Posterior or Anterior Revision?

[kimberly52]

Hi everyone,


My saga continues with my S&N recalled hip.  For those of you who have not seen my previous posts I am suffering from a hypersensitivity to the metals in my hip which was installed April 2013. I have been in near constant pain since 6-months post op and the pain is exacerbated by exercise, etc.  Since I last checked in Dr. Clarke had offered to replace the hip with a ceramic THR and said he would go in posterior as when he initially installed the BHR. I was told that the recovery for this approach is long and will again be in restrictions with no 90 degree bending for 4-weeks.


Subsequent to seeing Dr. Clarke I had a second opinion with Dr. Damron at Upstate Medical University. I knew of a BHR revision case the he performed successfully so that is how I selected him. Anyway, Dr. Damron said that he could do the revision anterior which would give me a much shorter and less restricted recovery.  He said he would install a titanium Stryker THR.


I need to do something soon because the pain is becoming unbearable with increased physical activity. Yesterday's gardening created a nightmare for me last night and a reminder that I really need to get this taken care of.


So my question is whether anyone out there has had a BHR installed posterior and then had to revise and chose anterior. Or is there are any opinions to offer me.


I also found that my new insurance would cover doctors such as Pritchett in WA for a revision to possibly keep the BHR as well as Dr. Raterman who I am unsure whether he could revise to keep the BHR.  And at this point I think I may just want to have the dang thing yanked out and replaced with a THR.  I am in Florida for the winter and could very well have something done by Raterman but know nothing about him other than I found him on the list of surgeons here and that he does participate with my insurance.


My plans are to travel the Pacific Northwest in May and could possibly wait and have this taken care of by Pritchett while in that area which would mean possibly being able to keep the BHR as I know he has done successful revisions installing some sort of polyethylene cup to eliminate the metal rub.


If I don't see either Pritchett or Raterman than I will have to wait until fall when I return to NY to get into either Clarke or Damron.


Maybe I am rambling here and just looking for someone to banter with about this as I really don't have anyone with me who can relate to any of this.


Any and all comments are appreciated!

[blinky]

I am sorry you are still suffering.


In your shoes, I would send my records to doctors Pritchett and Raterman to see if they could save my BHR. If yes, then I'd start figuring whether I wanted to do that. If no, well, then I wouldn't even have to think  about it and could ask them for opinions about a THR revision. Pritchett has loads of revision experience. That would tilt me towards him, whether I would stay with a BHR or not. (How much revision experience do the other guys have?)


Anterior vs posterior? From what I understand, anterior gives you a quicker initial recovery, but after about three weeks, the recovery is the same. Anterior has a different set of complications, including femoral nerve damage. (How common is it? I have met a woman who is crippled by it, but that is just an anecdote. Ask your doc how often it happens with him) Anterior can dislocate, so don't be persuaded otherwise. Might be more likely in a revision. Your scar will be in a different place. That is a small issue, but it might matter to you.


I guess the big issue for me would be which doctor is better at revisions, and which route, anterior/posterior and which prosthesis is the best for a revision. You want this surgery to fix you!


Best of luck.

[catfriend]

If your insurance will pay for Drs. Pritchett and/or Raterman then you should absolutely send them your x-rays for opinions/consults. You have nothing to lose by doing so.

Dr. P has a lot of experience with revision surgery, including from metal to his synovo reserve. In other words, he may be able to replace your BHR (so you get rid of it) with another resurfacing device. You might be interested in this article of his on this very subject: http://www.pritchettorthopedics.com/articles/resurfacing_revision.pdf

Surgical approach is obviously something you'll want to discuss with whoever your surgeon is. When I had mine done (with Dr. Pritchett) that is something we discussed. He told me the approach he thought would be best for me, and explained his rationale for this (he's used many different approaches over his career). I wouldn't pick or reject a surgeon over this, however.

After four years of pain you deserve better.

[kimberly52]

Thank you both for the feedback. I contacted both Dr. Pritchett and Dr. Raterman today and now just waiting to hear back from each of their assistants to see if they would be interested in seeing my scans and arranging a consult.

I will have to rethink my desire for the anterior approach due to the possible complications that you pointed out Blinky.  All I was thinking about was the fastest recovery. 

I totally dread having to go under the knife again and just want it over as quickly as possible when I do decide to have it done.

Catfriend, when did you have your revision with Dr. Pritchett?  Can you tell me what he did and how the recovery went? Was it worse than the initial surgery?

[Pat Walter]

I am sorry you are having problems with your hip resurfacing.  I would suggest talking to a couple of the top surgeons and get their suggestions.  Dr. Raterman and Dr. Pritchett are both excellent surgeons. 

