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Symptoms of Hip Implant Failures

Nothing is more frightening than the unknown.  Understanding a problem might not make it less traumatic, but it can make it appear more manageable.  It also helps to know that others have experienced the same thing and have survived to tell about it.

When I experienced problems with my resurfaced hip, I was desperate for information.  I went in search of others who likewise had experienced such problems.  As it turned out, I was able to discount a few of the potential problems based on the description of symptoms I was supplied by others.  In the end, the symptoms that most closely matched mine turned out to be the proper diagnosis. 

The following are descriptions of my own symptoms and the symptoms of others who experienced them first-hand. 

 

Femur Neck Fracture after Hip Resurfacing 

After released to start exercising with minimal restriction, I went to the gym on a regular basis to help rebuild the muscles.  I had worked my way up to one hour of cardio exercises (e.g. cross trainer, treadmill, and stationary bicycle).  Nothing real stressful or at a high tension setting, but I was going to the gym 6-7 days per week. 

A awoke one morning after my normal workout, and my leg felt sore.  I rested it that day, and the next morning it felt fine.  I then went to the gym for a lighter workout of 30 minutes, and it still felt fine.  Also, the next morning it felt fine. 

My job requires a lot of sitting, and when I stood to go to lunch the next day, the leg felt really sore.  It was more of a sharp pain when I tried to walk.  I was still using a cane at that point—mainly for support due to weak leg muscles—but I really needed the cane for support at that point. 

The leg continued to bother me into the night and the next day.  It hurt all the time like a dull ache, and I’d get a stabbing pain when I walked.  It was pain similar to what I experienced prior to surgery. 

An X-ray revealed that the prosthesis had shifted due to a femoral neck fracture.  It was clear as day in the X-ray.  Two days later I had revision surgery to a large head metal-on-metal total hip replacement. 

Everything happened in a relatively short period of time.  From the onset of pain to the revision surgery only six days transpired.  I had been to the surgeon and had X-rays two days prior to my onset of pain, and the fracture did not appear in those X-rays.  The fracture was a catastrophic failure that happened quickly and was resolved quickly. 

 

Loosening of the Femoral Component after Hip Resurfacing 

Scenario #1 

The main symptom was pain I’d experience when I'd get up from lying down or sitting.  It lasted for weeks and continued to get worse as time went on.  It became obvious that something was wrong, and it caused me to schedule an appointment with my surgeon.  The X-ray revealed that the femoral component had dropped or repositioned due to a loosening of the component.  

Revision surgery was performed, and a large head total hip replacement femoral stem was implanted.  I had my resurfaced hip for approximately 16 months before symptoms developed, and my revision surgery was performed 17 months after my original resurfacing surgery.  

Scenario #2 

Approximately two years after my resurfacing, a shadow appeared near the edge of the guide pin of the femoral component (i.e. radiolucency).  This did not necessarily mean an implant failure was inevitable, but it was something that needed to be watched.  I had had perfect function of the hip and no pain except for a little soreness when I had been on my feet all day.  I had already been diagnosed as having a soft bone condition at the time of surgery with small sponge-like crevices on the top of the femur. 

Later, I began getting referred pain in my knee, and I’d occasionally experience a sharp pain in the hip if I was leaning forward and putting a lot of weight on that leg.  Afterward, I began getting weight-bearing pain in the leg.  It was in the front of the thigh and running down to the knee, and it was different than the groin pain I had experienced before surgery.  

More X-rays did not show any differences in the hip structure, and it was determined that the femoral component had loosened—not catastrophically, but it had loosened nonetheless.  I began using walking aids while preparations were made for revision surgery to a large head total hip replacement stem.  The revision surgery was then performed without any complications.  The acetabular cup remained solid and was not replaced.

 

Loosening of the Acetabular Component after Hip Resurfacing & Total Hip Replacement

The patient may be reporting groin or anterior trochanteric pain;
The patient may have increased thigh pain;
The patient has significant startup pain with ambulation (walking), or rising from a seated position, may have buttock pain;
The patient may experience significant pain with weight bearing, and may require a cane or crutch;
The patient may be unable to exert resistance in a straight raised leg test and a side-lying abduction test;
Many patients experience debilitating pain and are unable to stand or walk unaided; and
An x-ray may show possible component migration.

