Acetabular cup slipped and femoral head dislocated 30 min. after surgery

[decooney]

Hello, I'm new here, with a serious question to ask the knowledgeable ones here. 

(EDITED/UPDATED) - read the doctors notes passed along and revsied this further.   


30 minutes after I came out of surgery, I was still coming out of anestisa, and my new hip resurfacing (acetabular insert) cup reportedly slipped out of place and they found my femoral head was dislocated, popped out of the cup.  Now I'm really confused. 

Situation:

• Have hip dysplasia (surgeon has noted my socket is "too shallow")
  
  • 43 years old
  • Flat headed femor, warn, no cartlidge remained, and I had a laberal tear with cyst there. 
  • 07:30 a.m. surgery used a 43mm Corin/Cormet steel ball and cup (1st surgery) it.  Another xray revealed new problems.
  • 10:30 a.m determination was made with post-op xray they would need to open me back up and find/replace any failing components.
    
  • 11:00 a.m do-over/2nd surgery they re-used the same femoral head, and replaced the loose acetabular cup with a new/larger stryker system setup with a larger 56mm cup and provision with/adding two screws to secure the cup, and adding a X3 poly liner
  
  
  Questions/Concerns:
  
  1. Why would the femoral head just become dislocated 30 min after surgery, in recovery room?
  
  2. Why would the acetabular cup just slip out of place so quickly?   It was noted as being "forward and upward"
  
  3. Shouldn't my surgeon have known to use a special dysplasia type cup the first time, in my case, him knowing I had hip displasia?
  
  

[Pat Walter]

Hi Decooney

Please don't lose any sleep over the different cup you have.  There are a number of different types of cups for displasia that are often used for hip resurfacing.  Basically the acetabular cups are the same for MOM THRs and resurfacing since the sizes are the same.  As long as your surgeon used the resurfacing femur cap - you still have a resurfacing. 

It is too bad that you had to have a second surgery, but at least you were able to keep your resurfacing.  The acetabular cups are often difficult to place and many less experienced surgeons have had a number of loose cups.  There are many different techniques for making sure the cup is securely placed, but sometimes the surgeons still have problems.

The surgeon had to be very careful in selecting the new acetabular cup for you.  It was designed to match the femur component.  They don't mix and match without a great deal of preparation and thought.

Don't be bummed out.  You have a sucessful resurfacing.  It was too bad that your surgeon didn't choose the displasia cup first - but as I recently learned, x-rays don't always tell the surgeons the complete story.  They sometimes need to see what is inside your hip.

Many people have had the displasia cups - don't worry.  Be glad you have your resurf and concentrate on getting well.  Unfortunately, your second surgery will slow you down a bit - but you are on your way to a pain free, active life.  It might not seem like that now - but you are.  Have faith and you will have a good recovery.  Don't forget that your mental outlook is as important as your physical recovery.

I would also talk with your surgeon about the cup.  Let him explain to you in his terms about why he did what he did.  Ask the questions of your surgeon - most of them are very kind and caring.  They will try to answer all your questions.  Since you had to have a second surgery, I am sure you doctor will be willing to talk about this with you.

Good Luck.

Pat

[decooney]

Edited/Updated -

Pat,
Thanks for your helpful and reassuring words.  Updated my first post after seeing a copy of the surgeons notes. I did not get all of the story verbally.  Just saw the written stuff. Feel free to edit your prior post so it does not mislead anyone. I edited both of my posts.  Corrections have been made on my posts. 

[decooney]

Pat,
Note: I edited my original and followup post.  I found out there was more to the story after I got a chance to read the doctors notes.  After you see my edits, maybe you could update/edit your post based on my new information provided.  Still looking for answers, and even more so now finding out it actually "dislocated" right after surgery.  Thanks, Duane

[obxpelican]

Just MHO.

I am NO DOCTOR.

I think he meant to use the femoral side just as it sat.  I assume the femoral side was cemented and I think the cement would have already setup and thereby lessened the possiblitly that you could re-do the femoral side.  Most of the time femoral cups stay, you usually lose that side from a femoral neck fracture.

Acetabular cups do sometimes slip and it's generally accepted that it's surgeon error when he set the cup it did not seat well.

It's a shame anyone has to go under the knife more than once in a lifetime for the same issue, let alone the same day. 

I am glad you're ok now.

Wishing you a fast and easy recover.


Chuck

[John C]

To put a positive slant on things; it may be good that it happened right away in the hospital, so that there was no delay in getting things fixed, and you will not have to go through two recoveries, or the pain and confusion of having the cup slip after you were home.
As Pat said, you might want to talk to your doctor about the new cup. I would particularly ask about the poly liner in the cup, and if based on past experiences, that has any implications that you should be aware of.
It sounds like things are in there good and solid now, so that hopefully you can look forward to a good recovery.
Best of luck,

John

[Pat Walter]

Hi

I listend to how each doctor sets acetabular cups - how each tries to check them to make sure they are set.  Some actually hit them twice to make sure they are right.  Others use computer aided surgery to make sure they are tight.  Some acutally try to "in laymans terms" jerk on the cup with a special suction tool to make sure it is tight.  It was discussed that loose cups have actually become more of a problem than femur neck fractures. 

The doctors each have their own techniques to make sure the cup is set properly.  I believe all the doctors take x-rays of the new hip before leaving or just after leaving the operating room.  They are very aware of making sure things are set properly.

Each of our bodies are different and the x-rays don't always show the true problems.  The placing of a hip resurfacing acetabular cup and femur cap is almost as much an art as a science.  That is why there is such a steep learning curve.  It is not cut and dry, it takes a great deal of experience.  The surgeons are humans trying to do the very best job they can.  I listened to their concerns for their patients and how hard they try to get everything perfect.  We have to remember, however, that each person's body is a little different.  Perhaps your doctor truly felt the regular cup would work for you.  They never try to make a decision that is wrong.  So in this case, there was some kind of problem. 

I know the doctors don't want this to ever happen, but at least you were taken back to surgery quickly.  So you still only have one recovery and you still have a hip resurfacing. 

Again, this hip resurfacing surgery is very difficult and there are no rules set in black and white. 

If it were me, I would probalby be upset about the second surgery, but I would be glad that I was able to keep my resurfacing and still have only one recovery.

I don't think we as patients can say much of anything else.  I greatly respect the surgeons and their skills.  I have learned this is truly a difficult surgery and it takes much experience to become a really good resurfacing surgeon and even the best surgeons still have problems with some surgeries.

Pat

[decooney]

Hi all,
So far everything said makes sense, however, I've ran across serveral references to different cups being offered for "hip dysplasia" patients. I have dysplasia in both hips and we discuseed it at great length, 4 times before I went into surgery.  I mentioned at least 10 times worrying about my cup pulling out and to be sure we used the right stuff.    My research shows larger cups with screws are used in my situation, generally.  My surgeon went to this on the 2nd surgery.  He is very experienced, very respected, and has done many many surgeries for hips. 

What I don't understand is why he did not use a "dysplasia cup" or "larger diameter cup with screws" on the first surgery.  I only spent 1/2 a day searching on the internet at various sites and apparently this is generally known to take a different approach for patients with hip dysplasia.  Many mfg different companies offerering these for this purpose.