Question

[mackzoore]

While looking into various options for my hip, THR or HR.  I spoke with Dr. Yun in LA and he said that the congenital defect that causes my OA is in part due to the thickness of my femoral neck.  He said that I would be a horrible candidate for a HR.  He said that my neck thickness would cause me to have the same impingement that I currently have.  He also said that any HR specialist that I see would tell me the same thing. Anyone ever hear of something like this?
That being said, I had an appointment with Dr. Schmalzried the following day and he looked at the same X-rays and said that I would be a perfect candidate for a HR.  He said that the femur neck thickness would not be an issue. 
I am very active and in my 30's and would like to do the HR, but am now a bit nervous.  Dr.  Yun is a very well regarded ortho in the LA area.
I set up another appointment with Dr. Don Sanders in South LA for the end of the month in the hopes of getting some more insight on this.  Anyone else have experience with this?

[Dannywayoflife]

Is your doc referring to the condition known as FAI? if so run as he is talking rubbish. I had both cam and pincer FAI and I got a BHR with no worries.

[DirkV]

Also I think Schmalzreid has a bit of a reputation as a discriminating HR surgeon (i.e., only works on good cases). So if he says you are a good candidate, that means a bit more coming from him.
Keep lookin up,
-Dirk

[morph]

Maybe he he is referring to the head/neck ratio being too low. The resurfacing should approximiately maintain the current ratio if it is placed correctly. ROM before, in a good hip, is normally indicitive of ROM afterwards. The neck determines the ball size you get, unless there is some other issue maybe with the acetebular/dysplasia. That is something I was a bit concerned about but now I am not. I would be interested to know what he means by the neck being a cause for dysplasia. My first visit to an orthopeadic over 10yrs ago said I had possible congenital dysplasia, but all subsequent surgeons said it was not an issue and it has not been.

If the ratio is too low (considered approx. less than 1.2 by many) some of the experienced surgeons can shave some bone off the neck to improve this ratio. Also component position is critical to maintain maximum ROM, the front of the cup must be positioned below the bone so that any impingement in flexion is bone on bone and not bone on metal. This can occur in a natural hip which then causes the hip to flex up too and is normal. All the literature I have researched and read on the subject does not suggest it is a problem but of course every case is different.

I think it is a good idea to get some more opinions from good surgeons. You can email xrays to some top surgeons listed on this site. ( Bose, De Smet etc).

This maybe a usefull read:

http://www.hipresurfacingsite.com/Ask-the-Doctors/20090120357/Ask-the-Doctors/ROM-better-with-THR-or-Resurfacing-/menu-id-44.html

[Tin Soldier]

I've never heard of a femoral neck being too large or it being a congenital issue that would cause HR to be out of the question.  I'm not a rugeon either thouhg.  If it is FAI, that's how about 50% of us got here.  It's the early to mid stage of regular old human hip OA. 

I'd stick with Schmalzirad and like others said, get an opinion from one of the other well known HR surgeons, like Gross, Bose, De Smet, Pritchett, McMinn,...

You might ask Yun how many HR's he's done.  He might be really good at THR, but maybe he doesn't have that much experience with HRs.