Smith & Nephew resurfacing complications

[rock_chic_fairy]

Hi, I am hoping to hear from others who have maybe had a resurfacing with a Smith & Nephew implant. I like many others have read the reportd on the DePuy and am amazed that the S&N hasn't also been reecalled! I have same symptoms, raised cobalt and chromium, have done for appprox 3 years now, x-rays show my pelvis on this side is very thin and I have the pseudotumours all. Around the joint. I am facing revision surgery, bone grafts for my pelvis and, due to the loocation of the pseudotumours, having to go to a different hospital farther from home as the risks are too high for my current surgeon. They are arround the main blood vessels in my groin area.
To say I am scared is an understatement, surely I am not alone in this?  Are any others affected by this too? I am seriously looking at legal action!

Has anyone else had this surgery? How was it? Recovery etc

Have to say this site is fab!

I am in UK

[Dannywayoflife]

Hi rock chick,
                  I'm assuming that by s&n you mean you have a BHR installed? I'm certainly no expert but from what I have researched the reason why devices like the BHR have not been subject to the same recalls as the asr is because unless they are very badly installed there's not. Really an issue with them. I think mr mc minn has has 1 confirmed "psudotumor" in over 3000.
Who did your initial op? Had he done many proceedures before?
I hope that you can get sorted and welcome to the site it's a great site for information!
Danny

[Pat Walter]

Hi

Welcome to Hip Talk. I wish it were under other circumstances.  Has your surgeon told you the reason for your problems with your BHR?  Is your acetabular cup at an especially high angle that caused edge wear leading to the high metal ions?  Just wondering what caused the problem.

I am sorry to hear you are facing a revision.  It is not easy at a young age or any age. If you are facing a revision, then you definitely need to be getting opinions from some of the top surgeons like Mr. McMinn or Mr. Treacy of the UK.  You need to specifiy that you want to get opinons from them.  I am not exactly sure how you do that in the UK, but I know it has been done.

Anytime you face a serious revision, you want very experienced hip resurfacing surgeons to do the revision.  They know best about what is wrong and how to repair any problems.

Most people with BHRs don't have probelms.  I am terribly sorry that you do.  The current world wide retention rate is 96%.  That means that about 4 out of every 100 patients could have problems.  Unfortunately, you are one of the statistics.  You will find some others on this group that have had revisions due to acetabular cups placed at wrong angles, femur neck fractures which are very, very few, infections and allergies to the cobalt/chrome metal composition.  There are many different reasons, but most often they are from surgeon's placing components at the wrong angles.

You are not alone and what ever the reason for the cause of your revision, the folks here will be supportive and share their experiences. Here is a special page with stories from people that required revisions  http://www.surfacehippy.info/hipresurfacingproblems.php  When you have finished your journey and have completed your revision and want to share - I would be happy to post your story.

Meanwhile, we will try to listen and answer any questions.  There currently are no recalls for the BHR from Smith & Nephew.  It has a completely different design than the ASR.  So it does not have the same problems as the ASR.  The ASR had a shallower cup than the BHR and could also become misshaped when press fit into the acetabulum, that caused many of the problems.  So there is no recall or class action lawsuits against Smith & Nephew.

Good Luck and please keep in touch.

Pat

[cwg]

Hello UK

SO  good people are moving some of this forward..

I believe there will be a lot more "stuff" coming out, is coming out.

Curious, how high are your levels? Say if Chromium "safe" is 1-5 what would yours be?
thanks

Oh, and good luck ARGH . Sucks, I know.
cwg

[ScubaDuck]

I agree with Danny that you may want to check the basis of a recall.  S&N make the Birmingham Hip Resurfacing implant which has been one of the best performing devices out there as confirmed by the UK and Australian registries.  It is also used by many of the top surgeons because of its great track record and design.

The DePuy was recalled because it was failing at a tremendously higher rate because of a poor design.  There are in fact many DePuy ASR implant patients that are doing fine because placement was perfect.

As Danny said if you have a BHR and have problems it may be because of really poor placement.  There may also be other factors like metal sensitivities. 

