Re: sooner rather than later?

[Guest guest]

If Dr. de Smet has seen your x-rays and agrees that you need

surgery, I suggest that you go ahead. From the report (I am a

radiologist, but I read x-rays, not reports), there is alot of

disease present. The report does not mention the location of the

osteophytes and cysts, that is are they related to the femoral head

or the acetabulum, or both? I doubt that the cyst are of any

consequence. De Smets paper reveiwing 310 patients does not suggest

that it is a factor. Osteoporosis is a problem. If you wait too

long, that may become the deciding factor.

Osteophytes are more common around the acetabulum, but indicate

reactive new bone growth. The " circumferential narrowing " , I guess,

means that you have lost a significant amount of cartilage which is

very important.

You actually have significant loss of hip function. The bending to

touch the ground is to a great extent related to your lumbar spine.

In addition your hip motion seems to retain some flexion, from your

description, but you have lost the ability to rotate your foot

outward and inward. Can you easily touch your knee to your chest

without pain or difficulty? I'll bet that an orthopedist or

physiotherapist wouldn't think that you are walking normally.

You have forgotten what normal hip function used to be. How far can

you walk without stopping? Do you sleep through the night without

difficulty? Have you stopped participating in sports or other

activities because of pain or fatigue? What other special

techniques have you developed to get around your hip limitations? I

am refering to bending down at the waist to put on socks.

Go ahead and get your life back! By the way, a modern metal on

metal THR is not the end of the world. It is a hell of a lot better

than severe hip joint disease. There are members of this group who

can testify to that. Eventually this technology will become widely

disseminated. Only a few thousand people it the world have had MOM

resurfacing (I'm guessing 8000-10,000) world wide. De Smet is up to

450-500 according to his web site, Amtutz about 450-500. In the US

alone over 150,000 conventional THR's are performed each year!

in NC

> I have a surgery appointment the 26th of August with Dr. De Smet

to get my

> right hip resurfaced. After reading so many posts on this site, I

need an

> opinion or two (or three, or four... I just had recent xrays

done and

> this is what the report says: " bilateral circumferential narrowing

involving

> both hips, right slightly greater than left, with a large collar of

> osteophytes noted about the femoral heads, right greater than

left. There

> is also some subchondral cyst formation. Also noted is some mild

sclerosis

> about the sacroiliac joints, right greater than left. " Okay, well

here is

> my concern: I have read so many posts about people's pre-op pain,

the need

> to use a cane etc. While my range of motion (internal and

external) is only

> about 5 degrees, I can still walk very normally and can bend over

and touch

> the ground though I have trouble putting on my socks on my right

side from a

> seated position and have to tie my shoes while standing up and

bending over.

> When I use my disabled placard I get dirty looks and sometimes

comments

> because I don't walk strange unless I am having a " bad hip day "

and then I

> have a slight limp. When I have mentioned to co-workers that I am

having

> surgery, they were surprised and had no idea I had a problem. The

question

> is, since I am not hobbling around too badly, am I rushing into

this? It

> seems like others on this list have been in much worse pain than

me. My

> fear has been to wait too long and the words " cyst formation " on

my xray

> report scares me, and I absolutely do not want a THR. I am only

getting the

> right hip done to start because I don't have much pain in the left

one yet,

> and I don't have the money to do both. I guess I still need

another pep talk

> about going through with this as the little doubts and fears are

creeping

> into my brain...

>

> Not quite a gimp yet at 44

>

> June

>

>

> June Bonacich <junebugproductions@e...>

>

>

> - " What would you attempt to do if you knew you could not fail? " -

[Guest guest]

If Dr. de Smet has seen your x-rays and agrees that you need

surgery, I suggest that you go ahead. From the report (I am a

radiologist, but I read x-rays, not reports), there is alot of

disease present. The report does not mention the location of the

osteophytes and cysts, that is are they related to the femoral head

or the acetabulum, or both? I doubt that the cyst are of any

consequence. De Smets paper reveiwing 310 patients does not suggest

that it is a factor. Osteoporosis is a problem. If you wait too

long, that may become the deciding factor.

Osteophytes are more common around the acetabulum, but indicate

reactive new bone growth. The " circumferential narrowing " , I guess,

means that you have lost a significant amount of cartilage which is

very important.

You actually have significant loss of hip function. The bending to

touch the ground is to a great extent related to your lumbar spine.

In addition your hip motion seems to retain some flexion, from your

description, but you have lost the ability to rotate your foot

outward and inward. Can you easily touch your knee to your chest

without pain or difficulty? I'll bet that an orthopedist or

physiotherapist wouldn't think that you are walking normally.

You have forgotten what normal hip function used to be. How far can

you walk without stopping? Do you sleep through the night without

difficulty? Have you stopped participating in sports or other

activities because of pain or fatigue? What other special

techniques have you developed to get around your hip limitations? I

am refering to bending down at the waist to put on socks.

Go ahead and get your life back! By the way, a modern metal on

metal THR is not the end of the world. It is a hell of a lot better

than severe hip joint disease. There are members of this group who

can testify to that. Eventually this technology will become widely

disseminated. Only a few thousand people it the world have had MOM

resurfacing (I'm guessing 8000-10,000) world wide. De Smet is up to

450-500 according to his web site, Amtutz about 450-500. In the US

alone over 150,000 conventional THR's are performed each year!

in NC

> I have a surgery appointment the 26th of August with Dr. De Smet

to get my

> right hip resurfaced. After reading so many posts on this site, I

need an

> opinion or two (or three, or four... I just had recent xrays

done and

> this is what the report says: " bilateral circumferential narrowing

involving

> both hips, right slightly greater than left, with a large collar of

> osteophytes noted about the femoral heads, right greater than

left. There

> is also some subchondral cyst formation. Also noted is some mild

sclerosis

> about the sacroiliac joints, right greater than left. " Okay, well

here is

> my concern: I have read so many posts about people's pre-op pain,

the need

> to use a cane etc. While my range of motion (internal and

external) is only

> about 5 degrees, I can still walk very normally and can bend over

and touch

> the ground though I have trouble putting on my socks on my right

side from a

> seated position and have to tie my shoes while standing up and

bending over.

> When I use my disabled placard I get dirty looks and sometimes

comments

> because I don't walk strange unless I am having a " bad hip day "

and then I

> have a slight limp. When I have mentioned to co-workers that I am

having

> surgery, they were surprised and had no idea I had a problem. The

question

> is, since I am not hobbling around too badly, am I rushing into

this? It

> seems like others on this list have been in much worse pain than

me. My

> fear has been to wait too long and the words " cyst formation " on

my xray

> report scares me, and I absolutely do not want a THR. I am only

getting the

> right hip done to start because I don't have much pain in the left

one yet,

> and I don't have the money to do both. I guess I still need

another pep talk

> about going through with this as the little doubts and fears are

creeping

> into my brain...

>

> Not quite a gimp yet at 44

>

> June

>

>

> June Bonacich <junebugproductions@e...>

>

>

> - " What would you attempt to do if you knew you could not fail? " -

[Guest guest]

Question - did you just make your appointment with Dr. De Smet now in February

and the soonest surgery date you could get was the end of August? Please reply!

ANd the word is - you will know when it's time.

Michele

sooner rather than later?

I have a surgery appointment the 26th of August with Dr. De Smet to get my

right hip resurfaced. After reading so many posts on this site, I need an

opinion or two (or three, or four... I just had recent xrays done and

this is what the report says: " bilateral circumferential narrowing involving

both hips, right slightly greater than left, with a large collar of

osteophytes noted about the femoral heads, right greater than left. There

is also some subchondral cyst formation. Also noted is some mild sclerosis

about the sacroiliac joints, right greater than left. " Okay, well here is

my concern: I have read so many posts about people's pre-op pain, the need

to use a cane etc. While my range of motion (internal and external) is only

about 5 degrees, I can still walk very normally and can bend over and touch

the ground though I have trouble putting on my socks on my right side from a

seated position and have to tie my shoes while standing up and bending over.

