2011 Australian Registry p.87 Aussie Hip Resurfacing continues to decline

[Luanna]

Hi Barbara,
So good to see you posting! I've been thinking about you and hoping that your revisions have gone/are going well. I recall the struggles you've experienced and know that you are in the process of finding solutions. I'd love to hear from you - PM or email and/or to get together for coffee and a conversation.

Yes, it's true. Dr. Pritchett has opinions that he is willing to voice that are not popular. But several of his colleagues are also showing interest in pursuing alternative options for small boned women. He will do BHR MoM for women with femoral implant size 46mm and above. There was one in the room next door to me in the hospital. I was a bit envious of her actually.

I'm only a few miles away. I'd love to visit if you have the time and inclination.
Luanna

[Boomer]

Barbara,

The orthopedic surgery community is keenly aware of the problems, and revisions occurring with hip resurfacing. That's why it's such an important topic at the upcoming meeting. I believe surgeons are doing a better job these days of discussing the risks involved. My surgeon, Dr. Rector, spent considerable time with me twice outlining the risks associated with hip resurfacing, and gave me the opportunity to choose more traditional hip replacement. He was very willing to discuss the metal on metal issues. A number of women posting on this site have been told by Dr. Rector that he advised against resurfacing because he believed they were too small to be an ideal candidate. In most cases, each of these women has found another surgeon to do their resurfacing. Only time will tell who was correct is their assessment.

There is health debate going on about resurfacing. Your input is surely welcome.

My first hip was resurfaced only five weeks ago. I am a long way from being able to claim that surgery to be a success. I'll keep posting regardles of the outcome.

Boomer

[curt]

    I will flog the dead horse some more.  First, I agree with Boomer about outcomes now,versus outcomes in the future.  I was not in a position to wait, but almost suredly profitted from the mistakes and ignorance of past HRs.  Mine may or may not last, but if it fails, maybe the next patient will be better off.  A decade ago, cup angles were less understood, now 50 degrees is talked about as a goal maximum.  My doctors had performed over a thousand HRs by the time I got there.  The device is hopefully improved and certainly, his skills and experience have improved. 
       The science of HRs is young and as it matures, with and without failures, it can only get better or it will go a different path.  We on this site, just by being patients are probably furthering the field with our successes and sadly, also with our failures.  Future hippies will be the beneficiaries.

Curt

[Two4One]

Hi Barbara,

Thank you for posting.  I am very sorry that your resurfacing failed.  I've had two failed arthroscopies circa 2009, and I think what you are going through stinks.  That crappy surgeon didn't catch on that I had undiagnosed bone on bone end stage bilateral OA, and "repaired" my torn labrums. 

My OA's location was the deepest center middle of the hip sockets and the top center of my femurs, almost a protrusio acetabuli because I was born with my femurs too deep back in the socket.  Every film and every scan showed normal healthy cartilage and perfect joints, right up until I was on the table for bilateral resurfacing where Dr. Schmitt said he saw the femor tops were sheared off flat like a mesa or an upside down "L".

You are absolutely correct that the data is not exactly super promising for small boned women, especially the ion situation.  I knew about the resurfacing risks for women, but I sought and found a reputable experienced resurfacing surgeon who would give it to me straight.  I had and have no illusions. 

I asked my surgeon, Dr. Schmitt, about the size of my bones and components, and he said my implant size was "man sized".  M Left Hip's angle is 32 degrees, and my Right Hip is 30 degrees.  My ball diameter in both hips is 44mm and my acetabular cups are 50mm.  What does everyone think of my stats?  Are they promising? Or am I considered to be at risk because my hardware is too small and I'm a woman?

My resurfacing may not go on successfully for a decade, it could fail sooner than that, or it could last for years and years, but I knew for certain I would burn through a bilateral THR quickly because of being active on a daily basis.  From what I understand, revising a THR is a tough gig.  With my eyes wide open and offered THR or BHR by my surgeon, I made the best informed choice for me.  My hipster friend on the coast is choosing bilateral THR, one hip now and one hip later; she feels a conservative procedure with a longer track record is best for her.

I truly hope you find an end to your multiple surgeries and find a solution to your pain.  Please keep posting and tell us your journey.  Thank you again for posting.

