Hello. I'm a 53 year old former jogger scheduled for resurfacing at Newton-Wellesley Hospital in MA at the end of October. I have questions, but the major thing that is bothering me is the gem of info I was given by the surgeon that if he doesn't like the fit of the acetabular cups he has available he will automatically start hacking away to give me a THR. Not certain now about the detail he gave for bail out to THR criteria, but the gist of it was that if he didn't like the fit then a THR was going in. Since I was belatedly diagnosed with oesteo 12 years ago, I have had no interest in getting a THR. I would rather continue with the loss of ROM, discomfort, Celebrex side effects, and occasional pain and sleeplessness than go in for THR. I'm being told I have to risk this in order to get the resurfacing.
What has the experience of others been with the preop pep talk, and results of the surgery? Do other surgeons warn of this, and have people woken up with a THR?
Thanks,
Mike
Hi Mike
You are very young and should not be considering a THR if possible. The really experinced surgeons will tell you whether you are going to get a Resurfacing or not. If there could be a problem, the really expeinced ones will tell you the odds of not getting one. Not having proper sized acetabular cups available is a new one on me. The surgeon should be able to measure your x-rays and know what is needed. This is not a trail and error surgery - it is a very difficult and precise surgery.
If you really want a resurfacing, maybe you should get a second or third opinion. Most of the doctors on my list that have done over 500, or even over 1000 will be honest with you and normally give you a resurfacing. It is the less experienced ones that do "bait and switch" Even a few hundred resurfacings are not that many any more. The top doctors are over 500 and a handful over 1000. Check out doctors like Dr. Su, Dr. Mont, Dr. Gross, Dr. Brooks, Dr. Rogerson, etc. to see what they say. It might be worth cancelling to get a top doctor to do your surgery. Many of us have had to travel to use to top surgeons. I went to Belgium and many have flown across country. Sometimes you just can't get what you want at home.
It is always good to ask other people about their experience with your surgeon. Who are you going to use? If you want to know info from other patients, let us know and maybe someone can talk with you. There are sometimes a mix of patient outcomes with the less expeirneced surgeons. The odds are currently that about 4% of resurfacings will have problems or need revisions. The statistic changed when the new resurfacing surgeons began doing resurfacing in the US. That brought the pre FDA approval of resufacing retention rate from 99.9% overseas down to about 96% worldwide including the newer surgeons after the US jumped into the resurfacing arena. I just retuned from the 3rd annual hip resurfacing course in Baltimore with 250 of the top resurfacing surgeons. I learned misplaced acetabular cups are causing the most problems and revisions. The way to make sure your acetabular cup is placed at the proper angle is to use a surgeon with a great deal of experince - not just a hundred or two hundred. The theme of the course was a device well placed is a resurfacing well done. That takes expreince according to all the medical studies and opinions of the top surgeons.
Pat
Mike,
I would for sure seek out an experienced surgeon, like Pat said an experienced surgeon should be able to tell you whether or not you would be a candidate or not for a HR. What your doctor said makes no sense at all, essentially the cup is done the same way but with an HR the head is in the way during the fitting of the cup (Pat I talked to Gross about cups when I was down in August) and that is why you see more cups failing during a re-surfacing.
When I got my hip done Dr. Gross told me he had 1 patient have to revert to a THR during his resurfacing surgeries.
Again, go for an experienced surgeon or you are at a higher risk for problems.
Chuck
Quote from: MikeHolloway on September 09, 2009, 07:10:36 PM
Hello. I'm a 53 year old former jogger scheduled for resurfacing at Newton-Wellesley Hospital in MA at the end of October. I have questions, but the major thing that is bothering me is the gem of info I was given by the surgeon that if he doesn't like the fit of the acetabular cups he has available he will automatically start hacking away to give me a THR. Not certain now about the detail he gave for bail out to THR criteria, but the gist of it was that if he didn't like the fit then a THR was going in. Since I was belatedly diagnosed with oesteo 12 years ago, I have had no interest in getting a THR. I would rather continue with the loss of ROM, discomfort, Celebrex side effects, and occasional pain and sleeplessness than go in for THR. I'm being told I have to risk this in order to get the resurfacing.
What has the experience of others been with the preop pep talk, and results of the surgery? Do other surgeons warn of this, and have people woken up with a THR?
