Going for a revision when i thought the problem was my other hip

[Lauren Lee]

Hello and here I am again. It's been awhile...I had my R BHR in june of 2013- and scheduled for  RTHR on Jan 13-less than two weeks away!  It was  great for a long time...fantastic ROM, no pain. Through the years, my metal ion levels have fluctuated with the last being  Cobalt 6, Chromium 10...inching up little by little. I noticed a gradual clunking in hip, dull ache near incision, a heaviness when walking any kind of distance. Of course, it seemed to get worse with covid and not being able to go to the gym. My biggest problem ( I thought) was the sudden awful spasms I would have in my LEFT groin if I step a certain way or twist. On first visit with surgeons PA an xray showed nothing abnormal with r bhr and mod OA in left. The  PA, on my second visit recommended a  L THR. Doc came in for a minute to answer questions and again stressed very strongly there was no justification for revising my BHR because the placement was perfect,  but the L THR was warranted.  We tried an injection to the L hip which did nothing for that pain in my groin.
Something didn't seem right so I sought a second opinion. This time,, Xray revealed on right hip presence of possible pseudotumor and a placement issue "the femoral stem appears eccentrically located", mild soft issue prominence. Mild left hip OA (remember they wanted me to have a L THR!!) I then had an MRI which showed the fluid collection and atrophy of the gluteus  minimus and maximus.
L Hip- mild OA
so...here I go again. I understand it is going to be more complicated this time with having to remove the implant. it has been discussed leaving the cup in place if in good shape and replacing just the ball and shaft. This makes me nervous because I also wonder if i have a metal allergy...I have gotten this odd rash on right thigh twice in last 6 mos. I have occasional general aching that was significant enough that I asked for an RA panel as my mother and grandmother both had it...which was (thankfully) negative. I have always had a sensitivity to metal jewelry but this was not considered an issue when choosing the BHR.
 Even though it is my LEFT groin that is giving me the most pain,  I am really hoping ( and the doctor believes it is a possibility) that the left groin pain will settle down once the THR is done. To say that I am disappointed in my original surgeon and the way he ( or should I say his PA) addressed my current issues is an understatement.
This site was an awesome support 7 years ago and it was a really good 7 years that I had with the BHR.
Any thoughts you may have on this are welcome. Thanks and Happy, Healthy New Year to all!!

[Ljpviper]

Hello Lauren,

   I had my HR taken out and replaced with a dual mobility femoral hip replacement three weeks ago.  My hip resurfacing lasted almost a year, from one day to the next I had chronic pain and weakness. I lasted three years like this as my cobalt and chromium levels were low and my X-rays looked perfect. No one could figure out why I had daily chronic pain and swelling.

I finally had enough and met with a revision surgeon at the new HSS facility here in Palm Beach around March 2020. They had me do a new MRI and the radiologist noticed a lucent area around the femoral shaft of the HR component.

I was very surprised what was found on the surgeons report. One was bloody synovial fluid which is supposed to be clear, the second was dark metallic tinged synovial around the hip joint. Basically my body was reacting to the metal on metal. I had no tissue loss or muscle damage, I think I got lucky and caught it in time.

The good news I was able to keep my acetabular component from the original resurfacing. They were able to put in a ceramic liner that went with the new femoral hip replacement component.

I had it done via anterior method and recovery has been great, I can walk unaided allready. Pain was not too bad and I had no restrictions. I go back and see the surgeon on Tuesday for my first follow up. I will get more details on his findings as I was out of it when he spoke to me after surgery. The constant glute,lateral ang groin pain is gone. I still have some surgical related pain but that is normal.

Good luck and please feel free to PM me if you have any questions.

Thanks,

Larry

[Lauren Lee]

Thank you! I feel encouraged! I asked about anterior but he said he will go through old incision , mainly because of orientation of bhr plus the location of fluid pocket. He said he has had to do " too many" of these revisions.

[Ljpviper]

Lauren,

  You should be ok going the posterior route. The only reason I went anterior was I had that chronic glute pain. I did not want to chance more disruption of any muscles via posterior.

I can tell you one thing the anterior leaves way less of a scar and you really get your mobility back very fast. Why did my HR fail is the big mystery. My gut feeling is the femoral component must have shifted, causing the daily chronic pain and metallosis discovered in surgery.

