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Old 08-26-2008, 02:00 PM   #1
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18 Years since my hip replacement, time for re-replacement??

I had my total hip replaced at 20 years old. I had a slipped capital femoral epiphysis of the left hip when I was 15. I had an ancient surgeon perform an antiquated procedure utilizing slivers of bone cut from my tuberosity to hold the cartilage in place. This lasted a couple of years, and I ended up with bone spurs where the slivers where cut from, and by my 21st birthday, I was recovering from a total hip replacement because the first surgery failed (I ended up with severe arthritis).

Now, Iím going on 38, and I am experiencing a lot of back and hip pain. This is becoming more prevalent as time goes by. My question is, how does one know when the old parts have given up their usefulness. I am married and have 2 kids. I am the main source of income for my family, and I am worried that the recovery time will be like it was all those years ago. Has anyone gone through a re replacement before (for wear reasons) and what was the recovery like, also how did you know it was time?

 
Old 08-27-2008, 12:34 PM   #2
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Re: 18 Years since my hip replacement, time for re-replacement??

Sorry for all the trouble with the hip. I had a total hip replacement about 10 years ago. I played tennis, danced, walked around the golf couse with no pain at all. Now I am experiencing enough pain so that I must limp to walk. I want to find a surgeon with experience reduing old hips. I had mine done at Duke University Hospital with first class results. My surgeon no longer works there but I am in the process of checking on what surgeons are experienced fixing old replacements. Sounds like you will need to do some checking too. Good luck.

 
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Old 08-27-2008, 05:50 PM   #3
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Re: 18 Years since my hip replacement, time for re-replacement??

Sorehip,

I would check in with the joint replacement clinic at Duke, they could give you a reccomendation for a good doc. I have two knee surgeons there and they are great.

 
Old 08-28-2008, 05:08 AM   #4
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Re: 18 Years since my hip replacement, time for re-replacement??

Quote:
Originally Posted by Sorehip38 View Post
Sorry for all the trouble with the hip. I had a total hip replacement about 10 years ago. I played tennis, danced, walked around the golf couse with no pain at all. Now I am experiencing enough pain so that I must limp to walk. I want to find a surgeon with experience reduing old hips. I had mine done at Duke University Hospital with first class results. My surgeon no longer works there but I am in the process of checking on what surgeons are experienced fixing old replacements. Sounds like you will need to do some checking too. Good luck.

I do appreciate your advice, however it is not that simple, and be prepared to hear what I have heard from the doctors for years.

The problem is that I have had pain since the replacement, and I have been to a number of doctors over the past 10 years or so. Every doctor that I see has told me the same thing (Including some of the foremost physicians in the northeast at the Hospital For Special Surgery in NYC), that they do not see any obvious problem. The last time I saw a doctor for my hip pain was about 5 years ago, and I was told the same thing. I don't want to keep making trips to the doctor to be told that "you shouldn't be feeling any pain" and "everything still looks good". I have walked with a limp since the original replacement, and have experienced pain to various degrees since the THR. I have learned to live with the pain that has been with me for nearly 20 years now, however I am feeling more intense pain in slightly different areas. I need to find someone who has had their hip wear out, and what their symptoms were. I also want to find someone who has been through a re-replacement to hear what the recovery is like.

Thanks for any feedback anybody might be able to provide.

 
Old 08-28-2008, 09:46 AM   #5
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Re: 18 Years since my hip replacement, time for re-replacement??

Sorry to hear all the problems you have had , nobody in this day and age want pain or indeed has to have pain, what kind of T.H.R. did you have in the first place ? was it a mechanicle one a bovine or a porcine [ metal, cow, or pig. ]? metal has a life expectancy of around 10 years bovine around 12/15 and pig unlimited, or so they say hope this helps you.

 
Old 08-28-2008, 11:59 AM   #6
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Re: 18 Years since my hip replacement, time for re-replacement??

If part of the artificial joint is worn out, that should be apparent on x-ray. It might be there is something else going on.

 
Old 09-15-2008, 07:39 AM   #7
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Re: 18 Years since my hip replacement, time for re-replacement??

I have finally found an answer to my question...
The Normal Wear Rate For A Total Hip Replacement:

<15 years is less than 1%
once the replacement reaches 15 years, the percentage increases quite a bit each year (not exponentially, but almost)

My problem is that the material used in my replacemt included UHMW or Ultra High Molecular Weight Polyetheline. As each step is taken small pieces shear off of the plastic. As this occurs at areas of the particles, the bone can reabsorb into the body. It is called Osteolysis. Apparently it is (in my case) severe enough that the doctor has refered me to one of the few people that perform the revision surgery in this area. He informed me that this operation is extremely comlex and the results are considerably less successeful as the original surgey. The lifespan of a revision does not come close to the virgin replacement.

