Hi all,
I'm a 43-year-old woman in the Boston area with very severe arthritis in both hips. Otherwise, I'm active and in good physical shape. I met with Dr. Snyder at Newton Wellesley Hospital this morning to discuss my options. I'd chosen him based on recommendations on this site, and he seems to be one of the few doctors in this area who has done of lot of resurfacing.
He told me that women are not as good candidates for resurfacing because of issues with metal on metal--I think bone size can also be an issue, but as I am six feet tall, that would not be an issue for me. He said that at my age, THR isn't a great option either, but that he felt I was a very good candidate for the Corin Minihip. He tells me it preserves bone, compared to the THR and gives great range of motion (a little better than resurfacing). This all sounds great, but I'm also finding next to nothing about this procedure online. He told me it is very new in the US and he is one of the only surgeons doing it. He trained in Wales where they have been doing it for quite a while.
So I'm wondering...a) how do I find out enough about this to really feel confident that it is the right thing to do, and b) how serious is the metal ion issue for women, and is that really the biggest issue women face (or is bone size the bigger issue)? It seems like there are plenty of women on this site who have done resurfacing, so I'm a little confused by that. I think that resurfacing is really my only good option if I don't do this minihip, but I want to know all I can if I'm putting myself at some extra risk by doing it as a woman.
Welcome to the site. My first reaction is to be skeptical of any procedure that doesn't have a 5 to 10 year record of success with the registry numbers to back it up. I don't know anything about the Corin Minihip but there have been other newer/better products or procedures that didn't work out so well in the end.
I would get more opinions from other surgeons before proceeding. My surgeon Dr. Marchand at South County Orthopedics in RI is excellent and has had success with many women.
Good luck, moe
Hi Welcome to Hip Talk.
I would suggest that you get an opinon from Dr. Su of NY and Dr. Clarke of NY. They are amoung the best hip resurfacing surgeons in the US. They do a large amount of resurfacings and have very good outcomes.
I personally would not want a device that is not well accepted and used in the US and overseas. The BHR has been used since 1997 and there are way over 100,000 people with them. You can talk to hundreds just on this site about their BHRs. The Wright C+ and Biomet are also great devices.
Some of the surgeons have a mix of good and bad reviews on this site and on the Yahoosurfacehippy discussion group. You might want to do a search for your doctor and see what others have to say. There has been a mix of reports that you might want to read.
I always suggest staying with the most experinced surgeons that use the device with the best outcomes. The BHR is the best with the Wright C+ and biomet coming in behind. I would not want to be a guinea pig for a new device that is not used very much. Just my opinon based on reading thousands of stories and learning about hip resurfacing since 2005. Stick with the best surgeons and devices and you will have the best chance of a great outcome.
Pat
One of the surgeons I contacted before my operation suggested I use a mini hip, the little know Mitch Per, instead of a resurfacing. He could give me absolutely no information about the device, even though he was supposedly involved in the design of that device. So I forgot both him and the mini hip.
Hi,
I agree with everyone else...get another opinion. I had a left BHR 3 1/2 months agon and I am a 49 year old small female. I had end stage arthritis, AVN, and a very large cyst. It is riskier to do the surgery on women, mainly due to bone density and women do seem to have a higher incidence of metal allergies (not sure why, but that is what I was told.) That is why it is imperative to use an very experienced surgeon. Luckily I had a very competent surgeon and have very strong bones due to being an athlete, so my surgery was a success.
Good Luck to you!
June
Hi,
I am a 64 year old woman scheduled for hip resurfacing with Dr. Gross next month, when I will be 65! Obviously, I have not yet had the surgery, but after talking with Dr. Gross about my situation, he had no problem with performing hip resurfacing surgery on me, in spite of my age and the fact that I am a woman. He looks at each person as an individual, not just numbers. I have no clue what a "mini-hip" is, but I definitely think you need a second opinion. Dr. Gross said nothing about metal on metal being a particular problem for women, and I have a female co-worker who had metal on metal resurfacing by Dr. Gross 7 years ago at the age of 39. She is fine and does everything. She is an aerobics teacher and competitive cyclist, and also runs quite a bit. She has had no problems.
I'm a satisfied patient of Dr. Snyder's and I would talk to someone else.
I went to him for an HR when someone else suggested a THR, trying something new would not be what I wanted. From what you've seen on this web site, there are many good experienced doctors who we have access to, get a second, a third opinion to make sure you're doing the right thing. It's your body and you should take the highest percentage procedure that lets you get to where you need.
Like I said, I've done two hips with Dr. Snyder, I'm very satisfied with everything, but if you're not comfortable or you're not hearing what you want, talk to another experienced doctor. Someone (can't remember who) in Rhode Island posted that they found a good HR doctor there, you may want to check with them, or go to the NY doctors suggested by Pat.
Good luck, once you get the right procedure done, you'll feel much better.
