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Monday, February 21. 2011
I'm about to do my LBHR with Dr. Philip Schmitt in
metro Detroit. He's done about 700 BHRs so far, and according to his
office he's got a great success rate - only 6 failures/revisions.
I apparently was born with femoracetabular impingement & have
arthritis (10y+ at 41 y.o), and over the last year or so it's
degraded on the left side to where I can't easily lift the leg up
stairs, or do the other stuff ya'll know full well about. It got
down to bone-on-bone, and through my anti-inflammatories & light
pain meds, it's been pretty tolerable, so to speak.
So this Friday, 6/11/2010, I'll have the left hip done, followed on
8/13 by the right one. The main reason for not doing both at once
was that Dr. Schmitt goes in through the side (lateral?) rather than
posterior approaches, and he didn't want to "roll me up on the
stitches" to do the right side. He also practices at a suburban
hospital that's not very convenient for my wife & kids to visit (~40
miles from the house). Once a month, he does surgery at a hospital
closer to my house (~4 miles), so that's what I'm doing.
Going in, he's saying I'll be out of work/driving for 3 weeks. I'll
be back at work for 5 weeks, then out for 3 with the right side.
Looking forward to getting some relief. I've been working on a lot
of stuff the last two weekends (shrub removals, lawn, oil changes,
etc) to try and get that all done before I start rehabbing.
As the Bud Lite (IIRC) commercial says, "here we go..."
Peace,
-Jim
July 9, 2010
4 weeks out from BHR #1, and recovery's been incredible. I've
been walking unassisted for ~2wks now, back to work this week, and
feeling great. Muscles are weak, which in some ways is surprising
but other ways not so much. After all, I didn't use the left leg
muscles all that much in the last year due to RoM issues. Even the
incision scarring is receding nicely. I can't say enough good things
about Dr. Schmitt from Commerce Twp, MI.
Stability's really good, except for climbing stairs - that's when I
really notice the weakness. I'm looking forward to getting the other
one done on 8/13 and finishing up my return to being a semi-normal
human being. :lol:
Sept. 6, 2010
2nd one down - now a full-fledged bilateral hippy!
My right leg's recovery was much more difficult over the first 2
weeks than the left one was. Not sure why, and Dr. Schmitt (aka "The
Wizard" according to my wife) said every leg is different. The right
was much more painful at the outset, and swelling took longer to go
down, even though the bruising wasn't nearly as bad.
At this point, I'm ready to return to work tomorrow, with only a
slight limp from stiffness still on the right side, and using PT to
knock that out. Happy Happy Joy Joy!
Monday, February 21. 2011
I am two weeks post op with Dr. Raterman. I live in New
Mexico and traveled to Tampa for surgery and am certainly glad that I did.
Dr. Raterman has now done more than 270 procedures. He did a
resurfacing on my right hip and I will return to Tampa in March for resurfacing
of the left hip. Resurfacing is one of his favorite things to
do and he has a really good team that he works with all the time. I went into
the hospital on Tuesday and was discharged on Thursday. I stayed in a hotel for
5 more days and they set it up for the physical therapist, who was excellent, to
come to me at the hotel.
My greatest surprise is how much better I feel already. The
hardest thing is to hold myself back from doing things that are too strenuous
too soon. Dr. Raterman is the team doc for the Tampa Bay Lightnings hockey team
and wants all of us to "get back out on the ice" as soon as possible.
I was out of bed the same day as surgery, walked 200 feet and
250 feet the next day, 250 feet the day after that, and then was discharged. The
first couple of days in the hospital were the most uncomfortable and the
situation has improved daily ever since.
If you are looking for a good doctor in Florida, I do not
hesitate to recommend Dr. Raterman. By the way, flying to Tampa and back was no
big deal, even from as remote an area as New Mexico, so don't be intimidated by
traveling for the surgery.
Monday, February 21. 2011
I am 48 weekend warrior guy who went from
constantly moving to slowly dwindling activity to the point of
pretty much forcing myself up to our home gym 4 - 5 days/week.
Ultimately I found it was OA in my L hip that was holding me back. I
tried steroid injections which only showed me how things could be
with a better joint; I met with a local joint replacement
surgeon/friend who thought with my anatomy, age, prior activity
level the BHR was my best option. Surgery (BHR + a
couple other ortho issues) scheduled for 10/4/10.
