2.5 weeks out, any last minute advice?

[ecchastang]

I was prescribed Nucynta for long term and oxycodone for short term pain. I actually drove 5 days post op, just for a few miles. I have a big suv and it an automatic. It is my right hip, and I just brake with the left leg. I also have great bone density, so recovery should be easier since I've been full weight on the leg post surgery. I'm still targeting 6 months post op for anything crazy like surfing or mountain biking. Staying on top of the rehab! Advil works best for me but it seems I read where it wasn't a good mix for hip recovery. Maybe I just dreamed it. If I could take a couple of Advil PMs, I could get a good nights rest.

My understand is you can't do advil because of the mobic prescription.  Don't want you having multiple anti-inflammatory sources.  I was full weight bearing immediately after surgery as well, but due to severe deformities, and Dr. Gross cleaning up an old surgery scar, I am sure to be a little slower early on.  Good luck and keep us informed.

[JHippy]

Congrats, surfhippy! Sounds like you are doing great.

[surfhippy]

I was pretty sore last night with my first full day on the cane. This morning, most the soreness had diminished. I was contemplating going back to the crutches for a day or 2, but the night's rest helped tremendously, although for obvious reasons I'm not sleeping the best. I'm already back from a short beach walk, and I've noticed when I walk with good posture and really let my leg relax and do the work, I have better results with full weight on leg. The first couple of steps when I get up are a little tough, but when I get into motion, I'm basically using my cane as a back up, although I will still be using it until I feel confident to walk without it. Thanks for the kind comments and encouragement!

[caverdave]

I am a 53 year old man-14 months post operation. I went under the knife for a hip resurfacing (BHR) and was informed after surgery that there was a problem with my femur and as a result was given a total hip replacement. Now here's the rub (in every sense of the word). I have developed a nasty clunking and loud squeak in my hip with no pain. Blood test and MRI show elevated cobalt 9.5-and Chromium 8.5 as well as pseudotumor. Research of my surgery shows that the BHR 62mm acetabular cup was left in place and I was "fitted" with a S&N 54mm modular head and stem.
Does anyone know if this sounds right? Are these parts compatible? My surgeon wants me to come right back for a revision surgery but I am uncertain. Am I just the unlucky one who got defective parts or was thus an "off label" use of BHR and modular parts?
Any help or imput would be greatly appreciated. 

[Dannywayoflife]

Hi Dave sorry to hear your having issues. It sounds like the surgeon didn't place the components correctly. The BHR cup can indeed be used with S&N large head THR components. The fact your having high metal levels likely means that the surgeon put the cup in at a steep angle and it's causing edge loading.

Danny

[caverdave]

Thanks for the beta Danny! I have been struggling to get this simple answer to my question. The next question tough question will be who can I trust to do the job correctly this time. Obviously leaving things as is is not an option. I'm guessing I'm married to S&N to avoid having to revise the stem as well.

[Dannywayoflife]

It will depend what stem has been used. Some of the best stems like the corail stem can be used with several heads.

As far as who to do your revision well that has to be the most experienced surgeon you can find!

[caverdave]

It says I have a "size 17 Synergy" stem # 71306117

[chuckm]

Hi Caverdave, sorry for what you are going through.
Do you mind telling us who the surgeon was?
I ask because your situation is unusual. The standard BHR procedure has the surgeon first confirm the femoral component size that will be used. That determines the rest of the sizing. The matching cup is then put in FIRST and then they return to put on the femoral component.
A 54MM head size (which you have) usually indicates the surgeon should use a 60mm cup size. But you have a 62mm cup. That could mean you started with a 60mm cup and had to change to a 62mm when he had problems. But then he says it was the femur that was the problem. The report and component sizes you ended up with are compatible but you probably wouldn't end up with a 62 unless there were problems at the cup too.
Not sure you should return to that surgeon because it sounds like he had trouble all around.

Chuckm

[JHippy]

Caverdave, to answer your question about surgeons there a great list here: http://www.surfacehippy.info/listofdoctors.php. If it were me I'd definitely consult with at least Dr. Gross and Dr. DeSmet before you do anything. They both do phone consultations (after you send them xrays) and they both have lots of experience with tough cases and fixing problems.

[Dannywayoflife]

Chuck you get a 62mm dysplasia cup which works with a 54mm head

[Dannywayoflife]

Caver the best advice any of us can give you is to go to a TOP surgeon. Where about's are you in the world so members can reccomend some?

