Because I hope to live a long time, based on life expectancy calculators, my goal is to have my bone on bone hip arthritis treated by sequential bilateral resurfacings separated by a few months. That way, if I outlast the hip resurfacing, I will have enough bone stock to have a successful hip replacement when it fails.

I also believe that I might expect a greater range of motion from resurfacing than from a hip replacement.

However, a NYC orthopedic surgeon just told me that in his experience revision surgery for hip resurfacing is not easier, after all. There is more bone stock, but also more soft tissue damage.

He told me that there is no evidence that there is a greater range of motion from a hip resurfacing as opposed to a hip replacement.

Does anyone have any experiential or evidence-based response to this doctor's claims?

Confused,

Roberta

Roberta the ROM is a simple bit of mathematics I believe. The small ball thr's are easy to dislocate. If you go to a really top surgeon I really doubt that you will ever need a revision. Again the argument about revision on which is more difficult will depend on why the revision is required and who does it. I'm currently 49 weeks post op and I'm not aware I've had an op 85% of the time. I reckon in 6-9 months I'll be back to normal there is NO WAY I'd be in the same boat if I'd gone THR. Use the best surgeon you can see and use a proven device like the BHR and you will do great.
Danny

I guess I hadn't heard anything about revision of an HR being more difficult than that of a THR.

In a non-medical view (mine), it doesn't seem to make sense, as any impact on the soft tissue has personally attenuated down to very little in my experience. I don't feel pain, a little weakness, but I am pushing it quite a bit now. 

I never like to discount any opinion outright, though so I guess the only thing to do would be to search for a study of HR revisions, then THR revisions and compare the two. The longevity and the satisfaction of the patients with their implant would play into it - both are quantifiable statistically and could give us real guidance.

Failing that, until we know for sure, I would get multiple opinions to make sure there is some consensus. I would also try to get the opinion of surgeons who do significant amounts of both HRs and THRs and revisions. They more than anyone would know their own results and could give better predictions.

Dr. Su, Dr. Marwin, so on in NY could give you their opinions, some are reachable by email through the links Pat has provided on this site. Maybe that's a path for you to get a good answer.  We also have hippies here who have had a revision and they can tell you their own experiences.

I have had a busy year in which I initially saw a general hip surgeon hoping to get scheduled for an arthroscopy to resolve FAI and a labral tear but was told that I was way beyond that and a short way off replacement. I then sought a second opinion off a surgeon who specialises in lost cause preventative surgery who is a strong advocate of THR and opposed to resurfacing, then a surgeon who specialises in resurfacing!

The THR surgeon said that revision was equally difficult post resurfacing, because whilst you conserve bone at the femur, you have to remove more bone from the acetabulam to install the cup and he said that made cup replacement a lot trickier.

What I have learnt over the past 4 months is that there is so much conflicting advice surrounding hip surgery and the best approach, but take this for what it's worth as I am certainly no expert and am seeing how long I can hold off before going with resurfacing.

A good hip surgeon will not have any issue with a revision from HR to a total, once the femoral neck is cut the surgery is much like a total hip surgery.

Where the real problem is when a cup revision is needed, many surgeons have problems dealing with installing the cup when the neck is still present, although that is probably why they botched the surgery in the first place.

A cup is a cup when a revision is needed and many times if it's the femoral component you keep the cup anyhow.

Chuck

A number of good questions brought up on this thread. Here are the conclusions (not facts) that I have come to over the years from reading studies and interviews.
1. The difficulty of the revising a resurfacing relates to the cause of the revision. If it is a loose femoral component, then it could be pretty straight forward. If it is due to metalosis that was allowed to progress over time, it could be extremely difficult due to soft tissue destruction. A cup only revision is going to be much easier for an experienced HR surgeon who is used to working around the femoral head and neck, than for a THR surgeon who is used to amputating those out of the way. The one thing that we have plenty of evidence on, is that THR revisions do not have good success rates, which is why people have always been told to wait as long as possible.
2. A common argument against resurfacing it that the larger head requires a larger acetabular component, which cost you acetabular bone stock, which could be a problem in case of revision. Some studies have shown that this may be less of a problem if an experienced surgeon did the primary resurfacing, since they are careful to use the smallest cup possible in order to preserve acetabular bone stock. A recent study from the HSS in New York showed that, given the same native femoral head size, resurfacing patients tended to end up with smaller acetabular cups and therefore less acetabular bone loss, than patients who received large head THRs.
3. It is possible that a THR can have a greater range of motion than an HR. Since the femoral neck has been replaced by a narrower metal junction, the THR can move farther in all directions before impinging on the edge of the cup. This is visually clear, and has been proven in cadaver studies. However, potential range of motion in a THR is not relevant if there is a small head that can dislocate when the range of motion is pushed, unlike an HR.
Once again, these are just my non-medical opinions, but it might show why a person could hear conflicting statements on these topics.

