Groin and Buttock pain after HRS

[krishnenduprasad]

Hi, my name is Krishnendu. I am 25 years old. I had my Birmingham Hip Resurfacing Surgery (left hip) in February 2009. Fortunately I can walk and do my regular actions except for some pain in the groin and buttock after long walk, sitting in same position for a long time and after long run. Now my worry is that, in June 2012 June, my surgeon asked me to do a metal ion test and MARS MRI test following the failure of Depuy ASR implant in 2010 August. In the metal ion test result I found that the Chromium level is 5.64 mcg/l and Cobalt level 1.24 mcg/l. And in the MRI result I found the following...

Bone Lesion: Cannot be commented upon

Soft Tissue: No periprosthetic soft tissue mass is seen

Muscle Atrophy: None

Muscle Edema: None

Iliopsoas condition: Good

Tendon/Muscle tear: None

Lymphadenopathy: None

Now I am so much worried that whether a revision surgery is necessary for me. Is there any problem in leading a normal family life for me. I am worried that the implant won't last long...

Any doctors out there that can give me advice, or any surface hippy that has dealt with a similar issue, would be much appreciated.

Thanks,
Krishnendu

[hernanu]

Hi krishnendu, welcome to the site!

Sorry that you have to worry about this. I assume that you have the ASR and that prompted your surgeon to do the metal ion test and the MRI.

There are several limits used as rules of thumb for metal ion testing, what is the upper limit. The most stringent is from a new study that came up in 2012, which set some strict limits. This is from researchers who also recognize that other surgical groups accept higher limits for the two metals tested for.

My surgeon is happy with anything under 7 for both, but to use the most stringent study to date, the latest accepted upper limits for both are:

(from this source: http://www.hipresurfacingnews.com/categories/20-Metal-Ion-Issues )

Chromium - 4.6 for one hip, 7.4 for bilats
Cobalt - 4.0 for one hip, 5.0 for both.

From the numbers from your test, it seems like you're slightly above the curve (5.64) on Chromium for this study, well below on Cobalt (1.24), based on one hip results (for two hips you're fine).

Your MRI results seem stellar, so there is no symptom to beware of present. No soft tissue mass, so on.

Remember, the numbers I quoted are the strictest out there, other surgical bodies recognize higher. The Medicines and Healthcare Products Regulatory Agency in the UK uses 7 ug/l as its upper end, which puts you below their threshold for concern.

One thing to consider is that the ASR, while it failed significantly more than other HR components, also succeeded in a large number of patients. The average percent revisions for that device over the years noted in the Australian registry study:

• 0-3 months - 1.66
• 3Mth - 1.5Yr - 1.95
• 1.5Yr - 4.5Yr - 4.21
• 4.5Yr - 5Yr - 9.56
• 5Yr+ - 6.40

Cumulative, the revision rate is 23.4% at seven years. So the success rate for this device, which was considered defective and pulled out of circulation is still 76.6% at seven years.

If you have the ASR, have no symptoms and the metal tests are reasonable, it seems fine, but I am not a medical person, and you should discuss these concerns with your surgeon, who will be much more able to tell you what he or she considers safe or worth observing.

Good luck and welcome again!

[krishnenduprasad]

Hi,

Thank you for your information....

In the metal ion blood test the biological reference range of Chromium level is indicated as 07.00-28 mcg/l. What does this mean? I read so many post and research study regarding this, but still I couldn't find the exact safer level of chromium and cobalt. And in some posts I read that the level of metals decreases/increases (fluctuate) as years pass and this may not be the main reason for hip failures. I cannot help worrying because I am only 25 and I haven't started a new life yet. Besides, my family cannot afford another revision surgery so on. Now my only concern is whether my hip is in the right condition.

Thanks
Krishnendu

[morph]

krishnenduprasad, from the info you have provided so far nothing appears to be too untoward from my unqualified opinion. How long have you had the device, I assume a while seeing as you are running? Has the pain always been there from the start or has it recently occured? Have you had x-rays to check the device? From what you describe it does not sound like it warrants anything drastic but that is just in my opinion, please get the proper advice and then if necessary get advice from a number of experienced surgeons.

I believe some surgeons are requesting ion tests for all MOM due to the recent scares so that alone is nothing to get too concerned about and your results are not astronomically high. Who is your surgeon and what is your surgeons views on the results? What device do you have?

Personally I would cut out the long runs whilst you are worried and have pain around the groin and butt and focus more on the walking and the simple gentle excercises and stretches. The pain is not necessarily the device and in many cases can be due to muscular and posture inadequacies, which is probably why surgeons prefer crutches to be used if there is a limp - if not further muscular problems can occur further down the road.

The only qualifications we have on here are that we have been through the surgery and rehab and we can provide support and advice to that extent both emotionally and physically, but obviously there are things which really should be followed up by expert advice.

Like Hern points even with devices with a high recall, majority are fine. I really hope all goes well and keep in touch.

[krishnenduprasad]

Hi Morph,

Thank you, the device is Depuy ASR Total Acetabular Implant Size 46 Standard Duofix Depuy ASR femoral implant. The surgery was held in Dec 2008 and I don't feel pain regularly. It comes occasionally(rarely) when I have long run or walk. Otherwise I am  okay.


Regards
Krishnendu

[hernanu]

Hi,

Thank you for your information....

In the metal ion blood test the biological reference range of Chromium level is indicated as 07.00-28 mcg/l. What does this mean? I read so many post and research study regarding this, but still I couldn't find the exact safer level of chromium and cobalt. And in some posts I read that the level of metals decreases/increases (fluctuate) as years pass and this may not be the main reason for hip failures. I cannot help worrying because I am only 25 and I haven't started a new life yet. Besides, my family cannot afford another revision surgery so on. Now my only concern is whether my hip is in the right condition.

Thanks
Krishnendu

In the case of the Medicines and Healthcare Products Regulatory Agency in the UK, a reading under 7 mcg/l for chromium is safe under their rules. I was also asked by my surgeon at two years to do a test, I believe it is now standard for his practice, given the concern lately about metallosis.

It seems, as morph mentions that your readings fall under that and are not in the range of concern. If you are concerned, though, you need to ease your mind and talk to the surgeon. We are aware of the issues and will support you here, but medical contact is a must if you are worried.

It is good to keep an eye on the device, but if it is working well and no symptoms are there, keeping in good contact with the surgeon and a watchful eye should be enough; it will allow you to enjoy your life while being prudent.

[krishnenduprasad]

Thank you,

 I just received my surgeon's mail that my reports are perfect and there isn't anything to worry at present. The next set of investigation is due in  1 yrs time.

[morph]

No worries, good news. You can lead a normal family life, treat the hip and body with respect and it will return the favour. Forget about it until next year and enjoy.

[krishnenduprasad]

Hello,
I would like to know the time/year limit set by Depuy Orthopaedics in India for reimbursement or a company-paid revision surgery in case of failed implants that need a revision surgery. I have gone through the 4th year of my Birmingham  Hip Resurfacing surgery and now i want to know whether the company will pay for a revision surgery in case I need after 5 or more years.

Thanks
Krishnendu