22/05/23 Orthopaedics at Broomfield

 An update on my left thigh / hip and the “benign cyst” identified in recent MRI scans:

I saw an orthopaedics consultant at Broomfield Hospital this morning. He took quite a detailed history, wiggled the hip joint around a bit, and sent me off for a pelvic X-ray. When I got back from that we looked at the images and did a compare & contrast with MRIs and X-rays dating back to the discovery of a big  (myeloma) lytic lesion in my left hip back in 2019. That had a course of radiotherapy which solved the immediate pain and walking problems (two sticks, very slow, very painful).

I have been led to believe from PET scans and other evidence that the lesion had largely or completely “re-modelled” itself so that my hip was for practical purposes back to normal and had been so for a few years.

It seems not. The cyst showing up now is a perfect match for the lesion of 2019 - same place, same size, same shape. There seems to have been no re-modelling. Why it is now being described as a cyst rather than a lesion is a mystery so far unsolved, but probably not important. You can see it on the image (not my pelvis, I found this one online and added the personalised stuff). 

The black area is the cyst, and it’s full of something that is not good hard structural bone. Probably some sort of proto-bony gloop. The base of the cyst lies very close to the top of the socket of the hip joint, and there is obvious potential for a rather nasty fracture there. The entire top surface of that socket should be embedded in good strong weight-bearing bone, but now that is reduced to the bit shown in white. Obviously that’s been enough to keep me going for the last four years, including all the heaving about of heavy boxes etc. that I did during the house move earlier this year, but now I know the weight-bearing area is so small, I can’t help being rather nervous about it. One fall, one ill-judged step off a high kerb, one over-ambitious lift…

So the good news is that it’s not progressing and it’s not giving me significant day-to-day trouble. The bad news is that it might very suddenly get a lot worse, and a repair job on a broken hip there would be difficult partly because there’s not a lot of good solid bone in the area to attach metalwork to, and also because one consequence of the radiotherapy in 2019 might be that it killed off a lot of “good” cells in the area as well as the “bad” ones, meaning that any kind of bone growth, including ideas like bone grafts or packing the cyst with bone chips taken from some other part of my skeleton or with an “artificial bone” matrix to encourage growth of my own bone cells might not work too well.

So it’s a “complicated” situation beyond the scope of Essex Orthopaedics, and I’m being referred to the Royal National Orthopaedic Hospital in Middlesex. You never know where your myeloma ‘journey’ will take you! The experts there will re-assess everything (new CT scan to be done at Broomfield first) and possibly a biopsy to find out exactly what is inside that lesion / cyst. Then they will suggest a way forward, which might include a custom 3-D printed implant. Shades of vet Noel Fitzpatrick and his TV shows – he always said that the real aim of his animal work is to develop the same techniques for people, and here I come….

Perhaps.

We shall see. And the mystery of that left thigh pain – mercifully now only a mere shadow of what it was - remains.