Carl and Pam

This patient is experiencing a lot of pain and he is over 10 months post op. Still no conclusion as to why he is having pain.  (April 2009 Update below and cause of pain found)

Surgery November 19, 2007, 39 year old male

From his wife
He was doing fairly well after the surgery. If you see from the posts, the accident left him with inadequate coverage from the socket for the femur head. Maybe Posteroinferior coverage of the acetabular wall, or something like that. I will look at the radiology report and see what it said. I will include that as well. March 3, he returned back to work. He was doing Ok, but might have a bit of start up pain, and didn't seem like too much out of the normal of what some of the people with "slower recoveries "where experiencing. Again, he is a union, commercial plumber, so his job requires much bending and stooping. Since about the end of May, he's been complaining of pain. Somedays just throbbing, somedays aching, until finally we called Clohisy in first of August, and they got him in.

Main symptoms he was having then, and still now are, 1.) Sharp shooting pain in groin while Standing on operated leg and lifting other leg to put on pants, 2.) Sharp pains in groin when rising up after being in a bent over position, or sometimes from a squating position. 3.) Sharp pains in groin when he's been standing on a ladder, usually with more weight on his operated side, then, comes off of that leg. 4.) Some pain that goes to his knee. Not sure if it's just localized to the knee, or if it is a continual pain from groin to the knee. 5.) He complains like he freezes in a bent position sometimes. Not sure what that actually means, kind of like he gets stuck there.

So...mainly he is having these pains that he was not having about 5 months ago. Sharp pains that take his breath away and stop him in his tracks. Seems mostly like when he is shifting weight from his operated, by taking the weight off, is when he has it a lot. Like I said before, he had an injection in the psoas tendon on Sept 9, and it provided NO relief. He is scheduled for a PT on Monday where they are going to try and release that tendon. The other day, he was limping just like before the surgery.

So..that's a bit of his pain right now. When I try and get these cd's converted, I will send some details of the accident, and radiology reports so the docs have a bit of history for him.

Thank You Vicky,
Pam

Mon Dec 24, 2007, 8:16 am

My husband had L hip resurfaced on November 19th. I would say he had a slower recovery than most on here as well. So, he was quite frustrated as well.

But...he has gotten much better. He is 39, with rather large muscles, his muscles are very, very tight too. He has always been a huge fan of working out, and he was in great shape before the surgery. So...of course he thought he might recover a bit more quickly. When he had a few setbacks, he'd get really frustrated, but just hang in there. It will get better. He just kept icing it all the time to keep the swelling down.

Each day seems to get better, and then maybe a bad one once in a while, but it is getting better!! Hang in there!

Jan 24, 2008, 5:54 am

I am sort of using this thread to get a bit of input from anyone about my husband going back to work. He is 9 weeks post op, and doing fairly well. Getting better every day. At 8 weeks post op check up last week, Dr. said everything looked good, and said when Carl felt he was ready, he'd let him go, but with some restrictions. Of course, my husband is mentally ready to go back, since, he has been off for almost a year due to the car accident that caused his hip problem. There was a fracture dislocation of the hip, and a serious elbow injury. Fracture treated conservatively, for 3 months, then hip scope, and off for about 4 more, and schedule for HR, that was done on Nov.19th...so...there has been significant trauma done to this hip, and seems like it has taken a bit longer to heal.

He started outpatient PT, and is going on his 3rd week of it now, and getting better daily.

He is a union plumber, and will be on various construction sites on uneven ground, on his feet most of the day, and has to carry about 50 and up to over 150 lbs at some times up and down ladders and what not, and will have to squat and get in various different positions throughout the day. He says he'll be fine, but of course, I worry terribly about him going back too soon. I see that a lot of people return about 8-12 weeks post op, and I am trying to get him to wait until his next evaluation on March 18, which will put him about 16-17 weeks, or 4 months post op. Does this seem logical to anyone, or am I just being a bit overprotective. We've been thru so much this past year, and the last thing I want him to do is hurt this new hip, and then he is back in the hospital.

Needless to say, we have spent this whole year together since I do not work outside the home, and I keep telling him that the bottom line is that "You really don't want to be home with me for another 5 months, do
you?"...heehee....Just trying to put a bit of humor in this.

If anyone can give me any reassurance, pls do!!

Thanks,
Pam, wife of
Carl, 39, LHR C+ 11/19/2007
Dr. X, St. Louis, MO

Thanks Vicky,

I don't have them at hand right now, but can get them. If you can recall, this was all due to an auto accident in which my husband was in in February of 2007 in which he was a back seat passenger and he suffered a dislocated and broken hip, so, then it healed incorrectly, and then in July of 2007, he had a hip scope that revealed severe stage 3 and 4 post traumatic arthritis, and a severely torn labrum. Dr. X did the best he could on that scope but warned that it probably would not be a great outcome, and he'd probably need a THR. Then, he got a hip res. in November of 2007. If you want more info, let me know, but you can probably type our email addy, and see all the posts. Not a lot of them, but it gives the story.

