Thursday, March 31, 2011

Updated recommendations re the decision: Depuy hip revision or not.

I received a key recommendation from one of my consults yesterday.  Recall that not all of my consults are in agreement as to how I should proceed. The recommendation:  Strong consideration should be given to revise this hip.  Why?
1)      High levels of cobalt
2)      High levels of chromium
3)      Osteolyis present
4)      Soft tissue damage present
5)      Known issues with the Depuy hip.

The really important points to take away from this:
1)      There is no one thing that should drive the decision to revise or not but rather, consider the big picture with your physcians
2)      I AM CURRENTLY ASYMPTOMATIC that is, I am experiencing no pain.....yet I have strong indications now to revise this hip.

4 comments:

  1. So what tests tell you that you have soft tissue damage and osteolysis? I have all kinds of fun symptoms, the elevated Cobalt, just had a bone scan (haven't heard results) and see the doc Monday about a bilateral revision. Just curious which tests you had that identify those two. Thanks, Connie

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  2. The only tests that will show this is an MRI with a Mavrick (newer protocol) or Mars (older protocol.) Your physcian should know about this protocal.

    "MRI Protocol We suggest you order a MARS MRI. Guidance regarding this protocol will be provided by DePuy. The MARS MRI requires special software to minimize interference from the metal implant. Not all facilities are equipped with the special software. If MARS MRI capabilities are not available locally, ultrasound is a suitable alternative"

    The Depuy guidelines can be found here:
    http://www.pritzkerlaw.com/pdf-file/depuy-hip-recall.pdf

    I am aware of no guidence to take a bone scan. Did you mean an ultrasound? The best test is an MRI which is indicated after you take the ion toxicity tests.

    following is the recomendation from Depuy:

    If either metal ion concentration is above 7 parts per billion (ppb), a second blood metal ion test (both cobalt and chromium) should be performed three months after the first if no symptoms are present.

    If the metal ion concentration is again above 7ppb, the surgeon should consider MRI or ultrasound, even if the patient does not have symptoms.

    If MRI or ultrasound scan reveals soft tissue reactions, fluid collections or tissue masses, then revision surgery should be considered.

    If metal ions are less than 7ppb and/or MRI or ultrasound are within normal values, patients should be evaluated on an annual basis for the first five years. These evaluations should be conducted according to your normal procedures.

    hope that helps!

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  3. I just wanted to add one more thing. I had an ultra sound it showed nothing. The correct MRI protocal should provide you with the information on osteolysis and soft tissue damage. Not all MRIs will show you this so the protocal used in the MRI is important.

    Connie

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  4. Connie - get it out before it kills you. Your test results are through the roof and it will be poisoning you and you don't want all the results of that - including deafness and blindness and ringing in the ears is just the start - I have a herd of crickets ringing in mine!

    Earl

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