In my endeavours to find the most experienced surgeon I received this reply:
Dear Simon
Re: Resurfacing hip replacement.
Many thanks for your correspondence regarding hip replacement surgery. Resurfacing procedures for hip replacements have been considerably controversial in the last 12 months, in Australasia particularly. One particular resurfacing design has been taken off the market because of poor results.
In this scenario, it has been the trend of our practice to reduce the number of resurfacing replacements done in the last couple of years. We now offer conventional total hip replacement but with materials that will hopefully last 15 years in 90% of individuals.
I wouldn't, in 2011, recommend a resurfacing for a 42 year old. The results for resurfacing do not match up on the New Zealand and Australasian registry to conventional total hip replacement surgery.
I hope you find this information useful. Please let us know if we can be of further help in the future.
Kind regards
Dictated but not sighted by
Kevin Karpik FRACS
I am not overly concerned about this response mainly because it lacks facts and stats to back up his "scenario". I thought it would be good toget your responses to this & see if anyone knows what he's referring to. Is he referring to the ASR recall?
On the upside I have received back answers to my questions from Dr Hugh Blackley who has confirmed he's the most experienced resurfacing surgeon in NZ - according to NZ Joint Registry and Smith @ Nephew. He's done over 600 BHRs (he does about 100 per year), was trained in Birmingham, device is BHR (hybrid). He's had 5 failures - 2 fractures. 2 loose cups & 1 infection. The surgical approach he uses is posterior.
As always - welcome your feedback above.
Cherz
Simon
Quote from: procters on June 25, 2011, 08:40:40 PM
... hopefully last 15 years in 90% of individuals ...
That's not good enough. The correct solution should be, 'it could last for life.'
D.
Quote from: procters on June 25, 2011, 08:40:40 PM
Resurfacing procedures for hip replacements have been considerably controversial in the last 12 months, in Australasia particularly. One particular resurfacing design has been taken off the market because of poor results.
...
I wouldn't, in 2011, recommend a resurfacing for a 42 year old. The results for resurfacing do not match up on the New Zealand and Australasian registry to conventional total hip replacement surgery.
It sounds like he hasn't a great deal of experience with resurfacing to buy into the media hype about failed products. As some of the top surgeons have commented, like McMinn, the ASR was a poorly designed device. I personally wouldn't compare it to the BHR or the Conserve + or many other devices that have had great results when implanted by
experienced surgeons.
I don't buy the comment on the joint registry either. The reports have shown better results than those that he has claimed for the THR. This may be that I haven't seen the NZ registry and am pulling data from the Australian registry, though I wouldn't expect to see that much of a difference.
I totally disagree with his comment about a 42 year old should get a total hip and not a resurfacing. I just can't fathom the logic in that.
Blackley seems like the way to go.
Hey Simon, I believe he is talking about the ASR for sure. I happen to have had two ASR's put in left and right hip nov 2008 and my life couldn't be any better since my surgery. I am super active doing all kinds of impact stuff and have never had a problem.
When i had consults before my surgery with like 5 different docs there were some that told me resurfacing is a total failure and they wouldn't touch it. Well I found a pro resurfacing doc who did a fantastic job for me and I believe if you can save more of your bone you should. Good luck and do your research.
Wayne
Great thanks all for your feedback.
I'm going to fly up to Auck for a consultation with Blackley next month - all going to plan.
Waney-O - It's great to hear first hand about people who have had resurfacing and are back to an active life. I can't wait & are actually starting to get pretty excited about having it done ...after a bit of apprehension. What sort of impact stuff are you up to?
S.
Does anyone else feel a responsibility to spread the news about hip resurfacing?
The advice I got from the first orthopedic surgeon to wait for a THR. It sounds like most of the people on this site have had the same experience.
So I now i feel like I need to spread the word so that friends and associates that may have the same hip issues can at least be aware there may be an alternative.
Hippy evangelist, Dan.
Hey Simon, So far in the last 2 and a half yrs post surgery I started surfing at 4 months post op, snowboarding 4 1/2 months post op, baseball,tennis,racketball after 6 months, windsurfing at a fairly aggressive level (which happens to be my big love in life) at the 12 month mark, ice skating roller hockey, trampoline jumping, running minor distances. You should be excited to have this surgery because it is a life changer. Just a note in my situation prior to surgery I got to the point where I could barely even walk anymore, even sleeping was painful. So now, not feeling that anymore is just the best feeling to have.
