Although I have never heard of a phenylenediamine allergy, becareful about over-reading the results of Allergen Patch Testing. Cutaneous sensitivity in most cases is not predictive of sensitivity internally. Cutaneous sensitivity usually requires dendritic cells to be present as the allergen presenting cells, and to my knowledge these cells are not present internally. I don't have any hard statistics to back up my statement, but in about 99 cases out of 100, the cause for constant pain after joint replacement is likely to be due to some other cause other than implant hypersensitivity. Metal on metal hips are one thing, however allergy to total knee replacement parts are another. There has been no documented or published consensus of what a normal Cobalt or Chromium blood level should be in well functioning total knees. Even less is known about more rarer serum levels.View Thread
In some cases an Ultrasound or CT scan can be done to provide greater evidence of this problem, however in many cases the diagnosis is confirmed after a trial injection of the psoas tendon sheath using flouroscopy or ultrasound as you have alluded to. Usually an orthopaedic surgeon is responsible for the evaluation of this disorder, however he/she may have a radiologist do the actual injection if it is done under flouroscopy depending on hospital policy.View Thread
I'm going to give you a biased opinion because I converted to the anterior approach for my patients 4 years ago -- so take this with a grain of salt. There are definitely not any post-operative restrictions with the anterior approach. I think the recovery is faster, but not markedly -- meaning possibly 3-4 weeks faster. The downsides are more swelling of thigh and leg, and a slight numb sensation over and just beyond the incision for about 3-6 months. I've had a few people complain about this -- most do not. All except one resolved in 3-6 months. As a comparison, the decreased sensation would be comparable to the incision after a total knee -- however rarely if at all do I have anyone complain about this pain either. The major upsides beyond recovery and pain advantages for the patient, are that the hip parts are placed with use of flouroscopy -- meaning they are put in more precisely than either lateral or posterior. The surgeon also is able to better control the lengths of legs since they can be measured clinically in the OR and via Xray.
Despite my opinion, you really want to go to a good surgeon that does good work. Finding out who does good work may be difficult so its very useful to ask around. If a good surgeon operates on you, its very likely you will have a great outcome independent of any type of approach (ant,post,lat) that could be used.View Thread
Your problem is very complex, however I wouldn't classify it as instability. I'd get a second opinion in your case and make sure to bring all your medical records and xrays to the second opinion. From what you are describing, its very difficult to recommend any other opinion based on the limited information you presented.View Thread
If its been six months since your surgery with no gain in flexion, I would definitely consider either a closed manipulation or arthroscopic surgery in conjunction with closed manipulation. Patellar realignments can in many cases produce many adhesions with the extensor mechanism. After the surgery you will need to go to PT every day (6 days a week), for several weeks then slowly back off the frequency of the visits. Scar formation is a very nasty problem, and can effect all knee surgeries (particularly open procedures). Its very frustrating for the patient to deal with.View Thread
The guidelines when to revise a metal on metal hip are in constant evolution so the answer to your question isn't as straightforward as you wish. Some helpful tips:
Make sure your surgeon rules out an infection. If you are still painful with a MOM (metal on metal) hip, usually both imaging (a metal artifact reduction sequence or MARS MRI is used) and serum metal ion levels are drawn. In some cases a hip aspiration is also performed.
If you are in constant pain after a MOM hip and its been some time after the initial surgery, you should really seek consultation by your original surgeon or a surgeon specializing in joint revision surgery.View Thread
Your ortho doc is prohibiting use of NSAIDs because he wants to maximize the bone ingrowth potential into your hip components (femoral stem and acetabulum). Additionally if you were on coumadin or another blood thinner after surgery, you usually do not have people on NSAIDs such as Ibuprofen with these agents. Usual standard of care of no NSAIDs ranges from 6 weeks to 3 months. If I were in your shoes however, call the doctor and just ask what he wants you to do. Usually a visit isn't necessary for a question like this.View Thread