Awaiting THR

[Ka]

Hi there, I hope I'm doing this post right. Thanks Pat for letting me join.
I am a 56 yr. old female, Canada, and waiting for THR (oxynium on XLPE) sometimes this summer.
As a child I had slipped epiphysis in my right hip, diagnosed after 1 1/2 years of pain, pinned, then
left hip done 1/2 year later, both pins removed after. I did well until I gave birth at age 34, and after
my right hip always gave me problems on and off. About 15 yrs. ago I slammed my right leg into a
sled (amusement park), but the doctor said 'take it easy', no xrays, just anti-inflammatories.
To make a long story short: I took them on and off for about 5 years, got an ulcer, more hip pain,
saw different doctors etc. And always the same result: nothing wrong, get a new hip when you turn 60.
I have moved, and my new family doctor wouldn't refer me to a specialist. Finally, last winter, he agreed, I met with him, and he said he is not comfortable with my problems, new referral to Toronto (took 7 months), saw a surgeon and was told I have osteo/traumatic arthritis/impingement, but too late for an arthroscopy, new referral for hip resurfacing, hip injection, finally was told 'osteoarthritis', no candidate for BHR, but need THR. So, this journey took 15 years, I'm on morphine sulfate now, massages/chiropractor/pilates don't  really help. My right hip is so damaged that I can hardly walk (only cane/crutches), driving, sleeping, daily life is a nightmare, my knees, feet and lower back are hurting, and I have osteoarthritis in my lower spine now.  This is my story, and I can feel my left hip starting to hurt. I am looking forward to a new hip and hopefully a normal again. Hard to imagine. But otherwise I'm doing good. lol

[Pat Walter]

Hi Ka

Welcome to Hip Talk.  Most of us here have had hip resurfacing, but understand not everyone is a candidate or wants to go that route.  I am happy to have you post here and receive some support from the great group of folks that are here. 

Both THR and Hip Resurfacing are both major surgery and have similar recovery problems.  Has your doctor told you what type of THR you are getting?  Hopefully it will be a large ball MOM, metal on metal, THR.  They are also an excellent option to hip problems and have few restrictions after recovery.

Most of us have been in the same position as you are.  Not able to sleep or be active at all even with strong pain meds.  Knee and back problems are also common since the rest of your body is trying to compensate for your bad hip.  Your body is not in balance with joint problems.  Hopefully, after your hip surgery and some time to heal, your knee and back problems will get better.  Many of us had the same problems.

Good Luck and keep in touch.  I put your post in the THR section.  Hope you did not mind.

Pat

[LMS]

Hi Ka,
I'm so sorry it took so long for you to arrive to this point.  It's a shame that some doctor's are hesitant to refer on when we are pleading for further investigation.  I was with my doctor for 16 yrs before I finally was seen by a physio therapist (of my choice this time round) who did something.  And even with the results of the initial hip x-ray, she still wasn't going to do anything about it.  And then once seen by the surgeon & fellows, I am told that my issue could've been addressed all those years ago & it would've changed or at least delayed the situation I'm in now.

Are you scheduled for a THR?  The waiting game in this province is impressive sometimes isn't it?

Where near TO are you? I'm just on the outskirts of Ottawa. *waves hello

[Lopsided]

... I am a 56 yr. old female ... oxynium on XLPE

I presume XLPE is cross linked polyethylene. As you are only 56, why don't you consider something that should last longer like metal on metal or ceramic?

[Pat Walter]

I am sorry I did not see the oxynium on XLPE    I am not sure what that is.  If it is not a large ball Metal on Metal or ceramic on ceramic - your activities could be very restricted.  You may not even be able to cross your legs.

Please check with your surgeon to make sure you don't get a small ball, old fashioned metal/plastic THR.  There are many studies showing how the plastic breaks down into small pieces and causes pseudotumors and problems too.  Add that to all the restrictions to what you can and can't do- means this is not the best solution for you.

