Advances in Hip Resurfacing

[Lopsided]

I would like to read the various responses.

[Dayton96]

Darn!  I was out of town the last couple of days and missed all the excitement.

Mac

[bluedevilsadvocate]

The post by "Wise Guru" was pretty clearly from someone who has a bone to pick --- so to speak.  It did intrigue me enough to do a little research on the 2010 Annual Report of the Australian Joint Replacement Registry.  "Wise Guru" said that resurfacing is declining outside the US, and the 2010 did report a 17% decline between 2008 and 2009 and a 34% decline between 2005 and 2009.  One explanation may be that inexperienced surgeons have realized that resurfacing has a substantial learning curve, and along the way some have stopped doing the procedure rather than continue along the curve.  More than a year before I had my resurfacing I saw a surgeon who said that I would be a good candidate for resurfacing, but he had done only 7; when I checked back with him about a year later, he said that he no longer did resurfacings because some of his resurfacing patients weren't happy with the results.  I ultimately went to a surgeon who had performed hundreds of resurfacings.  Obviously, other potential resurfacing patients who saw the first surgeon I consulted would no longer be given the option of resurfacing.

[lori.36]

Sorry, but I think the end user should be able to determine a b.s. Post.  I really thought this site was for free thinking?  I am not trying to upset anyone.

[phillwad]

Like others I am sorry I missed a BS posting. 

Pat - I think this is a great site, I do find enough new information to make me come back regular; it is a moderated site so somethings might be posted that should not be here - this way I know that there are wiser people than I making sure I do not totally misled.  But if it was that "good" it would have been worth a read  :o

Cheers - Phill

[Lopsided]

I did read the post and reply to it. It was waste of space, and if not mindless, designed to upset. The responses, however, could have remained and been of interest. And as such, I am going to quote my response to it:

Do what?

D.

[Pat Walter]

I do allow people to post their revision stories and opinons against hip resurfacing.  If they get to posting the negative information over and over and in many different places, I remove it.  Everyone is entitled to an opnion if written in a courteous manner.

I knew from the Guru post that is was not from a patient.  Since then, he has written me and is an orthopedic surgeon that does not believe in resurfacing except in a few cases.  If he had identified himself properly, I might have allowed him to post information about why he does not like the procedure.  This site is my personal website about hip resurfacing.  I pay for the hosting and do the work - so I have control over the content if it is not based on medical fact.  Too many surgeons are bad mouthing resurfacing based on the one study in the UK of the 30 assistants that had bad results or from the less expeirnced surgeons that placed components incorrectly.  There is no secret hip resurfacing is a diffiuclt surgery and must be done by an expeirnced hip resurfacing surgeon for optimum outcomes.

I do have a website featuring total hip replacement at http://www.hipsforyou.com  I developed that site for people that don't want hip resurfacing, don't believe in hip resurfacing or required a revision from a resurfacing to a THR.  I have a place for people to post their opinons on that site too.  I am not against THRs, I just prefer the bone sparing hip resurfacing procedure.  I had my resurfacing in 2006 and am a true believer in the surgery.  My hip resurfacing is fantastic and even if I every need a revision, I would still suggest the surgery for  active people if they are candidates.

I prefer not to concentrate on the negatives of hip resurfacing.  The bad outcomes are mostly from surgeon error in placing components poorly, bad patient selection and a few patients that are actually allergic to the metal components.  All surgeries have a possibility of bad outcomes, but fortunately, most people have good results.  If you want a 100% guarantee that any surgery will be perfect - you would not have surgery performed on your body.  I had a 1-3% chance of dying with my aortic valve replacement last summer.  I still choose to continue to live and had the surgery to do so.  I went to one of the best heart surgeons in the country at the Cleveland Clinic.  I choose carefully and had a good outcome.  I did not want a surgeon just learning to do valve replacments to do my surgery! Cleveland Clinic itself has had 0 deaths from minimally invasive arotic valve replacement while other hospitals have a 1-3% chance of death with full chest cracking for open heart surgery.

So the lesson is to the learn what you want and how to choose a good surgeon.  Not to read tons of negative information that is not based on medical fact.  The meeting I am attending this Saturday in Phoenix is to learn more about the BHR surgeries and to answer the incorrect negative information that is being spread by the press and many surgeons not knowledgeable about hip resurfacing.

