Kris C, Cup placed too deep, not symmetrical

My Hip Saga…..

My Hip Saga started many years ago.  I am a life-long athlete. I played three sports in high school. I then went on to play Division 1 Field Hockey on the way to earning a degree in Physical Education and Health.   I always lacked flexibility in my hips and shoulders.  During my Junior and Senior years I had multiple orthopedic surgeries on both my shoulders for dislocations and rotator cuff tears.   I remember my hips being vaguely bothersome at times but never severe enough to seek out medical help.

First I took care of my back
In the fall of 2004 I began to experience back pain.  I had an MRI which showed a herniated disc at L4/L5.   I tried to treat it conservatively, but the pain only worsened until I had difficulty with daily tasks and began to exhibit more severe neurological symptoms.  Ultimately in March of 2005 I had a L4/L5 lower lumbar discectomy.  I recovered uneventfully from the surgery. 

It’s time to face my hip issues
 In the fall of 2005 I began to experience right hip pain.  Some groin pain, but more so it hurt on the front and back of my hip (the doctor called it the “C” sign because you demonstrate where the pain is by gripping your hip, and your hand forms the letter “C”).  The “C” sign is indicative of a torn labrum.  This was confirmed by MRI.  I had arthroscopic surgery in February of 2006 to repair the torn labrum.   Within 3 months the hip pain had returned.  At 6 months post scope I talked my reluctant Doctor into letting me get an MRI.  The MRI showed that the labrum was re-torn.   The Doctor suggested going back in arthroscopically and basically repeat the surgery he did in February.  I felt the outcome would be the same, so it made no sense to do it again without addressing the underlying cause.

Femoral Acetabular Impingement – FAI  Surgeries
 I did some research online and felt that I may have Femoral Acetabular Impingement (FAI).  I found Dr Michael Millis at Boston Children’s Hospital.  He is a well known and respected authority on FAI.  I visited Dr Millis and he agreed that both of my hips showed FAI, though the right hip was the only one that was symptomatic at the time.  Dr Millis agreed that I could benefit from surgery to treat the FAI which would hopefully prevent further damage and would preserve my hip and either put off or prevent the need for a Hip replacement.   On December 2006 I had an Open Dislocation with a Femoral Head Osteotomy .   This allowed DR Millis to trim down the impinging bone in my hip.   It was a very hard surgery to recover from.  In July of 2007 I had the screws removed that had been holding my femoral neck together.   Unfortunately the pain continued and worsened as the fall progressed.  In December 2007 Dr Millis performed an arthrotomy of my hip joint to clean out scar tissue and to further trim the bone.   Initially I had some relief but as 2008 wore on the pain came back.  It was very debilitating.   I was unable to do many things that I enjoyed athletically.  By the end of the day I was in a great deal of pain.  Getting in the car after practice was torture. Sleep was impossible.   Dr Millis ordered a DeGEMERIC MRI which showed the condition of my hip in great detail.  Dr Millis advised me that unfortunately the hope of preserving my hip was not to be.  He was very apologetic.  He said he learned a lot from my case and that he was sad he didn’t help me.  I appreciated his efforts and his honesty.  He suggested that I begin looking in to THR.  

Is Resurfacing the right option for me?
I am not sure where I came up with the thought of hip resurfacing….possibly from my time on the FAI board on Yahoo.  I joined the SurfaceHippy board and began reading up on the potential of getting my hip resurfaced.   A resurface truly seemed to suit me….my age (41 at the time) and activity level (coach, athlete, personal trainer) were definitely better served by retaining as much bone as possible.  I religiously read the surfacehippy board and saw many names frequently mentioned.  I was awed by those who found the courage to go overseas for the operation.  My spirits were buoyed by all the reports of return to athletics.   People were living happily…PAIN FREE!  Jogging would be possible…I could play lacrosse and field hockey with my players….I could continue the active lifestyle that has always been important to me.   I read Vicky’s website thoroughly.   I looked in to a few Doctors but found that they did not take my insurance.  Because of many factors I knew I could not afford the out of network charges that would be associated with using some Doctors that I would have wanted.  Though I continued my research and found a Doctor more local to me, he took my insurance and had, by far, the most experience in Connecticut.  He came highly recommended, and was awarded TOP DOC status in Connecticut for many years running (TOP DOCS are voted on by their peers).  I went and met with him and was happy with how he answered my questions, as well, one of his early patients was his PA.  The PA was so happy with his BHR….everything felt so right!

