I was reading on about HR with Slipped capital femoral epiphysis (SCFE) and all I could find is how technically difficult it is.  That really scares me that I won't get good results.  My surgeon didn't say that he thought it would be an issue but I haven't see him since my MRI.  He has just looked at my x-rays.  Both the x-rays and mri was taken with my feet taped together because I can't get them that way (not even close).  Read this article and tell me what you think.

http://proceedings.jbjs.org.uk/cgi/content/abstract/87-B/SUPP_III/355-b

I hope the confidence I have in my surgeon pays off.  I have heard great things about him.  You just don't hear much about slipped capital femoral epiphysis in the area I live in.  Most of everything you read online doesn't tell about the prognosis in the future.  Just in the immediate future.  I had great a great prognosis since 1993 and all of this just started this year.  Am I jumping into surgery to fast?  Most of everyone on here has been dealing with pain for years and here I am several months and I'm ready to operate.  I have spent my life dealing with this and everytime things got bad I had surgery to fix them and it has always worked.  What if things don't this time.  What is the worst case senerio THR?  If that takes care of the pain is it worth it?

Hi Cindy

I just got back from the 2nd Annual Hip Resurfacing Course in La.  Spent 3 days with the best resurfacing surgeons in the world.  The one thing I again realized after sitting thru 2 days of presentations is  - the more difficult the hip problem, the more need for the most expeirenced hip resurfacing surgeon you can find.  I am not familiar with your problem, but if it is difficult, it means there will be a lot of special planning going into your surgery.  The placement of the acetabular cup and the femur component must be exactly right for problem hips.

I can't remember who you are going to, but if I had a difficult hip, I would be looking at the doctors on my list that have done over 1000 hip resurfacings or at least over 500.  You need skill and experience.

I listened to the large panel of doctors and even many of the experienced surgeons will often opt for a MOM THR in difficult cases and especially for women.  So if you have your heart set on a  resurfacing, you need the most experinced surgeon you can find according to what I have learned.  There is nothing wrong with a MOM THR except it is not as bone sparing as resurfacing.  I listened to doctors tell about their MOM patients that do everything the resurfacing patients do. So a MOM THR is not a terrible solution if you don't mind your femur bone being cut off.

Pat

Cindy,

Have you tried sending your x-rays to other doctors?  Many doctors will give you phone consults and I would bet that some of them would be able to get you in contact with past patients so you can find out how they did with their surgeries. 

If I had to do it all over again, I would for sure have gotten my surgery done 2 years earlier.  I missed too many things.

Chuck

Quote from: cindy26 on October 26, 2008, 10:23:11 PM
I was reading on about HR with Slipped capital femoral epiphysis (SCFE) and all I could find is how technically difficult it is.  That really scares me that I won't get good results.  My surgeon didn't say that he thought it would be an issue but I haven't see him since my MRI.  He has just looked at my x-rays.  Both the x-rays and mri was taken with my feet taped together because I can't get them that way (not even close).  Read this article and tell me what you think.

http://proceedings.jbjs.org.uk/cgi/content/abstract/87-B/SUPP_III/355-b

I hope the confidence I have in my surgeon pays off.  I have heard great things about him.  You just don't hear much about slipped capital femoral epiphysis in the area I live in.  Most of everything you read online doesn't tell about the prognosis in the future.  Just in the immediate future.  I had great a great prognosis since 1993 and all of this just started this year.  Am I jumping into surgery to fast?  Most of everyone on here has been dealing with pain for years and here I am several months and I'm ready to operate.  I have spent my life dealing with this and everytime things got bad I had surgery to fix them and it has always worked.  What if things don't this time.  What is the worst case senerio THR?  If that takes care of the pain is it worth it?

No I haven't sent my x-rays to other drs.  I am going to talk to my surgeon tomorrow about my concerns and if there is any question they I am going to see another dr.  I have only met him  once and see him tomorrow morning to schedule surgery.  I felt confident in him when I first met him, I have just read so much stuff and now I have more concerns.  I am going to sit down and discuss these with him.  So I guess we will wait and see.  I am anxious to see him.  I would love for the surgery to be scheduled tomorrow not to be scheduling tomorrow.  Every step I take anymore is like a grinding and rubbing sensation and no pain meds really help it.  Working is getting harder each day.  I can't miss though I will get fired.  The deal is they will give me leave but I have to wait until dec 8th to take it.

