burning pain 8 years after Burmingham resurfacing

[suni]

I had a resurfacing (Burmingham Dr De Smet) 8 years ago. The two first years I had problems (pains, clunking) and De Smet seemed to think it was because the prosthesis he put is slightly too large.
Then I had a metal on metal THR on the other hip (left 2005) with the hope (surgeon, here in Canada, said it might help the right hip) and this THR failed and had to redo it in 2010 (also because I developed a cyst in the hip consistent with metal on metal issues).
When the second THR (metal on plastic this time!) on the left got better, my right hip got better too. And I had about one year mostly free from pain and able to walk and was soooooo happy.

Lately I started to have pain, burning in the resurfacing hip going down my right leg and it's becoming worse. It even is during the night.
I have a very high level of metal ions.
Does anyone have any similar experience with resurfacing after several years? or does anyone have any advice?
thanks
I am new on this site!

[hernanu]

Welcome suni, we'll try to help out as much as possible.

Sorry that you're having issues after those issues and then one good year. How long has the pain that you got lately been going on?

I guess the thing I would do is to check that the implant itself is ok. Getting a good set of xrays and having some of the surgeons listed on this site that review them will let you know if there are any issues with the device itself.

Once you know how that stands, you can decide how to proceed.  If that turns out to be ok, then you can look at things like sciatica or something else.

Good luck and keep us posted, we'll be here.

[suni]

thanks Hernanu

It just happens that I had annual check up with my surgeon here in Vancouver Canada in Sept and Xrays seem OK except that he said there was a bit of fluid around resurfaced hip but did not seen concerned. He said that happens...??

I don't think it comes from my back it really feels like from my hip (I also have pain in the groin).
I will have to contact my surgeon here but do you think it worsewhile to send Xrays to specialised surgeon(s) listed in that website? My Doc here has done some resurfacing but they don't do them here anymore I think so he is a good surgeon in theory but may not be as experienced as the ones in the website?
thanks

[hernanu]

I think it would be beneficial. There are several surgeons here (including DeSmet, I think) who would look at your latest xrays and give their opinion. They are some of the most experienced HR surgeons, and do this service for free.

That would help to exclude the BHR as an issue, and they may have other suggestions on how you can go on to get relief.

[Tin Soldier]

Did the surgeon aspirate the fluid?  That is something they might do to see if it is dark or shows signs of metallosis.  I don't think that's a simple procedure.  I'm not surgeon, but I haven;t heard of fluid being around the joint happening after 8 yrs, unless it was an adverse reaction/infection.  In talking to Pritchett awhile back about metallosis or adverse tissue reactions to the metals, he seemed to think x-rays generally show problems if they exist and that often times the patient just knows that something is wrong, due to discomfort and pain.

You could certainly send your x-rays to Pritchett, he's only a few hours south of you.  I sort of think he'd give a free consult regardless of insurance or where you are.  He just called me directly after he got my x-rays and we talked it over on the phone.  I then scheduled a visit a month out.  I believe Gross might do the same thing.  Also, I thought there was a fairly experienced HR surgeon in Vancouver BC.  Take a look at Pat's page here on surgeons. 

Sorry about the problems.  This is something we all think about, even though it's not very common.  Hope you get some answers.   

[suni]

thanks Tin soldier.

at the last visit to surgeon in Sept I did not have pain so surgeon did not even mention fluid aspiration for checking. He seemed unconcerned about it! and since I did not have pain I put it away from my mind!
Now I am going to wait and see for a little while. observing what makes it worse or not etc...
Getting an apointment with my surgeon is very difficult here! so I want to make sure there is really lots to report!
and I will check this doc you mention Pritchett.

[Tin Soldier]

He's at Orthopedics International in downtown Seattle.  Easy to find on the net.

Good luck.

