It seems that there are too many of us suffering due to oversized implants. In a couple of cases on here, implants were too small. I had no idea that this issue could exist at all. In one case a tall American woman has a too small implant going south down the shaft of her femur. It was she who drew our attention the paltry range of sizes available. And to the fact that at least in the US surgeons are rewarded for sticking with certain manufacturers. Of course those of us going for a second THR will be wise to that now, but meantime, can anyone who believes their implant to be an incorrect fit, respond to this post as I am taking this matter up and drafting an article for a women's magazine. After all, post surgical complications must be costly and the NHS might better be served by addressing the question of fit before the event rather than coping with revisions and scans and all the miserable patients being treated for pain sometimes over a lifetime. Nearest available fit is just not good enough.....
I am pleased to hear you're drafting an article for a magazine. The word should get out that this problem exists. I'm the one whose shaft is sinking into my bone, pulling the ball down with it, and the femur neck is too narrow for my anatomy. I"m in the US. The fact that some manufacturers only make two sizes is unconscionable ... there should be multiple sizes, just like when we buy a pair of shoes or slacks.. The doctors using these manufacturers aren't asking for more sizes because, as you say, they're rewarded for sticking with that manufacturer, and they're getting away with putting in a size that doesn't fit the person because most attorneys don't want to bother with malpractice lawsuits. Their suggestion? Build up your shoe. We have no advocates. I hope you get a lot of responses. I'd like to read the article once it's published!
My foot drop brace was to way to small but they went ahead and had me wear it. My leg being numb and my head as well thanks to Percocet. I still knew it was to tight. The AFO might fit a my roommate but he had wore and AFO that size before. My calf ended up swelling from the AFO they fitted me for. It gave me a blood clot that shot up to my lungs. I think the surgeon didn't do his job or the other people because they didn't properly size me for it. Then didn't want to have to deal with what if that's not the one cause it doesn't fit right. I went to a professional who said he didn't know why they had delivered to me cause he knew that it was going to be to small and that it wasn't going to be the one. That brace that they all made me wear ruined my life and pretty much killed me sooner than expected. Just cause of their misdiagnoses. Get the right one next time.
Are you going to get one or two surgeons to say how they go about sizing a replacement. I say two because they probably won't agree with each other about how it should be done.
What's sad is that two surgeons like the ones that diagnosed me still couldn't pinpoint where the problem was. One said lower back and the other said left hip. Still they messed my whole cardiovascular system up and made me a cripple by the wrong sized brace and misdiagnosis my xrays. Now being totally disabled from healthy they are going to pay me a lot of money LOL
Hello,
I am happy with your post. I think you are right it is unbelievable but sems to be true. I am no expert but I believe the prothesis are made "fit" by removing bone but that´s plain crazy. In my mothers case it is the hip prothesis from a THR surgery. We are hoping that we figure out if her prothesis is the correct size and not too big or small or rubbing against something or anything. I hope we can contribute in order to help others.
I have learned recently that it has been just in the last few years manafactures have produced a 'woman' sized knee. It never occurred to me that my knee replacements of 12 years ago were man sized! It is inexcusable that there were not, at a minimum, two sizes available. I'm sure the same holds true for hip replacement hardware. At least a small, medium and large should be avaiable. A custom made prosthesis would be ideal but the cost would be prohibitive.
i think that the majority of doctors want the best surgical outcomes for their patients, at least in the USA where there are so many specialists and also lawyers.
Thank you for bringing up this issue. Now I can ask my doctor about it.
I was told by my surgeon that he had fitted the largest ceramic hip replacement to give me as much flexibility as possible bearing in mind my relatively young age. So there must be different sizes.
I think you are correct. They remove bone to accommodate the equipment. I can see this clearly from my xray pre and post surgery and would explain the pain levels. I cannot lie on the operated side even now after 14 months but had to buy a memory foam mattress. I understand that bone is organic and constantly changing and presumably will reform around the metal/plastic. Not once did any medic mention one year minimum to adjustment and recovery. It was more 6-8 weeks! But I am going to pursue diligently this question of sizing. If not custom, then at least dozens of permutations. They are probably turned out in China for pennies. The Exeter which I was told was the gold standard is not rocketscience. Perhaps the socket cup is even more important but with the two components being the wrong size the pain and recovery are doubled. A lot more bone than my femur head have been removed and it can clearly be seen that the femur has been sacrificed. We must be thankful they don't do trepanning and lobotomies with such gusto!
