Choosing a Hip Resurfacing Doctor

[labusas]

My first post here.
I'm also from Toronto, Canada like two posts above - Johnston. I'm on the waiting list to do right hip BHR with Dr. Emil Schemitsch.
During my last visit I was told that due to the latest research like Australia registry, they do NOT do it on women or small men anymore!
That scares me because it means even though I requested BHR I could still wake up with THR. They make final desicion during surgery from the size. I'm average male, hight 5'9", athletic build. Would this size be still in the small risk category???
Please advise, I'm confused and scared here.

[hernanu]

My first post here.
I'm also from Toronto, Canada like two posts above - Johnston. I'm on the waiting list to do right hip BHR with Dr. Emil Schemitsch.
During my last visit I was told that due to the latest research like Australia registry, they do NOT do it on women or small men anymore!
That scares me because it means even though I requested BHR I could still wake up with THR. They make final desicion during surgery from the size. I'm average male, hight 5'9", athletic build. Would this size be still in the small risk category???
Please advise, I'm confused and scared here.

I would think that would be in the small risk category. Too bad that they are going in that direction.

[John C]

Hi labusas,
If you want to get some clarity on what they might decide, I would ask ahead of time what size of prosthesis they consider to be the risk cutoff. This varies from one "authority" to another, so it would be useful to know exactly what cutoff they are using. Also, if they have your x-rays, they should be able to template what size they expect to use (though with some surgeons it is possible that they may change the size choice during surgery). This templating is often done just prior to surgery, so it may take some coaxing to get them to template at this point. However, if they are going to decide what kind of replacement to give you based on size, it is very reasonable for you to ask for this ahead of time so that you know what to expect.
With these two pieces of information, what size prosthesis you would need and what size they consider to be the cutoff for high risk, you should be able to get a clearer picture of what to expect, and therefore whether you want to go ahead with them.

[hernanu]

I am seven weeks post op BHR performed by a surgeon with a little over 100 procedures. He is highly respected as a hip surgeon and has been performing total hip replacements for 27 years. He is also chief of surgeons at a nationally recognized hospital. I know being an expert at THR does not make him an expert at BHR. However, I do believe that all the talk about a surgeon needing to perform 1000 BHR's is not serving the guests of this website in a positive way.

I would be interested in hearing success stories from hippies who took the leap of faith and went with a surgeon with 50-100 procedures under their belt.

By the way, so far I'm very pleased with the results. I am a 4'th Dan taekwondo master and expect to be performing at a high level after I reach the six month mark.

BHR 12/16/2013

I'm glad that your HR is going well. All of the surgeons, even the most experienced and capable ones passed through the 50-100 procedures period.

The advice given here is to pick the best and most capable surgeon. There are many subjective metrics you can use in picking that surgeon:

- Years of experience doing surgery.
- Reputation among his or her peers.
- Reputation among his or her patients.
- Years of experience doing hip replacement of either type
- The reputation of the hospital where the surgery is being done.

I consider these subjective because although they are very positive influences, they are not objective in that I can't tie the possible outcome of my HR directly to them. They are (in my opinion) very good indications, but I need more information.

To me, the things that I prefer to consider are:

- The number of HRs that have been done directly by that surgeon. This is important to me, because the number of HRs speak directly to his or her facility with the procedure. In the Australian national registries, the number of revisions per surgeon went down above 200 procedures. That means that for all surgeons, good or bad, the average number of revisions went down after the 200 HR threshold.
- The frequency of HRs done. If someone does five+ per week, they are apt to be more practiced than someone who does one every month. They are also more likely to be up on the latest technologies, since they are more committed to the procedure.
- The success rate for their patients. You should be able to talk to them and find out their failure rate, and why it happened. No one is perfect and I'm sure even the most successful have their failures. Their ability to talk candidly and to be able to see where the problem was is a quality that I value.
- Their regimen for recuperation. Some failures or scares in HRs happen because the patient did something incorrectly or too early. If the surgeon can list not just a good regimen of limitations and exercise (even if it's just walking), but talk well to you about it, that is important in my view.

Again, this is just my view of things. The results in the registries are very supportive of the success rates with more experienced surgeons, in a gross manner. Surgeons with greater than 200 HRs have fewer revisions. That's as measured over twelve years now.

Obviously, in the end it comes down to your own choice and opinion. I'm sure there are outstanding surgeons who have fewer than two hundred who do an excellent job of it and more power to them, we need them doing these.

But the overall results point to more repetitions giving better results, so I think  (and again, my opinion) that finding a surgeon who has more experience is an important metric. As I listed above, though it's not the only one.

I don't think anyone here says that you need to have someone with thousands of HRs. My doctor had 800+ when I did mine and I had no problem with that, but he was doing several per day and I felt comfortable with him.

As for the TKD, good for you, I have my first degree and have gotten back fully to it. It took me about fifteen months until I could do full contact, and really until about a year before I started doing kicks at speed.

[labusas]

Re below remply, Thanks for the tips,
I did requested the information about risk cutoff and templating. They told me to book another appointment and discuss it. So I'll do.
What is the other questions to ask the doc?
This is for Dr Schemitch in Toronto. Not sure how many BHR's he's done and how experienced he's in it.



