Not sure Resurf of THR?

[MRoberts]

Great site, THANK YOU! 

I have lots of reading to do then I am sure I will have many more questions.  After spending a year trying to get a proper diagnosis on my chronic groin pain, two chiropractors, one physical therapist and a biomechanics “expert” later, the correct x-rays were finally taken and I found my way to an orthopedic surgeon.  That was last June and he told me I was only 37 to young for THR, and he wasn’t sold on the resurfacing though it would be an option.  One year later and the pain is now in the hip as well as the groin and ROM on the right leg is very limited.  (I HATE SOCKS!)  Glucosamine, Aleve and Tylenol do not seem to be cutting it anymore.    I am now on Celebrex and it seems to be a little better, first ortho doc still wants me to wait as long as possible, but conceded I am much closer.  Saw second Ortho today, local doc who has done only 10 +/- resurfacings.  I liked the fact that he told me considering my age I may want to go to Madison to Dr. Rogerson if I choose the resurfacing option.  Either way I will do the metal on metal, but I am also still confused as to the risk rewards.  He would not recommend one over the other, said it really comes down to a personnel choice. 

So far biggest concern I have read about with the resurfacing is, “…using the currently available cemented resurfacing prosthesis in a young, active patient, although conserving bone for a future revision, ironically almost guarantees that a revision surgery will be necessary at some point due to loosening of the cement.  In contrast, using an entirely cementless total hip replacement could potentially last a lifetime, even in a young, active patient.”

Before the pain got bad I played basketball three times a week throughout the winter , and even competed in a triathlon.  I downhill ski almost every weekend with the kids in the winter and do the typical outdoor activities in the summer.  I coach my 11 year old sons football, basketball, and baseball  teams, help out with my 8 year old daughters gymnastics club and swim club and would love to be able to play all these sports with the kids again.  My wife is more ready for me to have one of these two surgeries than I am, as the crankiness that goes along with the chronic pain probably wears on here the most.   She went with me today to the doctor and came away with many of the same questions. 

I know myself, I am a very competitive person and when I start feeling better I will probably, overdue it.  Heck a game of lighting on the basketball court with the neighborhood kids can take me out for a couple of days.  I am sure my size 6'4" 230 pounds doesn't help matters, and would that make a difference on the procedure choice?

Again Thank You!

Mike

[TomBuell]

Mike - You've probably already discovered that your story is similar to many of our stories - increasing pain, uncertainty and (in my case, at least) near desperation. I'm an active, large (6'5" - 260 lbs) guy and I chose the Birmingham Hip Resurfacing method because I found a great, supportive doc (Pressman in Pittsburgh) who explained to me very clearly about the procedure, the risks (a few) and the rewards (many). I had my surgery done on July 1, 2008. I only needed the right hip done now.
Sounds like you've traveled a long road getting straight answers, but I think you've come to the right place to find guidance on locating a good, experienced, doctor and asking the right questions.
Good luck, and hang in there. You'll be glad you did. Recovery may be a little slower than you want, but I knew the day after surgery that I had absolutely done the right thing.
- Tom

[Pat Walter]

HI Mike

Welcome to Hip Talk.

The opinions you get from doctors NOT doing hip resurfacing or less inexperienced ones will usually be that a THR is better and resurfacings don't last.  It is very common.  I paid 4 local orthos to hear that.

If you talk or consult with the experienced hip resurfacing surgeons that have done many hundreds or thousands, they will always try to give their patient a resurfacing. They know it is bone conserving, allows the patient to be as active as they want and gives them a hip that feels natural or normal.  That is just the way doctors think.

Resurfacing is a much more difficult surgery and some doctors don't want to learn while others are not capable of doing the surgery.  So they know they better give a patient a THR for a good outcome.

I have a story from a lady with a 16 1/2 year old BHR on my stories page.  There is no reason, according to most resurfacing doctors, for a resurfacing to not last as long as a THR.  The problem is there is no proof yet since they surgery hasn't been done for 20 years yet.

The cement is not the issue .  The bone growth is the issue in a device becoming loose.  THere are many discussion about cementless resurfacings but only 1 doctor does a number of them and it is Dr. Gross.  You can read some of the best doctors in the world opinion along with Dr. Gross on this subject  http://www.surfacehippy.info/faqcementcomponents.php   Even Dr. Gross who feels it is better states there is proof yet and the jury is still out.

So you can get a cementless femur component if you want.  All the acetabular cups are cementless.  There is a long history of sucessful cemented femur caps.

