Tuesday, 13 May 2008

X Rated X-Rays - not for those of a nervous disposition!

First the good news about continuing progress in terms of mobility. I have now progressed to regular use of crutches instead of the Zimmer Frame. I can now negotiate steps in the garden and have therefore been able to achieve one of the two targets I had not set myself for achievement until well after the 2nd stage operation - to be able to top up the feeders for the birds in our back garden. The other longer term target is to get back to wood turning. I will wait to hear what the surgeon says next week about weight bearing and might even be able to give this a try after the clinic appointment.

At that clinic I will try to take a digital camera image of the current state of my right thigh.
In preparation for that however I was playing about with transferring 94 X-ray images provided on CD by the local hospital in response to a request for personal information in connection with my thwarted PhD studies. (The new digital imaging archive service broke down in the middle of transferring my X-Ray library so I'm not sure how many more there are to incorporate into my lifelong electronic health record but I will find out when I request a further update after the 2nd stage operation.)

I have selected 2 images to illustrate the metamorphosis of my right hip. I begin with an image taken a couple of months before the initial hip revision operation.

It shows the extent of protrusion into the pelvic cavity of the cup placed there nearly 23 years previously. You might note that the left hip joint prosthesis looks altogether in a better state. X-Rays tend to show the view of the observer not the observed - hence the left side will appear on the right of the picture.

The operation to replace this initial prosthesis required the removal of the metal ball and spike and the cement that was used nearly a quarter of a century earlier to secure it in place.(Nowadays most hip replacements are cementless and use sterilised and pulverised bone removed from previous operations to pack the metal spike into the cavity otherwise filled with marrow.) This would be quite normal, however in my case - because of the extent of protrusion - the bone that surrounded the cup (or acetabulum) had to be remodelled with pulverised bone. Like mending a rusty car wing with plastic padding the bone needed to be kept in place until it could graft onto my own bone and a metal grid was used and kept in place with a number of screws. In theory once the bone had grafted successfully the metal cage and screws could be removed - this would not normally happen in practice and would be left in place along with the prosthesis.
So this is the same hip after the extensive remodelling 4 years ago. All of the metal has since been removed along with a lot of the femur and soft tissue that became infected. In time I hope a new metal prosthesis will be in place without the need for any additional metal work. ( We'll see!)
I should explain what the loop is that appears wrapped around the top of the metal head of femur. It is in fact some wire that was helping to keep the surrounding bone at the top of the femur in place! Apparently during the insertion of the metal spike some of the surrounding bone at the top of what was then left of my femur chipped and was cemented back in place and secured with the metal wire looped around. So in addition to the metal spike my right hip had 7 screws a metal mesh and some metal wire to keep various bits in place. All of this metal was removed in the operation to fillet my right thigh nearly 2 months ago.
Although not conclusive the 2 X-rays do point to a difference in the relative lengths of both legs. Slight leg leg differences are one of the risks associated with this type of surgery. My previous 3 operations had not caused me any problems but in the years leading up to the revision I had lost half an inch of length in my right leg (due to the protrusion into the pelvic cavity)and walked with a waddle until provided with a polystyrene wedge to place inside my right shoe. This low tech solution straightened my posture and allowed me to walk with the family without too much pain. It was a pity that it required a referral from rheumatologist to physiotherapist and then from physiotherapist to podiatrist a chain of referral that took 6 months.
After the revision I felt that my right leg was longer than the left. It took about 12 months before this was accepted and I had a prescription for up to 3 shoes a year to be fitted with a half inch wedge to be inserted into the soles to compensate. I will wait until the 2nd stage operation before getting these removed.
The latest X-Ray shows a few inches of femur above the right knee and a "rudely" fashioned femur made entirely of cement with a knob at the end to act as a spacer. (I hope to provide a picture of this in a week's time) As the swelling in my right leg recedes I am becoming aware of the limitations of the knob that was fashioned. When I stand and let my right leg swing free it twists out to between 45 and 90 degrees. When I sit down I have difficulty drawing my right knee toward ny left and when I do my thigh sticks out to the right while my lower leg is bent inwards. I am not complaining as this is both temporary ( I hope) and I was not expecting any kind of fashioning to have been possible.
All in all though now that I am able to get around the house and garden - and further afield as a passenger in a car - I am beginning to contemplate a return to what I have considered normality for the previous 3 years. I did not think that this would have been possible while I was a one hip wonder so I remain grateful for the "emergency" remodelling that the surgeon managed during the extended operation.

1 comment:

But Why? said...

...No wonder you get stopped every time you head through the airport metal detectors.