Also, make sure to ask for a dual mobility femoral component. They are very hard to dislocate, and also feel very natural. I was super bummed I had to replace my HR so soon, but glad I did when did as metallosis can wreck havoc not only on your hip but also other organs in your body.

If you live near Ney York or Florida I highly recommend HSS. They are very good. They have a wealth of knowledge in there team.

Thanks,

Larry

[Saddlepal3]

Lauren,
I also had a successful revision of my R HR. My original surgery was in 2006 and seemed to be a complete success. In 2018 (12 years later), I had my left hip evaluated  for surgery. Because of my age (67), gender (female) and body type (petite), I was no longer eligible for resurfacing, so I had a THR, and I was fine with that. As a routine precaution, I had my blood ions tested and they were moderately elevated. In an abundance of caution, the THR doc ordered a MARS MRI of the resurfaced hip. Those images showed an accumulation of fluid around the joint. Interestingly, I had zero pain or other discomfort. I sent the MRI images to my original surgeon and he recommended a revision. 2nd and 3rd opinions agreed. So, in 2018, I had the revision surgery. Dr. Pritchett replaced the metal acetabulum cup with a lined one, and he kept the ball intact. It was an easy recovery. I feel very fortunate.

[Lauren Lee]

I am nervous because my glutes are already compromised. I guess he has to get in there and see what is going on. The fact that my original surgeon is not doing it seems odd to me but, even though all this surgeon does is hips, he isn't a specialist in hip revision like perhaps Dr.. Pritchett or HSS. Depending on wear to components he will make decision during surgery what to do. Should I be worried?

[jimbone]

Many surgeons reject the anterior approach because given the difficulty of HR the anterior provides additional technical problems of access.  I joked with my surgeon I'd never be able to sport a Speedo again, but scarring fades- it's the long term result I was after.

[dannythebeerman]

Lauren, I feel sorry for you.  Your story is a reminder that not everything goes right. 

Have you sought a second opinion from one of the Dr's predominately mentioned on this site?  Because you already have the resurfacing, you should really get a second opinion from a Dr that is actively performing resurfacings, a doctor that doesn't do them is surely going to remove the appliance.

I found the two I contacted Prichett and Gross rather accessible.  I think from reading other post Dr Brooks in Cleveland is just as accessible.  I ended up doing a remote consultation with Dr Gross, and it was free.  I mentioned Dr Brooks because I am taking a guess that you reside in Michigan, I read some of your past post looking for your Dr and went to the list and saw his name under MI.

I wish you the best.

[Ljpviper]

If you have any issues with the femoral stem on your present HR unfortunately there is no way of saving it. I had two remote appointments with Dr. Pritchett and he explained all my revision  options. He is very knowledgeable, and will lead you down the correct path even if you don't use him for revision.

Not sure how active you are but these newer hip replacement components are very durable. If your metal levels are elevated and a pseudo mass was found, it's best to get the revision sooner than later. You don't want to risk muscle damage from metallosis, as it can turn from an easy revision to a very complex surgery.

Thanks,

Larry

[Lauren Lee]

I know I am not alone because my surgeon, while he does not do resurfacing, does a lot of revisions on resurfaced hips and restorative surgery. I am scheduled for Jan 13, moved up from the end of Feb because of the increasing pain, instability, and psuedotomor plus the gluteal atrophy. I am pretty active so I think the best course is just get the whole thing out and a new one put it...i do think I am experiencing metallosis.  I appreciate your experiences and support. I am hopeful and anticipate feeling better than I do now and getting past this! I also hope that whatever is going on in my left hip (tendinosis) will go away once the right side is fixed.  Thank you!

[dannythebeerman]

Thanks for the color Lpjviper.  And good luck Lauren Lee.

[Pat Walter]

Lauren Lee    I am sorry to hear you are having problems. I hope your revision goes well. As you probably have read in the past, not many people have problems, but sometimes a few do.  I am sorry you are one of the people that ended up requiring a revision. Please let us know how you are doing after your surgery. I wish you the very best and wish that this had not happened to you.
Pat

[Lauren Lee]

Thank you Pat! You and this group have been a wellspring of information, inspiration, support , and hope! Thank you for all you do! Will check back soon!

[Saddlepal3]

Lauren,
Has your surgeon told you he is confident about keeping a resurfaced joint? If not, you might want to ask. Once he gets in there, he may feel that a THR is the best option if that's what he most familiar with. That may be OK with you, but it's good to discuss in advance.