Finally…I am getting a BHR!
I had my BHR installed December 17, 2008. The Surgeon used the direct anterior approach.  He told my Mother that everything went great.   I was quite ill from anesthesia and had passed out while out of bed twice so I was confined to the bed for a few days.  When I was finally allowed out of bed I had great difficulty walking.  I could not lift my operated leg or swing it forward.  The Doctor assured me that it was probably because of all the prior surgeries and that it would resolve.  I left the hospital using a walker.  I found that I could walk backwards without much trouble (that lead to a lot of family and friends making beeping noises as I moved about backwards…..thankfully I took their teasing well). 

I saw the doctor after a couple weeks as I was concerned about how I was progressing….or more correctly not progressing!  He assured me that I was doing fine.  I was on two crutches for about 8 weeks…then I was down to one crutch for a few weeks.  I went to physical therapy religiously.  My Physical Therapist, Kristin, worked hard with me to try and get back proper hip mechanics and strength.  She sent detailed notes to the doctor as well as calling him because she kept feeling like she was “hitting a wall” in her attempts to get correct motion/flexibility.  I was not making the gains I should have been with all the therapy time and effort I was putting in. 

For before and after pictures of Kris' BHR click here

At my three month post surgery appointment I was still having pain and still limping.  I complained of continued tightness, a feeling of impingement and pain on the lateral aspect of my thigh.  The doctor noted the issues but continued to assure me that the BHR was correctly placed and my issues must be from the prior surgeries and too much activity and physical therapy.  I was directed to take two weeks off from all activities.  I returned to the doctor in April (just one month after my previous appointment).  Again the PA noted all my limitations and suggested returning to PT.  I followed all instruction and returned to PT.  My next appointment was in June, approximately 6 months post surgery.  I was disappointed with my progress.  I was disheartened from reading about others success on the SurfaceHippy board….I was jealous!   Basically it was same stuff…different day.  My same complaints remained…my same concerns were voiced. 

I said the words “it feels like it is impinging” so many times.  I was assured that the Xrays showed that the BHR was perfect and that I should, “Stay the Course”.  I decided that I would begin riding my bike again for exercise seeing that my Doctor prohibits running for one year post surgery.   I started off slowly, but soon had worked myself up to 1 ½ hours of easy riding 5 days a week (no hills as I had difficulty standing and pedaling….I felt immense groin pain if I tried to mash the pedals too much).     I had pain, but I wanted my life back.  I simply decided to “suck it up”.  As the fall progressed I found that I needed to cut back on riding as the pain before, during, and after began to ramp up.  Sleep again became impossible….not just difficult.  I was dreading coaching field hockey each day….my hip hurt!  I limped.   I couldn’t stand how limited I was.  I hated how I had to coach because of my limitations and that at times I was short with my players because of the pain.  At my nine month appointment the doctor again acknowledged the feeling of impingement I was having and suggested that I should continue as planned with the possibility of having hip debridement surgery in the future if I don’t improve.   The pain continued….sleep was impossible….my activities continued to be severely limited.  

Bad News at one year post-op   
At my one year post surgical appointment I continued to express my concerns to one of the PA’s.   After waiting some time the doctor came in to see me.   He pulled up my Xrays taken earlier that appointment.   His review of the Xrays showed what he said was my BHR in unchanged position; however he noted what he felt was resorption of the femoral neck superiorly.  The doctor said that it was probably due to a metal allergy.  He suggested I take a month to really push my hip hard to see if my symptoms would improve or worsen.  He suggested that I would need to revise the BHR to a ceramic on ceramic total hip.   Needless to say I was shocked!   The BHR was my answer to returning to an active lifestyle.  I cried the entire car ride home.   I felt like another year was wasted.  I thought about the fact that my senior lacrosse players had never known me un-broken.  Year after year I began lacrosse season on crutches.   I would limp my way through the season, sure that the following year would be better.  Upon telling family and friends about the failing BHR they all encouraged me to get my Xrays and get additional opinions.  The next day I called the office and had them send me my Xrays on a disk. 

