Questions about being a proper resurfacing candidate...

[Joe_CA]

Hello All,

I’m glad I found this helpful site. I’m encouraged that there’s a chance it could help me. Let me state my story and questions very quickly, as to not bore any of you. 

-   Living with hip arthritis for more than 10 years. Until a few months ago I felt the only final option was an eventual total hip replacement on one, and someday, probably both of my hips.

-   Being active in sports that probably won’t be advisable after a THR (volleyball, running etc.), I staved off any surgical interventions until I was having problems in day-to-day life. Walking is now somewhat painful.

-   Had recent x-rays that show much thinning of the cartilage, and an area where there’s bone-on-bone contact. Was referred to a sports medicine physician (not a ortho/hip surgeon) and he immediately stated “hip resurfacing wasn’t an option at this point”, citing bone-on-bone and por joint spacing, but really nothing else. (To me, besides the lack of cartilage,  the x-rays appeared to not show any major damage to the femoral head/socket, but of course, I’m no expert).

-   So I was a little discouraged, and there’s a chance I have indeed waited too long. Regardless, after hearing about other’s inspiring stories, I won’t take the advice of this one physician just yet, though I hear the eventual surgeons at my medical provider (UC Davis Med) don’t perform many resurfacing procedures, and apparently aren’t huge advocates either 

-   I will indeed send my x-rays to other recommended physicians on this list, and I appreciate all the great advice here encouraging others to do so. But was wondering to those with experience here, what are some of the factors to not being a candidate? Does much bone-on-bone contact make one a bad prospect? What other factors are involved? After lurking on here, I didn’t specifically see the lack of cartilage made one a poor candidate. But I could be wrong.

-   I appreciate all that post here, and who have given their time to inspire those who are merely trying to get an important part of their lives back.

Thanks,
Joe

[Quig]

Welcome to the site Joe!


I think many of us here run into the same problem you seem to have encountered. Surgeons who don't do resurfacing tend to not be well informed on it and are typically quite predisposed to suggesting standard THR. The last hip surgeon I saw before making the decision for my resurfacing had very, very unkind things to say about resurfacing. When I pressed him on the strong likelihood of wearing out the THR implants he was suggesting he literally patted me on the knee and smiled and said... "No problem! We'll just replace them in 8-10 years". I was dumbfounded. Obviously that was NOT something I wanted to plan on. I pressed him on the resurfacing topic citing very positive results for young/active patients and he very reluctantly admitted that he had very, very little experience with resurfacing but knew of good results and then admitted that judging by my X-rays I was an IDEAL candidate. I had to nearly pry it out of him...


The moral of the story is that surgeons tend to prefer the procedure that they are comfortable and experienced with. I've read many, many times on here the suggestion to see one or more well regarded surgeons who have successfully done large numbers of both THR and resurfacing, only then will you be getting an unbiased opinion.


Furthermore, your situation doesn't sound much different than many of us here. I was bone on bone in one hip and had significantly reduced joint space in the other according to my X-rays. I had bilateral resurfacing 5 weeks ago and am doing well in recovery. The surgeon told me both hips were a mess and bone on bone at the time of the surgeries. Being bone on bone or having poor joint space is definitely NOT something that would eliminate you from being a resurfacing candidate!


Sorry for the long winded response. Don't let that first opinion get you down. Get yourself a 2nd and 3rd and 4th opinion from some of the experienced surgeons you see on this site.


Good luck!!

[Joe_CA]

Thank you very much Quig. I was hoping to get some responses like yours. I'm hoping my Sports Medicine doctor simply wasn't too knowledgeable about resurfacing, and who are good or poor candidates. Though, like I said above, my next referral to actual hip surgeons in my medical group, should involve similar interactions and recommendations to forego resurfacing, and proceed with a total hip replacement.

