ALVAL, PSEUDOTUMOUR, HYPERSENSITIVITY … WHATEVER YOU CALL IT, IT’S A REVISION TO THR
Having visited this site numerous times over the last few years, I thought it was time that I shared my experience with other past and future hip patients. I have recently undergone revision of my ASR to a THR because of a reaction to the metal on metal bearing. I know this issue is in the spotlight of the orthopedic hip community internationally just now as more patients emerge at the 3-5 year post-op mark with unique reactions.
I am a female and was diagnosed with osteoarthritis in my left hip when I was 33 years old (I am now 42). At the time I was an amateur triathlete competing at local events but struggling to meet training goals because of pain. Once I had the diagnosis at least I knew the cause, and also knew that heavy use of anti-inflammatory eased the symptoms. Ultimately however, whether I was resting or training the pain continued. In addition to the OA, I had some bone spurs and when I was 35 I agreed to have the spurs removed ("femoro-acetabular debridement") in the hope of alleviating impingement and delaying serious OA. My first major surgery.
After 12 months it was apparent that the debridement was unsuccessful
and in fact the OA had worsened to the point where I was ready for a
resurfacing. My second major surgery.
The resurfacing was
wonderful in that it got me back to pain-free life; walking, sitting,
sleeping, cycling. In fact I became a strong cyclist, riding over 100 km
every Friday morning at a strong pace in our local peloton, and going
on a number of international cycle-touring holidays. I kept trying to
run – that was my ultimate dream. Once or twice over the years I managed
to belt out 5 or 6 km, but usually I would start experiencing enough
discomfort to make me walk after just a few hundred meters. I was still
taking anti-inflammatory off and on for general aching in my left leg.
Range of motion was definitely improved, although not to the point where
I could, for example, sit with my legs crossed. I saw my orthopedic
specialist quite regularly – both professionally at his clinic for
follow-ups, and also socially as he is also a keen cyclist and we spent
many hours chatting whilst spinning along at 30+ kph. My x-rays looked
At about the 3.5 year mark, I started to notice
weakening in my hip flexor. I was dropping off the back of the peloton
and couldn’t do anything to get stronger. I saw my physiotherapist and
concentrated on strengthening the surrounding muscles for six weeks
before confessing to my doctor that I was really facing problems. The
only anomaly that was apparent on x-ray was re-growth of bony spurs,
which we discussed removing.
Before another major surgery
however, we decided to run a battery of tests … bone scan, bloods, MRI,
CT, ultrasound. All these tests were inconclusive, except for the
ultrasound which showed some fluid in the groin. It also showed that the
tip of one of the screws remaining from my resurfacing procedure
("trochanteric flip") was protruding into my groin so we agreed to first
try a less drastic approach of removing the screws. My third surgery.
was only on a crutch for a few days, but the swelling and limping
continued for months. My range of motion improved almost miraculously –
it felt like a brick had been removed from my groin and I was sure this
was a success! By three months though I still had a strange
half-golf-ball sized lump over the trochanteric wound site and I still
had pain. Back to the doctor, where alarm bells started ringing again.
He excised the lump that same day … expecting to drain fluid but in fact
finding dead tissue. My thigh was finally flat again but not for long …
by the next day the lump was back.
Infection, cancer and
loosening were all ruled out. A metal-ion test was requested of the
pathologist, but seemingly there was nothing apparent. Things were not
looking good but a definitive diagnosis was difficult.
this time there were a couple of European conferences which my doctor
was attending, dealing specifically with hip resurfacing. He was able to
talk to the presenting pathologist as well as a colleague of his who
represented the European Advisory Committee for adverse reaction to MoM
implants. Now the diagnosis was conclusive … classic symptoms and the
only option was revision to a ceramic THR. Surgery number four.
turns out that the fluid – actually necrotic tissue – had drained from
my hip joint and down through the holes left by removal of the screws to
present on my outer thigh. An incredibly unusual scenario! I think if
this hadn’t happened our next step would have been needle aspiration of
the hip joint to get a sample of the fluid/tissue. I have a whole new
appreciation for ultrasound.)
I am now at six week’s post-op.
Again the surgery went perfectly (6.5 hours) and the x-rays look great.
Definitely it has been the most difficult of all the procedures I have
had, with a slower recovery. I am walking on one crutch, but thankfully
can get in the pool and swim with the squad using a pull-buoy instead of
kicking. I’m still taking pain meds and imagine I will need them and
the crutch for another couple of weeks. For a semi-revision surgery
though I think I am doing okay; I am at work and am planning on joining a
gym this weekend to start getting some strength back in my legs. In a
couple of months I will get back on the bike (maybe not in the peloton)
and there is a surf-ski endurance race at the end of the year that I
would like to train for.
Whilst I breezed through the previous
surgeries I found this one very traumatic emotionally as well as
physically. Over the months I have spent loads of time surfing the web
for stories and information and experiences. I thought it was time to
share mine. If anyone has been through this I would love to hear how
your recovery is; and if anyone is facing this I would be absolutely
happy to talk about it more.