resurfacing to replacement - resurfacing ok'd!!!!!!

[maddy]

Hi, I'm due to see an OS next Wednesday. I know he does not do resurfacing, but I will get new xrays and his opinion, then send xrays to one or more OS that do resurfacing for second opinion...my top two choices are Dr. Gross in S. Carolina, or any of the docs in So. Cal. that carry my insurance (United Healthcare) and do a resurfacing that can be replaced later with a large head MoM....

I have been reading the total joint and surface hippy email lists for several weeks, but at this point my brain is spinning!

I can't find the posts which talked about which resurfacing acetabular cups can be used later in a large head MoM total joint replacement if revision is needed, but I know I read it once...

cemented/uncemented, the arguements are too esoteric for me.  I think leaving it to the doctor I pick would be best...

[maddy]

Well, wouldn't you know, someone just posted part of the answer to my question on the surfacehippy list!

"Resurfacing, BMHR/PER and Big metal head THR have been designed to the same cup and similar instruments.
 
This means the doc can open up prepare for a resurfacing first, check out the quality of the blood flow and fixation surface, decide whether to graft and use resurfacing or go to a BMHR/PER instead.
 
Even at that stage if he still has concerns about the anatomical restoration using the BMHR/PER he can choose to use a traditional THR. "

So, I'm guessing the resurfacing components would have to be the BHR and the per.   Who makes the PER?  What does PER stand for?

[Pat Walter]

Hi

Many people are confused when they first start thinking about hip resurfacing.

All of the major hip resurfacing systems - BHR, Biomet, Wright C+, ASR and Cormet and be revised into a THR.  They just match the size of what was your femur cap cup with the same sized MOM - metal on metal, THR femur stem.

Don't worry about how they can do a revision.  Worry about choosing a really experienced surgeon.  It is important that the acetabulum cup is placed properly for both a hip resurfacing and THR to operate properly.  A really exprienced surgeon will do the best job in placing the hip device.

The PER is very new and does not have much of a track record.  In fact, it is still in development as far as I have read. Dr. Crofford in Texas is one of the doctors working on developing it.  Herre is a temporary page about the PER  http://www.surfacehippy.info/per%20by%20mr%20richard%20field.htm   I have not had time to format it for a regluar page on the website.

The BHMR is also very new.  I have several stories about people that had those because they could not have BHRs.   Check the McMinn stories  http://www.surfacehippy.info/hipstories.php#Mr._McMinn_Hip_Stories_

Right now only 2 doctors I know of are doing the BMHR - Dr. Bose of India when he can get one and Mr. McMinn.  So you are limited to 2 doctors.

It is best to choose an experienced hip resurfacing surgeon and let them choose the device, surgical approach and PT for you. 

There is no way a non medical person can make all those choices.  You just don't have the medical and hands on experience the surgeons have.

Only Dr. Gross is basically doing uncemented hip resurfacing at this point. Dr. Su I believe did one because the person was allergic to bone cement.  There is a lot of controversary about which is better.  Even Dr. Gross will tell you he doesn't know until he gets some history which will take years.

Over 90,000 people world wide have cemented BHRS and they work great.  I am a person to go with the tried and true. 

So stop worrying - choose a really good hip resurfacing surgeon and listen the him/her.

Take a look at my list  http://www.surfacehippy.info/listofdoctors.php  and start there.

Dr. Gross is an excellent choice. He has many happy patients.  http://www.surfacehippy.info/hipstories.php#Dr._Gross_Hip_Stories_    You can see his new video interview here   http://www.surfacehippy.info/doctorinterviews/grossinterview.php

Relax, think about choosing a good surgeon - then come back with more questions.  We have been there and done that and can help you.

Good Luck.

Pat

[maddy]

Hi Pat, thanks for your reply!
I am in Arizona, and can't find any resufacing docs out here.  I can go to southern California, I have friends there who I can stay with for a couple of weks after surgery.  I can't go home right away, we are in a 5th wheel on 40 acres, and many animals to take care of.  I would be alone here except on weekends when my husband is home (he commutes across the state).

Amstutz does the Conserve +.  Can you tell me how it is different from the BHM?  I keep reading about other docs and the BHM or Biomet, no one mentions the Conserve + much, so it seems like it is less popular for some reason I have not ferreted out yet...

I know I want a resurfacing that can later go to a hip replacement with metal on metal large head.  No plastic for me, and no small heads!
I want stability, long life, and as much range of motion possible.

[Pat Walter]

Hi Maddy

The Wright Conserve C+ is a very good hip resurfacing device. Dr. De Smet often uses it when he can't get the right BHR size.  The hip devices are generally very similar - what is most important is WHO IS DOING THE SURGERY PLACING THE NEW HIP.

