Acetabular Placement Question

[B.I.L.L.]

Hi Gang !!  How are you guys ??  I hope everybody is doing well. I have a few questions about acetabular cup placement, hopefully you can help me out. I have read that improper placement of the acetabular cup is probably the most common mistake made in hip resurfacing, my questions are:What are the symptoms of an improperly placed cup ?What are the mistakes made ?  I assume the only ways to get it wrong would be it was placed to shallow, placed too deep, the wrong size, not tight enough or placed at the wrong angle, wich brings me to my next question.What is the range of the angle ? (viewed from the front)Is there a set standard range of what would be considered acceptable ?  or is it strictly patient to patient ? And finally is there a place in this site where we can post and compare x-rays ?  If there is I must have missed it ?  If not, maybe start a topic for that ?  The reason I'm asking is because I have been having some knocking/pain issues and wanted to know why. So I started poking around and found some x-rays on line and quite frankly they don't look anything like mine.  The cup angle on mine seems much steeper (more vertical) than the other shots that I have found on line, and I'm curious to know how big an issue that is (if at all).  I'm a little upset my Dr. would not let me keep the x-rays so all I have is a few pictures of them on my cell phone, but they show it pretty clearly.  It looks to me like the outer edges of the cup are just about flush with the outside edge of the pelvis top and bottom, (maybe slightly countersunk on the top) but the angle seems pretty steep to me ?  If my spine is straight up and down, the angle on the cup is way less than 45 degrees toward vertical. Anyway I thought if I had some examples to look at I could see if anyone elses is that steep. I am going to get new x-rays after the holiday and will get a good enough picture to post them on here, and will probably send them to the big name guys as well.Any thoughts or links on this subject will be greatly appreciated.Pat I know you just attended the Dr. workshop, your thoughts on this ?  Thank you very much !!,    Bill   

[obxpelican]

Bill,

From what I've read, acetablular cups when placed incorrectly the symptoms were pain, snapping and popping in the hip area.  Sometimes the pain can be really severe.  Everyone will have symptoms that differ from other folks.

If you look at Pat's main home page you'll see what I believe is a perfect installation of our hardware.  That is what I used when I got my 6 week x-rays to use for comparison.

I have a Internet friend who I will ask if he will talk with you about the symptoms he had.  His name is Brett.

This may not be anything Bill, some people have strange pains well into and beyond 4 months.


Chuck

[B.I.L.L.]

Thanks Chuck, I think your talking about the little picture of someones right hip where it says advertisements ?  If so I have looked at that picture and mine is steeper than that. I hope it's nothing but for whatever reason I still need a cane at 9 weeks or I have pain on the outside of the hip when I walk without it and I feel unstable.  I don't know man.....I wish I had more faith in the Dr. to be honest with you, I thought it was weird that he wouldn't let me keep the x-rays for one thing, I was able to keep the ones of the hip before the surgery, why couldn't I keep the ones from after ?  And why can I not find an x-ray anywhere that looks like mine ? Every single one I've looked at shows the cup being more "on the top" of the ball, where mine seems to be set to where it looks like its more on the side, like the top of the cup bareley goes past the very top of the ball, it looks to me like all the vertical force would be placed on the very top outside edge of the cup, rather than spread across the whole cup.  I wish I knew where I could find a good cup placement vs poor cup placement section, and what the differences are between the two, with x-rays of both.  Maybe it's all good and I'm just a slower healer than most, maybe when I read about people having no pain and cruising around like normal weeks before where I am I shouldn't get my hopes up , maybe I'm being a sissy drama queen ha ha , I don't know but wondering about it is driving me nuts. Either way I am going to go get new x-rays and demand to keep them, or at least get some pictures with a decent camera so I can e-mail them out for a couple other opinions. My biggest fear is that if it is wrong I want to fix it ASAP, I don't want to invest 6 months of healing time to start all over again.  I just want to KNOW that it is installed correctly. My wife says don't worry about it the Dr. says the x-rays look good, but I feel like well yeah what else is he gonna say ?  I mean if there is an "optimum placement" and then "acceptable" placement, where doe's mine fit in on the scale ? Am I closer to optimum or borderline acceptable ?  I would like to know as many facts as I can gather before my next appt.  Hopefully all is well and you guys can all say "Jeezus that B.I.L.L. cat sure is a worry wart, what a goof"  Just not knowing why I seem to be behind pretty much everyone elses story in here is eating at me and I need to know its right, sorry I'll stop rambling, I really am an optimist I swear...

