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Contribution by Amy Brown
In September 2007 I received a metal on metal hip replacement. The device, a DePuy Pinnacle (note this is not the ASR device DePuy recalled in 2012, but a similar prosthetic released by the FDA based on the trials from the ASR prosthetic), was intended to last me for the remainder of my life. A perfect fit for a 46-year-old active woman who taught yoga and spinning. The pain would be gone and I would resume the full life I was accustomed to.
In December 2011 I retired from my 30 years in credit unions to pursue my passion of opening up a yoga studio. I set my goals and was actively working toward them when I visited my hip surgeon in January 2012 to discuss some odd sounds and feelings coming from the hip surgery site. After several appointments, x-rays, and bone scans that were inconclusive, they sent me to have lab work done. By this time it was April 2012.
During these months of appointments I found studio space to lease and opened up a small Iyengar Yoga studio. I was so excited. I had worked 8 years to become a certified Iyengar yoga teacher and now my dream of opening a studio was finally realized. Business was strong from the start and I felt optimistic.
In late April 2012, I received a call from the doctor’s office. The news was not good. Tests showed extremely elevated chromium and cobalt levels, which meant I would most likely need a hip replacement revision to remove the device.
I was shocked! Never did I imagine that the discomfort I was experiencing was a direct result of the toxic metals leaking into my body from the prosthesis that the doctor placed inside me. I attributed my pain and discomfort to my active lifestyle, new yoga poses, and more miles on my bike, but never the hip prosthesis. It was supposed to last me the rest of my life, not just a mere 4.5 years!
Regardless, the news of the hip failure and toxic lab tests along with numerous visits to a metal on metal hip replacement revision expert confirmed that I needed the device removed ASAP. In the surgeon’s words, “You have a ticking time bomb inside of you that needs to come out immediately. We can’t delay this surgery.” Not a comforting feeling, but at least he was honest with me. Within 6 weeks, I was in the hospital for the revision surgery.
To say that I was devastated at the diagnosis as well as the terrible timing in my life would be an understatement. As a result I ended up closing my yoga studio after 2.5 months. There was just no way to keep it open with me incapable of teaching classes. My dream swiftly removed, just like my metal on metal hip replacement.
The THR revision surgery is relatively new, so I quickly found there is not much information out there on recovery, successes, failures, and long term results. The surgeon, while an expert in his field, also had only limited information to share after the surgery. The absence of any real post surgery information about this type of procedure is what convinced me that I should write this article – so those undergoing this surgery have some kind of information to move forward with.
About a week prior to surgery, I had some of the fluid aspirated around the prosthesis area. This was to determine if the area was infected and whether or not they might need to give me antibiotics prior to surgery. It was during this procedure that I realized the extent of harm the toxic hip implant was having on my body. I watched as the doctor pulled out about 25 CCs of a green, guacamole looking fluid from the right hip area. I was mortified. This green stuff is in me? I found out this is typical of metal ions being released in the body (and a major reason why several metal-on-metal hip replacements, including the DePuy ASR, have been recalled). Similar to how metal on the skin can cause the skin to turn green, the metal on the inside causes inflammation. Inflammation causes the fluid to build up, and then the fluid turns green (or black in some cases) as a result of the metal (ions) sloughing off from the metal prosthesis. This fluid and metal ions (metallosis) can also destroy bone and muscle leading to impaired mobility and bone loss. Once I saw this green fluid I knew that I wanted that prosthesis out of me, and fast! Any reservations I had about the surgery prior to that moment changed as soon as I saw that green fluid.
A week later I was in surgery. The metal on metal prosthesis (DePuy Pinnacle), which was originally put into my body, was designed for the bone to grow around; meaning no cement is required. Great if you don’t need to take it out, not so good when you have to remove it. The surgeon had to literally pry the device out of my hip bone. Often times this compromises the bone and can cause the bone to shatter or weaken. Fortunately the surgeon was able to remove the hip socket cup without incident. The femoral head portion of the prosthetic is modular, so the surgeon was able to remove the metal femoral head and replace it with a ceramic/plastic vitamin E lined piece. The surgeon also removed another 100 ccs of green goop from the surgery site. He said it was pretty bad and tried to get as much as he could, but was cautious when he was scraping around areas that had arteries. Even after he finished the surgery, I still had green goop from metallosis in my body.