I can not speak to your condition regarding resurfacing. I can speak regarding the mini-hip and Dr. Snyder. I went with him with high regard after some research for a hip resurfacing seeing the many happy recommendations for him for resurfacings. In my case, my femoral head was quite deteriorated and the resurfacing cap would not adhere so Dr. Snyder installed the minihip. I have seen the details of this prothesis and I am very satisfied. I am six months post-op and my recovery was quick and my new hip feels seamless. The femoral neck is cut just below the femoral head so this is a bone conserving method as compared to a full THR although not as much as a resurfacing. There is a metal cup, bone growth, with a large diameter ball and a small stem that seats into the femoral neck and a small part of the shaft with bone growth. I understand this is a new device. I found a report of one installed in Johnny Bench, of the Cinncinnatti Reds baseball fame early last year and he is acting as a spokesperson for this device. I like what I have researched on this minihip. You are welcome to contact as reply to this post or outside the site at my email address dbhearts@gmail.com. I also think as many opinions as possible are most helpful. I sought many before I made my decision. I hope that I have been of help.
This is very anecdotal, but it seems like the idea that woman aren't good candidates for HR is prevalent with surgeons that have not done lots of HRs. I don't think you'll hear that from Gross, Su, Pritchett, McMinn, Bose, DeSmet,... My local orthopaedic clinic in a very sporty town of 200,000 in Oregon also doesn't think HR is good for woman. I think outright generalizing like that is not something the really experienced surgeons do
Granted everyone will have their own specific circumstances that will drive the surgeon's decision, much like what dbhearts just said.
If you have good bone stock, you're 6 feet tall, young (I know that's relative, I feel like I'm 60, but actually 41), it seems to me you'd be a good candidate for HR.
Thanks for all your replies, I've been researching this like crazy over the past several weeks, speaking to family friends who are orthopedists, radiologists, googling, etc. Today I had a second opinion with a doctor who does Birmingham hip resurfacing. He actually echoed much of what Dr. Snyder said about women and resurfacing. He said that many doctors stopped doing them in women altogether because of fear of metal ions and issues with smaller frames, but that now they are cautiously doing them again in certain cases. I found an FDA warning about the metal on metal from last month backing that up. He said that if I pushed for it he would do it in me, assuming I was not planning on having more children (I'm not), as I have a plenty strong and large frame. He told me that all things considered though, he recommended the total hip replacement for me. He felt I would actually get greater range of motion with the version he would give me and that I would have a smaller scar and an easier recovery with the anterior approach he'd use. I am left feeling rather confused all around.
I have also done a lot more research in the past few weeks about Dr. Snyder and his approach, and I am very impressed with what he is doing in general. I'm wary of the newness, but I am actually leaning toward the Corin Minihip at this point. Thank you to those you you who weighed in with your experiences with him. I've heard other very positive outside reports about him as well and feel he knows what he is doing. Still this is a very big and scary choice to make!
I think that many doctors leaned towards using the ASR for women for sizing issues. (I know Dr Bose was very clear as to the that fact and that at one time it made up for 50% of his resurfacings and that he liked the sizing options for women.) This may have influenced the generally bad attitude regarding women and resurfacings.
You don't seem to be special in your situation that would push you away from the MOM resurfacing... especially at 43. Its my understanding that the corin mini stem doesn't actually provide much of an advantage to a traditional short-stem in the event of a revision and it has a short history/track record.
As for recovery... I suspect that the posterior/anterior difference also really depends on the surgeon. I'm at 4.5 weeks out from posterior with Dr Gross and feeling great.
Pros to resurfacing MOM
Unbreakable
Maximum bone preservation (I think that is a huge issue at 'our' age)
Long track record and good results (even in women! with good devices and good surgeons)
Cons to resurfacing MOM
Potential metal issue (Dr gross has had 3 in 3000 MOM implants as a reference. If it goes bad... you can revise to a thr or short stem)
Pros to Corin mini stem Ceramic
Low wear
Cons to Corin mini stem Ceramic
ceramic can break, revision after a broken ceramic is often difficult (shattered parts of ceramic)
short history on the Corin mini stem
more bone loss than resurfacing
I'm really hesitant to push this issue with you, but I was told by a 'top doc' that I should get a THR. At my age (40) i was convinced that the bone sparing resurfacing was worth the risk.
Regardless, I wish you the best of luck in your decision process.
-Bernie
Hi Hbing1967
I wonder what hip resurfacing surgeon has given you a second opinon? Has he done a thousand or more resurfacings? If you don't use the surgeons that have done a thousand or more, they will most often suggest a THR.
I would suggest that you do some searching on the Yahoo surfacehippy discussion group about the surgeons you are using and the anterior approach. Nothing wrong with the anterior approach for THRs and from a surgeon that does hundreds, but with an inexperinced surgeon for a resurfacing it might not be the best approach.
One interesting story is posted here http://www.surfacehippy.info/hipstories2010/andrewsnyder10.php (http://www.surfacehippy.info/hipstories2010/andrewsnyder10.php) There are more stories on other sites. Just thought you might want to search a bit more.
There are excellent hip resurfacing surgeons in the US that have done 2000 or more resurfacings. I would check with them before you make your final decision. Get some info from the top surgeons - use the major league doctors, not the minor league surgeons. You only get one chance to have your hip done properly, make sure you use a surgeon that does thousands and thousands - they are the best in the business. You don't want problems since you only have two hips. Read the revisions stories and then use the top surgeons so you are not a statistic. It is easy to see who the top surgeons are.
