Hello guys and girls,

My name is Etienne I'm from the beautiful province of Quebec Canada. I'm a 32 y/o man in a pretty good shape, if it's not that my right hip is pretty bad from playing ice hockey (goaltender)... I started suffering 3 years ago and stopped playing almost right away. However it was too late. Doctors didn't know what it was but I found my own answers on the net and it got confirmed by MRI that I had FAI with arthritis. I've been very careful since then and it's up and down.. good days and bad days. If I go jogging, then I'm suffering for weeks.

They wanted to do a surgery to remove some of the arthritis (arthroscopy), but from what I've been reading on other web sites, the results are really not that great when arthritis is already set in place. So far I've been postponing the surgery, I fear that I'll make everything worst if I do it. I'm trying to wait as long as possible before I go to surgery because of my young age. So my first question is: Does anyone here went for similar surgery before going to hip resurfacing and what was the outcome?

My doctor said that if it didn't work I'd need THR and I'm totally against this so I plan on going to India seeing Dr. Bose when I reach that point. My second question is: Would I need to go to India multiple times or if this all happens in one trip?

Third question: What if something wrong happen, complications or infections related to this surgery and I'm back in Canada? Would I need to travel to India once again to have anything done? Also what about the fees that would occur in such event?

Fourth question: Obviously at my age, I can assume that at one point the device will need to be replaced. With THR, after some years, the device gets loose and needs revision surgery, which is a lot more complicated and involves cutting more bone. What about BHR? Is it likely the the head of the femur rejects the device after a while and requires revision just like the THR would? If so would it be possible to replace the BHR (MoM) device with an hybrid one such as BMHR (CoM) that gets a little deeper in the femur, instead of going for a THR? I'm just assuming that if the device gets loose with the BHR after one point, the bigger BMHR could be installed instead of THR.

I searched the web site but could not find exact explanations for my questions, so I thought I should ask. At 32, I want to avoid THR until 65 at least, so if the BHR has a lifespan of about 15 years, or even 20 years, I'm still quite far from 65... so I hope there are better solutions than THR when revision will be required.
I know about the ions and stuff, that's why I want to go to a reputable doctor for surfacing. I'm not too worried about it at this time and I think surfacing would be very positive in my case.

Thanks a lot to anyone who will take times to read and answer my questions :)

Hi Etienne, welcome to the site.

I can't answer all of the questions, but I think if you search through the hockey discussion, you'll find a couple of goalies.

I'm not a medical person, so you should base your opinion on good medical people. There are several stories here of folks who had different types of arthroscopy and it didn't help their cause. That doesn't mean it won't help, so the thing is to find a medical person you trust who can answer your questions to your satisfaction.

There are several doctors listed here by Pat who will look at your XRays and give you their opinion. I believe Dr. Bose is one of these, so you can pose the question to them, and they can tell you what they think about that procedure vs. something more comprehensive, like an HR.

I was also told to go to THR for both of my hips. Both needed to be done - once I heard of the restrictions and did my own research, I decided to go with HR for the lower restrictions and improved quality of life afterwards. It also helped that the results were so positive in my view. It is a personal decision, but I believe a correct one for me.

As to the traveling, one thing that has become obvious to me is that traveling to get your hip resurfaced is lower risk than with other surgeries. The operation is done, any recuperation that can be done on site is taken care of, but once you get back home, the aftercare both medical and physical therapy can be done by local surgeons, doctors and therapists.

I had both of mine done by a local doctor, and have seen him two (soon to be three) times since - at 6 weeks, one year and soon at my two year anniversaries. I sometimes called his office if I was concerned about anything, but it could easily have been handled by text or email as well. So in my case, it was a very lightweight recovery in that no large medical presence was needed. I understand the concern, you don't want to be far away if any issues come up, but I think the local medicos can handle issues. I had an entire protocol for dealing with infections, and a visiting nurse who was well versed with THRs (had never done an HR), who kept a watchful eye for infections and such for the first three weeks. So that wasn't really handled by my surgeon, although he did schedule all of it for me.

As to the other hip, is there any arthritis in that? if not, there's no guarantee you will get it and need any work done. If so, there may be years left once you get the work done on the one in need. That's another question that those doctors who consult for free here can answer for you.

As to longevity, all of us are waiting for that answer, and we may be our own answer, in that we are in the first or second wave of people with HRs. There are some studies that point to longer survival, but none where enough people have reached 20 or 30 years so that we have good statistics about it. We do have anecdotal evidence from some really early hippies who reached 20+ years with no problem, but that's not enough to form a true opinion about its longevity.

We have several young HR hippies here, who hold the same hope that we all do, that the device will last for a long time. I am also hopeful, but if not, thankful that there is a transition to another device. Right now the device of choice is a THR, but in 20, 30, 40 years, who knows what will be available?

Anyways, good luck, welcome and use the information and the people here to make the best possible choice.

Etienne,
           Welcome! I had FAI both cam and pincer a large laberal tear and OA. I didnt really gain anything from the hip scope to be honest i think thats fairly universal for people who have OA in the joint.

