Cobalt chrome, Health, hip, hip joints, Hip Replacement, joint replacement, leg exercises, Medicine, orthopedic doctor, orthopedic surgeon, Orthopedic surgery, surgery, x rays
Very helpful blog. Trying to get my head around all of the information.
I am a 46 year-old active male and I am only at the beginning. I went to a chiropractor (who I see on occasion for minor low back discomfort). I told him of varying levels of pain in my left hip joint, which are not bothersome for the first half of the day, but by evening are quite painful (upon bearing any direct weight). The doctor took x-rays, and said essentially I needed to see an orthopedic surgeon as, in his opinion, both of my hip joints were “shot”. He attempted to point out the missing cartilage on the x-ray, but I am taking his word for it.
As anyone who believes they are too young for such a procedure, I have been doing voracious research in trying to determine the best course for me. I know from stories by friends and relatives that doctors can often make less than optimum decisions regarding techniques or components involved in joint replacement, so I thank you very much for this information.
Although I have not had my appointment with my orthopedic doctor, I am hoping and will be advocating a resurfacing. However, it does not appear that this can be done with ceramic, only metal (which i suspect would be cobalt chrome).
I am still researching, but I hope for that I can get the resurfacing for its advantages, yet still avoid the metal-on-metal design this usually entails.
In the meantime, I have been biking 10+ miles daily and ing leg exercises in the hope hat this will speed up any rehabilitation.
If you have run across any novel resurfacing designs in your web searches, I would be grateful for any links. Further, so as to minimize problems and complications, if you have any general advice for me as I begin what I hope to be a low-complication ordeal, I would be in your debt.
NB: Good idea to have forum for people on this subject… Look forward to seeing it.
Unfortunately our generation has done too much repetitive exercise and we have worn our joints out.
I was 48 when my hips gave up and I couldn’t walk.
I have done very extensive research and there is no benefit from resurfacing. There is a lot of hype around it but I can find nothing that supports it having any measurable benefit either in speed of recovery or long term. In fact there are about 200,000 people around the world with a timebomb ticking and, from what I will see, they will have a revision 5 – 10 years earlier than they should have.
DePuy ASR’s are up to 50% failure at present. And there is some evidence (search 26 percent on the blog) that failure rates are way higher with the BHR than Smith and Nephew would have you believe. Admittedly this is mostly due to metal on metal.
However, even if it was ceramic I still can’t see any evidence to suggest that resurfacing is anything but an attempt by certain parties to market a solution which is not required.THR’s are just as good.
I would however investigate the anterior hip replacement as this does not cut the hip muscles and the recover is very quick as a result. However, not many surgeons do this as it is a much more difficult procedure for them.
Bottom line – I am really happy with my Zimmer ceramic on ceramic – wonderful range of motion & I have no pain killers any more.
I think the modern ceramic on ceramic is the best choice by far.
I would not touch resurfacing with a barge pole.
- Smith and Nephew Issues Failure Warning on Metal Hip Implant – Florida Mass Tort Attorneys, Lawyers | Searcy Mass Torts (earlsview.com)
- Hip resurfacing ‘not suitable’ for women – Health – Beverley Guardian (earlsview.com)
- Growing metal-on-metal hip controversy threatens to swallow more device makers | MassDevice – Medical Device Industry News (earlsview.com)
- Patients with metal-on-metal hips being contacted after UK officials issue alert | Orthopedics Today (earlsview.com)
- Metal-on-Metal Hip Implants: Should You Be Worried? (earlsview.com)
- Dr Steve – Question & Reply – Stryker ABG 11 modular stem recall (earlsview.com)
- ‘Toxic’ hip replacement fears – Health – Bognor Regis Observer (earlsview.com)
- Ban ‘failing’ hip resurfacing implants for women, say surgeons | Mail Online (earlsview.com)
- Hip Replacement Found Safer for Women Than Resurfacing – Bloomberg (earlsview.com)
- Smith & Nephew BHR – A benign psoas mass following metal-on-metal resurfacing of the hip (earlsview.com)
I also would advise you to avoid the resurfacing…too many issues and potential risks/problems with the metals. I have had both mine revised into poly/ceramic and wish I had just done that to start with! Why take the chance? The benefits (if there are any) just don’t outweigh the risks…
Stephen S. Rodrigues said:
In my 30 years of medicine and 15 years in treating myofascial tissue disease issues, I’m convinced that Janet G. Travell, MD was correct when she stated that pain in the joint areas was not in the joint proper, but in the associated muscles.
