Femur
Neck Fracture after Hip Resurfacing
After
released to start exercising with minimal restriction, I went to
the gym on a regular basis to help rebuild the muscles. I had worked my way up to one hour of cardio exercises (e.g.
cross trainer, treadmill, and stationary bicycle). Nothing real stressful or at a high tension setting, but I
was going to the gym 6-7 days per week.
A
awoke one morning after my normal workout, and my leg felt sore.
I rested it that day, and the next morning it felt fine.
I then went to the gym for a lighter workout of 30 minutes,
and it still felt fine. Also,
the next morning it felt fine.
My
job requires a lot of sitting, and when I stood to go to lunch the
next day, the leg felt really sore.
It was more of a sharp pain when I tried to walk.
I was still using a cane at that point—mainly for support
due to weak leg muscles—but I really needed the cane for support
at that point.
The
leg continued to bother me into the night and the next day.
It hurt all the time like a dull ache, and I’d get a
stabbing pain when I walked. It was pain similar to what I experienced prior to surgery.
An
X-ray revealed that the prosthesis had shifted due to a femoral
neck fracture. It was
clear as day in the X-ray. Two
days later I had revision surgery to a large head metal-on-metal
total hip replacement.
Everything
happened in a relatively short period of time.
From the onset of pain to the revision surgery only six
days transpired. I
had been to the surgeon and had X-rays two days prior to my onset
of pain, and the fracture did not appear in those X-rays.
The fracture was a catastrophic failure that happened
quickly and was resolved quickly.
Loosening
of the Femoral Component after Hip Resurfacing
Scenario #1
The
main symptom was pain I’d experience when I'd get up from lying
down or sitting. It
lasted for weeks and continued to get worse as time went on. It became obvious that something was wrong, and it caused me
to schedule an appointment with my surgeon.
The X-ray revealed that the femoral component had dropped
or repositioned due to a loosening of the component.
Revision
surgery was performed, and a large head total hip replacement
femoral stem was implanted. I
had my resurfaced hip for approximately 16 months before symptoms
developed, and my revision surgery was performed 17 months after
my original resurfacing surgery.
Scenario #2
Approximately
two years after my resurfacing, a shadow appeared near the edge of
the guide pin of the femoral component (i.e. radiolucency).
This did not necessarily mean an implant failure was
inevitable, but it was something that needed to be watched.
I had had perfect function of the hip and no pain except
for a little soreness when I had been on my feet all day.
I had already been diagnosed as having a soft bone
condition at the time of surgery with small sponge-like crevices
on the top of the femur.
Later,
I began getting referred pain in my knee, and I’d occasionally
experience a sharp pain in the hip if I was leaning forward and
putting a lot of weight on that leg.
Afterward, I began getting weight-bearing pain in the leg.
It was in the front of the thigh and running down to the
knee, and it was different than the groin pain I had experienced
before surgery.
More
X-rays did not show any differences in the hip structure, and it
was determined that the femoral component had loosened—not
catastrophically, but it had loosened nonetheless. I began using walking aids while preparations were made for
revision surgery to a large head total hip replacement stem.
The revision surgery was then performed without any
complications. The
acetabular cup remained solid and was not replaced.
Loosening
of the Acetabular Component after Hip Resurfacing & Total Hip Replacement
The patient may
be reporting groin or anterior trochanteric pain;
The patient may have increased thigh pain;
The patient has significant startup pain with ambulation (walking),
or rising from a seated position, may have buttock pain;
The patient may experience significant pain with weight bearing,
and may require a cane or crutch;
The patient may be unable to exert resistance in a straight raised
leg test and a side-lying abduction test;
Many patients experience debilitating pain and are unable to stand
or walk unaided; and
An x-ray may show possible component migration.
AVN in
the Femoral Head and Neck after Hip Resurfacing
Five
months after my surgery, I began to notice a mild weight bearing
pain in the hip. It
was especially evident if I stood on one leg and then removed
weight from the leg. I
would experience a long drawn-out ache as the weight was removed.