As for the longevity question well at the moment we just cant say for sure. However the BHR was developed from know clinical successes. There are numerous THR's made from the same as cast structure still in situ and doing great after well over 40 years so the alloy obviously can last a long time! There have also been THR's that were recovered after 20+ years and the measured wear was around 20microns!!! So in reality they will never wear out. On the subject of loosening i know both Mr McMinn and Mr Treacy since changing to cemented femoral components have not had a single femoral loosening in 15+ years! On the actabular side there is a really good video by Mr McMinn it might be on here but i found it on Vicky Marlows site. It shows you the back of the cup under a microscope and the porocast beads on the BHR which are patented are a better surface for bone ongrowth and ingrowth thats for sure. When i asked my surgeon (Mr Treacy) about how long my BHR would last he said he couldnt give me an answer. What he could tell me was that in my demograpic he had a retention rate at 15 years of 98-99% and he saw no reason why that figure would change drasticly at 20 years. So that has to bode well for the longer term.
The most important thing is to use a top surgeon Bose is one of the best! also use a proven device which the BHR is. If you do this youll have a good outcome.
Danny

Thanks for the quick and long answers people this is encouraging!

I still wonder though, and maybe a doctor on this site could answer, if the BHR loosen up from the femoral head and a revision was necessary, would it be possible to do such revision with BMHR (ceramic) device instead of jumping to THR?

Since its slightly bigger i assume it would be an option??? But i'm not a doctor so i'm just asking. If thats the case i think that give me a lot of options if a worst.case scenario was to happen.

Ill try to talk to goalies from other sections, thanks for the hint

Hi Im certainly no doc but this has been asked here before and someone got an answer from the Mcminn centre. The BHR has been converted to a BMHR but its very very rare that its possible. I am a lot younger than you are i was 28 at time of my op im 29 now and to be honest im not worried about a revision. I believe this will last me a long long time.

Oh and i believe that Mr Mcminn only uses the ceramic BMHR in special cases

Etienne;

Welcome and sorry for your troubles.  Although I cannot add anything beyond the great responses above from Hern and Danny, I would add that you may want to also consider surgeons in the US, if an option with your coverage.   There are many Canadians who come to Ohio where I live for example, for this procedure, and I'm sure to other places as well.  My surgeon is a Canadian from Toronto, and he worked wonders for me, now that both are done (9.5 months ago and 5 months ago).   The BHR has been a godsend.

Best regards,

Dan

Welcome Etienne.
A lot of folk here were recommended by their docs the THR device as the only option, including myself. At 43 I wasn't prepared to have a THR and lead an relatively inactive life. I'm 7 months post op from my BHR & doing things pain free for the first time in several years.
With respect to the stats Danny has mentioned - look on McMinn website, the results at 14 years for a THR Vs BHR are chalk & cheese. For males under 55 I think it's THR 33% Vs BHR 98% Survivorship.
You can look at it like you're buying yourself time - I.e. at least 14+ years based on current solid data & still have the option of converting to a THR..
I also reiterate Hern, Danny & Dan - find yourself the most experienced doc & send them your X-rays!
Good luck with your decision.
http://www.mcminncentre.co.uk/birmingham-hip-resurfacing.html
Cherz
Kiwi

Hello DanL

How come canadians go to USA for surgery? Is it not like 45k $?
As far as i know we  are not covered in anyways, since insurance companies don'toffer that here. So India is a much better option price wise, unless i misunderstood something...

$45000!!! you could choose from Mr McMinn, Mr Treacy, Koen De Smet or Vijay Bose for a fraction of that cost!!!!!

Quote from: FutureHippy on July 22, 2012, 11:10:43 AM
Hello DanL

How come canadians go to USA for surgery? Is it not like 45k $?
As far as i know we  are not covered in anyways, since insurance companies don'toffer that here. So India is a much better option price wise, unless i misunderstood something...

Not knowing what the expense is for Canadians to go to the US, I'm sure those of us in the US just want you to know what the best options are down here. You can find the expense of going to a US surgeon and what the coverage is; if the US surgeons don't make sense financially, then as Danny mentioned, Dr. Bose and the other very good surgeons may be the best possibility.

Quote from: Dannywayoflife on July 22, 2012, 11:28:00 AM
$45000!!! you could choose from Mr McMinn, Mr Treacy, Koen De Smet or Vijay Bose for a fraction of that cost!!!!!

Yup looks like that's my best option. A few surgeons are doing it in Canada (free) but I'm not sure what their level of expertise is. I don't mind paying 10K if it means I have better chance of success... I guess I have more homeworks on my plate to do before I set my mind on where to go.

If I were in the same position I'd be looking at being a medical tourist!

Hi Torontogirl, I remember your talk with Pat about the Ghent experience, how are you feeling?

I think everyone heals differently. I had the same thing with my (  'better' pre- HR ) right - it took longer to recuperate. I think that each is different even on the same person. Mine were not simultaneous bi-lats, but three months in between. Good to hear that overall you're in good shape.

Hi torontogirl, I`m in the same position as you albeit 9 months later! My pre op "good side" is weaker. Gather this could be due to the extra work it did before to compensate, hence muscles are taking longer. Had no bother at all with the other one. When I asked at the post op check up, they said continue excercising both equally.