How can you fix a wonky new hip?
WITHIN the past two years my wife has undergone two unsuccessful replacements of her left hip. She has had the hip joint removed altogether in what is called a ‘Girdlestone’ procedure. Can you please explain the implications of this? R. Hollands, Maidstone, Kent.
WHAT a traumatic and disappointing time for you both. Medical professionals such as me are so accustomed to hip replacement being a routine and successful procedure that we have little experience of what happens when it goes wrong.
Though, of course, the recent reports of so- called metal- onmetal hip replacements causing complications could mean that more of us will see such cases.
However, from your letter it appears it’s not a metal-on-metal replacement that’s the cause of your wife’s bad experience.
The issue seems to be that the procedure was complicated by infection, and the only solution was to carry out a salvage operation — a compromise to save the leg. Once the replacement hip becomes infected, which can occur with even the most stringent precautions during surgery, it is very often the case that the bacteria can be beaten only by removal of all foreign bodies — in other words, the implanted hip replacement.
HIP REPLACEMENT is usually performed because of osteoarthritis (or wear and tear), though another possible reason is hip fracture.
Your wife’s first hip replacement would have involved the top of the thigh bone being removed and replaced with an artificial component made from metal, plastic or ceramic. A ‘cup’ would have been inserted into what was the hip socket (this, too, would have been eroded by the osteoarthritis).
At some stage, your wife had the procedure redone, probably because of infection — now this second replacement joint has had to be removed, with further infection being the most likely cause.
The ‘ Girdlestone’ procedure (also known as resection arthroplasty of the hip) involves removing the top of the thigh bone, then fusing the bone to the pelvis. This is done by putting the leg and hip in a cast — tough scar tissue then forms a ‘pseudo’ joint.
The dramatic procedure was named after Gathorne Girdlestone, a professor of orthopaedic surgery in Oxford, who devised it for treating tuberculosis of the hip before joint replacement became possible (the bacteria that cause tuberculosis can spread to bones and eat away the tissue).
The Girdle- stone procedure means the patient will be pain-free. However, the leg has effectively been shortened and the hip is much more rigid (it no longer has a proper functioning joint), so your wife will need a stick or crutch to walk — and this will be at a slower pace than before.
This is hardly ideal, but at least the infection can settle and your wife should be in no discomfort.
I hope that everything will settle down for her and she will cope at home.
It is possible, in theory, that after perhaps a year or so a third hip replacement might be carried out — but this very much depends upon the exact anatomical circumstances of her case, as well as aspects of her general health. My best wishes to the both of you. LAST year I developed a small clot in my retinal artery, causing a slight loss of peripheral vision.
My GP says I must take aspirin to protect my sight, as this will help thin my blood and prevent another clot. But I can only do so every other day because I do not tolerate aspirin well due to stomach problems. Is there any other option? Mrs Sally Launchbury,
Didcot, Oxon. I AM sorry to hear about this misfortune. But before I go into treatment options, I will explain a bit more about your condition — retinal artery occlusion.
The term refers to blockage of the central artery of one eye — this is the vessel that supplies the eye with oxygenated blood, which is crucial for the retina (the cells at the back of the eye that detect light). A blockage in this artery usually leads to a complete (painless) loss of vision in that eye.
There are a number of possible causes of this blockage, including a clot travelling from elsewhere in the body or a build-up of cholesterol that blocks the artery.
Those affected by this condition usually have high blood pressure, heart disease or diabetes, and it may be helpful, though alarming, to think of this problem as a sort of stroke.
ALL EFFORTS must be made to prevent another episode, and this means giving a ‘blood thinner’ to reduce the chances of your blood clotting. I was pleased to read in the longer version of your letter that you are taking the drug Plavix for this purpose.
Aspirin, in low dose, is also used, but the main hazard of either of these drugs is the potential for causing dangerous bleeding from the stomach or small intestine.
Because of that, there is a tendency for doctors to prescribe drugs that protect the stomach lining and reduce stomach acid. In your letter, you say you’re taking omeprazole for this purpose. However, omeprazole actually reduces the anti-clotting effectiveness of Plavix by competing with the system in your body that processes the drug.
For this reason, aspirin and Plavix are often given together in the hope that the combination will be even more effective.
However there is no evidence that this is the case, and there is much evidence that the rate of bleeding is even higher — 10 per cent as opposed to 2.9 per cent for Plavix alone, and 4.8 per cent for aspirin alone.
We are unsure why this is the case. So, unfortunately you are between the devil and the deep blue sea.
But I would hope that when the blockage first occurred you did undergo the relevant search for causes of a clot: an electrocardiogram to check your heart rhythm; an echocardiogram (an ultrasound scan of the heart) to check the valves and heart structure; an ultrasound scan of the arteries in your neck; even perhaps a magnetic resonance scan of the arteries in your brain.
Identifying the site from which the clot originated does at least give a focus for future prevention, apart from the more general precautions already mentioned. I wish you the best of luck.