I know we've all seen Dr Pritchett's videos of the Synovo. As I feel like I have a few more Ironman races in me, and as from what I've seen, the Synovo looks to be the most high impact friendly, I've been trying to find information on that device. The only things I can find online are Dr Pritchett's videos and advertisements for the Synovo. Can anyone point me to a resource not associated with Dr Pritchett or the manufacturer?
Another question. I already have three artificial joints (two cervical discs and one metatarsal/philange), one metal plate and four screws (in the cervical spine), and metal pins that were anchors to reattach my right achilles. I am aware that wear debris from metal-on-metal devices can cause problems in some people. Are there any thoughts when too much metal in the body becomes just too much metal in the body?
Make sense?
I asked Dr. Pritchett about the Synovo during my last consultation with him, he recommended the traditional MoM BHR implant for people like me who do a lot of running.
The synovo is VERY VERY new. The BHR is 17+ years old with the best track record in the world. In theory the asr was better than the BHR and we all know how that ended. When put in correctly the BHR wear rate is incredibly low. Were talking less than a micron per year of wear! A micron is 1mm devided by 1000! The human eye cannot register that small!
If it were me ( and if was 3 years ago & will be again next year) I would choose the proven BHR over any other device.
That would explain why I can't find any more information on it. From what I've seen it seems like it came out this summer or fall.
I was thrown a curve ball Friday and am not sure what to do with it.
I was told two weeks ago by a renowned arthroscopic hip surgeon that he could fix me with a scope, but it wouldn't alleviate the pain. He referred me to an associate to be evaluated for hip resurfacing. After he reviewed my images I heard back from that associate Friday. He said that he won't perform resurfacing or replacement unless the patient is bone-on-bone. I have half the joint space in my right hip as I do the left, but it is not bone-on-bone (yet).
I've also sent images to Pritchett, Gross and Rogerson, and expect to hear back from all of them before Thanksgiving. I'm concerned that they'll give me the same line; come back when you're worse. I'm in enough pain that I can't run or cycle, and that it's difficult to sleep, ride in a car (or do anything else), and that I never know what's going to happen with the next step I take.
Is it common for these three guys to turn you down because of images even though your in life-altering pain?
The top HR surgeons will not make you wait until you are bone on bone. In my opinion, that is an old-school view that's based on the fact that a Total Hip Replacement will only last for around 15 years and you have to wait as long as possible. I think it's almost comical that your first hip doc said that he will fix everything but it won't take away the pain. Pain is caused when something is wrong. What's he going to fix that leaves you in pain?
You've had a lot of work done already and I think you should really think about leaving long distance behind and embracing speed. I raced long distance for years but since my surgeries, both knees, both shoulders, and bilateral hip resurfacings, I race Sprints and Olympics and I love it. I can race every month and I can still do those long endurance building bike rides but I don't need to do them over and over. This year I will be stretching it out to do American Zoffingan F1 (5run, 29bike, 5r, 29b, 5r), all up and over the mountains in New Paltz, NY, but I'm only doing it once, then going back to short course racing.
Good luck with you hip. Keep looking for the RIGHT doctor for you. Also contact Marwin and Su in NYC. Maybe some day I'll be seeing you at Olympic Distance Nationals!
It might be worth you having an MRI mate. My plain X-rays show very little OA in the joint and a healthy joint space but the MRI showed I have zero cartilage on my femoral head and very little in the socket. I had the same on my left side also.
Comical? Well, I chuckled a little too. However, the first surgeon was an arthroscopic guy who doesn't do resurfacing or replacements. He said that he could fix the destroyed labrum and cam FAI, but not the osteoarthritis; which he thought was the pain generator.
By the way Woodstock, I'm sitting here watching the guys come in off the bike at IMAZ; and it's KILLING me. I haven't resolved to resume running if I have a successful resurfacing. but it is going to take some restraint. Perhaps that demon will be dead by the time I recover from the surgery? A resurfacing will leave me with four artificial joints. Do you have six??? 2017 Olympic Nationals? ... Deal! See you there.
Danny, I've had an MRI and an arthrogram. That's what the first guy used to conclude that fixing the labrum and cam wouldn't fix the pain. The second guy said that the arthrogram and MRI were too blurry to get any info from. I don't know. I'm not as bad off as you were, but the right hip has less than half the joint space of the left.