Pat
Quote from: Hbing1967 on March 21, 2011, 12:04:35 PMthis is a very big and scary choice to make!
Keep researching.
http://resurfacingscan.be/drforeign.htm
Is an interesting list of surgeons done by someone outside the US. Snyder is on the list, scan to the far right for some anecdotal feedback on him.
My understanding of the anterior approach is that it is a solution to a non-existing problem with resurfacing. Typical small ball THR's are very prone to dislocation. This isn't nearly as much of an issue with large ball THR or resurfacing due to the size of the component. Posterior approach does require that you not cross you legs for a while during recovery, but my own research on my decision for a posterior approach was that the higher risk of nerve damage from the anterior approach was not worth the small benefit.
This study was for anterior THR's. http://www.orthosupersite.com/view.aspx?rid=65572 Note that it is generally assumed that resurfacings require a larger incision than a THR or 'mini hip, because the top of the femur hasnt been removed to allow access to the acetabular work required.
Please note that in your search for the device and surgeon that traveling a bit may be worth the effort and cost if you can manage it.
Hi Hbing,
I would run from Dr. Snyder if I were you. I am 4 yrs post op with RBHR and he still has not spoken honestly with me. I sent my xrays to two foreign surgeons on this website and they replied to me within 12hrs and explained to me more than he EVER has. I got all my office reports from him and some of my concerns were never written down. He did the GANZ on me without telling me before or after. Now he tells me I am not a good candidate to have BHR on my left hip...why? Because he wasn't experienced enough or cared enough. I was athletic as they come, played multiple sports in HS and college, ran everyday (well not everyday but...). He says..."you were very muscular", well if you couldn't notice that before surgery maybe you are in the wrong Sports Medicine/Orthopedic business wouldn't you say? I just want people to know...do your research, get the most experienced doctor that you can, and if it doesn't sound right...it's not. Are there more of Dr. Snyder's out there? I know there are worse off people out there than me, but I went with this procedure based on my own research and he was even on television; in a news report, he had to be good and experienced. I will make it though...one way or another.
Just thought I'd give an update on my hip and what I did. I chose to go with Dr Snyder and the corin mini hip, based on some very positive reviews here of Dr Snyder and his experience level ( taking a few negative ones into consideration, though I really felt they were outliers, as my research showed that he is very experienced in HR and THR), and also from talking to experienced professionals in this area. I had my right hip done on Monday, May 9th, and I am very happy with my recovery so far. I left the hospital yesterday to go home on Tylenol only, I had a bit of heavier stuff the day after surgery, but it made me faint and I honestly never really needed it. I'm really amazed. Today I am getting around the house well on crutches, and have even found it easier to use only one, though the doctor suggested waiting till Monday for that.
Anyhow, so far I couldn't be more thrilled. I'm amazed at how little pain I've had. The staff at the hospital was telling me that many of Dr Snyder's patients manage to go home never needing more than Tylenol, so I guess I'm not all that atypical. I'm not sure if it's my youth, being in decent shape, or the anterior approach ( no muscles cut) that make the biggest difference here, but I am a happy customer.
I am wondering if I should post in the THR section to give people more info about this who might not have the bhr as an option. The mini hip is really somewhere in between the THR and resurfacing, as there is far less bone removed than in THR. The trick is that ther aren't many people doing this yet in the US. The hospital staff told me Dr. Snyder was one of four in the US doing this particular procedure.
Happy that you had a successful procedure and you're feeling well. I had the same experience as you, with two resurfacing operations - low pain, tylenol and none of the previous pain. Best of luck with your new hip.
BTW - I loved the staff there, who did you have for PT and Occupational therapy?
Glad to hear all went well with your surgery. Maybe Dr. Snyder is more experienced now after "he did his own thing" with myself and others back in 2007. Got to start somewhere, right? When things go right, he is a wonderful doctor...of course, but when things aren't well...is he honest, have the answers? I am just a statistic, and probably not even mentioned as a "bad outcome", and that just isn't right.
Rolls,
You are far more than just a statistic. A lot of people read these posts. I find it very difficult hearing of people's very difficult experiences and everyone matters a great deal. One person with a poor result is 1 far too many. Good Luck with your recovery.
Jeremy
Thanks Jeremy. I am way past recovery, I am basically just living with it right now. Going to get my left hip done probably before Winter. Going to try Dr. Marchand from RI this time. I am really hoping it goes well, as I am putting a lot of faith in the BHR MOM, as it makes a lot of sense to me. My RBHR still does not have the strength of even my bad left hip, but I have to hope it will work out and believe it was just the surgeon not being experienced enough. I will keep you all posted regardless.
Rolls
Quote from: Hbing1967 on May 12, 2011, 09:38:02 AM
Just thought I'd give an update on my hip and what I did. I chose to go with Dr Snyder and the corin mini hip, based on some very positive reviews here of Dr Snyder and his experience level ( taking a few negative ones into consideration, though I really felt they were outliers, as my research showed that he is very experienced in HR and THR), and also from talking to experienced professionals in this area. I had my right hip done on Monday, May 9th, and I am very happy with my recovery so far. I left the hospital yesterday to go home on Tylenol only, I had a bit of heavier stuff the day after surgery, but it made me faint and I honestly never really needed it. I'm really amazed. Today I am getting around the house well on crutches, and have even found it easier to use only one, though the doctor suggested waiting till Monday for that.
