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Author Topic: What are the odds: Five hips in two years  (Read 5038 times)

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petrops

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What are the odds: Five hips in two years
« on: January 24, 2012, 03:56:03 PM »
I bought the promise of returning to an active life after resurfacing.  I found a very experienced and well regarded surgeon in Dan Snyder of Newton Wellesley Hospital in Newton MA.  I was a healthy 52 yr old guy with every reason to believe that I would be playing soccer again in a few months. 

We knocked off the first one in February of '10 and the next one in March of '10. Both were with the Cormet device.  I followed his instructions and got specific clearance for any increase in physical activity.  Measurable progress was great but pain was constant.  Dr Snyder diagnosed Heterotopic Ossification as the source of the pain and informed me that I was one of the few that get this.  In July of '10 the left Femoral Head fractured and I had a Stryker modular device installed by Dr Snyder. 

Pain continued, mostly in the inner groin and outer hip particularly after sitting or sleeping.  Stability over uneven terrain decreased and I began to fall a lot as I walked through the woods.  Dr Snyder suggested stretching and yoga but in July of '11 pronounced the hips to be fit for any activity including soccer.

In November of '11, after many other trips back complaining of pain, I returned to tell my sad story once again in hopes of an answer.  This time I reportded clunking and squeaking.  His exam caused him concern and he sent me for blood tests.  Elevated levels of Cobalt and Chromium caused him to suggest a revision of both hips.  While he suggested that he could do the work he agreed that it made sense to refer me to Dr Young-Min Kwon of Mass General's Metal on Metal center.  Dr Kwon's exam and follow up MRI showed areas of dead muscle, fluid and affected bone.  He left no doubt that the devices have to be removed.  A third opinion rendered by Dr Carl Talmo of NE Baptist resulted in the same conclusion.

The first hip is scheduled for 2/1/12 and the second will follow as soon as the first is sufficiently healed.  Assuming that this happens in March of '12 I will have had 5 hips in 2 years.  Add to that the statistically uncommon incidents of Femoral Neck Fracture and Heterotopic Ossification, and this may be one for the record books.

All I know are the facts.  I have no opinion on Dr Snyder's role in this outcome.  I still like the guy a lot and I am sure that he will deliver great outcomes for many people.  I reserve judgment at the industry that is selling this metal on metal product that seems to be causing so much trouble for so many people.

I am still a lucky guy.  Some have it much worse.

Do your research and eat your Lucky Charms. 
Cormet by Dan Snyder_R.rsfc in 2/10 & L.rsfc in 3/10 > L.FemNckFrac in 7/10>>>Strkr Modulr _ In 1/12: Pain/Clunking/Hi Ion Lvls/Muscle & Bone damage>>Both being replace by Young-Min Kwon early '12 = 5 hips in 2 yrs. Still Smiling :)

Boomer

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Re: What are the odds: Five hips in two years
« Reply #1 on: January 24, 2012, 04:28:14 PM »
Thank you for posting your story. Not fun to have to lay it all out it writing I'm sure. Stories like yours need to be shared.

Dr. Kwon is recognized by his peers in the AAOS as the foremost expert on metal on metal research and he is a brilliant surgeon. You are in good hands.

Kwon's 2011 paper on metal on metal hip revisions is available on the AAOS website. I read it this morning. He has conducted a study of the resurfacing devices that have been removed from patients. He notes there is clear evidence of edge wear in almost every instance where a metal on metal prosthesis has been removed. He also indicates that the
reason for this is either improper patient selection, or improper placement of the prostheses. In some cases both errors were made.

Kwon is a serious researcher and is making progress within the AAOS to focus attention on the real issues. There should be some significant results from the AAOS meeting coming up in February. Surgeons are having healthy debate and discussion about resurfacing which should make things better for future patients.

I believe that Dr. Kwon will be able to provide you with some solid feedback on the causes of your problems after he has successfully completed your revisions. He really is the top guy in that regard.

Good luck to you. Thanks for posting.

Boomer
RBHR with Dr. Rector on 11/30/2011
LBHR with Dr. Rector on 6/11/2012

hernanu

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Re: What are the odds: Five hips in two years
« Reply #2 on: January 24, 2012, 04:29:13 PM »
Sorry to hear about that, Petrops. I had mine done by Dr. Snyder about the same time (8/10 and 11/10). Was there an agreed on reason for the high metal issues? Did he put in a mini hip after the neck fracture?