When I use my disabled placard I get dirty looks and sometimes comments

because I don't walk strange unless I am having a " bad hip day " and then I

have a slight limp. When I have mentioned to co-workers that I am having

surgery, they were surprised and had no idea I had a problem. The question

is, since I am not hobbling around too badly, am I rushing into this? It

seems like others on this list have been in much worse pain than me. My

fear has been to wait too long and the words " cyst formation " on my xray

report scares me, and I absolutely do not want a THR. I am only getting the

right hip done to start because I don't have much pain in the left one yet,

and I don't have the money to do both. I guess I still need another pep talk

about going through with this as the little doubts and fears are creeping

into my brain...

Not quite a gimp yet at 44

June

June Bonacich

- " What would you attempt to do if you knew you could not fail? " -

[Guest guest]

Question - did you just make your appointment with Dr. De Smet now in February

and the soonest surgery date you could get was the end of August? Please reply!

ANd the word is - you will know when it's time.

Michele

sooner rather than later?

I have a surgery appointment the 26th of August with Dr. De Smet to get my

right hip resurfaced. After reading so many posts on this site, I need an

opinion or two (or three, or four... I just had recent xrays done and

this is what the report says: " bilateral circumferential narrowing involving

both hips, right slightly greater than left, with a large collar of

osteophytes noted about the femoral heads, right greater than left. There

is also some subchondral cyst formation. Also noted is some mild sclerosis

about the sacroiliac joints, right greater than left. " Okay, well here is

my concern: I have read so many posts about people's pre-op pain, the need

to use a cane etc. While my range of motion (internal and external) is only

about 5 degrees, I can still walk very normally and can bend over and touch

the ground though I have trouble putting on my socks on my right side from a

seated position and have to tie my shoes while standing up and bending over.

When I use my disabled placard I get dirty looks and sometimes comments

because I don't walk strange unless I am having a " bad hip day " and then I

have a slight limp. When I have mentioned to co-workers that I am having

surgery, they were surprised and had no idea I had a problem. The question

is, since I am not hobbling around too badly, am I rushing into this? It

seems like others on this list have been in much worse pain than me. My

fear has been to wait too long and the words " cyst formation " on my xray

report scares me, and I absolutely do not want a THR. I am only getting the

right hip done to start because I don't have much pain in the left one yet,

and I don't have the money to do both. I guess I still need another pep talk

about going through with this as the little doubts and fears are creeping

into my brain...

Not quite a gimp yet at 44

June

June Bonacich

- " What would you attempt to do if you knew you could not fail? " -

[Guest guest]

Hi June,

I'd been thinking the same thoughts about my pain, as I spent the

past 3 years, slowly but surely loosing my life. I am now at the

point where many days I go from my bed, to my home office desk, to

the couch in my kitchen and that's the extent of my physical

activities. BTW, I'm a 58 year old woman with 23 years of martial

arts training, who loved teaching young turks 3 days a week. Now, on

good days I can get out to grocery shop or run errands but those days

are fewer and fewer. I got a jolt a couple of weeks ago when I

spotted my reflection in the grocery store window. I thought I was

walking along, looking pretty good but in fact my upper body was

angled over like an old woman who was trying to stand tall. And you

know what, there are still many das when I think maybe this isn't so

bad. Like that saying goes, " the definition of insanity is doing the

same thing over and over again and expecting different results. "

Truth is, I'm very lucky that I can work at home and that my husband

is patient and loving. But he's lost his karate sparing partner and

playmate and I know that's not fun for him. I don't feel I have a

life any longer. I could choose to wait but I think I've waited too

long already.

I'm scheduled to be in Dr. DeSmet's hands on 2/19 and as scared as I

feel sometimes, I am so looking forward to scheduling my day and

activities around what I want to do, not what my limitations and pain

will allow me to do.

No one could have made this decision for me. It's one I had to make

for myself. I am so glad I have finally made it. You will be too

once you've had enough.

Good luck in getting your life back soon. Hugs,

> I have a surgery appointment the 26th of August with Dr. De Smet to

get my

> right hip resurfaced. After reading so many posts on this site, I

need an

> opinion or two (or three, or four... I just had recent xrays

done and

> this is what the report says: " bilateral circumferential narrowing

involving

> both hips, right slightly greater than left, with a large collar of

> osteophytes noted about the femoral heads, right greater than

left. There

> is also some subchondral cyst formation. Also noted is some mild

sclerosis

> about the sacroiliac joints, right greater than left. " Okay, well

here is

> my concern: I have read so many posts about people's pre-op pain,

the need

> to use a cane etc. While my range of motion (internal and

external) is only

> about 5 degrees, I can still walk very normally and can bend over

and touch

> the ground though I have trouble putting on my socks on my right

side from a

> seated position and have to tie my shoes while standing up and

bending over.

> When I use my disabled placard I get dirty looks and sometimes

comments

> because I don't walk strange unless I am having a " bad hip day " and

then I

> have a slight limp. When I have mentioned to co-workers that I am

having

> surgery, they were surprised and had no idea I had a problem. The

question

> is, since I am not hobbling around too badly, am I rushing into

this? It

> seems like others on this list have been in much worse pain than

me. My

> fear has been to wait too long and the words " cyst formation " on my

xray

> report scares me, and I absolutely do not want a THR. I am only

getting the

> right hip done to start because I don't have much pain in the left

one yet,

> and I don't have the money to do both. I guess I still need another

pep talk

> about going through with this as the little doubts and fears are

creeping

> into my brain...

>

> Not quite a gimp yet at 44

>

> June

>

>

> June Bonacich <junebugproductions@e...>

>

>

> - " What would you attempt to do if you knew you could not fail? " -

[Guest guest]

Hi June,

I'd been thinking the same thoughts about my pain, as I spent the

past 3 years, slowly but surely loosing my life. I am now at the

point where many days I go from my bed, to my home office desk, to

the couch in my kitchen and that's the extent of my physical

activities. BTW, I'm a 58 year old woman with 23 years of martial

arts training, who loved teaching young turks 3 days a week. Now, on

good days I can get out to grocery shop or run errands but those days

are fewer and fewer. I got a jolt a couple of weeks ago when I

spotted my reflection in the grocery store window. I thought I was

walking along, looking pretty good but in fact my upper body was

angled over like an old woman who was trying to stand tall. And you

know what, there are still many das when I think maybe this isn't so

bad. Like that saying goes, " the definition of insanity is doing the

same thing over and over again and expecting different results. "

Truth is, I'm very lucky that I can work at home and that my husband

is patient and loving. But he's lost his karate sparing partner and

playmate and I know that's not fun for him. I don't feel I have a

life any longer. I could choose to wait but I think I've waited too

long already.

I'm scheduled to be in Dr. DeSmet's hands on 2/19 and as scared as I

feel sometimes, I am so looking forward to scheduling my day and

activities around what I want to do, not what my limitations and pain

will allow me to do.

No one could have made this decision for me. It's one I had to make

for myself. I am so glad I have finally made it. You will be too

once you've had enough.

Good luck in getting your life back soon. Hugs,

> I have a surgery appointment the 26th of August with Dr. De Smet to

get my

> right hip resurfaced. After reading so many posts on this site, I

need an

> opinion or two (or three, or four... I just had recent xrays

done and

> this is what the report says: " bilateral circumferential narrowing

involving

> both hips, right slightly greater than left, with a large collar of

> osteophytes noted about the femoral heads, right greater than

left. There

> is also some subchondral cyst formation. Also noted is some mild

sclerosis

> about the sacroiliac joints, right greater than left. " Okay, well

here is

> my concern: I have read so many posts about people's pre-op pain,

the need

> to use a cane etc. While my range of motion (internal and

external) is only

> about 5 degrees, I can still walk very normally and can bend over

and touch

> the ground though I have trouble putting on my socks on my right

side from a

> seated position and have to tie my shoes while standing up and

bending over.

