Choosing a Surgeon

[Shotohips]

Hello All - I sure could use some advice regarding making this very difficult decision of selecting a surgeon!

Brief background: 35 y/o American, active male living in Chamonix, France who is trying to get back to high level activities in the mountains. In the last 1.5 years I have had very complicated bilateral hip arthroscopies and they didn't end up helping me out as expected. I'm hoping to get surgery this summer on my left side. Right side will probably be up coming in the near future as well.

[/size]To date, I have reached out to 5 surgeons, 4 of them which have gotten back to me and I am waiting for the last one. 4 are in the States and 1 in Belgium. Health insurance is part of my consideration, but not wholly; I do not want to make my decision giving that too much weight.

[/size]My questions are:

[/size]How did you select your surgeon from a distance without meeting them face-to-face? I'm finding remote consultation beneficial in my case, but also hard.
[/size]How can I narrow down my options? Perhaps there are some considerations that may not have crossed my mind. They all have excellent track records, so I suppose it would just be about finding the best person for my case.

[/size]I've created a spreadsheet trying to take in all the information and different factors, but it would be extremely helpful with your input.

[Quig]

I did a ridiculous amount of homework online for about 6 months prior to picking my surgeon. I literally read everything I could find that related to hip resurfacing and probably read much of it multiple times. I also watched Youtube videos of the surgeries and interviews with many of the prominent surgeons listed on this site. I know 2 high level athletes who went to Dr. Su and I consulted with them on their experiences. They had nothing but great things to say about Dr. Su and I did consult with his office.


I found that there are several very, very good options for this procedure in the US. After weighing them, I picked Dr. Gross. I picked him because of his experience and passion for the procedure and because every time I watched one of his interviews I just plain liked the guy. I enjoyed speaking with him on the phone prior to  booking my surgeries and his office staff is nothing short of amazing. I also liked the idea of having surgery in South Carolina vs New York City with Dr. Su. I'm not a fan of big cities.


In the end, I couldn't be happier with my decision. One piece of advice I'd offer is to consider going bilateral. If you're going to have to have both hips done why not suffer through ONE recovery? That was the advice given to me by a friend who had just had his done and I completely agree. The first week or two is no fun (but totally do-able!) and other than that it's not horrible at all. Tomorrow is my one year anniversary and I can't believe what a great year it has been. This has been truly life changing.


Best of luck with your decision.

[Shotohips]

Quiq - thank you so much. Just sent you a PM, hope you don't mind!


Regarding billateral, all the surgeons have said to wait on my right side. There needs to be more narrowing then I currently have. I am like you, I would rather knock both of them out and be done with this!


Quick question for everyone regarding Dr. Su and surgeons who primarily do BHRs. From what I understand my femoral cap size is on the smaller size, 48mm. If I go with a surgeon who does primarily BHRs, and they need a smaller size cap, I would then get a total hip? From what I have been told so far is that it is tough to measure your size just from x-rays. ??

[blinky]

Hmm, that might be a risk, but I think Dr Su also uses non BHR devices. Ask him directly. If there is any waffling in the answer, and you don't want THR, go elsewhere.


Back when I was deciding where to go, I was drawn to the doctors with the most transparency and the most published results. I wanted to read about their outcomes. The next level of consideration was the the soft factors: location, ease of transportation, stuff like that. I am originally a southerner. Going to SC was attractive to me. I wanted a slower pace and more individualized attention in a smaller hospital. (If my husband had been the patient, he would have chosen NYC. He would have loved the required stay in in a nearby hotel and called all his friends and had them come visit.)


I also liked Dr Gross' demeanor, his matter of factness, the fact that he didn't over promise. When I asked if I'd be able to run again, for example, he didn't say yes. Instead, he referred to the data and told me what % of patients returned to running. He carefully didn't promise me that I would. (I did!) The morning before the second surgery, he warned that I might need a transfusion. He said he didn't think I would, but made me aware of the possibility. I said "why wouldn't I want one if my red count went so low?" And Dr Gross gave me a quick and complete summary of the reasons to avoid a transfusion even with a low count. (I didn't need a transfusion.) I appreciated his combination of confidence and full disclosure.


Yes, it is weird to pick a doctor over the internet. My husband went with me to SC and I think he saw his role to protect me in case this situation was not what it was what it appeared to be and to be my advocate and protector. We both worried that Dr Gross sounded too good to be true. He vowed to stay in the hospital with me, for example. Well, once we got there and met Dr Gross and Lee and Nancy and the hospital staff...my husband ditched me and stayed in the hotel. He saw I was in good hands.


