JMS's Hip Resurfacing Revision 2011

March 10, 2011

I have recently had a revision of my BHR to a THR because of high ion levels, even though I had no pain, nor any evidence of pseudotumor. My only symptom was a slipping or clunking sensation deep in the joint. My experience suggests that one can be at risk for metallosis long before symptoms appear, and that patients who have a serious clunking problem that persists would probably be wise to have their metal levels checked.

My resurfacing was done by a highly experienced surgeon 18 months ago. I had a smooth recovery and was delighted to be pain free within a few weeks. The hip clunked with certain movements, but I was reassured by both the surgeon, and much of the discussion on this website, that this would be a temporary problem that would resolve itself. It didn’t, however. In fact, the clunking became more and more frequent – eventually reaching a level of many hundreds of clunks a day.

At my one year follow-up appointment everything appeared to be fine – x rays looked good, (acetabular cup at a near perfect 40 degrees), excellent range of motion, pain free, etc. However when I raised the issue of the clunking yet again, this time the surgeon was concerned and arranged for my metal ion levels to be checked. The numbers came back sky high: 1616.9 for cobalt and 840 for chromium. When the ion levels were checked again six weeks later, they had risen significantly to 2265.8 and 1219 respectively.

Given these exceptionally high levels, and the rapid rate of increase, I was immediately scheduled for surgery to remove the BHR and replace it with a THR. The surgery went well. There was a great deal of metallosis but no sign of pseudotumor and no bone damage, confirming the value of the early intervention. The surgeon was able to remove the acetabular component with minimal bone loss allowing for what we trust will be a successful replacement implant. So far (8 weeks post surgery) I am very happy with the performance of the new THR, which is pain free and clunk free. I have been tested for metal ions again recently and am awaiting the results. Hopefully they will confirm that the levels are dropping.
 

August 7, 2011

I began diving again at seven months with my surgeon's ok and no depth restrictions. The diving was great although I used more air than usual because my muscle strength wasn't as good as usual and I was tired when I got back to the boat.

My real problems came on a later dive when I was visiting DR and found that the boat was not well equipped with a decent ladder. Getting in was easy of course but getting out was a different matter. I passed up my BCD and weights to minimize effort but still had difficulty accessing the short ladder, and much more seriously swinging my leg over the rail sideways. I didn't have the ROM to do it and ended up being hauled in! So be cautious about diving with unknown operators

August 15, 2011

Following on from my earlier post about clearing metal ions from the system after revision surgery, I have just received the results of the metals test done six months after the revision surgery.  The pattern was as follows:

                      Prior to surgery               6 weeks after                  6 months after
Cobalt             2265                              153                                38
Chromium       1219                              165                                98

The levels are therefore continuing to drop though less rapidly than in the first six weeks.  It is also of note that while the chromium levels never went as high as the cobalt levels, they are also clearing more slowly.
 

October 1, 2011

 Having been through a revision myself, I can assure you that the THR feels just as good as the BHR did, with all the freedom of movement I had before. It is also very good to be free of the various side effects of the elevated ion levels. None of us want to lose our resurfs or go through a revision, but the reality on the other side isn't half as bad as you might fear.

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