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Femoral offset too great

Posted , 5 users are following.

christine2107
christine2107

16 months of post operative pain and poor functionality I have now had a second opinion. This consultant said my femoral offset is too great which is why I am wonky with a leg length difference and everything is too tight.Stairs, sitting, slopes and walking distances all cause problems. I can't work or even drive far. All a bit rubbish.

Has anyone else been revised to sort this problem out? If so did it work? Seeing consultant tomorrow so quick answers v much appreciated. Btw the femoral offset is where the stem turns the corner and if it's too great your leg is " jacked out"

2 likes, 15 replies

15 Replies

  • Sredni393
    Sredni393 christine2107

    Posted

    I have this, to a lesser extent, and it is clearly visible. Perhaps my intake ofpainkiller  has masked the true discomfort levels. However, I am seeing a private ortho surgeon for an opinion in preparation for my other side. No way would I let the same thing happen again. And it is unforgivable to imagine they may take a similar approach on the other side to even things out. But revision is a big deal. Let us hope there may be a way around this for you. Terrible to wait in pain for so long when it should never have happened.  You must take control. I would send a letter to your gp outlining the error of your procedure. As a safety net. Passivity is not an option. You have lost all that time , it will be two years of your life. It really is disgraceful to have to go on suffering or endure yet more major surgery.  Be sure you get realistic opinion on the likely outcome.  How very tragic. Hope you have plenty of support.  And that you hear back some positive revision outcomes..
    • christine2107
      christine2107 Sredni393

      Posted

      Thank you - my second opinion has said that swapping the corner piece out is relatively straight forward as there's no digging around in bones to do as its a detachable piece that fits into the stem. So whilst you still have to be opened up its not a full redo....

      i checked because my other hip needs replacing and was told you can never be balanced out by a replacement on the other hip as that would jack you out painfully on both sides. They can sometimes sort out length differences if the stem was too long but not if you are also jacked out too far.

      going back tomorrow to see 2 consultants - my original one and the local second opinion. They have sent me to Oxford for a 3rd opinion so I will have his view too.Hopeully they will all sing off the same hymn sheet. Wish me luck 😊

    • Sredni393
      Sredni393 christine2107

      Posted

      Thank you for that information;  v useful for me, too.  I'd be relieved at the more minor procedure of reduction...  And looks like they are taking notice at least

      Whereabouts are you;  mine done Banbury, but I'm checking out Mr McKinn Edgbaston (very very expensive) as cannot undergo similar trauma.  But a lady in my Pilates classcannot sing their praises higher;  her result excellent.  You just don't know how things are going to resolve.  It does bring up this question of sizing again though.  Mine sticks out very "proud" and Im left with pelvic mis-alignment having chiro weekly, sometimes twice...  Let us know how they intend to proceed with you.  Pain relief is something to look forward to at least....Bonne chance Christine!

    • christine2107
      christine2107 Sredni393

      Posted

      Hi there again - am at the Royal Orthopaedic in Birmingham

      My Oxford opinion was with Roger Gundle who immediately spotted the problem and said that all patients he had fixed did well - so you could see him. The consultant who did my op also asked his colleague Mr Ronan Treacy to take a look at me - he thought I had some hypermobility (bendy) which would have impacted what head to use. So he and Mr Gundle are in the same place in terms of diagnosis and fix. Mr Treacy was partners with Mr McMinn in developing resurfacing. Mr Treacy still does NHS work as well as private, as does Mr Gundle. Mr Gundle is at the Nuffield NHS in Oxford - and he is a well known chap too. Good luck and I will let you know tomorrow what happens after my consultation with my consultant and Mr Treacy x

  • Sredni393
    Sredni393 christine2107

    Posted

    That's even more useful to know as I can get a referral maybe to Mr Treacy privately, then decide, having discussed telephonically with the McMinn clinic. Far better when you get some names than going in blindly.  I believe now you can select the consultant through choose and book. Let's hope they can decide on which best for you and give you a date. Good to know they confer (there, anyway)!
  • Jodi-France
    Jodi-France christine2107

    Posted

    I must say christine your comment made me wince.

     

    • christine2107
      christine2107 Jodi-France

      Posted

      Jodi - sadly the phrase jacked out is not mine but one used by an orthopaedic parts supplier i met recently. My condition has me limping and worse still i have to use my operated lleg to lead upstairs because my non operated one is now too unstable to manage it...so its pain and limping all the way until they operate again. I was supposed to be a model patient smile
  • Sredni393
    Sredni393 christine2107

    Posted

    Your case puts me in mind of the 3D THR now being done in the USA according to my gf in Boston.  Apparently Mr McMinn refers patients for a Cone Beam Scan which gives the 3D image.  I just don't understand how a hip implant can fit everyone just by a one dimensional xray, with all the permutations of the female pelvic area.  The stem component comes with the bend in it, as a fork or spoon, and how crucial is that angle?  Yet how many variations exist across all the manufacturers.  I wish I'd had those questions answered before I "elected".  There must be limits to how much the surgeon can sacrifice bone to accommodate the steel.  It should be the other way around, surely.  Jacked out.  C'est moi,but not as much as you poor thing...  Why could the implant not have been reduced at the time of insertion one asks...  It makes me think of inbuilt obsolescence, cynic that I am!
    • christine2107
      christine2107 Sredni393

      Posted

      Hi there 

      How have you been getting along with your offset problem?

