Hip replacement VS Hip Resurfacing age 50+

[23109VC]

Hi everyone.  I am a surface hippy… I had my left hip resurfaced by Dr. Gross in 2011 when I was about 38 years old.  My right hip has similar issues that my resurface hip had - it just took a lot longer for it to advance to the point that I am considering surgery.  My most recent X-ray shows that I am nearing bone on bone at certain portions of my joint.  I am in continuan pain on the right side and while it is bearable pain with anti inflammatory meds, I am at that point where I am starting to think about fixing it.

I live in CA, far from Dr. Gross and I see a local surgeon who does hip replacements only.  This same doctor, when I was 38, told me to look into hip resurfacing and he did NOT advise me to get a HR at 38.  I took his advice, found Dr. Gross and had my left hip fixed.  My left hip is still GREAT.  I have zero issues with it.  I don’t run, but I have snowboarded occasionally, and fairly active, and ride a road bike regularly.  My left hip with the HR from Dr. Gross is wonderful.  I have no pain and zero issues.  So I always thought that when the time came to fix the right one, I would go back to Dr. Gross.

The doctor who recommended I look into a HR in 2011, now says that he thinks at my age of 49 (I turn 50 later this year) i would be a candidate for a traditional hip replacement.  He thinks that at age 50, I would get at least 20 years out of a traditional HR.

Since I had such a good result with Dr. Gross, my initial reaction is to what to go back to him and get a Hip resurfacing, and NOT get a traditional HR.  But I was wondering what the current consensus is here amongst people now.  When I was looking into surgery last time, it wa sa decade ago. Technology was different and I was a lot younger.

Is HR still a viable option for people age 50?  I have no bone density issues that I am aware of and aside from my hip issues, I am a perfectly health person with no other problems. 

I know if I see Dr. Gross I will need to swap out from my current HMO and switch into a PPO - as he does not have HMO insurance, at least that was the situation back in 2011.  With my current situation, there would ge some issues switching from HMO to PPO as one of my children now has medical issues (type 1 diabetes) and has significant medical costs…so swapping into a PPO program would entail significant costs for the year I am in a PPO.  Insulin, pumps, CGMs etc.  It would likely max out my per person / per plan contributions, for both me and my son - so there would be a significant cost associated with options to switch to a PPO and get a HR. At the same time - if it is really worth it and in my best interest, I an afford to make the switch.

Any info appreciated!  Thanks

Sean

[petemeads]

Hi Sean,

I have a BHR and a ceramic on ceramic THR (Zimmer Biolox) and I cannot really tell the difference between them most days, and I run, bike, climb and hike in the mountains.  Bone quality meant I got the THR as a result of a failed BHR operation but it has all worked out well, I'm pretty sure both will see me out (I'm 71). Modern ceramic ball with crosslinked poly cup seems to be the way to go, lots of people on Hiprunner are performing well on this combination. Just my 2 cents (or two penn'orth as we say here)...

Pete

[YetiKing]

sean - i'm an active 57 year old male.  snowboard, running (until ~2 years ago, but hope to again), bike...  am getting my hip resurfaced with dr gross in 3 weeks.  dreams of marathoning and ironman again, and am fully committed to the resurface.  nothing you didn't know, but at 57, still feel like a have a bunch of miles left and know that the total hip will have more limitations than the resurface.
best of luck
tom

[LDub]

Hey Sean
I surveyed the literature on predicted prosthethic longevity (HR vs THR) last year before making my own decision. I believe your doctor is correct. Based on the data available you should expect to get about 20 years from a total hip replacement. The issue is, will you need a second procedure? No one likes to forecast their own death but do you see yourself dying by age 70? Doubtful. And if the first THR fails you will definitely want to have it revised.

A THR revision is much more challenging in your 70s than your 50s. I witnessed my father in law go through it in his 80s and although he was very healthy he was told the procedure represented a significant risk (of death) to him. And the surgeon was right. He survived the operation, but only after extended hospitalization. But my father in law felt he had no other option. The pain when the prosthetic failed was unbearable. It stripped away his activities, limited his ability to walk and no doubt would have compromised his health if left untreated. The good news was he went on to live well into his 90s. 

I think the chances of a THR revision should be a real consideration for anyone weighing HR vs THR. HR might improve your chances of living out your life without additionally surgeries and at the very least you preserve your bone stock for a THR later in life. As opposed to a second THR where you have already lost a significant amount of your femur.

As for the cost. I paid for my HR out of my own pocket last year. Everyone's situation is different, but I do not regret it for a moment. You can't put a value on health.