'One

[hernanu]

Hi Barbara, I am sorry for what you've gone through, and I know we don't minimize the issues with HRs. The problems are there and they are not small issues. I do contemplate that I may also run into problems, I may become one of the people who run into issues with the HR. I expect that if I do, the people here will back me up and I will go to a THR.

There are no guarantees here, and if there is a larger underlying issue, then let's tackle it here. In reading the Australian registry, I see that there is a better outcome than is being touted in the press. I have full respect for you and your struggles, knowing also that it is a possibility for me.  In the end, though, I have to say that I would still make the choice for an HR for myself, knowing the odds and being cognizant of future problems. Please keep in touch, we are not just looking for positive outcomes, but are just reporting on our own experiences.

[ScubaDuck]

@Barbara - I am definitely sorry for what you have had to go through.  It is easy to cite statistics and lose the real stories behind the failures.

What I react to is inflammatory wording and broad terms.  For example you used "a lot of failures."  What that represents to someone is generally more than single digit percentages.  Even the usage of "growing number" can indicate a worsening problem when it may be in the same or lower proportion to all procedures.  These are the kinds of terms that the NY Times reporter uses to create sensational stories to sell papers.

I support the honest look at the numbers and outcomes, even procedures that did not have favorable outcomes.  I researched this thoroughly before my procedure and appreciated all the stories.  In fact, once I decided that HR was a likely procedure I sought negative stories to ferret out any hidden issues.  In the end, I decided that the risks were worth it.

The bottomline is that this community seems to support everyone looking for support or information.  And we certainly are here to support you as well.

Best wishes.

Dan

[Dan L]

Barbara;

Also very sorry to hear of your issues with the surgeries, I sincerely hope you get some resolution soon.  It has to be very, very difficult to go through that many surgeries.

My impression is that people here are positive because most (96%) people who have had this surgery have reported as positive outcomes.  That is a very high number relative to other surgeries, for example if you compare it to back surgery (something I've also been through many years ago) where various figures suggest the success rate is something between 80% and 40% (depending on where you look for information), where the prevalence of poor outcomes is much, much higher.  My take is the upbeat mood here reflects the outcomes most have had. 

Sadly, this does not help folks including you who have had a bad outcomes, and I can empathize with your feelings reading about others who have not had those kind of incredible diffculties seeming overly positive, but I do think it is because most have had the tremendous weight of debilitating, chronic pain lifted from their shoulders, and are understandably happy about that.  I'm one of those.

This site also contains more than a few horror stories, each with a learning opportunity for anyone considering this surgery, and many of which I read before accepting the risks of going forward. 

I do truly hope you get better,

Dan

[Dannywayoflife]

Barb,
       im really really sorry to hear of your problems with your hip resurfacing. However i know that you must feel agreeved that your HR had to be revised but still in the vast majority of cases certainly the BHR has the best record of and replacement hip device be it THR or HR.
I know that female patients outcomes with HR are not as good as they are in young males such as my self but i have a suspission that the main reason for this is dysplasia. From watching interviews with Derrick Mcminn and talking to my surgeon Mr Treacy its only in the last few years that the technique is being perfected for ladies with dysplasia (which is far more co,mmon in women than men) as they now understand that the comopnents have to be placed at different angles not the standard 40 degrees inclination 15 degrees aneversion as is normal in most other cases. So its perfectly consevable that a lady with dysplasia could recieve a BHR with perfect positioning in a normal sense and it still not work properly and need revision due the the morphology of the femur and acetabulem in people with dysplasia.
I have read in several places that surgeons mainly in the USA have only realised the importance of the inclination angles and anteversion in the last few years. Now to me thats a cop out as the BHR was designed from the start to be placed with 40 degrees inclination and 15-20 degrees anteversion. Having spoken to Mr Treacy about the placement of the cup he proudly informed me that in his total series of around 7000+ he has never had a revision due to a mis positioned acetabular cup. I belive that this is not just due to his skill as a surgeon but because he was involved in the design of the BHR and understands the importance of placement. Now when smith and nephew bought mid med tec and rolled the bhr on to the market they made all surgeons who wanted to use the BHR train with one of 3 surgeons Mr Mcminn and Mr Treacy were 2 of them, i cannot belive that they would leave out the fact that the device was designed to be implanted in a certain orriantation!
From speaking to several surgeons on the subject i belive that 90+% of the outcome is down to the surgeons skill after all there are a good number of ASR implants out there performing well even though its a poorly designed device.
Sorry for the rant
Danny