One of the many downsides to a hip revision surgery is the doctor has to go in to the same surgery site and open it up again. The surgery area is already compromised by the first surgery (not to mention the effects of the metallosis), so now the entire hip area becomes even more at risk. The muscle, ligaments, tendons and soft tissue are pulled away from the device, the device is removed, a new device put in and then the site is closed up. It takes a long time for all of that to move back into place; much longer than an original hip replacement surgery. Calculate in the effects of the metallosis on the bone, muscles and tissue and it becomes clear that recovery from a second hip replacement is a slow and painful process (at least in my case).
After surgery and upon my return home, I immediately started physical therapy three times a week. At first all was going well. I was using the walker, doing my exercises and moving along well. The PTs, however, couldn’t figure out why I was still using the walker after 3 weeks, why I was walking all lopsided, and why I was experiencing back pain. My external range of motion on the surgery side was extremely compromised and the gluteal muscles that propelled me forward as I walked were not firing like they should be. It appeared that the gluteal muscles had been severely compromised from the surgery and simply were not working at all.
Another issue that arose was a leg length difference. Because the surgeon had to put the new prosthesis in at a different angle to stabilize the joint (the original prosthesis had a larger ball head than the new one), my right leg was now about ½ to 5/8 inch longer than my left leg. This imbalance was causing a lot of back and sciatica pain. To compensate for the difference, the PT inserted a ½ inch lift and that seemed to help. Now all my shoes have to be altered by ½ inch or I use a ½ inch lift in the shoe’s insole.
Overall I spent about 4 months in physical therapy. At the end of PT, the therapist basically said, “I’ve done all I can for you so the rest is you just working on gaining strength in that leg. Your recovery is now up to you and will just take time.” Little did I realize that a full recovery would take much longer than I ever anticipated.
My journey to recovery in this whole mess has been a learning adventure. I am 19 months post surgery as I write this. I still suffer from leg, muscle and joint pain as a result of the second THR revision surgery and my chromium levels are still elevated (cobalt is in normal range) as of October 2013 – but I will have labs taken in January 2014 to see if there is any change. The pain is not excruciating, and at times is just a mild discomfort, but it is always present. The doctors in their infinite wisdom (sarcasm) say the hip is stable and everything looks great! But I’ve found that the doctors really don’t understand because their knowledge comes from a textbook, not from a real life experience. They are doing the best they can (within the confines of managed health care and their experience), but I live in this body and I would really like some answers as to why I feel this way. Why after two surgeries and 19 months of recovery would I still have hip weakness, joint instability and pain in the surgery area and leg? I’ve been working hard to recover; I am not just sitting around waiting to get stronger! I am physically and mentally working every day toward 100% recovery and yet I am still struggling and having issues. I can’t understand why the doctors aren’t more interested in these questions as well, wouldn’t this knowledge help them as they treat future patients?
Some days all of this makes me angry, some days I learn to accept and let go, and other days I wonder when and if I will ever feel normal again. But the fact is I worry A LOT about my long term ability to stay active and lead a normal life. What are the long term effects of the high levels of chromium and cobalt? No one knows the answer to that question. I worry that this new prosthesis is bad or incompatible (even though the doctors say it is fine) and perhaps that is why I feel all this pain. At other times I chalk it up to my active lifestyle; I still continue to cycle and do yoga as these two activities help to keep me sane and strong. My hope is that all these muscle pains are just my atrophied muscles coming back to life, a little at a time. Perhaps these pains are compensating muscles that now have to overwork to make up for the muscles that are not working properly? Many questions, few real answers.
I started writing a personal blog as a means to deal with the many feelings and issues I was experiencing as a result of the defective prosthetic. As it turned out, the blog also became a place for others who were undergoing or about to undergo THR revision surgery to learn more as well as read about my recovery. As a result I have connected with a handful of others from all over the world who are suffering or have questions about their defective implant. If you would like to read more about my experience with THR revisions surgery visit my blog at http://yogamorethanposes.blogspot.com/