Got extremely nervous before the date poor sleep, etc. If you are in
the same boat talk to your MD about a sleeper as it will help
post-op. Because I was having a carpal tunnel
release during this OR time I ended up needing a platform walker
which freaked my wife out a bit. Surgery went great, woke up with an
epiphany... no joint pain! Granted with the dissection & positioning
required for the BHR the surrounding muscles hurt, spasmed & bruised
but what a relief! Got my immediately post-op with oral pain meds
(occasionally supplemented by IV morphine). Never needed a PCA pump.
Could have gone home as early as POD 2 but day 3 worked better.
Ditched the walker <1 week post-op, single crutch for a week, now on
a cane. Progress has been rapid & without a hitch so far. Using pain
meds only at night for >1 week. All-in-all
enthusiastic to the extreme - I can see the promise of getting my
old active life back. Many thanks to Dr Doug
McInnis (Coeur d'Alene, Idaho) & his entire team, Kootenai Medical
Center, the outstanding nurses, & PT/OT personnel!
Monday, February 21. 2011
I am 48 weekend warrior guy who went from
constantly moving to slowly dwindling activity to the point of
pretty much forcing myself up to our home gym 4 - 5 days/week.
Ultimately I found it was OA in my L hip that was holding me back. I
tried steroid injections which only showed me how things could be
with a better joint; I met with a local joint replacement
surgeon/friend who thought with my anatomy, age, prior activity
level the BHR was my best option. Surgery (BHR + a
couple other ortho issues) scheduled for 10/4/10.
Got extremely nervous before the date poor sleep, etc. If you are in
the same boat talk to your MD about a sleeper as it will help
post-op. Because I was having a carpal tunnel
release during this OR time I ended up needing a platform walker
which freaked my wife out a bit. Surgery went great, woke up with an
epiphany... no joint pain! Granted with the dissection & positioning
required for the BHR the surrounding muscles hurt, spasmed & bruised
but what a relief! Got my immediately post-op with oral pain meds
(occasionally supplemented by IV morphine). Never needed a PCA pump.
Could have gone home as early as POD 2 but day 3 worked better.
Ditched the walker <1 week post-op, single crutch for a week, now on
a cane. Progress has been rapid & without a hitch so far. Using pain
meds only at night for >1 week. All-in-all
enthusiastic to the extreme - I can see the promise of getting my
old active life back. Many thanks to Dr Doug
McInnis (Coeur d'Alene, Idaho) & his entire team, Kootenai Medical
Center, the outstanding nurses, & PT/OT personnel!
Monday, February 21. 2011
I had my operation on January 7, 2010 by Dr. Bose
and I came back into a whirlwind of work as a Certified Public
Accountant in the midst of tax season here in the United States.
Since then, as you’ve probably heard the economy has been in the
tank and running my business has taken precedence over almost
everything else.
I am from North Carolina, USA and had been having pain in my right
hip since 2005. The local orthopedic surgeons recommended I have a
total hip replacement. Well, to me that was not an option since it
would have restricted my physical activities tremendously and I felt
I was much too young for such a change in lifestyle.
Finally, I found your website over a year ago and did my research,
chose Dr. Bose and contacted several patients of his. They all spoke
so highly of him that I contacted him via email and he would always
respond in a timely and understanding manner. It took a while to
obtain the proper visas and arrange my schedule in a way that would
not greatly affect my work since I am the sole owner of my
accounting firm. My daughter, Vikki, wanted to accompany me and I
thought it would be a great adventure for both of us since we’ve
never travelled to India or Asia for that matter.
It had been nerve racking up to the day of travel and family members
thought I was crazy to travel half way around the world when there
are "excellent" doctors here. However, once we were on the plane, it
all went away and I was at peace with my decision though I did have
thoughts and concerns about all the complications that could occur
during and after the operation. Dr. Bose and Mohan were very
prepared from the moment we landed in Chennai to the hotel and
eventually to the hospital was a seamless transition with someone
already assigned to take us to our next destination. The most
wonderful experience came after the operation when Vikki and I were
taken care of for almost a week of post-operative care at the
hospital. We knew that care after an operation is very critical to
the recovery process and minimizing complications, if any. We
received, I felt, the gold standard treatment from each and every
hospital staff member. The nurses were always attentive and ready to
assist with a smile when I pressed the button. They weren’t just
nice but professional in their care. They knew what they were doing.
The food was excellent and I really couldn’t ask for better if I
were at a five star hotel. Rehabilitation was slow progress but the
Therapist was also excellent and a constant source of support and
motivation.
