12 days out from hip resurfacing with Dr Pritchett

[Robert224466]

Hi All,
I've mostly been reading on this site rather than posting but wanted to give a brief account of my recent surgery. I'm a 51 YO male and I just had my right hip resurfaced with Dr. Pritchett. The surgery was on 7/26/16 so I'm now at day 12. I flew from Northern California to Seattle for the surgery, spent one night in the hospital and two more in a local hotel before flying home. I just went back this past Friday for post op visit and all looked great.
Have to say that the anxiety before was (mostly) worse than the actual procedure. I was incredibly impressed by the professionalism of the surgery team and the hospital care (Swedish Orthopedic Institute). That certainly gave me a lot of confidence.
Dr. Pritchett used the superior surgical approach (as opposed to anterior or posterior). My recovery has been pretty uneventful. I stopped all narcotics two days after surgery and just took tylenol and naprosyn. I'm still taking those two but have moved to taking them on an as needed basis rather than on a specific schedule. I was on two crutches until post op day 5, then one crutch for one day and then a cane for one day. By post op day 8 I was going without any support. I've been doing the post op exercises regularly (the heel slide still hurts a bit) and going on longer and longer walks. This morning I did 2.1 miles around the neighborhood. I felt some pain but entirely manageable.
I'd say the biggest issues from the surgery were 1) my wound didn't stop draining until yesterday (day 11) so, despite constantly taping gauze over it, I ended up doing far more laundry than expected from leaking through, 2) my thermo regulation went to hell in the days after surgery - I would go from freezing to sweating in just a few minutes. I still have a little of this in that I wake up sweating each night although it is getting better, and 3) I do have trouble sleeping mostly because sleeping on my back is easier but less natural for me.
So, glad to be on the other side of this. Happy to answer questions.
Best,
Robert
R hip Synovo Preserve Dr Pritchett 7/26/16

[John C]

Hi Robert. Can I ask what caused you to choose the Synovo Preserve over one of the Metal on Metal resurfacing options that Dr Pritchett uses. I was under the impression that he used the Synovo for smaller women, and MoM on men, so I am wondering if that has changed.

[Robert224466]

Hi Robert. Can I ask what caused you to choose the Synovo Preserve over one of the Metal on Metal resurfacing options that Dr Pritchett uses. I was under the impression that he used the Synovo for smaller women, and MoM on men, so I am wondering if that has changed.

Hi John,


It was interesting - I did a pre-op visit with him about a month prior to surgery and, of course, asked what device he would recommend. I fully expected him to say a metal on metal device (I'm 6'3" and about 205 lbs) but instead he said the Synovo. I asked him a few questions about his reasoning and, to summarize, he felt that the metal on highly cross linked polyethylene provided the best combination of longevity, low problems, and keeping options open. I then spent the next month reading papers on the different materials, wear rates, biocompatibility, etc. At the end of the day, I became very comfortable with this option based on what I read. However, it is also true that there are no definitive studies saying that one option is better than another so others may very well come to a different conclusion. I do know that metal ions are not going to be a potential side effect for me (there are other possible issues, but not this one). There is a possibility of the plastic wearing out (although most of the wear studies suggest that it should last >20 years and potentially a lifetime but there are many caveats around this number.). At the end of the day, I hope that it will last a life time but if it doesn't and I get 10-20 trouble free years out of it without worrying about metal ions, etc. then I would consider it a win. Again, others may very well come to a very different conclusion.


At the end of the day, I have a titanium femoral component covered in titanium nitride ceramic and a highly cross linked polyethylene acetabular component. Neither were cemented.


Best,
Robert

[catfriend]

One other nice thing about the Synovo: I've never heard or felt the "clunking" that other people on this board have mentioned. At nearly seven months post op with Dr. Pritchett I feel no difference at all between the Synovo and my former natural hip, except the Synovo doesn't make those loud cracking pops like my natural hip did. It's nice and quiet. (Muscles still weak, but that's to be expected.)