Hope everything goes well with your revisions, sorry to hear that you've had these problems.
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

Dan L

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Re: What are the odds: Five hips in two years
« Reply #3 on: January 24, 2012, 05:52:22 PM »
Petops

Very sorry to hear of your experience, I hope this round gets you back to where you want to be.  I can somewhat identify with the stability over uneven terrain report, it sounds familiar for sure, earlier on after my first one was done last October.  When I'm tired, even now more than 3 months after, I get a little leery of uneven anything.

Your note that you're still feeling like a lucky guy is incredibly amazing, honestly-- is inspiring (with no slight intended whatsoever).  In the back of my mind I'm prepared for problems if they occur, but confess I would not be able to be so positive, so that's really something, which will hopefully carry you through this veru difficult time for you.

Thank you for posting and sincere best regards for better results soon.

Dan
LBHR Dr Brooks, 10/2011; RBHR 2/2012

Aerial

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Re: What are the odds: Five hips in two years
« Reply #4 on: January 24, 2012, 07:10:05 PM »
I too was sorry to read this.  Hopefully the 4th and 5th time will the be the "lucky charm"!  Wishing you the best!  Sounds like you have access to real experts.
Right hip resurfacing with Dr. Gross on 12/5/11!

mslendzion

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Re: What are the odds: Five hips in two years
« Reply #5 on: January 24, 2012, 08:30:12 PM »
I can only imagine how hard this is for you. Wishing you the best on the next 2 procedures. Thank you for sharing your story. What type of replacements will you be getting?
Left BHR 1/9/12 Dr. Schmitt

DGossack

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Re: What are the odds: Five hips in two years
« Reply #6 on: January 24, 2012, 08:48:45 PM »
I will add my thoughts and prayers for a successful outcome this time.  It will be interesting to know what caused the problem.  It sounds like you are in excellent hands.

I agree that your story, like other failures, stories need to be told. It must be done in context of the overall picture.  We can all learn and future hip patients will benefit.

Like Dan said I am prepared if there would be problems with my implant.  I read the good and bad reports and made an informed decision.  I would hope that I would take it as well as you have.

Best wishes.  Please come back and let us know how you are doing.

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

petrops

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Re: What are the odds: Five hips in two years
« Reply #7 on: January 24, 2012, 09:26:13 PM »
Thanks to all for the best wishes.

Mslendizon in answer to your question about the type of replacement: I am afraid to say that it cannot yet be determined what they will use.  It is a case of:  get in there and find out what is wrong and put in the device that fits the situation.  So it is a case of go to sleep and see what you wake up with.  This trip has been full of lots of revelations and I was determined to be as informed as possible this time.  So imagine my surprise when I asked if I had any choice in the decision of what type of device they would use, and Dr Kwon informed me flatly: "No".  I say that with an incredulous smile on my face today, but I have to say I was take aback when I first heard it.  But in the end, what could I possibly know about this thing that he doesn't know already in spades.  I am a firm believer that a little bit of knowledge is a dangerous thing.  So I am taking comfort in having researched this issue ad nauseum, finding a great resource, and having vetted both the resource and his recommendation many times over. 

So now it is time to trust, as anything I do to try to take control will be in vain and at the cost of unnecessary anxiety.  Others may approach something like this differently and that is the way it should be. 

And besides, what are the chances that something else could go wrong?

I'll tell you what could go wrong:  I may have to watch the Patriots play in the Superbowl on a small screen TV in the hospital.............with no beer!
Cormet by Dan Snyder_R.rsfc in 2/10 & L.rsfc in 3/10 > L.FemNckFrac in 7/10>>>Strkr Modulr _ In 1/12: Pain/Clunking/Hi Ion Lvls/Muscle & Bone damage>>Both being replace by Young-Min Kwon early '12 = 5 hips in 2 yrs. Still Smiling :)

hernanu

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Re: What are the odds: Five hips in two years
« Reply #8 on: January 24, 2012, 09:39:24 PM »

I'll tell you what could go wrong:  I may have to watch the Patriots play in the Superbowl on a small screen TV in the hospital.............with no beer!