> When I use my disabled placard I get dirty looks and sometimes

comments

> because I don't walk strange unless I am having a " bad hip day " and

then I

> have a slight limp. When I have mentioned to co-workers that I am

having

> surgery, they were surprised and had no idea I had a problem. The

question

> is, since I am not hobbling around too badly, am I rushing into

this? It

> seems like others on this list have been in much worse pain than

me. My

> fear has been to wait too long and the words " cyst formation " on my

xray

> report scares me, and I absolutely do not want a THR. I am only

getting the

> right hip done to start because I don't have much pain in the left

one yet,

> and I don't have the money to do both. I guess I still need another

pep talk

> about going through with this as the little doubts and fears are

creeping

> into my brain...

>

> Not quite a gimp yet at 44

>

> June

>

>

> June Bonacich <junebugproductions@e...>

>

>

> - " What would you attempt to do if you knew you could not fail? " -

[Guest guest]

,

You give good advice. One correction, if I may. There was a posting

here last week from Dr. DeSmet's 600th resurfacing patient. I didn't

look back to pull it up for you but it's here. Hugs 2u2,

> > I have a surgery appointment the 26th of August with Dr. De Smet

> to get my

> > right hip resurfaced. After reading so many posts on this site,

I

> need an

> > opinion or two (or three, or four... I just had recent xrays

> done and

> > this is what the report says: " bilateral circumferential

narrowing

> involving

> > both hips, right slightly greater than left, with a large collar

of

> > osteophytes noted about the femoral heads, right greater than

> left. There

> > is also some subchondral cyst formation. Also noted is some mild

> sclerosis

> > about the sacroiliac joints, right greater than left. " Okay,

well

> here is

> > my concern: I have read so many posts about people's pre-op

pain,

> the need

> > to use a cane etc. While my range of motion (internal and

> external) is only

> > about 5 degrees, I can still walk very normally and can bend over

> and touch

> > the ground though I have trouble putting on my socks on my right

> side from a

> > seated position and have to tie my shoes while standing up and

> bending over.

> > When I use my disabled placard I get dirty looks and sometimes

> comments

> > because I don't walk strange unless I am having a " bad hip day "

> and then I

> > have a slight limp. When I have mentioned to co-workers that I

am

> having

> > surgery, they were surprised and had no idea I had a problem.

The

> question

> > is, since I am not hobbling around too badly, am I rushing into

> this? It

> > seems like others on this list have been in much worse pain than

> me. My

> > fear has been to wait too long and the words " cyst formation " on

> my xray

> > report scares me, and I absolutely do not want a THR. I am only

> getting the

> > right hip done to start because I don't have much pain in the

left

> one yet,

> > and I don't have the money to do both. I guess I still need

> another pep talk

> > about going through with this as the little doubts and fears are

> creeping

> > into my brain...

> >

> > Not quite a gimp yet at 44

> >

> > June

> >

> >

> > June Bonacich <junebugproductions@e...>

> >

> >

> > - " What would you attempt to do if you knew you could not fail? " -

[Guest guest]

You are right, . My former plan was to wait until I was

crawling and then I would get a THR. Now that I've learned about

resurfacing, I don't have to get to the crawling point. What good

would that do me? Thanks so much.

June

> > I have a surgery appointment the 26th of August with Dr. De

Smet to

> get my

> > right hip resurfaced. After reading so many posts on this

site, I

> need an

> > opinion or two (or three, or four... I just had recent xrays

> done and

> > this is what the report says: " bilateral circumferential

narrowing

> involving

> > both hips, right slightly greater than left, with a large collar of

> > osteophytes noted about the femoral heads, right greater

than

> left. There

> > is also some subchondral cyst formation. Also noted is

some mild

> sclerosis

> > about the sacroiliac joints, right greater than left. " Okay, well

> here is

> > my concern: I have read so many posts about people's

pre-op pain,

> the need

> > to use a cane etc. While my range of motion (internal and

> external) is only

> > about 5 degrees, I can still walk very normally and can bend

over

> and touch

> > the ground though I have trouble putting on my socks on my

right

> side from a

> > seated position and have to tie my shoes while standing up

and

> bending over.

> > When I use my disabled placard I get dirty looks and

sometimes

> comments

> > because I don't walk strange unless I am having a " bad hip

day " and

> then I

> > have a slight limp. When I have mentioned to co-workers

that I am

> having

> > surgery, they were surprised and had no idea I had a

problem. The

> question

> > is, since I am not hobbling around too badly, am I rushing

into

> this? It

> > seems like others on this list have been in much worse pain

than

> me. My

> > fear has been to wait too long and the words " cyst formation "

on my

> xray

> > report scares me, and I absolutely do not want a THR. I am

only

> getting the

> > right hip done to start because I don't have much pain in the

left

> one yet,

> > and I don't have the money to do both. I guess I still need

another

> pep talk

> > about going through with this as the little doubts and fears

are

> creeping

> > into my brain...

> >

> > Not quite a gimp yet at 44

> >

> > June

> >

> >

> > June Bonacich <junebugproductions@e...>

> >

> >

> > - " What would you attempt to do if you knew you could not

fail? " -

[Guest guest]

Hi Michele,

I picked August because that is when my partner can go with me.

I don't want to go through it without her. She is a PA (or will be.

she graduates in August) and that could also be quite helpful on

the trip. I also needed time to figure out how to pay for it. My

father is looking into his finances to see if he can help me out. I

have no savings and of course, my insurance is probably

useless except for physical therapy afterwards. Dr. De Smet

said that waiting until August would be fine. He also said that

the left hip can medically wait, but he can't say how long.

June

> Question - did you just make your appointment with Dr. De

Smet now in February and the soonest surgery date you could

get was the end of August? Please reply! ANd the word is - you

will know when it's time.

> Michele

> sooner rather than later?

>

>

> I have a surgery appointment the 26th of August with Dr. De

Smet to get my

> right hip resurfaced. After reading so many posts on this site,

I need an

> opinion or two (or three, or four... I just had recent xrays

done and

> this is what the report says: " bilateral circumferential

narrowing involving

> both hips, right slightly greater than left, with a large collar of

> osteophytes noted about the femoral heads, right greater than

left. There

> is also some subchondral cyst formation. Also noted is some

mild sclerosis

> about the sacroiliac joints, right greater than left. " Okay, well

here is

> my concern: I have read so many posts about people's

pre-op pain, the need

> to use a cane etc. While my range of motion (internal and

external) is only

> about 5 degrees, I can still walk very normally and can bend

over and touch

> the ground though I have trouble putting on my socks on my

right side from a

> seated position and have to tie my shoes while standing up

and bending over.

> When I use my disabled placard I get dirty looks and

sometimes comments

> because I don't walk strange unless I am having a " bad hip

day " and then I

> have a slight limp. When I have mentioned to co-workers that

I am having

> surgery, they were surprised and had no idea I had a

problem. The question

> is, since I am not hobbling around too badly, am I rushing into

this? It

> seems like others on this list have been in much worse pain

than me. My

> fear has been to wait too long and the words " cyst formation "

on my xray

> report scares me, and I absolutely do not want a THR. I am

only getting the

> right hip done to start because I don't have much pain in the

left one yet,

> and I don't have the money to do both. I guess I still need

another pep talk

> about going through with this as the little doubts and fears are

creeping

> into my brain...

