Hip Talk Forum About Hip Resurfacing

I am 49 y.o. active female with osteoarthritis in my left hip.  My Kaiser doctor recommended a BHR so I scheduled a surgery for June 14th.  Then I got a second opinion outside of Kaiser who said "no way, I would never give you a BHR.  What you need is a THR!"  Mostly because he believes that BHRs are for large men engaged in weight bearing activities. I tell my Kaiser doctor and he says that in 20 years if I need another replacement, a second THR is never as good as the first, so why not do BHR now then THR later.  Then he says there are many diverging opinions amongst orthopedists and that I can decide if I want a BHR or THR.  I am going to get a third opinion, but still, how do I make this decision?  There is so much info out there.  Plus, my Kaiser doc has only performed 110 BHRs, though I hear he is quite meticulous and has only had problems in two cases.  Please advise.  I'm open to all feedback.  Thanks!  Signed, Limping in Los Angeles

Hi there Kaiser girl,
                           Im sorry to hear about your situation. If I were you I would get as many opinions as possible by as experienced surgeons as you can find.
Having said that it sounds like you may be a candidate for HR so going for that will leave you with more options in the future.
It seems that some orthopaedic surgeons are really against HR for some reason as far as I can tell this is largely due to early trials which obviously weren't as successful as they might have been but that's was back then not now!
I am yet to have a HR I'm currently looking for a referral to a surgeon but my understanding is that a HR leaves you with the ability to have a primary THR later on. Also it
Means that you can live a life without restrictions in the mean time.
If it were down to THR vs HR for me I would go with HR everytime!
Also it seems the old accepted trend that HR wasn't for petite women is generally disregarded by the top surgeons so anyone saying otherwise is Likely to be out of date. 
All the best danny

It is quite simple, K girl. Do you want the top of your thigh bone cut off and thrown away?

Didn't think so. Get resurfacing!

Limping Kaiser Girl

Welcome - you will get plenty of advice and suggests that will help from this forum - it is great.  Experience of the surgeon is key; my Dr has done about 1000 BHR.  

Also - my limp has almost gone - 7 weeks post op - Cheers - Phill

I have what my surgeon called petite bones and I was still able to avoid a THR.  I am in no way an athlete as I've had reasonably severe arthritis since I was a child.  The reason I'm such a fan of resurfacing and the BMHR is that they are more bone conserving and I know that in my lifetime I will need a revision that will be that little bit easier than a TH revision. There are other reasons but that's the big draw for me.

The bone quality on the femoral head wasn't good enough for BHR but a BMHR was fine.  This has a lot to do with me waiting 10 years putting up with the pain and restricted ROM, so I'd suggest not waiting that long!  I'd suggest seeking the opinion of a surgeon with greater resurfacing experience before making a final decision.

Kaiser Girl

Welcome to Hip Talk.  You are sooo young - don't even think of a THR.  Why have any restrictions to your activities and life.  Hip Resurfacing is for the young, active person.  You will keep your femur bone and "IF" you ever need a revision, that would be much easier starting with a hip resurfacing.  Many times a patient might only need half the revision surgery if they only need the femur portion instead of the acetabular cup and femur component.

You will have a much more natural gait with resurfacing and your body will remain much more in balance since no large portion of your femur bone will be sawed off.  You bone will remain active in it's normal state since it will not be sawed off and have a large, long hold drilled into it.  Please listen to Dr. Brook's two videos.  He explaines how having a long foreign rod placed into your femur bone changes the way your bone reacts and regenerates.  THR change the whole balance of the femur bone. http://www.surfacehippy.info/shvideos/videosdoctor.php (http://www.surfacehippy.info/shvideos/videosdoctor.php)

Your first surgeon is correct and at your young age - you should have a resurfacing if possible.  Can you see another Kaiser surgeron?  Dr. Klug is very experinced.  Please understand that many orthopedics can't do the surgery since it is very diffiuclt and will bad mouth it and push for a THR.  Many base their information on negative press and one medical study in Cambridge UK where only assistants performed the surgery and had a very bad record.  If you look at the national registries - you will see the BHR has a retention rate of 96%, similar and in some cases better than a THR.  Every hip device is foreign to your hip and it depends on your bone stock to remain strong to keep the device solid.  Either a THR or a resurfacing can become loose with time.  It really depends on your bone.  So there is no guarantee that you will not ever need a revision with a THR either.

Stay with the resurfacing if possible.  There are no restrictions and your gait will remain normal.  You won't know you even have a hip device placed inside you after you have healed.  Many THR patients are very aware of the device in their hip since it is also a foreign part.

Please read the many personal resurfacing stories  http://www.surfacehippy.info/hipstories.php (http://www.surfacehippy.info/hipstories.php)  and listen to the doctor interviews.  It is an easy way to learn.  Take time to learn now so you won't be dissapointed after your surgery.  You can't go back after they place a THR in your hip.

Good Luck.

Pat

Kaiser Girl-

I am a petite, 49 y.o. athletic female (48 at time of resurfacing), 6 months post-op LBHR. I also had AVN. I got my life back!!! Prior to surgery, my hip had totally collapsed and had some rather large cysts along with the AVN. My surgeon was able to handle it and due to my strong bones (even though I am small!!) the surgery was a success. I too was limping prior to surgery.

No limp after surgery and completely normal gait...it is amazing! I find myself smiling everyday. Please get another opinion and find an experienced surgeon and you will get your athletic life back!!!

If you have any questions of me, you can write me!! Take care.

June

Hi Kaiser Girl,

At 50', I have been diagnosed with OA. The two first surgeons I met pushed me for a THP. They do not want to hear about hip resurfacing. Perhaps they were not experts in this technique. The third surgeon I met was a real expert about resurfacing and he gave me a lot of details. One of the advantage for people of our ages (!) is that it should postpone the need for a THP for at least 10-15 years.

So, you really must have a third opinion before taking this (very) important decision.
Hope it may help you.

Here's another vote for resurfacing if possible.  The first surgeon I visited was a real butt.  Insisted that only a THR would do and that I couldn't do a resurfacing because I'm a female.  I dropped him like a hot potato just on the butt factor alone.  Turns out I was in fact a good candidate for resurfacing.  Had it done a week ago Wednesday with a doc who's done over a thousand of 'em.  It was kinda/sorta rocky for the first week or so, but it's going well now.  I'm mobile, out of the house, and relatively content with my progress.

Take your time, consider your alternatives, and choose what works best for you.

Kate

I was the first HR for Kaiser Mid Atlantic. My doc did mine under the supervision of a more exp HR surgeon.  All went well. I am almost seven weeks post op and loving it. Dont do THR if you don't have to.

