Resurfacing versus Mini-hip

[Lopsided]

I asked Dr. Snyder point blank why would one choose Corin Minihip (he has done 350 of these) vs BHR.  He cited three things:

1. No metal on metal ion issues.  I know long-term issues with that are controversial, but apparently 3% of people do have some kind of bad reaction after BHR.
2.  Success rate - BHR is 90-91% (his statistic) due to various reasons.  Corin Minihip has a 98% success rate, although I pointed out there is a much smaller sample size.
3.  Recovery is much faster with the minihip because far less muscle is cut away.

None of that answers my question about returning to be the runner I was....

1.) There is no metal ion issue. There is a bad placement issue and a bad choice of device issue, and definitely an inexperienced surgeon issue. All materials shed debris.
2.) 90%-91% means it is done badly.
3.) I don't believe recovery can be faster than with a well performed resurfacing operation.

A mini-hip might be better than a conventional THR, but it is still a bone amputation device that does not anatomically match. Resurfacing patients seem to return to running most successfully.

D.

[Tin Soldier]

I agree with Lop.  With the posterier approach I don't think there is much muscle getting cut, sure they have to spread things apart, but actual cutting of muscle?  Although I wasn't awake much during the procedures, but I don't think with HR they do a lot of muscle cutting.  I have heard that with THR you can get a smaller incision because the femur top if promptly removed so that you have more room to work with.  They same might go for mini, sort of.  don't know.

[John C]

I believe that Dr Snyder is correct about less cutting of muscle in the direct anterior approach that he uses. In the posterior approach, most surgeons will be cutting (sometimes referred to as splitting or dividing) a few muscles, in particular the small external rotators. In a video of Dr Gross's surgery, you will see him cut and tag these muscles, so that they can later be reattached. There has been some debate on the web-site about whether a posterior approach is possible without cutting these muscles, but my doctor did not believe it was possible.
As a runner, my concern would be that the mini-hip still involves a stem that transfers the stress to the inside of the femur, and in this   case the inside of the small remaining portion of the neck; whereas a resurfacing transfers the loads along a more natural path through the exterior of the bone. This internal loading is a main cause of stress shielding, which can lead to bone thinning.
The Corin Mini-Hip certainly looks like an interesting approach to a THR, but I am not convinced that it would stand up to impacts as well as a resurfacing. A 90-91% success rate with resurfacing does not sound as good as what the top surgeons are achieving.

[Pat Walter]

Hbing
You are welcome to post a copy of your story in the THR section, too.  It is nice for people to know their options.  The Mini-hip and BMHR, etc are in between the resurfacings and THRS, so they do have a place on this site.  I also don't mind having the THR folks post since their recoveries are similar to our resurfacing recoveries. Also,  hopefully most of the THR folks have devices that will allow them to be active without restrictions.

Most of us personally prefer resurfacings, but sometimes you can't have one, don't want one or even need a revision.  I welcome everyone to post as long as we keep on friendly terms since we all have bad hips and want to get back to an active life without pain.

Pat

[B.I.L.L.]

I was curious to know what a mini hip was and found this,

http://www.youtube.com/watch?v=GqhOcDuK0n0

[Arrojo]

There is no metal ion issue. There is a bad placement issue and a bad choice of device issue, and definitely an inexperienced surgeon issue. All materials shed debris.

My understanding was that a small % of Hip Resurfacing patients experience metal allergies from the metal on metal and that the effects of long-term metal on metal Ion discharge were unkown, (rather than "none").  I got that information directly from this website.

I was curious to know what a mini hip was and found this,

http://www.youtube.com/watch?v=GqhOcDuK0n0

Interesting.  Which reminds me that Dr. Snyder also mentioned that with the minihip there are different sizes of the implants that go into the femur and also a left and a right "socket" implant.  Intuitively, that seems better than a one-size fits all, but I am still leery of the newness of it all.

[Arrojo]

Goodness Vicky, calm down.  The 90-91% was industry, I believe, not him.  You seem to have a very clear vendetta against him.  It makes you seem less than impartial.  850 Resurfacings, regardless of why he may not be listed here (and I edited my prior comment), is pretty experienced one would think.  I certainly feel for Jeremy and anyone else who had a bad expierence with any surgeon.