[Robert224466]

One other nice thing about the Synovo: I've never heard or felt the "clunking" that other people on this board have mentioned. At nearly seven months post op with Dr. Pritchett I feel no difference at all between the Synovo and my former natural hip, except the Synovo doesn't make those loud cracking pops like my natural hip did. It's nice and quiet. (Muscles still weak, but that's to be expected.)

Agree - not something that I've noticed as a problem. The only thing I'm really trying to push through is groin pain (like when raising my knee or doing heel slides). But even that is getting better. And presumably has very little to do with the specific device.

[catfriend]

That groin pain lasts a while. At least mine did; I had had difficulty with those muscles for years owing to my dysplasia, plus Dr. P did some injections there, so that was my most sore area in recovery. Those initial post-op pt exercises are painful at first - who knew the leg could be so weak? - but they do get easier, I promise.

[Chris_RS]

Hi Robert,



I hope your recovery is going well!


I'm in a similar situation as I have been recently weighing the pros & cons of the CoP device used by Dr. Pritchett vs MoM, reading as much as possible, however I have not yet come to a firm conclusion.  I am a 48 YO male, 180 lbs and would like to eventually return to playing basketball and soccer, running, etc.


Were you active in sport activities before the HR and are you hoping to return to a similar level?  Did this figure into your decision to go with the CoP option?  What data or info did you find most persuasive in making your decision?


Thanks,
Chris

[Robert224466]

Hi Chris,


Thanks for the note - my recovery is going very well. I was off crutches after a week and walking several miles a day not long after (enough that my physical therapist suggested cutting back a bit). I was reasonably active before surgery but not at a competitive level. I got in about 25 days of skiing this past winter, often hike ~5 miles although about a year before surgery did a pretty strenuous 15 mile hike in Yosemite (was reasonably crippled for a day after that). I haven't run for a few years due to pain but hopeful that will come back.


Regarding the device decision, I honestly was settled on MoM before my first appt with Dr Pritchard so it was a bit of a surprise when he suggested something else. Normally he does the pre op appt on Monday and surgery on Tuesday but I was very glad I did it a month before because it gave me a month to do research. I'll start out by saying that I never found a paper that definitively said one was better than the other. In MoM favor is a longer history and it won't wear out. For TiN on polyethylene, I did a lot of reading on wear rates for the highly cross linked polyethylene. It is clear that it is a much lower wearing material than the polyethylenes that were previously used and prone to wearing out in 5-10 years. Depending on the study, wear rates for the new material were reduced up to 90% with wear of ~0.05 mm / year (there is a range for this depending on how the study was done, in vivo or in vitro, what was used for lubrication, etc). To me, this was a low enough wear rate that it could potentially last a life time (although far from guaranteed). The polyethylene can also be replaced independent of everything else and is presumably a simpler surgery. Another potential problem with polyethylene is the wear particles can cause problems like inflammation. However, this was for the older polyethylene (I haven't found anything for the highly cross linked variety so it may still be an issue - but at least the wear rates is far lower so fewer particles).


I also read Dr Pritchards papers on his results with these materials and, in particular watched his two videos (one on the device and one interviewing another surgeon that he had done a resurfacing on with this device). The logic that he laid out for these devices just made sense to me. I've always been concerned about metal ions (again, acknowledging that 'normal' blood levels don't seem to cause problems) and didn't want to have that as an ongoing worry (eg what will my next blood test show??).


Obviously, we probably won't have the real answer for another 10 years so any choice is a set of compromises and hopes. But on balance, I was more comfortable with the compromises that the metal on highly cross linked polyethylene device offered.


Hope that helps! Happy to answer more questions.


Robert

[Chris_RS]

Hi Robert,


I'm glad to hear that your recovery is going well - and thanks for taking the time for such a detailed response.


WRT research on MoM vs MoP or CoP (TiNoP?), I agree that there is a lot of info out there for old school poly but not nearly as much for highly cross-linked poly. 


Thanks,
Chris