Multiple Revision Hip Surgery

[Karen]

Hi

I'm 51 and had my total hip replacement in 1983 at the age of 27. Due to problems with bone defiency I have had to have it revised 3 times.

My current revision had an allograft (bone that came from the bone bank) to 'plug' the gap. Over the past 9 years this graft has shrunk in size causing shortening, my hip to rotate and generally it has become unstable.

My surgeon is talking about using a 'Trabecular Metal' graft to replace the allograft and revising the hip again; this depending on the results of a 3D CAT Scan that I need to have first.

I have found lots of information on www.zimmer.com but would like to here from anyone who maybe has had such a graft.

Thanks Karen

[Josephine]

Obviously no-one has had one, Karen. How did you get on?

[Tommy]

I am 61 and was bucked off a horse in November of 2005 and fractured my left hip. They put 3 screws in it to hold in place. It just got worse and so painful I had to go back. They give me a total hip replacement (left hip) in July 2006, and now I am limping very badly and is painful when I try to walk normal. They said I have arthurits and now my left leg is 1/2 inch shorter than my right leg. The doctor now wants me to come back in for my 3rd surgery in a year and half. He is saying that the screws are backing out that he put in there. Can any one tell me if they can make me walk normal again without limping and with out pain when walking? I am a very active person and before getting hurt, I could do more physical work than most 30 year olds. I want to be normal again, I have excellent insurance, is it possible that a surgeon can fix me to walk normal again?

Thanks,
Tommy

[Karen]

Obviously no-one has had one, Karen. How did you get on?

Hi Josephine

My consultant has changed his mind and decided not to use the trabecular metal as they have only got reports over a short period. The reports so far look promosing but he would like more statistics over a longer period, as he wouldn't like it to fail or reject in 5 years time. He has decided (after speaking with a bone graft specialist) that the operation I had approx 10 years ago should be repeated.
I had an allogaft, which has shrunk in size over time, the specialist said this could have been due to the bone not being of a good density. Hopefully this time it willl be better.
Then in 10 years - hopefully longer - they can look at more detailed statistics of the newer metal implants.
I've got to go with their judgement, they usually know best.
I'm having a better tine at the moment, still need crutches but not so much pain. So he's waiting and wil see me again in September to see whether to put me on his list for surgery.

[Karen]

I am 61 and was bucked off a horse in November of 2005 and fractured my left hip. They put 3 screws in it to hold in place. It just got worse and so painful I had to go back. They give me a total hip replacement (left hip) in July 2006, and now I am limping very badly and is painful when I try to walk normal. They said I have arthurits and now my left leg is 1/2 inch shorter than my right leg. The doctor now wants me to come back in for my 3rd surgery in a year and half. He is saying that the screws are backing out that he put in there. Can any one tell me if they can make me walk normal again without limping and with out pain when walking? I am a very active person and before getting hurt, I could do more physical work than most 30 year olds. I want to be normal again, I have excellent insurance, is it possible that a surgeon can fix me to walk normal again?

Thanks,
Tommy

I don't think anyone can tell you for sure - just trust your surgeons. Any improvement helps - I know I'm not as good as 20 years ago but I will always live my life as best as I can.

[Josephine]

Karen - actually, I'm glad for you. I have seen those implants used and while the ones I saw had a reasonable outcome, they are very new. At your age I would tend to be a bit cautious about such things. I wish you well in your future treatment.


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Tommy, sounds like you're another poor soul who's had bad luck. If I read your story correctly, you first had a fractured neck of femur fixed with screws which was then converted to a hip replacement. Now you have arthritis in the joint that requires another revision. Am I correct so far?

But are you sure it was a total hip replacement; that is the cup as well as the stem?

My experience is that a screw fixation of a neck of femur is followed by a HEMIarthroplasty which is just the stem and no cup because the socket part (acetabulum) is quite healthy and shouldn't need to be touched.

So, I would judge that the scenario might be that the screws you had in initially moved and damaged the socket. This happens occasionally when the fracture site ages and the whole bone loses mass. This accounts for the loss of bone length. The screws can either extrude from the bottom or at the top where they can cause damage to the joint surface. And though they replaced the top end of the femur with the prosthesis, maybe they didn't realise the extent of the damage or it was relatively minor. Or the arthritic changes were from the original injury and fairly inevitable.

This is a sad fact but true, that fractured necks of femur are very problematic and there is a great deal of discussion amongst surgeons world wide as to whether they should be treated with a THR straight off without going through all the other steps. It would seem that might have been so in your case but it's always easy to be wise in hindsight!

So you are now going to have a totally new hip which should sort out your problems and make up any loss of bone length. I think you should be looking forward to a good future and to being able to put this unhappy period behind you.

Do let us know how you get on.