Surface Hippies:
At Vicky's request, I am writing this report of my experience with metallosis in my resurfaced right hip, and my subsequent revision.  By revision, I mean having my acetabular cup replaced, thus retaining my resurfaced hip.

Throughout this report, I will tell you what I think I learned from my surgeon, Dr. Jim Pritchett, and the surgeon who I sought a second opinion from, Dr. Thomas Gross.  However, I am in no way trying to speak for either doctor.  If you want their opinion(s) on your case, you need to seek them out and provide them with the specific information they require to assess you as a patient.

MY STORY
Today, I am a 53 YO male, 6'2", 200#, athletic, and very active.  Ten years ago, I got wishboned in a ski crash and badly tore my right groin.  Although I was able to rehab from the injury, it would come back to haunt me 6 years later in the form of osteoarthritis in that hip.  

The onset was fast, and when I finally got it diagnosed, I was nearly bone-on-bone in that joint.  My initial meeting with an orthopedic surgeon here in AK left me with his recommendation to go to a ceramic THR.  When I asked him about resufacing, he cited all the normal risk factors (not enough history, metal ions in my blood, early failures, etc.)  However, it wasn't lost on me that nobody is doing resurfacings in AK, so I began to research doctors outside of AK.  In large part using information gathered through the Surfacehippy group, I opted for a resurfacing, and selected Dr. Jim Pritchett in Seattle as my surgeon.  Dr. Pritchett had done over 700 resurfacings at that time, had a good track record, and he was a preferred provider with my medical insurance.  Finding the right surgeon proved to be pretty easy.

Dr. Prichett peformed my resurfacing on 5/23/08 at Seattle's Swedish Hospital.  I have Conserve + components installed.  My rehab went well, and at 5 months post op, I was climbing and skiing.  At 8 months I began playing open-level raquetball again.  At one year, I felt like I had nearly all of my lifestyle restored, including the sports I love.  My resurfaced hip was stable, and my ROM was good.  But towards the middle of year 2, I began to notice increased vibration in my hip when I moved.  I even heard an audible squeek once in awhile...an unnerving occurance that began when I jumped off a deadfall that I was walking along, onto a gravel bar about 4 feet below me while fly fishing.  I was heavily loaded with gear, and the landing sent a pain shooting through my hip that I hadn't felt before.  It subsided immediately, but then the squeeking started, and persisted sporadically until I had my second surgery.  I had xrays shot when I got home from that trip...and again when I was involved in a motorcyle crash not long after that.  Both times, Dr. Pritchett looked at my component placement and told me I was good to go.

But the vibration, squeeks...and then the "clunks"...were all getting more pronounced as time went by.  I especially noticed it in the raquetball court...and as the noise got worse, so did my stiffness.  I started to notice a dull ache in my groin after playing ball too.  I had a few months of denial, but there was no getting around it...my new hip was starting to feel sketchy.  Finally, last October, probably 6 - 8 months after I started to take notice of my degrading hip situaion, I opened an email dialogue with Dr. Pritchett about my concerns.

METALLOSIS
Dr. Pritchett responded by sending me his excellent paper on metallosis.  A copy is attached to this email.  During this period, I read everything I could Google up on metallosis, and Dr. Pritchett's paper was by far the single most informative published paper on the subject that I found.  It was a fascinating read, and depressing as hell.  The more I read about the symptoms, the more it sounded exactly like what I was going through.  I knew I needed to go to the next step and actually get some tests done.

Dr. Pritchett prefers to aspirate fluid from the joint to test for metallosis, but being in AK, I opted for a simple blood test for cobalt first. My results came back quite high...100 micrograms / liter...high enough to diagnose metallosis without further testing.  Without giving a lot of thought to my options, I immediately scheduled a revision.  I should note that I have a good friend here in AK who had gone through the same process...resurface / metallosis / revsision...about a year earlier, so I had the benefit of watching his experience and discussing our respective hip issues.  But not long after scheduling the revision, I began to question my choice, and decided I hadn't done my homework well enough.  I began to push for more info...

