Hello All,
I’m glad I found this helpful site. I’m encouraged that there’s a chance it could help me. Let me state my story and questions very quickly, as to not bore any of you.
- Living with hip arthritis for more than 10 years. Until a few months ago I felt the only final option was an eventual total hip replacement on one, and someday, probably both of my hips.
- Being active in sports that probably won’t be advisable after a THR (volleyball, running etc.), I staved off any surgical interventions until I was having problems in day-to-day life. Walking is now somewhat painful.
- Had recent x-rays that show much thinning of the cartilage, and an area where there’s bone-on-bone contact. Was referred to a sports medicine physician (not a ortho/hip surgeon) and he immediately stated “hip resurfacing wasn’t an option at this pointâ€, citing bone-on-bone and por joint spacing, but really nothing else. (To me, besides the lack of cartilage, the x-rays appeared to not show any major damage to the femoral head/socket, but of course, I’m no expert).
- So I was a little discouraged, and there’s a chance I have indeed waited too long. Regardless, after hearing about other’s inspiring stories, I won’t take the advice of this one physician just yet, though I hear the eventual surgeons at my medical provider (UC Davis Med) don’t perform many resurfacing procedures, and apparently aren’t huge advocates either
- I will indeed send my x-rays to other recommended physicians on this list, and I appreciate all the great advice here encouraging others to do so. But was wondering to those with experience here, what are some of the factors to not being a candidate? Does much bone-on-bone contact make one a bad prospect? What other factors are involved? After lurking on here, I didn’t specifically see the lack of cartilage made one a poor candidate. But I could be wrong.
- I appreciate all that post here, and who have given their time to inspire those who are merely trying to get an important part of their lives back.
Thanks,
Joe
Welcome to the site Joe!
I think many of us here run into the same problem you seem to have encountered. Surgeons who don't do resurfacing tend to not be well informed on it and are typically quite predisposed to suggesting standard THR. The last hip surgeon I saw before making the decision for my resurfacing had very, very unkind things to say about resurfacing. When I pressed him on the strong likelihood of wearing out the THR implants he was suggesting he literally patted me on the knee and smiled and said... "No problem! We'll just replace them in 8-10 years". I was dumbfounded. Obviously that was NOT something I wanted to plan on. I pressed him on the resurfacing topic citing very positive results for young/active patients and he very reluctantly admitted that he had very, very little experience with resurfacing but knew of good results and then admitted that judging by my X-rays I was an IDEAL candidate. I had to nearly pry it out of him...
The moral of the story is that surgeons tend to prefer the procedure that they are comfortable and experienced with. I've read many, many times on here the suggestion to see one or more well regarded surgeons who have successfully done large numbers of both THR and resurfacing, only then will you be getting an unbiased opinion.
Furthermore, your situation doesn't sound much different than many of us here. I was bone on bone in one hip and had significantly reduced joint space in the other according to my X-rays. I had bilateral resurfacing 5 weeks ago and am doing well in recovery. The surgeon told me both hips were a mess and bone on bone at the time of the surgeries. Being bone on bone or having poor joint space is definitely NOT something that would eliminate you from being a resurfacing candidate!
Sorry for the long winded response. Don't let that first opinion get you down. Get yourself a 2nd and 3rd and 4th opinion from some of the experienced surgeons you see on this site.
Good luck!!
Thank you very much Quig. I was hoping to get some responses like yours. I'm hoping my Sports Medicine doctor simply wasn't too knowledgeable about resurfacing, and who are good or poor candidates. Though, like I said above, my next referral to actual hip surgeons in my medical group, should involve similar interactions and recommendations to forego resurfacing, and proceed with a total hip replacement.
I understand the bias involved with physicians who don't perform resurfacing, and would of course not recommend it. But it's a little troubling that some won't be up front and honest about their experience, and frankly tell patients that they don't do resurfacing procedures, and guide the patients to seek other practitioners. I guess you have to be your own advocate in these situations.
