Hip Dislocated 6 weeks post-op. Anyone ever had this happen?

[Roboclimber]

This happened to me yesterday. I had to be taken away from my home (again) by paramedics to the hospital, where they put me under and reduced the hip (left). Apparently it popped back out while I was under, and they popped it back in.


It doesn't hurt to weight bear, and I have contacted my surgeon (Pritchett). Anybody ever have this happen to them? Reading the posts and searching the web I am really coming up empty here.


I am 6 weeks post op, but my leg muscles are weak and atrophied and I suspect this had something to do with this. Reason being is I have a spinal cord injury and as a result my left leg is predisposed to getting weaker faster than my right.


Pritchett just wanted me walking for 3 months as he had to revise both femoral and acetabular components (this is rare). I'm now questioning whether or not this was a good idea, but I no longer no what to think and who to believe. It would a severe understatement to say I am demoralized. It appears that if there is a way to screw these things up I will find it.

[China Lady]

I tried to read back what you have told in the last weeks about what you have done. Maybe I am bad in research......
Please, here is the place to tell your story again:
With/without crouch, walking, exercises....
It does not happen without reason, never.
I am very sorry that it has happened to you and I hope, that you can solve the problem now.  My 3 cent, and I am preaching that since 2 years: slllllooooooow down your live down for 3 month.

[Roboclimber]

I found this today from the Hip and Groin Clinic (http://www.hipandgroinclinic.ie/ASRPatientAdviceandRehab.pdf):


"Q:What will happen if my hip does dislocate?
  A: If your hip dislocates, it can usually be put back into place again using light anaesthesia without having a further operation. Most hips only dislocate once but, occasionally they can dislocate more often. Normally if a hip comes out of joint on more than 2 occasions a further operation is needed."


Hopefully this will never happen again if I don't cross my legs...for a year!


Interestingly, the paper doesn't say what a possible future operation would be.

[hernanu]

Sorry to hear you've hit this.  I'd talk with Dr. Pritchett and see how to strengthen that side.

Dislocations are painful - I've had a couple on other parts of my body, and my left hip before the surgery was dislocating at will (I'd pop it back in).

Good luck, hopefully strengthening those muscles within the constraints of your injury will help.

[Roboclimber]

Left hip dislocated again about 10 days ago while moving from the floor to the couch. Crazy. Not sure what to do as Pritchett says I may be looking at a THR now. However, with weak abductors on that side due to the spinal chord injury, I'm not sure if this is a good idea. X-rays show implant is looking good. R side feels great. Sheesh. Pretty depressing.


I'm trying again here: has anyone with an HR gone through a dislocation? What happened?


BTW - left revision in June was done using a TARA prosthesis from Biopro on the femur, as it was the only one that would fit.

[jd]

Oh no Roboclimber, sorry to hear!

So you had one dislocation at 6 weeks, and then another at around 4 months just now?

It seems like a THR would just make it more prone to dislocation due to the (typically) smaller balls.

I'm sorry I don't have much help to offer, but intuitively it seems like a strong focus on strengthening whatever is letting it pop out would make more sense than a new implant!

[Pat Walter]

I am really sorry to hear your hip has dislocated again.  I wish I could give you some advice, but can't other than taking it easy.

This is a situation that you really need to talk to Dr. Pritchett about and consider some kind of solution.

I just wanted to tell you that I will keep you in my thoughts and hope you can find a solution.  It can't be any fun having dislocations.

Pat

[Roboclimber]

Thanks for these kind words, Pat, JD.


I saw Dr. Pritchett on Monday. He has been quite encouraging and has told me not to give up hope. However, this is what he is suggesting: “A hip spica cast or hip abduction orthosis would be much more likely to result in stable hip.  Casting is not practical in an adult. A orthosis would be made by a brace shop and worn at all times for 3-4 months except for a shower. This can work and I recently treated a patient from California this way.”


So…I am in the market for a hip abduction orthosis. Anyone you know who might have one? I have already been on E-bay. Some other thoughts he has shared have to do with going in again and again to these already compromised hip muscles. The spinal chord injury has left me with a deficit, and then every surgery after adds to that deficit and makes it harder and harder to come back. He says most patients go for a THR with an unstable hip, but my understanding is we are going to keep trying here and see if we can't get this thing to calm down. If my hip is dislocating with an HR, I have real concerns about getting a THR! There is a THR called the Delta Motion which is becoming increasingly popular. Supposed to be more stable.