Mid October is when I will be seeing this new doctor.

So, its time to weigh the options of pain and lifestyle vs comfort and a sever change in the way I live and work.

 
Old 09-15-2008, 07:59 AM   #8
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Re: 18 Years since my hip replacement, time for re-replacement??

I have had several hip revisions. Hip wear out for many reasons and CTs, MRI's and xray's do not always show the wear. Based on the age of your hip you may of had one of the cups that wears over time. My last hip lasted 13 years before I just couldn't stand being in pain anymore. I have had 4 replacements total on the left hip each one with a varying rate of time that it lasted. My first one was at age 8.

The new hips do last longer than the old ones, many up to if not longer than 20 years. The new cups are more durable and do not chip and flake like ones used during the time period you had your hip replaced. Most use a metallic liner now and most plastic ones as you mentioned are no longer available. A larger ball and proper angle of the prothesis will give you a greater range of motion without fear of dislocation. Other things that affect the longetivity of a hip is weight and activity. The more you weigh the quicker the hip will break down, the same can be said for the more active you are. I am pretty sedimentary and my weight is fine so that was never my problem. Technology was my problem.

The surgeon who did my last replacement is very well known for revisions. Often you do not need the entire prothesis replaced, you may only need a new liner/cup and ball, the femoral stem is rarely removed unless the type of hip you have can not be disassembled. Most hips can be disassembled so I wouldn't stress over having the entire prothesis being replaced.

The problem with revisions is that if you get a new cup or new stem they need to remove extra bone. If it's just the liner or ball there is no change in the bone structure itself. I boucned back quicker from my last revision than any other one I had done.

I have never been pain free from any THR I had but something I discovered was shocking. My real pain was not even from the prothesis for many years, it was my back due to a leg discrepancy since birth. Excessive scar tissue has always been a problem as well leading me to believe it was the prothesis causing the pain.

Given that you've had your hip for 18 years you are pretty lucky, back in the day they did not last that long. As far as when to have a revision done, thats a personal choice, its' about quality of life. you may never be pain free even with a revision.

Before you do have the revision I would suggest you have your lumbar region looked at first to rule out that it is not the real source of your problem. Thigh pain is generally referral back pain as is pain in the buttocks region. You indicated you are having a lot of back pain so please have that checked, I'd hate to see you go through a revision only to find out that it doesn't help and your real source of the prominent pain may of been caused by something else.

Good luck
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Old 09-15-2008, 12:18 PM   #9
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Re: 18 Years since my hip replacement, time for re-replacement??

I had X-rays taken on Friday, and it is confirmed that the bone has deteriorated to the point that bone grafts are necessary. I do have quite severe back pain as well as hip pain posterior and anterior. While having the examination done, the doctor was able to locate the areas of pain indicating hip problems. Some of my pain spreads which may indicate other issues as well. The main point being that the hip most certainly does need to be revised. There is no loosening, but the plastic has pretty much worn away and there is obvious signs of ostelolysis.There is scalloping of the bone around where the cup is screwed in. it looks like hollowed out areas where there is an obvious difference in bone density.

Last edited by moderator2; 09-15-2008 at 04:30 PM. Reason: please do not post pictures for any reason - as per the posting policy

 
Old 09-16-2008, 05:24 AM   #10
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Re: 18 Years since my hip replacement, time for re-replacement??

I feel so bad for you and can understand what you are going through. As mentioned I've had mine done 4 times, same hip, and am 42. I had a new cup placed during the last surgery and extra screws for security.

You situation is of course different. Some of my bone density also changed. It's really important to keep up on your D, A and Calcium levels. Lack of D means you do not absorb Calcium properly. Granted it wont fix the current situation but may slow down further loss. I had mine tested last winter, doctors don't usually test for this but I demanded it. Turns out mine was a 2, normal is 15 and even then that's the time to start watching it.

I still strongly suggest you ask to have your lumbar MRI'd. Back pain does cause hip pain and thigh pain. You will want to rule this out. Yes you in fact have a hip problem, but you may also have a back problem too, especially if your gait is off. This is all too common for those with THR's. If your insurance covers it at least you can get a little resolve that perhaps not all the pain is caused by the hip itself. The back part that is.

I was told at a young age I would indeed have back problems as an adult because of a large leg discrepancy. At the time it was 4 inches. I had a special proceedure done on my opposite knee to stop the growth of it and I ended up with a 1 inch difference. Between the replacements/revisions I've had anywhere from 1 inch to none. The last revision at the start I had no difference, they were exactly the same, 2 years later I have a little less than a half inch but enough to cause extra stress on the back and the thigh itself.

anyhow..

