BMHR vs THR

[horse doc]

I had a consult with a BHR resurf doc from the list of docs here.  I'm not a HR candidate so we were talking about THR and I stated that I saw my options as either THR in the US or BMHR in England.  He replied that he considered BMHR  the same as a THR.  Mildly surprised, I asked if it was worth trying to conserve the top of my femur for future revisions.  He replied probably not because the large majority of revisions are required due to problems with the cup rather than the femoral component. 

If that is correct, what advantages remain on the side of BMHR vs MoM THR?  I have read that it might spare the joint capsule and its associated proprioceptive functions.

In the couple of months I have spent researching HR, I have learned to think that any type of femur conservation was one of the top reasons to pursue HR and that BMHR was the next step down in the preferred heirarchy.   

[Dannywayoflife]

Personally I would go for the bmhr. I don't see how being conservative in anyway is a bad thing. Did he say why your not a candidate for a bhr?
Also as far as I'm aware the bmhr doesn't have most of the negatives of a thr like stress shielding etc. If comming to the UK to see Derrick Mcminn or my surgeon Ronan Treacy is an option then I'd go with that. They are both highly skilled and experienced between them they have done 10000+ HR's.
I thought that generally it was the femoral side that required revision in a THR usually due to the stress shielding. Could your docs comments be related to polyethylene THR's where the acetabular side would obviously wear as opposed to the femoral side that is either metal or ceramic.

[Pat Walter]

Hi

One suggestion I have is that many people get 2 or 3 opinions before accepting that they can't have hip resurfacing.  Even among the surgeons that have done thousands, they don't always agree.  I know people that could not get any US surgeons to do a resurfacing and went overseas to get their BHR.  They had good success.  So you want several inputs if you want a resurfacing. Dr. Gross of SC, Dr. Bose of India, Dr. De Smet of Belgium, Dr. Rogerson on WI are a few who will give you a free email consultation if you send them an email with a copy of your x-rays attached in a jpg format.  Make sure you are or are not a candidate first.

The BMHR is not really a THR since a great deal of the femur bone is saved.  If you listen to McMinns presentation you will understand more.  http://www.surfacehippy.info/bmhr.php  I would much prefer a BMHR to a THR.  Unfortunately, if you want a BMHR, you will need to go to McMinn or surgeons in the UK or Dr. Bose of India.  Smith & Nephew decided not to run trials in the US.

It is important to keep as much of the femur bone as possible to allow the bone to regenerate and stay healthy.  The large amount removed in a THR means the long stake of the THR is pounded into the femur bone and keeps it from working normally as in a resurfacing.  Dr. Brooks explains it well in my interview with him  http://www.surfacehippy.info/bmhr.php  In the number 13 interview from Baltimore, he takes a great deal of time to explain the difference between a THR and resurfacing.

Remember, it is your bone you are trying to conserve - not the surgeons.  That was not the answer that the top experienced hip resurfacing surgeons would give you.  Sounds like your surgeon prefers to do THRs than resurfacings.  Many of the less experienced hip resurfacing surgeons will often opt for a THR instead of a resurfacing.

Pat

[Dannywayoflife]

Well put Pat. I for one got opinions from Bose, De smet, Gross and Treacy. Luckily for me they all said the same thing.
Horse doc as Pat has said get several opinions the Docs she mentioned will do a consultation via email for free.
If you really are not a candidate for a bhr then as Pat again said it's your bone stock and personally I'd want to conserve it as much as possible.
Oh I'm pretty sure I've read that vijay Bose does bmhr also.
Danny

[Nemesis]

Find a new doctor. Dont look back. Don't even waste your time with a phone call other than to be courteous to cancel an appointment.  Your doctor doesn't have the same base of knowledge the top surgeons have.

[Woodstock Hippy]

Horse Doc,  I'd say it's time to get a second and a third opinion.  I found my first hip surgeon on the Hospital for Special Surgery websight.  He is also listed here and when I first saw him for the pain in my right groin almost three years ago, he said that I had arthritis in my hip and that I'd be a good candidate for Hip Resurfacing when the pain got bad enough, he gave me a cortisone shot and told me to stop running. After a few more shots, the last one in both sides, I asked him about HR.  He said that I should have a total hip replacement and learn to relax.  The next day I made an appointment with Dr Su at HSS and with Dr Scott Marwin at NYU Hospital for Joint Disease.  Dr Marwin told me that the doctors turned away from HR didn't take enough time to properly learn the procedure and didn't have success.  I really liked Dr Marwin and made my appointment that week for same day bilaterals at ''the Joint''.  Everything about it has been positive. I'm now at 13 weeks; walking, swimming, biking and going to the gym.  The doctor says I can start to run again on May 7.

You need to find another doctor to take care of you.

[horse doc]

Thanks for all the helpful suggestions, folks!  Your personal experiences and thoughtful advice are very supportive.  I'll flesh out my current situation in another post :D

In scanning the UK joint registry i found this table regarding which component gets replaced in revisions.  Cup gets revised in 49+26=75% of revisions, femoral side 49+16=65%

"Table 2.11 Components removed during hip revision procedures in 2010.
Hip single stage
revision
Hip stage one of a
two stage revision
Hip excision
arthroplasty
Total
No. % No. % No. % No. %
Total 6,717 486 60 7,263
Both cup and stem 3,121 46% 389 80% 44 73% 3,554 49%
Acetabular cup only 1,861 28% 23 5% 1 2% 1,885 26%
Femoral stem only 1,145 17% 32 7% 8 13% 1,185 16%
Neither cup nor stem 590 9% 42 9% 7 12% 639 9%"

So in 65% of all cases of revision, it would be a good thing to have as much of your femur available as possible.?.?

Has anyone seen the data broken down to specific component failure causes?

[hernanu]

Hi horse doc, I don't think it's component failure per se. The component is not failing, rather

• There is a neck break
• There is loosening or lysis of the cup or femoral component
• There is malpositioning of the components, usually the cup - metallosis
• Infection

The vast majority of the revisions come from (1) and (2), it seems. So recuperation management would seem to help address 1 and 2. Perhaps the design of the device, if it is widely different from the more conservative designs also contributes to it. The skill of the surgeon is effective on (3) and good care afterwards helps with (4).

As you know, there are no guarantees, but the percentages of successful outcomes are overwhelming. Over 90% success on any medical procedure is outstanding.

I chose the HR because it would distribute the stress of walking, etc. better in my engineer's mind than a post that is at angles to the applied force. It made sense that this would be a stronger way to mould the body to go on. I would have no problem getting a THR eventually, with the understanding that I would need to moderate the things that I do, and, given an alternative that doesn't force that in resurfacing, I went with the less constraining.

[Dannywayoflife]

As far as I can see both the BHR&BMHR were both designed to address some of the major issues associated with THR's namely being the stress shielding. And the amputation of precious bone stock. I believe that the loosening of THR's is largely down to the way they shield the bone from forces which normally act on it. The BMHR doesn't have the data yet of the BHR however from what I've seen the data available is very promising.

[hipnhop]

BHR will allow you to place more load on your bone thus strengthening it.  One benefit of impact sports is that it also strengthens bone.  Without it, you could be at-risk of weakened bone and the diseases that come with it.