Good luck in your recovery, and I hope you get back to all the activities you desire.
-Joe
Joe, qualified resurfacing surgeons don't consider a patient ready for hip resurfacing UNTIL they have progressed to bone-on-Bone. Occasionally they find someone ready before that but it is rare.
So whatever information you got is bogus.
It is also disconcerting that a "sports medicine physician" has so little knowledge of this type of surgery. One that regularly helps even professional athletes return to professional sports.
Get to a specialist from the list on this site.
Chuckm
I was considered a candidate before I was bone on bone. And now that I am (BoB), I was no longer a candidate. From what I understand, my OA had become too severe. I will be contacting my surgeon to clarify his decision. Not because I'm challenging him, I just want to know so it doesn't happen with my other hip.
Hey Joe!
I agree with the posters who advise sending your X-rays to one of the docs on the list. Heck, send them to several and see what they say. With luck everyone will accept you and it can be a question of insurance, scheduling, and travel.
I am no expert, but I think the situation you want to avoid is having waited so long that you don't have much femoral head left. You can be without joint space, you can be without cartilage, but you have to have good enough femoral head material to cap. (I say this as someone who almost waited too long. Lots of cysts in one of my femoral heads.)
I had the same experience of docs poo pooing the idea of me being a candidate for resurfacing, but they were docs who didn't do the procedure themselves. Best to consult with someone who does it and get his answer.
Like Quig, I went to Dr Gross, did two hips in a week, and had an outstanding experience. I have started running again.
Best of luck. Let us know how it goes.
I read your story when you first started posting LMS and you may not be getting a straight answer either.
Bone on bone with lack of range of motion is exactly what hip resurfacing is used to treat.
There are plenty of posts on this site where a top surgeons refuse to perform hip resurfacing on their paitents until they become bone on bone. Dr. Gross is one of those surgeons.
To me it is a travesty that so many will miss out on such a miraculous surgery because of misinformation.
Chuckm
Bone of bone is one of the primary reason we all had hip resurfacing. If we had cartilage left, we would not have the great pain many of us suffered. Many also had cysts which are normally filled in during surgery.
The very best way to know if you are a hip resurfacing candidate is to get free email consultations or actual appointments with the top, experienced hip resurfacing surgeons. You need input from a surgeon that does both THR and Hip Resurfacing. Just a THR surgeon will almost always tell you hip resurfacing is not a good option, most likely because they don't do them or had bad experiences with them. Hip resurfacing is a much more complicated surgery than a normal THR. All the hip resurfacing surgeons I know of will always suggest a hip resurfacing unless they really feel a THR is a better option for your case. Even if one or two surgeons say no to hip resurfacing, a third might consider it. I have seen cases where De Smet and McMinn said no, but Bose said yes. Or any other combination.
Don't get discouraged yet. You also don't want to use a surgeon that does not perform many hip resurfacings. You want a surgeon that does them daily or at least weekly. Look at the list and send some emails out with your x-rays attached in a digital format to a few of the top surgeons. You can see a few out your way that are closer to you than the other surgeons. There are many people that travel far distances to get their hip resurfacing since there are not many really experienced surgeons.
Here is the list
http://surfacehippy.info/surgeons-with-1000-hip-resurfacings/ (http://surfacehippy.info/surgeons-with-1000-hip-resurfacings/)
http://surfacehippy.info/hip-resurfacing-surgeons/ (http://surfacehippy.info/hip-resurfacing-surgeons/)
Stay in touch and let us know how you are doing.
Pat
Thanks Chuckm, I've "just" sent an email to my surgeon's assistant asking to elaborate on the decision to forgo the HR (in my case). As soon as I get a reply, I'll post it since it's relevant to the OP's question on being a resurfacing candidate.