>

> Not quite a gimp yet at 44

>

> June

>

>

> June Bonacich <junebugproductions@e...>

>

>

> - " What would you attempt to do if you knew you could not

fail? " -

>

>

>

>

>

[Guest guest]

Thanks, ,

I really appreciate your taking the time to reply. No, I can't get my

knee anywhere near my chest. I can't move my right leg in

circles without severe pain. I guess I wanted to hear that it wasn't

so bad! Sometimes I get woken up at night by pain when my leg

swings into a position and I get stuck. And I really avoid walking

too far. I've been trying to preserve my cartilage and was hoping

to hold out for another decade before needing a THR. I only

heard about resurfacing a few weeks ago and the speed at

which I have made plans to be operated on is quite scary. I'm

used to putting it all out of my mind. When I have good days I

question why I am going to put myself through this. Of course,

on good days I haven't tried to put my knee to my chest or move

my right leg in any direction but forward and back for walking. It

is so easy to adapt to pain when you can find ways to avoid it. I

can't answer your questions as to the location of the osteophytes

unless I send you a CD of my xrays. The JRI said that cysts are

a problem and you say that Dr. De Smet says they're not? Can

you say more about this? Thanks again for your honest

evaluation.

June

> > I have a surgery appointment the 26th of August with Dr. De

Smet

> to get my

> > right hip resurfaced. After reading so many posts on this

site, I

> need an

> > opinion or two (or three, or four... I just had recent xrays

> done and

> > this is what the report says: " bilateral circumferential

narrowing

> involving

> > both hips, right slightly greater than left, with a large collar of

> > osteophytes noted about the femoral heads, right greater

than

> left. There

> > is also some subchondral cyst formation. Also noted is

some mild

> sclerosis

> > about the sacroiliac joints, right greater than left. " Okay, well

> here is

> > my concern: I have read so many posts about people's

pre-op pain,

> the need

> > to use a cane etc. While my range of motion (internal and

> external) is only

> > about 5 degrees, I can still walk very normally and can bend

over

> and touch

> > the ground though I have trouble putting on my socks on my

right

> side from a

> > seated position and have to tie my shoes while standing up

and

> bending over.

> > When I use my disabled placard I get dirty looks and

sometimes

> comments

> > because I don't walk strange unless I am having a " bad hip

day "

> and then I

> > have a slight limp. When I have mentioned to co-workers

that I am

> having

> > surgery, they were surprised and had no idea I had a

problem. The

> question

> > is, since I am not hobbling around too badly, am I rushing

into

> this? It

> > seems like others on this list have been in much worse pain

than

> me. My

> > fear has been to wait too long and the words " cyst formation "

on

> my xray

> > report scares me, and I absolutely do not want a THR. I am

only

> getting the

> > right hip done to start because I don't have much pain in the

left

> one yet,

> > and I don't have the money to do both. I guess I still need

> another pep talk

> > about going through with this as the little doubts and fears

are

> creeping

> > into my brain...

> >

> > Not quite a gimp yet at 44

> >

> > June

> >

> >

> > June Bonacich <junebugproductions@e...>

> >

> >

> > - " What would you attempt to do if you knew you could not

fail? " -

[Guest guest]

June,

GREAT!! We don't get any award for being long suffering....and

there's no time refund that I know of. Life just goes on, with or

without us.

We'll keep in touch and I'll let you know how my surgery goes. My

surfacehippy friend, angel, cheerleader, and DeSmet alumni, Janet

Lynda, promises it will be a " Great Adventure " . I'm holding her to

that promise ;>) Hugs,

> > > I have a surgery appointment the 26th of August with Dr. De

> Smet to

> > get my

> > > right hip resurfaced. After reading so many posts on this

> site, I

> > need an

> > > opinion or two (or three, or four... I just had recent xrays

> > done and

> > > this is what the report says: " bilateral circumferential

> narrowing

> > involving

> > > both hips, right slightly greater than left, with a large

collar of

> > > osteophytes noted about the femoral heads, right greater

> than

> > left. There

> > > is also some subchondral cyst formation. Also noted is

> some mild

> > sclerosis

> > > about the sacroiliac joints, right greater than left. " Okay,

well

> > here is

> > > my concern: I have read so many posts about people's

> pre-op pain,

> > the need

> > > to use a cane etc. While my range of motion (internal and

> > external) is only

> > > about 5 degrees, I can still walk very normally and can bend

> over

> > and touch

> > > the ground though I have trouble putting on my socks on my

> right

> > side from a

> > > seated position and have to tie my shoes while standing up

> and

> > bending over.

> > > When I use my disabled placard I get dirty looks and

> sometimes

> > comments

> > > because I don't walk strange unless I am having a " bad hip

> day " and

> > then I

> > > have a slight limp. When I have mentioned to co-workers

> that I am

> > having

> > > surgery, they were surprised and had no idea I had a

> problem. The

> > question

> > > is, since I am not hobbling around too badly, am I rushing

> into

> > this? It

> > > seems like others on this list have been in much worse pain

> than

> > me. My

> > > fear has been to wait too long and the words " cyst formation "

> on my

> > xray

> > > report scares me, and I absolutely do not want a THR. I am

> only

> > getting the

> > > right hip done to start because I don't have much pain in the

> left

> > one yet,

> > > and I don't have the money to do both. I guess I still need

> another

> > pep talk

> > > about going through with this as the little doubts and fears

> are

> > creeping

> > > into my brain...

> > >

> > > Not quite a gimp yet at 44

> > >

> > > June

> > >

> > >

> > > June Bonacich <junebugproductions@e...>

> > >

> > >

> > > - " What would you attempt to do if you knew you could not

> fail? " -

[Guest guest]

Hi:

It's actually . Sub-cortical cyst formation is quite

common. it is probably due to micro-fractureing of the Chondaral

(cartilage) and cortical (bone) which allows synovial fluid to enter

the bone under the pressure (weight-bearing. Don't worry about it.

There are ways of dealing with it (let the surgeon do

the " worrying " . DeSmet had only 2 failures related to the procedue

itself, in his presentation about the first 310 pts. However, he had

a number of patients lost to long term follow-up Neither was

related to cysts. One, osteoporosis in a Pt. with bad dysplasia,

sucessfully converted to MOM THR. The other, " Fracture of the Pin "

which I think refers to the femoral component of the prosthesis. He

doesn't explain about it. The p-aper is under links, to the left.

Europen hip conference. Click and select De Smets paper.

I was sent some unpublished preliminary information from Amstutz.

They have a better follow-up long term. Only two pts. lost to

followup. Cyst formation is not a real problem for them. They had

had problems in some pts. with osteoporosis. .

Good luck!

in NC

> Thanks, ,

>

> I really appreciate your taking the time to reply. No, I can't

get my

> knee anywhere near my chest. I can't move my right leg in

> circles without severe pain. I guess I wanted to hear that it

wasn't

> so bad! Sometimes I get woken up at night by pain when my leg

> swings into a position and I get stuck. And I really avoid

walking

> too far. I've been trying to preserve my cartilage and was hoping

> to hold out for another decade before needing a THR. I only

> heard about resurfacing a few weeks ago and the speed at

> which I have made plans to be operated on is quite scary. I'm

> used to putting it all out of my mind. When I have good days I

> question why I am going to put myself through this. Of course,

> on good days I haven't tried to put my knee to my chest or move

> my right leg in any direction but forward and back for walking.

It

> is so easy to adapt to pain when you can find ways to avoid it. I

> can't answer your questions as to the location of the osteophytes

> unless I send you a CD of my xrays. The JRI said that cysts are

> a problem and you say that Dr. De Smet says they're not? Can

> you say more about this? Thanks again for your honest

> evaluation.

>

> June

>

>

[Guest guest]

Hi:

It's actually . Sub-cortical cyst formation is quite

common. it is probably due to micro-fractureing of the Chondaral

(cartilage) and cortical (bone) which allows synovial fluid to enter

the bone under the pressure (weight-bearing. Don't worry about it.