Pat,
      Am I right that most revisions are due to loosening? As opposed to wear?
Thanks danny

Hi Kaiser Gal,

I am older (58) and not petite...however not large boned either. I was told I was a candidate for either surgeries. The differences we're based on being female primarily (femoral head size) and age. I was told if I was younger resurfacing would be my only option in the opinion of my HR surgeon. You're that much younger. The other difference was the cup. It seems women are more prone to metallosis from metal-on-metal (although, it's not real common either way). I was told by both docs that at 58 a THR would need to be tweaked certainly. That's why I chose HR. However I have a polyethylene cup so I will probably end up with a tweak anyway. Ha!

I am 6-days post-op and have been walking unassisted all day today and started going unassisted at times by day 4 post-op. I am very happy with my resurfacing.

By all means get another opinion. But regardless, you will feel better with surgical result. I was also told those docs on the cutting edge of THR use better components now(larger balls) and recovery is subtle between the surgeries where it used to be huge. Also the new components are good for all but jumping exercises...but I'd research that more. Good luck.

Hi Kaiser Girl,

I am older (65!) and not petite.  I had resurfacing done a little over two weeks ago, and I feel great!  When I first consulted my resurfacing surgeon (Dr. Gross) he told me it was up to me to decide whether I wanted a total hip replacement or resurfacing because he could perform either one.  As Marymk says, the newer total hip components are much better than the older types, and, per Dr. Gross, the recovery and activities allowed after surgery are about the same either way.  I decided on resurfacing for two reasons:  1) I did not want to have a big piece of my thigh bone amputated and a great big hole drilled into what was left of it, unless absolutely necessary, and 2) people in my family tend to live a long time, so I may need a revision later - revision of a total hip replacement is a lot more difficult than revision of resurfacing.  At the time, I was not aware of the other issues with THR discussed by Dr. Brooks in Pat's recent interview with him.

Please get at least one more opinion, and gather as much information as you can before making your decision!

Isn't there a song that goes "I'm a Kaiser girl in a Kaiser world" or something like that?

Seriously:  For another opinion try Dr Thomas Barber, Kaiser Oakland.  Does resurfs, don't know how many he has done.  Good solid guy, straight shooter.

Best of Luck.

To Danny's question; my understanding is that the answer is yes and yes. Many revision are due to loosening, but the next question is what caused the loosening. Often the cause is osteolysis, meaning that the bone is being eaten away. If the deteriorating bone is near the prosthesis, it starts to loosen. Osteolysis is often caused by the bodies reaction to wear debris. As the body tries to clean out the wear debris, one of the unfortunate side affects is that chemicals are released that attack the bone. The amount of wear debris is a large factor in determining how much osteolysis occurs, and therefore the odds of loosening. So I think the answer to your question is that many revisions are due to loosening, which in turn is due to wear particles.
On a side note, sometimes with the older plastic cups, the plastic would wear out to the point that it needed to be replaced. If you were lucky, they could just replace the plastic liner, rather than doing a revision. The real problem, is that by the time that there is this much wear, the odds of osteolysis would be pretty high, and this might lead to a revision.
The good news about MOM resurfacing, is that there is a lot less wear debris than with the old plastic liners. A well placed HR is not likely to wear out in anyones life time, and hopefully the persons body will not react to what wear debris there is, in a way that will lead to significant osteolysis leading to loosening.

Thanks John that's pretty much what i thought (well that's what I took from the mark Bloomfield interview I saw!:-))

Dear Hip Vets,

Wow.  I feel grateful for all your responses.  Indeed this is a serious operation and I must be thorough before I allow anyone near me with a sharp utensil! 

Thank you, Pat, for that specific link.  Now I understand the value of the femur.  I also find it amusing that this 2nd opinion M.D. was so quick to dismiss it's utility.  "Who needs it anyways?  You won't even notice it's gone."  Consciously maybe not, but apparently from what you all are saying femurs play an important role in leg length, balance, and future revisions.

I did call Dr. Klug's office, and he's so busy I can't even get an appointment to meet him until July, let alone a surgery date.  Plus, he's in Roseland, North of Sacramento.  I'd have to travel back to L.A. post surgery and that cannot be comfortable...  Plus who'd do my follow up?  The L.A. surgeon?  I'm sure that would be an ego jolt for him.  So then what kind of aftercare does he give me?  These are my concerns about travelling to get a more experienced doctor.

Eitan, I think the song is: "I'm a barbie girl, in a barbie world. Life in plastic, it's fantastic!" I could change it to Kaiser Girl and after the surgery I hope to say "life in metal is fantastic." I will check out Dr. Barber, though, and find out how many he's done. I'll still have the same travel issues, though, but it's worth a look.

Marymk thanks for pointing that out.  I had heard that recovery and surgery was more brutal with the resurfacing, but if the differences are decreasing then that removes those objections.

Kate, HipnHop, Ainee sounds like you guys are doing well fresh out of surgery.  That is inspirational.

Lori, what is the difference between a BHR and a BMHR?  (Birmingham Metal? Hip Replacement?)

Thank you Danny, Lopsided and Phil.  I can see that experience makes a difference with the surgeon.  My Kaiser doc has given me #s of satisfied patients, but how do I know if his work is good enough?  They say they are happy.  One lady came into his office post-op one year later and did the splits right there in front of him!  That impressed me.

I am going to look at the list of local doctors on this site and get a 3rd opinion.  If anyone has any other Kaiser connections, please let me know.  Could a Kaiser group be started on this site so we can share info re specific docs?  Just a thought.

Today it was obvious that I cannot delay this surgery much longer.  I went to the Getty museum with my family for Mother's Day, but I could barely get around, dragging my left leg like a deadweight.  Someone wrote on this site that osteoarthritis is a very slow, imperceptible change over years.  That's me. I couldn't even go down to the beautiful English garden where I used to do somersaults on the grass with my kids... My time has come.  Thanks again for the warm welcome to the Hip Club.

Good luck and keep us posted!
My OA deffinatly wasn't a slow change tho I went from being mega fit training literally hours a day to not been able to move my leg in about 6 months!  ???

Quote from: Kaiser Girl on May 09, 2011, 02:41:52 AM

Lori, what is the difference between a BHR and a BMHR?  (Birmingham Metal? Hip Replacement?)

