Hi.new to this but need some feedback quickly.I,m booked in for a ceramic THR on 19th nov and very concerned about it.I would like to have a BHR but the hospital no longer offer them,stating that they are no good.I'm very active (mountainbike motocross)and feel the BHR would be a better option for me at 42 years.What can I do? please help
Ultimately you are the one who needs to decide which device you get, HR or THR. In my experience there are very few docs who will tell patients that they are agnostic as to device. They are for one or the other. Now I am sure a lot of this has to do with other factors (hospitals must have some influence on doctors selection of method/device) but the bottom line is that you have to pick the device, then find a qualified doctor who will do the surgery.
If you want a BHR then you need to cancel your surgery and continue shopping. I hope that your insurance/budget allows you to get what you want.
If you desire a hip resurfacing the only thing you can do is call and cancel, but first ask your doctor for a meeting and specifically ask what your limitations will be with the THR device you will be receiving. In most cases people don't ask enough questions then when the surgery is over your doc ends up telling you that you are severely limited in what you can do.
Some devices will allow you an active life, many don't. Once you have the surgery and the head of your femur is gone you cannot go back so think before you act.
Chuck
Quote from: gasyz on November 06, 2013, 10:33:18 AM
Hi.new to this but need some feedback quickly.I,m booked in for a ceramic THR on 19th nov and very concerned about it.I would like to have a BHR but the hospital no longer offer them,stating that they are no good.I'm very active (mountainbike motocross)and feel the BHR would be a better option for me at 42 years.What can I do? please help
Thanx for input,I've managed to get an appointment with Mr Ronan Treacy to discuss BHR,my doctor doesn't seen very amused, but after reading this forum I think it's my best option.I'm really depressed at the thought of a THR and having to pack up a lot of my hobbies.Like obxpelican said once the head is cut off theres no going back.I think I would rather carry on in pain for now than risk it at the moment.The biggest fear with THR is dislocation and it just doesn't look as strong to me.
I think you're smart to check out all of your options. Mr. Treacy is highly skilled and capable, he will let you know whether you are a good candidate for HR and is one of the best in the world at doing the procedure.
We are not here in this world to amuse our doctors. If they want to be amused, let them go catch a movie.
They are paid consultants to us with specialized skills; in the end we are the ones to live with the results of the choices made, the best thing to do is to make sure all choices are considered and a good decision is reached.
Chuck has given you good advice in my opinion (as he always does).
Gasyz
Do I take it you are also in the UK?
I have seen 3 surgeons;
First - stunned me by saying I was way beyond a scope and that I had maybe 2 years to THR
Second - was a referral from the first who specialised in scopes on "lost causes". He confirmed that scope was not an option and could only offer a THR and was very negative about HR
Third - was a surgeon I found through this site who has performed 1000+ HR's and gave a very honest appraisal of the pros and cons, concluding that whilst he could offer both HR & THR he thought HR was a better option for me when I feel the time has come
Now the point of this story is that surgeons 2 & 3 are amongst THE pre-eminent hip surgeons in the UK, yet have a completely conflicting view.
As others have said, you have to take control of the situation and go to see as many surgeons and ask as many questions as it takes to be comfortable with what YOU decide. IMHO this is not a black and white topic as with any surgery there are risks. THR has shortcomings such as longevity of device and more limitations on activity BUT does not carry the risk of metallosis which is getting all the bad press and causes your body to reject the device.
This is a calculated risk in that it happens on few occasions for those who are well suited to HR, but it does happen and you will read on this forum of a well suited meber facing correction after only 4 months.
Who cares what your doctor thinks as you have to live with the consequences, not him, so take your time and get it right so you never look back wishing you had gone about things a different way
Yes I am in the uk.Seems to me not many NHS hospitals are doing Resurfacing anymore.Apart from Birmingham orthopaedic what are the other options?
Adding to the other posts, this is my view.