In 2012, I will not refer anyone I come in contact with to have joint surgery of any type. BOLD … I have seen most if not all decide not to have surgery if they are back to normal activity and without any pain. No matter what the xrays may show.
Also I’m convinced that if the muscles are addressed and the joint is functioning in full ROM, it will auto-resurface all by itself, just as the skin will resurface over an ulcer. Remember the human body can self repair given the correct circumstances.
Read about Travell, MD and Dr Hackett who developed Prolo-Therapy which is a parallel injection therapy that focuses on the ligaments of a joints. Travell, if done properly and given a chance the need to do Prolo will fall to the wayside. See my other post on Myofascial Release Therapy with hands-on, Chiro adjustments, Trigger points and acupuncture.
Make sure the therapy releases the gluts, adductor, pectineous and the piriformis muscles plus the calf muscles.
I can send you a protocol to help guide you and your providers.
Stephen S. Rodrigues said:
Oh … as per JGT, joints are designed for a lifetime … 100 years. The few things that will destroy joints are … using them when they are out of alignment, steroids injections into the joint proper and the surgeon’s saw.
Joint health depends on range of motion, activity and alignment. All the associated muscles must act in concert as a team. If out of alignment, you will have aching, stiffness, loss of range of motion and pain. The joint is the passive component to the actions of the muscles. Those tight muscle will compress the joint capsule and force out all the nourishment and starve and stress the surfaces. That is what’s seem on X-ray.
Travell warning are ignored when it comes to steroids into a joint. The substance will halt the repair process leading to atrophy and death of the structures. Google “skin atrophy” from steroid shots and see what it does to skin, muscles and fat tissues. Remember in medicine you are not to inject a ligament with steroids because it will weaken and will rupture. Guess what .. that’s what we are doing except in a much more dangerous location … the joint proper.
If patients are given a choice as to whether to keep an aging joint that functions well without pain or limitations, why replace it with one that is less capable. But once it is removed .. all bet are off and you can’t go back.
I began to have groin pain at the age of 50 .I was an International 800m runner -then did marathons then pro Mountain Biker riding for GB -so as Earl says it was more than likely that the training I did from 15 years of age contributed to my problem. I loved training and ran or biked every day so when I knew that both were bone on bone it was to me a major crisis.
I researched alot and saw three surgeons until I felt I had the right man to deal with me and the soul aim was to get back asap to the life I knew and loved.
I chose to have a hip resurface and so my left hip was done.
I was out of hospital after two days and walking three times a day in no time but it always clicked .
The reason I chose hip resurface was that I wanted to Mountain Bike again and felt there would be less chance of dislocation with the large prothesis.
It took me since months to bike again and alot of exercises and hydrotherapy but i got there in the end but it was very stiff and clicked all the time.
I had my second hip done a stemmed hip resurface -basically the top of the femur is cut off but the prothesis is again large and metal -the reason for this was that the first was not a success so the surgeon said he would try it -still the large head for stability.
I was back in the gym in four weeks -mountain biking at 10 weeks and full mobility.
Out of hospital in under two days .
Unfortunatley they were both De Puy ASR so I have had them both out because my cobalt levels were very high and the clicking was pretty bad.
They have been replaced with ceramic balls and cups(48mm and 50mm -were in )now 36mm.Much smaller but I have had no problems yet.
I had them done within six months of each other and was back MTB after three months and have almost full mobility.
The main reason for the resurface was fear of dislocation but as the prothesis are much bigger now (metal ones are the biggest but ceramic are quite large)a full hip replacement with a good surgeon and a large ceramic prothesis is certainly better than the risk of cobalt poisening !!!!!!!!!!!!!!!!!!!!!!!!
Stephen S. Rodrigues said:
Shocked, that this surgery is so common place without Travell’s protocols every being on the table of therapies before major surgery??!!
Please everyone needs to be informed early at the beginning of the pain cycle.
You no doubt know that what you are describing is listed as ‘alternative care’ in most US insurance plans, meaning you are allocated a much small amount of money in total for the year for such treatment or it is reimbursed at a lower rate. I am a very firm believer in many of the treatment modalities you have listed, and have exhausted my yearly benefits for chiro/acupuncture. Fortunately, my son is an LMT and still does (painful) deep-tissue myofascial release — it hurts like hell but helps with many of the ancillary problems that have arisen from my inadequately researched metal on metal THA, i.e., gait changes, walking with a cane, collapsed disks, back spasms, etc. I was always taught to ‘trust the doctor, but I do not trust many surgeons now, and I have seen first hand the wreckage wrought by what I refer to as ‘Bonesmiths’. They look at only one part of your body, and any problems that arise in another area are not their problem. You are quite aware of that fact.