Wayne
and the hits keep on roll'n.........
["Simon
I do not do hip resurfacing due to the controversy over metal on metal bearing surfaces
I believe ceramic on ceramic bearings are potentially better for younger patients like yourself
If I can be of help am happy to see you and discuss further
Thanks for your enquiry
Haemish Crawford
Hip and Knee specialist"]
This was the first email I read on my way to work this morning!
DCossack - you're spot on. So far I've had 2 from 3 recommend THR and over resurfacing and that's when they 'appear' to promote resurfacing on their websites! I have gone back to them both asking for more detail and suggesting they may want to update their websites.
Wanye - Sounds like nothing is holding you back now. The activities you're now doing are all pretty high impact on the hip - particularly your passion windsurfing would give the 'wheels' a good work out. It's really motivational to hear this detail - my passion is squash which you'd know from racketball involves a lot of lunging and is high impact on hip - I've been unable to play competitively for 3 years now, or do other hobbies like diving (minimal - had to get my mate to put my left bootie on for me last time), fishing (can still do), tennis (standing still or taking painkillers), trailbikes (not at all), kicking balls around & playing with my 3 children (managable... but they're growing fast!) - so like all here just really just want to get back to a pain free active life.
S.
Dan,
I definitely feel like I need to be a hippy evangelist! In my case, Dr. Gross presented both the total hip replacement and the resurfacing option (I'm 65) and left it up to me to make the decision. As opposed to my first hip doctor, who does not perform resurfacing, and therefore did not give me that option. Dr. Gross basically told me that he though I would do well with either, same cost, same recovery etc. It just made sense to me to not have more bone removed than absolutely necessary, and since he was willing to perform resurfacing on this old female (not all doctors will), that was my choice, and I am very pleased with the results. Everybody I know is amazed at how quickly I have recovered. And I tell everyone who expresses interest about resurfacing as an option.
For somebody in their 30's, 40's or 50's, it should be a no-brainer to at least consider resurfacing, only so many doctors don't even mention it. It makes me sad to think of all the people, some of whom have posted on this site, that are told they have to suffer for several more years and then have a THR!
We need hippy evangelist T-shirts!
I'd be good to locate more than one resurfacing surgeon in NZ! He (Dr Blackley) does seem to be experienced and I'm booking consultation next month with him - but just for peace of mind it would be great to talk to others. Everyone else I've contacted in NZ seem to be driven by media and point me towards THR.
Does anyone know where the best place to look for resurfacing surgeons in NZ is?
This response is from Dr Hugh Blackley on others surgeons NOT reccomending resurfacing & I'm not filled with confidence after reading, however at least he's being straight up? Maybe I just need to accept the risks, have some faith & suck it up.
[Hi Simon
I think the comments below about metal on metal hips and resurfacing are quite valid.
There have been specific problems with the ASR hip resurfacing and hip replacement from DePuy.
This had led people to question all metal on metal articulating implants. (resurfacing and total hips)
The BHR appears not to be having these problems ( early failure and metalosis) to a major degree especially in young males.
However you the patient need to accept these risks and realize all artificial implants will fail by wear, wear particles and loosening.
The issue for young patients is preserving bone and tissue for inevitable revision and trying to reduce wear.
The answer is not easy, there is no perfect implant. ]
Kiwi,
That certainly does not sound at all reassuring! Maybe he just wants to make sure you understand there are risks, but I am not at all sure revisions are "inevitable"! I'm hoping someone on this site can refer you to another resurfacing surgeon in New Zealand for another opinion.
Personally I would give your Dr Blackley a lot of credit for trying to give a balanced picture, and a good reality check. His comment about eventual revision is supported by most long term studies on active people with THRs, which is almost all that we have to look at for long term track record. The theory that most of us believe in, is that resurfacing will change that track record, and will far out survive THRs at 15-20+ years, but there are very little statistics yet to support that. The only really long range study on MOM resurfacing is the one published by Dr Pritchett, that showed 99+ survival at 30 years, which was a major factor in my own decisions.
I would not shy away from Blackley based on that email. It was a pretty balanced picture based on existing data, with no promises based on theory.
Annie / John
Thanks very much for your thoughts. I agree with both of you. I'm certainly not writing him off as he's probably the most experienced BHR surgeon in NZ. He's done over 500 (not 600 as mentioned earlier) with 5 failures - 2 fractures. 2 loose cups & 1 infection. That's a pretty high (99%) success rate.