First, there is a risk with any surgery and it's an irreversible process (you cannot undo a HR or THR), that's why we all got anxious before taking the step. But once the OA is bad enough, the "not surgery" option is gone, you've to do it. We all hoped (I did) that a new/miracle less invasive solution would come up not requiring a hip replacement (HR or THR), but we are still far from that.
Second, it's not straightforward, there are pros and cons to both HR and THR:
- THR is a well proven technique, it should last a long time in normal conditions, it's more immune to surgeon skill it seems and generally suitable to most patients, the chance of your body rejecting it (including metal reactions -unless is Metal on Metal-) is lower, and allows for good level of activity, but impact sports are NOT recommended. Revision (more likely for young patients) can be done, but there is less bone stock after the primary THR.
Of course, there are a few types of THR devices, with varying materials both in the acetabular cup and the femoral component, and that's an important consideration. It seems ceramic THR are among the favorite now.
So it's a safe, sound procedure, that works well for daily life and allows you to go back to an active life, but is not as suitable for very high level of activity (in particular impact sports).
- HR on paper resembles better the original hip joint, preserves more bone, theoretically it can last a long time (however the records only go as far as 15 years or so at this point) and a potential revision should be a reasonably straightforward primary THR.
It allows for a high level of activity (potentially), including impact sports (running, soccer, martial arts...).
However, it is a technically difficult procedure, with a steep learning curve for surgeons until they master it (and they must keep doing it over time). The results depend on surgeon skill and experience, correct device placement, device design, and patient selection (it seems gender and cup size are relevant factors, also the hip must be in relatively good condition for this to work; and patients with certain conditions like Avascular Necrosis, big osteophytes, severe dysplasia, low bone density etc might not always be ideal candidates).
Also, there is a risk of allergic reactions to metal, of two types: One, there is people allergic to metal, full stop (this is very rare and hard to find in pre-op tests); and two, metal debris (due to incorrect device placement, and bad device designs -like the infamous ASR model-) can cause serious problems and lead to a revision within 5 years or so.
The statistics show mixed or less than ideal results when compiling all HR records together, but once you filter out the bad devices (some already being retired from the market) and the surgeons not specialized in HR (i.e. those that do less than 50 or 100 a year and with less than hundreds of them overall), there is a subset of surgeons whose statistics are really good.
So for me it was:
- THR is "safe" but would limit my high expectations regarding sporting activities.
- HR is more "risky" (less margin for error), but would allow to live a very active life.
- The HR risks are minimized by choosing a specialized HR surgeon with vast experience and good track record (who would assess my suitability, select the right device and place it correctly). If things go wrong, I fall back to a THR.
I went for HR.
Regarding HR devices, BHR seems to be on top of the stats. However it's not the only good one. Also, the surgeon's experience with each device counts. My surgeon has been using BHR and Conserve Plus for years (he has done around 2000 of each), he used Conserve Plus for me (and I believe is his preferred now in most cases).
Of course, in the UK they will be a bit more biased towards BHR as it was invented there and naturally (I assume) most specialized HR surgeons are trained on it.
I was in the same situation (46 yrs old) and visited 3 other surgeons that ONLY recommended THR simply because they do not do HRs. Do your research and take your time if you can.
I finally decided to use Dr. Schmalzried in Los Angeles which is 50 miles from where I live.
Was in a similar situation here in Australia,
First surgeon only performed THR wasn't trained in BHR and totally opposed to the procedure, so asked for a referral to another surgeon, who explained the pros and cons of both and the decision was mine. After doing more research I cancelled my surgery with the second surgeon and now 4 days away from having my RBHR performed by a surgeon recommended on this site. Had no issues with the second surgeon. Close to home but hadn't performed the high numbers of the surgeon I decided to of with. I am 50 , still cycling 100- 200 ks a week but in a lot of pain. Eventually I would love to incorporate some long distant running again. Regardless of the outcome the decision is mine and at the end of the day I just want to be pain free and active. Down the track the THR is another option /alternative. I am so glad that I hunted around until I was totally happy with my decision.
