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Author Topic: I Wonder What The Doctors Can See In X-rays  (Read 3444 times)

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Lopsided

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I Wonder What The Doctors Can See In X-rays
« on: September 14, 2011, 04:27:50 PM »
I really do not know what to look at in my x-rays.

The only thing I can see, which is good, is that the bone is growing onto the femoral neck of the device (red arrow), as you can see from my three month x-ray to my twelve month x-ray.

What is more difficult to see, is my other hip. I know it is degenerating, and the doctor said 'There is a little more narrowing.' But I cannot see it. In fact, My current x-ray looks better to me than my three year old x-ray.

Anyone else see anything in it?



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

Pat Walter

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #1 on: September 14, 2011, 05:08:10 PM »
It takes experience to know what your looking at.  If you are not a musician, then you can't tell what the score of the music means.  "You gotta know that language" to know what things mean on x-rays, maps, music, etc etc.  The really experienced surgeons can even see what the state of your bone density is, without a bone density test.  Ask your doctor next time to explain what he sees in your unoperated hip.  Sometimes there are additional views too.

Sorry, I can't read it for you.  I do know how to read and write html and php to keep the website going! LOL   ;D
 
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3/15/06 LBHR De Smet

DGossack

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #2 on: September 14, 2011, 05:29:25 PM »
Lop-

That is really cool to see the bone growth.  Otherwise I don't really know what to look at.

Please explain the last two x-rays.  Is that your other hip?  If so, OUCH!!!  I really hope it was your x-rays before hip resurfacing.

Dan
LBHR, Dr. Pritchett, 8/1/2011
fullmetalhip.wordpress.com

Neild5

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #3 on: September 14, 2011, 07:06:25 PM »
The resurfaced hip looks good, without the full pelvis I can't measure the cup angle but it does not look bad.  Your other hip, the doctor is right there is more narrowing, in fact it is almost bone on bone at the lower right.  There looks like a small amount of additional degeneration of the femoral head.  What did the doctor say about becoming a bilat?
50 yo male left Biomet 2/28/11, right BHR 2/20/12

Tin Soldier

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #4 on: September 14, 2011, 08:01:41 PM »
I'm an amateur when it comes to x-rays, but I do think the lower portion of the femoral head is becoming malformed.  You can see some heterogenous looking material, unlike the smoother looking part of the head.  That is similar to mine, although the spacing looks much better than mine did.  Now I have micron spacing, in both.  I like the idea of looking at the femoral neck in a few months to see how the bone fills in.  I have a bit of a shelf just below my new BHR and I would think bone ought to try to fill in there.  Talk to the doc.  I think most surgeons enjoy explaining the details of an x-ray.  Even the local ortho that told me to take up golf and wait a few years before getting a THR, actually spent some time pointing at the x-rays.
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

Eitan

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #5 on: September 15, 2011, 02:41:49 AM »
In terms of your operated hip the only thing that the X rays clearly show is that the stem of the femoral component is seen as being very slightly short on the AP (antero-posterior) view.  This could only mean that it was placed with some angulation (Diverging either anteriorly or posteriorly as it goes down the femoral neck.  Only a cross table lateral view, which you have not posted, would tell you.)  This is of no functional significance; otherwise it looks like the acetabular component is fine.  Should last you a good long time.

In terms of your un-operated hip I do not agree with the other posters.  The joint space is UNCHANGED from 3 years ago; it is NOT almost bone on bone at the lower right; the lower portion of the femoral head is NOT becoming mal-formed.  There are subtle signs of femoro-acetabular impingement on the right hip (see the very small bump at the superior surface of the femoral neck junction with the femoral head) which were present 3 years ago and essentially unchanged on your most recent X Ray.

In general this web site is really good for communicating our own personal experiences concerning our specific issues with getting our hips re-surfaced.  We CAN tell you about our pain before and after the surgery; we can tell you about how we perceive our surgeon's operating or communicating abilities; we can tell you about our post op rehab regimens; we can tell you how we are doing post op, etc.  We CANNOT tell you what your specific diagnosis is, nor what type of surgery you should have, nor who is the best surgeon to do it, nor which type of implant is best for you, nor how to interpret your X Rays.  Those kinds of issues are best discussed with qualified professionals.  I completely agree with Pat on this point.

DGossack

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #6 on: September 15, 2011, 04:43:21 AM »
Eitan-

We CANNOT tell you what your specific diagnosis is, nor what type of surgery you should have, nor who is the best surgeon to do it, nor which type of implant is best for you, nor how to interpret your X Rays.  Those kinds of issues are best discussed with qualified professionals.  I completely agree with Pat on this point.

Okay I can agree with you on this.  Who would follow any of the above listed advice from unknown posters on a website rather than their professional?  On the other hand some of these posts raise very good questions for those "professionals.". If I listened to the first professional I spoke with I would be in agony waiting for a THR.