Hi Cindy

I too suffered a SCFE aged 11. I have been suffering pain and rom since then but more so from 21 onwards.  Numerous visit to docs and no joy as too young to do anything as only option then was THR and they said I would need too many so not possible.  I was encouraged to revist the docs by a male colleague at work who had two BHR's due to extremely worn hips and is absolutely delighted with them.  My consultant said that he hoped a resurface would be possible but if necessary he would need to resort to a THR.  He described my hip as a challenge. 

When he visited after the op he said that all went really well and it was not as bad as he had expected from the x-rays and he was able to do the resurface as the preferred option.  To say I was delighted was an understatement.

I am from Scotland and the consultant is highly regarded here - and he really deserves the praise.

As far as I am aware resurfacing can last up to c 30 yrs wheras THR's c 10-15 yrs.

If you need any further help I would be happy to share my experiences with you.

Annie the frozen Scottie  ::)

Hey Annie,

I am there with you.  Usually all of the docs say your too young.  I feel that I am too young to suffer and I really want this thing fixed.  I want to live my life when I am young.  I would rather feel better now than 30yrs down the road.  I have a 22 month old and I really want to play with him.  My pain is so bad when I finally get home from work I can barely walk.  Not even with a limp.  I am pretty much just dragging my right leg behind me.  I don't know how bad you SCFE was I had a very severe slip and it has caused severe deformities of the neck and head.  The surgeon I am seeing said that he was not willing to resurface it.  It said it wouldn't fix my problem and probably cause more issues because the slip would still be present being only that the head was replaced.  I don't know I'm no doc, but it makes since.  I have been told that by 2 different orthos so far.  I went ahead and scheduled a THR on Jan5 but I have one more opinion on Dec17.  I don't know I am just confused and scared I guess that I will make the right decision.  My surgeon told me that if he does ceramic on ceramic then it will probably last 20-30 yrs.  For one thing, I don't know whether it is better to correct the whole anatomy with a THR or find someone who will do a resurfacing.  To me, because of SCFE the resurfacing kind of sounds like it is just sticking a bandaid instead of fixing the real problems.  If my hip wore out that fast (13yrs) because of the SCFE then would the resurfacing not wear out faster too?

Hi Annie and Cindy

I am not a doctor, but I know only an experienced hip resurfacing doctor can really give you good input when you have difficult situations.  I am not talking about a doctor with a hundred or so resurfacings, I am talking about the ones with 1000 or 3000 or more.  They are the ones that can do the difficult hips and are about the only ones who can do them sucessfully.

Hip resurfacing is not like a bandaid - it is a full hip replacement just like a THR.  It is actually a much more difficult surgery than a THR and can be used for many hip problems. 

Sometimes even the best resurfacing surgeons don't agree. Sometimes De Smet won't do a hip and Gross will or one of the other experienced surgeons will. There have beena number of times when they don't always agree.  In the end, it is up to the patient to decide which way they want to go.  If you have your heart set on a resurfacing, then sometimes you have to ask all the best doctors to see who will do it for you.  It is really a personal choice.

I just wanted everyone to realize that resurfacing is just as serious a surgery as a THR and there is no reason it won't last as long as a THR.  I have a story on the website of a lady whose BHR is now 16 1/2 years old.  Also all THRs don't last 30 years.  The normal life is just not that long - so don't let that kind of info make you think a resurfacing is not as good.

Pat

Quote from: cindy26 on November 26, 2008, 07:47:24 PM
I don't know how bad you SCFE was I had a very severe slip and it has caused severe deformities of the neck and head.  The surgeon I am seeing said that he was not willing to resurface it.  It said it wouldn't fix my problem and probably cause more issues because the slip would still be present being only that the head was replaced.  I don't know I'm no doc, but it makes since.  I have been told that by 2 different orthos so far.

I second Pat's statement that you would be well advised to send your x-rays to one of the top resurfacing specialists.  Ordinary orthopaedists, even very good ones, are not familiar enough with the procedure to understand which surgical risks are reasonable and which are not.

Your SCFE might scare the hell out of your local orthopaedist, but, for all we know, Dr. Gross or Dr. De Smet might consider it to be a worthy challenge.  You won't know unless you ask, and x-ray consultations are free.

