Dr. Gross's New Study - What is the Best Bone Fixation Type?

[Tin Soldier]

I haven't read the study yet, but will, soon.  I thought the most important part of cementless, vs uncemented is that the bone (in this case the femoral side) needs to have some decent blood flow to be able to lay in some fresh bone.  Maybe I'm off, but I'm thinking of De Smet's paper on BHR vs C+.  Maybe it was something Bose said in an interview,...it's all running together,  ???.  Somewhere, I saw some discussion on the aspect of necrosis from grinding and then capping the femur top.  This is why the cup has been cementless for a long time, it doesn't lose the circulation as bad as the femur top.  Seems to me that's why you would want cement.  Maybe?

I do know that I lay done some bone, it's in my genes.  Through most of my 20s and 30s I had elevated alkaline phosphatase, the enzyme that moves Ca.  Luckily it wasn't bone cancer.  I think that's part of the reason I have impingement.  I'm not an expert here, but I think cement would be unnecessary if you have good blood flow, a porous surface, and some Ca, at least for me.  You should see the knob on my big toe from breaking it some many times.

[obxpelican]

Dr. DeSmet is now doing cementless as are other doctors like Dr. Su.

Apparantly blood flow is not an issue, if it was we would be seeing massive failures from all the implants that Dr. Gross has performed.  When notching occurs and the blood flow is damaged it's usually 6 months or less for neck failures to occur.

It's been 3 years with good results, of course 4 or 5 years would be better.


Chuck

[John C]

Hi Tin Soldier,
You are absolutely right about questionable blood flow to the femoral head being one of the main arguments for using cement. Everyone agrees that the blood flow is affected during the surgery, and is reduced for awhile afterwards. Dr. Gross has referred to some studies that measured blood flow to the femoral head after surgery, that show that it usually does return to normal; I believe that it was over a matter of days, possibly weeks. It is also argued that the heat produced as the cement cures, may negatively affect vascularization as well, leading to hopes that cementless femoral heads may have better vascularization at the surface to aid in the necessary ingrowth.
I am of the hope that, since the cement is under compressional loads rather than shear loads as in a THR, both approaches will lead to long term success.

[Tin Soldier]

Good point, Gross's 10 year results did not appear to be overwhelming one way over the other.  Pritchett says insurance, at least in the US, is not wholly supporting the cementless femoral component.   Not sure on the financials with Gross and Biomet, but maybe they've got more support in the insurance world for the uncemented femoral component.

[Gino]

Now I'm bummed  :(   I had both hips done with cemented BHRs in 2010. The whole concept of no cement makes perfect sense. Going to SC for Dr Gross was not an option, sadly. Crap.

[obxpelican]

Don't be bummed, if you are doing fine your chances are good (cemented or uncemented) to have a great outcome.

Everyone has to realize the %s if this all works out like Dr. Gross things is a few % or less difference.  I just like that it gives the doctor one less thing to do during surgery.

Don't sweat it.


Chuck

[Tin Soldier]

Yeah don't be bummed.  Its only a few % and for me, and maybe many others, insurance won't pay for an un-cemented femoral component.

[Dayton96]

Yep.  So far the stats are great for the BHR and I hope they continue to be.  I have read on this web site, and others, that the choice of the surgeon is just as important as the choice of a device.  I didn't realize there were insurance companies that would not pay for a cementless device.  I know BCBS will pay for the Biomet.

Mac
 

[23109VC]

Insurance won't pay for uncemented femoral component?

I am getting the uncemented version from Dr. Gross and my ins is paying... Mi have a ppo, but I would think it would be the same whether you are ppo or HMO?  I switched to the PPO so i could see dr. Gross....my HMO was going to send me to a dr with virtually zero experience....

[newdog]

Dr. Gross does not contract with HMO type insurance. HMO's have a very limited list of doctors and hospitals and Dr. Gross is not one of them. The only way would be if someone needs something done and the list of doctors or hospitals with the HMO cannot provide the needed care. Then the case has to go to an appeal board for approval. His website claims that there has been an approximately 50 % success rate with an appeal.

BCBS PPO pays for uncemented femoral components.

[23109VC]

Ok, that makes sense.  I had the HMO and they sent me to a guy who I was not goingto use, he had not enough surgeries under his belt...like 30....I changed to the PPO, I didn't even want to mess with the bs appeal crap. 

My procedure will probably cost me a couple grand out of pocket...best money I will ever spend!

[Dayton96]

I'm still trying to get a handle on how much out of pocket I will end up spending.  BCBS will only speak in general terms, although Dr. Gross' office was very clear how much out-of-pocket I could expect from him. 

Bernie, you don't have BCBS by any chance do you?

Mac

[obxpelican]

Dayton, call the hospital and have them do a pre authorization, when I showed up to get my tests done the day before they had it down as to what the costs were going to be.

Yes, it's well worth the extra money to go to a good doctor, heck I probably spent a grand on travel alone between gas, food hotel and all the extra shopping my wife and daughter did while I was in the hospital.

Chuck

[newdog]

Dayton,
I have BCBS medical insurance.

Yes, I have probably about two grand between travel expenses and out of pocket co-pays, etc. It was very frustrating months before the surgery to get an answer on what the uncovered expenses would be. I knew that everything would not be covered 100 %, but I was worried there would be uncovered charges that I could not afford. Even within the BCBS network there are different coverages, it depends a lot on the employer. The hospital and Dr.Gross' office will give you a better idea on what things will cost.

Half of my approximate two grand total is a $1000 deductible it cost me as soon as I walked into the hospital the day of surgery. If I had my surgeries done in 2010, I would not have that charge. My employer changed our coverage Jan. 1,2011.

I was worried there would be uncovered charges in the thousands, but that was not the case. Hope this helps.

Chuck, I hope your wife and daughter bought you something while out shopping. LOL!

Steve (newdog)

[Dayton96]

I have a call in to the hospital but they haven't called back yet.  As a lot of you know Dr. Gross' office gives you a pretty good idea what his expenses will be - the only wild card is whether or not Lee's fee will be covered.  Steve and Chuck are right about not forgetting the cost of traveling to, and staying in, Columbia.  The Residence Inn for five or six days can add up.  Lee mentioned that the Residence Inn will give a "hospital rate," but I haven't checked into that yet.  I'm not sure how it would compare to AARP or AAA.

[obxpelican]

Sorry buddy, the only thing I got was a toilet chair and the kit they sell   ;)

Oh well, I came home almost pain free, and now totally pain free--- one caveat, the only good joint in my body is my hip that was operated on.

Chuck

Chuck, I hope your wife and daughter bought you something while out shopping. LOL!

Steve (newdog)

[Dannywayoflife]

Does anyone know of any surgeons who perform cementless RS in the uk?

[Dayton96]

There is a Mr. Richard Villar who uses a Corin cementless.  He is at Spire Cambridge Lea Hospital.  He can be contacted at:  www.richardvillar.com 

I contacted his practice by email last year when I was doing my research on cementless HR.  I wanted to see if someone other than Dr. Gross, was doing successful cementless implants. 
I had read about Mr. Villar authoring an article on cementless implants in the UK.  One of his staff responded to my questions, although it took about a week to hear back.

I hope this helps. 

[Dannywayoflife]

^^^brilliant thanks I'll start to compose an email now. Really appreciate your help.
Danny