[Barbara]

Hi Bill,
Sorry to hear you're having so many problems. Can you get your PCP to order an x-ray and then take it to different Ortho Dr for a 2nd opinion?
I hope it's not what you're thinking and that things start to improve for you soon.
Take care
Barbara

[stevel]

Bill,

I had my 4 weeks post-op x-rays taken at the local hospital, since I had my surgery out of town.  I had a prescription for the x-rays and could have them taken anywhere.  I choose the hospital because they put the x-rays on a CD and gave me the CD.  I then made copies of the CD.  I sent the original CD to the Dr. for his review and he said they look great.  I copied the CD on the hard drive of my home computer so I can review them or send them via email attachment to anybody I want.

The placement looks great because I had a pelvic x-ray which shows both hips.  The new implant on the left side looks symmetrical with the natural hip on the right side.  I was laying down on the table in the supine position.  They also took a cross table lateral where I bent my right knee and they took an x-ray through the space below your bent knee at the left hip.  In this case the socket is more vertical as the femoral cap (and leg) has rotated within the socket.

I have been reviewing the x-rays because I have a leg length discrepancy and the Dr. says it should even out in 3 to 6 months.  He knew about the shorter leg prior to surgery and placed the new implant accordingly.  The new implant looks even with the right hip, so I'm working with the physical therapist to strengthen and stretch the left side pelvic and hip muscles so my leg length evens out.  My physical therapist says I should have a pelvic x-ray taken in the standing position rather than supine position to verify if the hips are symmetric.

I will wait about six months and work on exercises and stretching, before adding a heel lift or foot insert, if needed.   

[B.I.L.L.]

Hi Bill,
Sorry to hear you're having so many problems. Can you get your PCP to order an x-ray and then take it to different Ortho Dr for a 2nd opinion?
I hope it's not what you're thinking and that things start to improve for you soon.
Take care
Barbara

Thanks Barbara, I hope it's right too. I guess I'm looking for some kind of diagram that shows whats good, bad, and in between. 

Hey Stevel,  Can you post your X-Rays on here ?

[stevel]

Bill,

I'd rather not as the x-rays have my patient information (identification).  Check out the x-rays shown on Dr. Bloomfield's website for difficult hip resurfacing patients.  They are located under "Hip Information" at the bottom of the page.  Go to the home page of this website to access "Hip Information."  Go to Dr. Bloomfield's website to view the photos as a lot of them were not viewable on this site.

[obxpelican]

Bill,


I emailed you my x-ray.

Check your email.


Chuck

Hi Bill,
Sorry to hear you're having so many problems. Can you get your PCP to order an x-ray and then take it to different Ortho Dr for a 2nd opinion?
I hope it's not what you're thinking and that things start to improve for you soon.
Take care
Barbara

Thanks Barbara, I hope it's right too. I guess I'm looking for some kind of diagram that shows whats good, bad, and in between. 

Hey Stevel,  Can you post your X-Rays on here ?

[stevel]

Bill,

I sent you an x-ray of my LBHR at 4 weeks post-op to your email address.  Check your email.

[Pat Walter]

Hi B.I.L.L.

I am sorry I did not get back to your sooner.

The perfect angle for the acetabular cup is 40 degrees.  It varies a little each way sometimes.  Also the doctors will purposely change the angle for people who need more ROM or doing certain sports or activities.  This is not an exact science and depends on the doctors experience as to how it should be properly placed for each person.

I would not be able to tell anything by looking at the x-rays since I am not a doctor.   There are also other angles and placement involved too.  It is very complicated.  I have 3 studies I will post in a few days about the angles and computer assisted surgery to make the angles correct.

I don't know what to tell you since I would not be able to read your x-rays to tell the angles, etc.

If you start having problems or pain, then one of the really expirenced surgeons will read your x-rays and give you an opinion.  If you are not in great pain, then they would not be very willing to take time to read you x-rays since they are so busy.

I have to look at the settings on this discussion group to see if I can let you post photos.  If you have an url where they are already posted you can use that.  I have a photo section, but have not let people join due to all the porn and problems.

Let me take a few days to figure out how I want to give you a place to post photos.

Pat

[wayne-0]

Hey Bill,
First of all the doctor can not keep the x-rays from you. You have a right by law to have a copy of them and anything else that is in your medical file.You can call his office and demand a copy of anything in your medical file be sent to you or for you to pick up.Also I will send you a copy of my x-rays after surgery but I'll have to have my wife do it cause I'm not to computer savy. Also when you get your new x-rays ask them to convert them to a cd that way you can send them to Doctors around the world if you need to.They did that where they took my x-rays and they didn't even charge me for it. Hang in there bro we're all pulling for ya.

                                                  Wayne-0

[John C]

Hi Bill,
I just emailed my x-ray to you, but as Pat said, each case can, and probably should, be a little different. My best advice is to do whatever it takes to have someone you trust look at your x-rays as soon as possible, so that you can put your mind to rest. In the past, I have emailed phone/photos of x-rays, and most docs have found them to be sufficient.