I am sorry to hear of your situation and want to make sure you direct your anger in the right direction.

Best wishes as you get this resolved.

Dan

[cwg]

Grrr. What I think some people are missing, is the people here who are saying there was no "really poor placement"..
Or  missing, there was "great placement"

And zero metal allergies.

What I "believe?" I read though, is that it is mostly females.. That has my eyes wide open.

cwg

[rock_chic_fairy]

Hi, thanks for the swift response! Yes you are correct with regards the surgery. Mine was done by Mr Ivory who has done several of these. My understanding, reading between the lines, is that they are trying to re-operate quietly! Research now shows that I shouldn't have had this op, these joints are not good in people with smaller bones, namely women. I have also just discovered that the wearing of jewelery can have an impact on this. The radiographer that performed. My ultrasound said this. I have been referred to Nuffield Hospital in Oxford, Mr Whitwell, an Orthapeadic Bone Cancer Specialist with hips being his speciality.
Maybe I have just been unlucky, who knows. This is what I have been trying to find out. All my symptoms are same as the DePuy, my own GP. Can give little advice as they know so little about this! It is incredibly frustrating, I just want straight answers really from them!
I am currently on huge amounts of medication, more recently morphine has been added to the list as the pain is so intense. The impact on my life, my family is huge right now. For the first time since I returned to work following my surgery I am off work again.
You have to laugh or you cry!
My cobbalt and chromium levels have been high for about 3 years. I also suffer from tinnitus, partial deafness, have been on antihistamines which we now know all these symptoms could be related, I am constantly tired forget what I want to say, lose concentration, have numbness in my foot, headaches to name a few! Presumably if I ask, my consultant will tell me what the angle of the cup is, what my levels are exactly etc. I did get the serial numbers of both parts of the implant, hence knowing it is a Smith & Nephew!!
There is so much to know, where do I start?!

[Luanna]

I'm so sorry that you are having to go through this. Many people on this site will have lots of good information to share with you. Pat, the site owner is extraordinarly knowledgable.

I'm a small boned female and my surgeon would not do what he called metal on metal (both parts being made of metal) instead he did a Smith and Nephew ball and a Stryker X 3 acetabular cup to try and avoid the potential of having a problem. Others will tell you that it doesn't matter if you are male, female, small or large boned - that placement and the surgeon's experience is key. I think both probably have some impact.

Keep posting.

CWG, here's an article by Dr. Pritchett about resurfacing and small boned females. You might find it interesting. Takes a while for the PDF to open.
http://www.pritchettorthopedics.com/articles/women_hip_resurfacing.pdf

Luanna

[cwg]

Hey rockchick, slow down...   I hear (and understand) your anxiety level. You need, and CAN, calm some of the really crap and scary stuff you are feeling. It is very important to try and do this. Your pain weakness etcetc is worstened with fear.
Anxiety is the shits and makes everything else, worse.

You are in a safe and anonymous zone here.
We all are getting all kids of information here.

Keep your head straight, and as morphine and other drug free, as much as possible. You well know the drugs muck up clear thinking.  Keep moving forward towards a solution.

Stay strong

cwg

[Jeremy76761]

I have a different idea.

Rockchick,

My idea is --- VENT!

This is hopefully a place where  no one has to be calm or feel anything in particular at all!

You seem damn frustrated, damn scared, and damn pissed. Don't blame you! Read every word.

You're doing all the right things based on what I can see.

--Jeremy

[cwg]

J. That's what I was saying. Use this site, it is safe and anonymous and full of information- But to  try and stay calm otherwise.

RC. I wil PM you- Believe me I understand what you are going through

cwg

[John C]

Hello Rock Chick,
Welcome to this forum. Hopefully it will help to able to talk to others who can, at least partially, relate to what you are going through. None of us are experts, just patients like you, but I think you will find some common threads.

The Smith and Nephew brand would not seem to be at fault, since it has a good overall track record in the hands of highly experienced surgeons.

You will definitely hear lots of differing opinions, even from the "experts", as to whether metal on metal resurfacing is appropriate for small boned females. There certainly does seem to be a much higher risk in the hands of most surgeons.

