What is the Most Popular Hip Resurfacing Device?

[Pat Walter]

People always ask what hip resurfacing system is the best.  That is a question only history will answer at some time in the future. The BHR, Birmingham Hip Resurfacing System, has been used since 1997 and is the oldest of the current systems, but is only one of at least 10 used world wide.

A recent survey of 855 Hip Resurfacing Patients on the Yahoo Surface Hippy Discussion Group gives an answer for that group of patients. The survey took place between Oct 16 - Dec 20, 2007.

Some people did not answer the question about what hip resurfacing device was used by their surgeon because they did not know. Therefore, there were only 842 answers. This is a tally of the answers that were given. View Original webpage here http://www.surfacehippy.info/mostpopularhrdevice.php




842 Hip Resurfacing Patients Responded

• BHR - 446
• Wright Conserve Plus - 146
• Biomet - 128
• Cormet - 56
• ASR - 36
• Durom - 14

[Big Bill]

Hi--popularity and availability vs. FDA approval vs.USA or abroad---pretty open subject---seems to me,according to my research and the confidence in my surgeon, most devices are about the same when you get into the newer resurface devices. The more important issue to be aware or is the skill and competence of the surgeon. If he or she knows what to do when an issue arises while you are in the OR, it could mean the difference in you getting a resurface or waking up with a total hip replacement. Do your homework,ask questions. My surgeon has used several devices...but is currently using the Cormet because of more size options. I trusted his knowledge and capability. My anterior procedure was 7/9/08. My surgeon told me that it went beautifully and it was the best he had done to date!   

      Big Bill, Cormet Anterior Surface Hippy   C.A.S.H.  8) 

[nwugrad]

Big Bill,

Who was your surgeon?  Did you like the anterior procedure?

MikeM

[Big Bill]

Mikem ---My surgeon is  Dr. Stefan Kruezer in Houston, Texas. Dr K has been performing the anterior approach for years ..and my anterior resurfacing was #  51 . He has trained on others like Birmingham(posterior approach) but currently uses the Cormet device and does the anterior approach. There were no muscles cut in this procedure and no real restrictions(like the 90 degree rule). Today was my 1st post op visit . They did x-rays and said everything looks great! YEESSS! The glued scar is 5" and is healing very well. I am at 12 days post op and was given the OK to start my own PT--lightly, moderately...no pool yet  :( . 2 more weeks or if the scar is totally scab free.  ::) I did alot of research and felt that this was right for me. There are only a handful of surgeons that do the anterior approach resurfacing. It is more technical. Anyway... I feel that I am doing very well and will continue to get stronger every day! I can't wait to get back in the pool!!  Best of luck to you !  ;D   ---Big Bill C.A.S.H.  8)

[Jon44]

I did alot of research and felt that this was right for me. There are only a handful of surgeons that do the anterior approach resurfacing. It is more technical.    ---Big Bill C.A.S.H.  8)

Big Bill:

Thanks so much for posting this.  Can you gives a heads up to what research you ran across regarding anterior/posterior approaches.  Also, any suggestions about finding an East Coast doctor to talk to about this? (The idea of someone dissecting my muscles and cutting into my joint capsule is yet another thing that gives me the willies about BHR..)

Jon

[Vicky]

Hi Jon,

On the East Coast, one of the best is Dr. Su in NYC.  There is also a Dr. Raterman in Tampa, FL that is really good.  There is a section on here that gives the various different doctors opinions on anterior vs posterior approaches, but please be aware that there are two different anterior approaches.  There is the DIRECT anterior approach that Big Bill got which spares the muscles and then there is tne antero lateral approach which cuts through the gluteus muscle and can give a patient a much longer and more difficult recovery than any other approach.  That approach is the one that most of the doctors do not like to do.  Dr. De Smet said that he stopped using the antero lateral approach after he got tired of some patients coming to see him one and two years post op, still limping and with some pain even though the device was placed correctly because it was due to the muscles that are cut.  The Direct anterior approach is the one that spares the muscles but so does the posterior approach.  Most of the top doctors use the posterior approach.  Where do you live?  Check with the two doctors I mentioned above, depending on if you are North or South East Coast.

Vicky

[Vicky]

Hi Jon,

I just read your post in another thread that said you already had an appointment with Dr. Su and realized you were asking about doctors that use the DIRECT anterior approach on the East Coast.  The only doctors I know that use that approach are Dr. Matta in L.A. and Dr. Kennon and Dr. Keggi in Connecticut. 

Vicky

[Jon44]

Thanks for the quick and informative response.  To be clear, when you say the posterior approach also spares the muscles, is that because of the idea that they cut the bones the muscles are attached to and also "staple" the ligaments back  (that is my very rough interpretation of what Dr. Su's assistant described to me.)   Clearly, I need to do some more homework on this issue, but I assume "there's no free lunch" and something needs to be cut somewhere to get to your hip...

I actually saw Dr. Su on Monday and left with mixed feelings. He agreed with the idea of my checking with a physiatrist at HSS to verify that all my lumbar and hip pain is coming from my hip and not some unidentified lumbar issue, before going forward with resurfacing.  To be frank though, I wished he had talked more about biomechanics and dealing with dysplasia--the overseas doctors, in the video interviews and written responses,  seem to go into those topics in much greater depth.  As an athlete, with "malformed" and assymetric hips, I really wanted to understand what my best option for correction would be (but I could have just caught Su on a particularly busy day with a full waiting room and a jack hammer going on the floor below).

For those in the diagnostic stage, an amazing resource that people should know about is the Hospital for Special Surgery's MRI protocols.  They test new equipment and software there, and the images are strikingly better than a conventional MRI.  (I had a wrist problem that two Boston surgeons couldn't diagnose, but the HSS MRI quickly identified the offending tear.)  Only drawback is that you're in the machine about 3 times as long--so 2 more hours of MRI fun for me to get hip and lumbar imaged....

[Vicky]

IMO, you can't get much better than Dr. Su here in the U.S.  AND HSS has one of the lowest if not the lowest infection rates of any hospital in the U.S. as well.  Read the doctors interviews on their explanation of the posterior approach, but all of the ones that talk about it compare it to the antero lateral not the Direct anterior approach.  The posterior approach is the one that McMinn, Treacy, Bose, De Smet, Su, Rogerson, Raterman, Ure, basically all the top doctors all use the posterior approach.  I would write up a list of questions, then contact Dr. Su's office and see if you can get them answered.  The questions always seem to pop us after you leave the doctors office.  :-)  It is best to keep a list going so you don't forget.  Seriously, Dr. Su is one of the top in the world.

Vicky

[Jon44]

realized you were asking about doctors that use the DIRECT anterior approach on the East Coast.  The only doctors I know that use that approach are Dr. Matta in L.A. and Dr. Kennon and Dr. Keggi in Connecticut. 

I believe Dr. Mont also uses the direct anterior approach.  Could you say more / point to any resources about what risks or drawbacks may be associated with the direct anterior approach? 

While the posterior approach is known as muscle sparing, it sounds like it disects the piriformis and other small rotators. These muscles are called the "rotator cuff" of the hip, so it's hard to imagine that there isn't some price to be paid here...(as I assume there is in any approach--no free lunch)

Dr. Mont's online chat was very interesting--I'm attracted to his emphasis on prehab (e.g. gait analysis) and rehab.   For comparison's sake, do you know what sort of rehab is part of the Hospital for Special Surgery experience?

Jon