The BHR is the Birmingham Hip Resurfacing which is the standard Birmingham device that is used in the US.  There is a newer one that isn't yet FDA approved yet called the Birmingham Mid Head Resection which is kind of like the next step along the path from a BHR (picture and info here: http://www.mcminncentre.co.uk/birmingham-mid-head-resection.html (http://www.mcminncentre.co.uk/birmingham-mid-head-resection.html)) and is still significantly more bone conserving than a total hip.  It is a solution for people like me that aren't suitable for the BHR due to bone quality of the femoral head and aren't keen to go total hip for all of the reasons that the rest of the crew have spoken about here and the reasons that you'll find in the rest of information on this site.  

We've all been where you are and have done the research and gone to a whole bunch of doctors and decided that this is the way to go for us.  Ultimately it is your decision and you need to work out what is right for you but before you do - please do get another opinion now you have a bit more information up your sleeve!  Good luck!

Hi Danny

QuoteAm I right that most revisions are due to loosening? As opposed to wear?
Thanks danny

Revisions are generally due to acetabular cups placed at wrong angles.  The edge wear occurs because the acetabular cup is rubbing on the femur cap in one or more concentrated areas which cause high metal ions.  When the cup is placed correctly, the wear between the components is spread over the surfaces of the two components rather than in just one area. 

Some cups and a few femur caps have become loose due to bone loss or bone never growing into the component properly. 

Some revisions are due to actual metal allergies of the patients to the cobalt/chrome/molybedum.  It is very rare, but there are a few cases listed on my Resurfacing Problems Page.

A few revisions are sometimes from femur neck fractures - some due to surgeon error and others from patient falling or doing something they most likely should not have been doing so soon.

So there are a number of reasons for revisions but many currently are from misplaced acetabular cups causing high metal ions from edge wear.  I don't have any statistics at hand about the various reasons.  If I find them, I will post them.

Pat

Dear Pat many thanks for the great info! Please keep up the great work!! :)

Hi Kaiser girl,

I know Dr. Klug very well and if you contact me, I can get you on the fast track with him if you like.  I'm a Patient Advocate.

With hip resurfacing, the single most important factor in it, is surgeon selection and Dr. Klug is the only "go to" Kaiser doc for hip resurfacing.  The only follow up you will ever need locally is with your GP doc who can order PT and x-rays which you can email to Dr. Klug for follow up.  I know of patients that have flown to Dr. Klug from even CO.  He really is very good at this. 

Many of us have traveled great distances for our surgeries and never had any problems with follow up care after.  I flew from CA to India for both my surgeries.  You can email me at vicky@ vmarlow.com, just delete the space, and I can get you in touch with Dr. Klug and get you on the fast track if you are interested.  I know a lot of the top hip resurfacing surgeons in the world and we are so fortunate that there happens to be ONE in the Kaiser system.  Feel free to email me and I can also give you my number if you want to call me.

Vicky

My 2 (more) cents:

Re:  "You will have a much more natural gait with resurfacing and your body will remain much more in balance since no large portion of your femur bone will be sawed off.  Your bone will remain active in it's normal state since it will not be sawed off and have a large, long hold drilled into it."  (From Pat's post)

Um . . . Sorry.  There is no actual proof that the above is true.  This is certainly the theory, but not anywhere near proven.  Mr McMinn, the guy who pretty much revolutionized resurfacing in the '90's (Along with Dr Amstutz, a holdover from the '70's who at age 75 is still going strong in CA, G-d bless him) would have you believe the above, but he's a salesman as well as a surgeon; so you need to take his "dogma" with a grain of salt.  The only worthwhile study comparing resurfacing to THR was done by some guys from Montreal (Vendittolli, Lavigne, and Roy).  They found no difference in any of the 15-20 indexes that they measured.  This includes all gait parameters, leg length, one legged hop, balance, proprioception and on down the line.  In fact, both the resurfaced patients and THR patients for the most part all returned to pretty vigorous physical activities.

The statistical reality (I know.  "There are lies, damn lies, and statistics."  But anyway.) is that, barring major complications such as dislocation, infection, component mal-placement, fracture etc) you have over a 98% chance of being very happy with your result whether you have a Resurf or a THR.  There is no CURRENT proof that a resurf will outlast a THR.  With the new THR technology, (ie better bearings such as Large head metal on metal, ceramic on ceramic, etc) you will likely NOT ever require a revision.   I do not know what your desired future level of activity is, but you probably can reach your goals with either surgery.  Reasons not to get a Resurf have to do with technical aspects such as a small femoral head or neck (found more commonly in women than men), osteoporosis (again, more common in women), severe head or neck deformity etc.  Only a qualified surgeon can tell you if you fall into these categories.

I got a resurf because I wanted to get back to wrestling and submission grappling, very demanding sports which require one to shoot the legs forward and back quite quickly and violently.  I felt that I was probably at higher risk for dislocation if I had gotten a THR.  I was comfortable with my surgeon, who has probably done more resurfs than anyone in Canada.  (I am doing well so far, but certainly not yet back to those sports). Were I not so active, maybe I might have gone for a THR.

In summary, there are some people on this site who have an almost religious revulsion towards getting their femoral head cut off (insert inappropriate joke here).  This revulsion isn't based on any current rational, scientific evidence, but rather on (so far) unproven theories.  Do your homework, choose the best option/surgeon for you, and I am sure that you will do well.  Best of luck.

Eitan   
 

Quote from: Eitan on May 10, 2011, 09:37:21 PM
In summary, there are some people on this site who have an almost religious revulsion towards getting their femoral head cut off. This revulsion isn't based on any current rational, scientific evidence, but rather on (so far) unproven theories.

No Eitan, the objection to getting your leg bone amputated is based on common sense.

I agree with the last poster, IF a patient is a perfect candidate for resurfacing after several top hip surgeons (that do many of both have determined them to be so), there is just NO logical reason to chop off a perfectly healthy huge chunk of bone for no good reason.  Of course if they do not qualify after getting the top surgeons to give them a truly unbiased opinion, then a THR is a great option to get someone out of pain, IF and only if they actually really do not qualify for resurfacing. 

Preserving bone just makes logical sense.  Each time you might need a revision, they have to remove more and more bone, why not start off with the least bone removal and the most natural hip.  There is just nothing natural about going down the bone marrow and it can cause some unknown issues with fatty deposits releasing into the blood stream.  This was brought up at the conference by Derek McMinn in AZ recently and Mark Bloomfield actually wrote about it in a post on the UK board a while ago, but it sounds pretty scary to me.

Then there is no getting around the stress shielding once you place a stem down the thigh, no matter how small the stem is, a THR is a THR is a THR.  Also no foreign device is going to have zero problems.  Did you know that the very first pseudo tumor EVER was found in a patient who had a Metal Poly THR device?  Ceramic on ceramic has it's issues as does any other material. 