Just for myself, I would want to know the exact angle that the cup was placed at, so that I would know if that was a major contributing factor, since it very often is. Some doctors are not always forthcoming with this information, so I would not settle for answers like " it is fine", but I would want to know the exact angle in degrees. If your doctor is not open with this information, you can request it from any orthopedic surgeon that looks at your x-rays, or you can request your most recent x-rays, and have them read by some of the top surgeons found on this site. Unfortunately, this may not change your course of action, but it may help you, and others, to know what caused your problems.

The most important thing right now is to find the best possible surgeon to help you to move out of these problems.
I sincerely hope that things get better for you soon.

John

[daylily]

Hi Rock Chick,
So sorry you are suffering like this. I had a BHR in February 2007 and have just had a revision operation complete with a bone graft where the cup was rubbing on the outer edge of my hip. Sorry I'm not as technical as some of the others.
Apparently the cup was at a 51 degree angle, it was too big for my smallish frame and was found to be loose when the surgeon took it out.
I don't know why but the cup was a 'Duron?' Not sure if that's the same as a BHR but this type of cup is, I have heard, prone to loosening.
My present surgeon said he would not have given me a BHR in the first place being small boned.
The BHR was OK for the first year and then gradually my range of movement lessened and the the pain started. It has taken me until this year to get someone to listen to me, all the other Doctors just had an x-ray taken and said it's alright.
I'm angry, very angry as I look after my seriously disabled hubby ( major stoke and now vascular dementia) and for the last 3 years I have had to sit on the floor when I wash his lower limbs because of the pain from the hip, even thinking about it makes me mad.

The new hip, ceramic both componants, feels brilliant at 4 weeks post surgery. Absolutely no pain at all from about the 4th day after surgery, just had my first physio appointment, delayed because I am non weight bearing due to bone graft, and the physio was so pleased with my range of movement and muscle tone that I do not have to go back until I have seen the consultant again in 3 weeks when I will start the weight bearing exercises.
I will be forever grateful to my present surgeon for listening to me, he is supposed to be one of the best and he definately gets my whole hearted vote.
Please try not to worry about the revision operation, it can only be good to get that bad hip out.
Take care and keep us updated please
xx

[rock_chic_fairy]

Wow, so many responses so quickly! What amazes me is the level of support offered.  At thgis point I do not know the level of my cobalt and chromium, I will endeavour to do so, nor do I have any of my x-rays, again I can but try to obtain them. If I am not successful, in time this is information my soliicitor can obtain. I now already go better armed wirh the knowledge of optimum cup angles, any knowledge and information is uuseful in helping to make a decision, do I have a case and if so who against. To be completely honest I feel a bit like a lad rat, if I hear one more time "if we knew then what we know now" or "further tests and research have shown us" Xrays do not show the pseudotumours, the knowledge these were in situ and their proximity to major blood vessels was not revealed until an ultrasound 2 weeks ago? Had these been picked up earlier maybe I wouldn't have to go so far from home for surgery. I have to wait until 8 November just to meet new specialist, that may be just a few weels away, it may as well be years away when you're in chronic pain!!

Gosh i sound like a winge bucket!!

[Dannywayoflife]

Rock chick,
               Getting your xrays is simple they cannot refuse! All you have to do is fill out a freedom of information request for them and pay a small fee(I had to pay a tenner).
Most of the pct's will have a freedom of info bit on there website. It's just a matter of filling out a couple of forms paying a cheque and getting them! Simpled.
If you do this you will be able to do as I did and email them to some of the top surgeons for a free oppinion.
If you have problems with the NHS I will give you any advice I can as I've just had my own battle with them.
Danny

[hernanu]

Rock chic, you can whine away as much as you want here, we've all done it (sorry about dropping the 'g', cultural thing).

I'm really sorry you're going through this; if anyone understands your pain (to some degree), we do. We all consider the possibility of revisions at some point, so you're going to get a lot of support here. The advice given already is good, you need all of the information from your previous procedure, and like daylily shows, a very good surgeon to get you right again.

