Barrie and Claire
June 1, 2009
Sorry to say, the BHR did not work for us... :-((
Claire had it put in left hip in Dec 2006, it worked at first, easy recovery, no restrictions on activity, she was rock scrabbling in the west less than a year after surgery. She has had increasing difficulty walking for the past year, blamed it on her known bad right knee. She just had a total knee put in Mar 16 2009, it is working well now, maybe 105 degrees flex, she still has a lot more PT to do. However, the hip hurt increasingly as she increased her exercise activity, and at surgeon's follow up visit yesterday for the knee, she reported the hip problem, xrays revealed a shortened femur neck compared to original xrays...obvious even to my untrained eye. Diagnosis is avascular necrosis in the bone under the sphere covering the femur head, treatment is emergency revision to a large ball MOM total hip using the same acetabular cup as placed for the BHR. Claire goes into emergency revision surgery Monday morning, is quite bummed about it, as she did NOT want a THR.
Surgeon's only statement about the cause of the AVN is that there is increased incidence of it with post menopausal women with esurfacing, and he now tries to talk post menopausal women out of getting resurfacing. He did NOT try to talk US out of it, and no mention of AVN was made at the time we considered our options. We do not feel we can wait for this revision surgery, as the knee rehab will be compromised if Claire cannot walk..... :-(
There are many success stories surrounding resurfacing, and we were VERY happy early on. However, we feel obligated to share this "down" part of our saga also... and hope and pray Claire gets the life out of the THR the surgeon tells us we can expect... and there are not further complications and "unexpected" conditions leading to MORE revisions... avoidance of which was our strongest reason for choosing the BHR going in.
Barrie & Claire
LBHR Dec 19 2006 Dr Snyder
R Otis Knee Mar 16 2009 Dr Snyder
Revision to L THR Smith & Nephew April 27 2009 Dr Snyder
UPDATE June 12. 2009
Claire's BHR failure cause.....
A while back I wrote the passage below, which mentioned Claire's
surgeon's opinion to us (when we asked why her resurfacing failed) that implied that her failed BHR due to AVN was due to her being a post menopausal woman, with corresponding higher resurfacing failure rates. We have since reviewed the currently available internet data, and found nothing new concerning failure rates for post menopausal women that was not known when we chose resurfacing....
it IS necessary to have good bone strength, and Claire's bone scan then was good.
Recently two expert resurfacing surgeons reviewed her post BHR xrays, and found the femur had been notched when the BHR cap had been placed. This was not obvious to our untrained eyes looking at the xrays, but we accept those findings, and the surgeons' opinions (both agreeing without knowing the other's finding) that the notching was the likely cause of the AVN failure more than two years later.
What our experience points out is to SELECT A SURGEON WITH A LONG TRACK RECORD OF SUCCESS. There are MANY ways to go wrong with resurfacing, and the only true test of a surgeon is his LONG TERM success rate. Dr Snyder had not done over 50 BHRs when he did Claire's, although he reported when asked at the time that all were very happy with their results. We were too, for well over a year.... when pain developed in the hip, we expected it was due to Claire's poor gait due to her arthritic knee. However, after the knee was replaced, the pain continued, and a new xray revealed the collapsed femur even we could see.... and THR revision occured in less than a week.
I write this to reassure those post menopausal women considering
resurfacing that, despite Dr Snyder's implied statement to us, it appears there should NOT be added risk of AVN in post menopausal patients with properly placed components, although there IS some increased risk of femur fracture in post menopausal women, especially if there is bone weakened by osteoporosis, or femur notching during cap placement....
As to the cause of AVN, the surgeon says post menopausal women have a higher incidence of it. Web searches indicate steroids can cause it (she had one shot, generally considered safe), colitis meds can cause it (she had a months treatment of these for intestinal problems brought on by too many antibiotics for dental work and intestinal complaints 6 months after the BHR), and arthritis pain relievers (which she used occasionally pre BHR), and alcohol abuse (she often has a glass of wine a day, but nobody defines this as "abuse"). There are some suggestions that too much blood flow
cutoff during resurfacing surgery can cause it too... but would that show up over a year post op? We just hope it does not continue down the femur, affecting the THR. Our surgeon assures us it does not happen....we still wonder a bit????? Time will tell. We do know of a friend's hubby who had a titanium stem THR put in 30 years ago at age 29 and still skiis, climbs mountains, and is very active.
Barrie B (& Claire doing rehab exercises)
L BHR Dec 2006 Dr Snyder
R Stryker TKR Mar 16 2009 Dr Snyder
L Revised THR, Smith & Nephew Large Ball MOM Titanium cementless stem,
April 27 2009, Dr Snyder