Saturday, November 12, 2011

Preliminary Post Op Report for Connie

Hello my friends.  I so appreciated your kind notes.  Thank you from the bottom of my heart.

Who would  project that I would be down for 4 days with the surgery but it is what it is. Summary of  my post op reports follow.  BTW/ always request a copy of the post op report. It is a detail overview of what happened in the surgery authored by your surgeon.  You should review it with your surgeon.  If you have not done so, make an appointment to do it.

My revision surgery took place on Monday Nov 7th and ran for about 1.5 hours.

Overall Reaction to the revision vs the initial implant:
  •  My first reaction to this surgery is that it was much more involved than I anticipated.  In the first surgery, there were several  things that stood out:
    •  minimally invasive surgery which involved only 2 incisions of about 2-3 inches each.  One on the front of the thigh and one on the rear buttocks
    • minimal pain medications which I discontinued in a few days.
    •  only a few days in the hospital
    • 5 days of rehab to learn to cope with the restrictions post hip 
    • up on my computer 2 days after surgery
    • no real  pain post surgery
    • up and walking the day following surgery
    • working from home full time in the second week
    • back to work and driving in 2 weeks
  • The revision:
    • large incision (10 inches or more I would guess-haven't measured it.)
    • Remain on continuous pain meds for the last 4 days...lots of trial and error on that...Dilauded (hydromorphone), Tramidol (opiate), Perkocet (oxycodine.)  I have found it very difficult to get some kind of balance between  pain reduction while maintaining some ability to  partake in physical therapy. 
    • I was just  transferred out of the hospital on wed  to the rehab center.  Not sure how long I will be here. You can be sure I will be out of here as fast as I can be.
    • Large incision resulted in  daily  bandage changing with an oozing wound....Amazing to me that someone has not invented a tape that can be used in wound care that enables painless bandage changes. 
    • Staples will not be removed for 10 days.  Appears I may have 30 or 40..... so says the PA.
    • Friday is the first day I  spent  on my computer.
    • Undergoing 3 PT sessions per day to work my way out of this thing. 
    • Thursday is really the first day that I have been functioning with  partially assisted  (vs fully assisted )for activities such as  bathing, clothing, using a bathroom. Prior to this day, I required fully assisted support staff to do most anything. 
    • considerable swelling in my feet and on the wound
    • lots of water retention.
    • sick (vomiting) for a few days post surgery.
Operative findings for an asymptomatic patient (no pain presenting prior to surgery):  I have included most of the information but have not investigated the implications thereof.

Questions in Red:
  • significant amount of inflammatory fluid within the hip joint
    • all evacuated  (Why?)
  • diffuse, hypertrophic*, synovitic reaction* within the joint itself
    • this was thoroughly debrided (cleansed.)  (Why?)
[definitions added by Connie
Hypertrophy*  is the increase in the volume of an organ or tissue due to the enlargement of its component cells
 *synovial joint

Typical Joint
A Synovial joint, also known as a diarthrosis, is the most common and most movable type of joint in the body of a mammal. As with most other joints, synovial joints achieve movement at the point of contact of the articulating bones.

Structural and functional differences distinguish synovial joints from cartilaginous joints (synchondroses and symphyses) and fibrous joints (Sutures, gomphoses, and syndesmoses). The main structural differences between synovial and fibrous joints are the existence of capsules surrounding the articulating surfaces of a synovial joint and the presence of lubricating synovial fluid within those capsules (synovial cavities).

Synovial membrane (or synovium)[1] is the soft tissue found between the articular capsule (joint capsule) and the joint cavity of synovial joints. [2]
The word "synovium" is related to the word "synovia" (synovial fluid), which is the clear, viscid, lubricating fluid secreted by synovial membranes. The word "synvovia" or "sinovia" was coined by Paracelsus,[3] and may have been derived from the Greek word "syn" ("with") and the Latin word "ovum" ("egg") because the synovial fluid in joints that have a cavity between the bearing surfaces is similar to egg white.]