Now what?
Continued pain, limitations, catching, clunking, pain goes from SHARP, to just plain annoying.   Limits activities, still walk with limp.  Pain fluctuates between sharp groin (especially on internal rotation, or when pedaling my bike if I stand to go up a hill and push hard on the peddles), to outside, to low back.  Sleeping is difficult.  Jogging is painful (which I now have permission to do).    Sitting in the car or a chair is bad...especially painful upon standing walking (start up pain).   I couldn’t continue that way.

Vicky to the Rescue!
I posted to the surfacehippy board that my doctor thought my BHR was failing due to a metal allergy…..I included some basic info and history as well as my doctor’s findings.   Vicky sent my email on to Dr Bose.   He suggested a number of potential causes of BHR failure and that Xrays and further tests would be necessary to properly diagnose the cause of my continued pain and limitations.  I received my Xrays which included Pre-op, 2 weeks post, 3 month, 6 month, and 1 year post-op.  Vicky volunteered to send my Xrays to Dr Bose, Dr DeSmet, and Dr Su in hopes that they could aid in confirming my doctor’s diagnosis or to suggest what may be going on.  At this point I was still standing up for my doctor….He had experience (more than 100 procedures), he came highly recommended.  I trusted him.  

All 3 of the surgeons who viewed my xrays said that there were issues with the placement of my BHR. I was shocked.  Excerpts from their e-mail replies are below.

Dr. Bose: "Thanks for sending all the images. I have gone through them very carefully. I have to say that there is no significant neck thinning. The apparent decrease in the breadth of the neck is due to change in the angle of taking the x-ray. If you compare the profile of the lesser trochanter , you can make out that they are basically different views. Even if there is slight neck thinning, I would think that it is insignificant in the absence of peg lines.
The more likely problem in your case is impingement. The cup has been placed higher and deeper in the socket. The femoral component is in relative varus producing a reverse unfavorable CAVA angle. If you look at the pelvis film you can make out the offset of the resurfaced hip is significantly less than the normal side. All the 3 above factors will predispose to impingement."

Dr. DeSmet: "Cup was placed to deep, maybe a little too small for the pelvis. There was not enough anterior shift on the femur. Both together can result in clunking because of impingement. Not everything of the cup is ingrown, but I think that a Technetiumscan could clear this out.
You have a non perfect placed and functioning resurfacing. This has in my view nothing to do with allergy!!"

Dr. Su: "Vijay actually emailed me the same pictures and asked me my opinion! What a thrill, being asked by Vijay! Of course, I can’t add anything more to his assessment, which is spot-on.
The offset of the resurfaced hip is poor due to the deep placement of the cup. And the flat positioning has led to impingement in abduction and flexion.
I agree that to remove the question of the metal sensitivity, a conversion to a ceramic THR makes the most sense."

The Xrays are so clear…why didn’t I see how deeply placed the cup was!
Over the years I’ve looked at plenty of hip Xrays.  Not only my own but also those on Vicky’s site.  I wonder why I never noticed how deeply the cup was set.  It is so clear and easy to see.  All you need to do is compare the right hip to the left.  Unfortunately I was so focused on what the doctor had pointed out that demonstrated to him the “thinning” of the neck (though Dr Bose pointed out that it is an illusion based upon the positioning in the Xray) that I missed the larger issue.  The cup was placed too deep so I had extreme impingement.   This is evidenced by how close the lesser trochanter is to the ischium on my right hip.

Dr Su saves the day!
With Vicky's support I began to realize that I needed to seek out help from Dr Su. Vicky spoke with him about my case. He agreed to see me....his office called on Tuesday and asked if I could come in the following day (I live in CT.....NY City is about 2 1/2 hours not FAR but not close!). I grabbed that appointment and went to see Dr Su. All of what I have read about him is true. He is down to earth, friendly, and helpful. As he entered the room he said "I feel like I know you from all the conversations Vicky, Dr Bose, and I have had about you".  Talk about putting me at ease! I was not another body being moved through the system. He really wanted to help me! So after getting examined and showing him the great "trick" I could do with my Right hip (in standing....take all weight off that leg...let it hang with knee slightly bent.....ball starts to slide out....when you feel that sensation.....tighten your muscles and an audible snap/crack can be heard (metal on metal).....pretty cool....NOT!).