I understand what you're saying about your femoral neck.  If the neck is deformed, a resurfacing won't correct it.  But does it have to?  Is the deformity the primary problem, or the arthritis?  Once the joint is replaced (by HSR or THR), the arthritis will not come back.  If arthritis is your problem, your problem will be solved.

The other consideration is whether the neck deformity arising from your SCFE is itself a problem that warrants addressing now.  Does that by itself, apart from the arthritis, give you problems and limit your activities?  If it does, then perhaps your docs are onto something in suggesting a THR, since a THR will address both the arthritis and the deformity.

Another thing to consider is whether you want to have more children.  Some people have raised questions about whether metal ions can cross the placenta and cause yet unknown problems to a developing fetus.  This concern may be exaggerated, and I know that many women who have had resurfacings have gone on to have trouble-free pregnancies, but it's something to keep in mind.

The deformities have caused me problems nearly all of my life.  I have always had very little range of motion and have always had issues with walking because my feet are turned out.  I have developed severe arthritis in my back and degenerative disc disease because of the way I walk and I am only 26 yrs old.  I'm not downing things I just want things to be normal for the first time in 13 yrs.  I am not saying that a THR will correct everything I don't know but is it not worth the try?  I really wanted a HR instead but now I kind of scared of it.  I still have one more opinion.  We will see.

One question you may want to ask the ortho is whether this problem could possibly be addressed with two separate surgeries.  The first would be to repair and/or reconstruct your femoral neck to make you a better candidate for resurfacing.  The second, once you've healed from the first, would be the resurfacing itself.

That's a lot to go through.  Perhaps it's better just to get the THR.

Another possibility is that, in repairing the femoral neck, it will be possible to rotate the head slightly to bring some fresh cartilage into the joint, thus alleviating your arthritis symptoms and avoiding the need for joint replacement, at least for several more years.

Cindy,

Since your case is so complicated, if you want a hip resurfacing, I would go to somebody that has done complicated cases in addition to hundreds if not thousands of uncomplicated cases.  See Dr. Bloomfield's x-rays of complicated cases posted under "Hip Information" on this website.  Go directly to Dr. Bloomfield's website to view the pictures.  One picture is of a bi lateral hip resurfacing with slipped capital femoral ephysis.  Since you are limited from traveling not much beyond Tennessee, you are probably stuck with a THR.  A THR is still a great solution, especially if you get a full metal or ceramic head.  This may last a lifetime.  My local retired OS, who is aged 60 plus had a THR a couple of years ago.  He said he was not a candidate for a BHR since his bones were too far gone.  He said either device is a great solution for alleviating severe osteoarthritis and other related problems.  I got a BHR since Dr. DeSmet said I was a perfect candidate (age 55, male, larger bones, good bone stock, many bone spurs but no cysts).  I sent my x-rays to Dr. Mont, Dr. Bose, Dr. DeSmet and Dr. Su.  They all said they could do a BHR.  Dr. Su did my surgery and I am very pleased with the results at 8 1/2 weeks post-op.

Another thing they would have to look at.  The entire neck and head has had 4 inch pins in them.  Which have been out for 8yrs but is my bone solid enough to hold another pin from the resurfacing?  On my MRI, it showed the pin holes where not open but theres no way to tell how strong the actual bone is with the regrowth.  Is it strong enough to hold another pin from the resurfacing or will the pin with the resurfacing be unstable.  I've done my homework.  I have looked into alot of things and alot of sites.  I'm a nurse so I really get in to reading some of this stuff.  When I was younger all I wanted to be was an orthopaedic surgeon.  I guess its were I went through so much as a child.  I didn't make it there of course but I work in the health field.  I don't work directly with orthopaedic (well one of our drs is ortho but he went and decided he wanted to do anthesia instead), we do alot of bone problems being that I work in pain management.  Most of our cases are back and neck though.  I just know I can't travel at all I am kind of stuck here.  The hospital in which my surgery is scheduled, is one hr away from my home, which is actually kind of an issue.  There is a hospital within minutes from my house.  It don't have the best reputation though.  It is huge (well big for here anyway).  I don't know I am not trying to 2nd guess everything but thats what I do best.  I keep going back and forth.  The dr I am seeing on the 17th is a good friend of one of our drs in our office.  He said that he is great and if anyone could resurface me then he could.  Thanks for all of the input.