Wednesday, February 15, 2012

What tests can you do post revision to ensure that everything is ok?

Question:
Can you please advise what type of tests/scans should be done in post depuy hip revision replacements?
We have undergone a revision a few months ago and the doctors have only done the heavy metals blood checks. We want to do more in depth x-ray scan and so forth to ensure all is okay. But the doctor is not sure and of course we are not sure how to go about it.

From Connie:

The only published protocol for monitoring purposes I know of right now is  the blood test for Cr and Co levels.

I presume this question arose as a result of my recent findings of the tumors.  A couple of comments:

(1) I don't know if these "tumors" are a result of the hip but we are examining the prospects of that.
(2)  If they are tumors, they can be benign or malignant.  I am hoping for the latter due to the results of the Pet scan.
(3) I identified these tumors incidental to an alternate exam that had absolutely nothing to do with the hip
(4) The test we used was a CT scan.  I was being followed annually for the last 5 years for something unrelated to the hip. We know that one year ago, no tumors were apparent anywhere.  When the scan was run this time, a multitude of tumors/enlarged lymph nodes appeared in the chest and pelvic cavity.
(5) I am looking into what tests can be used to eliminate the hip as being either causative or contributory to any of these tumors.
(6) 99.9% of the physicians, including but not limited to orthopedic surgeons will not  know anything about the nature of the tests that should be performed if faced with these growths insofar as the hip is concerned.  That is my personal experience.  We are seeking outside consults to guide this process.
(7) Most of the oncology physicians are interested in one thing and one thing only:
  • Is the growth cancerous?
  • What treatment should be instituted, should they be cancer to, get rid of the tumor.
(8) Given that oncologists often times do not know the origin of the cancer, understanding the cause appears to be off the radar of interest.  This has been my experience.  Sadly, cause does not inform treatment in cancer.  Only the nature of the cancer informs treatment.
(9) I don't know what they might do if the tumors are not cancerous.

I understand from the literature that the type of growth I am referring to (granulomas) are not typical ( much less than  than 1% of the patient population.)  I think it is  unlikely that you will get approval from any insurance company to run a CT scan for the propose of looking for growths when you are asymptomatic. I wouldn't do it myself because radiation is a risk in and of itself.  We were monitoring a few very small nodules in one organ which seemed to have doubled in size in one year.  This then precipitated the need for the CT scan and even then, I was leery of getting any more CT scans due to the radiation.  The pet scan of course, exposes you to higher radiation yet.  Tests involving radiation are not ones I would personally request unless there is a particular presenting symptom or growth to require those tests.

This whole testing area is net new area in my mind related to possible hip related issues.  I will get to the bottom of the testing and will let you know what I find.  My question may differ from yours though.  I have growths that require diagnosis.  I am not sure what you would look for otherwise given the incidence of occurrence  of these are  low.


previous posts

Connie's status with her investigation into tumor type growths (7 of x)

Granuloma journal articles provided to my medical Team related to the hip (8 of x)

Reminder:  I am not a doctor.  I am not trained medically.  I have no particular insight into this other than what I have read in the medical  journal articles.

2 comments:

  1. Revision is very needed, when you do some mistakes on it.

    ReplyDelete
  2. Liela,

    You can continute to run the blood tests to ensure that the chromium and cobalt levels are dropping. You can periodically (yearly) run a MAVRIK MRI.

    There are other potential tests but until I see the results of the ones I ran, I would not recommend them.

    Hope that helps

    ReplyDelete