osteolysis/avascular necrosis of femoral HR requires THR revision

[bcmaughan]

Hi. I have posted several times on this topic over the last year on this fantstic site. I had an Adept hip resurfacing with Mr Eastaugh Waring in Bristol on 21/01/2020 and have never been entirely happy with it. I felt from an early stage as early as a couple of months after the Op that something was not right and felt like clunking and loose. I have a breif period in the summer when things were pretty good. Still clunking but not too much pain and we did some decent walks in the Brecon Beacons in Wales. Then in October/November something seemed to change for the worse. I have had various xrays done at different times and I went to Mr Treacy for a second opinion who suggested that there was a possible indication of femoral component having moved into varus position and suggested a CT scan. I had this and it seems to be pretty clear from the scan that the femoral component has movement at the tip to the tune of 3 or 4 mm and the radiologist commented that it was very suggestive of osetolysis and micromovement. The pain has been getting steadily worse last few months and is now of a kind that makes me groan whenever I load the joint, like going upstairs, standing on one leg to put socks/trousers on etc or lifting something heavy. I can't lunge etc. I have been advised by both My surgeon and Mr Treacy that is does seem like this is an unfortunate and rare case of osteolysis/possible avascular necrosis(?) around the femoral component. I have been advised that conversion to a full hip replacement is the way forward and am booked in for April 6th. I'm very nervous about this operation as wasn't really ready for a full hip replacement and am worried about how mobile and active I can be afterwards. I was hoping to be able to save/redo the femoral component but it sounds as though this will likely not really be an option. Mr Treacy said he had only refixed femoral components 2 or 3 times and wouldn't really know if I was a candidate for it until halfway through the operation as depends on how easily the cememnted femoral bit comes out and the quality of the bone underneath. Does anyone out there have a similar experience and can give me some positivity about my forthcoming operation please? I'd be very grateful for any input or advice as to what I should be looking for in my hip replacement. As yet I do not know what sort of replacement I will be getting as am due to see the surgeon in 10 days or so for preop discussion.

[jimbone]

Hello-

That's bad luck, sorry it happened.  I know there are a few people on the site that had either a THR as replacement or as their only option for the second hip when HR wasn't feasible.  One woman who was also a patient of my surgeon has reported several times that her THR of the second hip works perfectly well and without issue.  I've heard nothing but good things about Treacy so I would expect you to be in good hands and from what I understand- not being able to judge bone quality or a device decision until during surgery is a common situation, that surgeons will have an array of hardware to choose from when they go to surgery so they can evaluate the situation critically in real time with the best outcome for their patients.  Might be a subject you can discuss further with your surgeon if only for the reassurance it might provide.  HR is the preferred solution by most everyone who has had a successful outcome but THR is not the worst case scenario necessarily.  Wish you the best of luck and that others will help better inform you.

[Saddlepal3]

Hi there, Sorry to hear about this unfortunate turn of events; however I commend you on being proactive and working with top notch doctors. Jimbone (above) mentions a woman with a THR. That's me. I have one resurfaced hip (installed in 2006 and revised due to metallosis in 2018). My other hip has a THR (2018) because I was too old to be eligible for resurfacing at that point.
I am not an elite athlete by any stretch of the imagination, but I'm an active, 70 year old petite female. Typically put in 2 hours of moderate exercise daily: Walking, swimming, elliptical, kayaking. If my knees were in better shape, I'd still be running and playing tennis. Both hips are great. I've been 100% happy with them and I thank God for modern medicine, realizing that, without my shiny man-made hips, I'd have been in a wheelchair before my 60th birthday. Sobering realization!

[bcmaughan]

Hi and thanks for replies. No I'm booked in with my original surgeon to have the revision Op not Dr Treacy. I am wondering whether I should pay to go privately as am very worried about the Op this time. This will be my 3rd Op on the right hip in 4 years. First was for kehole surgery of FAI, then resurfacing in January 2020. Both times I was hopeful of surgery fixing the problem. Now I have completely lost confidence so feel like money is not an issue I jsut want the best possible outcome! I'm in a lot of pain all the time now and the CT scan so clearly shows the femoral component has moved/is moving!