Saturday, April 16, 2011

My conundrum with the logic surrounding the revision options with the Depuy hip

The concept of “revising the hip” seems to infer that a patient will have the full hip replaced and that is not what was presented to me as an option (as I understand it)  in order to halt the progression of Osteolysis and decrease the ion levels.  The option provided  was replace the liner which fits into the dome or acetablum of the hip.  Now here is the conundrum I see with this.
1.      If the high rates of debris and wear are caused by the metal rubbing against the metal as a result of improper placement of the hip during surgery and
2.     If my second opinion on the placement of my hip joint was described as follows:
·          Couldn’t have done it better myself had I been your surgeon…
·          I have seen a lot of revision candidates and your hip was  placed correctly..
3.     Then why will the issues surrounding the metal debris change post surgery  if the alleged cause of the debris (improper placement) appears to not be the cause of the problems (osteolysis, high metal ion levels etc)???

So do you see the issue?  I don’t understand why the solution (replacing the liner with poly) is going to address the alleged cause of the problem if the hip placement in the surgery was perfectly placed.  I wonder if most “revisions” entail merely replacing the liner or do they entail replacing the entire prosthetic device?  I am now beginning to understand the conflicting information between the fact that my surgeon’s reassurance that this surgery is not a big deal vs the feedback from patients on this blog who have experienced big problems with this revision.

What constitutes a revision?  Is a revision replacing all parts of the hip or just the liner?  If it is the latter, is that alone going to address the problem?  I would be very interested in hearing any comments from hip revision patients as to what exactly has been replaced in their revision?  The liner or the entire devise including the stem, the ball and the dome (acetabulum) and the liner.

There are 4 parts in a hip implant:
·        Acetabular cup
·        Liner
·        Femoral head
·        Femoral stem

It appears that according to the attached overview from Rush Presby, a revision surgery can entail replacing one or more of these parts. http://www.rush.edu/Rush_Document/Ortho_Hip%20Replacement%20Revision_FINAL.pdf

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