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Author Topic: BHR Gone Bad....  (Read 9641 times)

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Magnus

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BHR Gone Bad....
« on: March 10, 2011, 03:27:19 AM »
I had a BHR on my left hip done 2 years ago.  I started getting fluid in my bursa sack and it was drained 3 times.  I went back to my surgeon (who I got of this website) several times.  He was stumped.  He took X-Rays, MRIs, CT Scans, tried draining fluid directly from the hip joint, and then he finally took a blood sample.  The blood sample came back with a cobalt level of 120 (most BHR Metal on Metal patients are below 10).  He recommended a non MoM THR (Metal on Metal Total Hip Replacment).  I sent it the XRay to another surgoen (who is also on this website) and he called me this evening.  He stated that he knew what my problem is.....the cup is not positioned correctly and is causing extra wear...causing the high cobalt.  He recommends just replacing the cup and positioning it correctly.    I am so confused....which doctor should I believe?  I am trying to get a 3rd opinion.  Also, do I have a lawsuit here?  I am not the lawsuit type of guy, but I am so frustrated that I not only have been bothered by this issue for over a year...I have to go thru the procedure again.  Ugh!

Has anyone elso gone thru this?

Pat Walter

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Re: BHR Gone Bad....
« Reply #1 on: March 10, 2011, 01:57:04 PM »
Hi

I am sorry to hear about your hip problems.  I know only of one other person that was able to have an acetabular cup revised.  It is very diffiuclt to do that.  Only the very top surgeons would be able to do that like the ones at the top of my list - DeSmet, Dr. Su, Dr. Gross, etc  The problem is that you know have all the high metal ions in your body.  Normally when that occurs, the revision is to a ceramic on ceramic THR.

It is much more typical of the inexperinced surgeons to misplace the acetabular cup. I would not want the original surgeon to do my revision.  I would get input from Dr. Gross, Dr. Su, Dr. De Smet and see what they suggest. Both Dr. Gross and Dr. De Smet will answer your emails.

this is very serious because you don't want to have a revision surgery and then find out it has not gone well, then another to go to a THR.

Lawsuits are not easy - you chose your surgeon and he/she did what they thought was best.  They did no purposely misplace your cup.  Many inexperinced surgeons did not place the cup properly. This was not understood by many in the early years.

I would get input from only the top surgeons. Don't listen to the rest.

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

B.I.L.L.

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Re: BHR Gone Bad....
« Reply #2 on: March 11, 2011, 12:59:37 AM »
Well that sure enough sucks, sorry to hear that Magnus. I have a steep cup that some doctors wanted to revise, and some said leave it and see how it goes, I left it and am keeping my fingers crossed. (I'm at 2-1/2 yrs)   I feel for you dude it's always there in the back of my mind wondering how long until I have problems, I try not too think about it but you don't have that option, sorry man, really. Heres what I was told about revising the cup only.
I had 2 doctors say they could revise the cup only (at 7 months) depending on what thickness of cup I had, I was told that bhrs have two different thickness cups, a thin one and a thicker one, as long as I had the thin one they said they could do it. I guess there is no way to yank the cup out without taking some bone with it, hence the need for a thicker cup, I was also told that they would have a thr on site "just in case". One doctor had done a cup revision before and the other had not. I don't know if this will help at all but here are the questions and concerns I had (still have)
If the ball is worn uneven due to the cup being off, how will it mate with the new cup ? will the small imperfections in the ball cause even more ions as it wears in with the new "smooth" cup ?
If I have to get a thr I don't think I want a metal on metal implant since metal ions are what caused the problems in the first place ?