I understand the bias involved with physicians who don't perform resurfacing, and would of course not recommend it. But it's a little troubling that some won't be up front and honest about their experience, and frankly tell patients that they don't do resurfacing procedures, and guide the patients to seek other practitioners. I guess you have to be your own advocate in these situations.

Good luck in your recovery, and I hope you get back to all the activities you desire.

-Joe

[chuckm]

Joe, qualified resurfacing surgeons don't consider a patient ready for hip resurfacing UNTIL they have progressed to bone-on-Bone. Occasionally they find someone ready before that but it is rare.   
So whatever information you got is bogus.

It is also disconcerting that a "sports medicine physician" has so little knowledge of this type of surgery. One that regularly helps even professional athletes return to professional sports.

Get to a specialist from the list on this site.

Chuckm

[LMS]

I was considered a candidate before I was bone on bone.  And now that I am (BoB), I was no longer a candidate.  From what I understand, my OA had become too severe.  I will be contacting my surgeon to clarify his decision.  Not because I'm challenging him, I just want to know so it doesn't happen with my other hip.

[blinky]

Hey Joe!


I agree with the posters who advise sending your X-rays to one of the docs on the list. Heck, send them to several and see what they say. With luck everyone will accept you and it can be a question of insurance, scheduling, and travel.


I am no expert, but I think the situation you want to avoid is having waited so long that you don't have much femoral head left. You can be without joint space, you can be without cartilage, but you have to have good enough femoral head material to cap. (I say this as someone who almost waited too long. Lots of cysts in one of my femoral heads.)


I had the same experience of docs poo pooing the idea of me being a candidate for resurfacing, but they were docs who didn't do the procedure themselves. Best to consult with someone who does it and get his answer.


Like Quig, I went to Dr Gross, did two hips in a week, and had an outstanding experience. I have started running again.


Best of luck. Let us know how it goes.

[chuckm]

I read your story when you first started posting LMS and you may not be getting a straight answer either.
Bone on bone with lack of range of motion is exactly what hip resurfacing is used to treat.
There are plenty of posts on this site where a top surgeons refuse to perform hip resurfacing on their paitents until they become bone on bone. Dr. Gross is one of those surgeons.

To me it is a travesty that so many will miss out on such a miraculous surgery because of misinformation.

Chuckm

[Pat Walter]

Bone of bone is one of the primary reason we all had hip resurfacing.  If we had cartilage left, we would not have the great pain many of us suffered.  Many also had cysts which are normally filled in during surgery. 

The very best way to know if you are a hip resurfacing candidate is to get free email consultations or actual appointments with the top, experienced hip resurfacing surgeons.  You need input from a surgeon that does both THR and Hip Resurfacing.  Just a THR surgeon will almost always tell you hip resurfacing is not a good option, most likely because they don't do them or had bad experiences with them.  Hip resurfacing is a much more complicated surgery than a normal THR.  All the hip resurfacing surgeons I know of will always suggest a hip resurfacing unless they really feel a THR is a better option for your case.  Even if one or two surgeons say no to hip resurfacing, a third might consider it.  I have seen cases where De Smet and McMinn said no, but Bose said yes.  Or any other combination. 

Don't get discouraged yet. You also don't want to use a surgeon that does not perform many hip resurfacings.  You want a surgeon that does them daily or at least weekly.  Look at the list and send some emails out with your x-rays attached in a digital format to a few of the top surgeons.  You can see a few out your way that are closer to you than the other surgeons.  There are many people that travel far distances to get their hip resurfacing since there are not many really experienced surgeons. 

Here is the list

http://surfacehippy.info/surgeons-with-1000-hip-resurfacings/

http://surfacehippy.info/hip-resurfacing-surgeons/

Stay in touch and let us know how you are doing.

Pat

[LMS]

Thanks Chuckm, I've "just" sent an email to my surgeon's assistant asking to elaborate on the decision to forgo the HR (in my case).  As soon as I get a reply, I'll post it since it's relevant to the OP's question on being a resurfacing candidate.