      I have just had my other hip replaced and it is working well - 6 weeks later. I am remeeting with my consultant in September to consider a revision. He is reluctant...due to revision risks ... but wont leave me like this. Just wants to give my hips a time to work together and see if I get an improvement.

      They did 3D modelling on me at the ROH under the NHS to help try and find out the problem. One thing it showed was that my pelvis tilted a lot - by 20 degrees when moving from sitting to standing. I think in time we will get more tailor made solutions but the technology is not there yet - so we will have bespoke medicines and joints and surgery

       - for our grandchildren anyway.

      Good luck and do please keep in touch - we share a rare problem!

      Chris x

       

  • Jeff1SantaCruz
    Jeff1SantaCruz christine2107

    Posted

    Dear Christine,

    I live in the US in California.  I'm supposedly one of the 'rare' cases that have too much offset from a hip replacement.  26 months of post surgical pain, and I've had to quit work.  Very painful around any area the Greater Trochanter presses agains, including the illiotibial band, which snaps and locks my hip into bad tilts, and pain in the butt muscles.  Very sore and inflamed almost continually.  I'm good for maybe an hour or a mile, then the day is pretty much over for me.  

    I've been seeing a few ortho surgeons, including one today in San Francisco.  He felt it was too risky to operate on, and could not get the offset reduced with just a new ball drilled deeper.  

    It sound' like you have a two-piece stem, is that correct?  That seems like it would allow them to change out piece for the offset.  Is that what you mean by 'the corner piece?  Unfortunately, I've got a one-piece stem, and it's considered risky and a big painful operation to chisel it out and replace it.  If I can find info on ball and perhaps liners with pretty large offset reductions, it could be very helpful to present it to my original surgeon.

    Did you ever find help for your situation?  Maybe I can get in touch with your doctor, as I've had no luck with the last 5 I've contacted since surgery.  

    I'm 58, formerly active, and can't stand this and the constant stress that pain causes.  Desperate to find some answers, and found your thread while scavenging the internet.  t says you posted over a year ago.  If you are still around, I'd appreciate communicating with you.

    Emis Moderator comment: I have removed contact details as we do not publish these in the forums. If users wish to exchange contact details please use the Private Message service.

    http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

    • Ripper
      Ripper Jeff1SantaCruz

      Posted

      Hi Jeff. I have an offset of about an inch. My foot turns blue when sitting, and the pain from standing, walking, sitting is horrible. I'm scheduled for a revision on August 9th with someone who is suppose to work miracles, but he told me he can't fix the pain, only the leg length issue. The offset is the big issue, but I haven't found anyone to fix, as if they do the joint becomes too unstable, and causes dislocation

    • Jeff1SantaCruz
      Jeff1SantaCruz Ripper

      Posted

      Hi Ripper - 

      I haven't heard from Christine.  Hope she got some relief.

      Your problems sounds worse than mine.  I've not found a doctor willing to work on it, with the slight possibility of my original surgeon perhaps changing the ball to adjust the offset - max change about 5 mm laterally.  Chance of nicking the titanium stem, which means a new stem could be needed which is a MAJOR REVISION.

      After about 2 1/2 years of very bad pain, it finally it started easing up, though still dysfunctional and causing me lumbar stress - terrible for my lumbar disc injuries - and some other issues.  Really, quite unhappy with the results, and its holding me off on possible lumbar surgery, but heck - its better than it was.

      One reason they are hesitant to reduce the offset is an increased chance of dislocation.  My physical therapist thinks if one is careful for the first few months, it should tighten up.  Right now, I don't know what to do.  Gentle cycling helps, as does strengthening the gluteus medius.  

      Feel free to stay in touch.

       

    • Jeff1SantaCruz
      Jeff1SantaCruz Ripper

      Posted

      PS - If the offset is a problem, see if he can reduce it at least a little.  Excess offset seems to be hell.
  • Ripper
    Ripper christine2107

    Posted

    OMG, finally, I found someone with the same issue I have, among other things. Have you learned anything about fixing it?

  • Jeff1SantaCruz
    Jeff1SantaCruz christine2107

    Posted

    Hi Ripper - 

    I haven't heard from Christine.  Hope she got some relief.

    Your problems sounds worse than mine.  I've not found a doctor willing to work on it, with the slight possibility of my original surgeon perhaps changing the ball to adjust the offset - max change about 5 mm laterally.  Chance of nicking the titanium stem, which means a new stem could be needed which is a MAJOR REVISION.

    After about 2 1/2 years of very bad pain, it finally it started easing up, though still dysfunctional and causing me lumbar stress - terrible for my lumbar disc injuries - and some other issues.  Really, quite unhappy with the results, and its holding me off on possible lumbar surgery, but heck - its better than it was.

    One reason they are hesitant to reduce the offset is an increased chance of dislocation.  My physical therapist thinks if one is careful for the first few months, it should tighten up.  Right now, I don't know what to do.  Gentle cycling helps, as does strengthening the gluteus medius.  

    Feel free to stay in touch.

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