I believe small medium and large still insufficient. Shoe sizes are a case in point. To remove good bone to accommodate that shortage of sizes seems very draconian. ... It is only stainless steel not precious metal and the item I was shown a very uncomplicated piece of stainless steel. The cup like a piece of Lego. Probably all patented and overpriced.
I think the ceramic piece is only the ball which substitutes for the head of the femur which is sawn off along with the required length of femur to allow for the"nearest" fit of steel shaft. I imagine you would feel it or even see it if it stuck out"proud" along the silhouette of your hip. It is the two components, socket and shaft into which the ceramic ball"sits" where size matters. I was unaware of cramic on ceramic so cannot comment other than to say I would have opted for that over metal or plastic. We are all of us wiser after the event Unfortunately!
Result! Let us hope that the cash will make you feel a lot better. ...
O I don't think I'll get any answers from surgeons here. ... it'll be manufacturers and the teaching hospitals doing the purchasing.I have seen the range of sizes available from the manufacturers of my own implant and they are Legion. The socket is more difficult as the hospital seem to know very little and only read the cursory notes on the completed surgical forms which we know are vague and very very brief.
It depends on the manufacturer. Stryker and a couple others only make two sizes ... narrow and "not quite as narrow". Or maybe they're small and medium, but not large. Other manufacturers make more sizes and some make modular/adjustable parts.
My reply should have gone to Gentilleschi!
Very alarming. I wear a dress size 2or 4 and I can see how the bone has been hollowed out. I am now hoping to get a third opinion as the second one worked alongside my surgeon at one hospital. He would not comment on the X-ray which raises questions in itself. Had we all been advised of this sizing anomaly and it's consequences I wonder if I for one, would have even proceeded. The sockets are even more questionable. The metal,ones resemble furniture castors while the plastic ones have a veneer of tiny little lozenges making an articulated surface. I was shown both but not told which I have implanted! I only wish we could all post our X-rays on here so we could be our own advocates
True, sharing our (or my mother´s) experiences here is a good start. Teaming up is also a good idea but combining eachother´s medical information, prothesis size, brand, model and manufacturer, X rays etc. would be perfect.
I was also hoping we could get doctors and surgeon´s input here. After all the participation is or can be anonymous so anyone could contribute without any hesitation or shame or fear. Even manufacturers could join in.
Let´s not forget we are trying to help people here!
I don't believe many ortho surgeons are so altruistic. And as pointed out on here many are offered financial incentives. Also in the UK trusts are Admin driven and their budgets are run on a tight rein. Surgeons probably have to accept what they're given! Now so many nhs Trusts use private facilities for hip replacements they seem to be wanting feedback on everything bar the actual outcome which is all that matters. There were no questions whatsoever on the pertinent matters voiced on this site. I also elieve that surgeons probably do read this site, but they are employees too and perhaps are limited in how much weight they carry in such decision making. Lamentable but we will never know how they arrive at sizing selection. The nhs is now like a secret society so litigation paranoid are they. .... But the sheer number of revisions for both length and width errors must be so costly you think they'd get the hint! Unless the surgeons like electrical manufacturers factor in inbuilt obsolescence to bring in more work! Cynical, moi!
Cynical but realistic, I agree. Nevetheless I am hoping not ALL doctors are alike. After all once they had the ambition to become doctirs to help people right? They swore an oath all of them also. True, they all have to make a living, are on a budget, strings, incentives and are only human too. So they also sometimes make mistakes but we all do, the right thing to do is correct your mistakes and continue to help people. Also on this forum.
One would hope they might contribute but I believe their policy is to keep silence behind the shield of Nhs legal departments. I know a Lloyds "Name" (the London re-insurance market) whose broker told his syndicates the sum of all negligence claims. It makes you shudder.... Then when you attend the clinics you see all the wheelchairs and swollen legs and feet in the ortho dept you realise just how huge must be the percentage of gross mistakes and poor outcomes. Of course you have to take into consideration the general health, obesity, diabetes etc of hip patients but I feel strongly that they should alert us to realistic outcomes. One year is not 6-8 weeks for example. And severe pain can persist for a year or longer .......I was not told just how much bone would need to be sacrificed. .. and on and on. ...