Wendy - Misplaced Component and Notch

About five years ago I was diagnosed with femeroacetabular impingement.. I was 39 and very active, enjoying working as a nurse and playing sport and going on long walks. I had two arthroscopies to try to prevent deterioration in the joint about one year apart but these failed to stop the progression of arthritis and I finally had my hip resurfaced on the 1st Dec 2008. My post op recovery was slow but I returned to work at three months post op and was walking up to a few miles a week. I was very keen to return to playing tennis although I continued to have some discomfort at 6 months. I played some gentle doubles and that sparked off an increase in pain and stiffness that made it very uncomfortable to walk. The pain increased in severity and my range of movement reduced and I noticed that it was painful to do a straight leg raise.  I went to see my surgeon and he suggested PT and ordered an ultrasound. The ultrasound showed some psoas tendonitis and bursitis and I was injected with steroid and told to rest for a couple of weeks. The pain did not subside and with activity it worsened to the point where I once again found it very difficult to walk. I saw the surgeon again and he ordered an x ray which he believed showed the joint to be in perfect position.

I continued to have difficulty walking and went back to the surgeon. He decided to take me to theatre for further steroid injections and he used a contrast dye to look at the soft tissues around the joint. The contrast showed a mass of tissue that looked like scarring or adhesions and he believed this was causing all my symptoms. He ordered regular PT and stretching. The steroid relieved the pain for a short period and I adhered to this programme for six weeks. The pain returned and was worse than ever and at that point I decided to email my x rays to Vicky. The surgeons she forwarded them to said that the cup looked misplaced and I needed a revision. This came as such a shock because it was not something my surgeon had considered at this time.

I took this information back to my surgeon and he reviewed my x rays and agreed that the inclination angle was on the outer edge of acceptability (56 degrees). He had mentioned metallosis at an earlier consult but wanted to exhaust all possibilities of soft tissue problems before facing a revision and he believed that taking metal ion levels within the first year post op showed misleading elevated results.

I had a revision to a ceramic on ceramic total hip replacement exactly one year after the resurfacing. My blood cobalt and chromium levels were 10 times higher than accepted levels. The post op reports came back describing ALVAL in the joint.

I am making a steady but slow recovery, I am now about 7 weeks post op and I cannot walk without a crutch and it all feels very sore and tender but I feel positive that I will make a full recovery. When I was struggling with my recovery I found the ‘hip’ community invaluable as a resource.. I am so grateful to Vicky for listening to me and for using her influence to help me find an answer to my problems.

Wendy

LBHR 12/01/08

Revised THR 12/11/09

Diagnosis from Dr. Bose on implant placement (see x-rays below)

“Hi Vicky,

I am afraid that this is bad news.  It is a combination of factors.  The following are contributing in not having a good result.

The cup is mildly open.

The femoral head is undersized

There is a inferior notch.

There is no satisfactory head neck offset - There is bound to be impingement.

There is an element of edge loading.

While each of above components by themselves will not cause a failure - their combination in the same patient may be detrimental to a good long term result.

I would advise a revision.

with best regards

vijay bose

chennai

wendy