If it was me I would want to keep the bhr if its possible 
I do have a couple questions if you don't mind, What were your symptoms of having fluid in the bursa sack ? Was it pain, or swelling, or both ? My butt cheek on the operated side is a little puffy compared to the other side, and it feels cold to the touch (compared to the non operated side) Do you have any symptons like that ? Just curious...Best of luck to you and please keep us informed, wishing you the best of luck, Bill
« Last Edit: March 11, 2011, 02:42:40 AM by B.I.L.L. »

Tin Soldier

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Re: BHR Gone Bad....
« Reply #3 on: March 11, 2011, 04:52:28 AM »
Hey Magnus -

I think you should get yet another opinion as Pat says.  There's a number of papers out there suggesting that high acetabular cup angles are what cause metallosis.  I suspect (I haven't asked them), but I think many of the top surgeons are in the same camp when it comes to the main cause of metallosis, that being excessive wear from edge-loading and high cup angles.  I have also read that when the component/s are revised you eseentially rid your body of the metals load, it takes some time, though.  Also, I have read that just becasue you had metallosis once, doesn't mean it will happen again.  I think it has a lot to do with the individual's ablity to rid the affected area of the metals that are being generated from wear.  Who knows, maybe some people can eat Cr and Co for breakfast and they have no acute reactions.  I wouldn't recommend it.  You could look up toxicological data for heavy metals like Cr and Co on the Agency for Toxic Substances and Disease Registry (ATSDR) webpage.  That may or may not be helpful, I guess from what I've read, I wouldn't worry too much about the long-term affects of the elevated Co in your blood.

I would focus on getting a few more opinions and see what some of the top surgeons say.    Good luck, I feel for you.   
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

Magnus

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Re: BHR Gone Bad....
« Reply #4 on: March 11, 2011, 05:40:39 PM »
Thanks....the Surgeon I have recently been speaking with is Dr. Gross.  I am now scheduled to have the revision with Dr. Gross on 3/21....I am excited and nervous.  I just want it done and start the rehab again.  I sent Dr. Gross addl X-Rays yesterday and I have an appoitment with him next week....he sounds like a great guy.  I have heard great things about him...so I got my fingers crossed.

The symptems I had were a swollen lump in my groin area....I thought it was a hernia.  It was not really painful, it was more uncomfortable.   It bothered me when I ran longer than 30 minutes, or if I bent 90 degrees (exercising, sitting on the toilet, etc).  I was debating dealing w the discommfort, but the cobalt level in my blood is forcing me to do something.  I wanted to stay away from a polyethylene THR because that would limit my activeness.  I also have some discommort in my butt...I hope that this will be fixed with the new cup.

Bill, I will keep you posted...hopefully a successful revision.

stevel

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Re: BHR Gone Bad....
« Reply #5 on: March 11, 2011, 07:56:12 PM »
Also read Jim Tork's story on Vicky Marlow's website.  Last Fall, he had his steep cup reset by Dr. Pritchett, who did the original installation. His case was also reviewed by Dr. Gross.
Interesting that it is possible to reset the angle of the cup.
Steve
LBHR 60mm/54mm Dr Su 9/29/08 age 55
RBHR 60mm/54mm Dr Su 11/1/19 age 66

John C

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Re: BHR Gone Bad....
« Reply #6 on: March 11, 2011, 10:26:03 PM »
Hi Magnus,
I am happy to hear that you have connected with Dr. Gross. If anyone can fix you up, it would be him. You will enjoy working with him, as well as his team and the hospital. For what its worth, I checked my metal ions at 2 years, and they were within the normal range for a person without any metal parts in them, which I attribute largely to how well Dr. Gross nailed the cup position (39 degrees). You are in good hands, and should come out just fine.

John
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

23109VC

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Re: BHR Gone Bad....
« Reply #7 on: March 12, 2011, 12:36:21 AM »
You are in good hands.  His staff is great, the hospital is nice.  Good luck!

Sean
Dr. Gross- Biomet uncemented, 2/23/11

Magnus

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Re: BHR Gone Bad....
« Reply #8 on: March 22, 2011, 03:24:30 PM »
came out of surgery yesterday...feel great.  Dr. Gross took out the old cup with minimal bone loss.  He installed a new cup at 29 degrees compared to the original cup, which was set in at 61 degrees.  Goal now is to make it more stable and almost more importatnly allow my cobalt levels to start declining.