[Tim Cunningham]

One of the data points involving revisions, which may be important to keep in mind, is the human element and behavioral differences in the management of the implant by those who recieve it, particularly in light of the different protocols every surgeon seems to use to restrict activity following the surgery.

Along with poor placement, surgeons who are inexperienced, and failures of certain devices (for any number of reasons) some unknown (and potentially unknowable) percentage of failures are certainly attributable to the actions of the persons who get the implant, via not following restrictions, their surgeon providing different restrictions that may increase the risks, weight gains, unforseeable accidents, high impact sports, etc, etc.  The very active population who get this done, are, well, very active and will remain that way when/if they can, which is completely understandable and expected, but that personality type does raise the risk of failure, just by virtue of who they are, and how they choose to live their lives, and doing what is very important to them.  Very active persuits like many here undertake, love and live for are going to cause failures for some people, at some point.

Conversely those who are much less active are not really condidates for this procedure, therefore impacting the statistics in the other direction for retention by individuals who do not put the implant to the test in very active persuits, and therefore would seemingly have a lower risk of activity-induced failures.  Many who get THR are in that population group, it would seem.

That is not a statement "blaming the victim" on any level, just an acknowledgement of the high level drive to be incredibly active many who get this done have, that adds to the overall stats on performance and revisions, based simply on the target population characteristics.

Hi Dan
Sorry if I am being redundant here
Would you be interested in sharing email addresses since have the same surgeon?
Tim Cunningham

[Dannywayoflife]

Hay Tim check your PM'S mate
Danny

[Dan L]

Tim;

Just shot you a message through this site with my contact info, very happy to help in any way I can.

Thanks

Dan

[Kiwi]

Tim,
If you want to contact someone personally, click on their name, then click "Send personal message".
Cherz
Kiwi

[Barbara]

Thanks everyone. I know the percentage of people that have had failures of their hip resurfacing is low but when you are one of those people, numbers really don't matter.

I was lucky to find this site before my first hip resurfacing and found it very informative and supportive. However since all my problems, that were ongoing,  I found myself coming on less and less and I've missed the support. I can't join in conversations because my experience has not been good and I don't want to frighten people who are about to have surgery. I have had to bite my tongue often because I have felt that people have at times dismissed the problems that are going on. Maybe it's my issue, I've found it difficult at work too. I am an RN/case manager and occasionally work in the Swedish Orthopedic Institute where I have had all my surgeries. I have had to assist patients with their discharge plans after hip resurfacing and I have had to keep very quiet. I am hardly the poster child for hip resurfacing  ;D

Before my first surgery my PCP told me that I was the Orthopods dream as I was young and had no other health issues. Ha, little did we know! Here I am 3 years later and once again in recovery mode.

I have, of course, been reading and researching all the data and information on failures and I am sure I interpret what I read differently from people whose implants have not failed.  I have made connections with other people who have had failures of their resurfacing. There are some horror stories out there and I consider myself quite lucky compared to some others. I have had Failures of my S&N BHRs and have had the exact symptoms as people with the recalled Depuy ASR implants. I have been in contact with Barry Meier, the NYT journalist and am grateful to him for the articles he is publishing. I now see a light at the end of the tunnel for the first time in 3 years but I also want some answers.

I have looked at the site for people with Total hip replacements but there is never a lot of activity on there. I will still hover around on here. I like to read peoples stories and hear about their successes and I wish everyone luck. I am hoping that I'll be hiking in the Spring and snowshoeing and skiing next season.

Luanna, I'd love to meet up with you, once I'm fully mobile again. I'm still walking with a cane but hope to get rid of it soon forever.

[Luanna]

Hi Barbara,
Sounds good to me. My schedule is flexible....very flexible. Just let me know what works for you and I'll head your direction.

Luanna