Since you have been very active in your life I would think you should conisder a resurfacing.  Since you are a tall person, I would make sure I used one of the really experienced hip resurfacing surgeons.  Dr. Rogerson has done 250 resurfacings and is starting to be experinced.  He still has not done some really difficult cases.  As I remember, he is still refering them to DR. De Smet in Belgium that has done over 3000 hip resurfacings.  He was my doctor.

There are some more experienced surgeons in the US if you look at my list  http://www.surfacehippy.info/listofdoctors.php

If you haven't read these articles they would be helpful  http://www.surfacehippy.info/visitorguide.php

I would also watch the videos about hip resurfacing and then listen to some of the doctor videos before I made up my mind.  http://www.surfacehippy.info/shvideos/videos.php

AFter investing some time reading and learning, I would then get some consults from the more expierneced surgeons.  They are free via email with most of the really experineced surgeons.

Pat

[MRoberts]

Thanks for the responses.  Right now all my problems are with the right hip, but the doctor yesterday did say that it looks like my left is starting to show signs of the same problems.  However he did say it is possible to go in and grind off the bone spurs that are mostly likely causing the early arthritis, and that could save the left before it get to the point where resurfacing or replacement are necessary.  The good news if you call it that is, my right hip is so bad it’s limiting my activity which is helping preserve my left hip.  Though I am sure the over compensating isn’t doing it any favors. 

I guess the first big question other than the two I asked above.  Was about the experience level of the Doc.  I had a long question typed up and as I went back the site to post it I read Pat’s response.  Thank you questions answered.

I defiantly have a lot of research to do, and as I do it more questions are sure to come up.  I guess the best course is to do the research, find out what the insurance will cover and then consult with some docs. 

Again thanks for just giving me a place just to write this stuff down.  I’m an engineer and my family likes to make fun of how anal I am and how much of an over planner I tend to be.  Heck it took me almost 6 months and 10 trips to Best Buy to purchase our last home computer.  This will help. 

Mike     

[DirkV]

Hi Mike, In case you haven't already discovered it, the Yahoo newsgroup http://health.groups.yahoo.com/group/surfacehippy/  is another great online resource. Your comment about the anal engineer made me think that you'd find that site interesting . I recall very involved discussions about cemented vs. uncemented and another where somebody determined something like at age x for a resurf, a person could run y miles (or play z games of basketball) per day and the prosthetic would wear out at when you are age 327. I'm just making up the specifics, but you can find that kind of discussion.
I could really relate to your comment about knowing it's time to seriously consider surgery - not being able to play with the kids, getting surly (or surlier than normal) when doing chores around the house, knowing it'll make me sore for the next day.
Regarding your interest in regaining a very active lifestyle, I didn't set a goal of getting back to higher impact sports (goals were hiking and bicycling and house/yard work), but at 4 months post surgery, things are going so well that I'm not thinking of whether but what timeline for things like playing hockey, tennis, and skiing. Skiing was the most recent aha moment: talking with a friend who lives in Salt Lake City, and I used to try to visit during the winter and get in a couple days of skiing. I haven't done that in 5 or more years, and just yesterday we were talking and it occurred to me that I'll be able to ski again!!
Good luck,and good researching,
-Dirk
Bilateral,03/08 and 04/08, Dr. Ball

[Pat Walter]

Hi Mike

I am also a Mechanical Engineer - BSME Carnegie Mellon 1966.  I like to look at all the medical studies and read the converstations about cement vs cementless.  The problem with the folks agruing what they think are technical points is - there is just no data to support it.  Dr. Gross even agrees there is none.  That's why he is doing the cementless version to gain experience and data.

So no matter how much folks want to talk, there is no solid evidence that cement in a resurfacing is a problem.  To date, it has not been a problem according to the experineced resurfacing surgeons.

I will be happy to post any published medical studies anyone finds indicating that cementless is the way to go and is currently sucessful.  Until then, I will still stick with my cemented BHR by Dr. De Smet.  He has done over 3000 and has not talked about any revisions due to the cement.

Just my technical input.  We all like to play doctor or engineer - but most of us aren't either.  Even if I were an engineer in the medical field - I still don't have the experience and input that an experienced hip resurfacing surgeon has.  So my words are only that - words, not even an opinion based on medical experience.  We still have to rely on our doctors for good information and published medical studies.

Pat

[MRoberts]

Again thank you for a great website. 

Well, I have decided to set a date for my right BHR.  I have given up on the idea of fighting with the insurance company (which is exactly what they hope for) and decided to go with a local doc who may not have the most experience with the BHR, but he comes highly recommend, plus I have a very high comfort level with him.  I have personally talked to a number of THR patients of his, plus a good friend of my fathers who had a BHR. 
I recently spent a bunch of time with this doctor at a swim meet (as our sons both swim for the same club) and he was recently at a resurfacing conference and had dinner with one of the BHR pioneers, I believe he said Dr. McMInn.  This conversation, along with the fact that I don’t want to wait any longer gave me the confidence to just PULL THE TRIGGER!