Best of luck to you. It sounds like you have some great choices and are picking based on the soft factors.

[Joe_CA]

Hi Shotohips.

Of all the factors involved in choosing your surgeon, for me the most important was selecting a surgeon who would provide the best outcome - that is, the most skilled surgeon. If you don't have limitations (insurance, travel, etc.) why not select the best surgeon you can? The general rule which is highlighted here is that the experience level and skill of the surgeon are the two most vital criteria. Selecting a doctor who has performed at least one thousand procedures is the advice which is suggested. Because the surgery is relatively complicated (compared to a total hip replacement), the surgeon is able to continue to learn and be more proficient after each surgery, and handle the tougher patients and issues that may prevent themselves.

This isn't to say that there aren't highly skilled surgeons who have only done several hundred procedures. But you're simply increasing your odds of having a positive outcome if you can select from the roughly 10-20 surgeons worldwide who have performed the most surgeries, and who have the best results. Like Quig and Blinky (we're all 3 recent bilateral patients!), I chose Dr. Gross because of his reputation and experience. He also publishes his results which show data with great results and very low rates of complications (for many years out).

Again, if you don't have restrictions on insurance or travel (and sometimes cost), I recommend choosing from the 10-20 of the best. I wouldn't have balked on the procedures if I could have gone with surgeons like Drs. Su, Pritchett, Rogerson, et al), or even some of the more experienced local guys, but it just put my mind at ease knowing that selecting Dr. Gross perhaps gave me that extra small percentage of obtaining a successful final results (I am doing great at 4 months).

The additional factors may be more important to others, for example, the demeanor and personality of the surgeon. However, even if found Dr. Gross to be an arrogant a$$hole (which I didn't), I probably would have still selected him. However, I must say that he is rather blunt and honest, which I didn't mind. I remember asking him in the OR post-surgery how the condition of my hip was before the procedure was done. He flatly said "Uh, I can't remember. I had three other patients that morning.". Lol!

So that is my two cents on the subject. Good luck on whatever your decide!


*Edited on 04/12/17**

Oh, I needed to add that another reason which was a contributing factor in my decision to go with Dr. Gross was due to the device which he uses (Biomet), the fixation method (cemented versus uncemented), and the associated published results. It appears Dr. Gross always felt that the best long-term outcomes come from using uncemented methods, by letting the bone grow into the cap. I believe he felt that using cement to fixate the cap on the head of the femur, while perhaps adding more stability in the initial months/years, had a greater chance of loosening in the subsequent years. His statistics seem to suggest that you get a little less failure rates (i.e. loosening of the femoral component) using the uncemented approach. This isn't suggesting there are major concerns of using the cemented method (as I believe Dr. Su does), since both approaches still have very high success rates. However, to me it's yet another small factor which I believed could slightly increase the odds for me.

-Joe

[Shotohips]

Hi All,


Thank so much for all the great input on this difficult decision. I'm glad to see I have a similar thought process to all of you,it is encouraging. I wasn't sure if I should share my conversations with the surgeons I have had, but thinking twice about it, why not?


I sent my x-rays and other data a month ago to 5 surgeons: Su, Pritchett, Gross, De Smet, and Brooks. Dr. Pritchett respond immediately and gave me his personal number to speak to. He was awesome and answered all of my questions and said I was on the right track and he would expect I will have an excellent outcome. Even with follow up questions, he responded immediately. He even joked and said I would be a record for him since I have 11 anchors in my left hip 


Brooks responded within weeks and answered all of the same questions and was consistent with Pritchett.


De Smet was amazingly quick with his emails and has said the same as the others.


Dr. Gross called me within the time frame they state on his website. He spent almost a 30 minutes talking to me and sounded extremely confident. Once again, stated I was a good candidate like the others did, but what really stood out was that he asked me if I wanted any recommendations for surgeons in Europe! He gave 4 names, all of which I had researched, and one of them was Dr. De Smet. He gave me an extremely strong recommendation for Dr. De Smet.


Dr. Su's office hasn't got back to me. I even sent an email after a month and they didn't respond to that either.