My two cents.... well we don't actually use pennies anymore so I have to make it a nickel ;)

LDub

[stevel]

Hi Sean,  I have Aetna for primary hospital insurance and they consider hip resurfacing a medically necessary hip replacement alternative for under age 65 for physically active individuals according to their clinical policy bulletin #0661.  This is because a traditional hip replacement may wear out if you are active even if you are age 65 at initial surgery thereby requiring a revision replacement some years later (15, 20?), which is a big deal!  For you at age 50, hip resurfacing is the obvious choice!

[BTMachine]

Hi Sean, I'm 4 weeks post op on my second bhr with Dr. Gross. From my x-ray I was borderline candidate. I knew from the pain that I needed the surgery. After the surgery Dr. Gross said the arthritis was more advanced than what the x-rays showed. Frankly, my family history is riddled with hip/arthritis problems.

I have enjoyed a great quality of life after my first bhr 10 years ago with Dr. Gross. Another concern played into my decision, how much longer will Dr. Gross be performing bhr surgery? In my mind he is one of the best and I wouldn't trust any other surgeon to do this procedure. I also paid out of pocket to get this surgery. To me it was worth it. I will enjoy many years of sports activity. Even at age 60, I wouldn't even consider thr as long as I am a candidate for bhr.

Good luck with your decision, hopefully I have given you another perspective.

[catfriend]

What LDub said.

I had both of my hips resurfaced in my 50s. I would not want to have to have a THR revised in my 70s. I hear the first THR is great. It's the revisions that cause trouble.

If you were happy with Dr. Gross it's worth it to see if you can work out the insurance issues and make the trip. If you don't want to travel that far you might consider Dr. Pritchett in Seattle. Not as far, but probably still insurance issues. (Dr. P did both of my hips.)

[imgetinold]

I agree with previous posters.  I had my left done by Dr. Gross in 2012, and my right in 2020.  I was 53 years old for the second one, and never even thought about NOT returning to Dr. Gross.  Your local guy suggested a THR because that's what he does.  Plan ahead, take time off of work, and have Dr. Gross do #2.  Or go closer and have Dr. Pritchett in Seattle do it.  Either way you'd be in good hands and not having a THR revision in your '70's.

[johnieappel]

I agree with everyone here, get the hip resurfacing. Especially if you dont have bone density issues. I had Dr. Ure in Mt Shasta, CA. and will probably go back to him again seeing as my Partnership insurance will cover my next surgery. Dr. Ure studied with Harlan Amstutz I believe, and has done many resurfacings. Great Dr. imo. Mine has lasted 14 years but unfortunately the socket is loosening due to osteoporosis. Also, if you are active, like me, check out the Dual Mobility THR if you go with a total hip replacement.

[Kingrob]

Hey Sean,

Not sure if you made any decisions. I was in a similar position as you. I got my first HR with Dr. Gross in 11/2015, and just got my second hip done by Dr. Gross 02/16/22. The first time I contacted his office was in 2014 when I decided I was going to have him do the surgery. At that time I did not have insurance that he took. I changed my insurance the following year and had the surgery. I kept the same insurance since that surgery (CIGNA) but when I contacted his office last year I found out he no longer takes that insurance. I changed my insurance to Blue Cross Blue Shield PPO. I scheduled the surgery last year and he gave me a quote of expected cost and I think it was about $7500. I am not sure if this is the total price of the surgery without any insurance or if CIGNA still paid something. When I changed insurance he gave me a quote of my cost to be about $3700 - part of that is for Lee Webb some insurances will pay to have her there and some won't. My insurance paid for it so my bill got reduced and I ended up paying around $3000.

I am in a little different situation then you because my kids are all grown, but like you I did have a previous HR with Dr. Gross and live out of state. Getting that first surgery was a bigger decision than the second. I really relied on the information in this forum to make the decision. The second surgery was not a difficult decision now that I can base it on my own personal experience. My health is not only important to me but also my family - bone on bone is debilitating. I went with the HR over THR for several reasons. The first is I felt that I could be more active on the HR with less risk. I really wanted to get back to running and I did.  With a THR I am l worried about doing to much and the spike they put down in the bone working its way loose and needing a revision. If the HR fails than I can go to a THR and I would baby that THR a lot more so I would never need a revision.

Things have changed in the past 7 years and there are more options of surgeons - maybe you could find somebody closer.

[golfmad]

Im 67 I had my first BHR at 65 and my next at 66. It does take longer to regain leg strength but I am 1year 5 months post my last operation and today shot 76 at a good golf course with 3 x 3 putts. Its the best think Iv'e ever done, was to go with a BHR, I can always have a revision if necessary.  Obviously bone strength and blood flow are prerequisites, buts thats between you and your Surgeon. I'm walking and playing three times a week now.

