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    Need advice on hip surgery to restore range

    Has anyone undergone HO resection on fused hip joints? Haven't seen much on this that doesn't have the usual "you'll get an infection, amputation or die". Anyone it actually worked on? Who's the best for this type of surgery?

    #2
    I would recommend that you only consider such a surgery with an orthopedic surgeon who has a lot of HO management experience. Complications from HO surgery are very common, and a girdlestone procedure (which is what this would be probably) is not an easy surgery. I assume your goal is to be able to sit. It is unlikely that weight bearing will be an option after the surgery.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      Given that HO is a relatively common complication for paraplegics (or so I was told in rehab), I'm surprised there is so little discussion of the condition on this site. I have HO as well and face surgery in the next several months, as my range of motion in my left hip decreases noticeably week after week. I understand this is a difficult operation and I want an experienced team, but I'm having a hard time finding out who and where that team might be.

      If I'm going to end up with a leg that will never bear weight, I might as well have it amputated, wouldn't you think?

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        #4
        Zero, where is your HO? Has it matured? Is your hip completely frozen? Each individual's HO must be individually managed. My response above to Brino was based on his situation. I have no idea if you would be able to weight bear or not. Do you sit now or is your HO so severe that you cannot sit?

        Amputation of course is the last resort. I have seen it done for HO, but even if you cannot stand, it should not be the first choice. First of all, having a leg is important cosmetically, if nothing else, and important for body image. The leg also still helps to bear weight and keep pressure off your ischiums when you sit. With no thigh, there is no way to keep all your sitting weight off your butt, and ischial pressure ulcers are much more difficult to prevent.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          SCI-Nurse,

          I was recently diagnosed with HO in my left hip, my range of motion is pretty good @ 90 degrees, I was told to get a bone scan and phosphotate test for maturaty. Are you aware of other tests? Is using the standing frame and FES bike going to make this worse?
          Thanks

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            #6
            Yes, a bone scan is needed to determine maturity of the HO (which must take place before any surgery is risked). Alkaline phosphatase is a less reliable test, as there are other conditions that can cause it to rise as well (healing fractures being #1).

            There is no indication from articles that I have read that vigorour ROM, FES, standing or other physical activity is contra-indicated with HO, in fact, the more activity that helps to maintain ROM, the better.

            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #7
              Originally posted by SCI-Nurse
              Zero, where is your HO? Has it matured? Is your hip completely frozen? Each individual's HO must be individually managed. My response above to Brino was based on his situation. I have no idea if you would be able to weight bear or not. Do you sit now or is your HO so severe that you cannot sit?

              Amputation of course is the last resort. I have seen it done for HO, but even if you cannot stand, it should not be the first choice. First of all, having a leg is important cosmetically, if nothing else, and important for body image. The leg also still helps to bear weight and keep pressure off your ischiums when you sit. With no thigh, there is no way to keep all your sitting weight off your butt, and ischial pressure ulcers are much more difficult to prevent.

              (KLD)
              I apologize, the amputation comment was (mostly) from frustration with this condition, though the thought of not having to lug this useless limb around anymore does have some appeal to me.

              I have had a bone scan and several x-rays. All show active growth in the area still, and it's hard to tell if the growth is slowing just based on my range. My orthopedic specialist has recommended surgery but said that there was no rush, that I should schedule it when it is convenient given work and personal matters.

              I'm not sure what the proper terms are, but my leg will not move left or right at all, nor will it rotate. There is still some movement up and down. I can't sit at 90 degrees, maybe 100-110, and when I lie down on my back the leg drops to 150-160 degrees I would estimate.

              Externally the HO is clearly visible as my left hip is much larger than my right, and the extra mass feels very hard. When sitting, I list about 5-10 degrees starboard, which I know from a recent pressure mapping puts extra pressure on my right ischium.

              Knowing that I face surgery, I was hoping (like Brino) to see some discussion from others who have had the surgery, where they had it done, are they satisfied with the results, etc.

              Comment


                #8
                SCI - nurse,
                What exectly is a girdlestone procedure. My ortho suggested it as an option a couple of years ago. Also, did you mean standing weight bearing? I'd like 90 degrees so I can sit normally and then lay flat at night. I know this might be a dream. Thanks.

                Comment


                  #9
                  In a girdlestone procedure, they cut the ball end of the top of the fever off so that the femer bone is no longer attached at the pelvis except by muscle.