AND the "NEWER" THR devices have NO history, no data to know whether or not they will last or not.  Many studies that have been done are usually comparing the two after only ONE year, I would love to see a LONG term study done comparing the two.  I know that there has been one on the BHR after 10 years showing that high impact does not at all effect the survival rate.  Who knows with these newer THR devices if someone decides to do heavy impact where they will be at 10 years out because all of these NEWER THR devices haven't even been around yet for 10 years. With the stress shielding and not loading like a normal hip, you risk the stem loosening.  It is all speculation on the docs parts on ALL of these NEW THR devices, seriously, ALL of them have less data than the BHR.

To me, and that is just me, the less invasive BHR and (removing a LOT less bone) sounds a LOT less invasive to me than a THR, and a resurfacing with a PROVEN device makes absolute sense, it is just logical, again, just my oinion.  Doctors have great arguments that sound convincing, but keep in mind that THR's are a lot easier for them to perform, a resurfacing is a very technically demanding procedure that takes a lot of skill and practice and training.  Many surgeons have no interest in learning it and going through the proven learning curve.

For anyone young and active with healthy bone, it just makes logical sense.  I am the perfect poster child for what NOT to resurface!  I am female, slightly hypermobile, have mild dysplasia, extremely tiny bones, my size is 42/48 and have extreme allergy to metal earrings.  I have had my first left hip for almost 5 1/2 years, NO problems and even went back for my right hip just 5 months ago and this recovery has been nothing short of amazing.

Yes a THR is a great option IF and only if a patient does not qualify for resurfacing.  But if they do, why would anyone want so much healthy bone removed for absolutely no good reason?  Just my .02 cents for what it's worth. 

Vicky

Kaiser girl. Kaiser put my cup in at a about 65 degrees, (too steep) If I could go back in time I would go to Dr. Klug in a heartbeat. You obviously have to use Kaiser,  why not go with the most experienced resurfacing guy Kaiser has ? No brainer from my point of view, and don't worry about stepping on another doctors ego, so what. (Just my $.02 8))
Vicky put me in contact with Dr. Klug after having no luck through the kaiser channels. Nor cal kaiser and So cal kaiser are two seperate entities that do not communicate well (if at all). Dr Klug looked at my x-rays and spent about 45 minutes on the phone going over all my options, he seemed to care more than the whole staff who did mine, and I never even met the guy ;D. If you gotta use kaiser I' d go see him. Best of luck to you 8)

(Thanks again Vicky !)

For me, back in 2004, I took the decision to go for BHR.    My main arguments were that it preserves more of the bone and can be revised to a THR later if needed.

As has been posted earlier, who know how long the different systems will last, particularly in different individuals.   You make your choice and go with it.    I have no regrets with my two BHRs.   

Ed

Hi, I wasted 2 years of my life before I encountered this site and Vicky's, I was advised to wait 10 years and have a THR. I actually considered taking up wheelchair racing!

9 months post op I am running again and well on my way back to full fitness.

Hi guys,

I have received a lot more feedback since my last post.  First of all, thanks to Vicky, I am now in contact with Dr. Klug.  Clearly, he's the Go To Guy at Kaiser.  He very kindly offered to be my surgeon and I am seriously contemplating this.  However, I still can't make up my mind... I've sent my x-rays abroad to 4 orthos in Switzerland and 2 in Spain (via family friends); without any financial incentive, they all say do a THR.  Mostly because now with MOM THR they are thinking that it might last a lifetime.  Of course, there is no longterm data on this and I'm not waiting any longer to find out.  BUT, I'd love not to have to ever have a revision.  It's hard to say what my hip and the state of the art will look like in 20 years, but I do have a history of osteoporosis in my family.  So some docs are saying that removing the femur removes the risk of a femoral fracture in the future (obviously).  Why not go THR now and not do BHR now so I can have THR later?  Just a thought.  I'm totally confused and open to more suggestions.  Thanks for all your support.

Quote from: Kaiser Girl on May 18, 2011, 02:22:26 AM
I've sent my x-rays abroad to 4 orthos in Switzerland and 2 in Spain

If you are contemplating Europe, why don't you try Dr. De Smet in Belgium?

~~ Why not go THR now and not do BHR now so I can have THR later?  Just a thought.  ~~

Not to raise the ultimate boogeyman, but what if your THR needs revision later?  Not a whole heck of a lot left to work with at that point.  For myself, part of choosing BHR is the conviction that I'd much rather have a far less intrusive revision later, if need be.

Just a little food for thought.

kate 

You can't run on a THR you know

Kaiser Girl, have you noticed that:

• There are many surgeons not skilled enough to do the operation that advise against it.
• There are many resurfaced hippies that are back up to full fitness.

You could get a THR if you are willing:

• to get your leg bone cut off,
• your marrow drilled out,
• fragile plastic inserted,
• never cross your legs, sit on the floor or run,
• never play with your children,
• definitely need revision surgery and preferably enjoy it,
• to get second best.

Your decision.

I wish I could go to Europe, but I have Kaiser and have to stick with that.  I was just polling for advice.

Of course, they're going to recommend THA if they cant do BHR, but I assumed if I'm just asking their opinion and they're not doing the surgery, they could give me a less biased answer.

And no, I did not know I could not run on THR.  Not that I've ever been a runner, but a quick sprint across the street to chase the dog so he doesn't get run over is sometimes necessary.

OK, Lopsided, you are freaking me out.  I have to look into this more.

Quote from: Eitan on May 18, 2011, 04:04:23 PM
Can't run on a THR

I've seen very few references to folks with THR's returning to running.  I know its been done, but it certainly isn't advertised like it is with a resurf.  It used to be a huge no-no with the old small ball poly.  The plastic would eat away at the bone in the femur.

Quote from: Eitan on May 18, 2011, 04:04:23 PMCan't cross your legs??

That applies to the old school small ball metal poly.  Modern larger head ceramic and MOM don't have this problem.  I ve even seen it argued that the large ball MOM THR is less prone to dislocation than a resurf due to the surgical technique, but i suspect its a non-issue done correctly either way.

Quote from: Eitan on May 18, 2011, 04:04:23 PMCan't play with your kids??

I don't get that comment either.  However, I have kids 4 and 6.  i feel that a resurface with the potential to a revision to a thr gives me the best shot of being active with them and someday grand kids. 

I think I hear from the OP that the argument for the THR is that it doesn't have possible the neck fracture issue of the resurface.  I personally would argue that this is HEAVILY outweighed by the fact that a revision from a resurface to THR is much easier than a revision from a THR to a second THR.  They may have to break it out of your femur and use a special larger rod.

I just went through the resurface.  Its fresh in my mind.  I feel I made the right choice even though I was told by one 'top resurfacing doc' that i should get a THR.  Bone preservation was absolutely essential to me.