  • Some metallic staining in the soft tissues (What are implications of this?)
  • capsular, ligament and muscular attachments around the hip were all in good condition [interesting given the MRI showed something else.] This was thoroughly debrided (cleansed.)  Why if everything was fine? 
  • Acetabular implant itself was removed without difficulty
    • There was a very large cavitary leison involving the dome of the acetablum extending somewhat into the anterior and posterior column.
    • the defect was entirely contained  (What is the implication of all of this?)
  • The columns remained intact along with the remainder of the acetabular anatomy.
  • The femoral component was assessed and found to be in good position and was very stable within the bone.
  • Reconstruction was accomplished with a  Pinnacle size 60MM acetabular component screwed with 2 screws to the ilium, a 36 mm Pinnacle marathon acetabular liner, 36 mm femoral head with 8.5 neck length [ceramic I presume since that is what we discussed].
    • The acetabular defect described above was grafted (bone graph) with deminarlized bone matrix. (it was noted that the patient tolerated this proceedure well.) (What is the issue with this?  seems like there was a question about the ability to tolerate this....why?)
Points in the description of the Operation:
  • The acetabular component was removed without bone loss (good news) and was stable.
  • There was a large cavitary leision involving the dome of the acetablulum and extending aneriorly and posteriorly.  The defect was entirely contained and was debrinded of all osteolytic dbirs down to a bleeding bone surface throughout.
  • Following this, the acetabular bed was then reamed.
  • Special note was made of the trunion as I requested he review this based on the MRI observations.  The trunion was in good condition with minimal  corrosive changes. (So I gather there was corrosion but it was not enough to necessitate changing out  the full femur?)
  • What labs were sent to  pathology?  Surgeon likely ordered some tissue biopsies and I would like  to see the lab results on all of them.
 I have no idea what all of this means just yet (need to reveiw with my surgeon), but my sense is that it is a great case study for asymptomatic patients.  This case should demonstrate that if you are a party to a hip recall, get tested even if you are exhibiting no pain.   Why?  You have no basis upon which to make a decision to not act  without the base tests. The three tests to discuss with your orthopedic surgeon:
  • Chromium and cobalt levels
  • Soft tissue scan  (ultra sound)
  • MRI conducted by a skilled orthopedic radiologist.  No, a normal MRI is not sufficient.  If you want more information on these procedures, type the words into the search box on the blog and it will take you to these topics reviewed in various posts.
The most important issue is the long term effect of these chemicals in your body.  This blog will continue until two things have happened:
  •  The medical equipment manufactures involved with these hip recalls (voluntary or ordered by FDA)  have been directed  (by court settlement) to set aside adequate dollars to fund research into the long term systemic effects of these chemicals.
  •  Adequate information is disseminated by the manufacturer to the orthopedic surgeons changing the standards which have been set for requiring patient testing.  Let's see, there are 93,000 insertions world wide.  Expensive testing?  Yes!  Necessary in order to determine the levels of silent pathologies?  You Betcha!
Short of that, this blog has just started. I will be reviewing the following in the next few posts now with a new perspective:

1) The key points in the journal article: SILENT soft tissue pathology is common with modern metal atheroplasty. 

2) Re-review the current standards for testing .  Early detection should be strongly encouraged by Depuy, FDA and every medical organization associated with these chemicals. 

3)  The outlook  for progressive deterioration if the silent pathology is not addressed.  Patients who have these hips and are walking around with potential time bombs in thier bodies for which they are unawareof any potential consequences due to the nature of the announcements that were sent out to the patients re the recall.

What percent of patients need to be tested ?  Who knows?  The oversease countries who have quite a bit more experience  with this feel that 50% of these hips will become problematic.  If you had a one in two chance of encountering this type of pathology in your hip, do you think the odds are good to run these tests for which I see downside.

Will resume with the "testing" posts as soon as I complete these next few posts.  sorry that line of thought was disrupted.


    1. Hi Connie,
      Would you consider doing my revision surgeries? You know so much more than my doctor. Glad to hear you made it through "OK". My pain went through the roof just reading about yours. May God keep our hipster safe and comfortable through your recovery. Avoid any marathons in your first few weeks. Don't overdo it!!

    2. Glad to hear from you! I was concerned, as you can imagine, by this longer immediate post-op down time. And very glad to hear that you will continue the blog. Pam