Thanks,
Mike
What little I've been able to find has suggested that Sean Rockett is one of three experienced orthopedic surgeons in the Boston area doing hip resurfacing. I've two responses so far, and it appears that some warning of a problem necessitating THR isn't unknown. It bothers me though.
Does anyone know if it should be possible to just put the damn thing back in and close up? I'd rather wait for cartialage regeneration than get a THR.
Thanks,
Mike
Hi Mike
I am sorry, but I have been developing my website for almost 4 years and reading personal stories from Surface Hippies for almost 5 years. I have never heard of a surgeon doing hip resurfacing by the name of Sean Rockett . How many resurfacings has he done to date? Are they all full resurfacings or is he including hemi-resurfacings and is he including assists for other surgeons. An expreinced surgeon is one who has done 400, 500 or 1000 or 1600 like many of the top surgeons.
Again, if you want a resurfacing, you will most likely need to use one of the top hip resurfacing surgeons if this one is telling you he thinks a THR is a possiblity. Many have been in your position where surgeons were on the fence about what to do and ended up with a THR. If you want a resurfacing, look at my list and choose a surgeon that does them for a living - not just a few here and there. You have a lot at stake since you are very young. http://www.surfacehippy.info/listofdoctors.php (http://www.surfacehippy.info/listofdoctors.php)
If your surgeon won't tell you all the info you want to know, then choose another. In this day and age, the patient is entitled to have all questions answered. Many have been in a situation where they have gone to other hip resurfacing surgeons because they wanted to make sure they got their resurfacing and not a THR. Not a good operation to gamble on if you want to remain active and keep your femur bone.
Good Luck.
Pat
Mike,
It's so common on here for us to read of patients who come back to us and say "I wish I would have gone for an experienced surgeon".
You must understand that the cups used for HR surgery in most cases are able to be used in a revision if necessary, in other words the femoral end just needs to be replaced. An x-ray is all that is needed for experienced doctors to figure out which direction the patient needs to go, in the majority of cases an HR can be accomplished unless the head of the femur has some issue with it.
I do not know if a doctor can dislocate your hip and pop it back in without further damaging the cartilage.... maybe Pat can answer that question.
Please heed our warnings, make sure you are dealing with an experienced surgeon or you may wake up with a THR instead of an HR that could have been done had you gone with experience. If you intend on going with your current doctor, make sure he does use large MOM THR devices.
Your point about stem cell regeneration is a really interesting concept that is being used by vets for dogs with some sucess, maybe in 5 or 6 years when I need my left one done all I will need is a couple of needles being shot into my hip joint, although knowing how our govt it probably will be another 10 years. >:(
Please keep us posted.
Chuck
Quote from: MikeHolloway on September 09, 2009, 08:43:01 PM
What little I've been able to find has suggested that Sean Rockett is one of three experienced orthopedic surgeons in the Boston area doing hip resurfacing. I've two responses so far, and it appears that some warning of a problem necessitating THR isn't unknown. It bothers me though.
Does anyone know if it should be possible to just put the damn thing back in and close up? I'd rather wait for cartialage regeneration than get a THR.
Thanks,
Mike
Pat, please, nothing to be sorry about. Thank you very much for the help. I have my doubts about my ability to get the procedure outside the Boston area, both for insurance and just logistics with my family obligations, but you list two surgeons at Newton-Wellesley. Snyder is a partner with Rockett. Nothing at any other Boston hospital though?
I guess I just have to call his office and ask how many he's done.
Chuck, there wasn't any doubt given about my being a candidate for resurfacing. I thought the surgeon was covering himself in case a problem occurred. He said it was unlikely.
I haven't seen any reports about use of stem cells, but a group at Rice U had reported encouraging results with treatment and transplantation of chondrocytes: http://www.media.rice.edu/media/NewsBot.asp?MODE=VIEW&ID=11084
There have apparently been some European clinical trials with stimulating chondrocytes by scarring, but this doesn't appear to promote enough cartilage. The thing is, eventually the hacking off of bone and hammering in metal isn't going to be necessary. I don't think I can afford to wait the ten years though. When I started reading about resurfacing I knew I had to do while I can still get back into exercise easily. I want to run again.
Mike,
Hey, whatever or should I say whoever the surgeon is that you go with we wish you great hippie health.
Like I said before, keep us posted.