Choose a good experienced surgeon and let them decide which device is best for you. 

I have an explanation of the different devices here http://www.surfacehippy.info/hipresurfacingdevices.php

I also just put together the results of a survey of 855 hip resurfacing patients that I had posted on the website.  I went thru and tallied up what the most popular hip resurfacing devices were.  You will find this new page interesting  http://www.surfacehippy.info/mostpopularhrdevice.php

It gives you an idea of what devices are most used.  Don't forget only 2 systems are FDA approved here in the US - BHR and Cormet.  The other brands have their components approved like Biomet, Wright C+ and  ASR.  That means a surgeon can use them off label together as a system and have insurance companies pay for them.  I assume some time in the future the others will soon be FDA approved too.

Did you look at my list of surgeons to try and find someone close to you?  http://www.surfacehippy.info/listofdoctors.php

I hope that helps.

Pat

[maddy]

All good info, Pat!  Thanks much.  Yes, I have seen all of your links!
Unfortunately there are zero doctors listed for arizona...
It's good to know the C+ is also a good device.  The BHR gets so much attention, it's just natural to think it is the best, when I guess the reality is it's the one with the longest track record.

Exciting news!  After repeated searches this past month on the internet for resurfacing doctors in Arizona, I came up with one in Tucson that does BHR, trained by McMinn and Tracey!  Plus they take my insurance plan. 

I have a call in for more info on how many he has done to date...have you ever heard of Dr. M. Wade Shrader of the CORE Institute?

The blurb on their website was referring to first "computer aided" resurfacing in March of 2007, so hopefully by now he will have done over a hundred...will be anxious to hear back from them...

here is what I found so far:
http://www.thecoreinstitute.com/pages/hip_resurfacing.php

My initial appointment for xrays etc is tomorrow.  The Orthopod I'm going to is a hip replacer, when I made the appointment I didn't know about the resurfacing, but it's a start.

[Pat Walter]

Hi Maddy

I am glad you found a surgeon.  Please let us know more after you meet him.  Try to find out how many hip resurfacings he/she has done.  It is always good to know about the doctors.

The really experienced surgeons don't like the computer aided surgery and find they can place a hip better than the computer.  However, they have done thousands.  The computer aided surgery is great for the newer doctors and means they should do a better job on you when they don't have a lot of expereinced.

I posted a CAS for Surgery - Computer Aided Surgery Video on this page - you might find it interesting

http://www.surfacehippy.info/shvideos/videos.php

Good luck and keep in touch.  We want to learn about the doctor and the computer aided surgery too.  You will be able to help others by sharing your experience.

Pat

[maddy]

Hi Pat, well, I'm back from my first consult, with the hip replacing OS.
Xrays show my hip is "very bad", he said. 
To me the ball looks quite flat on top where it is grinding on the socket (bone on bone)

Well, as expected, he poo pooed resurfacing, said it was a fad, that the doctors doing it would be switching back to replacing within a few years, high blood loss, many more muscles cut, much harder recovery, etc etc.
About what I expected to hear.
I asked him what type of device he uses, he said the old "tried and true" which is the plastic socket and small ball head.  I told him I would not consider plastic, IF I had total replacement it would need to be big head MoM, he said he could do that, and has in the past.  I believe he "defaults" to the plastic if patient doesn't know any better.  He told me about metal ion concerns, I told him I was more interested in plastic particles and disintegration, plus range of motion...

I asked him what percentage of replacements need revision, he said about 1% per year, so at 10 years that would be about 10%.  Sure sounded high to me, is that normal?

SO I have a surgery date for August 26, but I made it plain that I would seek to find out if I was a candidate for resurfacing...and got a cd with my xrays on it!

So I am ready to email my xrays around for free consults.

I also called the Doctor at the CORE Institute and got an appointment for June 3 for a consult.  They don't do free, and don't want the other xrays...
but this doctor HAS done somewhere over 100 BHMs and trained with McMinn!

For some reason in my searching I thought the CORE institute was located in Tucson, but it's in Phoenix!   And they take my insurance, so all is good there.  I may not have to travel out of state!

[Pat Walter]

Hi Maddy

Be sure to try and get some input from an experienced resurfacing surgeon.  I looked up the CORE institute yesteday and watched their computer aided video.

If you can't get to a really experienced surgeon, sounds like at least the CORE people should consider giving you a resurfacing. 

Many of us have cancelled THR surgeries.  I did when I learned about hip resurfacing.  They wanted to give me the old fashioned small ball plastic/metal thr.  That is not an acceptable option for anyone under 80 years old.  Glad you know that.

Stand you ground and try to get some more input about resurfacing.