[patrick_d]

Hi Suni -
I am so sorry that you are having to deal with this problem.  Tin Soldier and Hernan are right on when they say many surgeons will look at your x-rays and have a brief phone call to discuss their thoughts.  It might be worth your time to try to contact several of the top surgeons in the US and Canada and get their opinions.  I am very biased, but I would really suggest you contact Dr. Gross as at least one of the surgeons you talk too.
Best of luck.

[obxpelican]

High levels of metal ions and fluid around your hip are signs that something is going on with your device.  As others have mentioned get your x-rays to a different doctor and get their opinion.

It's possible your device is misaligned I am surprised it was Dr. De Smet, he's almost always spot on but any doctor can make a mistake, but,  Dr. De Smet is still a fantastic hip surgeon.


Chuck

I had a resurfacing (Burmingham Dr De Smet) 8 years ago. The two first years I had problems (pains, clunking) and De Smet seemed to think it was because the prosthesis he put is slightly too large.
Then I had a metal on metal THR on the other hip (left 2005) with the hope (surgeon, here in Canada, said it might help the right hip) and this THR failed and had to redo it in 2010 (also because I developed a cyst in the hip consistent with metal on metal issues).
When the second THR (metal on plastic this time!) on the left got better, my right hip got better too. And I had about one year mostly free from pain and able to walk and was soooooo happy.

Lately I started to have pain, burning in the resurfacing hip going down my right leg and it's becoming worse. It even is during the night.
I have a very high level of metal ions.
Does anyone have any similar experience with resurfacing after several years? or does anyone have any advice?
thanks
I am new on this site!

[suni]

thanks all for your responses and yes I am going to work on getting digital xrays and sending them to few surgeons!
At the time I had the resurf with Dr De Smet he had to choose the size of the prosthesis (Birmingham)-I am small and small boned- and he told me he hesitated between two sizes (at that time the interval between the sizes was higher than now, cannot remember exactly what that was) and chose the bigger one to give the largest range of movement since i do yoga etc.. Later when I had problems he said that it might be a bit too large for me.

One of my fear about redoing the hip resurf and getting a THR is: my surgeon has said to me in the past that because of the large size of the cup and me being small boned, it will be difficult to replace it with the right THR size.
That scares me.
Anyway I need to have an apointment with my surgeon here to get the Xrays and his opinion and then others.

[Tim Bratten]

Hi Suni
I don't know what your financial situation is, but did you ever consider going back to De Smet fpr a revision? I had a local surgeon make a mess out of a HR (there were many complications, including infection in the bone) and De Smet did a great job with a ceramic on ceramic revision. I'm nearing ten months after surgery and things are going really well. For example I'm rock climbing better than I have in more than three years and if things keep improving like they have, I should be climbing as well as I ever did in a couple more months.
Good luck with your problems, it seems like you've had more than your share of difficulties. 
Tim

[suni]

well financially it would be a challenge ... but I would consider it.
I am in the process of getting Xrays and will send them to him as well as to Dr Pritchett closer by (Seattle) and see what they say.
I have been reading the article that Dr Pritchett wrote about the subect of metallosis and resurf revision and I can see that if I need a revision I need a surgeon who has this experience! and I don't think my surgeon here has that kind of experience.

[Pat Walter]

Hi Suni

I am sorry to hear you are having problems.  I would get your new x-rays and email Dr. De Smet, Dr. Gross and maybe one other experienced surgeon to get several opinions of your resurfacing.  All the top docs do THR revisions.

De Smet sometimes used Wright conserve plus for other sizes.  That happened when I was in Belgium in 2006.  The one lady was small and he could not use a BHR.  Normally he does a very excellent job.  I would also contact him to find out what he thinks.

THRs can have misplaced acetabular cups too that can cause high metal ions.  Maybe you are still having problems from the first THR.  You definitely need a really experienced surgeon to sort it all out for you.

I hope you can get some information to make a decision on soon.

Good Luck.