Hi labusas,
If you want to get some clarity on what they might decide, I would ask ahead of time what size of prosthesis they consider to be the risk cutoff. This varies from one "authority" to another, so it would be useful to know exactly what cutoff they are using. Also, if they have your x-rays, they should be able to template what size they expect to use (though with some surgeons it is possible that they may change the size choice during surgery). This templating is often done just prior to surgery, so it may take some coaxing to get them to template at this point. However, if they are going to decide what kind of replacement to give you based on size, it is very reasonable for you to ask for this ahead of time so that you know what to expect.
With these two pieces of information, what size prosthesis you would need and what size they consider to be the cutoff for high risk, you should be able to get a clearer picture of what to expect, and therefore whether you want to go ahead with them.

[chuckm]

Tkdbob, glad to hear your surgery went well. There is a reason that you are not seeing why this forum gravitates to top surgeons (gurus). Unlike total hip replacement, with hip resurfacing, you only get ONE chance. If your surgeon doesn't get this very difficult surgery right, you don't get a second chance. It can't be repaired or replaced - except in rare circumstances.

Especially the young who are planning to return to impact occupations or sports, it is critical that they know the statistical correlation between a surgeon's experience and patient outcomes.

Pat Walter has done a great job setting up this forum and her website "surface hippy" to inform the masses about hip resurfacing. Thanks again Pat.

As bad as a total hip surgery gone bad would be, the surgeon could revise it to another total hip replacement.

And the comment about the those of less means or those who can't travel far - do you mean hide facts or change the way this forum feels so their feelings aren't hurt.

Chuckm

[Pat Walter]

Tkdbob

I choose to feature surgeons that have excellent outcomes over a period of time and a large number of hip resurfacings.  Using a surgeon that does not do hip resurfacing on a regular basis every day or every week does not mean you will have a poor outcome - but the national registries, medical studies and personal records of the top surgeons do show experience is important.  The overall retention rate of the BHR at 11 years is 94%   That means some patients, 6 out of 100, are going to have revisions and serious problems.  If you look at the retention rates of the top experienced surgeons they are 98 to 99% at 10 and 11 years.

It is simple math.  The way to keep from being a statistic is to choose the most experienced surgeons.  I doubt the professional football teams would use a quarterback only once a month and expect him to be on top of his game.  Hip resurfacing surgery is very difficult and a surgeon normally does better surgery when doing them on a daily basis.

This is not my opinion, this is based on National Registry Data and surgeon's personal series data.  I attend most of the hip resurfacing courses and listened to surgeon after surgeon state the same theory.  They are very concerned about hip resurfacings gone wrong and there is a great deal of discussion about it.  Methods presented to do better component placement, etc.  In the end - one thing all the surgeons agree on is to use a surgeon that is very experienced and doing them on a daily or weekly basis.  They suggest if there is a group of surgeons, the group chooses only surgeon to do the hip resurfacing so he remains their specialists doing them often.

Many people have used less experienced surgeons and had good outcomes - but many have had problems.  There are many stories posted where the patient states "If only I had listened to the group and choose one of the top experienced surgeons"   There is no going back when a resurfacing is not done properly. 

I have read personal stories on this website since 2005 and just by reading those stories, understand the very experienced surgeons have better outcomes.

I had no health insurance and no money, but I was not going to get an old fashioned THR at 61.  I put the $18,000 for the travel, hotel and all medical costs on my credit cards to go to Belgium.  I wanted a hip resurfacing and wanted a surgeon that had done several thousand.

The moral of the story is - it is your health and your body - you only get one chance to have it done right.  Most people can travel a reasonable distance to get their hip resurfacing.  I flew about 10 hours each way to get mine.  It took me a long time to pay the credit cards - but my hip is perfect.  I was not going to face a revision of my hip resurfacing because I could choose one of the new surgeons in the US to do the BHR.  Many of those surgeons no longer do hip resurfacing.  They had bad outcomes or it was just too difficult for them. 

I am going to lock this discussion since it is so many pages long and I am going to have the last word in this discussion. My opinion based on hundreds of personal stories, national registries, medical studies and surgeon series outcomes is - USE THE MOST EXPERIENCED SURGEON AVAILABLE, ONE THAT HAS DONE THOUSANDS, NOT A FEW HUNDRED.

Pat

[obxpelican]

Most of the problems that we've had on this forum with people with less than positive outcomes come from surgeons with small numbers of HR surgeries.

Being perfect at doing THRs does not make that surgeon necessarily someone who might be good at doing HRs, you are correct.

Locations or standing in a surgical community has nothing to do with what outcome you should expect.  My surgeon performs his surgery in the middle of South Carolina in a very small hospital but yet he yields excellent results.

You may or may not have a good result, I am sure I can speak for others that we hope, wish and pray that you have a great outcome, however by choosing someone with limited procedures under his belt you have increased the risk of a negative outcome.

It is all about the numbers, I wish I had $10 for every patient we've seen on this site end up needing revisions because they picked an inexperienced surgeon, I could buy a new car probably.

I think Pat should post in 4 inch font on her home page "Pick an experienced surgeon if you want good results".



Chuck

I am seven weeks post op BHR performed by a surgeon with a little over 100 procedures. He is highly respected as a hip surgeon and has been performing total hip replacements for 27 years. He is also chief of surgeons at a nationally recognized hospital. I know being an expert at THR does not make him an expert at BHR. However, I do believe that all the talk about a surgeon needing to perform 1000 BHR's is not serving the guests of this website in a positive way.

I would be interested in hearing success stories from hippies who took the leap of faith and went with a surgeon with 50-100 procedures under their belt.

By the way, so far I'm very pleased with the results. I am a 4'th Dan taekwondo master and expect to be performing at a high level after I reach the six month mark.

BHR 12/16/2013