Chuck
Hey Mike,
I had my right resurfaced in August 2008. I have been doing a lot of rersearch on this subject over the last couple of years. I would ask your Doc how many HR's he has done and how many he had to convert to a THR during surgery. If he can not, or will not give you these numbers I would look for another surgeon. I would also ask if there is something he he is aware of that put's you at higher risk for a revision. Revisions during surgery are extremely rare unless the surgeon determines that you are a marginal candidate before the surgery.
Fred
Mike, I'm a little over 8 months out after surgery at Newton Wellsely - Dr Hanmer (Snyder's other partner) performed my surgery. I know of a couple of "hard cases" that Snyder took on, and have been succesful. I believe it is their practice to have a back-up THR option in case of BHR complications -
I think it unfair for Pat and Chuck to jump all over this as a problem without knowing why or how they perform the work. I'm assuming (as are Chuck and Pat) that the Dr's in NWOA practice have similar proticals - if so, they do measure socket, and pick the corresponding cup and ball size - they do take in-situ x-rays during the proceedure (they did for me). They do shoot for 40 degree, ending up at 45 degree angle.
I'm sure that in case of AVN, or other complications, you'd want to come out with the correct device vs. going in for a revision. There are plenty of stories of those on this website as well!
DW,
It's not just Pat and I that think there is something wrong with the doctor's statement and perceived protocol. Mike posted the same quesiton on another group and he was inundated with replies that were more strongly worded than ours.
The fact that hardly anybody knows that doctor, the doctors statements to Mike, we do not know how many HRs he's done and whether or not the doctor is primarily a THR doc is why the red flag popped up in my (I cannot speak for Pat) head.
We jumped all over the problem because we've seen too many people post that they wished they too had listened to us. If what Mike says is true of what the doctor said then by all means if it was me I would seek out 2nd and 3rd opinions by truly experienced doctors who have done at least 4-5 hundred hip replacement surgeries.
Listen, we're not advocating boycotting the doctor because we don't like him, we're advocatting for Mike so that he gets the best possible outcome. Mike posted on here because he wanted opinions, and he got them, Mike also posted on other groups and he got even more strongly worded opinions from them, what can I say.... if Mike chooses to ignore the warnings he has read then he does so at his own peril.
Chuck
Quote from: dw on September 10, 2009, 10:01:08 AM
I think it unfair for Pat and Chuck to jump all over this as a problem without knowing why or how they perform the work. I'm assuming (as are Chuck and Pat) that the Dr's in NWOA practice have similar proticals - if so, they do measure socket, and pick the corresponding cup and ball size - they do take in-situ x-rays during the proceedure (they did for me). They do shoot for 40 degree, ending up at 45 degree angle.
I will again remind people that I am not a doctor or medically trained. I have, however, been talking to and reading stories from Hip Resurfacing Patients for almost 5 years. I have learned a lot about many of the surgeons doing hip resurfacing. I have read many stories from folks who said - if only I had listened to the advice given me about using the really experinced hip resurfacing surgeons.
I just participated in the 3rd Annual Hip Resurfacing Course for Surgeons in Baltimore MD. I also participated in last years course in LA. The most talked about problem in hip resurfacing is the improper placement of the acetabular cup. It must be placed at the proper angle or it will cause a great deal of problems that generally lead to a revision. There was discussion about how many resurfacing a surgeon needs to become experinced. That does vary, but it is pretty much agreed on that at least 100 to 200 are needed to become really experinced. Also the surgeon needs to be doing a number of hip resurfacings often, not just a few here and there. This is advice from the best resurfacing surgeons in the world including McMinn, De Smet, Antionio, Gross, Schmalzried, Mont and many others.
I can't tell a patient what doctor to use, but I can present information for them to help make a decision. If a patient prefers to use a less experinced surgeon - that doesn't mean he will have a bad outcome, but the odds are more likely that there could be a failure or revision required. That is not my opinion, but information based on medical studies. Right now in the US, approximately 4 out of every 100 patients are having revisions. That is based on BHR data http://www.surfacehippy.info/bhrhistory.php (http://www.surfacehippy.info/bhrhistory.php) not my opinion. So if you want a sucessful resurfacing, it seems to me to be very wise to choose your surgeon with care. I have a list that shows who the experineced surgeons are and a perspecitve patient only needs to look at the list. It is not always easy since most of the top surgeons are not in your own city or backyard. This is very serious stuff - hip surgery and your activity level for your life depends on it being done proplerly. Once a hip surgery is not done correctly and requireds a revision, it means another major surgery. Each revision becomes more diffiuclt. I have about 10 new videos posted talked about resurfacing and it's advantage over THRs. One advantage is that a possible revision is much easier from a Resurfacing to a THR.
