Obviously I am devastated. I went into this being told that resurfacing would last me at least 15 - 20 years. It has only been 18 months and I need to undergo a total hip replacement.
Usually you would return to the surgeon who did the first surgery, to do the revision, but I cannot as I have issues with the way his practice handled the recall.
Finding the Right Surgeon to do the Revision
05/03/2012
My husband makes numerous phone calls and is determined to find an expert on revision surgery. We strike lucky and find a surgeon in the area who specializes in revision surgery. He fits me in the same day and I feel like there is some hope. His credentials are impressive. He has a special interest in hip revision surgery. He has an MBChB (UCT), an FRCS (Eng) and an FCOrth (SA). He did a knee and an advanced hip fellowship in Bristol, UK in 2004. He has a number of papers published in peer review journals and has presented widely. All boxes ticked.
Here are some points as to why this new surgeon impressed me:
1) He took considerable amount of time studying my X-Ray, MRI and various tests, before he called me in.
2) He was empathetic, yet composed, and sure of himself. I trust him.
3) He did a THOROUGH examination of my hip - different angles, movements, pressure etc.
4) He listened to ALL my concerns and symptoms, and I felt that he genuinely understood.
5) He knew about the developments in MRI protocols and explained what what going on with my MRI. He showed me the images and we talked through all of it.
6) He spent some time on my X-Ray, and confirmed definite loosening of the femoral component. [I was amazed that no-one else had seen this?]
7) He was knowledgeable on metal toxicity and its systemic effects.
8) He had considerable experience with revision surgeries, as well as resurfacing. He said that he stopped doing resurfacing 3 years ago, when he had heard about the high failure rates of the ASR and others. He was a fan of the BHR and I was too.
After considerable discussion, I decide to go ahead with revision surgery. My surgery is booked for Tuesday 13th March 2012.
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| Orthopedic Surgeon #3 |
05/03/2012
My surgeon discussed my options with me, and has selected the design of the hip replacement and size of femoral ball to give me the range of motion and stability that I need to function. I have 2 choices of hip prosthesis to consider, each using varying materials and having different pros and cons:
1. Ceramic Ball and Ceramic Liner
Ceramic is the 21st century answer to hip replacement as it is both hard and durable, it wears minimally and the material is widely deemed to have no toxic or side effects in the human body. Because I am a very active and still young, my surgeon has recommended an all-ceramic hip joint. Ceramic-on-Ceramic is a good combination with longevity and reliability.
There has been a history of two issues with ceramic hips: catastrophic shattering and squeaking. Shattering was more of an issue in the 1980′s and 1990′s but the product has been substantially improved since then, essentially eradicating the shattering problem. Squeaking, however, remains a bit of a problem for a few patients. Often the noises abate over time but sometimes they don’t. If the squeaking is intolerable, a revision may be necessary.
Ceramic is the hardest implant material used in the body, and has the lowest wear rate of all, to almost immeasurable amounts. Consequently, there is usually no inflammation or bone loss, nor systemic distribution of wear products in the body. New ceramics offer improved strength and more versatile sizing options.This is first prize. If this won't work, my second option is metal ball and polyethylene liner.
2. Oxidized Zirconium
Because of its durability and performance, Metal-on-Polyethylene has been the leading artificial hip component material chosen by surgeons since hip replacement surgeries were first been performed. It is also the least expensive bearing.
OXINIUM material has no detectable nickel content. Compared to the traditional metal used in hip implants, the zirconium and niobium contained in OXINIUM material are more biocompatible. This makes OXINIUM heads an appropriate choice for patients with metal sensitivities. Whether it’s metal sensitivity or metal ions you are concerned about, OXINIUM heads on XLPE liners address both of these issues. OXINIUM, oxidized zirconium is a metallic alloy with a ceramic surface that provides wear resistance without brittleness. OXINIUM material combines the best of both metal and ceramics.
The combination of OXINIUM heads on XLPE liners offers:
• No risk of fracture, chipping or squeaking
• Hypoallergenic Biocompatible solution for metal sensitive patients
• Proven low wear rates
In addition, OXINIUM heads and XLPE liners are available in a wide variety of head sizes and neck offsets, which allow you the intraoperative flexibility to help restore a full range of motion.
09/03/2012
I am making notes of what I need to discuss with my surgeon pre-surgery on Monday:
1) Will he be willing to film the extraction of the DePuy ASR and also comment on any visible damage as a result of the DePuy ASR.
2) Will he be willing to photograph any damage caused by the DePuy ASR
3) I must have my periprosthetic tissues sent for testing, to see if they will reveal amounts of lymphocytic infiltrates, that can be suggestive of an immunologic reaction.
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| I will be taking the Smith & Nephew Ceramic prosthesis. In Pink . |
There has been a history of two issues with ceramic hips: catastrophic shattering and squeaking. Shattering was more of an issue in the 1980′s and 1990′s but the product has been substantially improved since then, essentially eradicating the shattering problem. Squeaking, however, remains a bit of a problem for a few patients. Often the noises abate over time but sometimes they don’t. If the squeaking is intolerable, a revision may be necessary.
Ceramic is the hardest implant material used in the body, and has the lowest wear rate of all, to almost immeasurable amounts. Consequently, there is usually no inflammation or bone loss, nor systemic distribution of wear products in the body. New ceramics offer improved strength and more versatile sizing options.This is first prize. If this won't work, my second option is metal ball and polyethylene liner.
2. Oxidized Zirconium
Because of its durability and performance, Metal-on-Polyethylene has been the leading artificial hip component material chosen by surgeons since hip replacement surgeries were first been performed. It is also the least expensive bearing.
OXINIUM material has no detectable nickel content. Compared to the traditional metal used in hip implants, the zirconium and niobium contained in OXINIUM material are more biocompatible. This makes OXINIUM heads an appropriate choice for patients with metal sensitivities. Whether it’s metal sensitivity or metal ions you are concerned about, OXINIUM heads on XLPE liners address both of these issues. OXINIUM, oxidized zirconium is a metallic alloy with a ceramic surface that provides wear resistance without brittleness. OXINIUM material combines the best of both metal and ceramics.
The combination of OXINIUM heads on XLPE liners offers:
• No risk of fracture, chipping or squeaking
• Hypoallergenic Biocompatible solution for metal sensitive patients
• Proven low wear rates
In addition, OXINIUM heads and XLPE liners are available in a wide variety of head sizes and neck offsets, which allow you the intraoperative flexibility to help restore a full range of motion.
09/03/2012
I am making notes of what I need to discuss with my surgeon pre-surgery on Monday:
1) Will he be willing to film the extraction of the DePuy ASR and also comment on any visible damage as a result of the DePuy ASR.
2) Will he be willing to photograph any damage caused by the DePuy ASR
3) I must have my periprosthetic tissues sent for testing, to see if they will reveal amounts of lymphocytic infiltrates, that can be suggestive of an immunologic reaction.
4) I want to retain possession of the prosthesis so that it can be sent in for testing.
5) I would like copies of his surgery/theater notes as soon as possible so that I understand what was found.
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