[bluedevilsadvocate]

Sean -

If you are still in the decision-making process, here are a few thoughts. First, there are numerous stories of people over the age of 50 who have had fantastic results with resurfacings (including me at age 62, now age 74). Second, I agree with those who point out that the prospect of a possible revision of a THR at the age of 70 or so would steer me toward a resurfacing. Third, before you incur the expense and hassle of changing from your current HMO to make Dr. Gross a more viable option, I suggest that you check with other resurfacing surgeons who have also performed thousands of resurfacings with fabulous records and glowing patient reviews (e.g., Drs. Pritchett, Brooks, Su), and who might offer the flexibility to work within your HMO coverage.

[MilRosanna]

I'm a 67 year old woman and just had my second hip resurfaced by Dr. Gross. I didn't even consider a total hip replacement at my age. Trusted Dr. Gross and his advice to proceed with resurfacing.

[TotalWus]

I'm 60 and my priority, in keeping with my forum S/N, was to go with the least amount of pain, shortest recovery, and quickest return to normal activities, which, in my case, is weight training, elliptical, and hockey 2 or 3 times a week. So I went with anterior minimally invasive plastic/ceramic THR with Dr. Neuwirth at NY Presbyterian. Walked out of the hospital and into my building with a walker 6 hours later (and only because it took me that long to urinate and stop feeling dizzy from the meds), and then folded it up, put it in the closet, and never touched it again. Started walking the next day and waited a week to start upper-body workouts only because I didn't feel energetic enough to start sooner; and got back on the elliptical as soon as I got home from my 2-week follow-up visit. Spent the next 5 weeks working out to recover my strength, doing my own rehab with a few hip exercises added to my regular leg training at home, and was back on the ice 7 weeks to the day from my surgery, and skating at 100% within a week or two. One of the other instructors with whom I run an adult beginner clinic had a traditional posterior-approach THR a few months after mine, and he was on crutches for weeks, then a walker for weeks, and it took him about 6 months before he could put his skates on again. My knees bother me and I just had a cortisone shot in both of them; but my hip is perfect.

[imgetinold]

I forgot to mention one thing.  Your local surgeon said you might get twenty years out of a THR.  What then?  Revision from a THR is MUCH more of a process, and removes a lot more bone.  No small consideration....unless you don't plan to live more than 20 more years.

[23109VC]

Thanks for all the great info!!  I haven’t logged in for a while..but I have been researching this a LOT since the last time I posted this some time ago.. plus I have been VERY busy with a new job/career that has consumed much of my other spare time…

I reached out to Dr. Gross and sent him my most recent X-rays and I enjoyed a detailed phone call with him not too long ago where we discussed my options, including the THR vs HR issues.  Dr. Gross had a lot of excellent info - not just opinions alone, but concrete data that clearly shows the benefits of HR over the THR, not only in objective measures, but also in subjective measures as well.

I have made up my mind to go back to Dr. Gross to get another HR.  The only issue is that I have to wait a bit longer.  I am going to switch my insurance from my current HMO into a Blue Shield PPO that will allow me to see Dr. Gross and have the procedure covered.  The actual cost of the PPO plan is not terribly more expensive than what I am paying now. 

So I can switch my insurance later this year, and the plan will go into effect Jan 1, 2023.  I will likely reach out to Dr. Gross shortly after I am in the new insurance company and start the process of booking my procedure.

It sounds like Dr. Gross’ protocol is different - I had my surgery years ago and was in the hospital for a few days.  Now it is an OUTPATIENT procedure!  I also believe I will be able to fly home much sooner than last time…great news.

Thanks to everyone here.  This has been a great website..I used it HEAVILY when I was researching and planning my first hip…which is now over 11 years old…and still going strong!

[23109VC]

I just thought I’d post a short update.  They recently went through the open enrollment. With my employer where I have the ability to change health plans after much research, I found a PPO plan that allows me to see Dr. Gross.  I’ve been in touch with his office and come January 1. I will be calling to schedule my surgery!

[ScubaDuck]

Well I am 4 days out from my second hip resurfacing with Dr. Pritchett.  The first was the Birmingham device  in 2011 at age 50.  This time it was the EndoTech titanium-ceramic device. 

I was surprised also that it was outpatient.  Last time I only spent one night in the hospital which I thought was quick.  Well I can tell you that after an afternoon surgery this time, I was fine to head back to the hotel by 8:30pm.  I did have to get some fentanyl and toradol after pain became a bit much.  I have to say the spinal block and sedation was much easier to recover from.  I think the procedure has gotten much better to allow for quick discharge.

So far the recovery has gone much easier and quicker than I recall from 11 years ago.  Neither time did I need the oxycodone past 24 hours.  Today I went for a longer walk with one crutch.  Pain has been much less and mobility have been much better this time.

Best Wishes