Clunking Hip

[Candidate]

I am a 50 year old male, quite active and in good shape physically, who developed OA several years back in both hips.  In November of 2007, I had my left hip resurfaced using the BHR.  All has gone well in my mind and in the mind of my surgeon..with one exception. 
 
I have since day one experienced what I call a "shifting" sensation in the operative hip. I think that I recognize on "surface hippy" others calling it a "clunking" sensation.  It feels to me like the 2 major parts of the prosthesis slide (like tectonic plates!)  or shift.  In fact, to me it feels exactly like the "bone-on-bone" slipping/friction/clunking that I experienced on the bad hip (fortunately, without the pain) before I finally had it resurfaced.  It feels eerily like bone on bone!  The shifting or clunking happens randomly.  It could be when I'm stretching, bending over, turning or shifting body weight.  Sometimes, when I'm standing still, it will "shift" and my leg will move noticably, sort of pivoting out.
 
The good news is that I feel absolutely no pain, my range of motion seems to be quite good and the shifting/clunking does not prevent me from doing anything at all that I want to do.  I was before, and quickly returned to, daily rigorous exercise of cardio equipment, weight-lifting and swimming.  I walk very comfortably--like I used to before I developed OA.  This feeling is distracting at the very least.  Far more importantly in my mind, however, is the nagging concern that I have that there's something wrong with the prosthesis, I will develop premature wear and tear or damage myself in some that will result in the need for a revsion.  It just doesn't feel right though it is not hindering my lifestyle at all.
 
My surgeon has always admitted (to his credit) that he's not sure what is causing this phenomenon but thinks possibly that it results from the trauma of the muscles ("cap") over the hip joint which in his mind would eventually heal and the sensation would go away.  He believed it would cease after 3 months; then 6 months, etc.  It's now been almost 8 months and the "shifting/clunking" is still there and in fact is more pronnounced now than in the beginning of my post-op period.    He believes that my xrays show the new hip to be perfectly positioned and looking exactly as it should and that the bone has fully grown around the acetabular metal cup.  His office checked with Smith and Nephew who apparently reported no other cases like mine (surprising??) in the U.S. but three cases in Australia (what about in Europe, I'm wondering?).   At this point, my surgeon has no other action steps or guidance to offer me.
 
What is the cause of this?  What are the consequences if any?  What if anything else can be investigated or done?  Do I simply have to live with this?  Should I be very concerned or not at all? 
 
I am hoping to have my other hip done within the next six months.  What would you do if you were in my shoes?  Have another resurfacing?  Will the same thing happen with my next hip?
 
Any insights or experience that you can share and advice going forward would be enormously appreciated.
 
Tom

[Pat Walter]

I will let you know that I am 61 and had the same problem you do.  It was a very noticible CLUNK for a long time.  Even now at 2 years post op, I can sometimes shift while sitting or move my leg while bending and feel the slight clunk and shift.
 
It never hurt, but feel strange inside.  Dr. De Smet told me it is because my muscles were loose and the two hip pieced are pulling apart the then clunking together.  It makes sense to me.  The clunk was very strong early on, they got less after the first year.  But I still have it sometimes.  Not anywhere as noticable, but feel like the hip is sorta sliding or of the pieces are hitting each other.  I also think that ligaments can be moving over the hip device too causing problems from what I have heard from others.
 
I would have my second hip done without any thought of worrying about the clunking.  I knew I was not in the best of physical shape since I was not able to be very active.  The one advantage to that is they can more easily dislocate your hip becuase your muscles are not as strong as the big athletes.  Sometimes they have had real difficulty with the really musclar men.
 
Who was your surgeon?  I assume you did get a BHR.  Did you have posterior or anterior approach?
 
So I will post your message to see what other people will say to you.  It is always nice to know other people have the same CLUNKING!!  I had read about it before my surgery, so I was not worried about it.  Did ask Dr. De Smet when I was in Belgium and he said it was weak muscles.
 
It is hard to believe Smith  & Nephew knew of no other cases.  I have read about a handful on the Yahoo Surface Hippy DIscussion Group. You might want to join it too. There are over 7000 memebers.  You will get over 100 emails a day if you choose to get emails.  YOu might just want to read the info up on the Yahoo site if you join.   http://groups.yahoo.com/group/surfacehippy/

I am glad you hip is doing well for you other than the clunking.
 
Keep in touch if you have more questions.
 
Pat

[tarasi]

Pat,

Thank you very much for your helpful and detailed response. 

I have written to Dr. Gross--closest to my hometown of Atlanta in case I decide to see an alternative surgeon for an opinion on the clunking.  My surgeon is Dr. Steve Smith who enjoys a very good reputation here, having done among other procedures around 1500 THR's and around 50-plus resurfacings by the time he did mine.  It was the Birmingham Hip.  I have to admit I'm not sure whether he did the anterior or posterior...dumb question...how to tell?

Your point about relative difficulty in dislocating the hip during surgery is interesting.  Like I said, I am an avid, rigorous exerciser and have fairly large muscle mass.  Perhaps, there was relatively more trauma in completing my procedure as one of the factors causing this clunking.

I'm encouraged by your reaction to go forward with a resurfacing on the second hip which needs to be done pretty soon. I'm trying to determine the cause and long term impact--or not--of clunking on the first hip in considering whether to make any changes on the second.  All advice is accepted!  I'd hate to be a "double-clunker."

Did Dr. De Smet recommend exercises or other things to strengthen the muscles and eliminate the clunking?  Does he expect it to go away completely at some point?  Does he feel that there will be any premature wear and tear on the prosthesis or need for revision?  Like I said, I do most type of exercises so I'm not sure what else to do...though I'm not doing the "PT" type resistance exercises that my PT took me through int he weeks just after the surgery.