I'd prefer to stay on topic here and focus on minihip vs resurfacing, without the sideshow.  JohnC at least is a bit more rational - thank you for the explanation John regarding concern about running and the different stresses involved.

[Arrojo]

Here's a quote from the prior post
2.  Success rate - BHR is 90-91% (his statistic)

What I meant by "his statistic" was that was the statistic he gave me for the industry, not his personal success rate.  I am no expert in this, so I don't know if that is the correct industry statistic, hence my qualifier. I should have said "90-91% (what he says the industry standard is)".  I aplogize for the misleading way I typed that.

There are a lot of people on this site who have RAVED about this Dr., not to mention a few I talked to personally.  Anyway, can we get back on topic?  ;)

[Dannywayoflife]

How can HR/BHR be compared to a mini hip? Mini hip is still a THR and will still have THR related problems to some extent as you loose the femoral neck so loading WILL be different.

[Boomer]

Vicky,

Keep on doing what you're doing, just the way you've been doing it! We newbies are counting on people like you to help us make a successful journey to the other side.

I elected to have Dr. Rector perform my surgery later this year after seeing your very positive comments about him. Your input was very helpful to me. What else do we have to go on except the information we can find on this website?

Thanks for all that you do.

Boomer

[Vicky]

I absolutely agree with Danny and Boomer, you made an excellent choice, Dr. Rector is an outstanding surgeon.   :)

Vicky

[obxpelican]

Vicky,

I see you are still a fiery little pistol   ;) .... I totally agree with you Vicky, I've read far too many things about Snyder.

Guys, Vicky is spot on IMHO.  Look up Snyder on Surface Hippy, then comeback here and tell me that all is well at Newton.


@Vicky I am glad to hear you're surgery went well.



Chuck

Here's a quote from the prior post

And I am calm, again, sorry if my passion comes across as anything other than a passion to truly help people.  But these are all facts and again, I have the proof, contacts names and email addresses, etc., post numbers from other message boards to show the lies, etc.  To me, there is something wrong with a surgeon that continually does that.   Doesn't that bother you?  I know it certainly bothers me, any a lot of patients come to me for facts.

Vicky

[Eitan]

Note from Patricia Walter: New perspective patients, please understand that this person is stating his non-medical opinon that a hip resurfacing is a type of total hip replacement.  I must note that it is not in my opinon and all the information I have collected during the last 6 years.  Please read the later posts from myself, Vicky and Chuck, etc to learn the difference between a hip resurfacing and a total hip replacement.  

Oh what the hell.  Some people are going to blow a gasket, but I don't care: A Resurfacing IS a type of Total Hip Replacement.  I repeat this in case you did not understand me:  A Resurf is a type of THR.  You get resurfed, you will undergo the same risks, and essentially the same benefits as a THR, ie dislocation, infection, fracture, loosening, DVT etc.  You get resurfed, and acording to ALL CURRENT literature, your results are equivalent in the short, medium, and long term to a standard THR (pick your THR bearing, metal on metal, metal on plastic, ceramic on ceramic etc; pick your fixation cemented/non-cemented, really it doesn't matter) in terms of longevity, complications, pain relief, and even return to physical activities.  Notice, I emphasize the word CURRENT.  I think that with a resurf you can probably be more active, but I cannot cite ANY current scientific evidence to back that statement up.  I had a resurfacing and now I am back wrestling, which is pretty frickin amazing.  I don't think I would be wrestling on a THR, but I will never know because I don't have a THR, and my one story does not a scientific study make.