                  In this picture, the right hip (C) is normal. A girdlestone procedure has been done on the left hip:



                  It is done to allow the hip to bend in the case of bad HO, and is also done for osteomyelitis or aseptic necrosis of the head of the femer. Unless it is repaired with a total hip (rare in SCI) you cannot weight bear (stand) on that hip any longer after the surgery.

                  (KLD)
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                  Comment


                    #10
                    Ug, I don't like the look of that at all, but if that's what it takes to free up the hip, I guess I'd go for it. Wouldn't this procedure leave the leg very "floppy"? In this photo, it looks like the entire left side of the hip and femur is degenerated, do you know if this was an SCI patient or something else?

                    Part of what bothers me about this whole situation is the attitude my doctors have toward my condition. They speak as if it doesn't really matter how much muscle or bone they remove because I'm paraplegic. I'm still holding out hope that I might need that leg for walking again someday. As you mentioned though, an eventual hip replacement might be an option, so I guess that fact keeps the hope alive.

                    Comment


                      #11
                      Girdlestone Surgery

                      I underwent Girdlestone Surgery around 1993. I have been paraplegic for around 19 years now. The leg muscles seem to hold my leg in place okay. Dr. Alexander G Hadjipavlou MD worked on fusing my back & he helped a little with Dr. Christopher Demas for the removal of the "ball" from my left hip. I lost a ton of blood during the surgery & luckily many of my family donated blood before my surgery occured.

                      Comment


                        #12
                        My update: I had surgery to increase range of my left hip about nine months ago and it went very well. Originally my surgeon wanted to do a girdlestone but I refused. As a result I don't have full range restored, but enough to sit up at 90 degrees and I can now reach my left foot to put on a shoe. No sign of recurrence so far.

                        Comment


                          #13
                          Originally posted by Lazlo View Post
                          My update: I had surgery to increase range of my left hip about nine months ago and it went very well. Originally my surgeon wanted to do a girdlestone but I refused. As a result I don't have full range restored, but enough to sit up at 90 degrees and I can now reach my left foot to put on a shoe. No sign of recurrence so far.
                          I am glad to hear that. I hope things continue to go well.
                          You will find a guide to preserving shoulder function @
                          http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

                          See my personal webpage @
                          http://cccforum55.freehostia.com/

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                            #14
                            Lazlo, glad your surgery was successful and you are doing better. Can you explain what the exact surgical procedure was? Was it primarily to remove the HO? I'm assuming the femoral head and left hip socket was more or less intact, so there was no additional dislocation or degeneration of bone or anything?

                            Comment


                              #15
                              H.o.

                              I don't want to hijack a thread but there is so little discussion here about HO that it seemed prudent to just keep this thread alive.


                              I was diagnosed with HO after undergoing a 3 phase bone scan of my hips. This was 28 days ago and the DR. ordered 1400 mg a day of didronel for 3 months.

                              The problem is, the pharmacy and the physician's staff which got involved have only now, after 28 days, found one month's supply of the drug Didronel. We are still looking for more for the other 2 months I'm supposed to take it.

                              I'm a c4 incomplete 33 yrs post sci. I reside in Colorado.
                              I have had no recent trauma to the area. My range of motion is becoming more restricted in my left hip...no sign of reduced range in my right hip yet. I can sit at 90 degrees as of now but my left hip resists being bent. Bending forward another 10-15% is possible but applying a bit of force is needed. (My wife puts a small amount of push on my shoulders and I slowly get there)
                              I recently purchased an adjustable bed because it was becoming difficult for my wife to sit me up in bed because the left hip resisted. Sitting up was needed because I was having some issues with AD. (currently not an issue)
                              I feel a small amount of pain in my left hip and it feels warm to me but take that info with a grain of salt because I have light touch sensation but detecting pain is a crapshoot. There is actually no heat or swelling going on at the hip. I have mild swelling below the knee and in the ankle and foot. That swelling goes down at night. (It was that swelling that caused me to see a doctor in the first place)


                              My questions:
                              1. How fast can\does bone growth occur with HO?
                              2. Was waiting a month before even getting started on the prescribed medication something I should be very concerned about?
                              3. I was not given any recommended therapy but I read here that increased range of motion exercise is recommended. Is that correct? It was suggested to me that it may actually be counter-productive. I have always been pretty limited in the flexibility department anyway.
                              4. What questions should I be asking my Doctor?

                              Edited to add: Some days.....maybe one day in 7 there is no tightness in the hip at all. Violet (wife\caregiver) says hips are "bending like a noodle" on those days. Is this normal?
                              Last edited by RickC; 11 Aug 2011, 11:01 PM.

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