Guys, thanks for the feed back. I've only posted two threads, but the info I've gleaned from trolling this site has been very informative.
Were here to help mate! ;) hope you get sorted out :)
Trust me, if you get an HR from one of the top guys, you will be running again. And you will be running better than you have been for years! I started running again at 6 months and it felt great! I did some 5k races that year then did my first tri at the Haliewa Sprint on Oahu. It was a great place to return to triathlon. I've been racing, one sprint or oly, every month through the season and absolutely loving being back!
Not 6 artificial joint, six surgeries. Knees: left one was a ruptured patella tendon and torn meniscus and right was a large flapping tear in the meniscus. Shoulders: right was a torn rotator cuff, torn labrum and a detached bicep tendon, left was a small tear in the labrum that I had to have fixed before I retired from work.
HR was with Dr Scott Marwin at NYU Hosp for Joint Disease three years ago and I don't feel them at all. I was not bone on bone on my left side, but my pain was equal.
Well fiddlesticks.
In the last 24 hours I've heard back from Rathjen (a Dallas area resurfacing surgeon), Pritchett, and Rogerson's PA. None think I am a good candidate for resurfacing. One says I won't have enough cortical bone on the femoral neck after the cam impingements are removed, and all three say I don't have enough good bone in the femoral head to support the BHR cap. Two of them will do the BHR if I insist; but that seems ... unwise.
My problem is this. In 1973 (I was 10), I was hit by a '61 Plymouth on my bicycle. I couldn't walk for weeks because of right hip pain. The doctors said there was nothing wrong with me. What seems to have happened is that the epiphyseal plate of the right femoral head was damaged such that the head quit growing, and the neck only grew in diameter, not length.
So a THR seems in the cards for next year; I want to get it done before the unknowns of the ACA (Obamacare) are realized. I've managed eight marathons, one IronMan and a total of a little better than 9000 miles covered on swim, ride and run since 2007; so I've had a good run. I'll concentrate on the bike and probably do some full aqua bikes, and will continue to volunteer at races; but don't see ever running more than a mile or two at a time.
So, I'll be off to research THR. Any words of wisdom would be appreciated.
Really sorry to hear that buddy! A thr isn't the end of the world buddy. However the same mantra still applies with surgeon selection! Find the best surgeon you possibly can, bear in mind decent resurfacing surgeons are also top thr guys as well because a resurfacing is far more technically challenging than a thr.
Stay in touch and let us know how you get on buddy
Danny
THR is still a good option and will last quite a long time. A guy I surf with has a THR and he still rips it up!
Sorry to hear about the bad news. I would still contact the other hip resurfacing doctors and tell them that you've already been told that you don't have enough bone. As an alternative to HR though, what about a large ball, metal on metal total hip replacement. I think Smith and Nephew, the makers of the Birmingham HR that we love so much, makes one of those. It would give you most of the benefits of the BHR except you lose a little range of motion. You still lose a lot of bone but any THR is going to do that. Even a large ball ceramic. They are all better than the typical small ball THR. Nobody likes having small balls ;)
Guys, thanks for the encouragement. I've yet to hear back from Gross, but with what I've heard so far, I can't imagine him telling me anything that would make me want to attempt a resurfacing. We'll see. And yes, I've started researching THRs and the diversity of products there is greater than with resurfacing implants. With all I've learned about the importance of large head size with resurfacing, I assumed it would be important in THR also.
I'll update this thread when something interesting occurs. Hopefully something in it will help someone down the road as their trolling the forum like did.
Good luck JSS, don't give up on running again. I'm still counting on seeing you at the starting line!
Have a look at hiprunner.com
Quote from: jss on November 18, 2014, 11:57:27 PMIn the last 24 hours I've heard back from Rathjen (a Dallas area resurfacing surgeon), Pritchett, and Rogerson's PA. None think I am a good candidate for resurfacing.
Four years ago, Rogerson was very hesitant to resurface my hip when I first went to see him. Gross barely flinched and thought it was definitely the way to go. Mine was difficult (he said), but the outcome was outstanding. This is a little awkward of a situation because you don't want to shop for the answer you want, but you should make sure that you fully investigate your options with those that have experience with difficult cases.
I'm coming up on 4 years and the last three years have included a ton of road racing and cyclocross.