Please to post this as I'd be most grateful for others' experiences, observations and advice and to hear back from any and all.

Yes, it's hard to believe that Smith and Nephew or any other device maker could not have heard of this clunking syndrome.  Even if not direct through their medical sales, isn't there anyone in the company that reads your site?  Is this denial?

Because of network protocols, I guess, my email address came through as "candidate@mulling.com."  My correct email is: tom.arasi@harbingeradvisers.com
Thank you, Pat!!!!

ta
ta

[Pat Walter]

Hi Tom

You can't tell if you had the anterior or posterior approach by looking at your incision scar.  It refers to the way they diclocate your hip.  You would have to look at your papers from the hospital or ask the doctor. The majority of doctors use the posterior approach, but a few have been using the anterior approach for resurfacing.  They are certainly in the miniority, but I guess if doctors don't try different things, we never get better methods.

Dr. De Smet did not give me anything special to do.  The few times I have the clunking now it is like a quiet little shift.  Not the same as when I had my hip first done.  It has gotten much better.  I imagine if I were really active, it would have gotten better faster.  I have bursitis in my other hip and arthritis in the rest of my body, so I just was not able to do much more than walking.  I pictured myself back on the tennis court, etc, but that did not happen since my other hip really hurts when I get active.  I had a cortisone shot for the bursitis.

I am sure Smith and Nephew know about clunking.  It is your doctor telling you they don't.  They are very knowledgeable and most doctors using the BHR know about clunking.  You can get on doctors websites and often they have patient FAQ or information with reference to the clunking.

Smith and Nephew do know about my website.  I talk to their top hip resurfacing people and they support the website by placing the large banner at the header.  You will notice it is a Paid Advertisement.  I started and operated the website for almost 3 years with my own money, then I decided to allow ads to help with the expenses.  Both Smith & Nephew and now Corin LTD who manufacture the Cormet advertise.  Cormet's ad will be placed shortly.  I am also going to receive much more Cormet info along with doctor interviews and hopefully I will do some doctor vidoes.

Both Smith & Nephew and Stryker who market the Cormet are going to allow me to attend some of the orthpedic training meetings and conferences.  So I will begin to learn more advanced information to share on the website.  They have talked about me observing a real operation - not too sure how I would react to that.  I am reather squemish about bloody stuff!  So both companies are suportive and knowledgeable about the website. 

It is a great help to me to have some financial support to keep the website operating and growing.  Also we are way in debt and still owe the $18,000 for my hip resurfacing to the credit card company.

You might want to consider using Dr. Gross for your second resurfacing.  He is very experienced with over 1300 hip resurfacings.  If you listen to the videos of the really experinced surgeons, they tell you to use the most experineced hip resurfacing surgeons when possible. THeir THR experience does not apply to their resurfacing experience.  Resurfacing is much more difficult than a THR.  I am just telling you what the doctors that have done resurfacing for years say.  Not my opinion.

I think you just need to be patient and your body will continue to heal.  It is still not a year post op and some people have taken almost 2 years to completely heal when they had difficult problems.

I wish you the best of luck and keep in touch.

Pat

[john]

I had two BHR's within the past 6 months
I too have some clunking
the surgeon said it was probably soft tissue and that it will lessen over time

[tarasi]

Pat,
Again, this is enormously helpful.
How can I help contribute to the site costs?
ta

[Pat Walter]

Hi Tom

I am glad my info was helpful. Sometimes it is just good to know how others are doing or what they went thru. Then you dont feel you are alone with some unusual situation.

You can click on the Donation Button on the right hand side, just under the header if you would like to make a donation.  You can use a credit card or use Pay Pal.

I always greatly appreciate donations, but never want people to think they are pressured to give.  The money always goes to help host the website and keep my software and hardward updated to service the website.

I wish you the very best.  Keep in touch.

Pat

[windpig]

I am almost six months post-resurfacing, and still have the same feelings.  My surgeon is similarly "baffled" and non-commital.  My PT offered what I think is the best explanation.  The muscle band on the outer hip is tight due to the surgery.  Therefore, when it passes over the knob on the outer portion of the hip bone it "snaps" like a tight rubber band, instead of sliding smoothly.  The solution is to loosen that muscle with stretching and massage.  Seems to be helping...

[Timbo]

I haven't checked this site in  awhile as my previous problem, seems to have settled down. However, a had a moment to review new posts and low and behold there was that "clunking" issue that I explained to my doctor who took about 10 x-rays and told me that he had no idea of what I was refering to. He told me to make it "clunk" for him and I told him this was nothing I could do on command or move my leg in a cerain way to make it happen every time. It just happened from time to time and about only once a day when I woke up and streached out. My main concern was that some of the hardware was shifting and everything was not going to knit together properly.

Doc told me go home and not to worry, but he had never heard of this situation and he had done over 150 Birminghams. Which made me feel more confused and perplexed. Six months later, I still notice, once in while, that there feels like a slight movement, but it does not hurt and appears to be less often, no longer daily, and less of a movement.

So thank you for making me feel that I am not an anomoly and I also have been told that I have tight hammies and gluts and although I do not work on them as intensely as a month ago, as I have gotten them to streach more, I am slowing showing signs of recovering every month that goes by. I am at a stage where my joint feels stiff but does not really hurt. Strenous work causes it to become sore but that goes away fairly quickly after sitting and putting my feet up. It also give me an excuse with my wife that perhaps I should not work so hard. 

But every once in awhile there is that feeling of a non painful slight movement in the joint. At this time and after reading all of this correspondence I assume it will go away or it is something I will have to live with. It is much easier to live with this if it does not cause any pain and now I know that I am not imagining this.

Good luck...................Keep stretching