Update 11/15/08

Hi Vicky!

How do you keep track of everyone??? You are truly amazing!!  My conversion from a BHR to a THR took place on 7/26/2008. The recovery from the THR went a lot smoother than the BHR primarily due to maintaining the acetabular cup. Needless to say, the conversion caused me some consternation as I could not determine what would have caused the femur fracture to begin with and did not know who should do the surgery.

Since I did not have much choice, it was a question of not 'if', but 'when'. I decided to have the doctor who performed my BHR to also do the THR and I am glad I did.  All X-rays show that he did an excellent job in placing the device. With your advice following surgery, I decided to keep my exercise routine rather simple through the use of a stationary bicycle and water aerobics.

It seems to have worked very well at this point.  With your advice following surgery, I decided to keep my exercise routine rather simple through the use of a stationary bicycle and water aerobics. It seems to have worked very well at this point.

I realized today (after almost 4 months) that my hip feels almost completely normal to me with no restrictions. In fact, I played golf this past week, and had no side effects at all! I still have somewhat limited ROM like touching my toes or putting on socks, but I can see improvement slowly, but surely! I go back to see my surgeon in January and will ask them then if it is possible to play racquetball again! If he concurs, I may try playing again, but only in doubles. If not, guess I will stick to golf.

The doctor tells me that sometimes what happens on one side of your body, tends to be mirrored on the other side. I am already seeing signs that I may arthritis restrictions on my left side as well. I may be having to consider a BHR vs. a THR then. With my experience thus far, however, I am probably leaning towards a THR since it has worked out so well.

Again, thank you for asking and if my experience would help anyone else, you certainly have my permission to use it on your new website. Don't know what major differences you are planning compared to the Surface Hippy website, but knowing you, it should be excellent!!

Bob

Posted Wed Jul 2, 2008 12:54 pm

A couple of weeks ago, I reported a Hip resurfacing failure which I attributed to playing racquetball too soon after surgery and alerting everyone to be tolerant of returning to stressful activities. While
 that is probably still wise to do, I wanted to report that subsequent x-ray evaluations has shown that my hip fracture was not a result of anything I had done physically! My bone stock deveoped an AVN condition or where the blood supply to the femur neck had been stopped causing the bone to die. This could have been caused during the actual surgery and did not surface until 7 months later. At any rate, for those of you anticipating a Hip resurface, this can serve as a timely reminder to select a qualified surgeon who has done at least 100 procedures due to the learning curve. We are all a little different and the more procedures peformed, the greater the success rate. I would also suggest that you make sure your doctor is participating in annual update clinics where they can be alerted to improved techniques or approaches to various situations or problems. For example, I was advised that if my surgeon had used a "Neck Capsule Preservation" technique, my condition may have been prevented.

Just want to alert everyone that my Hip fracture was not a result of any physical thing that I had done which was a relief somewhat! Thanks for listening and good luck to each of you!!

How it all started:
Posted by Bob on June 25, 2008

Hi Everyone!

Just wanted to share a 'not so fortunate' experience with my resurfaced hip. I just found out that I am one of the 2% who experience a broken femur, and will probably need to have a THR in the near future. Reading the positive experiences of so many prompted me to try resuming my prior activities, i.e., racquetball, too quickly (3-4 months). For whatever it is worth, it is wise to give yourself sufficient healing time before embarking on strenous activities. Everyone is different, but just make sure you and your doctor feel that you are ready! Hope this helps some who fall into the same trap I fell into!

Bob

Sent: Friday, June 27, 2008 12:14 AM

Hi Bob,

So sorry to hear of your fracture. Who was your doctor if you don't mind me asking and what was your condition prior to surgery? Was it AVN or OA? Were you in pretty good shape, bone quality?

Vicky

Sent: Sunday, June 29, 2008 4:05 PM

Hi Vicky!

Thanks for your concern! I had OA arthritic hip. My age was right on the cusp for a resurface rather than a hip replacement (being 65). But my surgeon, Dr. X - X Hip and Knee Center, felt that my physical condition would support a resurface so I went with that. I has asked him afterwards about bone quality, and he advised that it is normal for a person my age. Looks like I either subjected it too much stress too soon, or the bone was not able to provided the needed support.

I assume that you either have had one or are considering one. Let me know if you have any other questions.

Bob

Sent: Monday, June 30, 2008 12:27 AM

Hi Bob,

I had my BHR 2 1/2 years ago and stay very active as a patient advocate. Normally femoral neck fractures occur due to surgeon error believe it or not. Do you have your x-rays from early on? They normally take x-rays the day of surgery then again at 6 weeks out. I guess if someone went out and tried to run a marathon a few weeks after surgery could very easily cause the component to come loose but a fracture would have to take a lot of force, and playing racquetball at only three months out, well, that just might have been enough to cause that. How hard were you playing? Usually most doctors tell patients to wait six months prior to returning to anything impact, some say 4 months and some are going as short as three months now to start slowly returning. How serious of a neck fracture is it? Would you like me to get some other opinions for you? Dr. X should be past his learning curve by now. I just returned from Belgium after attending the Advance training course for surgeons.

http://www.resurfacing-congress.org/

I try to stay up to date on problems that occur and keep track of them for future patients benefits. I am learning more as time goes on and learned a LOT this past week in Belgium which I will share with the group when I have some time. Thanks for responding to me and I wish you the best please keep me posted.

Vicky

Sent: Monday, June 30, 2008 12:18 PM

Hi Vicky!

