How to Plan for Second HR?

[Pete]

I hope be active longer than my HR is likely to last. I am a snowboarder and want to continue doing it for many years. So I expect I'll need a second HR or perhaps a THR after my first HR wears out. I have heard that if this is the case, a HR is the best type of surgery. Does anyone have a link to an article that addresses this? Thanks!

[hernanu]

I assume you mean on the same hip as you currently have an HR. That's a good question, I don't know of anyone yet who has had a revision due to the hip component itself wearing out.

Several folks here have had a revision to THR, I think one or two had their cups revised, keeping their HR, but all were within a  set number of years and most seemed to be due to some issue during the surgery.

One person posted for their 20th anniversary, and they still seemed to be going strong, so again - I don't know of any failures here due to time - maybe the procedure's too young for that.

[obxpelican]

It's very possible you could get a MOM HR and it last you a lifetime.

The actual wear rates with MOM is really minimal assuming your hardware is properly placed.  Find a surgeon that is VERY experienced to reduce the possiblity of a revision.

Many of the doctor chats discuss the durability of a MOM and many times revision explanations are discussed.


Chuck

[Tin Soldier]

The failure rates are in the 2 to 4% (over a 10 to 15 year period or so) and that is generally associated with metallosis, thus all the fuss about metal ions.  I know, why are we so worried about such a low number?  Anyway, I don't think anyone has related failures to plain and simple-excessive wear.  The wear that is talked about tends to be related to poor placement of the components.  I think the study that you are looking for and many of us are looking for, is a study that takes all of the perfectly placed HRs and takes the millions of cycles per year that most extreme athletes are pushing and then compares failure rates.  I'm not sure it exists and I'm also not sure that it's something most experienced surgeons think is even valid.  I suspect that there is a general consensus amongst the most experienced surgeons that is, if you have a decent sized component, a well placed component, a decent CoCr alloy, continue with high level of activity, you may well outlive your prosthesis.

In short, I don't think many of us are planning for a revision, or THR.  The problem is, we are relying on science and we only have about 15 to 20 years of sound data to rely on.  That is partly why we wonder about the potential to have a revision.  Throw a little NY Times and a lawsuit into the mix and then the sky is falling.   I believe that the 96 to 98% success over the last 10 to 15 years will someday be more like 95% over the next 40 years.  Why would McMinn's 20 year patient all of a sudden need a revision?     

[curt]

      That very contingency is one of the main reasons I opted for a resurfacing in the first place.  Now, I'm extremely hopeful that the HR I did get will outlast my other organs, but who can be sure.  I was fairly confident that it would last at least as long as a THR, if not longer, but if I was doomed to have a revision, I would rather it be with most of my femur still intact, rather than doing one from an already reduced bone.
      I think the whole rationale is that if you want to be active and have a decent chance of having the prosthesis last, then a resurfacing is the way to go.  If you just want the pain to go away, then either one would work.  Trust me, if resurfacing was not an option I would have done a THR, even though I was only 50, in an instant.  Robust activity was a distant second to my robust pain and lack of mobility.
       I feel extremely forturnate that I had the option for an HR available to me, knowing that I may have to be revised in the very distant future.  Curt