In terms of your operated hip the only thing that the X rays clearly show is that the stem of the femoral component is seen as being very slightly short on the AP (antero-posterior) view.  This could only mean that it was placed with some angulation (Diverging either anteriorly or posteriorly as it goes down the femoral neck.  Only a cross table lateral view, which you have not posted, would tell you.)  This is of no functional significance; otherwise it looks like the acetabular component is fine.  Should last you a good long time.

In terms of your un-operated hip I do not agree with the other posters.  The joint space is UNCHANGED from 3 years ago; it is NOT almost bone on bone at the lower right; the lower portion of the femoral head is NOT becoming mal-formed.  There are subtle signs of femoro-acetabular impingement on the right hip (see the very small bump at the superior surface of the femoral neck junction with the femoral head) which were present 3 years ago and essentially unchanged on your most recent X Ray.

Does any of the above fall into things "we CANNOT tell you"?

Dan
LBHR, Dr. Pritchett, 8/1/2011
fullmetalhip.wordpress.com

Lopsided

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #7 on: September 15, 2011, 07:58:50 AM »
Thank you.

Pat, yes I have asked my doctor. I have also sent the latest x-rays to Dr. De Smet, but not got a reply yet. I will, of course, consider his opinion the highest.

Dan, the other two x-rays are my right, other, hip, three years ago and now. I cannot see much difference, but I can feel some. Certainly, the x-rays are nowhere near as rough as the pre-op x-rays of my left hip.

Neild, my doctor said come back for another x-ray next year, or any time if I start to lose movement.

Tin, yes my local doctor was pleased that the bone is growing onto the neck of the femoral component. He had previously advised me not to get resurfacing.

Eitan, yes, the joint space looks the same to me too. But my doctor did say, 'There is some narrowing.' I do not think I need the operation any time yet. The stem of the femoral component looks short because, the C+ has a very short stem.

D.



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

newdog

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #8 on: September 16, 2011, 12:27:32 AM »
Lop,

The bone growth is fascinating. Can't wait to see mine next year. Thanks for posting the pics.
Steve, Dr. Gross bilateral, uncemented Biomet, January 10 & 12, 2011, Columbia S.C.

Tin Soldier

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #9 on: September 16, 2011, 04:27:29 AM »
Eitan - Please tell me why you think the femoral head is not mal-formed.  The lower interior side looks a little bumpy to me, but then as I mentioned in my post I said I'm an amatuer when it comes to x-ray images.  Sounds like you might have some experience with radiology.  I'd like to learn more.  I'd also like to remind you that I did say, "talk to the doc".  If you spend a little more time here, I think you'll notice that's a pretty common recommendation (ie "talk to the professionals").  I and many others here certainly don't expect anyone to take something we say on here for good and not follow up with more research and discussion with a medical professional. 

I would say about a third of the info on this forum is technical in nature.  We get into healthy discussions about a number of things that I bet many doctors would totally dismiss us on simply because we don't have a medical degree.  Yet the info that we are discussing is straight out of peer-reviewed articles published in all the main ortho journals and presented at the ortho conferences.   I have learned lots from this forum and honestly I think I know more about HR than my primary and he IS a medical professional.  He didn't look at my x-ray images and sent me off to PT for 2 months of worthless painful stretching with full blown OA. 

Also I believe a lot of folks come here because they are tired of waiting 2 hours in a surgeon's waiting room to get about 30 minutes of a surgeon's time, which is often concluded with a simple statement, "you have OA, you need new hips".   The medical system, at least in the US, is not designed for the patient to be able to fully understand what they are getting into, maybe due to lawyers and CYA, the cost of a surgeon's time, and probably many other factors.  If I listened to the local ortho, I would still be in pain and be planning on bi-lat THRs in a few years.  He was a medical professional, too.  I don't mean to be an ass here, really I don't.  That's not what this forum is for.  I simply want to tell folks why I came here and why I like this forum.  I think there is way more to this forum than mental support and exchange of experiences, although that is an excellent piece of it, and I also like that we can discuss technical topics without worrying about being told we shouldn't do that because we're not professionals.

Let's not forget the famous quote, "Knowledge is power"

Lop - thanks for letting us have a healthy discussion about your hip. 
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

Lori Cee

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #10 on: September 16, 2011, 08:32:12 AM »
Until this year, I haven't been overly interested in x-rays.  Now I love looking at them and seeing all the differences between the good and the bad hips.  The post-op ones are of most interest to me.  Think they go beyond the good/bad label and have their own 'very cool' :D

Thanks for sharing!