Quote from: Eitan on May 18, 2011, 04:04:23 PM
Oh:  And let's stop with the "it just makes common sense" stuff as it really isn't helpful.

Well what is wrong with common sense? It seems like a good way to go through life.

Anyone out there ever cut a cow femur near the top and looked at the "grain" of the bone in that area and then cut through the ball of the femur and compared the "grain"?  I haven't, but I think it would be a really good way to present the notion that the femur (below the greater trochanter) is not designed to take lateral strain.  It would be similar to drilling out the inside of a branch from a tree, put a steel rod in the hole (a few inches in) and then tried to bend the whole unit.  I suspect the "grain" is linear in that area.  It's not designed to take a lot of lateral strain.  Seems to me a metal shank, with a moment arm (the thinner angled femur top) would want to push outward at the bottom and sort of pry it's way out of the femur.  I think that's why surgeons don't want you putting a lot of impact or excessive weight on a THR. Evolution designed the top of our femurs to have the angle for a reason and with it, the type of bone in that zone, also for a reason. 

That might not sound all that common sensy, but it makes sense to me, that's the main reason I went with HR.  Also, I know some folks with THR and they are pretty strict about not running, not even for a short jog.   

Thank you, All.  Objective and factual is what I'm looking for.  I do also have to consider frame of reference when I look at the videos/posts/articles/research.  That's what gets my head spinning, though.  What I don't understand, Pat, is why do some doctors who have no vested interest in my choice, look at my x-rays and say THR?  I want everyone to unanimously say HR!

Actually, Eitan, I must have mis-portrayed myself.  On the UCLA activity rating score, I'm proud to be an 8 out of 10: biking, hiking, swimming, dancing, camping, working out, etc.  And I appreciate your opinion re THRs even though you had a HR yourself.  Not to invite more controversy, but do you wish you had THR instead?  Why did you choose HR?

And einreb, it's certainly a fact that revision from an HR to THR is way better than THR to THR.  But what I'm being told is that the MOM THRs might just last...  Why not get the correct surgery now and never need a revision?  Am I too Polly-Anna on this one?

Hi Tin Soldier,
I think that your analysis is pretty strong. As an example, my mother had her first THR by the time she was 70. By the time she was 77, she was on her second revision (total of three THRs). By the time she was 82, the tip of the stem had worn its way through the outside of the femur, causing pain. They told her that there was little hope of her having a successful third revision, so she went from playing golf regularly, to ending up in a wheel chair. I realize that the materials in THRs have come a long way since then, but the outward load of the tip of the stem against the wall of the femur continues to not be an anatomically sound solution. As an interesting side note, the surgeon that did her last revision was one of the top joint replacement specialists in Seattle. His own knees have been so bad for the past ten years, that he has given up most of his sports. He has scheduled TKRs a couple of times, but has always canceled out. I guess he just saw too many bad outcomes.
I did have a friend recently who had a THR using a carbon fiber shaft that is designed to have the same flex characteristics as femoral bone, but other surgeons that I have talked to consider this to be too experimental, citing possible problems with the carbon fiber fatiguing and breaking down.
Looking at my mothers X-rays as the tip of the implant wore its way out through the femur, is one reason that I went with HR.

Hi KG. Whatever decision you come to, I hope it is something you will feel good about and that the surgery will "give you your life back".  I really have little to add to the robust debate, but if you have not done so already, I suggest that you read the Australian Orthopedic Association report which, as I understand it, is one of the best data analyses of hip prosthesis performance from the national registries, and it may help you settle on the decision.  While some care needs to be taken in interpreting the data (eg sample selection bias, omitted variable bias etc., ie the group of patients with THRs was different from the group choosing HRs, and so on) the data is very interesting.  For what it's worth, I take away great encouragement from the data for HR patients: the performance over time of HRs seems to me to have been remarkably good as compared to THRs considering that during the period of the data (the last decade) HRs were very new, surgeons were "learning" about the surgery (which is more difficult than THR) and optimal placement of the prosthesis, and the patients choosing HRs are the very active ones who are likely to place the greatest demands on the prostheses.  Now we have a good cadre of experienced surgeons, much more knowledge about optimal placement and best surgical technique, and so on, the performance of HRs in the next decade is likely to be even better. 

I know it is difficult to sort through the blizzard of information and opinion, some "expert", some really expert, and much personal perspective.  I respect the care that you are taking with the decision and recognize that as a female candidate you have considerations beyond those of us large boned males.  Good luck and best wishes.  (PS If I was betting on which would last longer, placed by an expert surgeon, between HR and MOM THR, I would bet on the HR - but then I already have  :) :) )

Disclaimer: all submitted as very humble non-expert personal opinion - so no flame wars please!

Kasier Girl

It is simple why all doctors don't recommend a hip resurfacing.  Either they don't do it or are not educated with up to date information. There are some that have done them and are educated and just don't think they are a good solution.  It is a bit like - should I buy a FORD truck or a CHEVY truck.  If you sell Fords, you are not going to recommend a Chevy. There is a lot of politics involved and some is based on the very negatively biased information by the media.  The national registries are the best source to see the retention rates.  They are excellent for the BHR and in some cases for certain selection of patients - better retention rates than THRs.  All of hip replacement is constantly changing.  There is no perfect hip replacement since you can't duplicate the human body.  So doctors and companies continue to design devices.  You make the best selction of what is available when you need it.  Look at computers - 15 years ago no one thought they would have an I Phone that could do as much as a small computer.  Techniques and devices continue to develop and you have to choose what is best at the time.

It is a fact, most orthopedic surgeons don't recommend hip resurfacing.  It is also a fact that many are not skilled enough to do them and choose not to.  That is good for the patient.  You don't want a botched hip resurfacing.  If they can't do them, few will recommend them.  They want you as a patient and will do what is most comfortable for them and what they are use to doing.  Few people in this world are adventerous and depend on the tried and true - if all did that, there would be nothing new.

Pat

PS Place particular weight on Pat's posts.  ;)

Quote from: Kaiser Girl on May 19, 2011, 01:14:36 AM
But what I'm being told is that the MOM THRs might just last...  Why not get the correct surgery now and never need a revision?  Am I too Polly-Anna on this one?

It is the resurfacing that might well last. The articulating surfaces of MOM THR and resurfacing might be similar, but the 'stress shielding' you get from a THR weakens what is left of your bone.

You do not need to get resurfacing because you think the revision will be easier, you get it because you should never need revision.

Choose a good device and a good surgeon. Choose the best device and the best surgeon.

