August 13, 2016 Update
I’m 4-and-a-half years out on my revision to THR (a la De Smet) and going strong. I would also say that the two year mark was an important dividing line in my recovery from THR surgery. After that point I never had to worry again about overexerting myself. In terms of performance, I see very little real difference between the THR and the HR. Maybe in some very subtle ways the HR excells a bit but both serve quite well up to this point.
November 9, 2015
I am coming up on 4 years post revision to a THR done by Koen De Smet and this is not necessarily the horror that everyone here paints it out to be. I regularly jog, hike, backpack, rock climb and boulder and my revision to THR works great. In fact, I am much more active than other people I know my age who have not had hip surgery. Anyways, even if revision is the last resort option, if the surgery is done by an accomplished surgeon who uses a good implant system (mine is ceramic on ceramic: no allergy concerns), revision surgery can have a very satisfying outcome.
December 30, 2012
I’ve learned a lot from this site. So thanks to Pat Walter and everyone who has contributed to my education. Here’s my story (I hope it’s not too long). After some difficulty trying to choose the right surgeon (I live in Argentina) I had my left hip resurfaced by a local doctor about a year and a half ago. I blamed early difficulties with movability and pain on my own weaknesses, and by 6 months post-op I was rock climbing again, hiking regularly and generally getting as much activity as I could. However I was having problems. For one thing, in spite of increased flexibility lifting my leg behind, I experienced very reduced flexibility lifting my leg in front. To this day I have to cross my leg under my butt to put on a sock. A more serious problem was recurring pain when putting weight on my resurfaced hip. Each time I thought I was over the hump and on the way to full recovery, I would get sore again and revert to limping around for a week or two. During the first 10 months, I tried to convince myself the implant was fine. All I needed was time to work it through. But I certainly had suppressed doubts. At any rate, one insomnolent night, I found an article on line by Dr. Koen De Smet et. al. considering the relation between the cup’s abduction angle and metal ion counts in the blood, that showed how to measure the angle by drawing a reference line. So I went to my post-op x-ray and measured. The angle was a good 65 degrees.
It was clear I needed a blood test for metal ions ASAP. Thanks to this site, I decided to contact Dr. Koen De Smet and Dr.Thomas Gross by e-mail for some initial advice. They were both kind enough to answer. As De Smet put it: “indeed the version and steepness are quite incorrect! It would be good to have your metal ions chequed”. So we did. But the test came back absolutely normal … for someone who doesn’t have a MOM implant. I couldn’t believe it, so we did another test at a different lab. Normal again. At this point my own doctor was pretty useless, and my wife and I decided he didn’t have a clue. Because of the low metal count, I decided to let things slide and see how it would go.
For the next 6 months I went through ups and downs. There were times when I thought things were really getting better, but every time I would get hit with another set back and revert to limping around in pain. We found a hip doctor who had a good reputation in Buenos Aires and went to see him. I was curious if he would recognize immediately the poorly placed cup (he did) and what he might say. After looking at one x-ray the guy wanted to do revision surgery. A new twist was the doctor thought the cup was coming loose. By this point I was resigning myself to the need for revision (after a year and a half I was once again back to limping around in pain) but I still wanted to know what my problem was. Looseness (if that were true) did not explain it. And my metal ion count was still completely normal. Once again it was time to contact the big guns. So I wrote to Dr. Gross and Dr. De Smet again, sending a description of my symptoms, data on implant make and size. etc. and a battery of x-rays. Dr. De Smet was the first to give me a diagnosis. He started his e-mail by writing in caps, just like this: “DEAR TIM, YOU HAVE NORMAL IONS BECAUSE YOU ARE WALKING YOUR OWN BONE INSTEAD OF THE CUP”. This made perfect sense to me. We had seen from x-rays that the offset cup was apparently letting the femoral component contact hip bone. My wife had suggested this could be causing my problems. Since my pain and limitations where not unlike the problems of bone on bone from osteoarthritis, hers seemed like the best explanation so far. When De Smet said this was also causing the low ion count, I knew that was right. Holy moly: for a year and a half I’d been walking on hip bone instead of the implant!
So now I’m off to Belgium to try and get fixed. Dr. De Smet told me cup revision was less certain to work out, but if I wanted to do impact sports it could be worth the risk. So we went for it. If the cup revision can’t be done, De Smet will be ready with a large head ceramic on ceramic THR.
February 6, 2012 Heading to Belgium today. We’re gonna spend a few days in Brussels, London and Bruges before the surgery. Should be pretty cool (with record cold in the area you can take that literally). One bar in Brussels is said to serve 1,300 different kinds of beer. We’ll go as far as we can with that. Check in day at the hospital is the 13th and surgery is scheduled for the 14th.
March 4, 2012 In light of all the negative press about MOM hip implants and HR (e.g. a slew of front page article in the New York Times) I found a recent comment by Dr. De Smet about the potential applicability of HR most interesting.