There are ways of dealing with it (let the surgeon do

the " worrying " . DeSmet had only 2 failures related to the procedue

itself, in his presentation about the first 310 pts. However, he had

a number of patients lost to long term follow-up Neither was

related to cysts. One, osteoporosis in a Pt. with bad dysplasia,

sucessfully converted to MOM THR. The other, " Fracture of the Pin "

which I think refers to the femoral component of the prosthesis. He

doesn't explain about it. The p-aper is under links, to the left.

Europen hip conference. Click and select De Smets paper.

I was sent some unpublished preliminary information from Amstutz.

They have a better follow-up long term. Only two pts. lost to

followup. Cyst formation is not a real problem for them. They had

had problems in some pts. with osteoporosis. .

Good luck!

in NC

> Thanks, ,

>

> I really appreciate your taking the time to reply. No, I can't

get my

> knee anywhere near my chest. I can't move my right leg in

> circles without severe pain. I guess I wanted to hear that it

wasn't

> so bad! Sometimes I get woken up at night by pain when my leg

> swings into a position and I get stuck. And I really avoid

walking

> too far. I've been trying to preserve my cartilage and was hoping

> to hold out for another decade before needing a THR. I only

> heard about resurfacing a few weeks ago and the speed at

> which I have made plans to be operated on is quite scary. I'm

> used to putting it all out of my mind. When I have good days I

> question why I am going to put myself through this. Of course,

> on good days I haven't tried to put my knee to my chest or move

> my right leg in any direction but forward and back for walking.

It

> is so easy to adapt to pain when you can find ways to avoid it. I

> can't answer your questions as to the location of the osteophytes

> unless I send you a CD of my xrays. The JRI said that cysts are

> a problem and you say that Dr. De Smet says they're not? Can

> you say more about this? Thanks again for your honest

> evaluation.

>

> June

>

>

[Guest guest]

Hi:

It's actually . Sub-cortical cyst formation is quite

common. it is probably due to micro-fractureing of the Chondaral

(cartilage) and cortical (bone) which allows synovial fluid to enter

the bone under the pressure (weight-bearing. Don't worry about it.

There are ways of dealing with it (let the surgeon do

the " worrying " . DeSmet had only 2 failures related to the procedue

itself, in his presentation about the first 310 pts. However, he had

a number of patients lost to long term follow-up Neither was

related to cysts. One, osteoporosis in a Pt. with bad dysplasia,

sucessfully converted to MOM THR. The other, " Fracture of the Pin "

which I think refers to the femoral component of the prosthesis. He

doesn't explain about it. The p-aper is under links, to the left.

Europen hip conference. Click and select De Smets paper.

I was sent some unpublished preliminary information from Amstutz.

They have a better follow-up long term. Only two pts. lost to

followup. Cyst formation is not a real problem for them. They had

had problems in some pts. with osteoporosis. .

Good luck!

in NC

> Thanks, ,

>

> I really appreciate your taking the time to reply. No, I can't

get my

> knee anywhere near my chest. I can't move my right leg in

> circles without severe pain. I guess I wanted to hear that it

wasn't

> so bad! Sometimes I get woken up at night by pain when my leg

> swings into a position and I get stuck. And I really avoid

walking

> too far. I've been trying to preserve my cartilage and was hoping

> to hold out for another decade before needing a THR. I only

> heard about resurfacing a few weeks ago and the speed at

> which I have made plans to be operated on is quite scary. I'm

> used to putting it all out of my mind. When I have good days I

> question why I am going to put myself through this. Of course,

> on good days I haven't tried to put my knee to my chest or move

> my right leg in any direction but forward and back for walking.

It

> is so easy to adapt to pain when you can find ways to avoid it. I

> can't answer your questions as to the location of the osteophytes

> unless I send you a CD of my xrays. The JRI said that cysts are

> a problem and you say that Dr. De Smet says they're not? Can

> you say more about this? Thanks again for your honest

> evaluation.

>

> June

>

>

[Guest guest]

Sorry about the mis-typing that was supposed to be chondral.

> > Thanks, ,

> >

> > I really appreciate your taking the time to reply. No, I can't

> get my

> > knee anywhere near my chest. I can't move my right leg in

> > circles without severe pain. I guess I wanted to hear that it

> wasn't

> > so bad! Sometimes I get woken up at night by pain when my leg

> > swings into a position and I get stuck. And I really avoid

> walking

> > too far. I've been trying to preserve my cartilage and was

hoping

> > to hold out for another decade before needing a THR. I only

> > heard about resurfacing a few weeks ago and the speed at

> > which I have made plans to be operated on is quite scary. I'm

> > used to putting it all out of my mind. When I have good days I

> > question why I am going to put myself through this. Of course,

> > on good days I haven't tried to put my knee to my chest or move

> > my right leg in any direction but forward and back for walking.

> It

> > is so easy to adapt to pain when you can find ways to avoid it.

I

> > can't answer your questions as to the location of the

osteophytes

> > unless I send you a CD of my xrays. The JRI said that cysts are

> > a problem and you say that Dr. De Smet says they're not? Can

> > you say more about this? Thanks again for your honest

> > evaluation.

> >

> > June

> >

> >

[Guest guest]

Hi June,

My situation was a little different to most as I had a fused hip to start

with.......... However after 35 years of waiting I found out I could have

the operation in April 02 and had it by 08 Aug 02.......... and it involved

travelling a long distance to boot........... There were no guarantees that

what limited muscle I had left would support walking passed a very bad limp

and any chance of flexibility was in the lap of the gods.........

Well I took the chance......... I used to say it was like going over a cliff

with a parashute, hoping it worked when I pulled the string........smile.

Anything, even a wheel chair as long as I could sit as a result of the

operation, was looking good most days then............ So here I am 6

months later with a walk slowly approaching normal, a hip bending to almost

90 degrees and looking 10 years younger with a grin on my dial most

days.......... Pity about the damage done to the rest of my body while

waiting - which is another thing you need to weigh up any day waiting seems

a good idea........... Your spine will be suffering your limited flexibility

along with your knees and other hip.............

Few things in life are guaranteed......... You can only plan as best you

can, cross the fingers and trust, trust, trust............... It will be

painful for a least a few days, it will test your courage and capacities for

being adacious - through needing to go to Europe, raising money etc........

but having found out about Resurfacing suggests you are bolder than

most............ Travel well,

Edith LBHR Sydney Aust 8.02

>

> I really appreciate your taking the time to reply. No, I can't get my

> knee anywhere near my chest. I can't move my right leg in

> circles without severe pain. I guess I wanted to hear that it wasn't

> so bad! Sometimes I get woken up at night by pain when my leg

> swings into a position and I get stuck. And I really avoid walking

> too far. I've been trying to preserve my cartilage and was hoping

[Guest guest]

Hi Edith,

Yes, I forgot about the damage I am doing to the rest of my body

while compensating for my hips. My sacroilliacs joints are

already being affected. And right now I am still pretty strong and

healthy. The longer I wait, the worse the pain will be and the

less exercising and stretching I will be doing. I also have good

bone quality according to Dr. De Smet. (Can they really tell from

an xray?) Maybe that won't last as I get more imobile.

June

> Hi June,

>

> My situation was a little different to most as I had a fused hip to

start

> with.......... However after 35 years of waiting I found out I could

have

> the operation in April 02 and had it by 08 Aug 02.......... and it

involved

> travelling a long distance to boot........... There were no

guarantees that

> what limited muscle I had left would support walking passed a

very bad limp

> and any chance of flexibility was in the lap of the gods.........

>

> Well I took the chance......... I used to say it was like going over

a cliff

> with a parashute, hoping it worked when I pulled the

string........smile.

> Anything, even a wheel chair as long as I could sit as a result

of the

> operation, was looking good most days then............ So here I

am 6

> months later with a walk slowly approaching normal, a hip

bending to almost

> 90 degrees and looking 10 years younger with a grin on my

dial most

> days.......... Pity about the damage done to the rest of my body

while

> waiting - which is another thing you need to weigh up any day

waiting seems

> a good idea........... Your spine will be suffering your limited

flexibility

> along with your knees and other hip.............

