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The Hip Talk Discussion Forum was hacked a few weeks back. It has taken me a long time to fix it. The only backup I could use was way back to April 2020. All members and posts up to that date are available. Anything newer has been lost. I am sorry, but that has been the only way to get things up and running again.

Author Topic: Choice of Hip Replacement vs Hip resurface  (Read 5203 times)

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Pylon 16

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Choice of Hip Replacement vs Hip resurface
« on: March 04, 2009, 05:01:42 AM »
Just interested in feed back on info on what type of hip operation to do for my left hip.

My history is : had a Durom hip resurface - right hip April 2007  - 48 years old male very active and play hockey/do lots of cycling. very happy with the operation but have hit a snag with the fact my left hip is now in need of an operation. BUT since my Durom replacement there has been a moritorium on using them here in BC. So my Dr has given me 3 choices BHR or complete replacement using ceramic on ceramic or metal on plastic. I was a little taken aback about doing a complete replacement as the whole idea of doing the resurfacing was to keep as much bone as possible and give me more options in my later years !!! I know that one of the most important items is the skill and comfort level of the Doctor in doing the various opertaion and I beleive my surgeon is very good at all three. Here are my concerns:

1) metal ion content in my body if I go for the BHR
2) complete replacement allowing me to contiue to play old timers hockey( non contact)
3) ceramic on ceramic - heard issues about them squeaking ??
4) wear characteristics on the metal on plastic( using the new corss linked polymer)

This forum seems like a great idea and a wealth of knowlede so I thought I would try this as I see the Dr April 23rd for my consult and want to have my questions ready !!!!


Thanks

Pylon 16

karenj_m

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #1 on: March 04, 2009, 12:55:10 PM »
Hi Pylon:
Here are my "non-medical opinions":

1) metal ion content in my body if I go for the BHR
There is an increase in metal ions for approx. anywhere from 1 1/2 - 3 years and then it levels out. The key is placement of the devices so that it does NOT cause excessive wear. To-date, there are no known issues with increase ions (as of to-date). Pat has a whole section you can read about it on her home page.
2) complete replacement allowing me to contiue to play old timers hockey( non contact)
Why would you do a THR? You've already experienced how well your other resurfacing is and you can do what you want to do (contact hockey if you wanted) after it heals.
3) ceramic on ceramic - heard issues about them squeaking ??
Yes there are...this is primarily for folks with extreme issues of metal allergies. We also don't fully know how ceramic can handle impact or heavy activity
4) wear characteristics on the metal on plastic( using the new corss linked polymer)
This is CRAP! stay away from this device....its a small head poly which can dislocate alot easier than a large Metal on Metal head THR device.


Karen
RH Biomet 56/50 uncemented / Dr. Gross (SC) 04/02/08

Pylon 16

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #2 on: March 05, 2009, 01:52:11 AM »
Thanks for the info  - I am leaning towards the BHR - if my surgeon is comfortable doing the procedure. From what I have been reading - the skill of the surgeon in placing the BHR correctly or any Metal to Metal resurface product for that matter - really determines how the product wears over time. (And also the amount of metal ions you  get in your blood stream due to wearing of the metal.) There is so much to read and it's great to talk to other people to get their experiences and opinions

Thanks again

Pylon 16 :0)

karenj_m

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #3 on: March 06, 2009, 12:38:09 AM »
Pylon 16:

I can NOT stress this enough...it is extremely important that the surgeon you choose is very, very, experienced in hip resurfacing....not that he/she is comfortable....

We all choose resurfacing for several reasons...
1. to have an active lifestyle
2. to of course be without pain
3. to conserve our bone
4. to "buy us time" should we need to revise to a THR (no one knows, except engineer speculations on machine models suggest that our resurfacings should last a lifetime, but we don't know yet)

It is definitely a difficult skill demanding procedure more so than a THR. The placement of the femur cap's pin, the socket cup, the shaping of the femur head, the saving of the hip capsule, etc...is really, really important.