Pat

[suni]

thanks Pat
I feel pretty overwhelmed right now... but I am taking the needed steps.
not sure how to tell my surgeon here that I might need someone quite experienced in this.
any idea on how to talk to him (he is pretty ego centered and believes in himself... and he has a good reputation here)

[hernanu]

suni, I understand being thoughtful and considerate, but your focus needs to be to find the best solution for you.

Your doctor is there to provide a service for you as a patient and as a customer. He or she can have an ego, but if you reach the decision that you need other input from surgeons who are specialists and are much more experienced, your decision rules this. It is your body and you will suffer any consequences and reap the rewards of your judgement.

If you had a problem with your eyes, no matter how good your general practitioner is, you are referred to en eye doctor because of their experience. The same principle applies here, especially if you have access to some of the best surgeons in this specialty.

So ego or not, he has no reason to be anything but supportive. Having said that, I and others here also had to assert myself and move to another doctor when the service (HR) that I wanted was being argued against by surgeons in very good standing in the Boston area. I had no problem telling them that I was going to another doctor for an opinion.

Too bad if their egos suffered. It is your decision.

[suni]

yes hernanu I agree with what you say but I don't think I would find a better one in Canada which means I would have to go to the States which is very expensive and also that I would have trouble with the follow up here.
In any case I will send my Xrays and Ultrasounds to a couple of other surgeons whose reputation is well established and see what i do after that.
This morning I had my apointment with my surgeon here in Vancouver here is what the result is:
he said X-ray are ok so we need to do ultrasounds to see if soft tissues are reacting to metal. My symptoms can be a sign of that.
 Depending on degree of metal tissue inflammation, surgery is recommended ASAP because if tissues deteriorate more or too much then the surgery is not successful. I should have ultrasounds in around one month. If ultrasounds are not bad then I should manage it with pain killer and monitor with ultrasounds once a year.
Surgery is replacing the resurfacing prosthesis by a THR (total hip replacement) which  is major surgery and very complex....
And surgeon here has done very few (less than 20) which means I will have to research and see if doing it with him is the best solution or if I should go to the states.

[hernanu]

In the meanwhile, suni  you could send your x-rays to some of the doctors on this site and get their take on them. They have a lot of experience and could shed some more light on this. It's one way to identify whether the HR is the source of your troubles.

In the case of a THR, you want to get an experienced surgeon as well. I have heard that HR surgeons are harder to find in Canada now, but I would expect that good THR surgeons are still available there if you need that.

If you are able to go to the States, you have a very good one right across the border from you.

In all of this, I wish you the best of luck, hopefully it won't lead to surgery, but in any ways, let us know what happens and how it goes.

[suni]

my surgeon here has lots of experience with THR (few HR) and some reconstructions and he has a very good reputation in Vancouver (He teaches and is considered part of the best ones in Vancouver).
But I am under the impression that the surgery for replacing the resurf by a full THR is complex and that is the surgery he has done only a few.
Do you have any idea if my impression is true?

I am thinking of waiting for the results of the ultrasounds to send Xray + ultra sounds to the other doc because according to my surgeon the Xray don't show any anomalie: everything OK on XRAy.
so the other doc (like mine) would need the ultrasounds to know if there is a metal problem sufficiently advanced to warrant surgery.
What do you think?
thanks

[Tin Soldier]

I don't think revison from a probematic HR to a THR is all that difficult.  A revision from a problematic HR to another HR is llikely very involved and that's the sort of surgery I think you need have a really exeperienced HR surgeon looking into.  As pointed out, I think a couple different really experienced surgeons looking into it is even better.  Also, through in the fact that you may have less bone to work with in the acetabulum, and I think you really want one of the most experienced HR surgeons you can get.

[suni]

thanks Tin SOldier

I just got my apointment date for the ultrasounds but it's only February 25 , (2013 of course
It's far away to wait but at the same time it gives me time to really assess the pain situation with my hip and do more research.
I want to assess how the pain becomes more or less because if the ultrasounds do not show a pseudo tumor then I need to see if I can avoid the surgery...