Thank for your interest! I am attaching a copy of the x-ray taken a few weeks after my surgery. Dr. X had done about 40 BHR's when mine was done and has now done about 150. He said that I am only the 2nd person he has had with a femoral neck fracture. I had my surgery on 10/1/2007 and after seeing him for my 3 month checkup, he indicated that everything looked great, and I could resume activities, but not to overdue it. I asked him about racquetball and he did seem too concerned, just to not overdo it.

I only played doubles (never singles) with some older fellows and generally only played about 3 games and would quit. I did not play that hard. As you know, it would only take one quick move, but I never experienced any sudden pain while playing to indicate a fracture may have occurred. I just assumed that RB caused it. That is what is kind of weird, never experiencing an identifiable moment as to when the fracture may have occurred. However, I was not happy with my recuperative abilities in playing RB, so I stopped playing in early May. At my 6 month checkup in March, he advised that everything looked normal from x-rays. However, I began to experience some discomfort in my groin and hip which has lasted for several months. I again saw him on May 13 for this problem and he did not detect anything, but called me later in the day suggesting that I take a bone scan which I did on May 23. When I say him again June 11, he advised that the bone scan taken did show some abnormal activity in the area where the femur turns northeast.

He could not explain it as he had never seen anything like that, but to watch it, and to see him again in 3 months. As I look back, I have questioned that the bone scan should have shown the fracture, but am not sure. Well, I got kind of fearful of possible bone disease, and called back expressing concern, and he had me come back in on June 25. He took another x-ray and, that is when he diagnosed a fracture and seemed somewhat distraught about it. Instead of 135-137 optimal degree angle, it is now significant less than that. He apologized and said that he should have had x-rays taken at the previous appointment. He also said that he did not think it was anything I had done, but I don't know he could come to that conclusion. He then discussed what my options were which included a THR as the bone angle could not be adjusted without surgery which he did not recommend. He advised that there is a chance the bone could heal itself, and still provide a functional hip. We would just have to watch it over the next few months. I go back to see him on July 23rd. He encouraged me to do what activities I could as that would encourage bone growth. When I go back, I am going to get a copy of my x-rays for each visit so I can see when the break may have occurred.

I have so far limited myself to most everything as I am fearful of not making it worse. I have tried walking, but now after walking 100-200 yards, my hip muscles become so severely fatigued that I have to stop and rest before resuming. This occurs repeatedly and has been occurring since the middle of June. I am trying to now use a cane as much as I can around my home. Normally, according to Dr. X, he would have put me on a walker, but it was not necessary in his opinion since the bone appeared to have begun healing.

Would be appreciate of any suggestions! Glad to know that your BHR is doing well! Don't exactly what a patient advocate would entail, but I do appreciate your thoughtful comments.

Bob

From: First Doctor
Sent: Tuesday, July 01, 2008 7:04 PM

Hi Vicky,

Welcome back! I can't wait to hear about Belgium and the conference. Another interesting and unfortunate patient situation. The first xray is hard to interpret because the detail is not great when magnified. There does appear to be a notch or irregularity of the superolateral femoral neck. However, it is hard to make out for certain, and it could have been there from before the surgery. It would be helpful to have his preop films.

In any case, it is a bit unusual to have the fracture at 4 months in the absence of a notch, but it could happen if there was some AVN of the head...another reason that I do Vijay's neck-capsule preserving approach.

Hope that is helpful.

From: Second Doctor
Sent: Tuesday, July 01, 2008 2:14 AM

Hi Vicky,

Good to know that you were to accomplish a  lot  during your belgium  trip.I have seen the x-rays. There is no major notching in the earlier x-rays. There is also no fracture in the recent x-rays. This failure mode is late varus collapse and this probably occurs due to compromising the blood supply completely during the surgery. The incidence would be around 1/400 in experienced hands. Some attribute a mechanical component like stress shielding by the peg. So there is a biological and mechanical element to it.

I do not think Playing raquet ball had anything to do with it. In this case there is no point waiting. He need to get a revision soon before further damage occurs. In this case there is no point waiting. He needs to get a revision soon before further damage occurs.

From: Third Doctor
Sent: Tuesday, July 01, 2008

Hi,

I have another patient that I would like to get your opinion on. Unfortunately he is facing a revision surgery to a THR. I am a bit concerned that the doctors are telling patients the reason for their failures are patient related instead of surgery related. Do you see anything in his first x-ray that would show neck notching or any reason for his hip to fracture?

[Koen De Smet] THERE IS INDEED A VOID TO SEE IN THE LATERAL CORTEX OF THE FEMORAL HEAD

He is a 65 year old male with healthy bone stock according to his doctor. He was within the first 40 procedures for his doctor so early within the learning curve. Do you see a fracture in his last x-ray taken in June?

[Koen De Smet] YES IT IS A FRACTURE OR ACUTE COMPLETE AVN BECAUSE IN THE MIDDLE X-RAY YOU SEE SHIFT OF THE HEAD INTO MORE VARUS AND FINALY THE FRACTURE

He had his surgery the 1st of October, 2007. He thinks maybe because he started playing racquetball again at around 4 months, but lightly, is what did it.

[Koen De Smet] NO NOT AT ALL

But I don't know if a fracture can occur at 4 months without some sort of notch? Maybe I am wrong?

[Koen De Smet] THAT IS A STATEMENT I WOULD NOT MAKE

Thanks,
Vicky