The Plan!
So we went through what he felt would be my best option....get that BHR out! I needed some rebuilding of the acetabular side with Cadaver bone (Does that mean I will be able to see dead people like the creepy kid in Sixth Sense?), a plate, and some screws will hold in the new ceramic cup. Dr Su cautioned me that I would be 50% weight bearing for 6 weeks and on a cane/crutch for 6 more weeks. He cautioned me that this would not be easy......but if I was careful I would hopefully be OK......No promise of 100% recovery or 100% pain free.......but considering the circumstances I appreciated his honesty.

So....I walked out the exam room to speak with his assistant Christina about booking surgery, she said early February. With my coaching and an upcoming Portuguese Water Dog litter I was afraid the timing would not work out and I simply could not imagine having to put if off until June when Lacrosse coaching was she looked at her book again....and said.....HOW ABOUT THIS MONDAY! YIKES! Dr Su agreed and off Christina went booking me with a Dr for Medical Clearance and with the hospital for pre-op testing. So after a whirlwind day in the City, I had to get everything in order here to get ready.
All I can say is: Thanks to Vicky for facilitating this and thanks for Dr. Su being DR Su! I wish I could keep the BHR. I know that IT WAS THE RIGHT thing for all comes down to who puts it in........

**WARNING Graphic Surgery photo below**

Get the BHR out….and put a Ceramic on Ceramic THR in!
My Mom and Sister-in-law drove with me to Hospital for Special Surgery early Monday, January 11, 2010.   I was nervous…as most people would be…but I was also excited.  I know that sounds strange to some people, but I truly knew that Dr Su was going to help me, that my pain was going to end, and that this WAS the correct procedure because of my circumstances.  I also knew that I was in the Number 1 orthopedic hospital in the country and that I was in good hands.   I got prepped for surgery, met with a PA, the anesthesiologist, and finally Dr Su came in to say hello and sign my hip.  My Mom asked him a couple questions; he told her that it would be at least three hours before I would be out of surgery and that he would find her then to apprise her of what he found.  Off to surgery I went.   The next thing I remember is waking up in recovery.  I was in a bit of pain.   Morphine makes me quite sick so I did not have a morphine pump so the nurses were attempting to control my pain with other drugs.   Finally after a full afternoon into early evening in recovery they transferred me up to my room.  Sadly I didn’t get the bed by the window that gives you a glorious view of the river as well as the sunrise.  The nursing staff was very attentive and helpful.  I had a few rough days but was finally released from the hospital on Friday. 

What Dr Su found!  (more information will be added once I have my Post-Op report)
Based upon my pre-surgery xrays, Dr Su had told me I should expect to be 50% weight bearing, though there was some possibility that the acetabular cup was so deeply placed that it may be through my pelvis.  If that was the case then I would be toe-touch weight bearing for 6 weeks. 

Unfortunately, there was a hole in my pelvis, thus Dr Su had to use cadaver bone, metal plate, and screws to rebuild my pelvis so that the cup could be positioned correctly  (see cup placement demonstrated in the before revision surgery and post THR surgery Xrays).

Dr Su explained that it “was like egg shells” in my hip so I needed to be very careful and follow all the precautions: along with the typical THR movement limitations, I was also toe touch weight bearing for 6 weeks, followed by 50% weight bearing, then 100% weight bearing all with two crutches over the next six weeks, and finally weaning myself from the crutches by using just one.  Though Dr Su was not a huge fan of them, he did allow me to use the forearm (Lofstrand) crutches I was used to from my prior hip surgeries.   I definitely find them MUCH easier than traditional crutches. I did have to prove to Dr Su and the Physical Therapist that I could maintain the weight bearing rules.

