New to resurfacing wondering about surgeons

[Angel Romero]

Hello All,

I’m thrilled to find this website. I live in New York and am looking at two different surgeons for resurfacing my left arthritic hip: Dr. Su and Dr. Marwin. Su is out of network for my insurance and I’d have to pay but I can afford it. Marwin would be in-network and cheaper. Anyone have thoughts on the two or even have first hand surgical experience with both and could tell me pluses and minuses of each?

Thanks!
Angel

[Saddlepal3]

Hi Sean,
My understanding is that Dr. Su is a high-volume resurfacing surgeon. I haven't heard much about Dr. Marwin recently on this site, so I would question if he is doing many resurface procedures. That is key. I suggest that you ask about case volume. Good luck.

[Angel Romero]

Thank you Saddle Pal.  I definitely will ask about volume.

Turns out there may not be much of cost difference between both after all so it’ll be expensive either way. Thanks for feedback though.

[imgetinold]

You might check out Dr. Thomas Gross, in South Carolina.  He did my right hip in 2012, and is doing my left in 2 days (10-28-2020).  I know that's a hike, but he is awesome.  I like him in particular because a) I think he's done over 8,000 resufacings by now, and b) the implants he uses are 100% uncemented.  Because they are bone-ingrowth implants, there is not cement to fail.  People go to him all throughout the country.  It's worth consideration.


www.grossortho.com


Andy

[blinky]

There are some Marwin reviews on here.

Su is the doctor to the stars---now Isaiah Thomas.

Is there a difference in wait time between the two? Su used to have an insane waiting list. DK if that matters.

[TotalWus]

Turns out there may not be much of cost difference between both after all so it’ll be expensive either way. Thanks for feedback though.

I saw Marwin a couple of times in 2017 and 2019. He's done 3,000+ BHRs but was very strongly encouraging me to trust him that my leg and back pain were being cause by nerve inflammation from my hip OA and wanted to schedule me for a BHR immediately without examining me or doing anything to rule out a back issue. I took the safe route and saw a neurologist first for an MRI to rule out a back issue, and sure enough, I had a badly herniated L2-3 and would have been in pretty bad shape if I'd allowed him to do my hip before having my back fixed. I had a microdiscectomy in September of last year and have been back to working out and playing hockey since then. My hip is now really shot and I can't really walk for days after I skate, so I'm not going to have any choice but to get it done this winter.

I'm still sort of paralyzed by the conflicting info about THR vs. BHR, with equally-qualified surgeons on both sides of the argument, notwithstanding all of the success stories on this forum. I also consulted Alan Inglis in 2018 who only does THR. I'm not ruling out Marwin because of his technical skill with BHR, despite his failure to consider the risk of doing my hip with all the signs of an undiagnosed herniated disc at the time.

Marwin is also in-network for me. Would you mind explaining how it is that Su and Marwin are equally expensive if Marwin is in-network for you?

[imgetinold]

Hey TotalWus.


Keep in mind that people who do THR and not HR will always guide you to THR because they want the business and they don't do HR.  Even in Dr. Gross is not amongst the surgeons you're considering (I think he should be), he has a great website for education.  Here's a link to all of the patient education:

http://www.grossortho.com/patient-education/explanations


More specifically, this is his discussion weighing THR agains HR.:  http://www.grossortho.com/types-of-hip-replacement


To save you clicking a link:


Stemmed Total Hip ReplacementStemmed total hip replacement is by far the most commonly used. John Charnley was the first to make this a routinely successful operation in the 1960’s. Numerous modifications have occurred since his time. Several millimeters of bone is removed from inside the socket and a metal implant with a porous ingrowth surface is tightly implanted into the prepared bone bed. A bearing liner is then locked into place in the implanted metal shell. This leaves a much smaller cavity for the ball.Therefore the head and neck of the femur must be amputated. A stem is then fixed into the hollowed marrow canal of the top of the femoral shaft using either cement or bone ingrowth technique. A smaller (than natural) ball is then attached to the trunion of the stem (morse cone taper junction). This ball fits into the smaller socket liner.Hip Surface ReplacementHip surface replacement accomplishes the same basic goal as THR with much less bone removal and preservation of normal biomechanics. Bearing size and femoral offsets remain the same as for the normal femur. This was tried in the 1950’s by Charnley with Teflon implants, by others with primitive metal on metal bearings, and in the 70’s with metal on plastic bearings. Finally Derek McMinn applied modern metal on metal bearings to resurfacing in the 1990’s. Mainly because the femoral head is preserved, it is much more difficult for the surgeon to get adequate access to accurately place the deeper socket component.In stemmed THR, the head and neck are amputated early in the operation allowing much easier access to the deeply placed socket. This technical difficulty the primary reason why many hip surgeons are reluctant to perform this operation. It has been demonstrated in numerous scientific papers that the complication rate is much higher when surgeons are learning this operation. This learning curve extends for several hundred cases. Difficulty in placing the socket component accurately is one of the major contributing factors to recent problems with adverse wear failure.Hemi-Surface Replacement for OsteonecrosisOne option to minimize wear debris and tissue reaction is to eliminate the artificial bearing by replacing only the diseased part of the joint. A hemi-surface replacement was sometimes recommended in the past for patients who had osteonecrosis of the femoral head (also referred to as avascular necrosis) and had intact remaining articular cartilage on the acetabulum or pelvic side.The hemi-surface replacement preserves and maintains bone by providing physiological stress transfer to the femoral neck and proximal femur. It avoids inflammatory reaction and loosening due to any artificial bearing wear debris. However, if only one half of the joint is replaced, the degree of pain relief is not as good as if both sides of the joint are replaced. It is not always possible to convert this to a total hip resurfacing. I do not advise the use of this operation.[/size]

[TotalWus]

So I finally did it. Thanks to all for your input. Yesterday I had a direct anterior THR with a ceramic ball and uncemented high-density plastic cup liner performed by Dr. Alexander Neuwirth at NY Columbia-Presbyterian. I was mostly awake and talking during the procedure, but fading in and out. It seemed too optimistic when they told me I'd most likely be discharged the same day and walking out with a walker, but that's what happened. Surgery at 7:30 AM and walking the ward with a walker at 2:00 PM; it would have been much closer to Noon but I was still too light-headed and dizzy from the sedation (spinal). The walker wasn't even necessary and I more or less just carried it off the floor in front of me just in case.

Zero pain 36 hours later other than feeling like I took a hard knee to my upper lateral thigh. He told me that my leg would feel like the sorest it ever felt after a workout, and that's also perfectly accurate: like I hadn't worked out for months and did a full hard leg workout on the first day after that long layoff.  I chose Dr. Neuwirth because he specializes in direct anterior (without cutting any muscle) and because he uses ceramic/plastic or ceramic/ceramic and doesn't use any metal-on-metal devices,which (together with shorter, less-painful recovery) is why I opted for THR vs. BHR. Went with ceramic/plastic instead of double ceramic after checking youtube (at his suggestion) for videos about how loud ceramic/ceramic often squeak. He also inpired my trust in our first consultation; the second time that I met him in person was when he came by my room while I was being preliminarily prepped. No precautions (other than high-impact anything) and no formal rehab; just my own workouts at home. He said I might be able to start skating again in 6-8 weeks. Really looking forward to being able to skate 6-7 hours a week again instead of 1 hour and still significant pain after that.

[jimbone]

Total-

Congratulations on your decision to move forward and relieve yourself from the pain of OA with a return to normality or the closest medical science can achieve.  THR is an alternative to HR for many patients that offers reliable and beneficial improvement to quality of life.  I hope you enjoy and benefit from your surgery for decades to come.

[TotalWus]

Thanks, Jim...I appreciate that.