Thanks for all of the support and experience....especially the article of Jim Tork.

Dr Gross and his staff are truly second to none....the people her in South Caroline have been super.


einreb

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Re: BHR Gone Bad....
« Reply #9 on: March 22, 2011, 04:33:01 PM »
Congrats! 

Interesting about the cup angle.  Mine (Dr Gross installed) is in the low 30 degree range.
40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

newdog

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Re: BHR Gone Bad....
« Reply #10 on: March 22, 2011, 05:46:39 PM »
Magnus,

When I read your post back on March 9, I would have bet that the surgeon is Dr. Gross. When you said he called this evening and so soon after sending him your xrays, that was a clue. Also he suggested replacing the cup at the correct angle. (Very rare.) I know Pat Walter gets beat up at times on this site for telling people to choose surgeons with the most experience doing HR, but it especially applies to Hippys having problems that may require another surgery.

I know that I may be biased because I am a Gross Hippy (that would make a good t-shirt!), and I do worry at times that others on this site may be tired of seeing his name here in the posts all the time, but he is especially skilled at diagnosing difficult cases that require difficult and custom surgeries. I am not saying that he is the only one in the world that has these capabilities, I know that there are others, but you chose one of the best if not the best. We who have been to Columbia, SC,  know exactly how you feel about him and his team.

What a great story! This is another one that made my day. Best wishes.
« Last Edit: March 22, 2011, 05:52:46 PM by newdog »
Steve, Dr. Gross bilateral, uncemented Biomet, January 10 & 12, 2011, Columbia S.C.

hernanu

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Re: BHR Gone Bad....
« Reply #11 on: March 22, 2011, 07:01:31 PM »
Like newdog said, great story. Have heard nothing but good about Dr. Gross.
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

Pat Walter

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Re: BHR Gone Bad....
« Reply #12 on: March 22, 2011, 08:28:05 PM »
Magnus - great news.  I am so glad you were able to have just the cup revision.  I hope things heal quickly and you have a great summer.
Keep us posted on your recovery.

Good Luck

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

toby

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Re: BHR Gone Bad....
« Reply #13 on: March 22, 2011, 10:26:27 PM »
Congratulations Magnus,
I'm really pleased that Dr Gross has resolved your problem and you've kept your HR. I'm from the UK and everything I've seen (Pat's viseo) and read about Dr Gross is incredibly impressive-so great choice. Your news is great news too for some who have high cup inclination to know that their cups can possibly be re-positioned and avoid a revision to THR.
Out of interest what Cup device did he use with your BHR femural component?
BW
Toby
LHR Adept-Prof Cobb-30-1-10

stevel

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Re: BHR Gone Bad....
« Reply #14 on: March 23, 2011, 05:08:19 PM »
Magnus,

Why 29 degrees?  Isn't 40 degrees the ideal cup angle?
Steve
LBHR 60mm/54mm Dr Su 9/29/08 age 55
RBHR 60mm/54mm Dr Su 11/1/19 age 66

B.I.L.L.

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Re: BHR Gone Bad....
« Reply #15 on: March 24, 2011, 04:55:11 AM »
Awesome. Hope this one is one you can eventually forget about, Good luck !

newdog

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Re: BHR Gone Bad....
« Reply #16 on: March 24, 2011, 07:23:54 PM »
I don't believe that there is an "ideal" cup angle. There is a range that good surgeons place the cup. There is a maximum and minimum but I don't know what they are. In other words a 40 degree is no better than a 35 or 45 degree. It's just that it can't be beyond the limits or there will be edge wear or edge loading as they say.

If anyone can explain this better or if something I stated is not correct please jump in because this is an interesting subject. Maybe it's even controversial, I don't know.

I hear it said that "the cup was placed at too steep of an angle", when someone needs a revision. ???
Steve, Dr. Gross bilateral, uncemented Biomet, January 10 & 12, 2011, Columbia S.C.

