Hi guys,
Im new here, have done some reading on the resurfacing but when it says for active younger patients most people are still around 40. I am only 26 years old, suffering badly with arthritis and bone spurs in my left hip. Im pretty sure its relating to a bad accident I was in 7years ago. I work on cars for a living and cant do anything active anymore, hardly make it through a days work cant sleep at night etc. Im nervous that getting this operation done at only 26 what will happen in the future if it fails. Is a resurfaced hip the only option or is there other tactics to consider. I am doing physio, drinking a ton of water and have started glucosamine. I have been waiting a while to see the local orthopedic department on what they suggest. Any and all info would be great. Thanks,
Mark
Hey Mark, welcome to the site... I'm sorry you're dealing with this, but treat it like any other illness, sometimes it strikes people who are not typical.
You've already been diagnosed with osteoarthritis?
We have several younger folks here who for any number of reasons had their hips go on them and had HRs or THRs. I'll let them chime in...
Again, welcome and ask anything, we've been where you are.
Thank you
Yes I have been diagnosed with osteoarthritis
Hay Mark! Welcome!
I was a young resurfacing patient at 28 at the time of my operation. If you have the symptoms that you have now its time to take action mate. You can leave it too long and do irreversible damage and end up with a thr.
My advice to you would be to go see THE BEST SURGEON YOU CAN!! That means a surgeon who has done thousands with great results. Where in the world are you? Maybe we can point you in the direction of a top surgeon.
Danny
Well I'm in Kingston, Ontario so not a ton of surgeons. There is one in our town that does them I don't know about thousands though. I am trying to deal with this as quick as possible especially trying to run a business and with a child on the way. I have been waiting over a month just to find out when my appointment is so speedy isn't exactly an option for health care around here unfortunately.
Mark any operation carries risk. But at your age you need to minimise the risk. Seeing a top surgeon who has done a large amount of these is THE BIGGEST way to minimise risk. I know you want to get repaired and get on with life but think about the bigger picture. If you see a less experienced surgeon who screws it up then long term it won't be good for you or your family and business. Look at your options even if it means going international. Vijay Bose is a top surgeon and he is pretty cheap thanks to a great exchange rate with India! :)
Backing for Danny's point about a top surgeon. They will often review X-rays sent to them as a start. Would give you an idea of whether you are a candidate.
David
Hi Mark, I agree with all the prior comments. Here is a link to all the doctors Pat tracks, hope it helps.
It was updated 10/3/13.
http://www.surfacehippy.info/listofdoctors.php
http://surfacehippy.info/hiptalk/doctor-information/
Bob
Hey. I'm Canadian too. I live in the Windsor area. I waited 2 years for my surgery with dr Richard Mcalden in London Ontario. I did my research on him. He is one of the best around our region. He wrote a few books on hips. He is only a few around that I would trust with my hip. I'm getting a hip resurface done in 10 days. So I'm nervous as he'll right now. I'm only 41. I would recommend him for you.
I appreciate the replies and info guys. Not that I want to bring it up but just because of the age IF a hip resurface fails down the road can it be re-done? The surgeon in Kingston that does them is the chair of the orthopedic department and also the teacher at Queens University. Do you still think I should seek further? Also would Arthoscopy be an option for me, or no?
Yes a resurfacing can easily be redone to a primary thr should the need arise.
As far as your surgeon goes you need to find out how many he has done how long he has been doing them with what success rate. What were the reasons for any failures and what device he uses. As I say being young it is even more important to see the best as the surgeon is the single biggest factor in success followed by device and patient selection. Get some X-rays on disc and send them to some of the top surgeons who will give you a free opinion.
Danny
Okay thanks Danny. I do see there is a surgeon in NY state which is close to me who has done over a 1000 but money may be a factor going out of country. Any idea on what the going rate is in the states?
Mark,
There is quite a lot of info out there that indicates there is a learning curve through the first 200 operations (Revision rate is higher during the early operations). Also there are some surgeons who are only doing this operation infrequently which is also not good. If you find out how many the surgeon in Kingston has done and how often he does HR surgery (And which device) please post here for others to find.
I don't know whether you can be referred to a surgeon in Ottawa under OHIP, but there are two experienced surgeons in Ottawa General (Dr Paul Beaule, and Dr Paul Kim who was my surgeon) who have done a lot of HR and are doing them every week.
Mark, have you had anyone talk to you about labral tears and femoral acetabular impingement (FAI)? These are conditions of the hip which cause pain in younger folks, and perhaps your dr is just saying osteoarthritis as a general cause of your pain. Have you had only x-rays? Need MRI for labral tear diagnosis. You can get free consults over the phone from some surgeons, I know Dr. Gross will. They can look at your x-ray and say whether or not you have FAI, which can cause labral tears. If you do, there are other options besides resurfacing. I had my hip scoped at age 32 and that gave me 4 years of relief before I finally needed resurfacing, some get longer. The only reason I say all this is because FAI and labral tears have only been on the ortho radar for the past 10-15 years. Some docs don't regard it as a real problem, though most have come around to the hypothesis. The arthroscopic surgery is less invasive and gets you back faster. Many professional athletes get this procedure and are back to playing their respective sport in 3 months. I imagine at age 26, you can have OA, but I wouldn't be surprised if you actually had FAI that was causing cartliage wear and tear. Google FAI/hip and hip labral tears.