I would choose the surgeon and let me decide when approach is best for you.  The anterior approach with hip resurfacing does have more chance of nerve problems and good exposure for placing the acetabular component.  There are however, surgeons that feel comfortable using that approach.

It is interesting that patients from some surgeons post their stories and comments quite often, while others don't.  Dr. Raterman has been doing hip resurfacing for a long time.  Here are some of his patient stories:

http://surfacehippy.info/hipresurfacing/stories/dr-raterman

Dr. Pritchett has also done a lot of revisions as other top surgeons have.

I would contact a few and see who you feel most comfortable with.  Always listen to that little voice inside you.  Good luck.

Pat

[catfriend]

I did not have a revision. I've only had my right hip resurfaced (to date), and it feels entirely normal and natural. The difference in recovery time for a revision vs initial surgery is another question you should add to your list of questions to ask whichever surgeon you choose.

[kimberly52]

After getting a second opinion from Dr. Damron for a THR I still was on the fence about what to do as I really don't want a THR yet at my young age. Anyway, I sent all of my records to Dr. Pritchett and spoke with him this morning. He gave me no guarantees but did say that he definitely can fit me with the polyethylene cup to prevent that metal-on-metal that is giving me such issues.  He also said that his revisions have been very successful of which I don't doubt.


My insurance company confirmed that they participate with the hospital and Dr. Pritchett but are looking at one more thing as they have my info mixed up with my husband in their system. Since my husband is on Medicare and I am not that poses a difference in benefits. Once sorted out they will call me back with confirmation and then I guess I will schedule my revision.


So with that I am wondering who else had a revision to the polyethylene cup?  Dr. Pritchett said that it is one day surgery about 90 minutes and that there is a 2-week follow up. 


What I want to know is how anyone else who had this done is making out.  There are no guarantees he said of course, but knowing who has had this done and if hopefully successful then that would give me comfort that I am making the right decision.


Dr. Pritchett said that I should make a decision to have either the THR done or the polyethylene cup done and I agree as I am finally crying uncle and just want it over with.

[catfriend]

On the thread listed below was this reply from Pappy. He had revision surgery to the cup. I have bolded the relevant passage. You may want to look at that thread and PM him for info.
 Re: Metal-on-Metal Devices and Neutropenia  « Reply #2 on: March 17, 2017, 11:18:36 PM » 

• Quote

   I am a 61 year old male. I live in Minnesota.7/01/10 Dr. David Palmer resurfaced my right hip with BHR, instead of good bone fixation Palmer cemented the cup. 2/16 the cup slipped out of place, this was amazingly painful. Palmer and two other surgeons said only femur amputation to a total hip was available. Dr. Pritchett said he could revise to a synovo highly cross linked poly cup and save my femur. 7/19/16 he performed the revision. 1/24/17 Dr. Pritchett resurfaced my left hip, BHR used. I traveled to Seattle both times, Dr. Pritchett and his staff were professional, all I ask for from anyone. I now look forward to skiing with my grandchildren, hunting,and  dog training. Dr. Pritchett gave me a pain free active life. 

[Pappy]

Hi, I am now 8 months since cup revision. I am able to walk with a long full stride, this was impossible for 6 years with the cemented cup.  I had cloudy fluid when drawn from the joint, Dr. Paul H.Johnson Park Nicollet, did the draw, he said THR only choice. Pritchett did the revision and then had me on a conservative protocol for rehabilitation, 6 weeks rehab, 4 months with posterior type restrictions, after 4 months hip xrays were forwarded to him. After review of xrays other hip was scheduled. On the day of the surgery I was in less pain at 5:00 PM, than 5:00 AM. Read, Single component revision of failed hip resurfacing, that is Pritchett. The revision was done using 90% of the existing scar, the left hip done 1/24/17, was I believe the Superior Approach.

[kimberly52]

Yikes Pappy! 4 months of restrictions?  When I talked to Dr. Pritchett this morning he said I needed to hang around Seattle for 2 weeks so he could follow up and then said that I would be good to continue my travels in my RV.


Did you have serious complications which might be why you had such a long restriction time?  I too have cloudy amber synovial fluid when aspirated and told THR was the only recourse until I heard from Dr. Pritchett today.


I am so looking forward to being on the other side but do want to go into this with my eyes wide open as my husband and I will be traveling to Seattle in our RV from our Florida home and the plans are to continue travel across Canada to our NY home but nothing was said about a long time with restrictions or rehab. 

[Pappy]

Restrictions were no 90 degree bend, pillow between legs when sleeping, i.e. posterior surgery restrictions. My PT had me walking 3 miles, ball balance drills, core workouts, etc by one month. Pretty sure RV adventures are allowed.

[kimberly52]

I had posterior and restrictions for just one month.  From the sound of what you are saying then is the recovery is pretty much like the initial installation of my BHR. Thanks, now I have a good idea how this will go.