[Joe_CA]

Thank you all for your helpful suggestions. I will soon send out my x-rays to some of the surgeons recommended on this very informative website to see if I am a viable resurfacing candidate. There's still a chance that I'm not, and the original physician simply wasn't conveying enough details why I'm not a viable candidate. Though I won't take No for an answer until most/all state that resurfacing simply isn't a good fit for me.

Thanks,
Joe

[Joe_CA]

Just a quick update. I'm in the process of sending several of the physicians on this site's list my x-rays. It will probably take some time to get feedback. However, one already replied (Dr. Brooks from the Cleveland Clinic). He stated my condition made me a "perfectly good candidate for resurfacing". This has really perked my spirits. So, again, I would like to thank those who participate in answering questions here. I'm so glad I found this helpful resource.

-Joe

[Saf57]

That's great news, and not at all surprising. 99.9% of the entrenched orthopedic community is either against resurfacing or know little or nothing about the procedure.

[blinky]

That's great! So one solid option already.

[RebeccaT]

My hip doc at home used to do resurfacings, and he was pretty negative on it. "Too many problems with the incisions" was his main thing. Dr Gross thought that was a bit crazy.

Anyway, I went to see my doc here after I had already scheduled surgery with Dr Gross. He never said I wasn't a candidate, and he even said he knew an ER doc from Birmingham who had gone to Dr Gross, but the most I could ever get out of him was, "If it works, I think you'll be happy with it."

well, it did, and I am.

I was bone on bone -- I waited until it was bone on bone to do anything (like I think many people do ... in fact, I am not sure Dr Gross would operate if you had much cartilage left.)

Although I am somewhat skeptical of "miracle" type procedures, resurfacing is pretty close and I am glad I did it!

[karlos.bell]

 :) Hi Joe. Don't take in other specialists opinions until you find out more facts. Example in 2007 I was told I would never walk properly again by a leading Olympic sports physician (I can now run) You may have a better outcome in life than you expect. Make your decisions wisely lots of experienced, positive  people here. Good luck. Cheers K 8)

[LMS]

Ok... third time trying to post...   :P


Met with my surgeon 2 days ago with a bunch of questions for him.  I asked him why I was no longer a candidate for resurfacing & it's because the bone quality is no longer there. 


Makes sense now when he said that he didn't want to have to do a revision.  And when I think of if, there are other tell tale signs in my overall health that supports his findings.  A lot can happen in 5 short years.

[Joe_CA]

Thanks again everyone. I'm so fortunate to have found this website. All 6 physicians who I have sent my x-rays to have found me to be an acceptable candidate, including Dr. Gross who recently called me. He was very helpful in discussing my condition and options. I'm going to start the process with him, and see if I can get the insurance issues squared away and then schedule a surgery date if everything works out. He recommends I do both hips in the same week, yikes!. Of course I'm a little concerned about doing both hips so close together in time, but perhaps that's the best approach. I will let everyone know my plight when I ultimately have the procedure(s) done.

[blinky]

Go for it! One recovery.

[Joe_CA]

Scheduled for bilateral resurfacing surgery with Dr. Gross for the week of December 12... :-). Let the anxiety and nervousness commence! I've said it too many times already, but I am so glad I found this website.

[Quig]

Congrats Joe! I think you'll be very happy with how the crew in SC treats you. I'd tell you not to be nervous but I think it's pretty much impossible. Just know that you're going to one of the very, very best surgeons and teams ANYWHERE and try to relax about it as much as you can.


You have a bit over 4 months to get yourself into the best pre-surgery shape possible. A triathlete friend of mine who had bilateral surgery with Dr. Su in NY told me to get myself into the best shape I could as it would facilitate a good recovery. I nearly killed myself in the gym for about 3 months prior to my surgeries and I believe that work paid off in a very big way as I have had a very, very good recovery. I'm about 3.5 months past my surgeries and am feeling better and better and better and could not be happier with my decision.


Good Luck!