[caverdave]

I am in New Jersey (USA) Danny and suggestions would be great. If I understand correctly the dysplasia cup is the one that uses screws. I do not have any screws. The 62mm BHR acetabular cup is catalog # 74120162 and the 54mm femoral head # 74122554

[Dannywayoflife]

I'd go see Dr Su then mate he's in New York.

[Pat Walter]

Hi  I am sorry to hear about your hip problems.  This obviously is not a BHR problem.  This is a problem of device components placed incorrectory and/or incompatible components.  None of us are medically trained or surgeons, so we reallly have no idea of what should have been done.

The very best advice I have is to get several opinions from top, experienced surgeons as others have said.  Dr. Su, Dr. Gross, Dr. De Smet - surgeons that have done thousands.  Sometimes even they do have a few very unusual problems, but I would definite not go for another surgery without some more input.

You can't keep having surgeries.  You need to choose the right surgeon and get it done right. 

I know that sounds mean, but it is the truth.  Even if you used one of the top surgeons that have done thousands and are having this problem, it is time you get input from several others.  Even the top surgeons will sometimes disagree on what to do.

You do need something done if you have such high metal ions and a pseudotumor.

Who is your surgeon?

Note: I changed the title of your post since there is no such thing as a hybrid BHR, you received a THR which obviously was not done correctly.  There use to be simmilar BHR cups that were used for THRs, but I thought I read that they are no longer used since metal on metal THRs are no longer used.

I wish I could tell you more, but I can't since I am not or any of us are not technically trained. We can give you support as you go thru this terrible experience.

Good Luck.

Pat

[chuckm]

Caverdave, that part # is the standard 62mm cup. The shell thickness is 6mm.
The 60mm cup is only 4mm thick. So a surgeon might start with the 60 and then if something goes wrong he can ream a little more and try to get the 62 to work because they both have the same inside diameter. You wouldn't want to start with the 62 because once the reaming is done you can't go back smaller.

But if that 62m cup is in properly one of the hip gurus should be able to match it with something.
Danny is right, go see Dr. Su at the Hospital for Special Surgery.

Chuckm

[ecchastang]

Caverdave, that part # is the standard 62mm cup. The shell thickness is 6mm.
The 60mm cup is only 4mm thick. So a surgeon might start with the 60 and then if something goes wrong he can ream a little more and try to get the 62 to work because they both have the same inside diameter. You wouldn't want to start with the 62 because once the reaming is done you can't go back smaller.

But if that 62m cup is in properly one of the hip gurus should be able to match it with something.
Danny is right, go see Dr. Su at the Hospital for Special Surgery.

Chuckm

If it has a shell thickness of 6mm, then the THR side should be 56mm, not 54mm.

[dumph]

Hi Surfhippy, I'm an 'older' surfer too and had a BHR in India with Dr Bose last November. My recovery has gone really well but haven't been able to get back into surfing yet. Tried a few times but I'm a natural foot and my operated leg was my left and I can't get this through quickly enough on take-off. Quite frustrating. I'm very active and quite fit so I thought my recovery would be quicker than it has which was a bit of a good reality check. I'm going hard out with lots of rehab and getting my range of motion back but probably a bit further down the track to get back into the water and catching waves. Ski season starts in a couple of months and I'm feeling very confident now that I could ski quite fine.
Anyway I'm looking forward to following your recovery and especially getting back into the surf. Keep posting regular updates.

[bluedevilsadvocate]

I think the 54mm femoral "ball" is correct. If the outside diameter of the acetabular cup is 62mm, with a thickness of 3mm, then the interior diameter of the cup would be 56mm (62 - 6 = 56). Typically, the femoral ball is 2mm smaller than the interior diameter of the cup, to allow 1mm of clearance on each side. So, a 54mm ball would be typical for a cup with an interior diameter of 56mm.

[Dannywayoflife]

I think the 54mm femoral "ball" is correct. If the outside diameter of the acetabular cup is 62mm, with a thickness of 3mm, then the interior diameter of the cup would be 56mm (62 - 6 = 56). Typically, the femoral ball is 2mm smaller than the interior diameter of the cup, to allow 1mm of clearance on each side. So, a 54mm ball would be typical for a cup with an interior diameter of 56mm.

1mm sounds a lot of clearance. I think the clearance is somewhat less than that, my understanding is it changes from size to size but the studies ive seen by McMinn and Treacy showed the best clearance was in the 150-200 micron range.