Anyhow, so far I couldn't be more thrilled. I'm amazed at how little pain I've had. The staff at the hospital was telling me that many of Dr Snyder's patients manage to go home never needing more than Tylenol, so I guess I'm not all that atypical. I'm not sure if it's my youth, being in decent shape, or the anterior approach ( no muscles cut) that make the biggest difference here, but I am a happy customer.
I am wondering if I should post in the THR section to give people more info about this who might not have the bhr as an option. The mini hip is really somewhere in between the THR and resurfacing, as there is far less bone removed than in THR. The trick is that ther aren't many people doing this yet in the US. The hospital staff told me Dr. Snyder was one of four in the US doing this particular procedure.
Very interesting stuff hibing. I saw Dr. Snyder today and he told me I was a good candidate for Corin Minihip. He also told me he has performed 850 RESURFACINGS! Maybe that's not quite experienced enough to get listed on this website, but its far more than many others who are listed. ???
Anyway, my concern isn't with the good Dr. but whether the Corin Minihip will provide me with a better chance to regain my former running (National ranked sprinter, as well as marathons) ability.
I asked Dr. Snyder point blank why would one choose Corin Minihip (he has done 350 of these) vs BHR. He cited three things:
1. No metal on metal ion issues. I know long-term issues with that are controversial, but apparently 3% of people do have some kind of bad reaction after BHR.
2. Success rate - BHR is 90-91% (his statistic) due to various reasons. Corin Minihip has a 98% success rate, although I pointed out there is a much smaller sample size.
3. Recovery is much faster with the minihip because far less muscle is cut away.
None of that answers my question about returning to be the runner I was....
Quote from: Arrojo on September 27, 2011, 09:31:07 PM
I asked Dr. Snyder point blank why would one choose Corin Minihip (he has done 350 of these) vs BHR. He cited three things:
1. No metal on metal ion issues. I know long-term issues with that are controversial, but apparently 3% of people do have some kind of bad reaction after BHR.
2. Success rate - BHR is 90-91% (his statistic) due to various reasons. Corin Minihip has a 98% success rate, although I pointed out there is a much smaller sample size.
3. Recovery is much faster with the minihip because far less muscle is cut away.
None of that answers my question about returning to be the runner I was....
1.) There is no metal ion issue. There is a bad placement issue and a bad choice of device issue, and definitely an inexperienced surgeon issue. All materials shed debris.
2.) 90%-91% means it is done badly.
3.) I don't believe recovery can be faster than with a well performed resurfacing operation.
A mini-hip might be better than a conventional THR, but it is still a bone amputation device that does not anatomically match. Resurfacing patients seem to return to running most successfully.
D.
I agree with Lop. With the posterier approach I don't think there is much muscle getting cut, sure they have to spread things apart, but actual cutting of muscle? Although I wasn't awake much during the procedures, but I don't think with HR they do a lot of muscle cutting. I have heard that with THR you can get a smaller incision because the femur top if promptly removed so that you have more room to work with. They same might go for mini, sort of. don't know.
I believe that Dr Snyder is correct about less cutting of muscle in the direct anterior approach that he uses. In the posterior approach, most surgeons will be cutting (sometimes referred to as splitting or dividing) a few muscles, in particular the small external rotators. In a video of Dr Gross's surgery, you will see him cut and tag these muscles, so that they can later be reattached. There has been some debate on the web-site about whether a posterior approach is possible without cutting these muscles, but my doctor did not believe it was possible.
As a runner, my concern would be that the mini-hip still involves a stem that transfers the stress to the inside of the femur, and in this case the inside of the small remaining portion of the neck; whereas a resurfacing transfers the loads along a more natural path through the exterior of the bone. This internal loading is a main cause of stress shielding, which can lead to bone thinning.
The Corin Mini-Hip certainly looks like an interesting approach to a THR, but I am not convinced that it would stand up to impacts as well as a resurfacing. A 90-91% success rate with resurfacing does not sound as good as what the top surgeons are achieving.
Hbing
You are welcome to post a copy of your story in the THR section, too. It is nice for people to know their options. The Mini-hip and BMHR, etc are in between the resurfacings and THRS, so they do have a place on this site. I also don't mind having the THR folks post since their recoveries are similar to our resurfacing recoveries. Also, hopefully most of the THR folks have devices that will allow them to be active without restrictions.
Most of us personally prefer resurfacings, but sometimes you can't have one, don't want one or even need a revision. I welcome everyone to post as long as we keep on friendly terms since we all have bad hips and want to get back to an active life without pain.
Pat
I was curious to know what a mini hip was and found this,
http://www.youtube.com/watch?v=GqhOcDuK0n0
Quote from: Lopsided on September 27, 2011, 10:25:32 PM
There is no metal ion issue. There is a bad placement issue and a bad choice of device issue, and definitely an inexperienced surgeon issue. All materials shed debris.
My understanding was that a small % of Hip Resurfacing patients experience metal allergies from the metal on metal and that the effects of long-term metal on metal Ion discharge were unkown, (rather than "none"). I got that information directly from this website.