Now THAT would be wrong!!! You've been punished enough!! No Pats fan should have to endure this!

I can see you've done things right, you're going to someone well versed in dealing with metal ions issues and are in good hands. Good luck, and let us know how you are and what they determine.
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

Aerial

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Re: What are the odds: Five hips in two years
« Reply #9 on: January 24, 2012, 10:31:27 PM »
Have a rootbeer!  :)
Right hip resurfacing with Dr. Gross on 12/5/11!

hernanu

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Re: What are the odds: Five hips in two years
« Reply #10 on: January 24, 2012, 11:44:07 PM »
All right, Aerial, that's it... You are extremely cute... Root beer...
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

David

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Re: What are the odds: Five hips in two years
« Reply #11 on: January 24, 2012, 11:51:31 PM »
Wow Petrops...that's some bad shit...
Keep on Keepin' on...
Sounds like you already have the mindset to do so...
Best to you...
David
RBHR Dr. Su 8/29/2011
www.jayasports.com

WTW15

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Re: What are the odds: Five hips in two years
« Reply #12 on: February 01, 2012, 10:26:22 AM »
Wishing you the Very Best Outcome on 2/1!
And hopefully a PATS win too! 
Successful LBHR 1/19/12 Dr. Cynthia Kelly
Fear causes Hesitation and Hesitation causes your worst Fears to come true

petrops

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Re: What are the odds: Five hips in two years
« Reply #13 on: February 01, 2012, 12:15:58 PM »
Thanks WT

Looks like you are in recovery mode.  All the best wishes for you.  Don't get too carried away on Sunday! 
Cormet by Dan Snyder_R.rsfc in 2/10 & L.rsfc in 3/10 > L.FemNckFrac in 7/10>>>Strkr Modulr _ In 1/12: Pain/Clunking/Hi Ion Lvls/Muscle & Bone damage>>Both being replace by Young-Min Kwon early '12 = 5 hips in 2 yrs. Still Smiling :)

obxpelican

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Re: What are the odds: Five hips in two years
« Reply #14 on: February 01, 2012, 02:49:19 PM »
What happened to you is totally inexcusable in almost all cases when a revision is done, that's it the patient is good to go. I am glad you found a new doctor.

My thoughts and prayers are with you, I wish you very smooth sailing from now on.  I can't say I'll be rooting for your team on Sunday though   ;)


Chuck



Thanks to all for the best wishes.

Mslendizon in answer to your question about the type of replacement: I am afraid to say that it cannot yet be determined what they will use.  It is a case of:  get in there and find out what is wrong and put in the device that fits the situation.  So it is a case of go to sleep and see what you wake up with.  This trip has been full of lots of revelations and I was determined to be as informed as possible this time.  So imagine my surprise when I asked if I had any choice in the decision of what type of device they would use, and Dr Kwon informed me flatly: "No".  I say that with an incredulous smile on my face today, but I have to say I was take aback when I first heard it.  But in the end, what could I possibly know about this thing that he doesn't know already in spades.  I am a firm believer that a little bit of knowledge is a dangerous thing.  So I am taking comfort in having researched this issue ad nauseum, finding a great resource, and having vetted both the resource and his recommendation many times over. 

So now it is time to trust, as anything I do to try to take control will be in vain and at the cost of unnecessary anxiety.  Others may approach something like this differently and that is the way it should be. 

And besides, what are the chances that something else could go wrong?

I'll tell you what could go wrong:  I may have to watch the Patriots play in the Superbowl on a small screen TV in the hospital.............with no beer!
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

Luanna

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Re: What are the odds: Five hips in two years
« Reply #15 on: February 01, 2012, 04:10:57 PM »
Petrops,
Thinking about you today and hoping that all is going well. Dr. Kwon is one of the best revision surgeons in the world. You are in excellent and and extremely well-skilled hands.

Keep us informed.

Luanna
RHR 8/30/2011 - Dr. Pritchett - Stryker Trident Shell /X3 Poly liner acetabular cup. BHR head.

Baby Barista

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Re: What are the odds: Five hips in two years
« Reply #16 on: February 01, 2012, 10:08:06 PM »
All the best to you in you recovery. Sounds like you're in the best place possible to ensure a positive outcome.