I do want both postive and negative, but it should be in proportion to the actual outcomes which currently is a 96% retention rate worldwide now.  So only 4% of the information on the site should be negative while 96% should be positive.  Many of the people with great outcomes are happy living their lives and don't post their stories at all.  So I just try to keep a balance for all the new people doing research.  

Pat

[Lopsided]

... currently is a 96% revision rate ...

Pat, 96% success rate.

[Pat Walter]

Thanks lopsided!   Yes - the overall RETENTION rate is 96% for BHR worldwide according according to the lastest statistics.  http://www.surfacehippy.info/bhrhistory.php

Please note again that I do allow people to post that don't think hip resurfacing is a good option, have had revisions and have had problems.  There have been people saying they just don't like hip resurfacing and the reason.  When a doctor makes posts and refuses to publically claim his profession and then bad mouths resurfacing, then I don't feel it is a fair post.  This is not a site to convience people that hip resurfacing is a bad option.  This is a website designed to help people learn about the positive outcomes of hip resurfacing.  Again, there are problems and they are listed on this site along with revision stories.  Other than that, this is a place for Surface Hippies to share their stories with others and give and receive support.  I paid to develop and run the site for over 3 years without a penny of income.  I gave 3 years of full time work out of my life to develop the site and I feel I have the control to determine the goal of the website.

The Goal is to inform people that hip resurfacing is a great option for a bad hip if they are a good candidate.  If someone believes otherwise, then they should start a website to educate people about the problems of hip resurfacing. Those problems, however, are small compared to the positive outcomes around the world.

Pat 

[moe]

Pat, Confused why you would not let people post negative items about hip resurfacing on this talk group?  This is your website, but as a follower, I am intrested in all angels of thought with hip resurfacing.  Just my 2 cents.

Lori, a friends co-worker had a THR 2 years ago at a very well respected hospital in Boston. I did some research on the surgeon, his website was loaded with negative info on resurfacing, was totally against it. Anyone going to him would never have a resurf, I can't remember his name but I wouldn't reveal it anyway. My point is, the negative info is out there, you just have to look for it.

moe

[Jeremy76761]

Hello All,

First of all, I wante to thank Pat for starting this site and bringing together all these people. What an incredable contribution. I believe it was this site and the MHR site which made me aware of the possibility of this optoin. Perhaps I could share a bit of my story and ask a couple questions? We are all so lucky to have this hip resurfacing option which can add decades to our sporting lives.

I was formally diagnosed with OA April 14th 2011 as X-Ray showed all but a couple of mm of my lower left hip joint space gone. I'm 36 years old and like many people on this site have been extremely active in sports all my life -- weightlifting in my teens; martial arts in my 20s; and running in my 30s. I was being trained by a world class Kenyan marathoner in 2007 when achiles strain put me out, followed by adductus magnus tear, then quad tear from a chiropractor treating the adductus with Graston. The OA seems to have been found indvertantly. Guess God had plans for me other than a running career.

Just in May and April, while being off even yoga and the exercise bike because of the quad tears, the OA symptoms have emerged. Mainly this Pain in the Butt all the time -- even when walking!  Man, do I hope that rehabing the quad, physical therapy, and sports take away the pain. Not sure how that could be.
I suppose there is a small chance that the hip resurfacing will never be necessary. However, I have a few question I will have space for only on the next post.......

[Jeremy76761]

My questions are as follows,

1. What developments can be expected in HR devices over the next 5-10 years? Pat, with your contact with the doctors and the field, can you inform us of some of the key areas of research?

2. Does anyone have information about THR and what improvements are being made in those devices? One wounders if it will become possible to safely run with even THRs by the time folks with current HRs need a replacement?

By the way, I am later this week speaking to a scientist who is on the front lines of stem cell research for OA in Toronto. If anyone wants to know, I'll post what she tells me, saving her identity of course. Unfortunately, by e-mail thus far she said "there is still a long way to go before stem cells will be used clinically."

On the other hand, is it too optimistic to believe that even for those of you even with HRs and THRs  regenerative therapies will have applications for you, too, within your lifetimes?