Quote from: B.I.L.L. on September 28, 2011, 12:41:46 PM
I was curious to know what a mini hip was and found this,
http://www.youtube.com/watch?v=GqhOcDuK0n0
Interesting. Which reminds me that Dr. Snyder also mentioned that with the minihip there are different sizes of the implants that go into the femur and also a left and a right "socket" implant. Intuitively, that seems better than a one-size fits all, but I am still leery of the newness of it all.
Goodness Vicky, calm down. The 90-91% was industry, I believe, not him. You seem to have a very clear vendetta against him. It makes you seem less than impartial. 850 Resurfacings, regardless of why he may not be listed here (and I edited my prior comment), is pretty experienced one would think. I certainly feel for Jeremy and anyone else who had a bad expierence with any surgeon.
I'd prefer to stay on topic here and focus on minihip vs resurfacing, without the sideshow. JohnC at least is a bit more rational - thank you for the explanation John regarding concern about running and the different stresses involved.
Quote from: Vicky on September 28, 2011, 03:52:51 PM
Here's a quote from the prior post
2. Success rate - BHR is 90-91% (his statistic)
What I meant by "his statistic" was that was the statistic he gave me for the industry, not his personal success rate. I am no expert in this, so I don't know if that is the correct industry statistic, hence my qualifier. I should have said "90-91% (what he says the industry standard is)". I aplogize for the misleading way I typed that.
There are a lot of people on this site who have RAVED about this Dr., not to mention a few I talked to personally. Anyway, can we get back on topic? ;)
How can HR/BHR be compared to a mini hip? Mini hip is still a THR and will still have THR related problems to some extent as you loose the femoral neck so loading WILL be different.
Vicky,
Keep on doing what you're doing, just the way you've been doing it! We newbies are counting on people like you to help us make a successful journey to the other side.
I elected to have Dr. Rector perform my surgery later this year after seeing your very positive comments about him. Your input was very helpful to me. What else do we have to go on except the information we can find on this website?
Thanks for all that you do.
Boomer
I absolutely agree with Danny and Boomer, you made an excellent choice, Dr. Rector is an outstanding surgeon. :)
Vicky
Vicky,
I see you are still a fiery little pistol ;) .... I totally agree with you Vicky, I've read far too many things about Snyder.
Guys, Vicky is spot on IMHO. Look up Snyder on Surface Hippy, then comeback here and tell me that all is well at Newton.
@Vicky I am glad to hear you're surgery went well.
Chuck
Quote from: Vicky on September 28, 2011, 03:52:51 PM
Here's a quote from the prior post
And I am calm, again, sorry if my passion comes across as anything other than a passion to truly help people. But these are all facts and again, I have the proof, contacts names and email addresses, etc., post numbers from other message boards to show the lies, etc. To me, there is something wrong with a surgeon that continually does that. Doesn't that bother you? I know it certainly bothers me, any a lot of patients come to me for facts.
Vicky
Note from Patricia Walter: New perspective patients, please understand that this person is stating his non-medical opinon that a hip resurfacing is a type of total hip replacement. I must note that it is not in my opinon and all the information I have collected during the last 6 years. Please read the later posts from myself, Vicky and Chuck, etc to learn the difference between a hip resurfacing and a total hip replacement.
Oh what the hell. Some people are going to blow a gasket, but I don't care: A Resurfacing IS a type of Total Hip Replacement. I repeat this in case you did not understand me: A Resurf is a type of THR. You get resurfed, you will undergo the same risks, and essentially the same benefits as a THR, ie dislocation, infection, fracture, loosening, DVT etc. You get resurfed, and acording to ALL CURRENT literature, your results are equivalent in the short, medium, and long term to a standard THR (pick your THR bearing, metal on metal, metal on plastic, ceramic on ceramic etc; pick your fixation cemented/non-cemented, really it doesn't matter) in terms of longevity, complications, pain relief, and even return to physical activities. Notice, I emphasize the word CURRENT. I think that with a resurf you can probably be more active, but I cannot cite ANY current scientific evidence to back that statement up. I had a resurfacing and now I am back wrestling, which is pretty frickin amazing. I don't think I would be wrestling on a THR, but I will never know because I don't have a THR, and my one story does not a scientific study make.
But the above paragraph is not really why I am posting. That was just a tease to get you guys thinkin about what I have previously posted about (which basically no one seems to give a damn about because I guess it's just not sexy): Here's what I really have to say: How do you know Snyder has done 800 Resurfs??? How do you know he's done 350 mini whatevers??? Answer: You absolutely DON'T. In the words of the famous bluesman: You don't know Diddley. You, (and me also for that matter) don't know because there is no National Registry where these numbers are kept. Ladies and Gentleman I submit to you that unless and until we get an obligatory registry, we can argue all we want about Snyder and any other surgeons, but we'd all be simply BSing ourselves and each other. We need an objective national data base. Once we have that we can answer all kinds of questions objectively such as best approach, best device, ideal candidates, best performing surgeons, most experienced surgeons etc. Gross tells his patients he's done over 2500. HOW DO YOU KNOW IT'S TRUE???? My own surgeon said he did "over a thousand". Maybe he did. Maybe he didn't. In the words of another famous Bluesman (paraphrasing of course): "I only trust my mommy. And she could be lyin' too".