Pat
It's fine to advocate for Mike - I have no problem with that. I've never heard of the Doc he went to (there are more docs listed in Boston that do the BHR - even at Newton Wellesly). I happen to have first hand experience with the practice, and how they approach things.
It seems like (my perception) is that a select number of surgeons are suggested on this site, and there is no room for others. As in anything, perfect practice makes perfect - my surgeon (Dr Hanmer out of Newton Wellesly) had done 15+ resurfacings between my discharge and one month check up. I know that their practice is big on BHR vs THR, and I also know they have a back up plan just in case.
Note by Patricia Walter Owner of Surface Hippy: Please do not say that the top surgeons in hip resurfacing are not honest. Everyone of the surgeons will tell you exactly what they see and what they expect. This is not a guessing game and should not be approached as one. Please do not indicate that most surgeons are not honest. Not a good generalization and will not be allowed on this discussion group.So, which would you rather have - a doc that isn't honest and doesn't say, what could happen during surgery, or one that says here's the things that can go wrong, and here's what we'd do about them?
As in any other forum, people have opinions, some educated and some not -
Just my two cents, for whatever they are worth.
My doctor, Dr. Poole, In Boise, ID, who has done 400 resurfacings, did mention to me that there was a slim chance that if he went in and saw something that said "NO" to a resurfacing that he would swap over to a THR.
The thing that I have come to realize, especially in my own case, is that the x rays and mr arthrograms and MRIs don't show everything that is going on in there. In my case it was moderate arthritis, floating chondral and non chondral bodies and a suspected (not seen) labral tear that would explain my terrific pain.
When he got in there- it was discovered that there was a patch on my hip ball joint- about the size of a quarter- where the cartilage was just gone- like it had lifted off and drifted away somewhere. Again- this showed up no where on my tests- and it was the number one reason why I have been unable to walk more than half a block these past 10 months.
btw I am 44 years old and female.
The first thing I asked when I woke up in recovery was resurfacing or replacement? I was thrilled to hear resurfacing and I am sure that is what you will hear too. I think the doctors have to set the stage tho just in case when they do get in there they find something unexpected.
Ask questions- a lot of them- I had a list of about 30 for my doctor and some of them (as my boyfriend who was in the room when I asked said) took him rather off guard. But he looked me in the eye and answered me honestly- of that I feel certain.
If you are not certain- find another doctor.
Certainly keep us all posted. I just had my three week post op doc visit yesterday- got the okay to drive, got the okay to do some low key snow shoeing this winter- and I am going back in two months to discuss getting the other hip done.
Getting this hip resurfacing - even now at 3 weeks with all the trials of rehab- is the best thing I have ever done. I have more of my life back now- even walking with a cane and unable to put on my shoes- than I did before the surgery.
Good Luck!
Quote from: dw on September 10, 2009, 11:42:25 AM
It seems like (my perception) is that a select number of surgeons are suggested on this site, and there is no room for others.
I know this thread is locked, but, I wanted to add to that statement, DW, reply in private if you want to discuss it further. I actually agree that some surgeons are mentioned a lot on here, Dr. Su, Dr. Mont, Dr. Gross, Dr. DeSmet, Dr. Bose and a number of others..... DW it's because those doctors are truly the tops in their field, few doctors come close to their success rates.
I like Dr. Gross, but I would not have a problem having my left hip done by any of the really experienced docs listed above, SteveL and I kid around a lot about Dr. Su and Dr. Gross but I think he understands that I respect Dr. Su and a number of other doctors.
What everyone has to understand is that if you want the best shot at getting the best results you need to find the most experienced surgeon possible, too many people have come back telling Pat that they wished that they would have listened. In Mike's case we were making sure that Mike has the best possiblity of having a positive result, no one was directing Mike to any one particular doctor mind you. Look at the top of the page on Pat's site, clearly there is a link to a list of experienced doctors.
I think Pat should have a 120 point sized banner on top of her home page that says "If you want a good result find an experienced surgeon!"
I hope that clears the air.
Chuck