Thank you all for your helpful suggestions. I will soon send out my x-rays to some of the surgeons recommended on this very informative website to see if I am a viable resurfacing candidate. There's still a chance that I'm not, and the original physician simply wasn't conveying enough details why I'm not a viable candidate. Though I won't take No for an answer until most/all state that resurfacing simply isn't a good fit for me.
Thanks,
Joe
Just a quick update. I'm in the process of sending several of the physicians on this site's list my x-rays. It will probably take some time to get feedback. However, one already replied (Dr. Brooks from the Cleveland Clinic). He stated my condition made me a "perfectly good candidate for resurfacing". This has really perked my spirits. So, again, I would like to thank those who participate in answering questions here. I'm so glad I found this helpful resource.
-Joe
That's great news, and not at all surprising. 99.9% of the entrenched orthopedic community is either against resurfacing or know little or nothing about the procedure.
That's great! So one solid option already.
My hip doc at home used to do resurfacings, and he was pretty negative on it. "Too many problems with the incisions" was his main thing. Dr Gross thought that was a bit crazy.
Anyway, I went to see my doc here after I had already scheduled surgery with Dr Gross. He never said I wasn't a candidate, and he even said he knew an ER doc from Birmingham who had gone to Dr Gross, but the most I could ever get out of him was, "If it works, I think you'll be happy with it."
well, it did, and I am.
I was bone on bone -- I waited until it was bone on bone to do anything (like I think many people do ... in fact, I am not sure Dr Gross would operate if you had much cartilage left.)
Although I am somewhat skeptical of "miracle" type procedures, resurfacing is pretty close and I am glad I did it!
:) Hi Joe. Don't take in other specialists opinions until you find out more facts. Example in 2007 I was told I would never walk properly again by a leading Olympic sports physician (I can now run) You may have a better outcome in life than you expect. Make your decisions wisely lots of experienced, positive people here. Good luck. Cheers K 8)
Ok... third time trying to post... :P
Met with my surgeon 2 days ago with a bunch of questions for him. I asked him why I was no longer a candidate for resurfacing & it's because the bone quality is no longer there.
Makes sense now when he said that he didn't want to have to do a revision. And when I think of if, there are other tell tale signs in my overall health that supports his findings. A lot can happen in 5 short years.
Thanks again everyone. I'm so fortunate to have found this website. All 6 physicians who I have sent my x-rays to have found me to be an acceptable candidate, including Dr. Gross who recently called me. He was very helpful in discussing my condition and options. I'm going to start the process with him, and see if I can get the insurance issues squared away and then schedule a surgery date if everything works out. He recommends I do both hips in the same week, yikes!. Of course I'm a little concerned about doing both hips so close together in time, but perhaps that's the best approach. I will let everyone know my plight when I ultimately have the procedure(s) done.
Go for it! One recovery.
Scheduled for bilateral resurfacing surgery with Dr. Gross for the week of December 12... :-). Let the anxiety and nervousness commence! I've said it too many times already, but I am so glad I found this website.
Congrats Joe! I think you'll be very happy with how the crew in SC treats you. I'd tell you not to be nervous but I think it's pretty much impossible. Just know that you're going to one of the very, very best surgeons and teams ANYWHERE and try to relax about it as much as you can.
You have a bit over 4 months to get yourself into the best pre-surgery shape possible. A triathlete friend of mine who had bilateral surgery with Dr. Su in NY told me to get myself into the best shape I could as it would facilitate a good recovery. I nearly killed myself in the gym for about 3 months prior to my surgeries and I believe that work paid off in a very big way as I have had a very, very good recovery. I'm about 3.5 months past my surgeries and am feeling better and better and better and could not be happier with my decision.
Good Luck!
Quote from: Quig on July 28, 2016, 07:31:01 PM
You have a bit over 4 months to get yourself into the best pre-surgery shape possible. A triathlete friend of mine who had bilateral surgery with Dr. Su in NY told me to get myself into the best shape I could as it would facilitate a good recovery.