[cwg]

Hey Rock Chick.. I flubbed where I put my last response to you- Distracted.

****I wrote you back under the "Presurgery condition..." by Bryan B

Am not techie enough to know how to move it here

cheers
Here is his reply to you, moved by Patricia Walter


Hey RC, got your message, thanks! I will write you later, and our time diff is around 7 hours. SKYPE doable

Am writing publicly about something that has my adrenaline in first gear... About when you mentioned to me that Hong Kong is on the suggested destinations for surgery holiday!

STOP, anyone considering surgery in HK, without talking to me!

I know most of the 'top gun' ortho guys there, from having done my BHR there, plus from the "shopping around" path I was on for one year or more. Pre and post (trying to figure out what went wrong) 
Also, I know many physiotherapists. They have the real goods on these docs. Some of these surgeons  dont believe in physio after the surgery, believe it or not
And scarily I know way too many people requiring all kinds of surgeries, mostly back surgery. And my mates are youngish 40-50 age
That is weird.

In HK some top name surgeons actually call you and see if you have decided yet whether you want to have surgery or not, six months or a year after your consultation

And I' ll end with mentioning that there are MANY airline pilots and spouses who have had mostly back surgery ( and knees and shoulders ) but also BHRS.

Cathay Pacific has a great insurance policy that provides good coverage for these surgeries .Too
 many of my friends have  had big surgeries. Especially before their husband may retire at the very young age of 55.

And rambling on but near the end, the newest "push" is on the cervical disks. One Chinese surgeon is somehow related ( part investor) with the maker in NYC ( I believe) This very nice doc works with for Aussie doctor who has a sleazy  ripoff surgeon reputation

I better stop, I know. Smile.

Thanks Rock Chick. I hope anyone considering any surgery in Hong Kong does a sht load of investigation, beforehand. Just the name of certain doctors sends a chill up my back

[Tin Soldier]

Durom is different than the BHR and is made by Zimmer.  I suspect the metallurgy is still pretty close, but not sure about the other differences.

Rockchick - you are not a lab rat.  There have been over 300,000 BHRs installed over a period of close to 20 years.  McMinn's latest results from his dataset (I believe 3000 HRs) showed 98% success at 13 or 14 years.  As Pat points out, success worldwide for the BHR is about 96% and thats for a similar timeframe.  BTW - the depuy ASR was recalled when they got to 12% failure.  That's still 78% success.  That was only about a year ago, and as Dan points out there are lots of folks out there going strong with an ASR HR device.

I'd recommend getting your Co and Cr results and doing some more research.  The metal ions section here has a fair amount of info. JMS who posts here also has a wealth of info on the subject. 

If you find out that indeed you need a revision, it can be replaced with another device and possibly with a better angle, if that is the problem.  Once revision has been, the body does rid itself of the metals, Cr slower than Co, but there is good evidence showing concentrations decreasing within the first year after revision. 

Also, measuring the abduction angle is not a hard thing to do.  Surgeons like a target of 40 degrees from a horizontal line across your pelvis.  The other angles are not really measurable from x-ray. 

Sorry about your situation.  You'll get a good start here with finding some answers. 

[ScubaDuck]

Tin-

100% - 12% = 88%!   

Dan

[rock_chic_fairy]

Hi Tin,
I already know mine has failed. I know I have to have a THR. I have raised ions, my pelvis is very thin on that side, I have pseudotumours and I am in a huge amount of pain. The pseudotumours are wrapped around my main bloodvessels, making my surgery very high risk, I have been referred to have this done by a bone cancer specialist, along with my bonegrafts and THR. I am not suggesting others have not had successful, positive experiences, however, my experience hasn't been good. I feel quite angry that may bome structure and the fact that I am female were only identified as not suitable after I had mine done. That does make me a guinea pig. I have a range of emotions, I am angry, upset, scared. I am 43 years old, I have 3 children, 2 grandchildren and 3 step-children! I don't want to be a statistic! I am a qualified horse riding instructor, horses were my life, I haven't even sat on one for about 7 years now! I have had hearing loss, confusion, this messes with my entire body. XxX