Thanks for your question:  "Do you wish you had a THR yourself?".  It's simply too early to tell, as I am only 11 weeks out from my resurf.  Perhaps I will have a clearer answer in a year or so.  I saw several prominent surgeons in my area.  One thought I would be best served with a ceramic on ceramic bearing THR, but he cautioned that I probably should not ever run or do high impact sports again.  I had already been aware of the problems with ceramic bearings (ie fracture etc), so in any case I wasn't interested in that option.  Metal on poly is probably the safest of options as it's been around a long time; I was worried that if I was too active on that bearing I might wear it out quickly.  I was also worried about dislocating because a metal on poly usually requires a 28 or 32 mm head, and the smaller diameter head has less length to travel before dislocating from the cup.  My problem with the large head metal on metal articulation, be it resurf or THR, is the not insignificant numbers of patients with groin pain that are being reported by many centers.  That scares me.  Because I have good bone stock, I am not terribly worried about a femoral neck fracture, although they say that it can happen anytime within the first 6 months . . . so far so good.  To Pat's post about her having videos, registry proof etc etc:  I will say again:  There isn't any good objective scientific evidence that resurfaced people are being more active than THR folks; in fact most studies of both types of replacements simply do not quantify numbers in this very important area.  This is an area of research that is ripe for some good objective study, and to date the only head to head (pun intended) study of resurf vs THR showed no difference in activity levels.  We need to get away from the "my neighbor had this type of implant and now he's paralyzed" comments so that we can really be of service to each other on this site.

Quote from: Kaiser Girl on May 19, 2011, 01:14:36 AMWhy not get the correct surgery now and never need a revision?  Am I too Polly-Anna on this one?

I think so, but that's just my opinion.  

Quote from: Eitan
I will say again:  There isn't any good objective scientific evidence that resurfaced people are being more active than THR folks; in fact most studies of both types of replacements simply do not quantify numbers in this very important area.

http://www.orthosupersite.com/view.aspx?rid=83509

ORTHOPEDICS TODAY May 2011
Study finds hip resurfacing offers clinical benefits over total hip

Despite being proclaimed as “The operation of the century,” total hip arthroplasty is far from an ideal procedure. In fact, one study found that “in spite of a good hip score, only 43% of patients had all of their expectations completely fulfilled,” said Robert L. Barrack, MD, chief of service, Orthopedic Surgery, at Washington University School of Medicine in St. Louis, Mo.

Although patient selection is rarely an issue with total hip arthroplasty (THA) and the surgical technique “is more forgiving,” selection and technique are major issues with metal-metal hip resurfacing replacement arthroplasty (SRA), according to Barrack, who spoke at the Current Concepts in Joint Replacement 2010 Winter Meeting. The indications for SRA are also “narrower, the implant is more expensive, and the technique is more demanding and less forgiving.” To justify the use of SRA rather than THA, Barrack noted, there should be some objective clinical advantage.

Barrack was part of a recent multicenter study that evaluated the current level of success and function of modern hip implants in returning high-demand patients to crucial activities. A modern implant was defined as an uncemented tapered titanium stem combined with an advanced bearing surface or a surface replacement.

Data collection

All patients were younger than 60 years old with a high demand (a premorbid UCLA score greater than 6). A novel method of collecting data was also employed.

“It was completely unbiased and blinded,” said Barrack, consisting of a phone questionnaire to evaluate functional outcome among hip implants at a minimum of 1-year follow-up.

Patients were from one of five geographically diverse medical centers, each with expertise and experience in various types of advanced bearing surfaces, and had a cementless tapered titanium stem with ceramic-ceramic, metal-metal (standard and large head), metal on cross-linked polyethylene or a surface replacement.

Moreover, the study contracted the University of Wisconsin Survey Center as an independent third-party surveyor because of its “long track record in administering health questionnaires for state and federal agencies,” Barrack said. The survey center “had no knowledge or interest in bearing surfaces, so it was truly unbiased.”

The study began with a consecutive series of 1,400 patients, of whom more than 60% completed the detailed survey, for a large sample size of more than 800 patients.

“All of these patients were very successful with modern implants in returning to employment â€" over 90% in every category of work, even for heavy and very heavy activity according to Department of Labor categories.” Barrack said. “There was no difference in implant type.”
Perceptions

However, patients who underwent SRA were much less likely to perceive a limb length discrepancy, thigh pain or to limp in comparison to their THA counterparts. SRA patients were also more likely to run for exercise, run longer distances, and walk for longer distances as well.

Conversely, SRA patients “had a higher incidence of noises emanating from the hip than other bearing surfaces, although this was transient and asymptomatic,” Barrack said.

In addition, bone density testing in a select group of SRA patients revealed substantially less stress shielding in the proximal zones at 6 months that continued to improve at 1 year. Therefore, “we now allow these patients full activity at 6 months,” Barrack said.

In conclusion, SRA demonstrated objective evidence “of a higher level of function and satisfaction compared to a similar THA cohort in limp, walking, running, perceived limb length equality, and thigh pain,” said Barrack, who advocates continued use and investigation of SRA in selected patients. â€" by Bob Kronemyer

Thanks einreb, very interesting.

At the present, there seems to be no clearly "right" answer on the resurfacing vs. THA question.  But there seems to be no clearly "wrong" answer, either.  About the best thing a potential patient can do is make a reasonable effort to review available information, sift out the outlier viewpoints, and then make a decision.

To add to the discussion, here is an abstract of study which found that there is a a "significantly higher postoperative activity level" in resurfacing patients as compared to THA patients.  Note that, according to the abstract, patients "with resurfacing arthroplasties were matched to a cohort of patients who underwent conventional hip arthroplasty by gender, age, body mass index (BMI), and preoperative activity level."

http://www.ncbi.nlm.nih.gov/pubmed/19583537

Bull NYU Hosp Jt Dis. 2009;67(2):116-9.

Resurfacing matched to standard total hip arthroplasty by preoperative activity levels - a comparison of postoperative outcomes.

Zywiel MG, Marker DR, McGrath MS, Delanois RE, Mont MA.


Source

RubinInstitute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.


Abstract

BACKGROUND:

Some studies have suggested that resurfacing patients are generally more active postoperatively than their conventional total hip arthroplasty (THA)counterparts, but controversy remains over whether this is a reflection of preferential use of resurfacing for younger and higher-activity patients. We hypothesized that, when controlling for preoperative activity levels, in addition to relevant clinical and demographic factors, resurfacing provides similar results to conventional hip arthroplasty.