A little background: there is a You Tube interview from late 2007-early 2008 where De Smet talks about his experience with hip resurfacing. He says he began HR in the late 90s and was truly surprised about how successful the procedure had turned out to be (he was talking in particular about his own success with thousands of patients, I think). In the video he says that about 12% of surgeries are HR and he felt as many 20% of the patients could benefit from this procedure. It’s interesting to note that he also predicts that when HR arrives in full force to the US and many inexperienced surgeons who are not specialists begin performing the surgery that this will result in a catastrophe of failures
At any rate, when I was in Belgium (February, 2012) for surgery, I asked Dr. De Smet about these figures. He looked at me and said that he is now so impressed with the results he has had, that he believes 50% of hip patients can benefit from HR. Of course he is talking about doing the procedure with a surgeon who has a proficiency like his own, but I was still truly amazed by this figure. According to De Smet’s opinion if hip replacement was truly state of the art, half of all surgeries would be HR.
Here’s how it went:
Looking over x-rays with Dr. De Smet the day before the surgery I could tell he was skeptical about the possibility of successful cup revision. Not only did the cup look loose, but it seemed also the femoral component was loosening as well. Cup revision might entail yet another surgery in a year or two, with more possible bone loss. I told De Smet I didn’t want any more surgeries and I trusted him to make the best decision once he was inside and could see things more clearly. Why would everything be loosening? I asked. He speculated that maybe I was having a reaction to metal ions (in which case the blood tests in Argentina were wrong) or perhaps I was one of those extremely rare cases that has metal allergy. We took another metal ion blood test, just to compare.
The morning after surgery, I was already feeling pretty darn good (by about two hours after surgery I didn’t need any more pain drugs) when Dr. De Smet came to talk with me. He had informed my wife the night before that he had opted for THR, so I knew about this. He told me he didn’t want to worry me, but I should know the truth. Apparently things were pretty much a mess inside. Lots of debris (bone and tissue) that needed to be cleaned up, the bone above the acetabular component had been poorly prepared and they found some shrinking of the femur. One little tap and the acetabular component had popped right out. The placement of the femoral component was also less than optimal. The kicker was they found staph infection, another gift from the previous surgery. In Dr. De Smet’s opinion, this probably accounted for the weakening of the bones (the infection, plus the fact I had been walking on the bone probably caused the debris and the loosening). I was immediately put on a massive dose of antibiotics which needs to continue for two months (actually about 6 and a half weeks more).
To conserve bone and get an optimal cup placement Dr De Smet decided to use a screw. This entailed a 40 mm ceramic ball (without the screw he might have used something larger). He carefully explained to me why he placed things like he did (e.g. the angle of antiversion, etc.) while I just nodded in trust and apologized that I had given him such a mess to clean up. And now I think: if only I would have gone to De Smet in the first place I would have saved my self 5,000 Euros and a second operation! Better not to think about it.
The rehabilitation was actually pretty fun (for me and my wife). De Smet had done (I think) six surgeries on Tuesday and six more on Wednesday. I was the last of the group on Tuesday (he saves the most difficult for last, everyone told me). Seven of the patients were medical tourists who stayed at the Holiday Inn, and we got along just fine, watching each other improve rapidly and going out on the town to enjoy the city of Gent. Now after two and a half weeks I’m back home and I feel really good. If anything, I have to be careful to not do too much, because they tell me I’ve just been through a difficult revision surgery (which seems like a cakewalk compared to my last surgery).
There is one remaining wild card. The blood ion test came normal (like in Argentina) supporting De Smet’s diagnosis, but there remains one question. Was the weakening of the bones (e.g. the shrinkage of the femur) due to the staph infection (as De Smet suspects) or possibly due to a metal allergy? At some point I will need to do the right hip, so do I go for HR or THR? I guess we’ll wait and see. At any rate, I plan on returning to Dr. De Smet, even though this means paying out of my own pocket.
As Warren Zevon said: Enjoy every sandwich!
I have the stickers to the devices stashed away in an envelope. The stem was made by Wright while the ceramic ball and ceramic lined cup were made by a company I’d never heard of. As far as restrictions I have the usual six week stuff.
The old implant was the Cormet 2000, but Dr. De Smet said (even though he doesn’t use this brand) he didn’t think it had anything to do with my problems.
The weird thing about the infection was that it didn’t have any outward effects (e.g. in blood tests, fever, swelling etc.) although it was apparently slowly pulverizing my bones. I feel very fortunate that De Smet was heads-up enough to take some samples during the surgery and check for this. Nothing about this possibilty was mentioned before the operation
March 13, 2012 When I was in Gent (Belgium) recently there was an American there getting resurfaced who told me his Blue Cross was paying for the surgery with Dr. De Smet. I only mention this because I was personally very impressed with the treatment I received from De Smet and because this particular thread showed up inside the zone dedicated to comments about him.
March 19, 2012 The doctor who did the original surgery was pretty much clueless and no help with the complications he had caused. There was a doctor in Buenos Aires who could see the cup was poorly placed (too steep) and coming loose (from the lucent lines). I choose Dr. De Smet to do the revision for various reasons and right now I’m really glad I did. All I know is my memory of what he told me. He didn’t say in particular anything about “no bone ingrowth” but obviously there was a problem there. The way I understand it the cup was placed in such a way as to cause a leverage against the hip plus the the bone above the cup was poorly worked plus I had infection. The cup was not moving before the revision but with a little tap it fell right out during the surgery.