Couldn't agree more. I carried on racing Triathlons and with the help of a program from my physio did a lot of strengthening exercises, lost some weight and it worked very well. I was back running at 4 months and doing Sprint Triathlons at 7 months. Next week I will be doing my first Olympic Triathlon at 9 months.
Good luck!
Thanks for the well wishes and advice to get myself in shape Quig and Alan. I have remained active via weight training, some cardio, and continued sand volleyball (though my level of play is now rather sad given my hips). Besides general overall conditioning and strengthening, is there any specific exercises or group of muscles that I should concentrate on in the next couple of months? For example, I still try and work my lower body via weights (squats, leg extensions). I say "try" because these are getting harder to do as the years go by, and my ROM worsens.
I would love to get any where near the level of recovery both of you have. Your stories are inspiring for sure.
Here are the exercises that if nothing else, they encourage us to do:
Lying on back:
With rolled up towel under neath knee, leg straight, push back of knee/leg onto floor
With same towel, same spot, lift lower leg up to straighten leg.
Slide heel toward body, bending at knee
Slide straight leg away from body.
With both legs straight, clench glutes/butt squeeze
So, taking these in mind, if you can do the variations of these standing up, do them. They were what we did pre & post surgery. Oh ...
Going up on toes & half squats.
:) It is a massive hard task Joe to keep the joint moving when it freezes up. Do anything you can that works to keep the ROM up and the joint moving.......... It depends also where the major of the issue is. Anterior, posterior or just weight bearing. From my experience of a Bilateral it is the year after how to get it back into shape. I did 21 k the other night plus now 6 k the last 3 days. Just to give the muscles the shock of there life and the tendons that have been inactive for so long to step up........ It is working.... Exercise... Nutrition... rest.... Exercise... Etc.... So there is no easy fix to keep it going just do what you can. Glut Max do help but mine gave in years ago now just finally getting some butt muscle back... It is hard work anything you can ... Cheers K 8)
Hi Joe. In support of what Chuck and others have said, here is my amateur understanding of why being bone on bone makes you a good candidate for a resurfacing. You should check my details, but I believe that as a hip joint progresses to bone on bone, the body changes the blood supply routes to the femoral head. This change in blood supply routes is important to a successful resurfacing, which is why many of the top resurfacing surgeons will ask people to wait if their arthritis has not progressed far enough yet. I think you can wait too long, which is often related to the presence and size of cysts on the femoral head. My hip was bone on bone with cysts, but Dr Gross was able to fill the cysts in with bone graft which is standard for him, and 8 years later things are still going great.
Uh oh. Bad news. I was scheduled to have bilateral hip-resurfacing with Dr. Gross this December. I have done all the pre-certification medical tests for clearance, flew out to SC for the initial evaluation, got approved time off work, made the airline and hotel reservations, and was truly looking forward to benefitting from this wonderful procedure. It's been 6-7 months since I started the process, and even though I was a little scared, I was more than ready.
Of course, the *very first* issue I believed I had resolved was to make sure that my medical insurance covered this procedure, as I didn't want to waste my time, nor the time of the medical staff. I put in the request to Dr. Gross's staff to run my insurance number to verify coverage. I was a little shocked, but even though Dr. Gross is an out-of-network physician, the results were 100% coverage, and no out-of-pocket expenses. Even with this seemingly legitimate approval, I double-checked my coverage with the staff at Dr. Gross' office when I have my initial evaluation a few weeks ago. With that huge hurdle out of the way, I started down the path to finally getting something done about these hips.
Several days ago, I received a call from Dr. Gross's office. When they re-ran my insurance coverage, they were told this time that I didn't have coverage (this time they stated I have no out-of-state benefits). Without going into too many details, I was originally told by my medical group that I would have to find a surgeon on my own though my insurer, since my medical group doesn't perform hip-resurfacing. I am now stuck in the Catch-22 situation where my insurer won't approve it until my medical group does, and my medical group continues to tell me to work through my insurer. I have one last Hail Mary play, where I can have my PCP submit a request for this surgery, and see if it gets authorized (unlikely).
