Op booked, Surgeon gave a THR warning!RHBHR booked for Jan 15.

[MPH]

Hi, although not a total newbie to the forum this is my first post. I'm a 47 yr old very active male with 3 kids. I cycle, swim, run(used to), waterski, wakeboard etc etc and keep fitter than most 25 yr olds I know 😏 . I live Down Under and recently flew interstate to see one of Melbourne's best HR surgeons who is named on the lists here. He's a researcher too and when I saw him he gave me the " if the head isn't big enough, and it looks like you're right on the cusp,  I may have to do a THR'. This is all down to the increase in revision rates for <50mm femoral components. I'm devastated because of my age, activity desires with a young family etc etc  I thought I'd tick all the boxes. I've now read all the HR research journal articles I can find (some written by my surgeon) and am worried I'm not going to get the resurface. I have a really active job and need to stay as active as possible. I've measured X-ray after X-ray hoping I'll fit the HR profile and think I do but hey, I ain't no surgeon! I really don't want a THR with worries of dislocation, employment worries etc etc. The surgeon is awesome, he knows his stuff that's for sure and I know I trust and respect him. I just wondered if this is a standard line they have to give or am I clutching at straws? I'm weighing up whether to live with acute pain for longer just to be able to do things with the kids. 🙏

[einreb]

Did he tell you what the 'backup' thr device would be?

I actually cancelled surgery with a doctor (Rogerson in Madison, WI) because I found out he had quoted a 20% chance of needing to go with a THR. 

I ended up going with a surgeon (Gross) with more experience with my condition (Perthes) that was able to more fully commit to the resurfacing.

Nothing is guaranteed though...

-B

[Evan Thoms]

50, huh? When I met with Pritchett before my recent HR, he said he would probably install a 48 and that only if he thought he might have to install a 46 would he suggest I consider alternatives. Being so close to that, I was a bit worried, but then my brother, who's a hero member on this forum (Tin Soldier), said that there were lots of posters with 48's that were fine which did ease my mind a bit. Although, as it turned out once he opened me up, he did install a 50.

[MPH]

Hi EvanT, hopefully treading the path you've recently done in Jan. That's encouraging that you had a bigger fem component than envisaged. I've got my pre-op tests and appointment with my surgeon, Andrew Shimmin in Melbourne, Aus in Nov. He's done over 1000 BHRs so hopefully should be able to tell from my images what he's likely to do I hope. It's his research paper that is listed on this site about increased revision rates the smaller the component. I really don't want a THR at my age with my activity levels. Keep us updated how the recovery is going. Good luck with it all.

[toby]

Hi there just thought I'd let you know that I'm a 5 foot 7 male with a fantastic 48/54 Finsbury Adept Hip Resurfacing. I think it could be the device that Mr Shimmin now uses. You are certainly with an excellent surgeon with whom to trust.
Best Wishes
Toby
L Adept Prof Cobb UK

[lgbran]

Hi MPh,
Greeting from another Australian. It's been 10 months since my surgery. I saw Stephen Mcmahon who is a few doors down from Andrew.Your in good hands and my surgeon was leaning towards a THR as opposed to a BHR but I wanted a Bhr. The avenue Hospital is the bees knees and I'm glad I made the trip up the coast to have this done. I Was really fit prior to my op and am in an active job as well. Regardless of what surgery you have the best thing is my osteo pain is gone. I'm a good 13kg heavier them what I was pre surgery but now as the weather warms up here in Australia and my restrictions are lifted. I've just made a 1 year post op appointment with the surgeon there will be no stopping me.Lucky we have access to some of the best surgeons performing this procedure.look forward to hearing of your progress. My hip just keeps getting better and better.
Good luck

[MPH]

Thanks for the positive responses. Really can't wait to get as fit if not fitter again. Still maintaining a base level but it is getting more difficult with the pain and stiffness.
I thought the Finsbury Adept had been recalled? Mr Shimmin is during the BHR, well that's all he spoke about.
Just need to find out his size parameters and hope mine fits!! The Avenues looks good, looking forward to the rest 😉

[Evan Thoms]

I couldn't pull up Shimmin's paper but I did find this 2009 overview by the American Association of Orthopedic Surgeons which, in part, reviews what I bet are the same data Shimmin looked at. Table 7 shows rates of revision for people in the Australian registry by component size. For the group with 44 mm components or smaller, the revision rate at 5 years was 9% vs 1.7% for the 55 mm or larger group.  Table 8 breaks it down more by sex.

The revision rates for the 50-54 mm group and 55 mm and larger group, while different (2.2 vs 1.7) were not considered significant - by the statistical definition.

So, yeah, I don't blame you for wanting a bigger device. I never knew the numbers before, so that's interesting.

Good luck! I hope you get the device you want.

[toby]

Adept recall? News to me-please point me towards where you read this
Thanks
Toby

[MPH]

Hi Toby

Here's the link. It's for anything below 48mm so you should be good.

[PDF]Urgent Field Safety Notice (FSN) Product Name: ADEPT® Hip ...
www.mhra.gov.uk/home/groups/fsn/documents/.../con364131.pdf
Attention: Surgeons who use the ADEPT® Hip Resurfacing System (Finsbury ... O 'Sullivan - Recall Coordinator, e-mail: aosulliv@its.jnj.com, Phone +353 21.

[toby]

Hi MPH,
Yeah, just to clarify the Finsbury Adept is still in use and the device has not been recalled. However the manufacturer has responded the the National Joint Registry Data showing higher revision rates for femoral heads lower than 48mm and decided to recall these so that surgeons are are only able to offer resurfacing with Adept for femoral heads above 48mm. This is in line with other comments we've read on your topic.
I did read the NJR report a short while ago and went through it again. Interesting pages around 138-150. BHR as know the most popular device-Adept second most used in UK.  Data shows overall  revision rates for BHR after 8 years 6.6% Adept 8.7% (ASR 29.6%)Obviously the smaller the head the higher the revision rate those with 54 + something like 2%.
Just want to add one other thing re a comment by Evan 'So, yeah, I don't blame you for wanting a bigger device' -it's not a choice it's about have a device which matches your natural femoral head.
Best Wishes
Toby

[MPH]

Thanks once again guys. You're right Toby, it's what's best for my fem head that counts. Fingers are crossed it's all big enough because I really want to fall off my waterski and wakeboard without worrying if my hip is going to pop out! 26th November is the pre op appointment, so trying not to think about it too much until then (he says lying through his teeth cos he's thinking about it all the time!!😊

[MPH]

Well, saw the main man today and RBHR is on the cards! Huge relief, it'll only be different if there's something bad when he opens me up. I can sit back, enjoy a 35 degree Xmas down here and look forward to becoming a hippy on 13th Jan. Can't wait to get it done, and this site has helped hugely. Thanks.

[toby]

MPH,
With the date now booked you can do lots on conditioning work to aid recovery and have a great xmas and look forward to a fantastic 2015.
BW
Toby

[toby]

Hi there,
Just to add to my previous post-
" just to clarify the Finsbury Adept is still in use and the device has not been recalled. However the manufacturer has responded the the National Joint Registry Data showing higher revision rates for femoral heads lower than 48mm and decided to recall these so that surgeons are are only able to offer resurfacing with Adept for femoral heads above 48mm.
I read on Keith Brewster's Hip Resurfacing Discussion group this week that Smith and Nephew have issued to BHR surgeons -Modification/Instructions For Use-recommending caution in using devices with femoral heads lower than 48mm due to higher revision rates in this subgroup.
Regards
Toby

[MPH]

Hi Toby, thankfully a 52mm head in my case! Thanks for the update.