Hip Resurface Revision

[tohandley]

Does anyone on the forum have any experience with having a revision done to their resurfacing?

I had my right hip done about 15 months ago.   The recovery was very much inline with the stories I've read here.  However, I was never able to run more than about 3/4 of a mile before my hip started really throbbing.  I tried stretching, yoga, massage, walk/run, ice, rest and even trying to push through it.

At my one year follow up the xray shows that on the acetabular side their is a gap of about 4 millimeters behind the cup so it doesn't sit flush with my hip socket.  The doctor thinks this could be the cause of my problems and is confident he can correct it.

So the only solution if i want to return to running is to go in for a revision and re-seat a new cup which sits more flush in the hip socket.    While there's no guarantee it will work, the doctor feels it is my best chance to being able to run again as if it was muscular it would have healed after 1 year.
The good news is the femur side would remain the same so I may be able to skip crutches and go right to a cane after the surgery.
as of now i am scheduled to go back in on 1/22.   Of course I'm just a bit nervous, so I was wondering if anyone had a similar experience.

Thanks for any input,
Tim
     

   

[Granton]

Sorry, nothing useful to offer but sorry to hear about your issue. All best wishes for getting a good resolution.

[stevel]

Have you had Dr Su evaluate the socket seating?
He also operates at the Hospital for Special Surgery.
It seems fairly basic that the socket should be seated below the acetabulum to avoid impingement and not protrude 4 mm beyond.

[Pat Walter]

Tim
I am sorry to hear you are having problems.Have you sent your x-rays to any of the other top surgeons who do free email consultations?  It might be nice to get more than one opinion so you have more to work with before you make a decision.https://surfacehippy.info/hip-resurfacing-doctors-over-1000-hip-resurfacing-surgeries/
I wish you the best in finding a solution.
Pat

[Saddlepal3]

Tim, I did have a revision. My original resurfacing was in 2006, but in 2018, I learned that I was developing the beginnings of metallosis. I sent MRI images to five top resurfacing surgeons to get their opinions about how to move forward. Four recommended revision. Dr. Pritchett replaced the cup with a poly cup in Sept 2018. Recovery was simple and I am doing great. Not running because of arthritis in my knees, etc, but walking, swimming, etc. Good luck!

[tohandley]

Thank you to everyone for you replies and Saddlepal3 for your experience.

That's very encouraging.

i was planning on getting more opinions.  As Stevel mentioned Dr. Su also is at HSS.  He and Dr. Boettner are actually now in the same suite.

Ultimately, I decided it comes down to two things.
1.  Can the revision solve the problem
2.  Having confidence that the surgeon is capable.

After going back and forth I'm still very confident that i am in good hands so I've decided to get it done.

Hoping for a great outcome.   

[stevel]

I am surprised that the socket was not recessed and is protruding as I thought the proper installation is basic training for hip resurfacing.
If so, why did your Dr install the socket too shallow?  I recommend Dr Su evaluate the xrays to confirm the diagnosis, even if you have to pay for it, before you have another surgery, ugh!  It should be easy to transmit them as both Drs operate at HSS.

[chuckm]

I doubt the cup was installed that way at the time of surgery. HSS has a protocol where xrays are taken immediately post surgery and then analyzed for correct placement. This is probably a case of cup migration. What restrictions did you have after surgery and what did you do for your recovery?

Chuckm

[tohandley]

Hi Chuck,

My recovery was pretty much in line with the better ones I've read on the sight. 

I was able to get my elbows to my knees by the third day.         
No running until 6 months but i started walking and was able to walk a half mile the week after surgery.

Got on the stationary bike for 40 minutes at the one month mark.

I also decided to take swimming lessons at the 2 month mark and ended up swimming a decent amount.  Over 130 miles for the year.  it became my substitute for running.

My current range of motion is pretty good.  I can sit with my leg crossed and I can get my right knee to within about a half foot of touching my nose.  The left side touches easily.

I just have not been able to run more than 3/4 of mile without it really throbbing.  If I try to push through it I limp for a few days.

I actually at first felt a little guilty at first since many stories on the site are for people who were in constant pain and are understandably happy to have that now relieved. 
I don't want to seem ungrateful.     I had the surgery a little earlier than many because I was no longer able to play basketball, and run races the way the way I wanted to. And that's taking into account the fight with Father Time. 

I thought at first maybe it was something I did that caused this, but the doctor doesn't think so.