Food for thought.
In the terms used today a THR is when the femoral head is removed and a shaft is jammed down the femoral canal and a cup is placed in the acetabular socket.
What is done during in a hip resurfacing at least from the femoral side has no similarity to a THR as you described above. The terms THR and Hip resurfacing for the purpose of any discussions are not the same surgery. I would have to respecfully and totally disagree with your whole first paragraph. You really risk losing credibility by saying that those types of surgeries closely resemble each other, they simply do not.
As a whole most people with succesful HRs end up having a more active life with less restrictions. This is not just conjecture but it's a fact.
In regard to Dr. Snyder, I've read so many posts about complications (again search yahoo's surface hippy group) that IMHO I would not want him on my short or long list of surgeons for my future left hip.
Chuck
although a THR and Hip Resurfacing (and Min-Hip) are different, they are also very similar. both would be considered "major" (not "minor") surgery. they are both NOT arthroscopic surgery.
i have read and been told that in the usa, the insurance code used is the same for these two different (but similar) operations.
Re: "As a whole most people with succesful HRs end up having a more active life with less restrictions. This is not just conjecture but it's a fact."
Dude, I'm sure you are a nice guy and all, but sorry: As of Sept 28, 2011 it totally is conjecture, and not fact at all. My sincere hope is that sometime in the future we will have some real objective data in this area.
Max, from the femoral side they are miles apart, yes, they accomplish the same results by re-creating a joint with a metal or plastic friction point I would agree.
Come on folks, with a THR you lose a huge section of your femur. With hip resurfacing you keep your femoral neck. That alone makes the surgeries miles apart.
Also bear in mind the doctors skills become more critical, not every doctor is a good hip resurfacing doctor, although they might have great results doing THRs.
Not everyone can be a pitcher in the majors.
Chuck
I do not know how anyone will be able to create a data set based on more active vs. less active. Maybe I prefer water skiing over snow skiing even though I know if I wanted to I could go back to black diamonds. If you have a THR chances are your doctor has given you restrictions, for good reason.
Ask any skilled doctor who has done both THRs and HRs, ask them which patient can return to the most active life. Sorry, but it's been well established that patients that have hip resurfacings are far less restricted post op. Just from an anatomical stand point a hip resuracing patient has a hip that is biomechanically more similar your original joint.
Sorry, you are a nice guy too but what you are saying goes against what the best hip surgeons in the world will tell you and that's a fact.
Chuck
Quote from: Eitan on September 28, 2011, 09:58:01 PM
Re: "As a whole most people with succesful HRs end up having a more active life with less restrictions. This is not just conjecture but it's a fact."
Dude, I'm sure you are a nice guy and all, but sorry: As of Sept 28, 2011 it totally is conjecture, and not fact at all. My sincere hope is that sometime in the future we will have some real objective data in this area.
Maxx
All of the surgeons trained and qualified to do resurfacing, are also trained and qualified to do total hip replacement surgery. The reverse is not true. Hip resurfacing is much more challenging from a surgical standpoint because the desired, and generally obtained results, are so much better for active patients.
I cannot think of anyone who would choose total hip replacement if their surgeon told them they were a good candidate for resurfacing. I also cannot think of any instance when a qualified surgeon would perform total hip replacement when resurfacing would address the problem.
The good folks on this website are trying to educate you. Listen up.
Now where is that like button on here?
Chuck
I'm looking for the paraphrase-it-for-me-paleeease! button, I need to go to bed.
Here's a thought with regards to trusting your surgeon. If I didn't trust my surgeon to tell me the truth about his experience, I don't think I'd trust him to cut into me arse. Although I do think a registry would be an excellent way to get some really valuable data.
BTW - I think this topic is very engaging and I like it when folks get fiery, once in awhile. Thanks folks.
Here's one for you. There may not be any proof about HR patients being more active than THR patients. But how Many people like say floyd landis or Corey fulks would be able to return to there level of activity with a THR? I mean there are even guys on here who probably wouldn't be able to do what they are with thr's.
Proof!
I just don't understand.
If there is something wrong with the surfaces of your hip joints, what do you do:
A.) Resurface.
or
B.) Cut the bone off and replace it with a compound system of various materials with multiple variables for error.
Well as far as I'm aware I may well be wrong but I've not heard of a study that proves scientifically that RS patients are able to be more active than THR patients but lets face it as you say lop it makes more sense why chop off perfectly healthy bone? And surgeons must be confident it's more durable as they would impose restrictions to cover there backsides otherwise. I was told by Mr Treacy when I asked what restrictions he would imposed on me with a BHR and he said "I don't like patients running marathons and playing rugby but plenty of my patients haven't listened to that and are still fine". Could you say that about a THR?
As I said before it's not conjecture, it's a simple fact, an resurfacing patient can be far more active doing activities that THR patients can't do.
Just ask any quality doctor who does/did both THR and Hip Resurfacings.
And to say that THR surgery is the same or nearly the same as a Hip Resurfacing surgery is just plain foolish, the only part that is the same is the cup.