I guess because there seems to be only one experienced surgeon in NZ and every other surgeon's response here is to have THR, I was shying away from the reality of the email as opposed to Blackley himself.
I have this morning confirmed flights to Auckland for a consultation with Blackley on 26th July.
Thanks again for your feedback - really appreciate your balanced views.
Cherz
Keep us posted!
Quote from: John C on June 28, 2011, 03:49:41 PM
The only really long range study on MOM resurfacing is the one published by Dr Pritchett, that showed 99+ survival at 30 years ...
John, do you have a link to this study?
Thank you.
D.
http://www.pritchettorthopedics.com/articles/hip_resurfacing.pdf (http://www.pritchettorthopedics.com/articles/hip_resurfacing.pdf)
Above is the link, but since I have had lousy luck posting links, here is how to find it.
On Pat's site, go to the doctors list who have done over 1000. Near the bottom of the list you will find Dr Pritchett; click on his web-site.
Once on his site, click on the picture for "Recent Articles". Then click on "Hip Joint Resurfacing". Much of this article describes the failure of early attempts at resurfacing back in the 70's that used plastic cup liners. For the good news, scroll down to the fifth page, last paragraph on the page, which includes the following sentences: "For patients with metal articulating directly with metal, there were NO failures. The average follow up was 27 years. The results were excellent in each patient.......The longest follow up was 41 years."
This article is a good read, and among other things, concludes that there is no difference between cemented and cementless femoral caps.
Quote from: John C on June 29, 2011, 02:13:28 AM
http://www.pritchettorthopedics.com/articles/hip_resurfacing.pdf (http://www.pritchettorthopedics.com/articles/hip_resurfacing.pdf)
Above is the link, but since I have had lousy luck posting links
That is a fascinating article.
-Bernie
Pritchett uses "a little" cement in the femoral component. That's what he told me when I asked him. I'd like to see more studies by Pritchett partly because of this paper, but also because he's been researching HR since the 80s. At my last checkup, he said he is doing research on polyurethane (harder than polyethyelene) on ceramic but that that particular HR arthroplasty is far from being approved and used.
Why are we seeing papers like Pritchett's, the recent one from McMinn, even all of the qualitative info here on this website from everyone about how positive HR is and the rest of orthopedic community is still questioning HR? Doesn't THR have the same or even worse survivorship data? I don't get it? Are we in a bubble?
Hippy Evangelists Unite!
Dr. Pritchett's paper is a great find! Positive information on HR seems to be a rarity these days. I agree with the question as to why much of the orthopedic community is negative on HR, while the experienced HR surgeons are so positive.
That's part of the reason I went with him. He's very positive about HR but also very frank and a great scientist.
John C - Thanks for posting link, I've sent to Dr Blackley just in case he's not read it. He keeps reiterating "BHR will fail - If I get less than 5 year it's unlucky. If I get more than 10 years it's good". It's more to make me aware of risks than anything else - which of course I must be (aware).
Quote from: Kiwi on June 30, 2011, 09:58:45 PM
If I get less than 5 year it's unlucky. If I get more than 10 years it's good
Are we expected to get revisions every ten years? I don't think so.
While there are no guarantees, I would expect a well placed good device to last.
Re: "Why are we seeing papers like Pritchett's?"
Interesting stuff, and I have no reason to doubt his results, but where was this "paper" published? I read through it, and it looks pretty "rough" to me. The first paragraph makes statements such as "faster recovery, less pain after resurf than THR" which I am pretty sure no peer reviewed journal would let slide, as that is totally unproven. Does anyone have more info on this paper? Was it really published in a peer reviewed jornal? Thanks.
Well I thought Dr. Pritchett's paper was bloody marvelous.
Here's a link to what seems to be virtually the same study. It appears that there are some differences to the paper linked by John C, but I haven't had a chance to read through both. This one was published in an orthopaedic journal.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2311483/?tool=pmcentrez&rendertype=abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2311483/pdf/11999_2008_Article_165.pdf
I think the 2 papers he has on his website are what Flbrmike just posted, but there were no publish dates on the ones on his website. I actually asked him when they were written. Maybe he published them on his website before going into a journal. Not sure, but I'be happy to ask for more detail when I'm laying on the operating table before the main line gets tapped.
If you guys think I blabber here, you should see me when I'm on Oxy.