Bilateral Birmingham Mid Head Resection (BMHR): 8 April 2011 (Dr Simon Journeaux at Mater Private).
To follow my progress visit my blog: Bilateral Hip Replacement

Eitan

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #11 on: September 18, 2011, 03:08:45 AM »
To Tin Soldier,

Sorry if I came on too strong in the advice to lopsided to try to keep the "medical" questions between himself and his medical team.  Hopefully I won't put my foot in my mouth by further explaining my view:  I don't see any problem with discussing the latest peer reviewed article amongst ourselves and trying to decide what it means to us and what it means for the field of resurfacing in general.  We will all become better informed about this fascinating field by having these discussions.  Same goes for technical discussions regarding the differences between the various devices on the market, understanding terms such as "clearance" "metal debris", "abduction angle", understanding the difference between a resurf and a THR etc.  By having these discussions we will become better informed and be better able to help and coach ourselves through the difficult decisions we make as we proceed through the process of undergoing some real scary surgery.  I have benefited greatly from many of the questions raised, discussions and comments of posters from varying backgrounds.  Where I do see a problem is when someone (admittedly, I am sure with the best of intentions) posts a specific medical question about their own specific condition, diagnosis, surgical treatment plan, X rays etc.  I think that in that circumstance we need to be cautious, step back, and say "ask your doc, don't ask us".  (And of course, I did not listen to my own advice when I shot off my big mouth about the X Rays.  But that's a story for another day.)

In terms of the X Ray that lopsided posted:  My opinion:  There is a bump on the superior head neck junction which is a subtle sign of FAI.   It was there 3 years ago and it is unchanged now.  The clear black space superiorly between the femoral head and the acetabular articular surface, is unchanged from 3 years ago.  What you are referring to on the lower interior side of the femoral head is a region that is normally irregular looking and is called the "fovea".  It does not form part of the articular surface, we all have one, and in any case if you look objectively at both X rays I think that you will agree that his fovea area is also unchanged from 3 years ago.

Hope I have communicated my thoughts more clearly this time.

Tin Soldier

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #12 on: September 18, 2011, 04:33:18 AM »
Eitan - Thanks for explaining the x-ray, I learned something.  That's good stuff, yet it makes me want to learn even more about the hip and how it shows up on an x-ray. 

You didn't come on too strong, that was your opinion and I think it's perfectly reasonable.  I appreciate the additional explanation. 
 
Thanks     

Hey, what happened to the guy on the other end of the femur?  Lop you out there?
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

Lopsided

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #13 on: September 18, 2011, 07:08:37 AM »
Hey, what happened to the guy on the other end of the femur?  Lop you out there?

I certainly am, thank you Tin.

And I have heard from Dr. De Smet too. He replied, in his usual economical manner, 'You hip looks great!!! Other hip is also still very good!'

I must gather that the condition of the hip is proportional to the number of exclamation marks after the comment for the respective hip.

Hopefully I won't put my foot in my mouth ...

If you can do that, your hip joint plus a few other joints, must all be articulating well.

D.




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

Tin Soldier

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #14 on: September 18, 2011, 03:46:12 PM »
I wish I could put my foot in my mouth.  Nice job on the hip Lop.

I took a look at Gray's anatomy sketches and I had no idea a ligament attaches to the head of the femur in the fovea, thanks Eitan.  So I guess that means I do not have the ligament capitas anymore.  Wonder how much that ligament helps hold things together.  Interesting, another question to add the list of many.   
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

Anniee

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #15 on: September 19, 2011, 12:29:45 AM »
This has been a great discussion!  I really could not see any change in the other hip, and thought probably it's because I don't know how to read X-rays.  Now it seems Dr.De Smet is of the same opinion, so I feel pretty good!
Annie/ Right Uncemented Biomet 4-20-11/Left Uncemented Biomet 10-12-11/Dr. Gross

Lopsided

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #16 on: September 19, 2011, 12:43:21 AM »
Thank you Anniee, I am glad you have enjoyed this thread. Now you, Dr. De Smet, myself and a few others cannot see any significant difference. But I can feel it.

I do realise that it has not degenerated much. Below is the x-ray of my left hip fifteen months before the operation.

D.



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

newdog

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #17 on: September 19, 2011, 03:56:51 PM »
Lop,

Is that a groove on the head of the femur? I can't read x-rays but that's what that line looks like where the bone is touching. Oww! :'(
Steve, Dr. Gross bilateral, uncemented Biomet, January 10 & 12, 2011, Columbia S.C.

Anniee

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Re: I Wonder What The Doctors Can See In X-rays
« Reply #18 on: September 20, 2011, 12:29:52 AM »
Lop, how you feel is obviously more important than how your x-ray looks!  If it feels bad, don't wait too long to get it fixed.  I was not aware of any real pain in my left hip 6 months ago, even though it looked bad on the x-ray, now I frequently have trouble walking more than a few minutes because the pain is so bad.  I am thankful that I only have to wait a few more weeks for surgery on that one.
Annie/ Right Uncemented Biomet 4-20-11/Left Uncemented Biomet 10-12-11/Dr. Gross

 

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