Anyway, I'm upset at these last minute circumstances, and please let my story be a warning to others to please verify their coverage independently on your own, perhaps several times to confirm your coverage. This is something I failed to do. I guess my excuse was I didn't know the specific procedure and hospital codes, and wasn't sure if I would complicate matters. I should have been more proactive with this.
I'm still staying positive overall however. And that is because while I may have been set back 6-12 months from getting to a pain-free existence, and on the path towards healing and being active again, I know that I will eventually have this surgery done, and will be able to report of my own success story someday.
Damn, what a mess. I'm so sorry to read this Joe.
I wish I could offer some advice on how to fix it but I don't have a clue. Don't give up! I sincerely hope you can get this resolved and get yourself some new pain free hips. Good luck!
That stinks.
What steps do you think you skipped? Do you need to get something in writing from insurance before knowing you will be covered? What insurance do you have, an HMO?
I'm sort of in the same situation about being reluctant to contact insurance company on my own fearing I would say the wrong thing. I've left it up to the office staff so far.
I've never had to get an approval since the only times I had to have surgery have been in emergency situations until now. I don't really have a PCP, have just gone straight to orthopedic surgeons for opinions.
Thanks Quig. I've always appreciated your kindness, support and wealth of information regarding your experience. I will keep fighting. Regardless of the outcome of this setback, I know that I will someday have new hips done by an experienced surgeon, even if it ends up being someone other than Dr. Gross.
HorseDoc - I'm not exactly sure what I've could have done differently. I keep going back, trying to reassess how this played out. I checked for insurance coverage via the staff Dr. Gross back in July, and then because I was paranoid, I double checked with them in October. Everything seemed okay. When they ultimately ran the authorization for the actual surgery a week ago, it was declined. I don't think my insurance would have provided me any written statements of coverage.
I looked at your posts, since you stated you were in a similar situation. It sounds like you were in the exact situation I am now in. It sounds like you were able to bump your situation to the medical director at Blue Cross/Blue Shield (BCBS), and you ultimately got them to approve your surgery. Great job. I might private message you to see what steps I can take.
My insurance is an HMO through BCBS, and Dr. Gross was one of the few who accepted my insurance. I previously looked into mostly all experienced surgeons in California, and they all stated they didn't take HMO insurance. So I'm somewhat in a bind, since they don't have surgeons with hip-resurfacing experience at my medical group (I have recently heard that there's one guy in the medical group who has done a grand total of *three* HRA procedures in the last *seven years* - no way I want to be the guinea pig for that particular surgeon :-))
Thanks,
Joe
Joe - Open Enrollment for insurance starts today. I suggest you very carefully comb through available plans and find one that will cover this surgery with your doctor of choice. It may cost more than your current plan, but will be worth it. After my consultation with Dr. P last Christmas Eve I called up my insurance company and bumped my policy up to the highest level offered so I could benefit from the lower deductible and max out of pocket. Higher premiums, but worth it considering the costs of surgery, pt, etc.
Thanks catfriend. This was something I was seriously considering back in the Summer. If I didn't already believe I had an authorization, I would have probably switched to the Kaiser medical group here in California (and would have been able to choose Dr. Klug, who is an experienced hip-resurfacing surgeon).
Unfortunately, the open enrollment period was closed several weeks ago through my employer. It's kind of sad (and humorous!) how all these little events kind of lined up, just at the right/wrong time for me. Oh well, I have to keep my spirits up, since that's the only thing I have going for me right now! :-)
Hi everyone,
I'm still fighting the good fight in terms of trying to get my hip resurfacing denial overturned. Things aren't going great, but I'm not giving up just yet, and will go down swinging. My contention is my medical group truly doesn't have even a remotely acceptable candidate who does the procedures. I reached out to Pat earlier with my question below in a personal message. I then thought of the rest of the this group have proven to be a invaluable source of information, so why not ask anyone willing to listen. Thanks.