Whatever...I have an appointment with Dr. Jando in North Vancouver December 16. Covering all my bases, second opinion, etc. by going to a local guy and see what he thinks. In the meantime I get a brace for 3 or 4 months, I guess.

[JHippy]

Very sorry to hear this, Roboclimber.

If the xrays look good then what difference would a THR make? I think that's one of the answers you need to get. Is he going to place it differently? Change the leg length?

What about the weak muscles? Do they need more time and physical therapy, or are they just not going to get better? Who can shed light on that?

I think you are doing the right thing on getting second opinions. The more info you have the better decisions you'll make. Fight for it if you have to.

[Roboclimber]

Just to answer some of the questions posed, I have pasted an image that explains nerve pathways. The ones I have damaged are S1-S4. Background story here, for anyone interested: http://mysynovorevison.blogspot.ca/2015/01/january-14-back-in-vancouver.html.


This means certain muscles are weak, and large parts of my left leg are entirely numb. This IS affecting the stability of that joint, and I can only work out so much between all these surgeries to affect any real change. Spine is fused from S1 to L1.


Dr. Pritchett has been quite helpful in suggesting I might want to just stick with this joint for now and wear a Hip Abductor Orthosis - a type of brace I have read about, which is not cheap and not pretty. I have been asked to wear this for 3 or 4 months all the time, except when I shower.


Although some of the newer THR's offer less likelihood of dislocation, the HR was supposed to be the best solution for this and I managed to dislocate that twice, so I am in no rush to lop off my femur head.


I am kind of breaking new ground here, and there is not a lot to fall back on in the way of comparisons. hence I am reaching out to try to find someone with anything comparable to get a sense of where I am headed. Pritchett has told me that I will likely have to avoid any extreme range of motion for life. That kind of sucks, having enjoyed rock-climbing for most of my life.


It sounds like I just have to hope this will work, and there is nothing that can be done to hold that combo unit in place as well as the right one has worked out....other than strength training in that leg. Too much though, and that can apparently set off nerve pain (from the back injury) which require heavy meds. It can also leave the leg weak...and potentially unstable.


Anyway, it's a bit of a pickle I am in, so anyone with some helpful leads on this will be most appreciated.

[blinky]

I am not a doctor so I know nothing, but I will suggest one thing: could you tighten up your ligaments or tendons surgically to hold everything in place? You would sacrifice some of the flexibility needed to climb, but maybe it would keep your hip in place.

[Roboclimber]

That was my hope and first question, too. Apparently not so simple.


Oddly, the joint feels less sloppy than it did before the dislocation. Hopefully that will continue.

[Roboclimber]

Time to check back in. I have been afraid to say anything until I knew where this all was going.


I dislocated my hip again sitting on the floor of my living room having a beer watching TV. I grabbed the couch to pull myself up and out she popped. Another epic ensued with paramedics, hospital, anaesthetic, and relocation.


I have then since sublexed the hip twice, both times while lying in bed reaching across to grab my laptop.


I had been diligently working at rebuilding strength in that left leg as it was believed that my spinal cord nerve damage was the main culprit here. However, I am still perplexed as to how something that isn't supposed dislocate keeps popping out without any provocation. This is one of the main reasons I sought the resurfacing option and spent $50,000 USD on staying with the resurfacing option. Now I feel like an idiot, and this is a total nightmare from which I can't seem to wake up. No - there is no satisfaction guaranteed with these hip implants, so there goes a good chunk of my savings down the tube.


I don't understand how some surgeons are saying that they put no restrictions on patients post-op. I also don't understand why I am not dislocating my hip doing things actively, but when I am essentially relaxed doing nothing out it goes.


It is Dr. Pritchett's opinion that I should consider a THR at this stage and go for a dual mobility unit.


Wow.


This will be hip surgery #5 if it happens. The THR I have been trying to avoid - in large part because of my active lifestyle - is now back on the table, and I am still riding the medical merry-go-round. I will have this done in Canada. Although I have contacted the surgeon's office here I still don't have an appointment, although I did see him back in December when I first discovered I had a "trick hip". At that time he too told me a THR would be the next option.


