Dr. Robert Trousdale at Mayo Clinic in Rochester, Minnesota

[jakemn]

Pat, thanks for this great wellspring of information.  I am a newbie here, and have been
recently reading a few posts regarding folks searching for HR doctors in Minnesota.  I thought
I would throw my two cents in here regarding my recent visit to the Mayo Clinic in Rochester, MN,
for my hip pain.  So, for what it's worth, here goes...

I'm a 50-year-old active male with right hip OA for about 5 years. Since I actually live in Rochester, MN,
I finally decided to call the Mayo Clinic for an appointment with Dr. Robert Trousdale. 

Pat, you had mentioned him in another post from June, 2007, with the topic "need doctor from minnesota". 
I can verify that the contact information you provided at that time is still correct, and is shown below:

Dr. Robert Trousdale
Mayo Clinic
200 1st Street SW
Rochester MN 55905
Appointment Secretary: Beth Swarthout
507-284-9218
Mayo Clinic - Dr. Troudsdale Website


I had my initial evaluation with Dr. Trousdale in April, 2011 (last month). Here is the summary of my experience and the Q&A of my initial visit.  This is my personal opinion and impression of my visit, so you can take it with a grain of saltif you like, but it is completely truthful to the best of my recollection.

The morning started off on the 14th floor of the Mayo Building with a comprehensive set of hip x-rays,
After the required ream of paperwork was reviewed, filled in, and returned to the reception desk, it was a few steps over to the half-full imaging waiting area. I just love the little flashing, wireless pagers they give you there to denote when they are ready for you, just like down at the "Outback Steakhouse".  I hardly had a chance to sit down when my little coaster starting flashing it's red LED's at me. The folks in the ortho imaging area are highly efficient professionals that got me in and out in about 30 minutes.  Then it was next door to wait for my actual doctors appointment. Approximately 45 minutes past my appointment time, they finally brought me back into the bowels of the ortho exam corridor.  After waiting about 90 minutes alone in an exam room (I just couldn't crack the passcode on the exam room pc to play solitaire), a resident came in to greet me and do the cursory background and preliminary evaluation and look-see at the x-rays.  Seemed like a nice chap, answered a few questions I had with politically correct answers so as to not step on the toes of "the boss", and went on his way stating that Dr. Trousdale would be in to see me in a short while.

To be sure, Mayo Clinic is a teaching clinic and hospital complex, so after numerous visits to the clinic
with anything from earaches to broken bones with the kids, I knew full well going in that there would be at least two students and/or residents in tow with Dr. Trousdale, and I was right.  After an additional half hour, Dr. T, the resident, and a wide-eyed medical student came in to the exam room. 

"So, what can we do for you today?" he asks, while pulling up my x-rays on the exam room pc screen, not fully understanding why his stored password didn't seem to take immediately.

I told him I had been suffering from right hip pain for about 5 years. It could be attributed to cumulative falls on the ski hill, mosh pits, water skiing injuries, martial arts, etc.  and that I've been walking with noticeable limp for few years now.   It's been harder to bear weight on right side, with an occasional near collapse.  The pain's getting progressively worse so that sleeping sometimes is an issue (a key thing to mention, by the way, to get some attention on the initial reservations phone call), and it's impacting my quality of life (another key phrase to latch onto). It's been hard to put on socks/shoes, my flexibility drastically reduced, etc.  I have been using the glucosomine-chondroitin tabs for about 3 years; seems to mildly help, but becoming less effective.

After staring at my x-rays for about 10 seconds, he pointed out the missing gap between my femur head and the hip girdle socket, inferring at least a partial lack of cartilage in my right hip, and the start of some bone spurs in a couple of spots, meaning that my bones are "reacting to that reality".  At this point, he didn't seem too dismayed when I pulled my 1-1/2 sheets  of printed questions out of my folder to start the interrogation.

I asked his opinion of cortisone injections into the hip joint.  He said in his experience, he thought it would only provide a month or two of real pain relief, if that, and he did not recommend it in my case.  I explained to him that I had been doing a bit of research regarding hip resurfacing vs. hip replacement and wanted his opinion of my options. He explained that if it were him or his brother sitting there in my place, he would opt for standard total hip replacement. I was somewhat shocked to hear this coming out of his mouth.