All the best
Many thanx for all the input,so glad I found this forum,Gonna push hard for a BHR,Feeling so upset at thought of THR at my age and limiting sport.My state of mind at the moment is if I can't get a BHR I'll go on as long as I can before a THR.Last month I did a 2 hour extreme enduro(motorbike) go practicing every sat and 2 hours mountainbiking with a club every week as well as the odd 30k xc ride.I'm in pain quite a lot but can't handle the thought of having to give everything up.Don't drink don't smoke,sport is what I live and work for.
Hopefully everything goes well with the Mr Treacy BHR consultation.
Re. NHS and resurfacing. I just got a BHR with Mr McMinn under the NHS's Choose and Book system. Your local CCG could have special rules about them, but mine raised no objections.
The procedure was carried out in a private hospital.
You will be seeing one of the very top surgeons with Mr Treacy and if you are a good candidate for BHR, that is what you will get.
Whyme,
Great post-so brilliantly balanced and articulated for prospective hippies.
Gasyz,
After all the research I did, I wanted to return to sport and could see no reason why to amputate a perfectly healthy femoral head/neck. Despite the UK media last week the success rate of HR is excellent. Indeed, my surgeon (Prof Cobb) said to me 4 years ago that with all we know now re-patient selection/device placement etc HR will last a lifetime.
I guess that you are unable to pay privately-if so I do hope that Ronan Treacy is still able to do BHR on the NHS.
Please let us know.
Toby
Just read Granton's post just after I sent mine.
BHR-NHS-Mcminn, doesn't come better!
Toby
If you can get Treacy to give you a BHR, buddy, you will be set, and probably for life.
With a hip resurfacing you will then get a 2nd chance, that is if for some crazy reason the BHR fails you can go to a THR (I seriously doubt it will fail).
I am of the opinion now, if you pick a good surgeon you will probably have a great chance of taking your device to the grave.
I'm 5 years out and I've never looked back and most days I forget I have an implant till I come here. ;D
When I went to my GP he thought I was nuts not getting what almost all doctors were giving their patients here in Pittsburgh, PA, a THR, so screw your doctor no matter what he thinks, pick the device that will give you the best results.
Good luck with Treacy.
Chuck
Quote from: gasyz on November 06, 2013, 11:34:51 AM
Thanx for input,I've managed to get an appointment with Mr Ronan Treacy to discuss BHR,my doctor doesn't seen very amused, but after reading this forum I think it's my best option.I'm really depressed at the thought of a THR and having to pack up a lot of my hobbies.Like obxpelican said once the head is cut off theres no going back.I think I would rather carry on in pain for now than risk it at the moment.The biggest fear with THR is dislocation and it just doesn't look as strong to me.
I know of many who have had problems with Resurfacing. I would go with something tried and tested.
Good luck with whatever you choose.
http://www.depuyhiprecallnewscenter.com/updates/united-kingdom-bans-metal-on-metal-hip-implants-from-hospitals/
Barbara, this forum has been discussing that same article since it came out.
Why did both of your BHR's need revision?
Chuckm
As far as I can tell from reading this forum the main failure reason is bad fitment,and it also seems that BHR are by far the safest product.So if I can get Mr Treacy to fit a BHR the odds should be in my favour.If it goes wrong then I can fall back on a THR,but I think it's worth the gamble(hopefully)
Hi I had a resurfacing done with mr treacy at the ROH on the 11th September 2 months ago? I feel you must be local I went to heartlands and Solihull hospital, they don't do resurfacing I then went to ROH and seen a lovely mr revell who convinced me in a nice way to have a replacement I agreed, as he did not do HR i came home and thought omg what have I done I then called the hospital and cancelled, and did some more research after a phone call to the McMinn centre to cut a long story short there and then I decided I only wanted mr treacy, so my doctor was great and re referred me again so I actually seen 4 surgeons and went to 3 hospitals, do your homework.
Ps Danny will be along soon, he actually had surgery as well with mr treacy.
The hardest I'm finding is the recovery, today I have had a long walk spent 2 hours in the swimming baths gentle swimming, then half hour in the easy gym yet I'm suffering still with the pulling/ stiffness in the hip it's just not getting any easier. But I am walking faster.
