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Forum Name: Joint surgery

Question: Hemi hip arthroplasty vs. THR ?


 leftyman - Mon Aug 03, 2009 11:09 am

My unfortunate story started on November 24, 2008 getting Christmas decorations down from storage in the garage using a 6 foot step ladder. I ended up falling from the ladder onto the concrete slab and landed on my right hip, displacing the head of the femur. I'm 61 yr. old, and have an above average activity level. Also FYI, I'm a fairly muscular guy from the waist down.

The next day (Nov. 25, 2008), a hemi-arthroplasty was performed on my hip, using a bipolar prosthesis. Physical therapy was started mid-January '09 and ended March 1, 2009 and I felt I was on the road to a successful recovery,which I had worked very hard at. However, from March '09 on, I had relapsed progressively into discomfort in the hip and thigh. When I complained to the original surgeon, she ordered xrays of my lower spine to assess if there was any evidence of disc problems. The xrays led her to believe that an MRI of the lower back would disclose any problems. The MRI did show some disc compression, but I've always had lower back pain. The xrays and MRI were done in April '09. Soooo, we went the route of epidurals in the lower back on 2 occasions to see if the hip/thigh pain could be helped. I thought I had 2 chances for relief from the epidurals.....slim and none. As it turned out, it was none. Frankly, I had trouble "connecting the dots" with nerve problems in my back deciding to inflict pain in the area where I just had major hip surgery.

Then in May '09, I was transitioned to the specialist revision surgeon in the same very large Orthopedic practice in our area. Around June '09, he ordered bloodwork to rule out infection (which was negative), a bone scan (which was negative), and a CT scan which disclosed little or no cartilage was left in the acetabulum, thus the need for a THR. What happened to my cartilage from the November '08 hemi surgery to June '09 ?? I do have alot of confidence in this surgeon. I know what I've gone through the first time, and my question is like most of you may me asking is "How come I didn't receive a THR in the first place based upon my age, and muscular build of my lower torso which would indicate an above-average activity level ?. All of the research I've found on the net points to the fact that I should have had a THR, not a hemi.

My THR is scheduled for August 7, 2009, and I'd appreciate any thoughts/comments.
 Tom Plamondon PA-C - Mon Aug 10, 2009 10:01 pm

User avatar Hello,
It would be easy enough to look at the x-ray film before the initial surgery back in 08 to get some idea of what the acetabulum looked like. Also, intraoperatively, the surgeon would have look at the area and noted it's integrity.

So can cartilage wear away so quickly in 6 months time?
You would not think so.
If this is very concerning, you could talk to the surgeon who did the hemi-arthroplasty and ask a few questions about the acetabulum's initial status (as noted above).

In the end, you have a THR and given your motivation and previous fitness level should do very well.

Take care.

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