I really feel blessed to have found this site.   It's been such a wealth of information and feedback.

Thank you,
Tim

         

[stevel]

Is the 4 mm gap behind the entire socket or is it an overhang at the outer rim  from the acetabulum?

[tohandley]

The top right of the cup.
I have a picture of the X-ray if you are interested but I’m not sure how to post it?

[stevel]

Take a picture of the xray with your smartphone, then while on this website using the smartphone,  attach the photo.
Also, what did the radiologist's report for xrays say about the placement immediately after surgery vs now?  Is it cup migration?

[tohandley]

stevel,

I've tried to attach it to this post.  Hopefully it worked.

They do not think it was cup migration.

[stevel]

Tim,  I was wondering about your description of "gap"?  If it isn't cup migration and it isn't lack of bone integration then was the cup installed too shallow into the acetabulum?
The area behind the cup looks similar in composition to my xrays but I'm not a radiologist or OS.
I've heard of revisions for slipped cups, unbonded cups, shallow cups and misangled cups to another cup.

[tohandley]

Hi Steve,
 
The picture might be a little grainy but there is a 4mm space behind part of the cup so it doesn't sit completely flush all the hip bone.   So I guess that technically makes it too shallow.  Looking at some other x-rays online mine might stick out a little over the outer hip bone but if so,not by a lot.

As for the space, it doesn't seem like much but the doc thinks that's the likeliest reason for my issues.

I'm set to go in tomorrow so I'm really hoping that's it.  We will know over the next few months.

   

[stevel]

Hi Tim,  Good luck!

[tohandley]

I just wanted to take a moment to give an update of my revision.

Everyone is different but here is my experience so far.

I had my surgery a week ago on 1/22.
The pre-op routine was very similar.   HSS is a terrific facility. Everything is very organized and timely.   My surgery was scheduled for 12:30. I was in the OR at 12:25.
When I first woke up in recovery I was in a bit of pain.  A dose of tramadol took the edge off and I was up and walking by around 4 pm.
Day 1
One night hospital stay.  My roommate, Chris, was coming from a double knee replacement. It was nice to have someone to talk with as we compared procedures.
I was able to go to the bathroom twice during the night using a walker with no assistance at all.
In the morning the PT came by and we decided I could try walking and stairs with one crutch. It was much easier than the first surgery.  The morning after that one I had passed out. 
I had a good friend pick me up and was on my way home by 1pm.

Getting home I felt really good but a bit tired so I slept.
Over the next 3 days I did the prescribed exercises: pedal pushes, quad squeezes, glute squeezes and heel slides.   The heel slides which I could barely do the first time were pretty easy by day 3.    I also slept a lot!

Day 5-7
On Monday I took a walk around the block.  1/2 mile using only a cane. I took it slow and easy.    The doctor called that afternoon to check in and I told him how great I felt.   He cautioned that he would like me to stay on the crutches for a week so that’s what I’ve done. 

It’s still too early to know if this revision will get me back to running but for anyone considering a revision where only the acetabulum side is revised I can say at least in my case:
Trauma to your leg is way lower.   I have much less bruising.
The recovery is faster.  I’d estimate I’m at about a month ahead of the original surgery.
By day 7 I am able to walk unassisted around the house with only a slight limp.
And I can get my socks on already!

I’m hoping for continued progress  but very happy so far that I took this chance. 

[Pat Walter]

Tim
I wish you the best with your recovery.  Sounds like you are doing well.Looking forward to your updates.
Pat

[stevel]

Tim,  Great to hear you are recovering well!  I had a young bilateral hip replacement roommate (say 35 yrs old + or -) at HSS who didn't qualify for hip resurfacing due to dysplasia.  I liked the nurses and PT and I was checked by Dr Su's former PA (for my left hip over 11 years ago) who now works at HSS.  Best wishes for your recovery. 

[ahausheer]

Tim,  I was wondering about your description of "gap"?  If it isn't cup migration and it isn't lack of bone integration then was the cup installed too shallow into the acetabulum?
The area behind the cup looks similar in composition to my xrays but I'm not a radiologist or OS.
I've heard of revisions for slipped cups, unbonded cups, shallow cups and misangled cups to another cup.

Could it have been stress shielding?  The rigid metal cup can prevent some areas of the acetabulum from experiencing stress forces and I have heard about rare cases where the unstressed bone will loose significant density. Sorry to thread jack, hope all is well.