Then I started noticing an ache when walking that would
increase as if building to a sharp jabbing pain if I walked too
far. It then became very tender to certain movements and having
weight applied to it.
This
eventually subsided, and I went several months with just some mild
tenderness in the hip in the form of a “start-up” pain when I
would start walking. By
nine months, however, the joint increased in tenderness and pain.
A mild pain would also extend down the leg into the shin
area, and then one day the pain became extreme enough that it was
hard to walk.
The
intense pain subsided, but would resurface sporadically if I
engaged in strenuous activity.
After two months, I was getting regular weight bearing
soreness, and I began walking with a cane to help alleviate it.
It was mainly “start-up” pain, and I could often
“walk it off” by walking a distance. I had less discomfort on longer, straight walks than with
short quick steps and movements.
My
X-rays at that time started showing a shadow along the guide pin
of the femoral component, and the femur neck was developing a
jagged or remodeled appearance instead of the prior smooth
contour. The pain
then became intense and started bothering me in my sleep.
Any movement of the hip could cause a sharp jolt of pain,
and I began getting referred pain in my knee that felt like
someone was sticking an ice pick in the side of my knee.
By then I was walking with crutches and putting little or
no weight on my leg. I
was also taking pain medication (i.e. Vicodin) at night.
One
year after my resurfacing surgery, I had revision surgery to
implant a large head total hip replacement stem to replace the
resurfaced femoral component that could no longer be supported by
the femur head and neck due to avascular
necrosis (AVN). The
acetabular component was solid, so it was not replaced.
Infection
after Hip Resurfacing & Total Hip Replacement
Scenario #1
I
experienced a lot of swelling up to three months, plus I had a
fair amount of pain. I improved slowly, but I still used two
crutches for distance walking up to six months after surgery
because I could not full bear my weight on the operative
leg. I would, however, use one crutch around the house.
I
experienced a lot of pain at night, though it was variable, and
the doctor said that night pain can be an indication of
infection. The pain was both deep in my groin, particularly
during the last 5 months, and in my adductor (?-the outside of my
thigh) muscles. Blood tests after three months showed raised
levels of inflammation, but no infection was indicated in those
tests. The next step was a hip aspiration (i.e. extraction
and analysis of synovic fluid from the hip capsule) that could detect
the presence of an infection.
The
aspiration of my hip capsule revealed that I have an infection,
but a low-level one. The infection, which did not shown up
in my blood tests other than in raised inflammation levels, did
not immediately show up on initial testing, but it was grown on an
enrichment culture and is from the bowel, of all things. It
is called Enterobacter Cloacae. (It
is one of the bacterium from the bowel--an E-coli. It was
low level, and it did not show up in my white blood cell count, only in my raised inflammation
levels.)
My
consultant said it was rare (he had not seen it before) and that it
could have come from many sources—all very uncertain. He
said that some bacterium form a polysaccharide layer—as I
understand it, a kind of a tent—that makes it difficult for
antibiotics to reach. It is also difficult if the bacterium
is on the metal, as opposed to in the blood or fluid or bone, as
the antibiotic cannot connect properly with it.
He
wrote to a microbiologist to ask for advice about this
particular bacterium and which antibiotic was possible, and in the
meantime, he gave me different night pain killers. Despite
the new pain killers, I still had a lot of night pain, and I was often awaken by the pain every 1 ½ - 2 ½ hours, particularly at
the beginning of the night. This left me pretty wiped
out during the day. Other days, however, I was not too bad.
I did seem to have quite a lot of energy again in spite of all
that
happening.
The chance of an antibiotic working was only about 30 - 40%, but
the treatment was not successful. I am now scheduled to have two operations. The first
takes out the resurfacing and puts in a spacer.
I am then given antibiotics for six weeks in order to clear
the infection. The second operation gives me a Total Hip
Replacement.
