Wednesday, January 5, 2011
My 2nd Appointment with My Orthopedic Surgeon.
Test Results: Preliminary results are not good.
As discussed in prior posts, the standard protocol for following up the recalled hips is to run three tests:
· Cobalt levels
· Chromium levels
· Soft tissue scan of the hip
Apparently only one test result was returned for some odd reason. The doctor advised that normal chromium levels were in the 4 range for patients with hip replacements. My results were 26 which he thought was extremely high. I was asked to have both cobalt and Chromium levels rerun again.
Reviewing these results will require now a 3rd appointment.
Recommendation by the surgeon: Remove the hip
The following questions from my post on dec 30th were all answered. (I am reporting these so that anyone following this blog might ask similar questions to their surgeon.)
1. He confirmed that osteolysis (loss of bone bone around the hip implant) is likely caused by the metal debris. My last CT scan noted: “there is extensive osteolysis involving the acetabulum which has progressed as compared to the previous examination. “
2. The previously noted fluid collection in the bursa was resolved and is not a psudotumor which is really a soft tissue mass that is sometimes found with this hip replacement.
3. Unfortunately, there is no simple test to supplement the customary free ion blood test to determine whether the chromium has concentrated in the lymph nodes, liver and spleen. The only test would be a biopsy which he did not recommend.
4. While I have not had an MRI, I asked whether having Dr. Hollis Potter, who specializes in running these scans and is a strong advocate in using MRIs for diagnosis and treatment surrounding the hip, should run an MRI scan on me. We decided to do that. She is practices out of Cornell.
5. It was confirmed that the size of the femur head used in my transplant was 49 and the acetabulum was 56. I asked about this because femoral head sizes less than 44mm presents a 5x failure risk over the larger sizes.
6. We actually measured the angle of hip replacement on the xray with a protractor like device to get confirmation that the hip placement angle of 45 degrees was achieved. The angle of my hip was 46 degrees which my surgeon seemed very comfortable with.
7. I had neglected to ask him to confirm that early revision of the replacement that generates metal debris should give a better surgical outcome which of course was one of the recommendations by Depuy on the recall notice sent to physicians so I presume this is correct.
8. He confirmed that if I were to get a replacement, he would use a titanium cap with a polyethylene insert. No more metal on metal. He mentioned that there were a number of devices available. I would have to investigate this before selecting the implant. He made a special point to note that he continues to use Depuy replacements in his practice because he believed that this particular implant had a design defect but thought that other solutins provided by this manufacurer should be considered. He did say some of his patients wanted nothing to do with Depuy implants but my guess is that his patients are not up to speed on the many recalls that have taken palce with hip replacements in general.
9. He confirmed that it is not a fait accompli that the revision surgery would result in severe bone destruction when removing the first femoral head. Recall that the bone grows into the metal so one would presume that getting it out is not easy.
To date, the risk factors that apply to me are numerous:
· Extensive Osteolysis which is progressing
· Small femoral head size
· Very high chromium levels
· Fluid sacks have formed in the bursa but now resolved
· Intermittent pain (discussed in previous posts)
Plan of Action:
· Review the new blood tests for chromium and cobalt levels
· Review the results from the soft tissue scan
· Find a toxicology expert to get a perspective of the danger surrounding the levels of metal in my blood.
· Have Dr. Hollis Potter, an expert in MRI imaging for hip replacement patients conduct an MRI of my hip.
· Investigate thoroughly the options available for a new hip.
Bottom line: My surgeon continues to tell me that surgeons are continuing to make recommendations without large amounts of clinical data to indicate the “right” decision re the replacement. Therein lies my discomfort with moving ahead with yet another replacement lacking a thorough investigation of the facts.
Posted by Connie at 5:33 AM