Having said that, I tried everything before I was forced (by excruciating pain) to have a hip replacement procedure due to the severe arthritic tumors that were evident on film (at all the three of the different doctors I consulted), and I disagree with your statement that irrespective of that horribly distorted and dysfunctional joint image, one can still pursue the alternative treatments you list. At that juncture, such an alternative is not a viable one, and I speak here not as opinion but from empirical experience. There is a point of no return, and I reached it. My left hip, however, has only moderate degeneration and acupuncture and tissue work have helped tremendously, and my goal is to stave off a THA on that other hip as long as I can. I believe it can be done this time, because i have caught the degeneration early enough.
To Paul, I would try everything other than the scalpel for as long as you can, until the pain becomes absolutely intolerable (preferably without having to take pain relievers that might mask a worsening condition). And as Earl notes, by all means, do not fall for the resurfacing sales pitch! It is just that, not anything like what is advertised. Also discuss with your surgeon the materials he plans on ‘installing’ in your body in great detail, and I agree with Earl (my tutor) that the ceramic-on-ceramic or ceramic into poly is the best route to go.
I know this only because I have researched component problems after the release of metal ions from metal-on-metal articulation, which poisoned my flesh and literally killed it (necrosis), where large ‘chunks’ of this dead flesh were in my body for at least a year and were excised (whereupon they created pitting edema into my entire leg past my calf and plague me to this day (There is ‘fluid’ around my second hip and it still hurts with use. Metalosis is a very ‘new’ and serious discovery/development, and any surgeon who doesn’t explain that to you is not a good nor trustworthy one. We have no idea of what it might mean regarding other aspects of ones overall health during our remaining years on the planet.
So keep doing your research, pay heed to Stephen’s cautious advice above and take your time in making this HUGE decision. As he so aptly put it, once you cut off pieces of your bone and have them drive a stem (read spike) into your femur with a mallet, you can never go back. I had my first joint replaced at 47, and I’m 59 — (yes, I endured twelve years of surgery, rehab, surgery, rehab, rinse, repeat, seemingly ad infinitum). I have had three TKAs on one side and two THAs on the other. I now think had I tried every other holistic method of treatment I could have back then, at the very least I might have forestalled my first knee replacement surgery at such a young age. Like most of us on this site, I have been an athlete and a fitness freak all of my life, and it’s now evident I stopped the bone-on-bone, high impact stuff a bit late. I find swimming a great form of exercise now, and I also feel it has a therapeutic effect of increasing ROM and relieving pain.
Good luck man, and think this through — over and over and over again. But if you take the leap, allow no metal-on-metal configuration of any kind to be implanted in your body (I would refer you here to Howard Sadwin and Stuart Cain in addition to Earl). You can read all of their stories (and many others on this great web site).
Hi Brooks, HI Paul, Stephen, Deb, Alison,
great advice from one and all. Nothing should be rushed at for sure and if and when the time comes, you will well researched. I wish I had been. I was in so much pain and couldn’t walk that I just believed what the surgeon told me – and I paid for that mistake.
Forewarned is forearmed as my dear old dad use to say!
Stephen S. Rodrigues said:
1. wellness, yoga, stretching and acupuncture are NEVER taken off the table. They all should be routine done daily and weekly.
—- All yall still need hands on therapy, exercise, ROM exercises and needles!!!!
2. Acupuncture or needle therapy comes in different intensities, lets say 1-5.
L-, is just plain thru the skin to the traditional level — light weight.
L-2; the needles are inserted deeper, maybe to bone — medium
L-3; The needles are used as a tool to tenderized the dense muscle tissues.
as per C. Chan Gunn, MD. Painful and most pt would not tolerate.
L-4; Using a hypodermic needle to do the same …. ouch. which is why lidocaine is use as an anesthetic.
L-5; Travell and Rachlin therapy, really using the needle to mince the muscle tissues in an attempt to transform beef-jerky to Filet Mignon, nice soft and buttery muscles. Time and effort are the key.
For the hip and gluts you have to have needles that are as least 3 inches and at times 4 inches!!!! Or you will not be able to reach the bone or the small rotators of the hip then … the gemelli muscles and quadratus.
Severe arthritic tumors can be treated without removal of the joint when using all the above!
Again a rickety old “alive” joint is better than an artificial one… if the above it followed.
I know it is easy for me to say and harder to do or to prove.
Feedback or comments please
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