 

AVN in the Femoral Head and Neck after Hip Resurfacing 

Five months after my surgery, I began to notice a mild weight bearing pain in the hip.  It was especially evident if I stood on one leg and then removed weight from the leg.  I would experience a long drawn-out ache as the weight was removed.  Then I started noticing an ache when walking that would increase as if building to a sharp jabbing pain if I walked too far.  It then became very tender to certain movements and having weight applied to it. 

This eventually subsided, and I went several months with just some mild tenderness in the hip in the form of a “start-up” pain when I would start walking.  By nine months, however, the joint increased in tenderness and pain.  A mild pain would also extend down the leg into the shin area, and then one day the pain became extreme enough that it was hard to walk. 

The intense pain subsided, but would resurface sporadically if I engaged in strenuous activity.  After two months, I was getting regular weight bearing soreness, and I began walking with a cane to help alleviate it.  It was mainly “start-up” pain, and I could often “walk it off” by walking a distance.  I had less discomfort on longer, straight walks than with short quick steps and movements. 

My X-rays at that time started showing a shadow along the guide pin of the femoral component, and the femur neck was developing a jagged or remodeled appearance instead of the prior smooth contour.  The pain then became intense and started bothering me in my sleep.  Any movement of the hip could cause a sharp jolt of pain, and I began getting referred pain in my knee that felt like someone was sticking an ice pick in the side of my knee.  By then I was walking with crutches and putting little or no weight on my leg.  I was also taking pain medication (i.e. Vicodin) at night. 

One year after my resurfacing surgery, I had revision surgery to implant a large head total hip replacement stem to replace the resurfaced femoral component that could no longer be supported by the femur head and neck due to avascular necrosis (AVN).  The acetabular component was solid, so it was not replaced. 

 

Infection after Hip Resurfacing & Total Hip Replacement 

Scenario #1 

I experienced a lot of swelling up to three months, plus I had a fair amount of pain.  I improved slowly, but I still used two crutches for distance walking up to six months after surgery because I could not full bear my weight on the operative leg.  I would, however, use one crutch around the house.

I experienced a lot of pain at night, though it was variable, and the doctor said that night pain can be an indication of infection.  The pain was both deep in my groin, particularly during the last 5 months, and in my adductor (?-the outside of my thigh) muscles.  Blood tests after three months showed raised levels of inflammation, but no infection was indicated in those tests.  The next step was a hip aspiration (i.e. extraction and analysis of synovic fluid from the hip capsule) that could detect the presence of an infection.

The aspiration of my hip capsule revealed that I have an infection, but a low-level one.  The infection, which did not shown up in my blood tests other than in raised inflammation levels, did not immediately show up on initial testing, but it was grown on an enrichment culture and is from the bowel, of all things.  It is called Enterobacter Cloacae.  (It is one of the bacterium from the bowel--an E-coli.  It was low level, and it did not show up in my white blood cell count, only in my raised inflammation levels.) 

My consultant said it was rare (he had not seen it before) and that it could have come from many sources—all very uncertain.  He said that some bacterium form a polysaccharide layer—as I understand it, a kind of a tent—that makes it difficult for antibiotics to reach.  It is also difficult if the bacterium is on the metal, as opposed to in the blood or fluid or bone, as the antibiotic cannot connect properly with it. 

He wrote to a microbiologist to ask for advice about this particular bacterium and which antibiotic was possible, and in the meantime, he gave me different night pain killers.  Despite the new pain killers, I still had a lot of night pain, and I was often awaken by the pain every 1 ½ - 2 ½ hours, particularly at the beginning of the night.  This left me pretty wiped out during the day.  Other days, however, I was not too bad.  I did seem to have quite a lot of energy again in spite of all that happening.