"How many hip resurfacings have you personally done?" I asked.

"Over two hundred." came the response.

"And how many standard total hip replacements?" I followed up.

"About ten thousand" he calmly replied.

In my mind, that instantly explained where he was coming from.  He went on to explain to me that he knew about all the opinions out there about how resurfacing saves more of your thigh bone for later revision, etc., but he said it depends on how you look at it.. the acetabular cup is bigger, and you can have problems on the hip girdle side with revisions just as much as you could have problems dealing with a THR revision.  He explained it's statistically a dead heat in the fail rate and/or revision data between HR and THR, so why not go with an option that gives you slightly better movement and flexibility, which is the standard total hip.  Again, I was surprised to hear this opinion.

Wanting to focus more on the resurfacing, I pushed him harder on that option. 

"About how big would my scar be after resurfacing surgery?" I inquired.

He held up his right hand with the forefinger and thumb spread apart as widely as possible, which
looked to be about 7 to 8 inches.

"What type of device do you use for resurfacing?" I asked.

"The Conserve Plus system by Wright, with a posterior approach" he replied. 

"That's surprising to hear.  I thought perhaps you used the BHR implant system.  There's a website called 'surfacehippy' out there on which someone mentioned you were a BHR device doctor."  I explained.

"I've heard of the website, but never personally visited it.  The only people I have ever used a BHR implant on are dead people."  he joked.  "Cadavers in the implant lab, that is."

He went on to explain that he had tried numerous trials in the cadaver lab with about 5 different implant systems a few years ago, including both the Conserve Plus and the Birmingham devices.  He simply thought the Conserve Plus was the superior resurfacing device for fit, retention, installation, and functioning, so he prefers using that particular solution.  He said that he knows of no other Mayo Clinic surgeons that are currently using, or that have used the BHR device. When I asked if any other doctors perform hip resurfacing, he mentioned that one of his colleagues, Dr. Rafael J. Sierra, also performs hip resurfacing, but that he had been using the recalled DePuy ASR system, up until the recall notice.  I did not continue with that line of questioning regarding Dr. Sierra, so I did not find out what device he employs now (but I do know it is not the BHR system).

"How may failures and/or revisions have you done out of your 200 resurfacings?" I asked.

"Only one so far, and that was due to femural head fracture." he answered.

"Now, once again, about those cortisone injections.. what type of imaging do you use for.." I began.

"I already told you. I'm not doing that in your case, so it doesn't matter" he replied, cutting me off.

I was somewhat pissed off at this point, feeling a bit like being back in Mrs. Geislemann's third grade class
when I tried to speak out of turn.

"I don't suppose Mayo Clinic has any orthopedic patient blog databases, or any other patient resource that
I can use to contact any of your resurfacing patients to ask them about their experience or results?" I asked.

"No, that would be illegal." he responded.

Now, don't get me wrong here.  Even though Dr. Trousdale is definately not the type of doctor who is going to pat your hand and tell you everything's going to be just fine, he is a no-nonsense straight shooter that gets right to the point. He explained, at the end of the day, he and all doctors have to deal with patients that are biased in their viewpoints, one way or another, and he knows that I am biased toward resurfacing and against total hip replacement.  So, it's really up to me to decide which approach I want to go with.  He told me that with either choice, I would probably be in the hospital for 2 to 3 days, and would be in the pool and on the stationary bike after about two weeks, and after about 6 to 8 weeks, for the most part resuming my normal activities with very few restrictions.  He also told me that it really didn't matter if I decided to have the surgery next week, or wait for a year or two, because it wouldn't make it any more difficult for  surgery options if I wanted to wait. So, in that respect, it was a pretty low pressure sale.

As an aside, I spoke with Dr. Trousdale's scheduling secretary Beth (listed above) just hours ago, and she was quite pleasant  and knowledgeable. She informed me that the lead-time for scheduling surgeries with Dr. T is approximately 6 to 8 weeks, so call ahead when you make your decision and get your insurance loose ends decided upon.  The cost would be somewhere around $50K for a total hip replacement, and somewhat less for resurfacing, around $45K.

