Failed BHR - need revision surgeon

[ikep]

I had left hip BHR in August 2011 to relieve constant hip pain from stage 4 arthritis.  I have never been pain free since the operation. Clunking, grinding, and pain - in the joint, groin, low back and all the way down the leg.  X-rays show good positioning (Dr Su).  The only thing that shows is radiolucency around the acetabular cup. Very limited ROM.  Can't stand more than 10-15 minutes. Spine negative.

The surgery was done at California Pacific in SF (Dr. Gilbert).  His colleague Dr Cox, and head of orthopedic surgery at Stanford, Dr Maloney both said I need revision to THR.  I am now very scared that the outcome will be even worse.  Dr. Maloney is a failed implant revision specialist, but not a resurfacing specialist.  Dr Callander at California Pacific is familiar with BHR and has done revisions, but I don't know whether I want to go back to the group that did my (failed) BHR (whether or not there was surgical error.  Finally I know of Dr Vail, head of ortho surgery at UCSF.  Any suggestions, please, to whom I should go? For 6-7 years, chronic pain has taken over my life and I would so much like to take some normalcy back. Thank you!

[hernanu]

Hi,

I'm sorry you've had to deal with this, but we will try to help.

There are doctors who are resurfacing specialists in California:

http://www.surfacehippy.info/listofdoctors.php#California_

as listed in Pat's directory. Probably many or most of them handle revisions, and can tell you whether revision to an HR is possible, or to THR is warranted.

What was Dr. Su's opinion on the revision?

If it's possible for you to go outside of the state, there are several good options available to you, and you could check whether those work. There are Dr. Rector in Colorado, or Pritchett in Washington.

I believe most HR surgeons also perform THRs, so the extra knowledge from a well versed HR surgeon may calm your mind as you go through this.

Whichever way you go, the THR is a good alternative, the relief of pain is definitely what I wish for you. Good luck, and let us know what happens.

[Dan L]

Sorry to hear it has not helped, I can only imagine how difficult the period since the surgery has been.

In addition to what Hernanu mentioned, I would find the most experienced HR/THR surgeon possible either close to home or as far away as would work for you, with the experience being the key variable.  I've read of various options for revision here, not sure what may work for you.  I'd probably not go back to where #1 was done, if I were faced with your situation, but that's just me.

THR revisions can be trouble free for many years, so with a good doc you have a reasonable chance of getting some relief.

Best regards for a better road ahead,

Dan

[Dannywayoflife]

Seek out the most experienced surgeon you can! Is it just the cup that has issues? If so is a cup only redo possible?

[Ross]

Hi there. I see that you may be relatively new to the site but the top surgeons in the world are listed for you.  Dr Su is very experienced but you will wait forever and a day for your first interview and then another 4 months for surgery.  Dr Pritchett in Seattle and Dr Gross inColumbia , SC would be a good place to start in The USA.  Do not make the mistake of going back to be butchered again first and for most.  You could still be revised to a functioning resurfacing but you will need someone like Dr Su, Dr Pritchett, or Dr. Gross.  If you can travel, I would see Dr McMinn.  He is the BHR master.

[Barbara]

Dr Pritchett would be a good choice. He is not recommending BHR for females any more due to failures. PM me if you want to talk

Barbara

[Dannywayoflife]

McMinn would be a very wise choice if your able to travel

[ikep]

Thank you all for the suggestions.  I really can't travel, so I have to decide between the two local surgeons, Dr Maloney at Stanford and Dr Vail at UCSF. They are both world class orthopedic surgeons and heads of their respective departments.  Since this will be a revision to THR (I do not want to further experiment with BHR given the appalling failure percentages for women), I was hoping someone can give me intel on these two doctors to help me decide. Thanks again!

[Manny]

Hi,

I'm sorry that you have to deal with this situation.  I can relate to you in a sense.  I had my LBHR in August 2011 also.  I had a break for about three weeks.  After that, the pain, the stiffness, soreness never went away. I did a lot of PT unsuccessfully.  Last month, I saw another orthopedic surgeon, his conclusion (after looking at the X-ray):  the acetbular cup is loose.  I'm now waiting on a total hip replacement.  If anyone here had a revision, please tell me which hip implant was used.  I plan on revising my hip soon.  I have no other choice.  I'm in so much pain and the worst, my knee is greatly  affected.  I can't put full weight on the affected leg without hurting my knee.  When I stand up, it clicks.  I can't even explain why.  I hope you feel better and find an experienced surgeon to do your revision.
Good luck!

[Dannywayoflife]

Really sorry to hear your issues Manny. The best thing I can advise is go to the best surgeon that you can find.

Good luck

Danny

[John C]

Manny,
If your cup is loose, and the femoral component is still good, I would certainly at least look into getting just the cup revised. Dr Gross and others have done a few of these, so you could check on their results. I believe that sometimes they use a cup with screw fixation ( I think that it is a dysplasia cup) in addition to bone ingrowth, so there is hope for a successful cup revision while keeping your femoral component if it is solid. To my non-medical mind, it would seem a waste to cut off a good resurfacing head because of problems just with the acetabular component. I read that the exception would be if the femoral component was damaged by edge loading, but a loose cup may not have had enough consistent edge load to do much damage.
I think that it is pretty certain that 99.9% of surgeons would not have the experience to consider or recommend this option, so if you want to explore it, you will need to consult long distance with the four or five surgeons in the world who will have experience and a track record with this issue. You will find each of them, along with their contact information, on this site.
Good luck with whatever your decision.

[cwg]

IKEP- I think you made a good decision to stay near home, especially with top surgeons nearby.

I had my unsuccessful BHR (pain clunking weakness and more..) six years ago and recently had neck surgery for severe cervical stenosis. That was a major success, thank god. In my search for the right spine surgeon ( four  world wide different opinions on which procedure), my BHR came up in the discussion: Not good for females over 40.  *And my cup angle  positioning is perfect..

Am just writing you, for support. I had zero choice on the cervical spine surgery and the thought of another hip surgery makes me shudder. Be strong. I know someone who had a THR after her disaster MOM (her metal levels were 600), and one year later she walks 3-4 hours every day.

Yep, great choice to stay close t0 your  home. I hope it is a lovely home- smile.

I won't say "breakaleg" (actors) but I will say MERDE (dancers)