MATERIALS AND METHODS:

The specific question asked was whether resurfacing patients had differences in postoperative activity level, clinical outcomes, or rate of revisions, as compared to a matched cohort of patients treated with conventional THA. Thirty-three patients (23 men and 10 women) who were treated with resurfacing arthroplasties were matched to a cohort of patients who underwent conventional hip arthroplasty by gender, age, body mass index (BMI), and preoperative activity level. Mean preoperative Harris hip scores and length of follow-up were similar for the two groups. Postoperative weighted activity scores, Harris hip scores, patient satisfaction score, pain scores, and revision rates were evaluated at a mean final follow-up of 42 months (range, 25 to 68 months) for the resurfacing group and 45 months (range, 24 to 67 months) for the conventional hip group, and analyzed for differences.

RESULTS:

At final follow-up, activity levels were significantly higher in the resurfacing group, with a mean weighted activity score of 10.0 points (range, 1.0 to 27.5 points), as compared to a mean score of 5.3 points (range, 0 to 12.0 points) in the THA group. Mean Harris hip scores, patients satisfaction scores, and pain scores were similar for both groups. There were no revisions in either group.

CONCLUSIONS:

The results of this study suggest that patients treated with hip resurfacing arthroplasty have a significantly higher postoperative activity level, as compared to those treated with conventional THA, when controlled for preoperative factors.


PMID: 19583537 [PubMed - indexed for MEDLINE]

Thanks for the articles and links.  Very interesting.  They will be part of my discussions with several MDs over the next few days.  I'm hoping that the choice will become clear to me by sometime next week.  Dr. Klug is patiently waiting for my response... It's true, there is no right or wrong choice for me.  I am fortunate enough to still be healthy/strong enough that I will do well with whatever device I get.  I just don't want to have any regrets later. 

Quote from: Kaiser Girl on May 20, 2011, 01:41:14 AM
It's true, there is no right or wrong choice for me.

Really?

Lopsided, from what I've been told, I will do very well with whichever insert I get.  I'm young, healthy, active.  I'm not so much worried about the present.  I'm trying to control the future (ha, ha) by trying to pick the device which will be the least likely to need a revision. 

I'm also a surgery virgin so am reluctant to jump in to bed with any surgeon doing whatever surgery he thinks is best.  I need to be 100% behind the surgeon and surgery.  This is no easy decision for me.

And, btw, clearly you are braver than I.  First uncemented Conserve Plus for your doctor?  That is a courageous claim to fame, in my opinion.

K Girl,

I am glad you are young and healthy, and you may well recover well from any operation. There are, however, most definite right and wrong choices. And your health and strength does not mean that you will do well with any device, it means the opposite, that you may wear the device or part of yourself out.

Yes, you want this to be your only operation, and hopefully not need revision. That is what we all want and hope for.

Replacement and resurfacing differ in that:

• A correctly placed and well chosen resurfacing device might well never wear out.
• All replacements have a limited lifetime, because of 'stress shielding'.

I don't know who told you that you will do very well whichever device you get. This is ridiculous.

We all have had concerns over which surgeon to use. It is no easy decision for any of us.

And I am certainly not brave. Much as it seemed obvious to me that I needed resurfacing, it also seemed obvious to me that I should get uncemented. This is another debate. After much research, I chose Dr. De Smet, one of the world's best. Confident in the choice of device, fixation and surgeon, I did not need courage. I committed to it in the belief that it was the single best choice, and knowing that there are no guarantees in life in general.

So do your research, K girl, and you make your choice, as everyone else who is young and healthy here has done too.

Dan

Quote from: lopsided on May 20, 2011, 10:07:41 PM
We all have had concerns over which surgeon to use. It is no easy decision for any of us.

Confident in the choice of device, fixation and surgeon, I did not need courage. I committed to it in the belief that it was the single best choice, and knowing that there are no guarantees in life in general.

lop,

VERY well said. There are no guarantees. I also knew that I didn't want my bone sawed off, didn't want a long, deep hole drilled in my femur and I wanted the device that most closely resembles and functions like a natural hip. That is of course if I qualified for resurfacing. I never once doubted my decision before or after my surgeries. Not one bit! Thanks to you Pat for setting the record straight.

Quote from: Eitan on May 19, 2011, 08:17:53 AM
Metal on poly is probably the safest of options as it's been around a long time

That is madness! In the young active patient there is a high risk of dislocation, wear debris etc. It simply is not fit for purpose, too limiting and will not last.

Dan and Steve,

I agree with everything you guys said.  There are never any guarantees, you have to make the best, most informed decision you can and go with it!

A person that I know with a THR has had a re-occurring problem with the stem in the femur loosening .  Now after revisions they don't want work on   him anymore. This is the main reason I looked into  HR . When I asked my GP doctor about resurfacing, he told me don't get HR , get THR. He was in a hurry and didn't explain why he was against HR. Because of the way he answered, I changed doctor's immediately. This is a big decision and needs more than a 10 second  , slightly arrogant answer. Next doctor I went to  was more open minded and took way more time with me. He prescribed HR to me and now I am 6 weeks post op HR.

I plan to run this piece into oblivion in the next 15 years. My goal is 100 triathlons before I even think about a revision.  I needed a procedure that would give me the best chance at achieving this goal. Everyone has different goals. If I wanted to go to the park and throw around a ball with my kids, I would have done a THR. So I hope HR lives up to hype. It's gonna need it.

Well said, HNH.  Just be sure you leave a sports beverage or two at the finish line for me ... I'll be crossing it right behind you!

Kate

There is a new article on Mr McMinn's website in response to a tv program shown here in Australia.  The article has a look at some of the data that has been discussed in earlier posts in this thread: http://www.mcminncentre.co.uk/response-abc-corners-program.html (http://www.mcminncentre.co.uk/response-abc-corners-program.html)
Mr McMinn's article is interesting and informative and challenges the media speculation with scientific data. His opinion is that "A well-designed, well-engineered, well-implanted resurfacing is a much better option than a hip replacement."  The article explains why.  Even if you disagree, the article is well worth reading.

(He also reminds us: "Choose your device and your surgeon carefully." - again I agree and believe that I did!)

His reply is not really a criticism of the television program, but more promotion of the Birmingham.

He states that there are twenty brands of resurfacing devices, but only compares the Birmingham to three, ASR, Durom and Corin, that he does not like, two of which have been recalled. What about all the others, are they good in his opinion? Why were there no comparisons with the others?

"Not really a criticism"? No, more of a destruction with data, everyone should check the link, thanks Lori.

One other thing Kaiser girl to keep in mind is that all Hip resurfacing surgeons also do THR's, but most THR surgeons do NOT do hip resurfacing.  So the ONLY docs that will ever be able to give you a true unbiased opinion are the ones that do both and a lot of both.  You are listening to docs that ONLY do THR's, now you tell me whether or not their opinions are biased?