***********************************************************************************
Hi Pat,
I'm still in the exhaustive process of appealing my medical group's decision to go outside their network and find an experienced hip resurfacing surgeon like the ones listed on your site, with a minimum of several hundred procedures. Believe it or not, they are trying to say that an orthopedic surgeon who is in my medical group is available to me, even though he's done no more than *3-4* hip resurfacing procedures in *5-7* years, and isn't even an believer in hip resurfacing (he tried to talk me out of it with some not so subtle scare tactics, and into a total hip replacement).
Do you have any research literature, or any form of other documentation I could cite to add to my appeal in regard to the relative complexities of hip resurfacing versus a THR, and benefitting from using a surgeon who has experience and not be a guinea pig to a surgeon who doesn't even believe in the successes of hip resurfacing?
Thanks,
Joe
I thought I would post my answer to you in case someone else might be interested:
Here are some appeal letters. Maybe they will help. Many are old, but not much has changed
http://surfacehippy.info/insurance-appeal-letters-and-information/ (http://surfacehippy.info/insurance-appeal-letters-and-information/)
Here are some medical studies about doctor experience and outcomes of hip resurfacing.
http://surfacehippy.info/category/medical-studies-general-hip-resurfacing-studies/medical-studies-doctor-experience-learning-curve-studies/
(http://surfacehippy.info/category/medical-studies-general-hip-resurfacing-studies/medical-studies-doctor-experience-learning-curve-studies/)
I hope that helps.
If anyone knows of additional information, I would be happy to post it on the website.
Pat
I hope your able to get something worked out to your satisfaction.
Update:
Finally some good news. I've been authorized for my bilateral surgery with Dr. Gross for next week! I'm so happy right now I can barely contain my emotions. I'd like to be able to say that logic and reason won out and that my appeal was granted, and the powers that be understood my need for hip-resurfacing, and my choice to go out of my medical group since the only surgeon in my group has done a mere handful of resurfacing procedures. I wish I could say that (the appeal is actually still pending).
I believe I had something similar to a guardian angel here in the HR/Benefits department at my employer, who sympathized with my plight. I had to meet her in person and explain my situation. There's a chance she felt sorry for me, seeing how I was hobbling around and such. Anyway, to make a long story short, I was miraculously able to get my insurance changed to a PPO, effective at the first of this month. After that, things started falling in place.
So I will soon have my own story to share here. I again want to thank Pat and all the others here who share their stories and give the much needed advice and support. If I didn't somehow stumble on to this site, I don't know where I'd be right now.
Awesome news Joe!! It sure is nice when a story has a happy ending.
Best of luck with your surgeries, and enjoy your time in SC. I'm looking forward to hearing how things go. I have no doubt everything will go well, you're in GREAT HANDS with Dr. Gross and his crew.
Great news! I am so glad this worked out.
Yes, can't wait to hear your story.
Thanks Quig and Blinky. I've always appreciated your well-wishes and advice. And soon I will join an even more exclusive group here which you two are already members (bilateral/same week with Dr. Gross). :-)
Congratulations! All the persistence will be well worth it.
Hi everyone! As of 1:00 PST yesterday, I am an official bilateral recipient of two brand new hips (performed by Dr. Gross). Everyone who responded to my questions were completely correct. Dr. Gross and his staff are highly professional and very nice. I believe I have made the right choice. I only brought a small tablet to send messages, so I will wait until I get home to share my experiences. So far, I am completely satisfied with my decision. Thank you all.
Upward & onward from here on! ;D
Congrats Joe, and welcome to the other side. I hope your recovery is a great one!
Good luck, now its healing time!!! Dr. Gross is great.
Regards,
Larry