Surgeons Who Revise HRs (in FL?)

[smcazimuth]

My 15 year old Cormet 2000 gave me 14 good years.  I'm pretty sure it's worn out.  I've been told that a THR is the only revision option but I've read here that Dr. Pritchett of Seattle has saved HRs?  Are there other surgeons, closer to Florida who revise HRs without going to THRs?

[John C]

Dr Gross in South Carolina would be much closer, and is certainly a top expert in the field.
I am curious about your statement that it is "worn out". I don't think it is possible to "wear out" a properly positioned Metal on Metal resurfacing in 14 years or even a lifetime, though of course there are other things that can necessitate a revision such as loosening or soft tissue reactions in the area. Have you had a resurfacing expert like Dr Pritchett or Dr Gross confirm that you need a revision, and confirm the reason? Personally I would not have confidence in a THR surgeon suggesting revising to a THR, without confirmation from a skilled HR surgeon. A friend of mine was told by a THR surgeon that he should have his well functioning HR revised, simply because the surgeon did not like seeing HRs in people. Knowing what is going wrong in your case is going to be key in anyone knowing if it can be revised to an HR.
Wishing you the best of luck in finding an ideal solution.

[smcazimuth]

Thanks John,
For the past year, I've had pain in the joint.  It's worst on getting up from a seated position.  In the same time frame, I've heard/felt it creak like the door of a haunted mansion in a movie.  I've also felt it "clunk" on occasion.  Like you, I didn't think the implant would wear out.  Maybe it hasn't.  I have heard horror stories though, of joint capsules full of black goo, the result of excessive wear or spalling. 
The surgeon who put in the Cormet has retired.  He and others told me that THR was the only revision option.  I am just starting to search for a new doctor so I haven't been evaluated since Corin ended the follow up of the clinical trial I was part of.
Dr. Gross wrote a few years ago that he saves resurfacings by changing only the cup but doesn't do Cormets since Corin pulled its products from the US market.  He also said that Pritchett was the only surgeon he knew of who had access to poly inserts that he (Pritchett) used to save HRs.  I don't understand how or why that would be.  I'm hoping that the pool of surgeons who fix HRs has grown in this country since then.  There has to be more than these two.

[jimbone]

Hello Azimuth-

I don't know anything about the Cormet devise and I haven't read any stories about its revision but as a patient of Dr. Pritchett and someone who's communicated quite a bit with other Pritchett patients, despite his distance from you in Florida I would strongly recommend getting his opinion at the least.  First- he may be your only option for a revision so why rule it out?  Secondly, one of the haulmarks of his reputation is his innovative perspective which is so well grounded in technological understanding and so many years of experience.  At my 6 week follow up for the second hip that he had needed to use two screws to set the cup, we looked at the x ray.  In locating it he passed over a different case image of a patient who'd had a resurfacing that was involved in some really horrendous accident that drove the entire structure [leg, devise, acetabulum] up into the pelvis.  There was a lot of hardware that needed to be replaced and put back together- very complicated looking procedure- he made it work successfully.  You would be well served getting his opinion.  Best wishes.

[MattJersey]

I would ask what is your exercise and strengthening programme like? I remember getting casual with it thinking I was fixed after about 9 months post op, and found that I was having a bit of pain, a bit of wobbliness, maybe a clunk sensation ...

Any possibility that could be a factor?

Hope it works out well.

[smcazimuth]

Matt,
Interesting.  I haven't worked out since post op. PT, 15 years ago.  I've always been active but have gone from age 44 to 59.  My job no longer requires much physical labor.  I'm not in the shape I was.  I will try exercise before seeing a surgeon.  Thank you.
Steve

[smcazimuth]

Jimbone,
Thank you for the recommendation.  So far, Dr. Pritchett looks like my only option for avoiding THR if I do need a revision.  Thanks again.
Steve

[jimbone]

Azimuth-

Can't hurt to get his opinion, however I think Matt has pointed out an excellent and overlooked "symptom".  A couple of months of regular gym work- starting very gently- might just be your answer.  I've found the elliptical machine helpful in both strengthening and increasing ROM of the hip joints and legs.  Gotta maintain the machine.  Best of luck.

[Saf57]

Steve--I too have a Corin device that was implanted by Dr. Gross more than 16 years ago, during the original FDA clinical trials. I think like most of us here, we have had occasions where we felt the device was failing. In my case, these have always resolved, so I am still going strong. Hopefully, that will be the case with you--best of luck.

[smcazimuth]

Saf57,
This is great news!  I didn't know people experienced symptoms with HRs that got better without surgery.  After fourteen pain free years, I assumed the onset of pain signaled a failing joint.  I am much more optimistic now that working out will solve my problem.  Thank you.
Sincerely,
Steve

[Pat Walter]

Steve
I am sorry to hear you are having problems.  As Saf57 said, Dr. Gross did a lot of Corin Devices.  He does free email consultations if you send him a copy of your x-rays in a digital format.  He will eventually call you on the phone. It would be a great way to get some input from a surgeon who understansd your device and problems.


I wish you the best.


Pat

[Rn2md]

This discussion Reminds me of a lecture given by Dr. Mont, posted on this site, which raised some excellent points that I hadn’t heard other experts mention.
One in particular though:
He raised a very good point about hip resurfacing being more or less a lifetime commitment to basically maintaining ones excellent health, including bone health and other physical strength/fitness parameters, particularly the hip muscles. Otherwise the hip may eventually lose the strength and bone density necessary to prevent hip fractures.
Therefore, He gives all his patients a lifelong hip exercise program involving 20minutes to be done every other day.
He also raised an excellent point that people would be again at high risk for femoral neck fracture if for whatever reason (injury, illness, immobility, disability etc.)  their bone health deteriorates. (And unfortunately a higher mortality rate is observed for the elderly with hip fractures)

I think his points make excellent sense. We probably can’t expect that the bone density and hip strength will not eventually deteriorate without regular attention, particularly as we age. There are some studies showing increases in bone density, but in the early years when people are probably more active. I haven’t seen any studies on what would happen much later on. Since these implants may last a very long time, a diligent long term plan to maintain strength and bone density may be something to carefully consider.

[Pat Walter]

Rn2md  - Thanks for reminding us about Dr. Mont's information.


Several of the top surgeons say you can increase your bone density by walking and doing weight bearing activities.  So it seems if you can build it up with activities, lack of activities might also make it decrease. Always a problem as we age and have other health problems.


I posted an interesting study of a large study about longevity for a total hip replacement.  It was not about hip resurfacing, but many of the same principals are involved that the bone growth around the components must remain strong.




Pat

[Saddlepal3]

Hi there,
I live in Florida, but Dr. Pritchett did a revision on my 12 year old resurf in Sept 2018. He works with a lot of out of town patients. I got opinions from several HR surgeons, near and far, but concluded that Dr. Pritchett has the most experience solving problems. Before making the decision, I sent him blood ion levels, x rays and a MARS MRI of the hip. It was the MRI that convinced him I needed a revision. The surgery went very smoothly and recovery has been good (except for some soft tissue issues which are my own fault from overdoing and not stretching). In the revision, he replaced the acetabulum cup and left the femoral component alone.