We got a lawyer because of the severity of Carl's injuries, and the amount of work he would miss. I know we have some of the xrays, but not all of them, however, I'm sure he has everything,) so I will contact him tomorrow and let him know what's up. He will be 40 on November 1st, and plumber for his job, so, he's still young, and that's the only occupation he's known. After almost 2 years of everything, we just want this thing as good as it can be, and from hearing about everyone elses stories, it seems like he could be doing better.

So...what xrays would you like. The ones that they took about a month a 1/2 ago, or some others before that.  Just let me know, and thanks for your help, concern, and support.

Pam

Well...we live in Springfield, ILlinois, so, actually going to the radiology dept in St. Louis is a bit out of the way, but, if I have to, I will do that. However, I will try the other route first, and have them send a disc to us, and try to convert. I might need a bit of help doing it, so if I run in to problems, I might contact you if you don't mind. I kind of thought like you, and that they didn't need to know anything either, and that Carl has a right to those w/out any kind of questioning whatsoever. So...I will do that w/in the next few days, and try and have them FEDEX it to us. Thanks so much for your help.

He had a painful day today as he has been having lately. Kind of scares me. I've been reading about other peoples symptoms of problems, and some of them sound a bit like Carl's. Also, he has been having pain in his knee as well. We don't know if that is from the traction rod that was in his leg for 4 days after the accident, or if it is from something with this.

Thanks Vicky, and I'll be in touch,
Pam

Diagnosis Finally
January 18, 2009

From First doctor

From what I can see, I would say like I already mentioned before he has an impingement problem, with a non perfect placed prosthesis that results in conflict from the femoral neck with the cup. If the cup is well placed this can be solved with a stem and big metal head, if not, this means a full replacement. If the metal ions would be very high, it means also a full replacement has to be done.

Second doctor response

Thanks for sending the recent images. Now the diagnosis is very clear. As I had indicated in my first mail - he shows evidence of pincer type impingement with an indendation sign in the pre-op x-rays. This was due to effective acetabular retroversion consequence of the fracture. The hip resurfacing was not the ideal surgery for him as the same pathology would continue postop. The Aug  x-rays that you sent to me later & the Nov x-rays show very clear features of impingement even in the A-P view. This is undoubtedly the cause of his pain. It is highly likely that he will need revision surgery.

Third doctor

Yes, it is now clear from his most recent xrays that the femoral neck is impinging against the acetabular component."

January 26, 2009

Carl is now waiting for an appointment with the third doctor and we will keep you updated on his progress.  It looks like he will need a revision to a THR.

February 27, 2009 Update

We went with a less experienced surgeon, and now Carl is going to New York, to get it all fixed!. Surgery date is set for April 17th, with Dr. Su. His Doctor before is a great THR guy, but was not very experienced in the resurfacings. Carl's case was more complicated, because of a fractured socket that healed w/ deformity. It seems that the cup may be loose, and there is serious impingement. Symptoms are getting worse all the time. His previous doctor though has agreed to help in any way he can with any information he can offer to Dr. Su, if needed. I just hope and pray for a good outcome and end to his pain. I am a firm believer that experience does matter, and, it took a unperfect surgery for us to find out.

Pam, wife of Carl, LHR Wright C+
November, 17,2007

Update April 23, 2009

Hi to All,

Was just wanting to update everyone on my husband Carl. Carl went up April 13th, met Dr. Su on the 15th, and had surgery on the 17th. I got up there on the 16th, and got to finally meet Dr. Su on the day of surgery. He was everything we'd expected and heard about. Surgery went very well, and Dr. Su came out and talked to me afterwards. He explained that the cup, (which he originally thought may have been loose), was indeed, nice and tight. So, he was able to salvage the cup. Which, enabled him to do a conversion to a total hip replacement on the femoral side with a large metal head prosthesis, with a smith and nephew component. Not sure which one it is though. Carl was discharged back to our hotel on Monday, which was Courtyard Marriot on 3rd and 52nd, which was a short mile walk for me and our son while Carl was in the hospital. Dr. Su had visited him before that, and showed

 Photo: Post op Pam and Carl in NYC, no crutches!

Carl pictures during the surgery. He said that after he put him under, and he opened him up, he began to move Carl's leg in diffferent directions. The femur neck was hitting the cup implant (causing severe impingement) every time he moved the leg in all different directions about 2 inches each way. He showed Carl the divets, or notches it had carved in his femur neck. He also released the psoas muscle, and said Carl had severe inflammationan around the hip joint.

So, we are back safe and sound in Springfield, IL, and he is doing great.  He woke up Sunday morning in the hospital and called me and said,"it finally feels right. I'm in pain from the surgery, but the hip feels right!" I will keep you updated on the progress, and thanks so much to Vicky and Dr. Su.  If it weren't for Vicky, we would have never moved forward to seek out the most experienced of the docs!

Dr. Su truely is a "Rockstar Dock" in our opinion.

Pam, wife of Carl,
left hip resurfacing, Wright Conserve+, Dr. Clohisy,
St. Louis, MO 11-19-2007
Photo Pam and Carl NY Post op
Conversion to Total Hip Replacement
Dr. Su. April 17,2009

 Photo: Carl back at home, finally pain free!