But I'm trying
Good luck
Jackie
Hi, there's been some good advice given here. Don't rush into anything.
They are trying to ban giving BHR's on the NHS because of a high failure rate (due to the surgeons who do not know what they are doing!). Most surgeons will not perform them. Mr Treacy I'm pretty sure is still doing them on the NHS at the minute so go get your ass to see him!! He is the best surgeon in the UK for BHR's and I would listen to his opinion. I had my heart set on a BHR and my local surgeons dismissed it straight away telling me about metal levels. I was not happy with their advice and booked myself a private appointment with Mr T. I am so glad I did because his opinion is just the best. He told me I was not suitable for a BHR because of the angles of my hips. I was gutted as I would have jumped at the chance of resurfacing so I could continue with my sports, but on the other hand, if Mr T says no, then it's a no. That appointment confirmed to me in my mind that I had no option but to go for a THR and I needed that confirmation so I would have no regrets. To know that what route I was taking was the best and that I had explored all options. If I could, I would have had a BHR. As others have said, its like a second lifeline. If it goes wrong, you just revise it to a THR. I think you have definitely made the right decision to see Mr T and he is such a lovely man. He will be honest with you.
On the other hand, I just want to say that I had my THR 3 months ago. I absolutely love mountain biking, skiing, horse riding and any other daft sport that involves speed, heights and danger. Yesterday I spent the day mountain biking for about 15 miles along some single tracks and today I went road riding. Although I am currently not doing anything dangerous or risky, I feel really good. My surgeon has told me that I have no restrictions whatsoever other than he wouldn't recommend lots of marathon running as it will wear the implant out faster. I have a ban of any risky sports till 6 months, at which point he said he will be perfectly happy for me to go skiing and 'proper' biking and start having some fun. If, for whatever reason Mr T says no to the BHR, life with a THR will still be great. THR's have come on leaps and bounds and they are not as restrictive as people make out. I put off my op for a long time because I didn't want to give up my biking but it turns out, I don't have to. My THR was the best decision I have ever made.
Good luck with your appointment
Anna
Thanx for that Anna.You seem to be in the same frame of mind as me.I want to have the option for a BHR first and if I can't have one for some reason then I'll be happier to be have a THR, but at least I tried.Really glad to hear your getting on with the THR.My biggest worry was not being able to do mountainbiking e.t.c .The mental strain is a massive battle at the moment and this forum is really helping.Wishing you a speedy recovery.
Great post Anna and wonderful to hear how well you are doing with your THR. As a Londoner I know that in Mr Witt you had a surgeon with a great reputation. I agree when you say that if Ronan Treacy says a patient isn't suitable for an HR then one must trust this opinion. I also think it's worth noting that although BHR in UK has a low revision rate (see NJR stat's in my post on NHS Ban MOM) many of those included in the 6% rate over the 8 year period, were the consequence of surgeons with insufficient skill/experience such as those from the Oxford study and a significant number were also smaller women with dysplasia. Hence, I am suggesting that with the knowledge acquired over the past 5 years (re-patient selection/inclination angles etc) that the BHR stat's will be even greater.
Regards
Toby
ps just booked in for 4 year appointment to get xrays/metal test and Prof Cobb's sec said he has absolutely no worries whatsoever about his BHR/Adept patients
I couldn't agree with you more Toby! For the right patient with the right surgeon, a BHR is life changing. Unfortunately it has such bad press in the UK due to all the surgeons not fitting it correctly...but I guess that's why everyone on this site says it so many times.... "Go find the best surgeon possible who has done a healthy amount of resurfacings". That's the best advice anyone could give. It's why I travelled so far to London to see Mr Witt because he's one of the best in the UK for dysplasia patients and I wanted to give myself the best chance possible of a good outcome.
Congratulations Toby on your 4 year checkup!! ;D
... and gasyz - I think you have made the right decision to go see Mr T. Whatever happens, I'm pretty sure you will be back out mountain biking in no time. I was out playing in Dalby forest today (nothing too risky, just some easy routes!) but come next summer I hope to bump into you on some harder more skilful trails all over the country!! Good luck and let us know how you get on!!
