importance of procedure order in BHR

[Deb]

I was watching a BHR video with Dr. Riyaz H. Jinnah, MD at Wake Forest University Baptist Medical Center in Winston-Salem, NC, USA.  He seems to be doing the procedure differently than Dr. Cook and Dr. Bose...  perhaps these questions should be posed to a surgeon...  I found this video on an advertising site on surface hippy - www.righthealth.com

It appears that he shapes the femural head first and during this he was mentioning that he was considering a size? 38 or 42.  Then he dislocated the hip.  Once he shaped the cup area he mentioned he was going to use a size 48 instead.  Is it okay or common to do the head first and then the socket?  He also mentioned that most of his patients have a regional anesthesia vs. general because then his patients are not asleep or sedated but merely numb in their lower part and says this reduces the chances of blood clots or 'hang overs'.  He also mentions that many doctors are choosing to not drain the fluids before closing.  I can't say that I know much about BHR but all this seems very different to me than other videos I have watched and I feel more comfort with the video procedure of Drs. Cook and Bose.  Discussion that doctors are still in the learning curve around 20 procedures and comfortable after 40??, after 10 - 12 should be good...  Also mentions that he feels it is not safe to do both hips at the same time...more likely to have a neck fracture.  Are all these differences okay or are some doctors getting too comfortable with the procedure???  I don't ask these questions to be offensive to any of the doctors, just noticed such a difference and wonder why?
Thank you!
~Deb

[Pat Walter]

Hi Deb

I definitely can't answer your question.  I guess each doctor just has their own way of performing the surgery.  I have never watched any of the surgery videos all the way thru -  I am not a good blood and guts person.


I will say if you want answers - it is best to ask the really experienced hip resurfacing surgeons.  Dr. De Smet does bi-lats at the same time quite often.  It does not increase the possibliity of a neck fracture.

Each doctor is different. The US doctors are much more conservative than the experienced overseas doctors.  They just don't have the number of resurfacings to judge from.  How many have done 3000 hip resurfacings like Dr. De Smet or 4000 like McMinn and Treacy? 

Other people have noticed that Jinnahs technique was quite different than some of the other surgeons.  I don't know what to say.  I personally just didn't take any chance and choose experience - I don't think I could judge any surgeon from a video since I haven't learned to perform the surgery.

If you are a great sportsman or muscian - you see or hear much more in a performance than the normal person.  Unless that is your passion and expereince - you don't have a clue about what is happening. It is all very subtle.

So I depend on expereince. Dr. De Smet uses a general becasuse he wants the body as relaxed as possible.  He also feels the less time you are under - the quicker you will recover.  He does his single surgeries in about 45  minutes. 

If you talk with the experienced surgeons like De Smet he will assure you it takes at least 100 surgeries if not more for the doctor to become experienced.  The learning curve is real. 

Pat