>

> Few things in life are guaranteed......... You can only plan as

best you

> can, cross the fingers and trust, trust, trust............... It will be

> painful for a least a few days, it will test your courage and

capacities for

> being adacious - through needing to go to Europe, raising

money etc........

> but having found out about Resurfacing suggests you are

bolder than

> most............ Travel well,

>

> Edith LBHR Sydney Aust 8.02

> >

> > I really appreciate your taking the time to reply. No, I can't get

my

> > knee anywhere near my chest. I can't move my right leg in

> > circles without severe pain. I guess I wanted to hear that it

wasn't

> > so bad! Sometimes I get woken up at night by pain when my

leg

> > swings into a position and I get stuck. And I really avoid

walking

> > too far. I've been trying to preserve my cartilage and was

hoping

[Guest guest]

Hi ,

The reason I have been worried about cysts is because I wrote

to Chuck at the JRI in January. This is what he wrote to

me:

" Dear June,

There is some risk in delaying resurfacing if you have advanced

OA as manifested by large cysts. Our surgeons now believe that

there is a direct correlation between these cysts and the risk of

femoral head or neck fracture. In other words, the quality of the

femoral bone can be compromised as OA progresses and as

the cysts become larger. So, we now encourage patients to seek

treatment sooner rather than later if surgery is indicated so that

they don't risk their candidacy for resurfacing.

Best regards,

Chuck

Executive Director

Joint Replacement Institute at Orthopaedic Hospital "

You said that cyst formation has not been a problem for them.

What do you think is going on? Has there been a direct

correlation between cysts and femoral head and neck fracture or

was he just pulling my leg?

June

P.S. Are osteophytes bone spurs?

> > Thanks, ,

> >

> > I really appreciate your taking the time to reply. No, I can't

> get my

> > knee anywhere near my chest. I can't move my right leg in

> > circles without severe pain. I guess I wanted to hear that it

> wasn't

> > so bad! Sometimes I get woken up at night by pain when my

leg

> > swings into a position and I get stuck. And I really avoid

> walking

> > too far. I've been trying to preserve my cartilage and was

hoping

> > to hold out for another decade before needing a THR. I only

> > heard about resurfacing a few weeks ago and the speed at

> > which I have made plans to be operated on is quite scary.

I'm

> > used to putting it all out of my mind. When I have good days I

> > question why I am going to put myself through this. Of

course,

> > on good days I haven't tried to put my knee to my chest or

move

> > my right leg in any direction but forward and back for walking.

> It

> > is so easy to adapt to pain when you can find ways to avoid it.

I

> > can't answer your questions as to the location of the

osteophytes

> > unless I send you a CD of my xrays. The JRI said that cysts

are

> > a problem and you say that Dr. De Smet says they're not?

Can

> > you say more about this? Thanks again for your honest

> > evaluation.

> >

> > June

> >

> >

[Guest guest]

June:

Chuck is not pulling your leg {or injuring your hip ;-) }.

This is a complicated issue. THE FOLLOWING IS EXTRACTED FOM AN

UNPUBLISHED PAPER FROM JRI WHICH IS STILL IN PREPARATION. THE FINAL

PAPER WILL REFLECT OVER 400 PATIENTS. I HAVE ADDED EMPHASIS IN

SOME SECTIONS. This may be more detail than some people may

want. Don't over analyse. The final data won't be known for

20-30

years.

BASICALLY, AMTUTZ ET AL. BELIEVE THAT VERY LARGE CYSTS IN SMALL

FEMORAL HEADS MAY BE CONTRIBUTING TO FEMORAL COMPONENT LOOSENING AS

A RELATIVELY LATE COMPLICATION. THIS IS NOT THE CAUSE OF EARLY

FEMORAL NECK FRACTURE.

KEEP IN MIND THAT TRADITIONAL THR has its own set of complications.

_____________________________________________________________________

" The initial results of the first 300 hips with a new metal-on-

metal hybrid surface arthroplasty were studied at an average of 3.5

years (range 2.5 - 6.0). The average patient age was 48, 75% were

men and the majority received the device for osteo

arthritis…. " All

measures of function and range of motion showed significant

improvement and many patients returned to a high level of activity

including sports. ...conversions (3.6%) to total hip replacement; 7

for femoral loosening at average 32 months (20-62), 2 neck fractures

at 1.4 and 2.3 months " ...

_____________________________________________________________________

AMSTUTZ IS NOW CEMENTING THE ENTIRE FEMORAL COMPONENT AND MAY DRILL

ADDITIONAL HOLES IN THE FEMORAL HEAD IN PATIENTS THAT HE FEELS ARE

AT HIGHER RISK. THIS IS ALL VERY NEW AND DIFFERENT SURGEONS WILL

HAVE SLIGHTLY DIFFERENT APPROACHES. THEY ALL HAVE A GOOD TRACK

RECORD SO FAR. YOU NEED TO CONSIDER THE DANGER OF WAITING, ALLOWING

FURTHER DETERIORATION (AND BEING LIMITED DURING PRIME YEARS OF YOUR

LIFE). ( in NC)

___________________________________________________________________

....

" Bone Grafting

THE PRESENCE OF LARGE FEMORAL HEAD CYSTS EMERGED AS A HIGH

RISK FACTOR FOR LOOSENING AND FEMORAL LUCENCIES. Initially, the

senior author surgeon accepted patients with large cystic defects

and fifteen hips were grafted using a bone paste from the

acetabulum and in combination with ground cancellous autogenous bone

taken from trimmings. From these 15 cases, 1 presented with a very

large 25-mm central cyst in the femoral head which was reamed to

35.5mm for a 44-mm component. He did well and returned to cycling,

swimming and hiking for 2 years but the component loosened, migrated

and was revised (pt # 15 Table 7). Although the other 14 hips which

were grafted have no evidence of any radiolucencies we would not in

general recommend grafting as opposed to filling the defect with

acrylic or if the cystic degeneration is too large, proceeding to

total hip replacement. Certainly if a defect is filled with bone

paste it is likely that acrylic will not contact host bone so that

fixation area will be less. If the bone chips are used similar to

the technique of Ling and Gie in impaction then some acrylic may be

incorporated in the initial fixation but we will have await

retrievals to establish efficacy. " ...

" Risk Factors for Fracture and Femoral Loosening.

We now have identified some risk factors for fracture and loosening.

Although variable, the risk of revision increases in proportion to

the number of risk factors present..

These include 1. Preoperative factors: bone quantity and quality

(smaller fixation area, cysts in males, previous surgery in

females,) and lighter weight males. 2. Operative factors: Component

orientation more 3. Postoperative factors of activity and weight..

The preoperative factors can be assessed by the surgeon prior to

implantation of the device, and the operative factors can be

addressed by the surgeon during the implantation of the device.

As a result of our analysis, we believe the surgeons are now in

better position to advise their patients regarding risk factors and

institute steps to minimize technical risk factors which are under

their control or advise a total hip replacement. Ultimately, the

control of the key post-operative factors are up to the patient

but it is the duty of the surgeon to properly inform them of the

risks which confronts each patient. At this time we do not have

definitive contraindications to the surgery but those patients who

have compromised bone stock, particularly large head cysts and small

femoral heads warrant special scrutiny as to the advisability of the

procedure. Patients also should be informed that, even though not

statistically significant at this time, high activity levels

(especially impact sports) are likely to shorten the life of the

implant in a similar manner to the effect of those activities on a

normal hip or a total hip replacement. Two of seven patients who

developed radiolucencies after the two year X-ray are regularly

participating in impact activities (one in long distance running and

the other in tournament tennis) " ...