The chance of an antibiotic working was only about 30 - 40%, but the treatment was not successful.  I am now scheduled to have two operations. The first takes out the resurfacing and puts in a spacer.  I am then given antibiotics for six weeks in order to clear the infection.  The second operation gives me a Total Hip Replacement.

I hate the thought of two more ops, but there is nothing I can do about it.   Whenever we go into surgery, we always face some risk, however small, and must weigh up the difficulties if we never bother to take the risk.  If I had to do it again, I would still have my op.  It is unfortunate, (to say the least) what has happened.  It is not life threatening.  (I have friends fighting cancer and strokes.)  In the end, I should get a functional hip.  And I am getting wonderful attention from all my superb friends, colleagues, clients, acquaintances and family.  I'll be all right.


Scenario #2   

I did not have any symptoms other than pain. My pain began about four years post-op, but I had a large amount of bone loss between the first and second year.  My one-year follow-up x-ray looked good, but when I went back one year later, there was a large area of bone loss. I had no pain at that time, no fever, and no indication of any problem.

My doctor was surprised at the bone loss so soon,  and he consulted with another doctor, the doctor who actually designed the type of replacement that I had received.  It was suggested that I wait on the revision since I had no pain.  

When I began having pain, the doctors attributed it to the bone loss.  Five different  surgeons looked at my x-rays during that time, and I was finally revised by a specialist whose main area of research is in osteolysis caused by the polyethylene liner.  Since my stem appeared to be okay, the plan was to remove and replace my liner and then do a bone graft to the area of bone loss.  

Well, when I woke up from the surgery, everything had been removed and left out of me, and they said I had an infection.  What he found surprised the doctor because I had no signs of infection.  When he went in and removed some tissue, it came back positive for infection.  He then did another sample, and it was also positive, so they decided to treat the infection before doing any more surgery. 

It was a difficult time, I was unable to walk any because there was no hip, and it was painful. I was given IVs of  Vancomycin twice daily for three months. I was able to do this at home with my husband and my mom learning how to give the IVs.  After 12 weeks of this the surgeon put everything back in, but he left me on the antibiotics for another month. That was in 1998 and I have not had any pain since.  (It is now 2004.)  

The odd thing is that when they cultured the specimens to find out what bacteria it was, my cultures never grew anything.  We don’t know where I got the infection, but it is possible that I got it during the original operation in 1993 because there were some complications with one of the pieces of equipment getting lost inside of me, and they had to call in a vascular surgeon to remove it .  The surgery lasted about seven hours with the surgeon coming in and going out to talk to my husband, and they think I might have contracted the infection then because I was open for so long.  Another strong argument for that is that my incision drained for much longer than it should have.  They put me on Vancomycin then, and I stayed in the hospital for 21 days.  After about two weeks, the draining finally stopped, but this was after I had gone home.  Since I had no other signs of infection, the surgeon hoped that it was just a fluke, but it was probably not.  It was probably due to the infection and the reason that I had the bone loss.

 

Loosening or Wear of a Total Hip Replacement 

Scenario #1 

After ten years, I began experiencing some lingering stiffness and increasing discomfort on rising.  There were also a couple episodes where the joint “froze up” for several hours with excruciating pain if I moved.  Also, there was a bit of a popping sensation in the joint when I made certain movements.  The “start up” pain upon rising is what finally did me in.  Because of wear revealed in X-rays taken during one of the hip freeze-up periods, I already knew that a revision lurked in the future. 

The total hip replacement in my other hip also had to be revised even though there were no outward signs or symptoms.  The X-rays revealed that the wear on it was worse than the hip causing the pain.   

Scenario #2 

The very first symptoms of anything wrong in my hips were occasional weakness or a kink in my legs—a pulling or nagging discomfort behind the knee. 

Revision symptoms were:  

Leg weakness after rising from a sitting position that would correct itself after several minutes, but it would return at various intervals over a year or more until I was unable to bear weight on the leg at all.  

Noticeable tenderness in the sitting-bones when I was sitting on hard surfaces.  There was also the feeling of sitting on a small rubber ball. 

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