Chuck
Quote from: Dannywayoflife on September 29, 2011, 02:13:05 AM
Here's one for you. There may not be any proof about HR patients being more active than THR patients. But how Many people like say floyd landis or Corey fulks would be able to return to there level of activity with a THR? I mean there are even guys on here who probably wouldn't be able to do what they are with thr's.
I believe the term the results speak for them selfs sums it up quite well.
Danny, we do need proof, and you can help, as you have not had the operation yet. We need a controlled experiment. You might want to contact Mr. Treacy beforehand to agree to this.
This is it:
You get both hips done at once, the bad hip gets a resurfacing, and the good hip (the control) gets a conventional replacement. Then you can report back about the recovery and life afterwards, and provide the rest of us with definitive proof.
Now, I know this is not what you were envisioning. But considering your GP originally recommended you get a THR on your bad hip, not necessarily by an experienced surgeon, you would actually be getting significantly more.
Plus, you would be given all us other hippies a good laugh, I mean some useful information.
D.
Hmmmm let me think......... Much as I like the idea of pushing the envelope. I'll have to pass on that mate!
;D
No! You don't want it do you.
But if I was offered a resurfacing on my good hip, I would take it.
Hell no I hope that when I'm done that I never need a THR! The thought of all those restrictions fills me with dread!!!!
Quote from: Eitan on September 28, 2011, 09:58:01 PM
Re: "As a whole most people with succesful HRs end up having a more active life with less restrictions. This is not just conjecture but it's a fact."
Dude, I'm sure you are a nice guy and all, but sorry: As of Sept 28, 2011 it totally is conjecture, and not fact at all. My sincere hope is that sometime in the future we will have some real objective data in this area.
http://www.orthosupersite.com/view.aspx?rid=83509
I stand corrected! :)
Quote from: einreb on September 29, 2011, 08:45:07 AM
Quote from: Eitan on September 28, 2011, 09:58:01 PM
Re: "As a whole most people with succesful HRs end up having a more active life with less restrictions. This is not just conjecture but it's a fact."
Dude, I'm sure you are a nice guy and all, but sorry: As of Sept 28, 2011 it totally is conjecture, and not fact at all. My sincere hope is that sometime in the future we will have some real objective data in this area.
http://www.orthosupersite.com/view.aspx?rid=83509
I am getting confused now. Which way is this thread going?
I thought we were debating the merits of HR and mini hip.
Danny,
That's the first thing we can agree on. ;D
Yes, this thread has come to the end of it's usefulness. At this point it's locked, if Pat wants to unlock it that is fine.
This is a Hip Resurfacing site dedicated to promoting this wonderful sugery. I'm sorry, but a total hip surgery and a resurfacing are not the same, with the exception of the cup. And if you get a chance look up what the really skilled doctors are saying about the benefits of hip resurfacing, many of them have done and still do total hip surgery. Ask them about the limitations of both.
As to who you choose as a doctor, please, pick and choose wisely. Search this site, search the yahoo surfacehippy group with the names of the doctors you are looking into. If you do not pick a doctor with lots of experience or one that has had a lot of failures you are playing with fire. I'm sure Vicky would be happy to tell you how she feels about various doctors too. IN the end, be the best patient advocate that you can be for yourself.
Chuck
I am going to make the last post on this thread because it is very important for new people to understand that hip resurfacing is not the same as a total hip replacement. Resurfacing only requires that the femur ball be reshaped to accept the femur cap that has a very short stem that is used to place the device. A THR requires that a large part of the femur bone be cut off, a long hole be drilled into the femur and a long rod be pounded into the long hole. Here is an x-ray showing the different between the large amount of bone removed in a THR compared to a hip resurfacing:
(http://www.surfacehippy.info/images/bhrthrdr.bloomfield.jpg)
Here is a sketch I did to better show the difference between a THR and a BHR. It is clear that the bone is conserved.
(http://www.surfacehippy.info/images09/thr%20bhr%20sketch09.jpg)
As the bone is conserved, it means that the gait and all actions of the hip are still operating in a normal placement. There are medical studies showing there is a more natural gait after resurfacing than a THR.
http://www.surfacehippy.info/gaitstudy.php
(http://www.surfacehippy.info/gaitstudy.php)
When a long THR stem is used, the placement of the femur cap and action of the hip is different than when the natural bone and surrounding tissue is in place. If you want to understand the negative reaction to the long THR stem, listen to several of Dr. Brook's video interviews. Videos number 4 and number 12 by Dr. Brooks explains why cutting off a large portion of the femur bone, drilling a long hole into it and pounding a long stem into the bone keeps the bone from functioning properly. Pounding the long stem into the femur bone also creates a large amount of pressure to your blood system and your heart. Mr. McMinn had a relative die during this procedure due to the increase in pressure thru the heart valve. This has not been studied much, but is an interesting reaction to such high pressure caused by pounding the long stem into the femur bone.
