Hip replacement w' suggestion of Avascular Necrosis

[cccourt1942]

This is a message to Tharrell: I am hoping she will see it. 

Arthur banged on my door nearly a year ago.  Took me to my knees.  Started Celebrex...then two orthos and two PT Rxes later, I asked for MRIs of my hips at end of 2017.  Surely enough, the arthritis in my left hip is major. The 1st impression on the MRI report follows: 1) Moderate to severe left hip arthopathy w' high-grade partial and full thickness cartilage loss of femoral head and acetabulum, most pronounced superiorly.  Joint effusion.

Two other impressions...about as bad.  btw: the right hip doesn't look too promising but not as severe as left.  I had continued to hurt beyone PT, w' celebrex and my LDP @3mg per day unless i was on a trip...at which times i took 5 mg per day.  I did manage 3 trips in 2017 tho.  So...slowed me...but didn't stop me.

I am the one who asked for the MRIs (both hips...same day) and the ortho, internist, and rheumy showed wide eyed surprise w' results.  In the meantime, because the internist had refused to renew Celebrex RX (which keeps me on my feet) I was sent for yet MORE labs.  And wouldn't you know it: Anemia.  ANOTHER blood draw resulted in low in ferritin. 

This leads to EGD/gastro, which resulted in discovering an ulcer...and loss of blood via that organ.  Wait..wait...haven't gotten to my question---or condition:

On the MRI report, left hip only, the following is noted:  Avascular necrosis cannot be excluded w' certainty.

I'm pretty realistic in separating old age stuff (and symptoms) from conditions resulting from Sjogren's.  So back to anemia:  find out this is prevalent (tho not a lot of studies available on google search only) but did pick up "abnormal bone marrow changes w' anemia in primary SjS as a positive.  Searched further to learn prednisone can lead to anemia....which i knew but had to SEE to fully take in...and of course, we ALL know the perils of Non Steroidal Anti Inflammatory Drugs to the stomach lining.

Well...no overreaction of the ulcer:  we'll watch and do another EGD in 2 months (and went back on Rx strength of Nexium)...but it's stopped everything.  (gastro said to wait on some dental work..nothing pressing tho)

BUT HERE IS MY QUESTION FOR THARRELL:  (and anyone else who has had hip replacement revision)  Did orthopedists ever say "out loud" Avascular Necrosis.  I am of the belief if you have "blood death" the ability for the femur to accept the shaft will be unsuccessful.

And ==for those of you who wonder why I'm asking on this board: a) Tharrell has been thru this (not for same reasons), and b) YES---all of the above can be associated with AI diseases/sjogren's.  Of course it is! Who could have hoped it wasn't?

I am 75 (galloping toward 76)...and have talked with two REAL people in my local SjS group who have had up to 2 revisions.  Oh moan.  They have little knowledge (or maybe understanding) of why they have the revisions.  The cause, according to both, is the bone never attached to the shaft. 

Please help me if you have any knowledge of this topic or the relation to it to Sjogren's. 

Thank you for your help,
Courtenay

[jazzlover]

Were you at one time a heavy drinker? My sis in law had necrosis from drinking. It eats away at the bone.

[cccourt1942]

I did abuse alcohol in late 30s.  Stopped completely about 41-42.  About 60, I'd have either a beer or margarita once a week-Mexican food!!  Oral dryness so bad, it exacerbated dryness. BUT— I did smoke about 25 years.  Quit decades ago.  My vice is prednisone!  Really!!

      Yhanks for the tip/ input tho.  I really think this happens in old people and in old age.  Most of you are 40s , 50s.
c3

[Linda196]

Unfortunately, Prednisone use is another "high risk" for AN. I had one work up in my early 50s to rule it out because of sudden onset intense joint pain, and now it's become a routine every couple of years. The various episodes of pain so far have all been attributable to radiculopathy or, once, a stress fracture,  but as my doc says, better to rule AN out than to miss it.

Sometimes, as various symptoms occur that elicit a "do you drink" question from the doc, I kind of wish I had, at least in my youth. One shouldn't have to put up with the liver, stomach, and assorted problems without at least having had the "fun party times" (JOKING!!!!--don't want to appear as if I'm recommending it LOL. Everyone has their own reasons for taking a drink or not)

[jazzlover]

Oh yes... the smoking also. My SIL did both. She also had taken quite a bit of prednisone for her knee and back pain over the years. It all adds up, unfortunately.

I'm 67, by the way.

[irish]

Linda, I sure get what you are saying. I am telling people that when I reach the point when I think my end is getting near I am going to start drinking and lay around under the porch all day....as the old saying goes. Seldom drank in my youth and add all the pills it becomes a not very good idea.  It is hard to make oical decisions at times.!!!!! Irish

[Jenny]

 I have not had hip replacement, but just had my revision surgery for shoulder replacement last month because the bone did not attach. Not sure if that is Sjogren?s related or not.

[Tharrell]

So sorry, just saw this today. Have not been feeling to well. No, my doctor never mentioned AN to me ever. To this day he does not know why there was no bone growth to the stem. The last time he put in a much longer stem and so far so good, knock on wood.
Mind you, my joint damage did not even show up on MRI! It was not until first an arthroscopic proceedure and then followed by the hip replacement that the ortho saw that I was end stage. He was shocked!

[irish]

I don't know much at all about this problem but I will add that many times MRIs don't show anything. My hubby had such a bad back and needed back surgery. He needed much more repair work done that they thought because none of the MRIs or scans showed this up. It gets frustrating at times. Good luck. Irish