Hip resurfacing with a dynamic hip screw

[simonfr]

Hi Everyone!

First post here so please be gentle...

I was knocked off my bike by a car 15 months ago and had a displaced intracapsular fractured neck of femur (subcapital). Anyway long story short, I now have a dynamic hip screw fitted.

I have of late started to get more constant hip pain, and although they last xray in november looked 'ok', I obviously can't have an MRI because of the metalwork in the hip (it's stainless steel Smith and Nephew device). I have assumed this pain to be the start of AVN.

My personal preference would be for a resurfacing, but how long before would they need to take the device out so the body could repair the femur as best it can to fit a BHR?
Can they fit a BHR post DHS?

Any help or advice would be appreciated

cheers

Simon

[Dannywayoflife]

Hi Simon,
            Sorry to hear your problems. But welcome to the site. You would best be advised to seek out the mist experienced HR surgeon that you can find and ask there opinion as no one on here is a surgeon and will not be able to give a reasonable answer. There are several top surgeons in the US and UK.
Danny

[simonfr]

Hi Danny

Thanks for your reply. I was hoping someone on here might have had a similar problem as me on the forum. I ask as the cyclist, Floyd Landis has a BHR performed by Ronan Treacy, and his broken hip was repaired using 3 screws at the time of the accident.

He would have had a few holes in the top of his femur through the neck, which may have made the fitting of his BHR more difficult?
Whereas I have 2 holes, one for the DHS and another for a screw....

Cheers!!

Simon

[Dannywayoflife]

I asked mr Treacy about the landis case and he said it was an extremely difficult operation. And he has done many thousands. He specialises in that kind of thing though. But each and every case is different so even if it's been done for one person doesn't mean it's aplicable in every case. Go and see the best most experienced surgeon you can find. If you can go the see Ronan Treacy I would strongly recommend that as he specialises in very difficult cases and has lots of experience with them.

[simonfr]

Hi Danny,

Thanks for that. I am going to see my GP and get in contact with my surgeon this week about the possibility of removing the DHS so to give the bone the best chance of regrowth and remodelling prior to any future operation.

My surgeon also perform BHRs too.

I think it's best to get the ball rolling sooner rather than later about this.

Cheers

Simon

[Dannywayoflife]

Where are you based Simon?

[simonfr]

Fife, in Scotland.

[Dannywayoflife]

That's well up there then! Hope that you get sorted mate. As I say though if you want a second opinion contact Mr Treacy. All the best
Danny

[simonfr]

Cheers Danny!!
I've just emailed my surgeon. Let's see if or what he replies with....

[Pat Walter]

Welcome Simon

You made the best decision by asking your surgeon.  Only an experienced hip resurfacing surgeon looking at your x-rays can tell you if you are a hip resurfacing candidate.  I have seen x-rays of hip resurfacing components fit around screws, etc - but it is tricky and you need a really experienced hip resurfacing surgeon.  Also a lot depends on the exact location of screws.

Good Luck.

Pat

[simonfr]

Thanks Pat and eveyone else for their support 

I'll let you know what he says......    

The surgeon does BHR's as well as hip fracture repairs and THR's. I have contaced him through his NHS email address first off, as it was through the NHS he did the DHS (i didnt have much of a choice!!    )
But he also privately consults with one of the BMI hospitals in Scotland, so if he doesnt answer his emails or calls, then i'll make a private appointment with him!! Obviously Mr Ronan Treacy is very high on my preference list, but i shall let the surgeon who performed the DHS on me have his input as i am technically still under his 'care' and he knows my case....

Thanks all

Simon

[Dannywayoflife]

Keep us updated Simon
Danny

[simonfr]

Well, after writing my weighty tome (email) to the surgeon asking about AVN, Hip Resurfacing, Dynamic Hip Screws, etc etc...  i got a reply...

The chances of AVN at this late stage is remote. We should wait until your next checkup in November. A metal-on-metal articulation is not to be recommended. I am surprised you have not seen much about this in the press.

Im going to scream..........

[hernanu]

I'd get a second opinion.

[Dannywayoflife]

Well, after writing my weighty tome (email) to the surgeon asking about AVN, Hip Resurfacing, Dynamic Hip Screws, etc etc...  i got a reply...

The chances of AVN at this late stage is remote. We should wait until your next checkup in November. A metal-on-metal articulation is not to be recommended. I am surprised you have not seen much about this in the press.

Im going to scream..........

Simon have you had any more movement with your case? If your surgeon is saying that theres an issue with the MOM bearing couple then i would suggest that hes not great at doing the Hip resurfacing operation. If i were you then i would ask your GP for a refferal to Treacy at the ROH in birmingham

[simonfr]

Hi Danny,

I went to see my surgeon yesterday to see what he was saying because of the short reply.

Got some more xrays of my hip and it looks fine on the xray. No signs of AVN, no obvious signs of arthritis or cartilage damage on the femur head. To my eye, my good and bad hips both look the same from the xrays. But it's still really painful.

He doesn't see the need to remove the metalwork which is in situ because of the lack of signs which require it's removal. The assumption is that it's soft/scar tissue injuries and/or nerve damage from the accident and resultant surgery.
He is dead against using any MoM devices period whether THR or BHR when I asked about the future and my preference for a Hip Resurfacing.

My next scheduled appointment in in November which takes me to just before the 24 month mark from the accident.

[simonfr]

Oops. Posted too early last post!!
So my only option would be to go private to get a BHR in the future. However as I am showing no clinical signs for any future surgery from xrays (can't do MRI because of DHS), it leaves me in a bit of a limbo......  :-/

Simon

[Dannywayoflife]

If it were me I'd get another opinion mate.

[horse doc]

Simon, i'm in a similar situation except screw fixation rather than dynamic screw.  I think you need to push forward for a diagnosis of the pain.  I have had both mri and ct scan so i don;t understand why you can't.

If you  were you normal after the initial healing and now have pain, something is wrong despite the lack of xray evidence.  I had a conversation with a radiologist recently.  She said that one must treat the patient, not the xray....

[Dannywayoflife]

I had grade 4 OA that hardly showed up on my initial xrays. So they don't tell the whole story all the time.