Loose Acetabular cup causes revision to THR

[rcorbin]

Hello,

I am new to this site and am very appreciative of the information on this topic.  I too have a slipped acetabular implant on the left side.  The x-ray is very dramatic.  I have considered surgeon error, but I also had a car accident last August with some muscle tearing and hematomas on my left thigh & buttock.  I am not sure what caused this now.  My MD is advising a total hip, but I too have concerns about this....especially since the femoral head & neck are perfectly fine. 

My Left hip is a "study" hip done before FDA approval of the Birmingham and was done by a surgeon who is a 5 hour drive from my home...and someone I have grown to dislike.  The surgeon I have consulted is someone who is near my home and is well regarded (performed successful hip surgery on major league atheletes who have gone back to play post recovery,etc) & was my first choice as a surgeon, but was not involved in the study & couldn't do resurfacing at that point.  Sadly, my hip was so bad it couldn't wait.  We have had 1 visit so far & he is waiting for my records and x-rays to be sent from downstate before he will make a final recommendation as to what needs to be done.

The study hip was done using Cormet hardware.  Does anyone know if there is replacement hardware available for the acetabulem?  Is it possible to just do a revision to the acetabular area or is a total hip the only option out there?

[Pat Walter]

Hi

I started a new topic for you.

There have been at least 10 - 12 slipped cups that I know about.  Dr. De Smet says that it is surgeon error. There is not way a person could make the cup slip.  He did not say a car accident could or could not cause it.

I would get some more input about your problem before you make a decision.  Both Dr. De Smet and Dr. Bose will do free email consultations if you send them your emails in a digital format  .jpg

You can ask what they would recommend based on what they see.  That way you would have more information to make a decision on.

Several of the people with the slipped cups had second surgeries to get the cup replaced and kept their hip resurfacing.  There is another poster here waiting to get some more input.

I know that if my BHR needed to be revised to a THR, there are components that match it. 

I would imagine Cormet has matching devices too.  If I get a chance and can remember, I will ask at the AAOS conference next week.

I am sorry to hear about your problems. I hope you can get some more input before you make a decision.

Keep in touch.

Pat

[Vicky]

You need to find a hip resurfacing surgeon that uses the Cormet device and has had experience with it.  The slipped cup IS due to doctor error.  This subject was touched on at the Miami ortho conference that I attended and the surgeons there agreed that if a cup slips it is only because the surgeon did not place it correctly or the cup was not seated properly.  Off hand, I do not know the top doctors that use the Cormet device.  You might want to contact Dr. Su in New York, he is extremely skilled and uses different devices.  I believe Dr. Clarke also has experience with different devices, both have done over 500 hip resurfacings and are in NY.  Where do you live?  There is NO reason to have to get a THR if the femoral component is fine.  I would immediately find a doctor that has a lot of resurfacing experience and get another opinion. 

Vicky

[rcorbin]

Guys,

Thank you for the information.  It has definitely confirmed what I was thinking...that it is possible to "do over" the cup without having to convert the whole system over to a total hip.  Especially when with a total hip, there has to be a cup component to the surgery anyway.  I didn't ask those questions initially because I was just so stunned that after almost 2 years after having my first resurfacing, that I was facing having to go through it all over again. My first surgery was such a miserable experience that the thought of having to do it over again sent me into an emotional tailspin.  

I had almost no pain control during the first surgery.  In fact, I spent the first 24 hours sobbing with no one seeming to care.  You see, I was taking prescription oxycontin given to me by a pain specialist for 4 weeks before my surgery as I had a long wait due to Dr. A's schedule.   Rather than adjust my pain medication accordingly to compensate for my higher tolerance, I was labeled as an abuser by the team and for some reason, given inadequate control.  Hopefully this was not deliberate.  In fact, one nurse even told me I was "lucky to be getting what I was getting." The second surgery was somewhat better since I complained to the hospital administration and to the physician.  I only had one episode of uncontrolled pain that was quickly rectified when I started sobbing.  My biggest regret is allowing Dr A to do my second procedure.  

I live in the Chicago area and chose Dr. A in Springfield because he was only one of two surgeons in Illinois that was still accepting study patients for resurfacing.  It was either that or going overseas & I couldn't afford to go overseas.  My insurance company at the time (Aetna) agreed to pay for the surgery.  Dr. A had also done quite a number of these procedures and I was able to speak to some of his former patients and they all seemed to be satisfied.  I felt comfortable with him, but after the pain control issues above and what I felt was inflexibility about several other issues, I grew to become very uncomfortable with his program.....as if I my body had to conform to the protocol.  On day one I had to accomplish this and by day 3....out the door....period, if I felt comfortable or not.  Turns out I had to be readmitted.  Your raising the possibility of surgeon error really makes me doubt my own judgement in allowing him to have done my second procedure.  My only defense is that I was in so much pain, I would have done almost anything to get relief.

The surgeon I have currently consulted is Robert Daley from Hinsdale Orthopaedics.  He was once one of the team MD's for the Chicago White Sox and did Bo Jackson's hip surgery.  Bo Jackson went on to resume his major league career.  Dr. Daley was my first choice for a surgeon and in fact, diagnosed my hip problems.  However, Dr. Daley did not do hip resurfacing at that time but began doing them when the procedure became FDA approved.  He uses robotics as well.  I really have faith in his abilities.  Also, Hinsdale Hospital has a teriffic pain management program....I used to work as a nurse at that hospital and have seen the wonderful things they do.  This brings me some comfort.  

Even though Dr. Daley uses Birmingham, he is listed on the Cormet website so I know he is familiar with that hardware.  When I have my next appointment with him, I will definitely bring up all of the issues the both of you have suggested.  Thank you for letting me know about the on line consultations.  I will pursue that as well.  Do any of you know any surgeons in Chicago that use the Cormet?  I would be interested in knowing.  Despite all of the wonderful things I have just stated about Dr. Daley, this is my one and only body and I am not going to put blinders on as before and move toward a total hip if there are other options.  Again, thank you for your help.  I am very grateful.

Rebecca

 

[Vicky]

You might check with Dr. Rubinstein.  I am not sure if he has ever used the BHR device but he is a pretty good doctor.

Vicky