Why No bone ingrowth, 4 years post op. Failed bhr - Susessfull bhr revision

[Rick Rubio]

After 4 yrs my BHR cup broke loose. At surgery we found no bone growth to acetabular cup. Cup was completely loose, created some issues and resulting damage.  A new cup was Installed and I am recovering. Any similar situations with no bony ingrowth.

[Pat Walter]

Hi Rick

Welcome to Hip Talk.  I am sorry it is under such circumstances.  Were you able to keep your BHR with a new cup?

I have your original story posted here http://www.surfacehippy.info/hipstories07/rickrubio07.php unless you are a different Rick Rubio.

As your recovery contniues, I hope you will keep us updated.  I want to wish you Good Luck.

I know of a few people with acetabular cup problems that had them replaced, but sooner than yours. I wish I could tell you more, but I can't.

Pat

[Dannywayoflife]

Wow that's weird! Hope your recovery goes well. Did you have a revision to a THR or did they manage to do a cup only revision?

[johnd_emd]

Yeah,

I'm sure a lot of us are dying to know if you the doctors were able to just replace the cup and that you're still with just the hip resurfacing and that they didn't have to do a THR.  Who was yoru doctor?  Did they have to put in a different size cup or use the same size?   Did they use the same type cup or one that anchors (screws) in?

[Rick Rubio]

No THR, I had my "cup only" replaced, bone puddy graft, with new cup secured w 3 screws, with a liner that fit the old ball. This was done in England. Had metalosis issues also. I was able to get my insurance to cover. I am an athlete, and want to continue to do endurance sports. Very slow recovery due to damaged caused by the loose acetabular cup to the femoral neck.  No running for 1 yr. Looking for information regarding absolutely no bone ingrowth. Happy to help anyone.

[Dannywayoflife]

Rick I'm so so glad you had your bhr saved!! If you don't mind me asking who did your revision? Mcminn? Treacy? Bloomfield?

[Nemesis]

May I ask your:

Any supplements?

Any weights workouts?

Any history of osteoperosis in your family?

This was a concern also with one of my friends but he had a THR?

[hernanu]

Sorry about the loose cup, but really glad they could save the HR. So, did they give an opinion on what caused the lack of ingrowth? Was it a Duron cup?

[Rick Rubio]

I am now 58 - did 6 marathons, raced lots of triathlons, after bhr 2007-  lifted to keep muscle tone., not much in supplements, except sports fuel. Aminos,  protien after workouts. No osteoporosis in fam. My doc who did the BHR wanted to do thr revision as most all other docs. Was lucky to have Dr. McMinn take me on. 

[einreb]

I am now 58 - did 6 marathons, raced lots of triathlons, after bhr 2007-  lifted to keep muscle tone., not much in supplements, except sports fuel. Aminos,  protien after workouts. No osteoporosis in fam. My doc who did the BHR wanted to do thr revision as most all other docs. Was lucky to have Dr. McMinn take me on.

Sounds like you did a lot of running right away.  With the bone in-growth happening during that first year, have you seen/heard anything to suggest that might have impacted it?  What did McMinn have to say about it?

You ended up with a poly liner in the cup? 

[John C]

Hi Rick,
Very sorry to hear that you had to go through this, but delighted that Mr McMinn was able to save your resurfaced femoral head.
You asked about information about no ingrowth, and I can only pass on second hand info from my doctor. He said that minor impacts during the early healing process can cause micro movements at the bone interface. He said that if these happen often enough, the body will give up on bone ingrowth, and a fibrous layer will develop instead. This is one of the reasons that he insists on no impact activity such as running for six months. I also read somewhere that Mr McMinn has attributed later failures to impact activity too early. In your great report shown in Pat's link, you mentioned that you had run five miles at one month after surgery. Based on what these doctors have said, this might be worth looking at as contributing to the lack of ingrowth.
Hopefully with Mr. McMinns advice of no running for one year, this new cup will grow in well, and last you a good long time.
Best of luck.

[obxpelican]

John, I thought the cup is spiked into place?  If that is true could it have been that the cup was not fit properly to begin with.

Many a discussion with bad cups I've read that it's nearly always a doctor error.  Either a cup placed at the wrong angle or the cup was not placed firmly leaving it a loose fit, of course that would also account for your explanation.

@ 6 weeks I could clearly see a lot of bone ingrowth on my cup as compared to my post-op x-ray.


Chuck

[Dannywayoflife]

Thats very well explained Jon. I have read somewhere that Mr Mcminn has attributed several revisions to early impact I think one at 9 years and 2 at 12 years. I wonder if there's any way of checking how well your bone has grown into the device via xrays?

[hernanu]

Was that years or months, Danny?

[Dannywayoflife]

That was years if my memory serves me correctly. I'll try and dig out the article if I can I'll post it on here. I've defiantly seen him attribute early return to impact as a reason for failure in the mid term though(my figures might be slightly off but I'm sure there near on).

[Spanielsal]

Hi Rick, I'm very interested in how the metallosis and loose cup were dealt with, did you go to a poly liner or a ceramic? such good news that you were able to save your bone by keeping the resurfacing on the head.  I'm due to see Mr McMinn for pain in both hips and think my Cormet is going wrong as pain is mostly in the pelvis.  your story is very encouraging, thanks!  keep us posted how you are getting on.  Sal

[Dannywayoflife]

John, I thought the cup is spiked into place?  If that is true could it have been that the cup was not fit properly to begin with.

Many a discussion with bad cups I've read that it's nearly always a doctor error.  Either a cup placed at the wrong angle or the cup was not placed firmly leaving it a loose fit, of course that would also account for your explanation.

@ 6 weeks I could clearly see a lot of bone ingrowth on my cup as compared to my post-op x-ray.
Chuck, there's defiantly no spikes on the back of the BHR cup. I think that some of the biomet designs have spikes though.


Chuck

[Rick Rubio]

My revision was with a metal bhr component. Both, cup and liner. With my first bhr.. My doc/ physical therapist said I can do pretty much anything. He was not a fan of early running but never had concern of movement. I also rehabbed with endurance athlete Cory Fault who was sponsored by smith n nephew. He ran a marathon at 3 mos.  Although my doc did not support early running, he never said I absolutely should not run. Impact was not an issue.. As it is now becoming. Different Docs  look at this differently. I would like to see any studies of the acetabular cup failures. Prior to my revision surgery  Dr. .McMinn and his associates reviewed my xrays done at 3mo,6 mo, and one year and said the lucent line of my xrays did not show bone growth. Nobody caught this. Tough lessons.

[Spanielsal]

Tough lessons indeed Rick, I hope that this one goes well for you.  Mr McMinn seems to be a bit of a legend from all the info I'm reading.  hang in there, i am sure you will be back doing the stuff you love before too long.  thanks for the info.  Sal

[Tim Bratten]

Hi Rick
I had lucent lines as well (barely visible at four months) that got worse as time progressed. In the end when I went to Dr. Koen De Smet for revision the cup was so loose it came out with a simple tap. It is my understanding that he felt the problem was due to the combination of a poorly placed cup and a staph infection in my bones.
Good luck with the revision!