Anna
Barbara,
Sorry you had to be revised, most of us who went with experienced doctors who used quality components are all doing well. If you were to take the top doctors and look at their results with MOM HRs you would find something around 95% + survival rates @ 5 years.
Now, what do we say to the 5 or less percent who's HR failed, "Were sorry" that is all we can say, we cannot take back the failure and we certainly do not take any failure likely, but, the facts still remain that with the choice of a quality surgeon you are going to get a good result with a hip resurfacing.
Hip resurfacing failures due to high metal ions are almost ALWAYS due to surgical error in the angle of installation, not because the patients received metal on metal bearing surfaces, of course we cannot discount those devices that have been re-called because of poor design.
Saying you know people who have had HR failures does not make HRs bad, maybe you've had friends who were either unlucky or they chose doctors who were not experienced or possibly had devices installed that were faulty.
Chuck
Quote from: Barbara on November 07, 2013, 11:45:29 AM
I know of many who have had problems with Resurfacing. I would go with something tried and tested.
Good luck with whatever you choose.
http://www.depuyhiprecallnewscenter.com/updates/united-kingdom-bans-metal-on-metal-hip-implants-from-hospitals/
Im so happy for you Anna. We all can empathize. I was dx with OA about three years ago but you know what? Knowing these surgical options are available give a lot of relief and hope. Good luck with your new lease on life.
Thanks Canadian-Ice ;D
Hi,Just got back from seeing Mr Treacy,said I am a good candidate for a BMR and he will be able to do it when I feel the time is right.Nice man and well worth a visit,put my mind at rest and feeling a lot more positive now.Many thanx to everyone on this site for all the info.I was booked in for a THR in 4 days time and if it wasn't for this site I would have gone with it.While a THR is probably ok for a lot of people I feel for me the BHR will suit my needs more.Just goes to show you need to get second opionons and do your own research.Seems my first consultant wasn't trained in resurfacing so I wasn't given that option.(lucky escape)When I feel the time is right I'll go with the BHR,but I will also be keeping an eye on future developments in resurfacing.Been looking at ENDURE which is in development at the moment.Thanx very much and good luck to everyone.
That's good! If Mr. Treacy feels you're a good candidate, then you are. Great step along the way.
Glad you managed to see Mr Treacy he's really a great surgeon.
The endure system looks interesting the problem is though the record of the bhr in the hands of surgeons like McMinn Treacy Su de smet etc is hard to beat! Also things move very very slowly in orthopaedics. The bhr is still considered new and un proven by many and its nearly 20 years old! And one thing you really want is a long proven track record the asr was tauted as being far superior to all other devices and obviously several years down the line the reverse was obvious!
Quote from: obxpelican on November 09, 2013, 03:14:25 PM
Barbara,
Sorry you had to be revised, most of us who went with experienced doctors who used quality components are all doing well. If you were to take the top doctors and look at their results with MOM HRs you would find something around 95% + survival rates @ 5 years.
Now, what do we say to the 5 or less percent who's HR failed, "Were sorry" that is all we can say, we cannot take back the failure and we certainly do not take any failure likely, but, the facts still remain that with the choice of a quality surgeon you are going to get a good result with a hip resurfacing.
Hip resurfacing failures due to high metal ions are almost ALWAYS due to surgical error in the angle of installation, not because the patients received metal on metal bearing surfaces, of course we cannot discount those devices that have been re-called because of poor design.
Saying you know people who have had HR failures does not make HRs bad, maybe you've had friends who were either unlucky or they chose doctors who were not experienced or possibly had devices installed that were faulty.
Chuck
Well said Chuck. here's the team who did my BHR
(http://i188.photobucket.com/albums/z263/kelley124_photos/3stoogedrs_zpsd8f65b8f.jpg) (http://s188.photobucket.com/user/kelley124_photos/media/3stoogedrs_zpsd8f65b8f.jpg.html)
^ classic!