Questions to ask non-BHR surgeon

[antun]

I'm very likely facing a hip replacement. Been in quite severe pain for the last 4 months. So far I've had an x-ray, seen a sports doctor, seen the surgeon, an had an MRI, which came back with a whole bunch of issues. Both the sports doctor and a PA told me that based on what they saw, if other approaches weren't improving things for me, then a hip replacement would probably be my best option. I have the follow-up meeting with the surgeon next week. I'm 45M, and very active. (Jiu jitsu, CrossFit, hiking, skiing, mountain biking.)

I learned about the BHR because I have a friend who had both done hips in the last few years, and he's very happy with them. I've been researching it as much as I can. From what I understand it has generally been preferable for people my age who are determined to stay active.  I understand the concern over metals, but that seems like a low-risk. I'm not a doctor, so I'm not going into this with the assumption that I need one type of HR or another. I plan to listen to their advice, of course.

I have an HMO health plan, and in general I'm very happy with them. However, from what I understand, in my immediate area, they aren't doing BHRs these days, so I assume they won't offer one. (I could go further afield, although of course I have to ask for that.) I want to make sure I ask the right questions to understand the approach they're recommending too, so I can make the right decision.

So, any suggestions for what to ask a non-BHR doctor?

Stuff I'm thinking of asking:

• What device would you recommend for me? Why that one? (I'm conscious that the tradeoffs with BMR/THR may change as time goes on.)
• What's the expected lifespan for that device for a highly active person?
• Any restrictions on my movement or activity can I expect in future?
• How many of these have you installed, what's your revision rate?
• Can you name any famous athletes who have that device and have returned to their sport at a professional level?

Any other recommendations? I want to be clear I'm not focused any type of approach.

[YetiKing]

antun - best thing is you are in the right place to get some input from tons of people that have been in the same spot as you.  will share my thoughts/experience with you fwiw.

considered both the replacement and resurfacing options and interviewed/seen by doctors on both sides.  my take is that it is like buying a car - the honda dealership extolls the virtues of a honda at the same time the toyota dealership extolls the virtues of a toyota. the don't provide much, if any pov, on the other.  i had to get to a place where i felt i made the right decision.  i looked at lots of data and felt that the resurfacing was best - 58 (at time), very active, dreams of running a marathon/ironman again and wanted to have the best long term optionality.  i ended up going to sc to have dr gross do my resurfacing - could have had dr brooks do it at cleveland clinic at the time but opted for gross because of extensive data he shares and the fact he has done the most (i believe but could be wrong) resurfacings in the us.   some additional questions:
- infection rate
- duration of stay (out patient or overnight)
- if resurfacing path, how many of resurfacings have had to be changed to replacement

last thought - go for the absolute best surgeon (who you feel most comfortable with after doing all your reserach) once you decide your path.  it is a big decision and i wanted to make 100% sure i never second guessed myself.

best of luck

[antun]

Thanks - I didn't think about infection rate and stay duration. I'll include those.

I totally understand that surgeons who do one type will recommend that type, and it seems that my HMO has moved away from resurfacing, at least in my immediate area. I just don't know whether that's because they feel that newer total replacements are catching-up with resurfacing, or they're simply worried about the metal issue or availability of skilled surgeons. My priority is to be able to continue with my highly active lifestyle.

[Pat Walter]

The majority of orthopedic surgeons never did recommend or learn about hip resurfacing. There was also hemi-hip resurfacing in the beginning.

https://surfacehippy.info/hemi-resurfacing-a-poor-option-compared-to-total-hip-resurfacing-2/
They just put a cap on the femur bone, but no metal cup in the acetabulum.  So there was much wear from the metal on bone combination.  It was not very successful and most surgeons never decided to learn about full hip resurfacing which is very successful.  So hip resurfacing is almost never recommended in the orthopedic community.  That is why I started this website in 2005.  A place to learn about hip resurfacing.  The experienced surgeons have done 4000, 5000 or more and have wonderful retention records.  It is successful in the hands of experienced surgeons. Also it is a much more difficult surgery than a THR, so most orthopedics just don't want to be bothered.  The can slap in a sloppy THR very easily. 

So nothing has changed since 2005 and 2006 when the BHR was FDA approved.  At one point, over 4% of hip replacement was hip resurfacing.  The number is smaller now since far few surgeons are doing hip resurfacing.  BUT - for the right candidate using an experienced hip resurfacing surgeon can give excellent outcomes with no pain and no restrictions on activities.


Read the many successful hip resurfacing stories here    https://surfacehippy.info/category/hip-resurfacing-stories/  and on the discussion forum.
I wish you the best.
Pat

[jimbone]

Antun-

All of the responses above as well as your own input are credible and reflect concerns you'll want to resolve.  One perspective might be to ask a surgeon that does both is which would they recommend.  The top HR docs can do both.  I know there are folks that go THR and still have relatively active lives but I don't know of any professional athletes with THRs- although there are several with HRs.  That might speak to your question.  I am 5 years out with bilateral HR, Synovo device, Dr. Pritchett, Seattle WA, in and out of the hospital the same day, 8 weeks between surgeries.  Rarely a week goes by when I'm not reminded how fortunate I am to have had these done.  I was 63, in good overall health and going strong still at 68.  The Synovo device is cross poly surfaces so there are no concerns with metal ions, although Dr. Pritchett can and will do an MOM.
Regarding your jiu jitsu- there was a younger practitioner that posted on the forum about 2017-18 when I was looking into HR.  He recovered well enough to continue his practice and has a Youtube out there somewhere.  I followed a similar MA prior to surgery but given my age and concerns about taking Ukemi made the decision to remain in retirement even though the doctor gave it a green light.  That said, after a sail this last weekend I caught my foot on a piece of concrete and heading for a face plant just took the roll without any damage but a bruised shoulder from a rock on the ground.  At 45 I'd guess you would still have a good chance to remain active in that arena after an HR- not so sure of that with the THR.
Your approach seems rational and considered- I wish you the best.

[antun]

Thanks. Yeah, I'm aware of several famous athletes have had HRs done, and like you said, none that have had THRs.

Regarding the jiu jitsu, I know other people who have had hip replacements, and my concern isn't so much about not being able to train in general, as it is being able to train at the level that I want to. Being competitive means lifting weights, sprinting, etc. to stay in shape, and from what I understand, that's discouraged with THRs, but from reading these forums, it's OK with HRs.

The Synovo device is cross poly surfaces so there are no concerns with metal ions, although Dr. Pritchett can and will do an MOM.

What's the advantage of getting crosslinked poly HR over a crosslinked poly THR? As I understood it, the main advantage of a HR is that they're (usually) MOM, and therefore have miniscule wear rates, so you can stay highly active for many years. Is there something else?