" THUS FAR WE HAVE INVOKED MEASURES TO ELIMINATE THOSE RISK

FACTORS

WHICH ARE UNDER OUR CONTROL. IF THE SHORT-TERM COMPLICATIONS CAN BE

ELIMINATED WITH THE LESSONS LEARNED BY OPTIMIZING FIXATION (SUCH AS

METICULOUS BONE PREPARATION AND CEMENTING IN THE STEM) THEN IT MAY

BE FEASIBLE TO ADVISE YOUNGER PATIENTS TO CONSIDER SURFACE

ARTHROPLASTY BEFORE THERE IS SEVERE BONE DESTRUCTION. " ...

" IN RECOGNITION OF THE HIGHER RISK FOR THIS GROUP, WE NOW

RECOMMEND

CEMENTING IN THE FEMORAL STEM AND USING ADDITIONAL DRILL HOLES IN

THE PREPARED FEMORAL HEAD TO INCREASE FIXATION AREA. FIXATION AREA

IN THE CEMENTED FEMORAL SURFACE ARTHROPLASTY IS, IN TURN, RELATED TO

THE QUALITY OF THE BONE AND THUS THE PRESENCE OF CYSTS EMERGED AS A

RISK FACTOR IN OUR ANALYSIS,... "

++++++++++++++++++++++++++++++++++++

I HOPE I HAVEN'T COMPLICATED THINGS FOR YOU. I WOULD RECOMMEND

TRUSTING DE SMETS JUDGEMENT IN HANDLING YOUR CASE.

( in NC)

> > > Thanks, ,

> > >

> > > I really appreciate your taking the time to reply. No, I

can't

> > get my

> > > knee anywhere near my chest. I can't move my right leg in

> > > circles without severe pain. I guess I wanted to hear that it

> > wasn't

> > > so bad! Sometimes I get woken up at night by pain when my

> leg

> > > swings into a position and I get stuck. And I really avoid

> > walking

> > > too far. I've been trying to preserve my cartilage and was

> hoping

> > > to hold out for another decade before needing a THR. I only

> > > heard about resurfacing a few weeks ago and the speed at

> > > which I have made plans to be operated on is quite scary.

> I'm

> > > used to putting it all out of my mind. When I have good days

I

> > > question why I am going to put myself through this. Of

> course,

> > > on good days I haven't tried to put my knee to my chest or

> move

> > > my right leg in any direction but forward and back for

walking.

> > It

> > > is so easy to adapt to pain when you can find ways to avoid

it.

> I

> > > can't answer your questions as to the location of the

> osteophytes

> > > unless I send you a CD of my xrays. The JRI said that cysts

> are

> > > a problem and you say that Dr. De Smet says they're not?

> Can

> > > you say more about this? Thanks again for your honest

> > > evaluation.

> > >

> > > June

> > >

> > >

[Guest guest]

June:

Chuck is not pulling your leg {or injuring your hip ;-) }.

This is a complicated issue. THE FOLLOWING IS EXTRACTED FOM AN

UNPUBLISHED PAPER FROM JRI WHICH IS STILL IN PREPARATION. THE FINAL

PAPER WILL REFLECT OVER 400 PATIENTS. I HAVE ADDED EMPHASIS IN

SOME SECTIONS. This may be more detail than some people may

want. Don't over analyse. The final data won't be known for

20-30

years.

BASICALLY, AMTUTZ ET AL. BELIEVE THAT VERY LARGE CYSTS IN SMALL

FEMORAL HEADS MAY BE CONTRIBUTING TO FEMORAL COMPONENT LOOSENING AS

A RELATIVELY LATE COMPLICATION. THIS IS NOT THE CAUSE OF EARLY

FEMORAL NECK FRACTURE.

KEEP IN MIND THAT TRADITIONAL THR has its own set of complications.

_____________________________________________________________________

" The initial results of the first 300 hips with a new metal-on-

metal hybrid surface arthroplasty were studied at an average of 3.5

years (range 2.5 - 6.0). The average patient age was 48, 75% were

men and the majority received the device for osteo

arthritis…. " All

measures of function and range of motion showed significant

improvement and many patients returned to a high level of activity

including sports. ...conversions (3.6%) to total hip replacement; 7

for femoral loosening at average 32 months (20-62), 2 neck fractures

at 1.4 and 2.3 months " ...

_____________________________________________________________________

AMSTUTZ IS NOW CEMENTING THE ENTIRE FEMORAL COMPONENT AND MAY DRILL

ADDITIONAL HOLES IN THE FEMORAL HEAD IN PATIENTS THAT HE FEELS ARE

AT HIGHER RISK. THIS IS ALL VERY NEW AND DIFFERENT SURGEONS WILL

HAVE SLIGHTLY DIFFERENT APPROACHES. THEY ALL HAVE A GOOD TRACK

RECORD SO FAR. YOU NEED TO CONSIDER THE DANGER OF WAITING, ALLOWING

FURTHER DETERIORATION (AND BEING LIMITED DURING PRIME YEARS OF YOUR

LIFE). ( in NC)

___________________________________________________________________

....

" Bone Grafting

THE PRESENCE OF LARGE FEMORAL HEAD CYSTS EMERGED AS A HIGH

RISK FACTOR FOR LOOSENING AND FEMORAL LUCENCIES. Initially, the

senior author surgeon accepted patients with large cystic defects

and fifteen hips were grafted using a bone paste from the

acetabulum and in combination with ground cancellous autogenous bone

taken from trimmings. From these 15 cases, 1 presented with a very

large 25-mm central cyst in the femoral head which was reamed to

35.5mm for a 44-mm component. He did well and returned to cycling,

swimming and hiking for 2 years but the component loosened, migrated

and was revised (pt # 15 Table 7). Although the other 14 hips which

were grafted have no evidence of any radiolucencies we would not in

general recommend grafting as opposed to filling the defect with

acrylic or if the cystic degeneration is too large, proceeding to

total hip replacement. Certainly if a defect is filled with bone

paste it is likely that acrylic will not contact host bone so that

fixation area will be less. If the bone chips are used similar to

the technique of Ling and Gie in impaction then some acrylic may be

incorporated in the initial fixation but we will have await

retrievals to establish efficacy. " ...

" Risk Factors for Fracture and Femoral Loosening.

We now have identified some risk factors for fracture and loosening.

Although variable, the risk of revision increases in proportion to

the number of risk factors present..

These include 1. Preoperative factors: bone quantity and quality

(smaller fixation area, cysts in males, previous surgery in

females,) and lighter weight males. 2. Operative factors: Component

orientation more 3. Postoperative factors of activity and weight..

The preoperative factors can be assessed by the surgeon prior to

implantation of the device, and the operative factors can be

addressed by the surgeon during the implantation of the device.

As a result of our analysis, we believe the surgeons are now in

better position to advise their patients regarding risk factors and

institute steps to minimize technical risk factors which are under

their control or advise a total hip replacement. Ultimately, the

control of the key post-operative factors are up to the patient

but it is the duty of the surgeon to properly inform them of the

risks which confronts each patient. At this time we do not have

definitive contraindications to the surgery but those patients who

have compromised bone stock, particularly large head cysts and small

femoral heads warrant special scrutiny as to the advisability of the

procedure. Patients also should be informed that, even though not

statistically significant at this time, high activity levels

(especially impact sports) are likely to shorten the life of the

implant in a similar manner to the effect of those activities on a

normal hip or a total hip replacement. Two of seven patients who

developed radiolucencies after the two year X-ray are regularly

participating in impact activities (one in long distance running and

the other in tournament tennis) " ...

" THUS FAR WE HAVE INVOKED MEASURES TO ELIMINATE THOSE RISK

FACTORS

WHICH ARE UNDER OUR CONTROL. IF THE SHORT-TERM COMPLICATIONS CAN BE

ELIMINATED WITH THE LESSONS LEARNED BY OPTIMIZING FIXATION (SUCH AS

METICULOUS BONE PREPARATION AND CEMENTING IN THE STEM) THEN IT MAY

BE FEASIBLE TO ADVISE YOUNGER PATIENTS TO CONSIDER SURFACE

ARTHROPLASTY BEFORE THERE IS SEVERE BONE DESTRUCTION. " ...