Dr. Su: "I've attached some pictures of her xrays and the operative photo. However, it is hard to see deep into the hip with the picture, but basically it is showing the socket in a very deep position, so I had to move it outward with bone grafting."

On my way…

I was very careful with all of Dr Su’s precautions.  I basically was home bound for the 6 weeks of toe touch weight bearing….but it all paid off when I had my appointment with Dr Su.   He had them take Xrays and viewed them with me.  He said everything looked GREAT!!!!  The bone was clearly healing.  Obviously the geometry of my hips was once again symmetrical!  Dr Su was very happy with my progress.  While I still have far to go….I know I am on my way to having a more pain free hip.  I still morn the loss of the BHR, and will continue to regret that I didn’t use Dr Su for that operation.   I know there are many patients who have had success with less experienced doctors…but in the end I would encourage each person to think in terms of the long run….its not about convenience….its about getting the prosthetic put in correctly.

Update May 19, 2010

5 month Post Surgery update:
Well it has been a long and slowly winding road on the way to recovery and I am not even close to being 100%.  I have had a few set backs and remain on crutches for the time being.   As is demonstrated by the surgical report and the reminders from Dr was a VERY difficult that will take a significant amount of time for the healing process to be complete.   Dr Su is VERY happy with how everything looks on Xray.   I must agree!  The cadaver bone has taken and the acetabular cup looks very firmly placed.   I have more flexibility and motion in that hip, it no longer feels like I am hitting a wall when I go through my hip's range of motion.   My physical therapist is very pleased.   Because of my coaching duties I must be on my feet for three or more hours each day, thus the decision was made to have me remain on crutches (two outside the house, and one inside) for the near future (I will be re-evaluated in early June in hopes of going off crutches for good).  I still have some pain...significant at times.  Though I am sure that will resolve as times goes by.   There are so many things I need to retrain myself to do correctly, such as walk, that my left hip and back are none to pleased with my current state.  Certainly my muscles and soft tissue have been through a lot of trauma and I am working hard to gain back my strength, though I must say because of all the crutching around my Biceps are looking pretty diesel!  Though I remain confident that with the work that Dr Su did I will be able to get on with my life soon.  I am truly fortunate to have him on my case.


Surgical Report for REVISION surgery

Operative Record for Kris C
Attending Surgeon: Dr Su
Date of Operation: 1/11/2010

Findings: There was a well fixed femoral and acetabular components with medialization of the acetabular component, medialization of the hip center.  There was no evidence of infection.

Indications: This is a 42 year old women who had her right hip resurfaced approximately one year ago.  After extensive physical therapy and follow-ups, she has continued to have pain in the right hip.  Imaging studies reveal probable impingement  of the right hip due to medialization of the cup.  To correct this, as well as to remove any possibility of metal sensitivity, the decision was made to perform a complete revision.  After a careful discussion of risks and benefits of the surgery, she wished to proceed.

Procedure:  (some portions removed by Kris Cofiell in transcribing from the original as deemed immaterial to illustrating the repair and installation of the THR, as well bolding of type and any information included in (***) was added by Kris Cofiell)
The previous lateral incision (*** this prior incision was NOT from the installation of the BHR but instead was from the Open Dislocation with Femoral Head Osteotomy used to treat FAI) was utilized, but it was curved posterolaterally for a total length of about 8 inches. 

A portion of the maximus tendon was released.  The anterior and posterior labrum was separated bluntly from the abductor musculature.  There was extensive scarring of the abductor musculature as well as the posterior structures.  The Charnley retractor was placed.  The posterior pseudocapsule was separated from the gluteus minimus and a C-retractor was inserted.  The arthrotomy was performed using the Bovie.  Clear synovial fluid was obtained, very slightly tinged with gray.  Please note that tissue specimens were sent to rule out metal hypersensitivity.

The posterior pseudocapsule was now released continuously along the posterolateral aspect of the greater trochanter and the femur and continued proximally along the posterior wall, all the way to the level of the ischium.  There was some nerve activity in the area, however, care was taken to diminish this as best possible using the Bovie.

Superiorly, the capsule was released and a pocket was made under the capsule and minimus along the ilium.  The hip was now gently dislocated.  It was quite hard to dislocate it, given the depth of placement.