I may check into that, if it was FAI would I still have bone spurs due to that? When they gave me the results they told me there were minor bone growths (spurs) as well as moderate OA. I was an athlete my whole life hockey, extreme sports etc. Had a bad motocross accident where I broke numerous bones. I expected arthritis in my wrist and arm which is full of plates and screws but its all good still (knock on wood) so this was very unexpected. I have had pain in the groin and my SI joint for a while. Now its full hip sometimes right into my knee etc. Maybe I should have an MRI done to see further. That gives me a lot more hope too. Thanks
Mark, labral tears cause groin pain and the fact that you have been athletic your entire life doing high impact sports, it is highly likely you have one and that it may be caused by FAI. Bone spurs are definitely associated with FAI as the bone on the head of the femur is constantly rubbing the rim of the acetabulum (socket). As the bone rubs, the labrum tears and the cartilage gets worn. Also, bone spurs result as the small pieces of bone (osteophytes) that get rubbed off start growing together and calcify. The calcification of the osteophytes results in less joint space and thus further rubbing and eventual cartilage damage/wear (osteoarthritis). I do think you should exhaust less invasive options as at least a stop-gap before major hip surgery (resurfacing or replacement). Like I said, I got 4 years extra before I needed further intervention, though I had a less state-of-the-art procedure. Some folks, according to literature, who have arthroscopic repair and microfracture procedures may get 10-15 years before further intervention is needed. That would put you in your late 30's-40's like many of the rest of us here.
That is some excellent information. Thank you so much gfunk309. I pray that's what it is, because this is exactly what I was hoping for something minor to get me through like your saying to me mid-late 30's before a major surgery. I have just emailed my doctors office on sending me for an mri
Good luck and let us know how it goes!
Mark, to make a long story short, I to0 had hip and groin pain prior to surgery. Also, 3 months prior I started to experience knee pain. My diagnosis was minor OA, and than a MIR (with dye) showed a labral tear. The OA by itself was not enough to make me a candidate for a BHR, but add in the labral tear and I was a candidate.
I am know 4 months post op, no hip nor groin pain. I do have minor knee pain when weight bearing and am doing PT in hopes it goes away.
Hope this helps.
Bob
Hi Mark, In my early 20's i had a snowmobile accident. I was told I had a "groin pull" but for years (30+), I sufferred. It just got progressively worse and worse. Of course, now I know it was a labral tear with developement of osteoarthritis and spurs. I was holding on until I was "old enough" for a hip replacement but then I found out about BHR. If I had had that option sooner I would have done it a whole lot sooner. I am one day ahead of my friend bestbob in the previous post and am recovering nicely. It's no easy walk in the park but it sure beats not being able to walk in the park at all.
Hi Mark,
I live the Toronto area and have been reading this site since diagnosed with OA about three years ago. There are surgeons in Ontario who can do Birmingham Hip Resurfacing covered under OHIP and do not cost us anything.
But personally, I want to minimize risk of problems from the surgery and causing an early revision. I'm going to go to Dr. Bose in India who is widely recognized as one of the top surgeons for this surgery in the world, yet costs half that of other private surgeons.
I wish there was hard objective data to support the results of any surgeon. But we have meta data from national registries and data provided by the surgeons themselves. However some surgeons have stellar reputations and if you canvass this and other sites you can hear from enough people, patients and long-time advocates and professionals, and make up your own mind.
If I were 26, I would be willing to pay the ten grand in pursuit of the best outcome possible.
Having looked into longevity, the best data I know of is by the McMinn Centre which reports 98% of young male resurfacings done over 12-15 years in the first cohort of 1000 are still functional. It's implied this 98% do not have any significant pain or loss of function. These are the results of Derek McMinn.
You are wise to raise questions about eventual revision. From what I can gather, hip resurfacing revisions occur for many reasons but in the event of loosening (or hypothetical wearing out) the acetabular side will require a new cup as with a THR.
Basically you would end up with a Revision THR. These last about 12-15 years and do not allow for any impact sports. Each subsequent revision lasts less time and is a more complicated surgery.
No one has ever wound up in a wheelchair as far as I know. But from what I can gather, having a revision THR is bad news for any athlete or highly physical person. Hopefully, though, by the time any of us younger folks requires a revision, technology will allow for a longer shelf life of our second hip.
Any thoughts?
Good luck.
If ever required revisions generally are a primary thr not a revision thr.
Danny, how do you know that? I did get an email from Dr. Bose that while the bone stock on the femur is preserved the acetabulum bone is not.
This means the acetabulum side requires a "revision" component and potentially bone grafts just as with a second THR.
What causes for revision are you referring to? I'm speaking of the "natural" causes of revision that may eventually come after decades for us all, not the exceptional cases.
The subject of acetabular bone loss is a controversial one. Watch the McMinn videos he says that revision of a resurfacing is equivalent to a primary thr. That is one of the beauties of this operation.