I will probably call St. Croix Orthopedics and set up a second opinion with either Dr. Palmer or Dr. Panek, and see what they have to say about the BHR system.  If so, I will post more info after my appointment.

Peace Ya'll,

Jake in Minnesota

[Lopsided]

Jake, resurfacing is not just Birmingham. There are many devices. I got the Conserve plus which my surgeon thinks is better, and I am happy with it.

From my days in sport twenty years ago, it was well known then that the short term benefits of cortisone injections are outweighed by the long effects.

... an option that gives you slightly better movement
and flexibility, which is the standard total hip.  Again, I was surprised to hear this opinion.

Well then, he ain't doin' it right.

[DirkV]

Hi, If you are thinking of getting a 2nd opinion, you might consider the guy in Madison, Rogerson I believe. He seems to have a lot of satisfied patients on this board. From personal experience driving some 6 hr for my resurfacing, it was worth it to find a good surgeon, good communication, etc. I think Rogerson is very well suited for somebody traveling because of his rehab protocol.
Good luck,
-Dirk

[jakemn]

Thanks for your feedback guys... keep it coming.

lopsided - I was wondering if you could expand on your experience with the Conserve Plus implant, how the surgery went, the details and timeline of your rehab, etc.?   Did Dr.  De Smet elaborate at all on Conserve Plus vs. BHR and the reasons for his preference?  This seems to be a very pro-BHR site, and I  haven't found a lot of info or feedback here regarding the Conserve system.  Apologies if you have already posted this info in another place.. I'm new here and haven't had a chance to poke around very much.

DirkV - yes, I had read a couple posts on here about Rogerson.  Madison is only about 4 hours from Rochester, so it's a possibility.  The St. Croix clinic has a handful of branch clinics in the twin cities also, which I frequently visit, so I could be slipping into the "locality is best" syndrome a bit :)

Is anyone on here a patient of either Dr. Palmer or Panek from the St. Croix clinic?

[hernanu]

Hey Jake, as lopsided noted, there are several HR devices in play, mine is the Corin (Stryker in the US) Comet, which I had inserted in both hips.

There are some differences in the makeup of the different devices, but the main idea is similar in that they are minimally invasive to the bone, "capping" the bone. Check out the "HR devices" section of this web site for good explanation / descriptions of devices that are in use and some not in use any longer (ASR).

There are also devices which some of us had implanted that are for situations where a resurfacing is not indicated, but are not full total hip replacements, like the minihip or the Birmingham mid head resection. We have serveral members that have had these implanted and seem to be doing well.

This is a great web site (thanks Pat) and gives us all a leg up ( ;D) when dealing with these issues.

[Lopsided]

Dr. De Smet compares the C+ with the BHR in this document:
    http://www.hip-clinic.com/media/docs/BHRCONSERVEFINAL_LOWRES.PDF

He has used ten different resurfacing devices,
    http://www.hip-clinic.com/en/hip-info/treatment/resurfacing-prostheses
so there is more to the resurfacing world than just the Birmingham. Some devices are better than others. You must do your own research.

I specifically wanted an uncemented device, and Birmingham does not do one.

Two days after the operation, I walked one kilometer (pausing for rest three times). Now, nine months out, not only does my operated hip feel better than the other side, it is the smoothest joint in my body.

D.

[Lopsided]

As you might note from the picture,
Hernanu's enitre body has been resurfaced!!

[hernanu]

As you might note from the picture,
Hernanu's enitre body has been resurfaced!!

One can only dream....  8)

[cwmoto]

I have relatives in Minnesota. I believe there is more than one doctor doing resurfacing in MN. Driving a few hours may be worth it.  I live on the west-coast and drive 4 hours each way to go to the surgeon I like. This week I had a doctor visit that took about 30 minutes, while the drive was 8hrs total. Driving from  Rochester to the twin cities is easy IMO. [I have the C+, as my doctor prefers the installation process of the C+ over the BHR and he has  implanted both types.]