Coincidentally, since the sublex a couple of weeks ago my nerve pain has been going off the charts. This is related to my spinal chord injury from 1982, but as I have noticed these things seem to work in tandem and tag team off each to keep things interesting.


If anyone knows of someone I could talk to in order to find a resolution to my case I would love to hear it. It now seems like a very long time ago since I remember thinking I might be able to get my life back, and that dream feels as far away as it ever was, if not further.

[Pat Walter]

I am so sorry to hear you are still having problems and facing a THR.  You have really been thru a lot of pain and problems.  I wish I had a solution, but don't.  I am not a doctor.  I would get several inputs to see what solution would be best.  Sometimes it seems people have real problems with HR and end up with THRs.  Normally that works well.  You have lost a lot of time out of your life with hip problems.  I do hope you find a solution to stop the pain, dislocations and problems.  I will keep you in my thoughts and prayers.

Pat

[Roboclimber]

Hi Pat,


Thanks for those kind words.Best of luck to you, too. I'll post something if I think anyone stands to gain from it, which is all I am trying to do here.


RB

[chuckm]

Roboclimber, I so sorry about your situation. I can tell you have been through a lot.


There are some basic things that come to mind here. The hip is held together two ways. One is by the hip capsule which is made up of strong ligaments that surround the hip joint. The other is with the musculature surrounding the hip.


During hip resurfacing surgery, the surgeon completely cuts through all the hip capsule ligaments in order to dislocate the hip and perform the surgery. When closing up the wound one of the first steps is to suture half the hip capsule back together. The whole capsule cannot be accessed to repair and so it must heal on its own. That takes up to six weeks. But that half that is sutured must be cared for, otherwise the sutures can tear early on. That is why many surgeons say not to cross your legs for some time while the capsule heals.


When the muscles are not engages, that is when the capsule will keep the hip in place. Since your hip can dislocate while in bed the capsule is not performing.


Chuckm

[LMS]

I would've thought sitting on the floor in the first 6 weeks would be a no-no because of what Chuckm mentions regarding the capsule?  Not because of the sitting but the getting up part?


Even with lying in bed, I was told to get a bar & someone to help me move as no tilt whatsoever for anterior approach was allowed.  Even if it was to scootch over to get more comfortable.


So thinking about how to go about rising from the floor would risk a dislocation. 


So sorry you're going through this.

[Roboclimber]

Thanks for the interest in this post. You really do have to go a ways back to better understand the situation. So no - I am not 6 weeks post-op at this point.


Chuckm: I am wondering if you are suggesting something I might be missing. I have been told I have an unstable hip joint and neuropathy that is affecting the integrity of the joint. If you know of someone who might be interested in my case I'm all ears.


I suspect that the dog's breakfast of parts that were scrounged to make this work...didn't work. Take a look at what the revised parts are that were used and I am willing to bet that no one has ever even heard of them.


Meanwhile, the R hip was also revised, doing well.


I think that it's maybe not such a great thing to keep opening a person up this way. The body needs time to recover from such major surgeries. My left leg had gotten pretty week.


As it will be weeks if not months before I get to see Dr. Jando (in North Vancouver), in the meantime I am hoping a bolt of lightning from the heavens hits me and turns me into an X-Man, thus alleviating all my concerns.


Mutants don't need THR's.


Trying to keep a sense of humour and perspective here.

[blinky]

My first thought would be that a THR would help because you can get special cups that don't allow for dislocation. They may well limit your ROM, but at least one problem will be solved.


Have you sent your case to some big ortho center like HSS? Just contacted them and said hey, I have a rare and unusual situation and see what solutions they offer?


My other thought would be are you in contact with groups for people with spinal cord damage? Put aside the hip issue and think of yourself primarily as a guy with nerve damage.

[LMS]

I mentioned 6 weeks because that's when you mention it started dislocating, sooooo maybe that weakened the capsule or compromised it & didn't quite heal properly etc. 


Ooooh yes becoming a mutant!  Lol!  Speaking of which, isn't "Logan" coming out sometime in the near future?