[hipnhop]

Jeremy, My surgeon is a big advocate for MOM THR.  I've heard Pat say that their are a few runners who had MOM THR and continue in their sport. I had a HR because I know I will wear it out over the next ten years and I didn't want to risk a full THR revision in my 60s.

I dont know the data on each in terms of effectiveness. It would be great to see that data.

[Pat Walter]

Jeremy

I always ask what is on the horizon for resurfacing, but new devices and changes move very slowly.  I will ask this weekend when I get a chance.

I am always interested in new research. Would be happy to learn more about stem cell research.

Generally the companies are developing ceramic on ceramic resurfacing devices.  Most THR devices are being developed with shorter stems.  Since metal of metal is causing problems, the goal is to coat or change the material in the devices.  Very general - but what is happening now.

Pat

[Jeremy76761]

Hipnhop, are you running with your HR? If so, what does it feel like? Are there any limitations?

I get that you have decided to continue with your sporting life despite that the HR will wear out sooner. These are years of your life that are very valuable. The only thing is, it seems to me, that given the THR last only 10-15 years, you will have to have revisions in your old age no matter what. . . but...based on the little I've read, that won't be such as bad thing...The procedures is becoming simplified, the recovery times shorter, and the devices better (at least slowly, as Pat said).

Pat, I didn't know there were issues with the MOM THR. But, I'm sure the data on longevity will be very clear in the years to come of the various newer devices. There are also these biological devices used for knees now, like at the Stone Clinic. Hips will be more complicated but eventually candidates as well.

[23109VC]

i can see the benefit of ceramic if metal is causing problems.

it would really suck to know that my new hip was bad becasue it was made of metal instead of ceramic.

my local doctor told me he does mostly ceramic on ployetheline total hips... and avoids metal becasue of the potential for problems...  but when i point blank asked him if i shoudl wait to see if HR gets ceramic or some other substance, he said no.. he said it is uncommon to have problems from metal... but the industry is moving away from it because of the potential for the problem.. while it's rare, why use metal if there is another substance tha thas zero problems.

lets all hope we don't have metal problems...  and hope for the next generation of hip resurfacing patients that there is some other substance that is even better.  i opted to fix my hip... waiting was no longer an option.  I felt lucky that hte uncemented appproach was available for me...  if i had done this 5 eyars ago I wouldn't have had that option.

if we had had this problem 30 years ago... we'd be getting our hips fused...and we wouldnt' have the HR or THR optiosn that are available today.

at least we have options.  i hope there are even better options in the future....

[Lopsided]

... continue with your sporting life despite that the HR will wear out sooner ...

Why should the device wear out sooner? From what we gather, a good device implanted correctly could have the potential to last for life. With correct placement, the metal should never wear out in a lifetime. Doing moderate sport might improve bone density and so extend the functional life of a device.

i can see the benefit of ceramic if metal is causing problems ... my local doctor told me he does mostly ceramic on ployetheline total hips... and avoids metal because of the potential for problems ... why use metal if there is another substance that has zero problems ...

Metal is not causing problems. It is only a small minority that have problems because of allergy or bad placement. Small ball hips do not avoid problems of metal, they have their own problems. No substance has zero problems.

There are no guarantees. I hope my resurfacing lasts me for life, and am so happy with it, I would like to get the other hip done, even though it does not need it yet.

[Jeremy76761]

lopsided,

You would know more about longevity of the devices than me...but hipnhop seems to expect ten years with his lifestyle...surgeon I talked to was non-commital...the BMHP website indicates that 5 years at least is virtually certain . . . .how do we know they're intended to last for life? Would be great....I'm just not sure we're there yet...Maybe up to 30 years?

One other question: does anyone know if it is possible to actually sprint 100% with the HR? If so, what are the limitations imposed by the device?

[sroberts]

No limitations on sprinting, running very fast 200 repeats, 400's, 800's or miles. Or for that matter, heavy squats, heavy deadlifts , box jumps, box jumps with a weighted vest, walking lunges with a 45lb bar overhead....you name it, it can be done all you need is a skilled surgeon.


best,

spencer

[Jeremy76761]

AWSOME!!!!!!!

Spencer, you know how to talk my language!