Vicky

There was one comment in Dr McMinn's piece that is worth taking a closer look at. He said

QuoteIt is just coming to light that with nonMoM hips as we try to extend bearing life through improved materials and as we increase the bearing diameter in order to reduce dislocations, metal can leech from the (taper) joint connecting the stem and the head or the cup and the insert and cause the same problems as seen with bad resurfacings.

I had read a study from England that showed high levels of metal debris from large head MoM THRs due to these junctions in the modular femoral components. This holds some good news and bad news for resurfacing. The good news is that resurfacing is one of the few prosthetic options today that does not involve some sort of junction between the modular portions of most THR femoral components. This advantage of resurfacing eliminates a potential source of metal ions that is present in most THRs. The bad news is that if a resurfacing needs to be revised, it is usually planned to be converted to a large head MoM. I do not know of any of these that are not modular systems with one or even two MoM junctions in the femoral component.
This leaves two big takeaways. Anyone concerned with metal wear debris must look at any modular THR system as potentially being a source of metal wear problems. Secondly, anyone looking at a revision from a HR needs to inquire into this issue, since to my knowledge, all large head MoM femoral components are modular, and will have this issues of metal wear at the junctions.
It will be interesting to see if the manufacturers will go back to making non-modular femoral systems, since I believe that many of these were the source of the good long term results that were achieved with the older MoM systems.

John - can you explain the dif between modular and non-modular.  Maybe it's late, but I don't recall ever hearing that terminology.  I'm just trying to absorb as much as possible out of this debate and I bet there are some others that would benefit also, thanks.

Hi Tin Soldier,
I think that the reason you have never heard the term, is that it does not apply to resurfacing. However, it is a common term used by manufacturers to describe a common category of THRs. For example, Smith and Nephew (the distributor of the BHR in this country) describes its "Modular Plus" THR model as being "the most frequently implanted artificial joint in primary care in Europe". To my knowledge, all the major brands offer modular systems as the basis of their THR lines.
The word "modular" refers to the characteristic of having more than one part to either the femoral or the actetabular component. For example, in the Biomet brand, we find the "Arcos Modular Femoral Revision System". In this model, the femoral component has three parts; the stem that goes down into the femur, a short angled section that goes on top of that and replaces the femoral neck, and whatever type of head (metal, or ceramic) that goes on top of that. On the acetabular side, Biomet makes the "Ringloc+ Modular Acetabular System" for THRs, which is the common cup with a metal back and a plastic liner. Smith and Nephew's R3 acetabular system has three parts to its ceramic acetabular component. When a surgeon installs some of these modular systems, a patient could have five or six separate parts to his THR; the ultimate modular system.
The big advantage to modular systems is that surgeons can match up parts with differing sizes, angles, and materials to customize a solution for the patient. This has been seen as a huge advantage to the surgeon and the patient, and is considered to be cutting edge technology.
If you read my quote from Mr. McMinn again, you will see where he refers to the " (taper) joint connecting" these various parts as being a new potential cause for concern. Some studies are showing that each of these connecting points may be a source of wear debris, and since most of the connections are MoM, you can understand his cause for concern. Please note that I have not read any studies specifying either the Biomet or the Smith and Nephew models as being a source of problems; I used those brands only as examples of top of the line, leading edge, "modular" systems.
So to get back to my original two takeaways: one of the advantages of resurfacing is that it is one of the few non-modular systems in that each side of the joint has only one part, so there is only one interface to create wear particles. My second takeaway is that many revision systems are modular, so a resurfacing patient going in for a revision may want to discuss this issue with his surgeon.
Sorry for the long response, but if more studies like this come out, modularity may become a controversial topic. It is way too early to tell if it will, or what brands and models may be at issue. I brought it up largely because it was an important, though easily overlooked, part of Mr. McMinn's commentary.

John,

Thank you for that explanation!  I was confused about this subject before I read it, and I'm sure many others learned a lot too!

http://www.gentili.net/thr/material.htm

As I understand it, the stem is titanium but the bearing surface is always Co-Cr-Mo; I am now wondering what the electrochemical potential difference is between these materials. Are we in effect making a 'battery' across the junction with the body fluids as electolyte? That would certainly contribute to leaching of metal ions.

Quote from: gary2010 on June 01, 2011, 05:47:30 AM
As I understand it, the stem is titanium but the bearing surface is always Co-Cr-Mo; I am now wondering what the electrochemical potential difference is between these materials. Are we in effect making a 'battery' across the junction with the body fluids as electolyte? That would certainly contribute to leaching of metal ions.

I have considered this as well. Two different metals, or two alloys together, one of them will corrode. I doubt there would be enough current to affect the nerves, but one of the metals would remain pristine and the other would rust.

I am concerned enough about this that when I have my other hip done, I want a similar device of the same brand so that both sides have the same composition.

Sooo... Kaiser girl, you still on the fence on which to get ?  Just wondering.... 8)

Hi Vicky,

Another respected doctor, Dr. Sculco who is Chief at the Hospital for Special Surgery (where Dr. Su works), puts THR longevity at 95-97% at 10 years, and 90% lasting to 20 years. The discrepancy with Mr. McMinn's data is interesting, if not confusing. 

http://www.hss.edu/condition-list_hip-replacement.asp

i had my left hip resurfaced 2 years ago in India with Dr Bose.  It is the best. I am 55 female.  i do not have a limp and have about 85% range of motion.  no pain.  I need my right hip done and i want resurfacing but my density is a bit low. I am hoping i can have HR.

Zendy,

Are you taking any medication to improve your bone density? 

Hi Jeremy,
You said
"Hi Vicky,
Another respected doctor, Dr. Sculco who is Chief at the Hospital for Special Surgery (where Dr. Su works), puts THR longevity at 95-97% at 10 years, and 90% lasting to 20 years. The discrepancy with Mr. McMinn's data is interesting, if not confusing."

Actually Jeremy on that link it says 80% at 20 years for THR's.  Here's an excerpt below:

Longevity

A total hip replacement has a lifespan much like anything with mechanical parts. Its longevity depends upon a variety of factors, including:

    * Patient weight
    * Patient activity
    * The mechanical properties of the prosthesis

The question of how long a prosthesis will last has been studied in detail over the years. Current studies indicated that about 80% of prostheses will function well for 20 years.
http://www.hss.edu/conditions_hip-replacement-for-arthritis-of-hip.asp

Then he goes on to talk about NEWER THR devices that have absolutely NO solid data to back it, so any of the NEWER THR devices are only speculation. 

Vicky