-Rob
LBHR Pritchett 01/23/12 - 52mm head, 58mm cup
RBHR Pritchett 12/10/12 - 52mm head, 58mm cup

Pat Walter

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Re: What are the odds: Five hips in two years
« Reply #17 on: February 01, 2012, 10:13:16 PM »
petrops

Good Luck.  I am keeping you in my thoughts and prayers.

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

curt

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Re: What are the odds: Five hips in two years
« Reply #18 on: February 01, 2012, 11:34:34 PM »
     Good luck, Petrops.  I usually root for the HR people pretty hard, but I reserve my best wishes for revision folks.  You deserve a good turn, hang in there and keep positive.

Curt
51 yr, RHBiomet, Dr. Gross, 9/30/11
happy, hopeful, hip-full

petrops

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Re: What are the odds: Five hips in two years
« Reply #19 on: February 05, 2012, 05:50:52 PM »
Hi Curt, Pat, Rob, Luanna, Chuck, WT, David, Hernanu, Dan, Aerial, WT, Mslendzion and the many others that have offered their best. It is amazing what a few wishes from some anonymous people can mean.  I'm doing well and in good spirits with little pain an lots of hope.

So the the blessing and the curse of hooking up with Dr Kwon is that, if you ask, you are going to get a lot of detail about the impact of the metal on the body and the range of potential complications and recovery outcomes.  I try to not go into this stuff with most folks just because I find it incredibly boring to listen to people talk about their problems but the focus of this list suggests that maybe details and information are exactly what people are looking for, so here are a few that may be of value to some people:

Base condition: 
A 2 year old (Cormet) resurfacing on the right side had to be revised due to high ion levels, clunking, weakness and pain.  MRI showed fluid buildup and damage to muscle and bone.  No prediction was made on the time or extent of surgery.  A minimum of 2 hours was set as the minimum, and a:"we'll know when we get in there" approach was taken to express the maximum.[/li][/list]


Outcome:
*Surgery took 4 hours.
*There was more damage to various muscles in the abductor group than had been visible in the MRI.  He had to remove slightly more than what was observably damaged, as the nature of metallosis is that it current damage is not a predictor of future necropsy (I understand that this is always the case). 
*There was less bone to work with in the pelvis than expected, as it looked like more bone than usual was removed in the original resurfacing.  As a result, a bone graft was used to strengthen the area.  This may have implications for future revisions.
*A considerable amount of ossification was observed but not removed due to the amount of abductor muscle that had to be removed as a priority.
*I did not ask about the specific device implanted.  I am sure I will find out at my follow up.
*Restrictions for the first 90 days include the 90Degree rule, toe in and blood clot precautions.
*Crutches on day 2 and stairs and home (nice) on day 3.
*Woke up pain free on day 5 (go Pats!) Small doses of pain meds are effective (2 mg dilaudid) when activity is high.



Prognosis:
*Pain will be reduced but Dr. Kwon is not willing to make predictions about being 'pain free'.  Ossification is an example of the possible contributors to future pain. 
*The assisting surgeon suggested that they did not expect additional ossification to be a problem.
*The risk for dislocation is elevated due to the need to remove abductor muscle.
*Other 'complications' are possible but I am not clear on what they might be other than pain and dislocation.
*As mentioned above, future revisions may be complicated by the amount of bone removed from the pelvis during the original resurfacing. (This may also hold some implications for the pending revision to the left hip which was resurfaced and  has been revised once already by the original surgeon)

So all in all things are good and progress is evident.  I am told that it is not likely that I will be climbing trees to install tree stands, but if this is my biggest limitation, then.......it could be a lot worse.

My sincere thanks to those of you that took the time to think about my situation and to those that wished me the best in one way or another.  If you are faced with similar challenges, my hopes that your journey may be as good or better than the one I am on.

Bon Voyage!
Cormet by Dan Snyder_R.rsfc in 2/10 & L.rsfc in 3/10 > L.FemNckFrac in 7/10>>>Strkr Modulr _ In 1/12: Pain/Clunking/Hi Ion Lvls/Muscle & Bone damage>>Both being replace by Young-Min Kwon early '12 = 5 hips in 2 yrs. Still Smiling :)

 

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