23109VC

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Re: BHR Gone Bad....
« Reply #17 on: March 25, 2011, 02:34:46 PM »
I'm a Gross Hippy too...

It is great to hear that he was able to revise your cup and keep the femoral component!  one reason many of us choose HR is to avoid a THR so early in life.  One of my fears was that at only 38, if i did HR and something went wrong early on, I'd be prematurely forced into a THR.  Ultimately, thevTHR couldvwork out great, but my fear was 20 years later when I was in my 60s...and needed a revision...could I wind up on multiple revisions? That's not a road I wanted to go down.

I can imagine how nervous you were facing the prospect of having to revise and convert to THR so soon.... 

I specifically went to Dr. Gross because of his experience - sounds like not only is he doing great work for first time hippies, but that he can help people who need a HR corrected as well!

He and his staff are top notch indeed!

I hope you recover quickly and are back in action soon!  Keep us posted on your recovery!

I'm curious, did he reopen the exact same incision site of your first doc, or did Dr. Gross go in a diffent spot? 



Sean
Dr. Gross- Biomet uncemented, 2/23/11

Magnus

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Re: BHR Gone Bad....
« Reply #18 on: March 27, 2011, 06:40:22 PM »
I am 6 days out of surgery and I have moved to a cane and completely off of any pain meds.  I am more more mobile than I was after the first surgery...i think that is partially due to the procedure/process that Dr. Gross uses.  I am by far no expert at this nor will I ever state that I even understand all of it...but I believe that some of the proactive measures that Dr. Gross has allows for faster mobility that I had on the first surgery.  Some of the examples:  Smaller incision (5" versus 11"), ice machine, the blood platletes, anti-blood clotting "stockings", etc.  He just appears ahead of all the other doctors/surgeons.    I have no idea what is the ideal degree to install the acetabular component...but he showed me where I was (60 degrees) and where I should be (30 degrees)...there I could tell that femoral head was excessively rubbing against the acetabular component.   During the surgery, Dr. Gross also cleaned out all the "junk" (fluid, metallosis, osteophytes, synovitis, etc) in my hip.  He used a tool called Zimmer Cup Removal System to romove the original cup....I have not seen one of these at Home Depot.

I wont know for sure how successful the operation was for a few months....but so far, I feel great.   I am hoping to compete in Ironman Florida in November....cant wait to be pain/discomfort free again. 
 

23109VC

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Re: BHR Gone Bad....
« Reply #19 on: March 30, 2011, 06:55:33 AM »
Great news!  Off crutches and onto a cane in only six days?  Wow.  Maybe since you only had the cup moved and no work on the femoral side, you are covering faster?  Maybe you are just superhuman!  I was still on crutches 6 days post op!

Dr. Gross does do a small incision.  He knows what he is doing and can visualize the stuff without needing to see it...  My scar is very small...about 4"

Being pain free is an amazing thing.  I still find myself in disbelief that I can sit up straight in my chair, and not have pain.  Sneezes no longer cause my hip to hurt...  Before surgery, a big sneeze would hurt!  You know you hip is screwed when a sneeze hurts! 

Good luck with the iron man!  I'm hoping to play racquetball again! 

The cup removal thing sounds scary....I wouldn't want to see it until AFTER the surgery!

The platelet thing is very cool!  I remember when the profusionist walked not my prepp room wit that big needle thing.  My wife was with me, she saw the needle and I heard her say"uh oh"....  I looked and thought "oh shit".. that is big.  I was kind of worried because I'm a big wuss and hate needles and it looked big but it ended up not even really hurting.  The fact that I was already on oxycontin and had been given some versed probably helped....

  But he explained that they take the blood sample and separate the blood and the platelets are used to help healing and bone growth... They spray that stuff in the wound and I think it gets sprayed on the parts where the implants touch the bone?  Very neat stuff. It's amazing what they can do to fix us!
Sean
Dr. Gross- Biomet uncemented, 2/23/11

 

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