John

[obxpelican]

Pat.... I think Bill wants the porn on here    Don't mess him up, ok?


Chuck

I have to look at the settings on this discussion group to see if I can let you post photos.  If you have an url where they are already posted you can use that.  I have a photo section, but have not let people join due to all the porn and problems.

Let me take a few days to figure out how I want to give you a place to post photos.

Pat

[B.I.L.L.]

Pat.... I think Bill wants the porn on here    Don't mess him up, ok?


Chuck

I have to look at the settings on this discussion group to see if I can let you post photos.  If you have an url where they are already posted you can use that.  I have a photo section, but have not let people join due to all the porn and problems.

Let me take a few days to figure out how I want to give you a place to post photos.

Pat

  Hey now........Ha Ha.

[obxpelican]

Pat.... I think Bill wants the porn on here    Don't mess him up, ok?


Chuck

I have to look at the settings on this discussion group to see if I can let you post photos.  If you have an url where they are already posted you can use that.  I have a photo section, but have not let people join due to all the porn and problems.

Let me take a few days to figure out how I want to give you a place to post photos.

Pat

  Hey now........Ha Ha.

I am just trying to keep your spirits up Bill 


Chuck

[B.I.L.L.]

Ha Ha I'm ok thanks.  Sounds like theres no real set rule so I'll stop stressing and post my X-Rays when I can.  Thanks to you guys that sent me your x-rays for comparison, actually none of them look the same, but none are as steep as mine.  Have a great Thanksgiving

[wayne-0]

Bill,
The two laws that I was talking about are called the erisa law and hippa law.I think you have Kaiser if I remember correctly. Call Kaiser and demand from them those x-rays that you want.If the person on the phone doesn't give you what you want demand to talk to their supervisor,talk to the supervisors supervisor if need be.Keep going up the chain until you get what you want.Also ask for every persons name you talk to and have them spell it for you and write all this info down and ask for a reference # to every call you make.Bylaw they have to give you this info and they know it, don't let them tell you otherwise.By the way remind them you know that every phone call is recorded (that is the reason you ask for the reference # so you can have it brought up if you need this firepower for later).Stay strong and talk to ya later.

                                             Wayne-0

[Barbara]

Everyone is entitled to have access to and copies of their medical records, however there is a process you have to go through to access them. Hipaa is a law made to protect your health information and give you control over who has access to this information. It also gives you rights over your health information and you can request that corrections be made to your records if you feel it necessary.

Call the medical records department of the hospital or Doctors office. You have to fill out the relevant paperwork stating what parts of your records you actually want and might have to pay a small fee. Doctors do have the right to keep some of your records private from you if they think the information could be harmful to you. This would only happen in extreme cases though. I would think you would have the right not only to your x-rays but also to the dictated x ray report, pre and post op report and surgical report if you wanted them.

Good luck
Barbara

[woodway2]

Hello Bill, Pat et all
Getting back to the acetabular cup angle......I have a high angle but my hip works great. If you check some of the studies that Pat has posted, there is one that includes xrays of high angles, in the section on metal ions. At my 3 month check-up I noticed that my xrays did not match the other patients, and asked my doctor, who confirmed my high angle. He thinks it's around 59 degrees. I don't know if it slipped or was always like that.
My doc is great, a very caring and compassionate man. He has allowed me to take specialized blood tests for the metal ions, and, they are very high. I have worried about this all fall, and have recently decided it's time to enjoy my hip and stop obsessing on the ions. My doc is surprised I have no pain or metallosis and is going to take new xrays in February.  He is also going to discuss my case at an upcoming conference. I feel very cared for, and know that he is concerned as well. But I have a hip that is working great! I had my surgery 14 months ago. I am fully active and don't restrict myself at all. I do, by the way, follow the regime by Keith Brewster, with vitamin C, NAC, and (when I remember,) selenium. I can't remember the URL but if you google him you will find it.
I wonder, am I the only surface hippy out there who has had my blood tested?
Nancy/woodway

[stevel]

I reviewed my 4 week post-op pelvic (both hips) and left side (LBHR) hip x-rays and measured some angles with my protractor.  The x-rays were taken in a supine (laying flat on my back) position with my legs fairly evenly spaced although I believe the technician did not adjust the space much.  The angle between the longitudinal axis of my femoral neck and the longitutinal axis of the femoral shaft is 135 degrees on the left side.  I've read where this angle is normal.  The angle between the longitudinal axis of the femoral neck and a vertical line (matches spine) through my pelvis is 30 degrees and matches my right side (unoperated).  I'm not sure what a acetabular cup angle of 59 degrees is referenced to?