You know by know that resurfacing is NOT a fad, there is not more blood loss and there are not more muscles cut and the recovery certainly is not harder.

There are thousands of us that are living proof of that.  I did not need blood and I was on one crutch at 4 days and none at 4 weeks.  I could do a deep knee bend at 4 weeks. Normal old fashioned THR people don't ever do that.

Keep looking until you get what you want.

Pat

[maddy]

Hi Pat, well this Dr. Shrader HAS done over 100 BHRs, according to his PA, so I guess he qualifies as being beyond the learning stage, although nowhere near the numbers for the Dr.s talked about the most on here...

I am sending my xrays off for free consults, other than Dr Gross and Su, do you know of any others in the US, esp. in Cal that do free consults over the internet?

Oh, also,  I can save the xrays to  JPEG or BTMP, do you know which one most doctors prefer?  The JPEG results in some data loss, the BTMP does not but the files are much much bigger....

thanks for all your help, it is so nice to know there are people out there to talk to, even if it is only handholding sometimes   

[Pat Walter]

A lot of people like Dr. Ure in northern CA.

Keith Ure, MD
300 Hip Resurfacings to date***
Doctors Park
635 Lassen Lane Suite 100
Mt Shasta, CA 96067
530-926-521
Email: info@doctors-park.net
Doctors Park Website


I don't know if he will give a free consult - but it would be worth a phone call to find out.

Many liked Dr. Vail also.  Again a phone call would tell you.

Thomas Parker Vail, MD
180 Hip Resurfacings to date
UCSF Department of Orthopaedic Surgery
500 Parnassus Ave.
MUW 320 San Francisco, CA 94143
Phone: (415) 476.1166
Fax: (415) 476.1340
E-mail: calcagno@orthosurg.ucsf.edu
UCSF Website

It always feels good to know there are people who understand and have traveled the path you are currently on.  It has not been easy for many people.  Some of us had to fly to India or Belgium to get what we wanted - so hang in there.

Pat

[maddy]

An update, Dr. Gross said I was a candidate for resurfacing! - pending a Dexascan which would tell him I need a THR if bone density is too poor.

I am going to the CORE Institute in one week, and they said they would take their own xrays, don't want the ones just taken, so I'm guessing they will do a Dexascan too, which I can then let Dr. Gross know...

However, I REALLY don't want to fly out of state to get this done, since we are on "short rations" -we lost everything in California wildfires, (between insurances, wouldn't you know) and starting over at our age is pretty hard to do.  At least we have medical insurance right now.

My husband would feel obligated to go with me, and we can't afford that, let alone me flying, so I am really hoping this doctor in Phoenix is a good one for resurfacing.

A poster on the surfacehippy email list went to him with her daughter, said he had done just over 60, but his nurse thought it was over 100, guess I'll find out in a week...

I'll post here what I find out, maybe we can have a surgeon on your list from Arizona!

By the way, when a doctor says he was trained by Dr. McMinn, do you have any knowledge of how extensive that training is?  Is it just a "juncket" where they go watch one or two surgeries, mostly an excuse for an overseas trip, then say they are "trained" or do they get hands on experience and advice?

[Pat Walter]

Hi Maddy

If you don't feel you should be traveling to Dr. Gross, then see how you feel about the CORE doctor.  YOu will have a little voice inside tell you how you feel about it.  If you like the doctor and feel good about him/her - by all means use him/her. 

Sometimes it is difficult when you don't have a lot of money, I know about that.  I still owe over $18,000 on my credit cards for my hip resurfacing with Dr. De Smet in Belgium.  At 63, it is difficult to get large debts paid off.

If you find out more about the doctor, please let me know.  I am trying to only add new doctors that have done at least 100 hip resurfacings.  If you use him/her and like them, I will consider adding them with less.  A lot depends on how patients feel about them and how committed they are to hip resurfacing.   I am trying to keep the "bait and switch" doctors off the list.  They do a few for the perfect candidate, but often suggest THRs since they are easier.

I have no way of knowing the extent of the surgeons training.  Some only train on cadavers.  It is difficult to get too detailed about the doctors background. I do the best I can.  I go a lot on what patients have to say and how easily their recoveries are.  You can always ask a doctor about their training experience and let me know.

Good Luck. Keep in touch.

Pat

[xocy]

The cost would be the airline ticket to Columbia and the hotel located on the campus of the hospital (Marriott) is $93 per night. My point is that it might not be as bad a you think.

Good Luck

[maddy]

Yes, it would add about $1000 to the cost, not peanuts in my book!

