Sarah's BHR revision 2014

October 4, 2013

I am the proud owner of a BHR (2007 Mr John O'Hara) to my left hip and a Duron (2011Aled Evans) to my right.
 
I was 39 for my fist HR following an osteotomy the year before which didn't deliver the anticipated benefit. In short I laid the removed bone back within 3 months!
 
The reason I am emailing is that my BHR is failing and this seems to be accelerating at a huge rate. I first noticed issues 12 / 18 months ago, though reading some other stories my left hip has always popped & banged, though now I'd show the best rapper the way to go, unfortunately this is now accompanied with sharp pain.
 
If you have any additional information / back ground you can share I would be very appreciative. I will also catalog my experiences over the last 7 / 8 years coupled with my up coming diagnosis as I see my 2012 Duron fitting consultant tomorrow (2 Oct).
 
Original prognosis for my problems were growth plate slippage in puberty put down to a very competitive time practicing martial arts through my early to late teens, coupled with a healthy addiction to exercise always. First symptom of something wrong with my hip was tearing the ligament across my pelvis during delivery of my fist child.
 

November 13, 2013

I saw my consultant today and thought I'd update you on where I am with my hip situation, to date.

I had an MRI initially which has shown marked atrophy to my gluteus medius and minimus. The Radiographers reports suggests the atrophy was as a result of nerve damage!
 
My appointment today was to review the result of my blood test, my cobalt level is 44! I'm guessing you appreciate the significant of these level. My consultant explained 7 is good, google tells me 20 is enough to consider a revision!
 
I have a couple more tests scheduled before we take any decisions, one to check nerve conductivity and one to pull some fluid from the joint.
 
In reality, because my bloods are so bad and based on the reading / research I've done, plus the conversation today, once my consultant has established the facts & knows what he's dealing with, I'd put good money on having to have a revision to a total hip replacement, irrespective of what's behind the muscle atrophy.
 
The harsh facts however is that the total hip will have a significantly higher risk to hip dislocation because of the marked muscle atrophy and that will mean adjustments to my life style. He could put a joint in that would restrict movement & reduce this risk, but for someone my age and with the level of exercise that I have enjoyed, he feels that this would be a real extreme choice and not a good choose for me. He can & would use a bigger hip joint to help minimzse this risk.
 
I have to say it's not quite where I expected to be but life is never predictable and there are plenty worse things going on in the world. I'll just have to adjust! Oh and see what comes of the other resurface on my right hand side!

January 28, 2014

 I am now 3 weeks from revision surgery, and have to say this recovery more arduous than my last! Due to the significant bone graph I am only touch loading my new hip for the first 6 weeks and the pain is worse than with my previous surgeries. This makes the 3rd major surgery to my left hip in 7 years and I am only 46 (this doesn't include the resurface to my right in 2011)

What my consultant found when he operated was significant bone necrosis to the pelvis, behind the acetabulum cup of the BHR. Thankfully whilst the necrosis was significant it was not not enough to require additional metal structure to re sight the new cup and was still managing to hold onto the old cup. He also commented that it was the first time he had seen metal staining from the high level of wear from the prosthesis. The 'offending' BHR is now back with Smith & Nephew for test & measurement. It's important that I understand why this has occurred given the Duron fitted to my right hip.

Fingers crossed when I have my 6 week check up, X-Rays and bloods all will be good.

Assuming that I am able to get a definitive answer to this failure, again I will let you know. From my perspective it has to fall in one of the following 3 options:

1) It was fitted badly - however numerous X-Rays didn't indicate this
2) There was a manufacturing problem with the specifics BHR - I work in product design, manufacture and inspection (aerospace) and am not sure how this would occur given the level of quality control procedures
3) I / my skeleton can't accommodate metal on metal implants. Not good for me as this will lead to a further revision. Not a happy thought

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