Thursday, September 29, 2011

Pre Op Appointment with Orthopedic Surgeon tomorrow

Hi guys, I have kept you informed on the topics I discuss with any of my orthopedic surgeons/consults or other medical professionals with whom I have appointments.

As I have mentioned previously, my surgery is scheduled for Monday Nov 7th.  These are the remaining items on my agenda for the meeting tomorrow (hopefully my last meeting prior to surgery):

(1) Review the order for the test to detect  t (14:18) translocations in peripheral  blood lymphocytes  from my current hip. (some studies suggest there is is an increase risk of lymphoma and leukemia in patients with total hip replacements in patients with  the hip in situe for more than 10 years.  I want to know at this point whether there is an increase in the frequency of mark of mutagens  t (14:18) translocations in my blood.) While I have not had the hip for 10 years, I would like to start a baseline.  Preliminary data suggests that  t (14:18) translocation frequency is 37.5% higher in frequency than those undergoing primary hip replacement which has a frequency of 22.2%. Wear debris including the potential carcinogens of Cr and Co accumulate at highest concentration in the bone marrow and the lymph nodes.

In genetics, a chromosome translocation is a chromosome abnormality caused by rearrangement of parts between nonhomologous chromosomes. A gene fusion may be created when the translocation joins two otherwise separated genes, the occurrence of which is common in cancer

(2) My MRI showed that I have some elevated bone resorption at the top outer portion of my femur.  Given the surgeon has no plans at the moment of removing my femur (pretty extensive surgery), I would like to know what he knows now of the condition of my stem and how he knows it.  If he thinks it might be possible he discovers wear on the stem during surgery, then what?  What's the plan?

(3)   He had suggested that we look at the Pinnacle as a replacement for the ASR (both manufactured by Depuy.)  Likely one of the reasons he selected Pinnacle is that it is compatible with the stem I have now.  The stem would have to removed if we switched to another manufacturer  which I will confirm.

I would like some assurance that the recent surge in hip complaints re the Pinnacle to the FDA are based on the Metal on metal Pinnacle and not the ceramic or poly component.  I then want to know specifically, which components he intends to replace and then insert.  Also would like to know what the composition of the liner is he intends to use if there is one.  I would like to stay away from the ultra high molecular weight  stuff (associated with high wear rates).

While the overall performance of the Pinnacles are good, I only care about the performance of the exact items/materials he intends to use as a replacement.

(4) Some surgeons believe that a majority of chromium debris comes from the corrosion between the femur and head and not between the head and acetablum (rubbing of bearing surfaces.)  If this is true, why do we need to place a poly liner between two things that are not really causing the problem?

(5)  Curious about the percent of patients in his practice with MoM hips?

(6) Since my ortho surgeon has a genetics background, I would like his take on the observation that  although there is  good evidence that suggests Cr 6 is the ion responsible for most of the toxic actions,  much of the underlying molecular damge may be due to its intracellular reduction to the even more highly reactive and short lived chromium 3 and chromium 5.

Depuy maintains that the chromium found in the ASR is chromium 3.  My question:  Is the chromium 3 (known to be less toxic....NOT NON TOXIC) actually oxidized chromium 6?
Well, hope to get through these questions so I can have this surgery in peace!

2 comments:

  1. Hi Connie,

    Have you heard anything about the Lima Delta TT cup.
    We also have the Depuy ASR MOM and will get revision surgery later on this year and the surgeon recommended we use the above with ceramic on ceramic. I believe that the Delta TT cup is compatible with the Depuy ASR stem system.

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  2. Hi,

    I am not familiar with the Lima company at all but I understand it is Italian? Ceramic on Ceramic is a good choice though depending on your age and other factors...Overall, ceramic on ceramic is quite safe historically.

    you might want to ask about the squeaking associated with this?

    Type in Ceramic on the search blog on my home page and there will be a number of things that come up on Ceramic.

    Best of luck and let me know if you have any more questions.

    connie

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