Also realistically it's not likely any of us will "wear out" the bearing couple in the bhr. As for the loosening its not an issue as I see it. Look at McMinn or Treacys results and at nigh on 20 years its a non issue. May it be an issue further down the line? Time will tell.
I will take a look at McMinn's video regarding revision. Is this view that a resurfacing revision is to a primary THR including that there is not significantly more bone loss after revising a resurfacing?
If the new device is a THR not a revision device, that is good news. However it still leaves the question of acetabular bone. I've never heard of a resurfacing doctor saying a resurfacing device preserves acetabular bone.
What would be good would be data on THRs that followed resurfacing devices. Playing the devil's advocate, I'm not sure there is much if any consensus in the field on the issue.
I'm sure Dr Su has published a study on the matter of acetabular bone loss by weighing the bone resected. I don't think there was much difference between the 2 mate. And as for large head thr's that all the manufacturers are going to there was no difference from my recollection
Yes my understanding is there is no real difference in acetabular bone loss between resurfacing and most THRs. Resurfacing does preserve femur bone, and there may be a few THRs that preserve more acetabular bone than most THRs/resurfacings. So it seems to me that a THR, even a primary THR, revised from a resurfacing will still be a revision insofar as acetabular bone.
This is important, because seems to me that this will affect restriction levels on the new device should (if) the resurfacings ever fail over the course of the lifetime of an athlete.
Just as an informational point, according to the 2012 Australian registry, the type and proportion of revisions to a failed HR practiced have been:
- Total hip - both acetabular and femoral (53.3%)
- Isolated femoral (38.5%)
- Acetabular only (5.2%)
Apparently this is the first year where Total hips were the top item, before it was femoral.
In my opinion, that may be more a surgeon's choice or a more accepted method now than before.
So based on previous revision choices and even now, a major number of revisions (and before the major number) were femoral revisions. So the acetabulum component once inserted stands a good chance of remaining in place even in the case of revision.
The argument for bone preservation still stands as a good one if the acetabular component is left as is.
And to remind us the largest reasons for failure (of the total cumulative failure rate of 9.5% over 11 years, meaning all failures with all devices (including recalls) and all surgeons over that time):
- loosening/lysis (33.6%) or (9.5 * 0.336 = 3.92% of all HRs during the 11 years)
- fracture (25.7%) - this is mostly limited to the first year in HR (9.5*0.257= 2.44% of all HRs)
- metal sensitivity (16.6%) or (9.5*0.166=1.57% of all HRs over 11 years)
- infection (7.2%) or (9.5*0.072=0.684% of all HRs)
- pain (6.0%) or (9.5*0.06=0.57% of all HRs)
From what I've read, fracture is mostly an issue during the recovery period (0-1 year), with most failures during the first six months.
Wow some great information here!
As for going to India I think that will be out of the question. In all honesty what makes some of these surgeons do the surgery so much better? Im sure there should be some very talented surgeons in Canada is there not?? Also NY state is very close to me where Dr Clark is. I have no idea what that would cost though.
The attraction to travel to India is both the skill and experience that the doctor there has, as well as the affordable prices he charges.
Some folks here have had theirs done there, and given the sheer number and success he's had, despite the distance traveled, he is a very attractive option.
I understand the distance involved, both physical and mental, but in this surgery, the aftercare does not have to be done by the surgeon in my opinion.
My surgeon thankfully lives near me (one hour's drive), but to tell you the truth I would easily have traveled to New York, South Carolina, Cleveland or any place that would let me have the best chance at a good, successful HR. Pat, who runs the site travelled to Belgium to have hers done as several of our hippies have.
There are many good surgeons that you can reach, but as with everything, your circumstances both personal and financial will influence the choice.
The important thing to me in making sure this is done right is to choose the best possible surgeon, who fulfills these criteria (again my own opinion) :
- Experience. Has to have done at least 2-300 HRs. Mine had done 800 at the time of my first
- Committment. He can't be a dilettante. He or she has to endorse HR, believe in it and be actively intelligent in explaining what will be done and why.
- Frequency. Can't have done one per month. My surgeon was doing three per day. No matter the skill, in my mind the less repetitions, the less effective. Would you hire a mechanic that did mostly bicycles, but fixed cars once a month? How much more important is your body
- Aftercare. The surgeon has to have a plan in mind not just for the procedure, but also for the recovery. Different surgeons have different plans that they believe in, but they must have a plan that makes sense to you.
- Skill. Demonstrated by results. Quiz them about number of successes, how many failures and ask about what happened with the failures. They are not gods, each has failures.
- Connection with you. You are entrusting your hips in a complex operation to this person, you have to feel a good trusting connection to them and their staff
Again, one thing that is clear is that the most important choice is of a good surgeon. The choice of the device if he's a good surgeon is probably going to be good also, since they are aware and practiced in which devices they believe work well.
You've been given some good choices in Canada, I think we've had several folks here who have successfully had HRs there. The US and overseas choices are also good ones if they fit personally and financially, but again - only if it's a good, successful surgeon and facility.
Personally I would have travelled the length of the globe to see a top surgeon it's THAT IMPORTANT!