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Early on (after resurf Dec'05) I
experienced a lot of clicks pops etc and so had others, so
whenever I mentioned it to Dr.. Ure and got x-rays which
were just simple straight on AP x-rays he said it all looked
fine no problems, but it didn't really go away although when
I did a lot of clams, it did go away for awhile, but it
returned, the instability as I had come to realize and it
got worse and worse. And became crunches and clunks. And I
told Dr.. Ure and he said that he really didn't know what
could be wrong and suggested more physical therapy, which
didn't help and the physical therapist felt that some
surgical error was involved. And it got worse so that when I
turned in bed at night it would go crunch crunch crunch and
I became less and less able to walk and had given up Pilates
some time ago and swimming even was difficult except for
short bits. But no real pain, except when bending and then
there was severe pain from impingement which would take half
an hour to go away.. So got in touch with Vicky who sent my
x-rays both recent and I think 1year post surgery to De Smet
and Bose and Su and all three said that the acetabular cup
was malpositioned. DeSmet and Bose said that it had been so
from the beginning and Su couldn't be sure of that. Oh yes,
I had in the last two years also consulted a local othopod
who does do resurfacing but I don't think his experience is
great, who had said that all looked ok from xrays and best
to just live with it. When it got worse I'd consulted him
again and had insisted on an xray from another angle - cross
table lateral - and when he saw this, and I guess this is
also what DeSmet and Bose and Su saw, all did agree that
acetabular cup was malpositioned. "Too high anteversion"
said DeSmet. And this is quite confusing to me since I had
the operative report from my resurfacing with Dr.. Ure, and
it described how he'd placed the acetabular cup and then did
a fluoroscopic look at it and then repositioned it to 45
degrees and that that was satisfactory. But perhaps he
wasn't referring to the anteversion and perhaps I think that
my unusual anatomy wasn't sufficiently taken into
consideration including the bio dynamics of my walking since
a physical therapist who specializes in such things would
need to work with surgeons pre-surgery and of course that's
never paid for so it doesn't happen.
Anyway, I spoke to Dr. Ure, and when I'd described my
symptoms of clunking he said I needed revision and that
metal wear is an issue and that were he in my shoes he'd see
Dr. Schmalzreid. He also suggested that I come back there,
but at that point I felt that I'd better not.
I went in late May to Schmalzreid for
consult and he said that he could make me more functional.
He also said that the risks of revision surgery were greater
than with primary surgery...ie, dislocation and sciatic
nerve palsy...
I was scared and retreated home for a couple more months and
then it became apparent that I couldn't go on and that
metallosis from the 2 surfaces rubbing together and wearing
down was obviously getting worse and so I went to LA for
surgery with Schmalzreid. And I no longer could do endless
research and worry. He said that in my case he would use a
highly cross-linked polyethyline cup and a metal stem into
the femur. I no longer could go on thinking that under no
circumstances would I allow this poly implant. I just went
and had it done. LA seemed the closest unless I went with
the local orthopod who also said that he could do the
revision. I could no longer consider the trip to India or
Belgium, mainly because of money but also because I felt
that I simply didn't have the energy to travel. Even NY and
Dr. Su seemed too far and too expensive.
But this revision surgery is so very
difficult. My resurfacing was so easy. There were no real
restrictions. I had no pain after a couple of days and
walked without crutches using only trekking poles for couple
weeks after surgery, and regained strength and flexibility
very quickly. Now I have no pain. Good. And of course I'm
very flexible and this is what is so terrifying. Trying to
monitor my every move so that I don't swivel or rotate or
bend at the waist beyond 90 degrees. And I cannot put weight
on that leg so am on crutches for 6 weeks possibly longer
and so am essentially totally dependent and helpless and yet
still make wrong moves and get so scared of having a loose
hip and forever being at risk for dislocation. And the
revision surgery was long _4 hours-he had to chip the
acetabular component from the surrounding bone; it was all
well grown in as was the femoral component ..too
bad..nothing was loose despite my age the bone was good
enough ...but now of course I no longer have a femoral head.
So, I lie on the bed a lot of the time because if I crutch a
lot as I could do, then my shoulder hurts because I have a
frayed biceps tendon...so that's where it's at. Just hoping
for the best but it's impossible to notice every single move
one makes especially if one is -or had been, very strong
flexible and agile. Aug 5 was my revision surgery. I have
reconciled myself to some limitations. But hope I don't mess
it up so that it could dislocate and so that I must watch
every move for the rest of my life.
Dr. Schmalzreid felt that my structure and my posture and
the degeneration of my discs in my spine and the consequent
accentuation of my lower spinal curve were contributory to
the total situation, that is, the way that I aged
exacerbated the effect of the malpositioning ..at least I
think that's what he said as he spoke afterwards to my
husband ..I was obviously not quite able to take it all in,
but perhaps I was and he just didn't really bother to
explain to me. He also told my husband that the op was very
hard work as he had expected--4 hours in surgery. Lots of
grey metal gunk around hip, prosthesis with black stains.
And I mentioned elsewhere perhaps that in June '08 I had to
undergo Posterior Tibial Tendon surgery which torn posterior
tibial tendon was, I believe secondary to the imperfect hip
surgery and caused by the torquing consequent to the
malpositioned hip prosthesis.
Ok, that's it...Can't think of any cheery
note to end on. No pain at present is it.
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