Right now my biggest source of pain is scar tissue, from so many surgeries in that hip I have masses of scar tissue and the bursa is scarred over so injections don't help. Removing the tissue is only asking for more problems because it compounds itself when removed.

Good luck and let us know what the doctor decides. Be sure you go to the best revision specialist you can find because it's a more difficult proceedure, even if it's just changing the lining.
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Old 09-16-2008, 02:59 PM   #11
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Re: 18 Years since my hip replacement, time for re-replacement??

Piolet1559'
I am very interested in what the doctor has to say. I seem to be in your situation. My x-rays show some osteolysis(sp) but everything looks to be in place. I walk with a limp and control the pain with I-B. My hip ball was glued into the bone. I am 70 years old and wonder if I should wait(because I can tolerate the hip) or should I get the surgery before the bone gets too weak? I plan to go to Duke where I had my THR and consult with a doctor. The last doctor I saw told me to wait until I can't stand it any more and come back to see him. I am not sure that this is the best solution. Keep us posted on what your next visit to the doctor. Thanks.

 
Old 11-11-2008, 04:45 AM   #12
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Re: 18 Years since my hip replacement, time for re-replacement??

Hello everybody,

Sorry I haven't updated, I have been so busy getting ready for my surgery. The bottom line is that the old implant is done...The poly lining is badly worn, and according to the surgeon, has been for some time. The socket appears to be pretty loose as the threads are seen in the x-rays as being almost stripped if their pitch and depth. The retaining ring that held the socket and liner together are broken into pieces just floating in the hip area. My surgeon informed me that the original implant is the wrong shape for my anatomy, and may be able to get both legs the same length again...yeah!!

Also the Osteolysis is severe, but he may be able to complete the surgery without having to do any grafting. The location of the osteolysis is not in a position that he feels will create any issues down the road.

One thing that is very different from the original surgery 18 years ago is that he expects me to be in the hospital for about 4 days then have me transferred to an inpatient physical therapy rehab facility for up to 6 weeks. Although due to my age, I may be home within a week of entering the rehab.

I was originally going to wait until January to get the surgery, but there are days that are unbearable. So I have moved the date up to the 25th of this month. I have been getting my Christmas shopping done and preparing my home for my return.

For those who are wondering about the surgeon. The nicest physician I have ever dealt with. He teaches at UMDNJ and will be performing the surgery at my local hospital. He specializes in joint revision surgery and an expert in his field. I am looking forward to finally getting this done! My wife has been nagging me for years about getting a new hip, and I am tired of the constant pain.

And Sorehip38, if I were you, I would just get it done. From where I stand, the newer procedures are light years ahead of where they were when I had the original surgery done. I have spoken to physical therapists that tell me, even if I had the grafts done, the recovery is not that bad, generally up and about in 6-8 weeks.

Last edited by pilot1559; 11-11-2008 at 04:49 AM.

 
Old 04-06-2010, 04:53 PM   #13
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Re: 18 Years since my hip replacement, time for re-replacement??

Hi there, I had a THr October of 2009 but I was limping from the pain for almost 1 year prior to the surgery. I have been doing physiotherapy and the limping caused a muscle imbalance and also twisted my spine. I have been doing intensae exercises and stretches to aleviate the problem. What I want to know is, have you tried a good physiotherapist? They are worth their weight in gold. It is amazing what walking with a slight muscle imbalance can do to your overall pain threshold. Try it if you haven't already.

 
Old 04-15-2010, 09:00 AM   #14
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Re: 18 Years since my hip replacement, time for re-replacement??

Quote:
Originally Posted by pilot1559 View Post
I had my total hip replaced at 20 years old. I had a slipped capital femoral epiphysis of the left hip when I was 15. I had an ancient surgeon perform an antiquated procedure utilizing slivers of bone cut from my tuberosity to hold the cartilage in place. This lasted a couple of years, and I ended up with bone spurs where the slivers where cut from, and by my 21st birthday, I was recovering from a total hip replacement because the first surgery failed (I ended up with severe arthritis).

Now, Iím going on 38, and I am experiencing a lot of back and hip pain. This is becoming more prevalent as time goes by. My question is, how does one know when the old parts have given up their usefulness. I am married and have 2 kids. I am the main source of income for my family, and I am worried that the recovery time will be like it was all those years ago. Has anyone gone through a re replacement before (for wear reasons) and what was the recovery like, also how did you know it was time?

 
Old 04-15-2010, 09:06 AM   #15
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Re: 18 Years since my hip replacement, time for re-replacement??

There are certain hospitals that specialize in replacement of older hip prostheses .The Hospital for Special Surgery in NYC is one that does . When I was in rehab after my RTKR , the guy in the room with me had just had such an operation done at the HSS . It had broken after exactly 15 years to the day.

 
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