April 1, 2012 I recently returned (getting back home March 1) from a revision surgery with Dr. de Smet. Because my surgery was rather more complicated than a straight forward resurfacing it was considerably more expensive. However it is my understanding that de Smet is charging about 12,500 euros for a resurfacing. This includes hospital costs, medications, bandages, the pre-op exam, a pair of crutches and daily visits by a nurse and a physical therapist while you’re rehabilitating in the hotel. You will have to pay the additional costs of 7 or 8 nights in the hotel (about 100 euros a night) while rehabilitating for the journey home.
I have had a remarkable recovery from my revision surgery and I now believe Dr. de Smet is one of the world’s best hip surgeons. I only wish I had paid out of my pocket to have him resurface my hip in the first place.
Five weeks and four days after my revision surgery I started training in my home climbing gym. Today it’s eight days later and I’ve completed four diffrerent training sessions, getting stronger each time
April 3, 2012 I could get down on my knees within a week or so after my revision to THR. In fact, I remember distinctly going to my knees to tie the shoes of one of the other hip resurfacing patients whose wife had left a few days early. This had to be less than nine days after surgery.
On the other hand, about the morphine pump, I have to tell you that Dr. Koen de Smet was using this at the hospital. However I should mention that I, as well as most of the other patients (most with their hips resurfaced), experienced very little pain after surgery. For example my room-mate at the hospital was a 68 year old man with a resurfaced hip who used no pain medication at all by the day after surgery and was walking fine with one crutch (including stairs) by the second day after surgery.
I wired almost 18.000 euros in advance to Dr. Koen De Smet in Belgium and I’d never even met the guy face to face. Made me a bit nervous, to say the least. At this point I’d say without hesitation that paying for that surgery was one of the best choices I’ve made in my whole life.
April 11, 2012 Right now I’m 8 weeks post-op and, well, seems I’m doing great. Yesterday went for my first “long” hike without the trekking poles (just 2 miles, so as to not push too hard) and this weekend (if the weather cooperates) I’ll do my first outdoors rock climbing.
April 18, 2012 After two full months, yesterday I finally finished taking my antibiotics for the infection (6 grams=12 big tablets of “Floxapen” per day). De Smet e-mailed yesterday and said I should be AOK: no follow-up to the antibiotic treatment is necessary. Barring any unforeseen circumstances, my next contact with De Smet should be at six months post-op, when I send him an x-ray. Meanwhile, I hope to continue easing myself back into full activity mode. It seems I’m doing quite nicely with my recovery and plan on posting from time to time in other threads.
At some point I will need to do my other hip (it’s gradually bothering me more and more, but still seems to have some life left). I’m thinking it would be best to go for HR, in spite of my current satisfaction with De Smet’s THR, and I’ll be talking this over with the good doctor when the time comes.
I havs a large diameter ceramic on ceramic THR (head and cup by Adler Ortho, stem by Wright) that was placed in a revision surgery by Koen De Smet. So far (2.5 months post-op) the thing is working like a dream.
I would like to emphasize this: I’m convinced Dr. Smet is one the best hip surgeons in the world and I would recommend him to a potential patient in a millisecond.
When I got my revision surgery in Belgium, one of the many patients getting resurfaced by Dr. De Smet was my roommate in the hospital room who was a 68 year old man (not particularly athletic). He recovered marvelously from the surgery and was walking with one crutch a few days after. His wife was a heavyset women who had previously had both hips resurfaced by De Smet. The older of the two surgeries had been done more than eight years earlier and she was very happy with the results.
I had a very good experience with De Smet and would definitely recommend him. He has had good results with bilaterals and seems enthusiastic about doing them (we talked about this when I was there). For me (and my wife) traveling to Ghent turned out to be kind of fun and the medical tourism aspect wasn’t a drawback at all
August 3, 2012 When De Smet did my surgery in February I was part of a sequence of twelve surgeries he did over a two day period. I got to know a few of the other medical tourists during the rehab and recently my wife sent out some e-mails at the five month mark to see how things were going. Four people wrote back (three had resurfacings and the other had a ceramic THR because of damage to the hip from a car accident). It seems everyone is happy with their results and recovering well, so I thought I’d give kudos to the good Doctor by posting here.
September 25, 2012 A well done revision to THR doesn’t seem to be such a bad deal. This was a 4-day holiday weekend in Argentina and here’s how I spent it: I cut the grass (large yard, unassisted push power mower) and did yardwork on Friday, drove four hours to some nearby mountains and hiked (steep) about 8 miles on Saturday, hiked in (very steep) with a backpack (not too heavy) one hour to some cliffs and climbed six new route mostly 5.9s and 5.10s on Sunday, then hiked up another steep hill (maybe five miles round trip) on Monday before driving back home four more hours in the car. Today I’m at work and my revised hip feels just fine. I’m 7 months post-op.