With all this said, they all seem fantastic. I have ruled Dr. Brooks out because of his surgical approach and post-op protocol; even though his stats are unbelievable. Dr. Pritchett sounds great, but his distance is putting me off a little and since I am on the cusp of a 48mm, I cant find any longterm data on the synovo preserve incase I need a smaller size, even though the synovo preserve sounds theoretically great. Dr. Gross sounds great and is in-network but the date of surgery wouldn't correspond with my partner who would be my caretaker. I am trying to get surgery in June or in July the latest, and I think Dr Gross is further out then that. Dr. Su has always left a good impression on me from reading his literature and watching his videos, but the lack of response from his office is a little deterring. Now, that leaves me with Dr. De Smet. He seems to be the most experienced and the endorsement from Dr. Gross was huge! Logistically, he would be the easiest as well since it is a 7 hour drive from where I am at, or a short flight. The only problem with Dr. De Smet, and why I probably haven't booked a date is because of the finances. My insurance doesn't cover me out the states unless it's an emergency. With that said, Dr. De Smet's office is still trying to get preauthorization (really cool of them).


Financially, Drs. Brooks, Gross, and Pritchett would be the cheapest in that order. I have Carefirst BCBS PPO and I am in-network with all three of them. Drs. Su and De Smet would be the most expensive. I know money shouldn't be the issue here, but it still lingers in the back of my mind since I probably have my right side I have to deal with in the future.


Logistically, Dr. De Smet would be the easiest and most preferred. Next would be Drs. Su and Gross since I have family in Washington, DC.


Regarding devices, the Biomet and Conserve+ give me peace of mind because of the success with the smaller sizes (although Dr. Pritchett thinks I would be a 48mm.)


So all-in-all, I think I can't go wrong, but since I had two surgeries in the last 1.5 years, it's really hard for me to make a decision. For my arthroscopies, I chose a surgeon who had over 2000 scopes and I just pulled the trigger. In hindsight, I could have done more research. All I am waiting for is to hear back from Dr. Su. I promised myself this time around I would wait until I hear back from everyone.


There it is...my whole story! Please feel free to let me know if I am missing something, or whatever you think will help. I cannot stress enough how grateful I am for this site and for everyone who contributes. The world needs more of this!

[Shotohips]

Well...I guess I just had to write it all out because decision has been made! I just sent an email to Dr. De Smet asking to schedule me for his next availability.


Late last night, one of Dr. Su's PA called me and was very kind and patient to answer all of my questions. He really left a good impression. However, he also gave a strong endorsement for Dr. De Smet and mentioned since it is so much closer to where I am living now, it would make a lot of sense.


The two strong endorsements I got from my top two choices in the states really made things easier. Financially, it will be the most difficult out of the other surgeons, but I think the logistical conveniences will make up for some of it. If anyone has any experience with CareFirst BCBS, I would appreciate their input as well.


One less thing to worry about and time to really focus on my gym work and nutrition! I moved to Chamonix to focus on my mountaineering aspirations, but life has given me another type of mountain to climb. So much easier knowing there are communities like the people on the site out there.


Thanks again everyone!

[blinky]

That's great!


If it is a financial stretch, crunch the numbers and see what the difference is. Being close is an advantage. I flew home to Texas from SC and that was the hardest part of the experience. Sure, it can be done, but if you have a strong surgeon nearby, it makes sense to take advantage of him.


On to getting ready!

[Pat Walter]

I don't think you will regret choosing Dr. De Smet.  I flew from OH to Belgium to use him 11 years ago.  Would do it again, if need be.

I wish you the very best.  Let us know how you are doing.

Pat

[Shotohips]

Thank you so much, Pat et al. Surgery date is set for June 7!

[karlos.bell]

  Hi Shoto.
As you have been through so much arthroscope work prior to resurfacing.
Dr Koen  De Smet has a handle on this and has helped many a person in the predicament you are in.(like myself)
I don't recommend specialists I only give my experience.
I can say after 2 years I would never assumed I would be as active and back to full time work.
My goal was to be able to sit pain free but I have blown that expectation.

Be patient and grit your teeth, but look forward to rehab and improvements they come slowly.
Don't be too aggressive or hard on your self.

I was on crutches for 8 years and that has had an impact on my rehab (its still improving).
I believe the longer you leave it the longer the rehab to stability.

I would be confident to have a raw guess that I will be 4 years and stable by then.

My good guess "stable" is about half the time you had the issue. And 2 years the minimum.
6 years = 3 years to stable. 4 years = 2 years to stable. Get the picture.

Any less and your real lucky.
It does not take long and 2 years flicks by.........

Good luck all the best.
Cheers K

[Shotohips]

Thanks, K! You have been so kind and helpful!


Looking forward to getting on the right track. Any advice on traveling to Dr. De Smet would be appreciated!

[karlos.bell]

  Nope just enjoy it.
If you have time look around and do the sites first.
I was by myself and on crutches in absolute chronic pain.
If you can get around ok enjoy your time before your operation.

All the best.

Cheers K