[drmike-s]

Hello Maddy,

Check out Dr. Schmalzried in Los Angeles.  He's a very experienced orthopedic surgeon who by now has performed more hip resurfacings than most U.S. surgeons.  I consulted him about 4 years ago before having a Rt. BHR by Koen De Smet in Belgium.  Dr. Schmalzried has done more than 500 procedures
by this time.

Good luck!
Mike Sulman

[maddy]

Thanks, Mike!

 Well, my appointment with Dr. Shrader at the CORE Institute didn't go well.  He has about 70 resurfacings under his belt, with no complications, but that is because he essentially "cherry-picks" his patients.
 
1. He believes there is no point in anyone "older" like me at 60 getting anything other than a replacement, and a plastic one at that.
 
2.  He has seen (what sounded to me like VERY SLIM) evidence that Metal on Metal causes cancer in some patients
 
3. He thinks those who are doing resurfacing in older patients and are doing many resurfacings are "in bed" monetarily with the applince companies (My words, not his, I can't remember exact words, just relaying the "gist" of his arguements)
 
4. At 60, and being a female, the chances of my bone being strong enough is pretty much zero in his opinion. (I did get him to order a Dexascan)
 
5.  He said even if I have a good bone scan, I have a large cyst, and he doesn't do anyone with those, doesn't even consider bone grafting.
 
6.  He agrees that so far the resurfacings seem to have a lower failure rate than replacements, but at my age he thinks that should not be a factor (boy did THAT piss me off) He essentially said a replacement and one revision should be all I need at my age, after that I will be dead.
 
7.  He thinks the excellent resurfacing records from Europe and India are not accurate, said it's too early to tell, here the rates are worse.  I pointed out that most of the doctors here are in the learning phase, where one would expect more failures, he didn't disagree.
 
8.  He said the FDA had not approved the resurfacing for woman 60 and over
 
So all in all, if anyone in AZ wants a resurfacing, you better be young or plan to fly out of state.
Also, because he is only taking on "easy" uncomplicated cases, he probably is on a pretty flat learning curve.  Anything not simple and straightforward would default fast to a replacement.  Plastic at that.
 
I guess our little backwater state is gonna stay behind the times in this field for years to come, this guy is the "most experienced" resurfacer...

Now I have to try to contact Dr.'s Ball, Smalzreid, and Ure and see if any of them would schedule me on the basis of my existing xrays, or if I have to go see them first and have a consultation/workup in their office.  I need to get someone lined up fast, I'm afraid we might not have insurance after Sept when my husband's currant job is over...
 
maddy

[Michael Thompson]

"He essentially said a replacement and one revision should be all I need at my age, after that I will be dead."


Holey moley, that guy is heartless! 

good luck, I hope you find a good Dr. who know how to treat a lady!
 

[Pat Walter]

Hi Maddy

I am sorry - he sure sounds like a local yokel ortho!!   I had 4 of them tell me much of the same thing.

Heartless jerks!!!!

I was 61 when I had my hip resurfacing with a loss of bone density and cysts.  The newer less experienced surgeons seem to always use the same message

I am not very experienced and won't even think about doing a difficult case!!!!  That's what it comes down to.

Everything he said I can give you medical studies and info that shows it is incorrect.  I am not going to bother since it is all on my website.  Don't accept a small ball/plastic THR.  At least get a MOM THR if you end up going that route.

I know Dr. Ure will do older women.  I think one lady was 67 that went to him.

I definitely believe Dr. De Smet's records which are posted on his website are accurate. So are Dr. Bose of India.  I know many, many patients of theirs and have not heard of problems for the last 3 years.  When you have 7000+ memebers on Yahoo writing and now another 500 plus on Hip Talk, you hear a lot of the good and bad.  The bad is normally from the inexperienced US surgeons.  You can get on the Yahoo Surface Hippy Group and start reading the old messages.  It becomes frightening when you read some of the stories. I know of 14 lose acetabular cups that required revisions or second surgery to replace.  One doctor had 3 of them!!!  Now I know the people posting might not be real, but I pretty much believe what they post.

I get lots of personal stories sent to me via email.  I think most of them are ture.

Keep up your spirits and just look further.  You can get what you want if you find an experienced surgeon.  That's what you should use anyways - remember they call a doctor's work a PRACTICE  and we know why!!!!

Dr. S will often not do older women - so don't let him discourage you.  Dr. Ure is probably going to be your best bet.

Good Luck and keep in touch.  You can get what you want if you go to an experienced surgeon - I know because I have a great 2 year old BHR with absolutely no problems.

Pat

[maddy]

Please don't think I was quoting him verbatum, I was paraphrasing what  I took from him, not what he actually said in so many words.

If I was young and had no bone cysts,etc I would go to him, he just isn't gonna budge from what he sees as a surgery not needed by those of us that are "longer in the teeth".

The search continues....