There is NO perfect hip replacement device or surgical approach

[Pat Walter]

We all want the perfect solution to our hip problems or even health problems.  We have to realize there is no perfect solution.  Hip devices and artificial parts are constantly in a process of development and change. We think if we choose the right surgeon and right device, it will last a life time.  Sometimes hip replacement can last a lifetime, but in many cases the bone growth around the components determines if the device will remain in a body for a lifetime.

When artificial parts are used to replace body parts, there are no perfect solutions.  What we have to do is to choose from the current choices that seem to have the best results. We try to choose a surgeon that has a great track record of excellent results.  We try to choose a hip device that has a track record of excellent results.  There are national registries that help us determine which currently used devices seem to have the best retention rates.  Surgeons' statistics are not easy to find.  Some will share their information on their websites or when you talk with them, while others won't.  We can talk to other patients to find out how their surgeries and recoveries turned out.  That is where discussion groups and the internet is a help. Other than doing some research and talking with other patients, we finally have to make a decision about what surgeon and device to use.  No surgeon will tell you that any hip device whether a resurfacing or a THR is guaranteed to last a lifetime.  They have no way of telling.  They can tell you trends of what they see happening in their practices and other surgeons practices, but there are no guarantees.
 
There are no perfect bodies and no perfect hip devices.  If we all had the same physical shape and body, then hip devices would be easier to design and place during surgery.  Humans come in all sizes and shapes, so no two are alike. Therefore, we rely on a surgeon's experience to know how to place a device in our own personal bodies. If anyone ever worked in a manufacturing environment, they would realize that any manufacturing process for parts is not always perfect.  There are tolerances in the design, the making of the components, the machining of the components and the metallurgy of the components.
 
There are so many possible variables in the making of the devices and in our individual bodies, it is amazing to think that any hip replacement surgery even works besides working perfectly for a lifetime. We as laymen need to understand the large amount of research it takes to develop hip products. The problem is that designs don't stay static.  They are always changing so it is difficult to get long histories of use for any one device.  So again, we rely on national registries and surgeons experience to choose good hip devices.

Artificial parts are just that â€" artificial parts that are foreign to our bodies.  I have an aortic valve replacement.  The history of the development of valves continues to change. Many variations from human valves, swine valves, bovine valves and artificial valves have been used.  The technology changes constantly so that the valve you have now will most likely not be the valve used 5, 10 or 15 years from now.  The problem with artificial valves is similar to artificial hips, they eventually wear out.  You can limp around or use a wheelchair if you don't want to have your hip replaced, but when your heart depends on an artificial valve, it has to keep working to keep living.

The discussions by patients are often about "will my hip device last a lifetime".  I want people to realize there are no guarantees for any artificial parts.  The retention rates on national registries tell us what is the best choice at the time, but devices will change.  We need to concentrate on choosing what surgeon is best for us and what device is best for us.  We have to put our faith into the surgeon's experience and opinions.  We can't look for perfect, we are trying to find the best solution to a problem in our imperfect human bodies to help keep us active and moving for as long as we can. There will always be questions about the products and surgeons that need to be answered, but there is no guarantee of the perfect device that will last forever. That would be great, but in life few things last forever including our lives. 

[Luanna]

Well said Pat. It is a great relief to read your post as I've been second guessing my implant selection. I trust Dr. Pritchett and know that he has made the best decision for my situation (two brands in one hip) and as you say he can not guarantee that it will last a lifetime - in fact he suspects not. But that's life and the best we can do right now.

Cheers,
Luanna

[Boomer]

Pat,

I haven't had my resurfacing surgery yet, and go through periods of anxiety from time to time because I have no idea what the future holds for me. As you point out frequently, we are all different and my experience will be unique. There are other times when a smile comes to my face, and I chuckle a bit, because I know there is a fix for what is wrong with me. Instead of feeling stricken, I feel lucky to have an ailment that can be alleviated. There is proven technology and skilled, experienced surgeons to help us get our quality of life back. We have a very good shot at the kind of future we want. No guaranties, but pretty good prospects. That's something to hang on to.

Thank you for running this surface hippy ship as well as you do. I come here every day to get my dose of information and an overdose of inspiration. What an extraordinary group of people we have hanging around this blog!

Boomer

[Jeremy76761]

I guess that if Derek McMinn publishes his results and, based on survival rates of BHRs implanted since 1997 by him, we have a projected retention rate of 97% at 14 years....how unrealistic is it not to expect 90% to last 30 + years???

No guarantees, no, as Pat says, there can be no guarantees with an implant. Actually, there can't be any guarantees for a NORMAL hip either. Let's face it, living itself is precarious

I guess that 97% at 14 years looks pretty good to me...not like there is anything worth worrying about at this stage. I mean, of course, anyone could be in that 3% (or that 10%)! But I wouldn't worry before that point.

There's bigger things in life to worry about than a hip resurfacing wearing out. I guess that's my conclusion, pretty much.

[Boomer]

Well said Jeremy.

[Tin Soldier]

Totally agree.

[JMS]

Thanks, Pat, for this sensible reminder that there are no perfect guarantees. A thoughtful and helpful piece.

[cwg]

Yes, but I have to say, in 2007 my surgeon Dr Hooley (and the other  top ones in HK) were claiming the BHR was pretty  damn near perfect...

This Thursday I go see Dr CLIVE DUNCAN ( anyone know of him?) ,top gun  here in Vancouver. This is for another look at my x-ray and other things I hope, to try and determine something  about my high ion levels .

Oh, and on Tuesday, the toxicologist Dr James Anderson wants to see me, this time he has more information on some stuff. I am to bring all meds and supplements.... Perhaps they are considering my levels are coming from something else. Don't know.
So far everything looks fine, except very high Chromium and Cobalt levels..

Will stay posted
cwg

[Jeremy76761]

Hi CWG, do keep us posted. Hope all is well with you. I don't know Clive Duncan so can't help you with that. I am in Toronto but from Victoria and obviously know your area fairly well. I'm sure you have very good care. But from experience, I have found that professional opinions can vary widely. Are you considering a second opinion, maybe on the source of the problem and what to do about it?

[ScubaDuck]

cwg-

Best wishes on your consultation tomorrow.  I will be hoping that he will be offer some solutions.

Dan

[Dannywayoflife]

"I guess that if Derek McMinn publishes his results and, based on survival rates of BHRs implanted since 1997 by him, we have a projected retention rate of 97% at 14 years....how unrealistic is it not to expect 90% to last 30 + years???"
That's fairly logical. I really hope it works out that way as even if I get 30 years out of one I'll only be 58.

[Jeremy76761]

Danny,

So you were 28 when you got them....well, uncertainty can be difficult to tolerate....but just gauging probability, honestly even in your shoes, you probably be in your 50s at the earliest if you need a revision ever, as you say. The virtual certainty is that by then, the service history on existing implants and the new devices available will be far better than what we have on today's MOM THRs. Uncertainty itself sucks, but on a practical level, I don't believe you have anything to worry about. I'm not just saying that to be positive. Yes there is risk, there is risk you could end up not being able to safely do impact sports in your old age. But more likely, you will be able to do whatever you want. Compared with all the other risks of living, I'd say that's fairly small.

Just my 2 cents.