Quote from: einreb on November 21, 2014, 09:26:32 PM
Quote from: jss on November 18, 2014, 11:57:27 PMIn the last 24 hours I've heard back from Rathjen (a Dallas area resurfacing surgeon), Pritchett, and Rogerson's PA. None think I am a good candidate for resurfacing.
Four years ago, Rogerson was very hesitant to resurface my hip when I first went to see him. Gross barely flinched and thought it was definitely the way to go. Mine was difficult (he said), but the outcome was outstanding. This is a little awkward of a situation because you don't want to shop for the answer you want, but you should make sure that you fully investigate your options with those that have experience with difficult cases.
I'm coming up on 4 years and the last three years have included a ton of road racing and cyclocross.
Excellent point mate. If you got to the reall top of the tree of surgeons and they say no they you can rest assured that it can't be done.
Guys, I do appreciate the continued input.
Hmmm... Pritchett said that I was neither a 'great' nor 'good' candidate. Rogerson's office said that I was not a good candidate. I've heard stories of children that were resurfaced where the surgeon thought they didn't have a chance of success, but the implant was still in place years later. Gross is the only surgeon I've contacted that I've yet to hear from. If he 'barely flinches', that will create a real dilemma.
einreb, what reason Rogerson give for not wanting to resurface? What was Gross's reason for not having that same issue? And congratulations on the excellent outcome.
A dilemma in the making.
Last week I spoke with one of Dr Rogerson's PAs. They said he would call me later but believed I was not a good candidate for resurfacing. I just hung up with Dr Rogerson who believes that though my anatomy is unusual (because of an accident when I was 10), I have plenty of bone in the head and neck to support a BHR; even possibly returning to high impact activities.
I have opinions from two of the top guys. Both will do the BHR, but one thinks I'm not a good candidate and believes I am. Maybe Gross will break the tie.
Quote from: jss on November 24, 2014, 03:29:59 PMeinreb, what reason Rogerson give for not wanting to resurface? What was Gross's reason for not having that same issue? And congratulations on the excellent outcome.
Rogerson initially said no. When I followed up to ask 'why', he then realized how young I was (39 at the time) and said that he would 'try' but that there was a chance he would switch to a THR during surgery.
As i poked him a little more, it became clear that he didn't have experience with Leggs Perthes hips. I then asked who did and he suggested Dr Bose. When I asked him about Dr Gross, things got a little weird and he went off a bit about the uncemented part. Rogerson was(is?) a BHR guy.
You can see my x-rays here (hope this link works)....
http://surfacehippy.info/hiptalk/hip-resurfacing-topics/ramblings-regarding-my-scheduled-216-resurfacing-with-dr-gross/msg15037/#msg15037
If you've seen hip x-rays you should be able to see that my hip was really weird shaped and had a huge cyst.
I spoke with Dr Bose (in India) via email and he had done perthes hips and was confident. Dr Gross had done 60+ and was also confident. I was VERY interested in the uncemented route (since shown to work very well) and ended up going with Dr Gross.
btw, here are his latest stats....
http://www.grossortho.com/forms/HRA%20consent-3-12-2014.pdf
98.5% survivorship with the uncemented device with potentially 'high risk patients' at the 7 year mark and a very good trend line. I'm an engineer and I really like how he analyzed every failure, made adjustments and made improvements to minimize failures.
Again, your situation is different... but this is an example of how different surgeons approach cases. I suspect that Dr Rogerson is a very skilled surgeon, but he deals with more of the 'norm'. When you are 'special', you have to go talk to those that have the experience, interest and success in special cases.
einreb,
I didn't know there was a name for that condition, which I'm reading about right now. That was your left hip? Here's an xray of my right. It could almost be a reflection of the same hip! Thank you so much!
Quote from: jss on November 24, 2014, 08:55:07 PM
einreb,
I didn't know there was a name for that condition, which I'm reading about right now. That was your left hip? Here's an xray of my right. It could almost be a reflection of the same hip! Thank you so much!
Interesting to see that x-ray.
Keep in mind that your hip is what it is and you just need to explore the best options.
Quote from: jss on November 18, 2014, 11:57:27 PM
One says I won't have enough cortical bone on the femoral neck after the cam impingements are removed, and all three say I don't have enough good bone in the femoral head to support the BHR cap. Two of them will do the BHR if I insist; but that seems ... unwise.
I'm completely shooting off the cuff here, but I think there is a difference that *may* be the reason you're getting pointed away from the resurfacing.