But the above paragraph is not really why I am posting.  That was just a tease to get you guys thinkin about what I have previously posted about (which basically no one seems to give a damn about because I guess it's just not sexy):  Here's what I really have to say:  How do you know Snyder has done 800 Resurfs???  How do you know he's done 350 mini whatevers???  Answer:  You absolutely DON'T.  In the words of the famous bluesman:  You don't know Diddley.  You, (and me also for that matter) don't know because there is no National Registry where these numbers are kept.  Ladies and Gentleman I submit to you that unless and until we get an obligatory registry, we can argue all we want about Snyder and any other surgeons, but we'd all be simply BSing ourselves and each other.  We need an objective national data base.  Once we have that we can answer all kinds of questions objectively such as best approach, best device, ideal candidates, best performing surgeons, most experienced surgeons etc.  Gross tells his patients he's done over 2500.  HOW DO YOU KNOW IT'S TRUE????  My own surgeon said he did "over a thousand".  Maybe he did.  Maybe he didn't.  In the words of another famous Bluesman (paraphrasing of course):  "I only trust my mommy.  And she could be lyin' too".

Food for thought.

[obxpelican]

In the terms used today a THR is when the femoral head is removed and a shaft is jammed down the femoral canal and a cup is placed in the acetabular socket. 

What is done during in a hip resurfacing at least from the femoral side has no similarity to a THR as you described above.  The terms THR and Hip resurfacing for the purpose of any discussions are not the same surgery.  I would have to respecfully and totally disagree with your whole first paragraph.  You really risk losing credibility by saying that those types of surgeries closely resemble each other, they simply do not.

As a whole most people with succesful HRs end up having a more active life with less restrictions.  This is not just conjecture but it's a fact.

In regard to Dr. Snyder, I've read so many posts about complications (again search yahoo's surface hippy group) that IMHO I would not want him on my short or long list of surgeons for my future left hip.


Chuck

[maxx6789]

although a THR and Hip Resurfacing (and Min-Hip) are different, they are also very similar. both would be considered "major" (not "minor") surgery. they are both NOT arthroscopic surgery.

i have read and been told that in the usa, the insurance code used is the same for these two different (but similar) operations.

[Eitan]

Re:  "As a whole most people with succesful HRs end up having a more active life with less restrictions.  This is not just conjecture but it's a fact."

Dude, I'm sure you are a nice guy and all, but sorry:  As of Sept 28, 2011 it totally is conjecture, and not fact at all.  My sincere hope is that sometime in the future we will have some real objective data in this area. 

[obxpelican]

Max, from the femoral side they are miles apart, yes, they accomplish the same results by re-creating a joint with a metal or plastic friction point I would agree.

Come on folks, with a THR you lose a huge section of your femur.  With hip resurfacing you keep your femoral neck.  That alone makes the surgeries miles apart. 

Also bear in mind the doctors skills become more critical, not every doctor is a good hip resurfacing doctor, although they might have great results doing THRs.

Not everyone can be a pitcher in the majors.


Chuck

[obxpelican]

I do not know how anyone will be able to create a data set based on more active vs. less active.   Maybe I prefer water skiing over snow skiing even though I know if I wanted to I could go back to black diamonds.   If you have a THR chances are your doctor has given you restrictions, for good reason.

Ask any skilled doctor who has done both THRs and HRs, ask them which patient can return to the most active life.  Sorry, but it's been well established that patients that have hip resurfacings are far less restricted post op.  Just from an anatomical stand point a hip resuracing patient has a hip that is biomechanically more similar your original joint.

Sorry, you are a nice guy too but what you are saying goes against what the best hip surgeons in the world will tell you and that's a fact.

Chuck

Re:  "As a whole most people with succesful HRs end up having a more active life with less restrictions.  This is not just conjecture but it's a fact."

Dude, I'm sure you are a nice guy and all, but sorry:  As of Sept 28, 2011 it totally is conjecture, and not fact at all.  My sincere hope is that sometime in the future we will have some real objective data in this area.

[Boomer]

Maxx

All of the surgeons trained and qualified to do resurfacing, are also trained and qualified to do total hip replacement surgery. The reverse is not true. Hip resurfacing is much more challenging from a surgical standpoint because the desired, and generally obtained results, are so much better for active patients.

I cannot think of anyone who would choose total hip replacement if their surgeon told them they were a good candidate for resurfacing. I also cannot think of any instance when a qualified surgeon would perform total hip replacement when resurfacing would address the problem.

The good folks on this website are trying to educate you. Listen up.

[obxpelican]

Now where is that like button on here?


Chuck