This site helped me decide that the resurfacing was definitely the way to go considering my age and activity level, the hard part for me over the last couple of months has been choosing a surgeon.  What a complicated decision!   

Hopefully I’ll be able to schedule the surgery before Christmas.  If I can figure out the Blogging, I’ll start logging my experiences. 

Thanks again. 
Mike

[decooney]

Mike,
keep in touch on how it goes for you.  At 43, we are similar in history, groin and back pain discoveries as it evolved for you too.  Started just like that for me, and kept sort of moving its way around until it was obvious I had a serious hip problem along with growing lower back problems as a result.  I too was a very active person, and looking forward to getting back to some of the things I use to do as well.  I ended up with a hybrid THR screw-in cup / Resurfacing femor cap; long story.  My surgeon had to go this way due to my deformed hip socket. 

The main thing that I can recommend is to not push it after you get out of surgery. Don't take any risks to push beyond recommended physical therapy.  You want it to stick and heal and have a great outcome.  Take it easy, and report back on your progress after you get it done.  I want to compare progress and pain reduction timelines with others to see just where I am on track too.  At three weeks yesterday post-op, I started healing much faster and was moved from a walker directly to a walking cane.  Starting to see the benefits already, and I stopped taking all pain meds for my own reasons.  Good decision to just get it done and over with now. Duane 

[Stucch]

Mike,

There is probably nothing here I can say that nobody has already mentioned but Ill keep it short and sweet.

I'm 36, I'm a lot like you, very active, coached my kids, heard the same stories from the OS's and on and on and on. Granted at our age it's a tough decision but my family doctor summed it up perfectly......"why hold off as long as you can, get fixed for the now and change your lifestlye, technology will be that much better come second time around if required." Since he told me that I haven't looked back.

I lived in pain since 21, my life has changed forever, my spirits are up and my kids are finally a joy to play with , I'm 9 weeks post op and I feel amazing, groin pain gone ( let me tell you...pre op groin pain.....ouch), in fact all the points that were aching on my right leg and hip joint are gone!!! 

  My surgeon was one of the few people in my area performing resurfacing, he was relatively a rookie at it with about 25 under his belt. I still went with him with the lack of resurfacing experience. Mind you he has been doing hips for 21 years. Here is where I tend to disagree with the experience thing and needing 100 under the belt. I know resurfacing is a more difficult and percise procedure..I've heard it a thousand times and talked about in depth with my OS. I just feel 100 is a number too high. Doctors are skilled trades people with a lot more schooling than the average tradesperson. I'm a tradesman(electrician) and work with tools day in and day out. We do some very difficult work, I'm talking major conduit work and stuff like that. Granted after 100 times of doing whatever, you'll get it, but I'm confident enough after 15 to 30 times, I'll master whatever I'm doing in the field and thats a confidence thing, the same feeling I had towards my OS. FOLKS, I'M NOT CHALLENGING THE INTEGRITY OR SMARTS OF A DOCTOR, THEY SAVE LIVES AND I HAVE THE UTMOST RESPECT FOR WHAT THEY DO, I HOPE NO OFFENCE IS TAKEN. WHAT I'M COMPARING, IS THE SKILL OF WORKING WITH TOOLS AND GETTING THE HANDS DIRTY. LETS FACE IT, YOU WANT SOME BODY WHO CAN ACTUALLY TURN A SCREWDRIVER, HIT A HAMMER. HOW MANY PEOPLE DO WE KNOW THAT CAN'T DO EITHER. A DOCTOR SHOULDN'T BE DIFFERENT.   

Day one of meeting my third OS, I knew this was the guy I wanted.  As I meet him he looks at my x-ray and says " man you are wayyyy too young to have this problem".  He looks at me and says " I love performing surgery and I would love to get in there right now....but before we do anything....lets walk before we run..." Meaning lets take every action possible before we make the final decision.  First, tried a few different pain killers....nothing. Second, went for the cortisone shot.....nothing. We were running out of options and finally the decision was mine. I'm not going to lie I chickened out and pulled the pin, I thought I'd fool myself and believe my hip would heal up one last time....negative. Finally, I packed up drove to his office and booked my time in. Keep in mind, I had gone through all of this with 2 previous OS's, the difference was they himmed and hawed about my age and having it done.  I went through physio, chiorpractors, acupuncture, pain killers, cortisone, mri's, x-rays.  Bottom line, I got it done.

Not so short and sweet,

Eugene
Toronto, Canada