Note in mine that there is a pretty wide neck to the hip under the collapsed ball. I think it was the collapsed ball on mine that gave Rogerson concern because the normal measurements and templates involve removing the ball with a hole/saw type device to make a 'can shape' that the cap fits on, but the cuts cant notch the neck.
The neck on yours looks a little more slender and shorter? i.e. it may not have enough volume to fill up the cap?
Quote from: jss on November 18, 2014, 11:57:27 PMMy problem is this. In 1973 (I was 10), I was hit by a '61 Plymouth on my bicycle. I couldn't walk for weeks because of right hip pain. The doctors said there was nothing wrong with me. What seems to have happened is that the epiphyseal plate of the right femoral head was damaged such that the head quit growing, and the neck only grew in diameter, not length.
Perthes (what I had) is actually very similar to this but it occurs without an 'accident'. Usually children, 3-7, growth plate gets messed up ball of hip is starved, collapses, eventually gets resupplied with bloodflow, firms up but is misshapen.
einreb, thank you for the (sobering) input.
I'd made the same observation; that my deformed femoral neck was smaller than your normal neck. Which leaves me to wonder the same thing; will I have enough neck left to hold the ball? And I didn't interpret Dr Rogerson's opinion that I was a good candidate to mean that BHR was the way I should go. Reflecting on the conversation, he didn't say that BHR would be a better route for me than THR; only that I should have a good enough outcome with BHR to return to high impact activities; maybe even another Ironman.
I'd just begun a pre-training regimen as a precursor to another Ironman training cycle when this hip flared up. As much as I hope to do another race, at this point I am holding onto that hope with an open hand.
While I'm still hoping for resurfacing, THR is more likely in my future, and so I've been researching that route; and have a question...
MoM is persona-non-grata in the THR world. A number of MoM devices have been removed from the market by the manufacturer or the FDA, and have been replaced with mostly MoP and CoC implants. The reason being the metal debris and ions created as the devices wear. Reading this site, posters are forever talking about monitoring their own metal ion levels and encouraging others that are in a questionable state to have their metal ion levels checked with all deliberate speed.
The metal ion problem that necessitated the removal of most MoM THRs from the market seems to exist in the resurfacing world with the BHR. Given the experience from the THR world, why has the BHR not been replaced with a MoP or CoC equivalent?
Yea I always wondered the inverse: With advancements in component placement in the HR world that have almost eliminated the wear problem, why hasn't that found it's way back to THRs? I would think that even the metal on plastic would last longer with optimal positioning. Of course that is much more dependent on surgeon skill, but then again some of the well-known HR surgeons are using non-MOM in their THRs so it's an interesting question.
But I'm pretty sure that one of the reasons why you don't see MoP or CoC in resurfacing is because the plastic and ceramic has to be much thicker which would necessitate too small of a ball to cap the femur.
Hi Jss, your question is really loaded and could take volumes to answer. Here is a rough answer.
There was a long period before the use of poly and ceramic for total hip replacement when all hip replacements were crude metal on metal devices. Even resurfacing. But it worked reasonably well. Then polyethylene came along and it worked even better. But it was only successful in improving the small ball total hip replacement. When tried in resurfacing the poly broke and wore out too quickly because the material needed to be very thin to fit in the tight space. Ceramic also was far too brittle when produced as a cup and shell for resurfacing.
So poly and ceramic were good for THR but not resurfacing. As good as it had become, THR was still not durable enough to last in young patients or active patients. So around 1980 some surgeons began to try metal on metal again because the technological advances in metallurgy made it possible to manufacture advanced low wear metal on metal joint bearings that could not have been produced before. That was the beginning of the BHR.
The BHR has been performing about equally as good as the most modern THR devices since it began being implanted. Unfortunately, the stigma of metal ions from the old THR and resurfacing devices came back when a couple of poorly performing resurfacing devices made it to the market. They have since been withdrawn.
Why check ion levels? Any device (poly, MOM, or ceramic) has certain levels of wear particles that are shed from them. When any of them are implanted at less-than-optimal alignment, the wear rate and particle shedding goes up. With ceramic and polyethylene, you get bits of those materials foreign to the body accumulating around the hip joint that just stay there. The interesting thing about resurfacing is the materials in the device are chromium cobalt and nickel. These are naturally present elements so the body will eliminate them as they are shed unless the device was put in poorly and the rate of shedding is to high for the body to process. So if someone is experiencing problems, an early way to see if it might be the device is to look at the concentration of chromium and cobalt in the blood to see if they are higher than someone who doesn't have a resurfacing device.