The best way to learn about the difference between a hip resurfacing and a THR is from viewing the video interviews of the top surgeons. They do an excellent job of explaining the difference and explaining why they prefer to give patients hip resurfacings, when possible, instead of THRs.
http://www.surfacehippy.info/shvideos/videosdoctor.php
(http://www.surfacehippy.info/shvideos/videosdoctor.php)
I would also like to add that a mini-hip, as I understand, is still a version of a THR since a portion of the femur bone must be cut off. The BMHR is not a THR in my opinion because although there is a larger stem than a BHR, a large portion of the femur bone is still conserved and does not have to be cut off. To me the real difference of resurfacing devices and THRs is how the femur bone will react after the device is in place and how much of the femur bone must be cut off. Any device that is placed deep into the femur bone prevents the bone from reacting normally. We can discuss this for a long time, but since the website is about hip resurfacing, I want to continue to concentrate on the advantages of hip resurfacing.
This website is my personal project to help people learn about hip resurfacing. I have a BHR placed in 2006 and know of thousands of others with great outcomes of their hip resurfacings. I am very pro hip resurfacing and that is the purpose of this website. I understand people want to learn about all options and don't mind discussions about resurfacings, THRs, devices, doctors and outcomes. I don't, however, like to dedicate too much of the website to trying to convience people that THRs are better than hip resurfacings. For the large majority of us who received hip resurfacings, we are very happy with our outcomes and want to share our stories with other perspective patients.
Pat
Hi Chuck,
Yes, I think it is in my nature to ALWAYS be a fiery pistol! Always have been and always will be. LOL. Thanks for the kind words about my new hip. This recovery has been nothing short of amazing. I agree with many of your points.
Hope you are doing well.
Here is an excerpt from that article, you need to purchase it to get the full article
"The results of conventional hip replacement in young patients with osteoarthritis have not been encouraging even with improvements in the techniques of fixation and in the bearing surfaces. Modern metal-on-metal hip resurfacing was introduced as a less invasive method of joint reconstruction for this particular group.
This is a series of 446 hip resurfacings (384 patients) performed by one of the authors (DJWM) using cemented femoral components and hydroxyapatite-coated uncemented acetabular components with a maximum follow-up of 8.2 years (mean 3.3). Their survival rate, Oxford hip scores and activity levels are reviewed.
Six patients died due to unrelated causes. There was one revision (0.02%) out of 440 hips. The mean Oxford score of the surviving 439 hips is 13.5. None of the patients were told to change their activities at work or leisure; 31% of the men with unilateral resurfacings and 28% with bilateral resurfacings were involved in jobs that they considered heavy or moderately heavy; 92% of men with unilateral hip resurfacings and 87% of the whole group participate in leisure-time sporting activity.
The extremely low rate of failure in spite of the resumption of high level occupational and leisure activities provides early evidence of the suitability of this procedure for young and active patients with arthritis."
No matter what THR's ARE definitely different than resurfacing, just no two ways around that.
Plus a top UK surgeon wrote this about THR's vs. Resurfacing and made a point, even though this was written a while ago, it is starting to show up in some of the recent ortho conferences I have attended.
The main point is the fat that is released when the bone marrow is invaded, you do NOT get that with resurfacing.
I apologize to those of you that opted for a THR or mini hip (same difference) but these are very important facts that newbies looking into surgery need to know. It is not meant to argue, put you down, make you feel bad, make us feel better, etc. It is strictly pointing out the cold hard facts. The majority of the top hip resurfacing surgeons have done more THR's than they have done resurfacings, just FYI, so they are truly the world experts. The majority of THR surgeons do NOT do resurfacings, too complicated, they don't have the skills to, they tried it and failed, they went to a training and said, this is way too difficult, I think I will just stick with THR's. It is NOT what is in YOUR best interest it is in THEIR best interest. If you think metal ions are an issue, then watch these six world renowned surgeons talk about the FACTS, what the negative press, the negative docs conveniently leave out. Like Paul Harvey used to say......heres' the REST of the story.
This should not be a battle, those that ended up with a THR, well all I can say is just because you made that decision, give the newbies a chance to listen to the cold hard facts. Pick a SKILLED surgeon, numbers do NOT tell the whole story, go by RESULTS. Anyone that wants opinions from some of the worlds top surgeons are welcome to contact me, I usually get responses within 24 to 48 hours, not several months like if you went through the normal routs on your own and tried to contact them yourself. I do NOT get kick backs, blah blah blah. I am a patient advocate that is here to educate the patient community. A THR is not the end of the world, but if you qualify for a resurfacing, my question to you is WHY in the world would you go with a THR?
And thanks again Chuck.
Vicky
Quote from: Vicky on September 29, 2011, 08:18:43 PM
Quote from: obxpelican on September 28, 2011, 08:18:45 PM
Vicky,
I see you are still a fiery little pistol ;) .... I totally agree with you Vicky, I've read far too many things about Snyder.
Guys, Vicky is spot on IMHO. Look up Snyder on Surface Hippy, then comeback here and tell me that all is well at Newton.
@Vicky I am glad to hear you're surgery went well.
Hi Chuck,
Yes, I think it is in my nature to ALWAYS be a fiery pistol! Always have been and always will be. LOL. Thanks for the kind words about my new hip. This recovery has been nothing short of amazing. I agree with many of your points, but why is it that I can no longer respond to this thread?
Hope you are doing well.
This thread delivers, thats all I'm saying. Tons of information and entertaing as well. ;D