" IN RECOGNITION OF THE HIGHER RISK FOR THIS GROUP, WE NOW

RECOMMEND

CEMENTING IN THE FEMORAL STEM AND USING ADDITIONAL DRILL HOLES IN

THE PREPARED FEMORAL HEAD TO INCREASE FIXATION AREA. FIXATION AREA

IN THE CEMENTED FEMORAL SURFACE ARTHROPLASTY IS, IN TURN, RELATED TO

THE QUALITY OF THE BONE AND THUS THE PRESENCE OF CYSTS EMERGED AS A

RISK FACTOR IN OUR ANALYSIS,... "

++++++++++++++++++++++++++++++++++++

I HOPE I HAVEN'T COMPLICATED THINGS FOR YOU. I WOULD RECOMMEND

TRUSTING DE SMETS JUDGEMENT IN HANDLING YOUR CASE.

( in NC)

> > > Thanks, ,

> > >

> > > I really appreciate your taking the time to reply. No, I

can't

> > get my

> > > knee anywhere near my chest. I can't move my right leg in

> > > circles without severe pain. I guess I wanted to hear that it

> > wasn't

> > > so bad! Sometimes I get woken up at night by pain when my

> leg

> > > swings into a position and I get stuck. And I really avoid

> > walking

> > > too far. I've been trying to preserve my cartilage and was

> hoping

> > > to hold out for another decade before needing a THR. I only

> > > heard about resurfacing a few weeks ago and the speed at

> > > which I have made plans to be operated on is quite scary.

> I'm

> > > used to putting it all out of my mind. When I have good days

I

> > > question why I am going to put myself through this. Of

> course,

> > > on good days I haven't tried to put my knee to my chest or

> move

> > > my right leg in any direction but forward and back for

walking.

> > It

> > > is so easy to adapt to pain when you can find ways to avoid

it.

> I

> > > can't answer your questions as to the location of the

> osteophytes

> > > unless I send you a CD of my xrays. The JRI said that cysts

> are

> > > a problem and you say that Dr. De Smet says they're not?

> Can

> > > you say more about this? Thanks again for your honest

> > > evaluation.

> > >

> > > June

> > >

> > >

[Guest guest]

in NC,

You are amazing and sooooo helpful. Thanks for being on this

list!

June

[Guest guest]

in NC,

You are amazing and sooooo helpful. Thanks for being on this

list!

June

[Guest guest]

Thanks , I was alittle worried about possible fixation

problems in the future due to fairly large femoral cysts. I'm glad

that Dr De Smet uses cement to fill cysts and fix the femoral

component. Last May when I had my BHR I was aware that many Dr's

used bone graft and that Dr De Smet used cement. I just trusted

that it would be ok. Now it looks like the all cement way is best

for people like me with good sized cysts.

> > > > Thanks, ,

> > > >

> > > > I really appreciate your taking the time to reply. No, I

> can't

> > > get my

> > > > knee anywhere near my chest. I can't move my right leg in

> > > > circles without severe pain. I guess I wanted to hear that

it

> > > wasn't

> > > > so bad! Sometimes I get woken up at night by pain when my

> > leg

> > > > swings into a position and I get stuck. And I really avoid

> > > walking

> > > > too far. I've been trying to preserve my cartilage and was

> > hoping

> > > > to hold out for another decade before needing a THR. I only

> > > > heard about resurfacing a few weeks ago and the speed at

> > > > which I have made plans to be operated on is quite scary.

> > I'm

> > > > used to putting it all out of my mind. When I have good

days

> I

> > > > question why I am going to put myself through this. Of

> > course,

> > > > on good days I haven't tried to put my knee to my chest or

> > move

> > > > my right leg in any direction but forward and back for

> walking.

> > > It

> > > > is so easy to adapt to pain when you can find ways to avoid

> it.

> > I

> > > > can't answer your questions as to the location of the

> > osteophytes

> > > > unless I send you a CD of my xrays. The JRI said that cysts

> > are

> > > > a problem and you say that Dr. De Smet says they're not?

> > Can

> > > > you say more about this? Thanks again for your honest

> > > > evaluation.

> > > >

> > > > June

> > > >

> > > >

[Guest guest]

Thanks , I was alittle worried about possible fixation

problems in the future due to fairly large femoral cysts. I'm glad

that Dr De Smet uses cement to fill cysts and fix the femoral

component. Last May when I had my BHR I was aware that many Dr's

used bone graft and that Dr De Smet used cement. I just trusted

that it would be ok. Now it looks like the all cement way is best

for people like me with good sized cysts.

> > > > Thanks, ,

> > > >

> > > > I really appreciate your taking the time to reply. No, I

> can't

> > > get my

> > > > knee anywhere near my chest. I can't move my right leg in

> > > > circles without severe pain. I guess I wanted to hear that

it

> > > wasn't

> > > > so bad! Sometimes I get woken up at night by pain when my

> > leg

> > > > swings into a position and I get stuck. And I really avoid

> > > walking

> > > > too far. I've been trying to preserve my cartilage and was

> > hoping

> > > > to hold out for another decade before needing a THR. I only

> > > > heard about resurfacing a few weeks ago and the speed at

> > > > which I have made plans to be operated on is quite scary.

> > I'm

> > > > used to putting it all out of my mind. When I have good

days

> I

> > > > question why I am going to put myself through this. Of

> > course,

> > > > on good days I haven't tried to put my knee to my chest or

> > move

> > > > my right leg in any direction but forward and back for

> walking.

> > > It

> > > > is so easy to adapt to pain when you can find ways to avoid

> it.

> > I

> > > > can't answer your questions as to the location of the

> > osteophytes

> > > > unless I send you a CD of my xrays. The JRI said that cysts

> > are

> > > > a problem and you say that Dr. De Smet says they're not?

> > Can

> > > > you say more about this? Thanks again for your honest

> > > > evaluation.

> > > >

> > > > June

> > > >

> > > >

[Guest guest]

Thanks , I was alittle worried about possible fixation

problems in the future due to fairly large femoral cysts. I'm glad

that Dr De Smet uses cement to fill cysts and fix the femoral

component. Last May when I had my BHR I was aware that many Dr's

used bone graft and that Dr De Smet used cement. I just trusted

that it would be ok. Now it looks like the all cement way is best

for people like me with good sized cysts.

> > > > Thanks, ,

> > > >

> > > > I really appreciate your taking the time to reply. No, I

> can't

> > > get my

> > > > knee anywhere near my chest. I can't move my right leg in

> > > > circles without severe pain. I guess I wanted to hear that

it

> > > wasn't

> > > > so bad! Sometimes I get woken up at night by pain when my

> > leg

> > > > swings into a position and I get stuck. And I really avoid

> > > walking

> > > > too far. I've been trying to preserve my cartilage and was

> > hoping

> > > > to hold out for another decade before needing a THR. I only

> > > > heard about resurfacing a few weeks ago and the speed at

> > > > which I have made plans to be operated on is quite scary.

> > I'm

> > > > used to putting it all out of my mind. When I have good

days

> I

> > > > question why I am going to put myself through this. Of

> > course,

> > > > on good days I haven't tried to put my knee to my chest or

> > move

> > > > my right leg in any direction but forward and back for

> walking.

> > > It

> > > > is so easy to adapt to pain when you can find ways to avoid

> it.

> > I

> > > > can't answer your questions as to the location of the

> > osteophytes

> > > > unless I send you a CD of my xrays. The JRI said that cysts

> > are

> > > > a problem and you say that Dr. De Smet says they're not?

> > Can

> > > > you say more about this? Thanks again for your honest

> > > > evaluation.

> > > >

> > > > June

> > > >

> > > >