Hi,
Most of this site seems to be about people who have already had the operation, and this is very informative. I have not had my operation yet, and it could be sometime off, so I have the luxury of doing research beforehand, before I choose what device and which surgeon. So this site is very useful, but, I still have lots of questions. The manufacturers of the devices do not provide much, if any, information, and all the surgeons seem to have their own preference.
Where I am located, in Thailand, there are very few surgeons that do resurfacing, and it seems the only option is the Birmingham. So I will probably travel to England, where there seems to be a fair amount of choice, and many specialists. Maybe, if I have the Birmingham, I might even travel to Birmingham to the McMinn Centre.
Of the various devices, there seem to be different categories with no clear definition:
* cemented femoral component / uncemented femural component
* as-cast alloy / double heat treated
* metal on metal / ceramic
The Birmingham appears to cemented and as-cast. This is all very good, seems to be popular and very successful. It might be my best option, but maybe I would like an uncemented device. The argument by Dr. Gross seems to make me think this would be the best.
Which are the devices that can be fully uncemented. From what I have read, this seems to be some versions of the Cormet and the Biomet.
There is a lot of debate amongst the surgeons about whether double heat treated alloy is as good as as-cast. Well I hope it is, but if it is not, which devices are made as-cast? From what I have read, this seems to be the Birmingham and the Biomet.
So if I want an uncemented as-cast device, I need the Biomet. Are there any others? Although I can travel to England, I cannot travel around the world to America to have it done by Dr. Gross. Which surgeons do the Biomet in England, preferably London?
As for which type of alloy is better, is ceramic better still? Which devices are ceramic? There are one or two reports in this site from people who have had ceramic devices, but no mention of what type. I can find absolutely no information from manufacturers about ceramic resurfacing devices. Who has had it done, what devices, and by which surgeons?
I might well end up with a Birmingham, and I am sure it would be a good choice, but if I can, I want a device that I can understand the advantages of.
Maybe I will not get answers to all my questions, but I hope this will help other undecided pre operation patient too.
Thank you, Dan
Hi Dan
Welcome to Hip Talk.
You are actually close to one of the best hip resurfacing surgeons in the world - Dr. Bose of India. I know a lot of people that went to him and had absolutely wonderful outcomes. He was my second choice after Dr. De Smet of Belgium. I did not want to fly quite that far.
I certainly would trust Dr. Bose since I know so many that went to him. I have talked with him via email quite a few times and we even did a live chat for the website awhile back on Aug. 16, 2009 http://www.surfacehippy.info/doctorchats.php (http://www.surfacehippy.info/doctorchats.php)
As perspective patients, we really have a lot of questions. Many of the newer types of approaches and devices seem very appealing. Without new devices, approaches and doctors - hip resurfacing would not continue to grow.
As a person that has read thousands of stories for over 5 years and owning a BHR that is almost 4 years old, my opinon is to stick with what has the best record according to the national registries, medical stories and personal stories. By far, the BHR is the most used hip resurfacing device with the very best track record to date. It was back in 2005 when I was considering resurfaicng. Dr. Gross is the only surgeon in the US doing cementless resurfacing. I don't know of the surgeons doing it abroad. I am sorry. There has not been that much interest in cementless at the hip resurfacing courses I attend. All of the surgeons are of course interested, but are waiting for more data. Dr. Gross is slowly acquiring that data. So the jury is still out on the cementless. It could turn out to be the standard of the industry years from now - but at the moment there are very few surgeons performing the cementless.
I always suggest, as do the medical studies and national registries, to use the very most experienced hip resurfacing surgeon that you can. Since I don't know of any others than Dr. Gross, that propbably means they have not done many. So the results are not in yet.
I would not want to chance using an inexperinced surgeon just developing a new technique. But that is just my opinion based on the many hundreds of email I receive including many people that used the inexpeirnced surgeons and are now facing revisions.
Dr. Bose of India uses both the BHR and ASR. He also does the BMHR. I don't believe he is doing ceramic on ceramic resurfacing, only Mr. McMinn in the UK is doing that and he has only done a few to this point. The technology is still being developed.
The best advantage of the BHR is that is is the most sucessful hip device used in the world and the most used. It had a track record of a 99.9% retention rate before the US doctors started doing resurfacing. It is now down to about 96% since the new US doctors have started. There is definitely a very steep learning curve. There are medical studies showing that and I listened to 250 of the best surgeons talking about the difficulty of the surgery at the 3rd and 2nd annual hip resurfacing courses. Placement of the acetabular cup seems to be causing the most probelms now and that is normally due to a surgeons inexperince. There has been a lot of discussion about how to teach the surgery and develope new instruments to help.
So althought you have many options, if you want the device most used and most sucessful, it is the BHR. Many of the surgeons in the UK are very expeirnced like Mr. McMinn, Treacy and others. Dr. De Smet of Belgium is also one of the best in the world and has done over 3000+ resurfacings. He has a great rehab program.
So I can't tell you what to choose, only tell you what the track record is of the resurfacing devices and who the most expeirnced surgeons are. Some people want to try the new doctors and newer devices. Most don't have problems, but there is about a 5% chance that you could. If you want to keep that statistics in your favor, choose a really expeirnced surgeon and listen to what he suggest for you. They know the device since they have placed thousands of them and are able to make the best fit for you needs. Peoples individual hip structure and problems do make a difference and only the really experinced surgeon can determine that. We as laypeople can read and learn, but we will never have the experinced that the top surgeons do.
Pat