Make sure to get a very experienced hip resurfacing surgeon...

PS: A NOTE (about metal ions): the types of metal combinations (like resurfacings) have been in joint replacement devices for over 40 years
Karen
RH Biomet 56/50 uncemented / Dr. Gross (SC) 04/02/08

Pat Walter

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #4 on: March 06, 2009, 01:51:47 AM »
H Pylon 16

I would not be worried that a BHR is going to put more metal ions in your body than your existing hip device.  All hip resurfacing devices are very similar when placed properly by an experienced surgeon.  It is a misplaced acetabular cup that can cause very high levels of metal ions.  Normal devices placed properly wear in and don't cause any problems with metal ions according to existing information.

So I would not be worried about getting a BHR.  I think it would be a shame to have received one hip resurfacing and then getting a THR for the second hip.  Remember that MOM THRs are fine solutions, but I have studies posted that show resurfacing loads the hip more naturally than a THR. THere have been gait studies done showing the resurfacing is more natural than a THR plus it is very bone conserving.

So I would want to keep my hips alike, especially at your young age.

The ceramic on ceramics used in the US are also smaller sized than the ones used overseas.  So you want to make sure that you will be able to do anything you want.  There has been some squeaking reported from a number of ceramics, but don't have any statistics.

Also make sure that you are getting a MOM sized THR. Make sure the cup and cap are the same size as your femur ball just like MOM THRs.  Anything much smaller could cause your problems.

Good Luck.

Pat
« Last Edit: March 06, 2009, 01:58:58 AM by Pat Walter »
Webmaster/Owner of Surface Hippy
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Pylon 16

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #5 on: March 08, 2009, 05:42:00 PM »
I see the surgeon April 23rd and I will be talking about the BHR as I think it's my best option. But again - he has to be good at doing them !!! Thanks again for the comments.


Pylon16

Pylon 16

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #6 on: April 25, 2009, 07:35:45 PM »
Saw my surgeon and also a fellowship Doc from England who has worked in a couple of the clinics in England. I am now booked for some sort of hip operation either THR or a BHR for July. Left the Doc's office with lots to think about. Doc would do either a BHR or a THR for me - both operations he said would be fine for me- it's just the pro's and cons of each I have to weigh out and it's totally my choice as the doc's just presented me with the facts as they know them.

THR - apparently new studies are out with the cross linked Polymer that are very encouraging - although I have tried to surf the web for them to find some. They think I could get a 36 mm head due to my bone structure - which although would not be as big and possibly as stable as the BHR it should allow me a pretty good range of motion.  I could possibly get 25 years out of the operation and then a revision would not be so hard on me when I am older !!! Doc feels I would be able to do most of my sports  - hockey(old timers) biking,golfing,fishing  - the big question mark is this operation doesn't expose me to more metal ions( right hip has a durom cup resurface)
just as a side bar there is a "hold" on using the durom cup here because of some failures that have happened with the cup not growing into the bone. Other positives is that the THR isn't as long an operation as the BHR

Down sides are:
1) losing my femoral head - IE  I did the right resurface to try to keep as much bone in my body as possible. ( I was 48 at the time)
2) I  still some concerns with the cross linked polymer due to the stigma of the history of the poly ethylene inserts
3) possibility of having one leg longer than the other


BHR - what can I say - I am posting to a site that is all about hip resurfacing. Our medical system in BC - based on their research is saying they will not pay for a BHR because there is no medical evidence that resurfacing is a better option than a THR - so If I get one I pay the difference for the operation.  All the reasons I had a hip resurface on my right hip are still valid for my left hip. the key is the metal ion content - and although no long term effects have been noted - I am worried that I could increase my ion content in my body that may casue some effects - pseudo tumors sound nasty and make any revision very tough. Now I know the chances are very small but here is what I am thinking:

1) I have a Durom cup. The Durom cup ( not mine) is showing to have some issues in a small percentage those that have had them.
2) Do I increase my chances with a BHR on my left to cause some issues with metal ion content
3) I have a family history of type 2 diabetes and currently am being monitored on my A1C - but other than diet and exercise when my left hip allows it - I am not taking anything for it. My blood sugars have been good - but that is now - suspect I will be more of a risk as I get older - which then puts me at risk for some kidney issues - which is the main way the body gets rid of the metal ions !!!!! Also - my dad lost both his legs due to complications from type 2 after he had a stroke ( he passed away last year at the age of 83) -this may not have any relevance but I doubt anyone can say one way or the other.
4) a good chance that I will have to have a revison some time in  my right hip  - don't know how long the resurface will last - no one does - too many factors involved. Do I minimize the number of revisions I could possibly have or the severity - IE have to go from a Durom to a THR on the right by having the THR on the left where the metal parts don't normally have to be changed - just the insert.
5) and who knows what new mdical advances will happen in the next 5/10/15 years - which lends itself to the BHR to try to keep as much bone in my body as possible.

So - so much to think about. I was very thankful for the comments made by everyone on my last posts and knowing the importance of having a good doc - I have the utmost confidence in the Vancouerv complex joint clinic and the information  I am getting. The problem is new data and info is coming out all the time. The Doc from England said that he saw surgeons in England leaning more towrads THR now than resurfacing ( except in Birmingham !!!) My Doc said to try to keep an open mind - both operations would work very well for me but he is trying to give me the most up todate info to make MY decision. I have till the end of May when I finally book my time to make the call.( which will be in  July  some time)

Any thoughts/comments would be appreciated

Thanks

Brent



annie

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #7 on: April 25, 2009, 09:39:16 PM »
Hi,

The choice of op between a BHR and THR is normally chosen by the surgeon at the time of operation with regard to how far the hip has degenerated, bone density etc. 

If I were given the choice I would go for BHR definately.

Cheers
Annie

karenj_m

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Re: Choice of Hip Replacement vs Hip resurface
« Reply #8 on: April 26, 2009, 02:19:03 AM »
Pylon: (my 2 cents below)

"THR - apparently new studies are out with the cross linked Polymer that are very encouraging " This device is crap-0-la! (sorry) but there is evidence of plastic shedding in the leg from this device. Its not durable enough for having an active lifestyle.

"(#5) and who knows what new mdical advances will happen in the next 5/10/15 years - which lends itself to the BHR to try to keep as much bone in my body as possible" Engineers "models" say that a resurfacing will last way past our lifetime

But on #5 you answered your own question....if you have bone left by having a resurfacing, then you have something for a surgeon to work with down the road..."should our resurfacings not last as long as engineers project". If you have a THR, that's it! no turning back....

My hope is that...those of us with resurfacings can move to something like McMinn's BMHR (should our resurfacings not last our lifetime)...then to a THR after that. Thereby keeping the socket cup and just working on the femur side. Each time taking very little bone until a THR.

Something that "wigs me out";.... okay hockey man...what if you are on your skates and fall and do something along the position of a split? Will the long stem of a THR handle that? Or break bone?

Sorry not trying to give you more questions to your long list now...but there is a difference between stress handling of a THR vs a Resurfacing.

A BHR has a long track record with excellent results when done by a very experienced "resurfacing surgeon (not a THR surgeon)".

Please note: That a large metal-on-Metal THR is a good product for those who "can not" have a resurfacing ....but that should be a last resort.

Regarding psuedotumors...they are very rare...."most" cases are due to mis-positioning of the device so they don't run over each other smoothly, thereby causing excessive shedding of ions.

You should be basing your decision on how good your other resurfacing is working for you now...

Good luck to you .....



Karen
RH Biomet 56/50 uncemented / Dr. Gross (SC) 04/02/08

 

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