I hate the thought of two more ops, but there is nothing I can do
about it. Whenever we go into surgery, we always face
some risk, however small, and must weigh up the difficulties if we
never bother to take the risk. If I had to do it again, I would still have my op. It is
unfortunate, (to say the least) what has happened. It is not
life threatening. (I have friends fighting cancer and
strokes.) In the end, I should get a functional hip.
And I am getting wonderful attention from all my superb friends,
colleagues, clients, acquaintances and family. I'll be all right.
Scenario
#2
I
did not have any symptoms other than pain. My pain began about
four years post-op, but I had a large amount of bone loss between
the first and second year. My
one-year follow-up x-ray looked good, but when I went back one
year later, there was a large area of bone loss. I had no pain at
that time, no fever, and no indication of any problem.
My
doctor was surprised at the bone loss so soon,
and he consulted with another doctor, the doctor who
actually designed the type of replacement that I had received.
It was suggested that I wait on the revision since I had no
pain.
When
I began having pain, the doctors attributed it to the bone loss.
Five different surgeons
looked at my x-rays during that time, and I was finally revised by
a specialist whose main area of research is in osteolysis caused
by the polyethylene liner. Since my stem appeared to be okay, the plan was to remove and
replace my liner and then do a bone graft to the area of bone
loss.
Well,
when I woke up from the surgery, everything had been removed and
left out of me, and they said I had an infection.
What he found surprised the doctor because I had no signs
of infection. When he
went in and removed some tissue, it came back positive for
infection. He then
did another sample, and it was also positive, so they decided to
treat the infection before doing any more surgery.
It
was a difficult time, I was unable to walk any because there was
no hip, and it was painful. I was given IVs of
Vancomycin twice daily for three months. I was able to do
this at home with my husband and my mom learning how to give the
IVs. After 12 weeks
of this the surgeon put everything back in, but he left me on the
antibiotics for another month. That was in 1998 and I have not had
any pain since. (It is now 2004.)
The
odd thing is that when they cultured the specimens to find out
what bacteria it was, my cultures never grew anything. We
don’t know where I got the infection, but it is possible that I
got it during the original operation in 1993 because there were
some complications with one of the pieces of equipment getting
lost inside of me, and they had to call in a vascular surgeon to
remove it . The
surgery lasted about seven hours with the surgeon coming in and
going out to talk to my husband, and they think I might have
contracted the infection then because I was open for so long. Another
strong argument for that is that my incision drained for much
longer than it should have. They put me on Vancomycin then, and I stayed in the hospital for
21 days. After about
two weeks, the draining finally stopped, but this was after I had
gone home. Since I
had no other signs of infection, the surgeon hoped that it was
just a fluke, but it was probably not.
It was probably due to the infection and the reason that I
had the bone loss.
Loosening
or Wear of a Total Hip Replacement
Scenario #1
After
ten years, I began experiencing some lingering stiffness and
increasing discomfort on rising.
There were also a couple episodes where the joint “froze
up” for several hours with excruciating pain if I moved.
Also, there was a bit of a popping sensation in the joint
when I made certain movements.
The “start up” pain upon rising is what finally did me
in. Because of wear
revealed in X-rays taken during one of the hip freeze-up periods,
I already knew that a revision lurked in the future.
The total hip
replacement in my other hip also had to be revised even though
there were no outward signs or symptoms.
The X-rays revealed that the wear on it was worse than the
hip causing the pain.
Scenario #2
The
very first symptoms of anything wrong in my hips were occasional
weakness or a kink in my legs—a pulling or nagging discomfort
behind the knee.
Revision
symptoms were:
Leg
weakness after rising from a sitting position that would correct
itself after several minutes, but it would return at various
intervals over a year or more until I was unable to bear weight on
the leg at all.
Noticeable
tenderness in the sitting-bones when I was sitting on hard
surfaces. There was
also the feeling of sitting on a small rubber ball.
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