Though after a week, Vikki and I were itching to get out and taste
the fresh Indian air. I had chosen to stay at the Fisherman’s Cove
for the last week of recovery. This was as a result of the feedback
of those that had been previous patients of Dr. Bose. It is a
beautiful hotel right on the beach. We did not get to sightsee much,
however, one day I did follow Vikki to the store as she shopped for
traditional Indian woman’s clothing. We met some very nice folks
downtown and also had a good time at the mall where we purchased
more gifts for family. I was walking everywhere with my two crutches
and it felt great!
We returned on the 20th of January and it felt great. It was the
start of tax season and we were in full swing of cold weather and
snow in the Carolinas.
Well, once I got home I did what every silly man does when he starts
to think that he’s "cured". I saw snow and I started shoveling and
it felt great. However, there was this tinge of pain and as the day
wore on it got a little worse. Well, it turned out ok, however, it
was one of several episodes trying to rush my recovery. Thus, my
recovery has been like taking two steps forward and one step back
because of my stubborn nature to "push it".
I made one other smart decision and that was to hire a special
trainer to teach me exercises that would focus on strengthening my
core and hips muscles without injuring myself in the process. I did
this for one and a half months before my six month checkup. Fast
forward to July 1st, 2010, this was my six-month checkup and I had
it done at Wake Forest Baptist Medical Hospital with Dr. Jinnah. I
had seen Dr. Jinnah in April because of some concerns that I had
with aches and pains in my hip area. Prior to my travel to India, I
had met Dr. Jinnah and he promised to look after me and review my
progress after I returned from India. As had many others before me,
one of the main reasons I travelled outside the U.S. was because I
did not have medical insurance and the cost would have been
prohibitive. Dr. Jinnah has a friendly demeanor and always seems to
have a teaching moment for the interns. The x-rays show an excellent
recovery and development and it sure was great to hear that. Since,
at times, I felt that I had done something to re-injure the hip.
Though, the swelling on the surgery is still there and has reduced
some, I’ve been told it would take time for that to go completely
down. Otherwise, both Dr. Bose and Dr. Jinnah gave me the green
light to do most anything. After almost five years, I went out and
ran and jumped for about an hour at a park near my home. Well, you
can guess that it wasn’t long before I had aches that forced me to
slow it down for at least another week! The pain did go away and I
have been running slowly, doing jump rope and slowly working on
getting back the rhythm that I had lost five years ago.
I also know that I have to be careful because the left hip will act
up and it’s a reminder that nothing lasts forever. Though that may
be true, I smile inside because so long as Dr. Bose and his team of
experts are here, I know that there is hope for those young at heart
like myself.
Thank you Dr. Bose, Mohan and the rest of the team for doing such a
wonderful job of taking care of us and giving me a chance to live
fully.
Sincerely,
George
Monday, February 21. 2011
ALVAL, PSEUDOTUMOUR, HYPERSENSITIVITY … WHATEVER YOU CALL IT, IT’S A REVISION TO THR
Having visited this site numerous times over the last few years, I thought it was time that I shared my experience with other past and future hip patients. I have recently undergone revision of my ASR to a THR because of a reaction to the metal on metal bearing. I know this issue is in the spotlight of the orthopedic hip community internationally just now as more patients emerge at the 3-5 year post-op mark with unique reactions.
I am a female and was diagnosed with osteoarthritis in my left hip when I was 33 years old (I am now 42). At the time I was an amateur triathlete competing at local events but struggling to meet training goals because of pain. Once I had the diagnosis at least I knew the cause, and also knew that heavy use of anti-inflammatory eased the symptoms. Ultimately however, whether I was resting or training the pain continued. In addition to the OA, I had some bone spurs and when I was 35 I agreed to have the spurs removed ("femoro-acetabular debridement") in the hope of alleviating impingement and delaying serious OA. My first major surgery.
After 12 months it was apparent that the debridement was unsuccessful and in fact the OA had worsened to the point where I was ready for a resurfacing. My second major surgery.
The resurfacing was wonderful in that it got me back to pain-free life; walking, sitting, sleeping, cycling. In fact I became a strong cyclist, riding over 100 km every Friday morning at a strong pace in our local peloton, and going on a number of international cycle-touring holidays. I kept trying to run – that was my ultimate dream. Once or twice over the years I managed to belt out 5 or 6 km, but usually I would start experiencing enough discomfort to make me walk after just a few hundred meters. I was still taking anti-inflammatory off and on for general aching in my left leg. Range of motion was definitely improved, although not to the point where I could, for example, sit with my legs crossed. I saw my orthopedic specialist quite regularly – both professionally at his clinic for follow-ups, and also socially as he is also a keen cyclist and we spent many hours chatting whilst spinning along at 30+ kph. My x-rays looked perfect.