Chuckm
Jhippy and chuck, thanks for the info, it does make sense.
I just hung up the phone with Dr Gross and got his 2 cents on it; which is just a more technical version of what y'all just said. He belabored that metal ions are not a problem unless the patient has an innate problem with them, or unless the implant was improperly positioned.
His opinion is that, even with the deformity from the accident, that I have the same probability of a positive outcome as someone without that deformity. I have plenty of bone that is strong enough to support the implant.
I'll talk it over with my wife tonight and sacrifice a few more brain cells on it; but given the confidence of both Drs Gross and Rogerson, I'm heavily leaning that direction. As Dr Gross has a published successful record with my deformity, he would of course be my first choice.
Any information and wisdom anyone would like to share would be appreciated.
Thanks, jss
Quote from: jss on December 01, 2014, 05:26:26 PM
His opinion is that, even with the deformity from the accident, that I have the same probability of a positive outcome as someone without that deformity. I have plenty of bone that is strong enough to support the implant.
Gross said he could do a resurfacing?
Quote from: einreb
Gross said he could do a resurfacing?
Yes. He gave me the same probability of a positive outcome and of femoral neck fracture as anyone else. Last night we thought up a few more questions. When/if I get to ask those, I do intend to revisit the "I have enough bone in the femoral neck" question with bilateral measurement comparisons I've taken from my xray.
Quote from: jss on December 02, 2014, 09:56:49 AM
Yes. He gave me the same probability of a positive outcome and of femoral neck fracture as anyone else. Last night we thought up a few more questions. When/if I get to ask those, I do intend to revisit the "I have enough bone in the femoral neck" question with bilateral measurement comparisons I've taken from my xray.
Ah, cool. Then you have options. As for your follow-up question to him, I suspect there is enough bone for him if he is saying its doable. :)
I'm scheduled for BHR with Dr Gross on Jan 7. He says there's a good chance that my marathon/ironman career is not over.
Guys, I'm trying hard to be stoked that Rogerson and Gross say that I'm a good candidate for BHR. But looking at my xray I am concerned that I will never have the confidence to do the things I want to do. Below is my pelvic xray with some measurements I've made. The intertrochanteric line along the neck is 25% wider on the good hip. The epiphysial line between the neck and head on the good hip is over 50% wider. I'm trying to share Rogerson and Gross's confidence that this is plenty of bone for me to pound out 430 miles of running during a marathon training period with a BHR, but ... I can't. Any thoughts?
If the femoral neck you have now has been through high impact activities before, then it will be fine. The BHR femoral component is fitted onto the head and maintains the same load transfer to the neck. Except for the stem that is inserted into the femoral neck, the neck remains the same and can become stronger after the surgery (after a six month healing period - the neck can be weaker for a few months before it regains its strength). Dr. VJ Bose even argues that the BHR "splinting" effect eventually makes the neck stronger. What doctor's watch for are cases where the femoral component will only fit if some of the neck has to be cut (notched) to fit the cap. That is not the case for you.
Good luck
Chuckm
Quote from: jss on December 08, 2014, 12:08:19 AMI'm trying to share Rogerson and Gross's confidence that this is plenty of bone for me to pound out 430 miles of running during a marathon training period with a BHR, but ... I can't. Any thoughts?
To a certain extent, you will need to put your complete trust in the surgeon making the decision. They don't want their patients to fail, so if there was significant risk... then they wouldn't do the surgery.
Also, your hip is what it is. If you don't do the resurface and get a THR, where does that land you with marathons and iron-man length races? I may be missing something, but there is not a lot I've seen on folks doing that sort of distance work with a THR.
-B
Thanks chuck, that is encouraging. I've been looking for information of the integration of the bone into the metal surface. I would like to find some data on the measured strength of that (if it exists).
Ben, you're right of course. I know that someone with Dr Gross' eminence on the subject can be trusted implicitly. And yes, most doctors strongly contraindicate running after a THR; so most recipients stop. I've been researching that issue and have yet to find a single instance of a horrific complication of anyone that's resumed running after a THR.
Does anyone know of a bad outcome of a THR because of running?
Thanks for the thoughts guys.