At this point, the center of the head was measured from the lesser trochanter, approximately 55 mm.  A neck cut of about 15 mm as decided by preoperative templating was marked out in terms of the trial prosthesis and this was then made using a reciprocating saw.  The femoral head was now removed and sent to the back table.

Attention was now turned to the acetabulum.  Retractors were placed.  The edges of the bone were clearly seen protruding beyond the socket.  The socket was in a neutral version and in set to about 5 to 10 mm medial from the bony edges.  Circumferential exposure was obtained using retractors, Steinmann pins and an Aufranc.  The pseudocapsule was now removed from the periphery of the cup.

The Moreland instruments were used to start the disruption at the bone-implant interface.  The bone was extremely thin posterolaterally and posterosuperiorly.  It was much thicker anteriorly.

Using a trial liner, the explant system was now utilized.  There was disruption of the posterior-superior bone, continuing towards the sciatic notch.  The cup was now removed without any bony loss. However, because of the disruption of the posterior area of bone, which was from about ten o’clock continuing posteriorly for a length of about 2.5 cm towards nine o’clock position it was decided to use a Recon plate.

Some touch reaming was performed.  The medial wall also had a hole measuring about 1.5 cm in diameter.  The rest of the bone was intact.  The rest of the bone was intact, posterior-inferiorly as well as directly superiorly and the entire anterior bone was intact.  Touch reaming was performed with the size 52 up to the size 56.  At the size 56, once pressure was applied to the rim, the posterior spike of bone did displace.  It was not a separate piece and could be easily reduced.  In addition, because of the desire to place the cup laterally upon the rim, it was felt there would be a lot of pressure in this posterior-superior aspect of bone.  Therefore, it was decided to place the Recon plate.

The 3.5 pelvic Recon plates were now contoured to go from around the circumference of the face, buttressing this piece of bone.  It was fixed supra-acetabular and in the ischium with excellent purchase.

At this point, the trial cup was now inserted and it had excellent fit.  The actual cup with three cluster holes was now inserted and the fit was good.  However, additional screw fixation was certainly necessary.  Please note that this was done after the placement of approximately 60 ml of cortical cancellous chips medially and reverse reamed at 52.

The cup was now inserted and the screws were inserted.  Two trans acetabular screws were inserted with excellent purchase.  A manhole cover was inserted. The liner was now engaged and fixation was felt to be excellent, of both the plate and the cup.

Attention was now turned towards the femur.  After the placement of the liner, the femur was now prepared.  The size 4 and size 3 were trialed.  The 3 would provide a better offset by being shorter and allowing for a longer head.  Therefore, it was selected.

The actual stem was now impacted into place with firm blows of the mallet until it could no longer advance.  the +0 head reproduced the desired lesser trochanter to center of about 55 mm.  The hip was again relocated and trialed.  The actual head was placed on a cleaned and dried trunnion.  The hip was relocated. 

The previously tagged structures were now brought through drill holes and tied down.  The interval between the point pseudocapsule and the medius was repaired.  The gluteus maximus tendon was repaired using Ethibond stitches. Two ConstaVac drains were placed.  Copiously irrigation was utilized.  Number 2 Quill was used to close the fascia.  The remainder of the wound was closed using 0 Vicryl, 2-0 Vicryl for the skin.

Update January 11, 2012

I don't write much on here...but wanted to catch everyone up on my progress since revision surgery 2 years ago today.

My story can be found on Vicky's website at :

so I won't retell my whole story.

My taking the time to post has zero to do with wanting people to feel sorry for me...but instead warning people how important your choice of surgeon is when getting a resurfacing done. You need to put aside convenience and only hearing what you want to. I thought I did all the right things....I DID research my original doctor. He had done over 100 procedures prior to me. I found him listed on Vicky's website. He said he only had two failures and both were in his first 10 patients. He was well respected....all the hospital staff raved about him.

