Uncemented Conserve Plus, Left, August 2010

 

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