That was very well put, John.

I have both so thought I'd back up your statement, with the left resurfacing I have a 40mm head and 46mm acetabular cup.  With the right mini thr I have a 36mm new head and a 50mm acetabular cup. It is metal lined with plastic and I think that the plastic liner is pretty "easily" replaced.  The problems with both types of surgery is if you have metalosis causing acetabular cup loosening. I have two metal acetabular cups so this could happen in either prosthesis.  My rom is about the same although I seem to have fewer issues with my psoas with my thr. 

So for me, those issues about revision are the same in the acetabulum, I have slightly less bone stock on my right but by far and away the most important difference to me is longevity of prosthesis life.  I don't think there are any/many studies of resurfacing wearing out, just failures

Cup loosening
Femoral loosening
Uneven wear causing metalosis
Neck fracture

My thr may fail before my resurfacing due to the spike moving in the femoral neck, again, not too much data out there because mini hips are new.  I'm confident that positioning is good in both cases.

To some extent, because medicine moves so quickly, we are all Guinea pigs. It is a pain relieving operation, in all forms it is generally very successful at that. The future is a leap of faith, but then it is for everyone.  I just know that I am grateful every day that my pain is gone and that've been given back my life twice now. How darn fortunate is that!?!

Hurrah for hip surgeons!

I was in the position a few months back when I may have needed a revision. In my case Mr McMinn said it would be easier for him and me than the original resurface. This is because my cup was fine, so I would have the head removed and a large ball short stem THR inserted. When you think about it the head of the femur does not have to be tucked out of the way whilst preparing the socket in a THR so I would imagine that must cut down on bruising etc.
So far i seem to have dodged that bullet.

Jas

Roberta, I Had a BHR in 1/2009 and had a revision in 12/2010 due to a loose femoral ball. My surgeon removed the loose ball and replaced it with a short stem THR keeping the socket so I wound up with a large diameter MOM THR. The ROM of the THR is considerably better than the BHR as mentioned in another response due to the smaller neck of the THR. The soft tissue recovery was more difficult I think due to additional trauma to the same area. It has been 22 months since the revision and I for the most part have very few issues. My left hip will require replacement eventually and I will likely go the BHR route (unless something better comes along) basically because I feel it will give me more options if a revision in needed. One other thing the BHR did have a more natural feel I think due to conserving more bone

John,

Where does it make the revision more difficult when soft tissue has occurred?  I thought I either read or heard that Dr. Gross feels that it's not more difficult, I am going to dig but I think he's said that.

What could a surgeon do except for excise the bad tissue anyhow.


Chuck

Quote from: John C on October 22, 2012, 12:11:09 AM
A number of good questions brought up on this thread. Here are the conclusions (not facts) that I have come to over the years from reading studies and interviews.
1. The difficulty of the revising a resurfacing relates to the cause of the revision. If it is a loose femoral component, then it could be pretty straight forward. If it is due to metalosis that was allowed to progress over time, it could be extremely difficult due to soft tissue destruction. A cup only revision is going to be much easier for an experienced HR surgeon who is used to working around the femoral head and neck, than for a THR surgeon who is used to amputating those out of the way. The one thing that we have plenty of evidence on, is that THR revisions do not have good success rates, which is why people have always been told to wait as long as possible.

I found it, it was a Pat interview, look at 8/26/2011 Part II about 6:10 into the video.

http://www.surfacehippy.info/doctorinterviews/grossinterview.php

It did not seem a big issue with Dr. Gross, 10-20% more time on average and that is probably for cleanup only.

Chuck

Never forget that surgeons are only human and have their own biases, especially when their practice is private and their next sports car or their alimony is at stake!  If a surgeon is not skilled at resurfacing then he is likely to advocate THR.  If a surgeon is skilled at Resurfacing he could advocate either THR or BHR as THR is an 'easier' technique (or certainly not as technique dependant, IMHO).
The surgical practice of Urologists is a great example of this, where surgery is driven by the volume of billing.  Just saying ....

You are right Chuck. In the interview, Dr. Gross did comment on the importance of catching these cases early, and not allowing the damage to progress over time as I mentioned in my post. He also referenced other reports of how difficult these cases can be if allowed to progress. In the cases where damage had progressed, what I was referring to with the soft tissue destruction from metalosis was not the mechanical difficulty of doing the surgery, which as you say just means time and decisions in removing the damaged tissue, but the difficulty in achieving a highly successful outcome when soft tissue such as muscle has been damaged and removed. The difficulty is not in doing the surgery, but in achieving a good result.
Thanks for taking the time to dig up and share that interview.