Sadly, for me on December 17, 2008 I had a BHR incorrectly installed. The doctor used the DIRECT ANTERIOR approach. The cup was placed so deep that it was actually through my pelvis in a few places. Sadly, this was CLEARLY obvious from my immediately Post Operative films had the Dr recognized his mistake. Though it would take a year before I was made aware of ANY issues even though I had significant issues and was evaluated by the doctor and his PAs, numerous Xrays were taken. At one year, Dr Keggi (CT) said I had a metal allergy. Through Vicky's assistance my Xrays were sent to Drs Bose, DeSmet and Su. All agreed that the cup placement was the issue, not an allergy.

Dr Su operated on January 11, 2010. I know I was blessed to have him on my case. The revision included going to a ceramic/ceramic total hip, as well plates, screws, and cadaver bone were required. Sadly, I have never gotten off of crutches. Certainly I hope to some day.....but to this point I remain on one crutch (I use a forearm (lofstrand) crutch). Dr Su has continuously evaluated my hip....the prosthetic looks well grown in. I still have pain in that hip (less/different then with the BHR) But my back (which has been diagnosed with a reoccurrence of a blown disc that was previously operated on and moderately severe arthritis (Type 1 Modic changes). As well my left (un operated) hip causes significant issues. Sleep is impossible. I am unable to work regular hours, though I have maintained my coaching jobs (High school lacrosse and field hockey), and try as best possible to have a productive and pleasant life.

I have no doubt that had I had Dr Su do the original installation of a BHR I would not be in the current state. Maybe at some point the left hip would be an issue, and the back may have flared up again...but the extra forces they are required to do to make up for my right hip took them quickly down a path of poor alignment causing wear.

I really want people to know that a revision with complications due to improper installation of the components is not always a quick fix......even a great Doctor can not always put you back together and pain free. If I could turn back time....I would still choose the BHR, I believe in it, but would choose a different doctor. Doctors are not infallible...but I question how Dr Keggi could not recognize his tragic mistake.

Kris Cofiell (CT)
Dr Keggi BHR (12/08) Failure due to improper placement of components
Dr Su Revision with complications to Ceramic/Ceramic THR (1/10)

Update November 30, 2012

On Nov 30, 2012, at 10:35 AM, cnsandpwd wrote:

So......I made the biggest mistake of my life in 2008. The full story can be read on Vicky's site at:

That was the year I decided to stay local and get a BHR. I thought I found the perfect Doctor....I was certain that all would be well. How wrong I was. My BHR surgery was on 12/17/08. My life has never been the same since then.......on that day the Acetabular Cup was placed so deeply in my pelvis that there were actually holes through the bone. I spent a year battling the pain and debilitation....all while being assured that everything looked great. It was not until Vicky became involved and I had my XRays viewed by some top Docs that I understood the extent of the problem. On 1/11/10 Dr Su revised my hip to a Ceramic on Ceramic total hip. The surgery was difficult as plates, screws, and cadaver bone were necessary to trying to rebuild my acetabulum. Dr Su was honest.....he said he couldn't guarantee pain free perfection....but that he did his best to rebuild the damaged areas. Unfortunately......I head back in to surgery on 12/21/12 as I have continued to have pain and remain on one crutch. I am now 45 years old....a high school coach and personal trainer.......

The surgery Dr Su will perform is to check on the cup, plates, cadaver my continued pain seems to be related to the cup......there is the possibility that the cadaver bone never took and the cup has never fully integrated with my bone. This has nothing to do with Dr Su's skill....he is amazing......he is trying to put together what another surgeon carelessly created by removing too much bone from my acetabulum.

I hope this operation finally gives me the pain relief and function that I so hope for.

My point is........make a wise choice....choose a surgeon that has a LONG and positive track record (my original surgeon had done over 100 BHRs prior to mine). Read the a search to check on outcomes. I sung the praises of my original doctor until I recognized the truth of what he had done.

I hope those with prolonged positive results sing the praises of their doctors...and those with less then fabulous outcomes share their experiences as well......I always hope that the stories told about failed BHRs don't dissuade people from this wonderful option, but solidify the need to go to an experienced and successful doc.

Kris in CT
12/08 BHR Dr Keggi
1/10 Revision to Ceramic/Ceramic THR Dr Su
12/12 ????? Dr Su