At about the 3.5 year mark, I started to notice weakening in my hip flexor. I was dropping off the back of the peloton and couldn’t do anything to get stronger. I saw my physiotherapist and concentrated on strengthening the surrounding muscles for six weeks before confessing to my doctor that I was really facing problems. The only anomaly that was apparent on x-ray was re-growth of bony spurs, which we discussed removing.
Before another major surgery however, we decided to run a battery of tests … bone scan, bloods, MRI, CT, ultrasound. All these tests were inconclusive, except for the ultrasound which showed some fluid in the groin. It also showed that the tip of one of the screws remaining from my resurfacing procedure ("trochanteric flip") was protruding into my groin so we agreed to first try a less drastic approach of removing the screws. My third surgery.
I was only on a crutch for a few days, but the swelling and limping continued for months. My range of motion improved almost miraculously – it felt like a brick had been removed from my groin and I was sure this was a success! By three months though I still had a strange half-golf-ball sized lump over the trochanteric wound site and I still had pain. Back to the doctor, where alarm bells started ringing again. He excised the lump that same day … expecting to drain fluid but in fact finding dead tissue. My thigh was finally flat again but not for long … by the next day the lump was back.
Infection, cancer and loosening were all ruled out. A metal-ion test was requested of the pathologist, but seemingly there was nothing apparent. Things were not looking good but a definitive diagnosis was difficult.
Around this time there were a couple of European conferences which my doctor was attending, dealing specifically with hip resurfacing. He was able to talk to the presenting pathologist as well as a colleague of his who represented the European Advisory Committee for adverse reaction to MoM implants. Now the diagnosis was conclusive … classic symptoms and the only option was revision to a ceramic THR. Surgery number four.
(It turns out that the fluid – actually necrotic tissue – had drained from my hip joint and down through the holes left by removal of the screws to present on my outer thigh. An incredibly unusual scenario! I think if this hadn’t happened our next step would have been needle aspiration of the hip joint to get a sample of the fluid/tissue. I have a whole new appreciation for ultrasound.)
I am now at six week’s post-op. Again the surgery went perfectly (6.5 hours) and the x-rays look great. Definitely it has been the most difficult of all the procedures I have had, with a slower recovery. I am walking on one crutch, but thankfully can get in the pool and swim with the squad using a pull-buoy instead of kicking. I’m still taking pain meds and imagine I will need them and the crutch for another couple of weeks. For a semi-revision surgery though I think I am doing okay; I am at work and am planning on joining a gym this weekend to start getting some strength back in my legs. In a couple of months I will get back on the bike (maybe not in the peloton) and there is a surf-ski endurance race at the end of the year that I would like to train for.
Whilst I breezed through the previous surgeries I found this one very traumatic emotionally as well as physically. Over the months I have spent loads of time surfing the web for stories and information and experiences. I thought it was time to share mine. If anyone has been through this I would love to hear how your recovery is; and if anyone is facing this I would be absolutely happy to talk about it more.
Paula
Monday, February 21. 2011
WHAT IS THE
BEST BONE FIXATION TYPE? 1/11/2011
A Comparison of cement vs. bone ingrowth
Thomas P. Gross, M.D.
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At 2 years
of follow-up cemented and uncemented femoral resurfacing is equivalent.
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Femoral
cement failure is the most common late cause of failure in hip resurfacing
(3% @ 8 years).
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Wear-related failures with the Corin or Biomet implant systems are rare in
my experience.
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We have
demonstrated that failure of bone ingrowth does not occur in a properly
designed uncemented femoral resurfacing component (provided femoral neck
fracture or osteonecrosis does not occur).
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Uncemented
fixation of implants in stemmed total hip replacement surgery is more
durable at 10 years than cement, especially in young active patients.
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Every
patient who is a candidate for hip resurfacing is a candidate for an
uncemented femoral resurfacing component.
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Most clinical data on hip surfacing to date is based on an uncemented acetabular
component and a cemented femoral component.
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Uncemented
femoral resurfacing components are now available from Biomet for any patient
who desires them.
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Wright
Medical is beginning initial studies on an uncemented femoral component.
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Corin has
had an uncemented femoral component available in Europe for several years.
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I recommend
uncemented resurfacing for every patient who is a resurfacing candidate; I
don’t require cemented components or stemmed total hips as backups except in
unusual circumstances (2/2300 = 0.23%)
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Combination
of the Biomet Magnum and Recap components for total hip resurfacing is
defined by the FDA as an off-label use.
Continue reading "What is the Best Bone Fixation Type by Dr. Gross 1/11/2011"
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