Please drop Dr. De Smet an email and attack your x-rays in a digital format as a .jpg    He will tell you if you are a resurfacing candidate or will recommend a THR for you.  He never uses a small ball THR for younger active people.  PLease ask questions and do some more checking about what you are getting.  Dr. De Smet is in Belgium and not far from you.  I flew form the US to Belgium to use him.  He is one of the best in the WORLD  and he will give you a free consultation.  McMinn is also fantastic but I don't know how you go about getting a consult with him.  I do know some people in the UK have been able to change doctors, but don't know your system well.

Pat

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

Mr. Derek McMinn FRCS, Consultant Orthopaedic Surgeon
3095 Hip Resurfacings to date
The McMinn Centre
25 Highfield Road
Edgbaston
Birmingham B15 3DP
Tel: [+44] 0121 455 0411
Fax: 0121 455 0259
email:enquiries@mcminncentre.co.uk
http://www.mcminncentre.co.uk/

Mr. Ronan Treacy,  MBCHB 1983, FRCS 1988, FRCS Orth 1995
5000 Hip Resurfacings to date
Birmingham Nuffield Hospital, UK
Orthopaedics,  Knee and Hip Surgery
Tel: 0121 454 6161
http://www.roh.nhs.uk/

[Pat Walter]

I have been busy, but took a quick look at your proposed device.  It sounds like a newer THR that is ceramic and metal.  I still would ask about the cup and femur cap size you are getting.  Ask about any restrictions.  Here is the info:

http://global.smith-nephew.com/us/OXINIUM_ALLOY_XLPE_24434.htm

R3◊ system with OXINIUM◊ alloy is the most advanced bearing option available
OXINIUM◊ is an Oxidized Zirconium alloy (97.5% Zirconium and 2.5% Niobium) with a transformed ceramic surface providing the wear performance of ceramics and the strength of metals. This provides all of the benefits of ceramic and metal bearing technology. OXINIUM◊ material is especially useful for nickel-sensitive patients. OXINIUM material is an award winning, clinically proven advanced bearing material that is designed for active patients.

OXINIUM◊ material along with 10 Mrad XLPE provides the wear performance of hard bearings along with the intraoperative options of hard-on-soft bearing. OXINIUM◊ material has a clinical history of more than 10 years. Over 190,000 components have been implanted successfully to date. Impressive clinical wear performance of OXINIUM◊ heads was supported by an RSA clinical study from Dr. Bo Nivbrant.4

[Lopsided]

It is not the zirconium that will wear out, it is the polyethylene. It might be better than polythene, but it still wears out. I use polyethylene water pipes. They are good pipes, but they are flexible, certainly nothing near as hard as ceramic or metal.

[Ka]

Hi there, Thank you so much for all the information. I live in Huntsville/Muskoka, the surgeon is in Toronto (3 1/2 hrs. one way).
When I saw the 'arthroscopy' dr. in September, he said I should have come earlier, now it's too late. I was not able to get a referral for years. Here in Canada you have to fall apart first to be referrred. He suggested the Birmingham resurfacing with Dr. Schemitsch in Toronto.
I saw Dr. Schemitsch, and he clearly ruled out resurfacing due to my age, small bones, being female, having damage due to my previous slip and beginning of osteoporosis. He was very thorough, and I had a hip injection later (just anaesthetic) to rule out referred pain from my back. In my case the oxynium on xlpe is the best solution I was told, and no weight-bearing for at least 6 weeks. I'll take that. I will ask about the ball size when I go back for my pre-op info day. Sorry Pat, but I cannot consider Belgium due to the costs. It won't be covered. I had considered Germany (because I'm German), but again .... no coverage.
What makes me very sad is reading your stories and the choices regarding doctors you have. I am beyond ecstatic to have finally seen a real hip doctor and get help. Dr. Schmemitsch has an excellent reputation. Now I'm just waiting for my date, again long waiting list.