38 years old, THR 15 years ago, pain, unanswered questions

[nh_user_1133193]

Hello,

Due to developing traumatic avascular necrosis after a femoral neck fracture, I received a total hip replacement in 2002, when I was 23 years old. Anterior, titanium/ plastic. Everything has been great for the past 15 years, and I have enjoyed a very normal and active lifestyle (while taking care not to engage in too much high impact activity).  

Over the past couple of months, I've begun to feel something in the area of my hip replacement, and now there is a constant, low level pain that increases after activity or stretching.  

I am a graduate student and a working artist and have Medicaid.  I was able to see a PCP. They took ex-rays and sent them to the local orthopedic clinic that accepts Medicaid.  The Ortho surgeon looked at my ex-rays and claims that there is nothing noticably wrong with my hip - which means they won't see me at all until their next available appointment- August 30, 2018.  

I'm terrified.  I'm aware that revision surgeries are often more problematic than initial surgeries, but even though I've sorted through medical research articles, I'm not exactly sure why.  I don't know if I am suffering from osteolysis, I really don't know anything and I can't get even a conversation with an orthopedic physician.  This is why I've come to this forum.  If anyone has insight into any of my questions, I would be so grateful for your help.

1. What are the risks I should be aware of with THR revision surgery?

2. What are the signs that a THR revision surgery is needed?

3. *My Biggest, Scariest Question*: Assuming I need a revision surgery, are the chances of a successful surgery decreased the longer I wait?  If I continue to walk on this painful hip until the Dr will see me in August, am I lowering the chances that I will have a successful revision? 

4. Do you think there could be another reason to explain my pain?(the Dr said my ex-rays don't indicate a problem)

5. Should I attempt to get more specific imaging done (MRI, bone scan)?  I don't know if an ex-ray would even show osteolysis or other things that could be potentially causing my hip replacement to fail. 

6. Does anyone know of research that I can be a part of?  Young patient needing a revision?

Please help if you can.

Thank you so much and I wish everyone the best.  

 

[nh_user_987288]

Dear Carolyn

Sorry that you are worried. I will answer whee I can but will be brief because I have an early get up in the morning but please come back with questions if you need to and I will do my best.

It is most unlikely that you are suffering from osteolysis after this time period. X rays should show up osteolysis. I have osteolysis in a replaced ankle joint that started within about six months but at four years worsened quickly.

You are most likely to need revision surgery If the stem has become loose but if uncemented is rather unlikely or if your poly cup is wearing through. This is a possibility and may not show up on X rays until almost worn out.

The danger of not catching the collapse of the poly quickly is that the head of the stem will be metal on metal and will be depositing a metal sludge. In the case of my hip revision due to the time I had to wait there was quite an amount of sludge which the surgeon had a job removing it all and there was a chance that I would need an additional surgery to remove it. In the event I did not have any averse reaction and so no additional surgery.

My poly failed at twenty years of very hard use and the revision surgery was fine at 76.

If you have the feeling of clonking in the joint when sitting down and rotating the leg or if you are standing on the good leg and allowing the hip with the prosthesis to hang loose and relaxed and you feel that there is a looseness up and down then I think it is very likely that the poly has lost quite an amount of it's thickness and failure can be expected within 2 -4 years going on my own experience.

Apologies if I've missed out anything.

Cheers, Richard

[nh_user_1002270]

"... I really don't know anything ..."

Hi Carolyn-

  We are all amateurs here, and all of us have been in your (painfully pinching) shoes. So we can commiserate. As for the scariest of your questions:

"... are the chances of a successful surgery decreased the longer I wait?  If I continue to walk on this painful hip until the Dr will see me in August, am I lowering the chances that I will have a successful revision? ..."

I would say: not really, and not really. What happens with the passing of time is a bit more wear and tear on the bearing surfaces, and a slow accumulation of the associated bad stuff inside you. It's more of a chore for the revision specialist to contend with. But, ultimately, that's his chosen profession, and he is good at it. As a patient, you are helpless to affect the outcome in any event. So, you can relax a bit.

As for immediate tactics, I can only observe: 8 months is way too long to hobble about on a bum hip joint. At best, you will be miserable; at worst, you can overload your opposite side knee and twist your back, adding to your pain woes. Try this: give a call to a university affiliated medical center in a nearby big city, ask for a referral to a THR revision specialist. If the word is that he doesn't take medicaid patients, try their community health center, or whatever they are calling their Get Treatment for Poor People organization these days. You have to get in front of an expert: you have a problem and the first-line professionals can't see it.

Another action: go to your local physical therapist, ask them to evaluate your gait. While they exercise you, they can spot other issues. For instance, maybe your hip is fine, but you have sciatica. Who knows? They see lots of THR patients; ask them who they would recommend for their mother's surgery.

Congratulations on enjoying 15 years relief from AVN pain. Can you imagine?

Hope this helps.

[nh_user_292332]

You have a lot of information and questions. Good to see you keep up on hip issues.

I had revision a few months ago and it went very well. All components were removed and new were all replaced . It was 6 years after the first THR. It was a problem with the manufacturer of the components.

The other hip also THR it is 22 years old and still ticking! It pops and is sore from time to time especially in cold weather. The cup is wearing out and will need replacement. I go in every 6 months to check on it. I would ask for  X-rays every 6 months. If it's only the cup replacement and the component in the femur needs no replacing,then it's may not be a complicated procedure in some cases,not all components need to be removed. Ask for a surgeon who specializes in revisions.

Some things don't always show up in X-ray or MRI. Keep all your info on pain in a diary ask for a copy of your X-ray. I was in severe pain could hardly walk. Before my revision. I now can do everything since revision.

The ER will see you if needed before the next appt. Keep in mind that you know what to expect and if necessary ask for the name of the manufacturer of your implant if you don't already have that info and do a check online .

Sometimes we need physical therapy to get thru muscle tendon issues. I'm surprised that was not suggested. I hope you can get another opinion and remember there are many hippies on this forum that are here to support you. 

Take care

Happy Holidays 🎄