DECISIONS
I wrote my surgeon a long email that started by asking if he knew the cliche definition of insanity?  The answer is: doing something over and over, and expecting different results each time.  I wanted to know WHY I had metallosis. I also wanted to know that I had a high probability of long term success if I had a resurfacing revision done.  I wanted to hear what Dr. Pritchett had to say about these concerns, but just to make me feel better, I also wanted another qualified opinion.  I contacted Dr. Thomas Gross in South Carolina, and he agreed to review my case.  I had my recent xrays, lab results, and operative notes from the initial surgery sent to his office.

Dr. Pritchett's response was revealing.  He told me that by current assessments, my acetabular component had a relatively high abduction angle...in the upper 50 degrees range...with current thinking that the optimum range is in the 40s.  This is caused in part by my natural anatomy, which being in the 60s is quite steep.  He felt that this steep angle was causing edge loading, and hence my metallosis.  Dr. Gross gave me the exact, same feedback.  I now had a definitive answer to the "why?" question.  This was the first time I actually got my angle numbers from Dr. Pritchett, and I felt remiss for not requesting this info at the time I had my surgery done.

Both Doctors Pritchett and Gross told me that because there was a superior placement angle to be had, my prospects for success with a revision were high.  They also told me that in their respective practices, neither had seen clinical issues (aside from the hip itself) associated with elevated cobalt levels in their patients who had metallosis.

Dr. Pritchett informed me that he has had great success with the revsions he's done, and attributes it to the fact that he is very selective about who he offers one to.  He told me he applies the following criteria:
1) the desires, needs, and goals of the patient
2) the condition of the femoral component
3) the patient's risk tollerance
4) the patient's desire for a limited procedure (recovery from revison surgery is about half the time as my initial resurfacing)
5) the availability of sufficient acetabular bone for a larger outside diameter cup
6) the quality of the results from the initial resurfacing.  They need to be good.

My alternative was to go with a THR, but wanting the perfomance of a resurfaced hip, and meeting all the listed criteria, I stuck with my game plan and went ahead with what Dr. Pritchett calls a "isolated acetabular revsison".  He removed my original acetabular cup (don't ask me how they get that thing out...I still don't know), and replaced it with one that has a slightly larger outside diameter.  It was placed at a new, shallower angle (39 degrees).  My original femoral component stayed in place.  I was in the hospital for 2 days, had very little swelling, and flew home to Alaska 6 days after surgery.

RESULTS
As I write this, I'm just shy of 7 weeks post op.  I feel great, I have no limp, I can walk as far as I want, I've been doing daily one-hour spin classes and lifting, and as soon as we get some new snow, I'll start nordic skiing.  The rehab truly is going along twice as fast as the original, but I still have to be patient before I subject my new hip to impact.  No alpine skiing or raquetball for awhile yet.

The new incision was right through the old one, making the scar kind of gnarly.  After surgery, I was on crutches until day 6, then used a cane for about a week.  By the beginning of week 3, I was walking without any support, and started spinning on a staionary bike.   By week 4, I was comfortable sleeping on my rebuild side (my favorite sleep position).    90 days from now, I expect to be alpine skiing again, and not long after that, I hope to be playing competitive raquetball again.

I mentioned my friend who also had this same revision procedure to his resurfaced hip.  He's 1+ year post op now, and is doing great. He has not had his blood cobalt level measured yet, but intends to in about 6 months.

Jim

Update July 19, 2012

On Jul 19, 2011, at 4:02 PM, Jim Turk wrote:

Hi Vicky,

Hey, I got GREAT results!  My hip is better now than it ever was after my first surgery.  I'm 8 months post op, and from 5 months on, I've been completely uninhibited.  I've skied, I'm playing open-level racquetball, I'm hiking, cycling, lifting weights...all with no noise in the joint.  I'm totally stable, pain free, and very happy with my decision to get my resurfacing revised.

I have not had my blood tested for cobalt yet...waiting until the 1 year mark to start monitoring that.

......Pictures coming soon..

Regards,

Jim Turk