Neighbor getting a THR and the questions they asked

[obxpelican]

I have an elderly neighbor who is getting a stryker total hip today.  I am worried by the answers their doctor gave them.

My neighbor is in his 70s so he went with all the doctors who said to get a THR, really to me is not that much an issue because of his age, but now (and I told him this) that he would have some restrictions.  Yesterday talking over the fence my neighbor he was angry and said "my doctor says I will never be allowed to go down to my knees", my neighbor usually has a garden.

Now to the questions, so I told them to ask the doctor how many cups that he's had to revise, he told them "I do pretty well"  <--------------  what kind of an answer is that???  I told them to ask him about his pain protocol, well he was told that he would have a morphine pump post-op, well that tells me that most of his patients are in major pain post-op.  A doctor with a good pain protocol will not normally have you hooked up to a morphine pump post-op.

Everyone, you need to ask questions, talk to people who have used that doctor, if the doctor does not answer your questions or is very vague, run don't walk away.  A good doctor will tell you how many cups he's had to revise.

I hope my neighbor turns out ok, I am not really that optimistic at this point.

Chuck

[Tim Bratten]

Well I'm certainly not seventy years old, but I could get down on my knees within a week or so after my revision to THR. In fact, I remember distinctly going to my knees to tie the shoes of one of the other hip resurfacing patients whose wife had left a few days early. This had to be less than nine days after surgery.

On the other hand, about the morphine pump, I have to tell you that Dr. Koen de Smet was using this at the hospital. However I should mention that I, as well as most of the other patients (most with their hips resurfaced), experienced very little pain after surgery. For example my room-mate at the hospital was a 68 year old man with a resurfaced hip who used no pain medication at all by the day after surgery and was walking fine with one crutch (including stairs) by the second day after surgery.

I agree it does sound your poor neighbor picked the wrong surgeon. If only he knew what a huge difference this can make ...

[obxpelican]

Tim,

Yes it is a shame that my neighbor did not look into the sugery more.  Everyone wants to listen to their doctor when they get a referral, too many assume that the guy they were referred to is the "best".

Yes, Dr. DeSmet patients in general will usually not need drugs like morphine post-op, I know Pat was up and around very quickly post-op, but, I've read too many people in major pain post-op who have had to hold that morphine button down the first day or so post-op.

Much of controlling pain is surgeon technique and if the doctor treats the surgical area with anesthetics or not.  Nobody should be in agony from surgery from, especially now with all the new technology that is available today.

That is great that you have little or no limitations although that is not always the case, many docs will limit you on what you can and cannot do with a THR.  I have a friend that I grew up with who posted on FB from Florida that he has limitations, he got a THR recently.


Chuck

[Tim Bratten]

That is great that you have little or no limitations although that is not always the case, many docs will limit you on what you can and cannot do with a THR.  I have a friend that I grew up with who posted on FB from Florida that he has limitations, he got a THR recently.


Chuck

Hi Chuck
I wouldn't say I have no limitations ... I will always be more worried about the possibility of damage from impacts than if I had a well done resurfacing. For example, I don't think any Doctor would think it was a good idea that I should take up long distance running as a hobby (and I won't, either). I wouldn't exactly call this next point a limitation, but I will also be more worried about problems that might occur because I'm doing "too much" activity (on this point, very little seems to be known). A third concern is dislocation: my 40mm ball shouldn't have "much" risk of dislocation but it's certainly a lot smaller than the 52 mm head I had before. De Smet would have put in something bigger, but the previous surgeon had butchered things so badly that my acetabular component needed to be screwed into the bone.

I certainly wouldn't want anyone else to take my advice about their limitations after a THR, but from what I understand the type of implant and the way it's placed make a huge difference. To give an example, there is a much cited study (small scale) which shows that wear (and thus time before failure) of a THR is based directly on activity level. The more activity, the faster the THR wears out Many doctors in the US treat this as a given fact. However, the implants in the study were all metal on plastic, so that result doesn't seem very surprising (or interesting) to me. Use of ceramic on ceramic implants has essentially been abandoned in the USA, because they squeaked. I heard de Smet say this was mainly due to surgeon error, and (at least in my case) my implant hasn't spoke a whisper so far. 

So I guess what I'm getting at is if you neighbor gets a poorly placed, small headed, metal on plastic THR he just might find himself so limited he can't even kneel down in the garden. I feel for him.

[obxpelican]

Tim,

At least you know by choosing DeSmet that you gave yourself the best shot at a long life with your THR, clearly he is one of the worlds best hip doctors.

One other factor with THRs that I found troubling is the stress shielding issue which is why many of us went for the hip resurfacing since it gives more of a natural geometry and the possiblity if we have to revise to a THR we can do so more easily.

I have 4 years on mine and I am hoping for 40.

Chuck

[obxpelican]

Talked to my neighbor's wife and her husband is in a good bit of pain, very bad night, pain meds making him sick.

So she asks him, "don't you anesthetize the surgical area" his answer, LOL  "only if they are drug addicts".

Obviously this doctor has no idea about modern pain protocols, I would have hit the door the second he told me that he does "really well" with cups, well what does that mean?  Every other cup comes loose?  Every 10th cup?

I just have a bad feeling about this doctor.



Chuck

[hernanu]

Yikes!

[Tin Soldier]

Interesting discussion Chuck and Tim.  Sad for your neighbor.  I just recently had a sinus headache for a couple days and it was way worse than any pain I ever from either surgery and I only one's worth of had oxy, the rest was aceteminophen. 

I wonder if the stress shielding issue is more acute when you have less of the leg to work with with (kneeling).  Standing you get the knee joint, the calf, and the ankle all playing a little role in reducing the amount of direct lateral force on the femur where the implant is located.  Just a thought. 

Hope your neighbor does better.  You didn't realize that "a few" is an actual scientific term? 

[obxpelican]

Actually stress shielding is the abnormal weight distribution placed on the inside of the femoral bone from a THR as opposed to the more natural weight distribution that a resurfacing gives.

The more you stress or use a bone the more dense it gets, that's why folks with lower density are told to walk.

Chuck

[Tim Bratten]

The definition of stress shielding in the surface hippy site seems pretty good:

"Unnatural distribution of body weight to femur reduces stress to parts of femur, such shielding can lead to bone loss and possibly implant loosening"

It's my understanding that the stress shielding issue is what's known as a "theoretical" advantage of hip resurfacing, since I don't think the benefit has been verified by clinical studies.

However I will testify to the "ease" of revision for resurfacing, at least for the femoral component (been there, done that). It scares me to think of the possibility of a another revision if my modular neck should "fail" and somehow damage the femoral component. Good bye femur. In terms of "scare factor" I'd rate this right up there with the fear of high metal ions or metal allergy for a surface hippy. At least my neck is a short one and was placed by De Smet, so that helps.

Enough morbidity! I'm going back to the climbing gym NOW

[hernanu]

Tim, you had one of the best surgeons in the world, and if karma works, you'll be able to take that new hip anywhere you want to. Happy climbing.

[obxpelican]

Tell that one to those that had to get revised because of the lossening of the femoral component on their THRs.

It makes all the sense in the world, ask any of the experienced, well known hip surgeons.


Chuck

It's my understanding that the stress shielding issue is what's known as a "theoretical" advantage of hip resurfacing, since I don't think the benefit has been verified by clinical studies.