Author Topic: Dr. that comes highly recommended but has not done 100 BHR (Read 6682 times)

kmminer4 · « **on:** July 27, 2009, 08:18:04 PM »

Hi Have any of you used a doctor that has not had 100 or more BHR and had success with the results? My Doctor comes highly recommended(but has done less than 100 BHR) and has never had a patient that needed a revision but I'm a little nervous on whether he is experienced enough for the BHR.Everything that I have read,people say to use a doctor that has at least 100 BHR's.I'm trying to be open minded because I was new out of college and was highly recommended for my job over people who had more experience and I worked in a hospital in the Labs.I'm trying to have the same way of thinking and give the guy a chance if he has had success with his former patients .Please let me know if any of you have had doctors who were not quite as experienced as recommended.I have surgery in 2 weeks.
Kelly

obxpelican · « **Reply #1 on:** July 27, 2009, 09:31:01 PM »

Kelly,

Many people have had good experiences with doctors with < 100 HRs. The problem is that you're rolling the dice on this one, someone who lacks experience will have more problems than someone who is experienced.

I wish I had a dollar for every patient I've seen who has posted their regrets at using an inexperienced surgeon.

You must realize that hip resurfacings are not like a total hip surgery, more things can go wrong, especially when you are dealing with a doctor who is not experienced.

This is JMHO, but it comes from hearing too many people regretting their decision to use a doctor new at hip resurfacings.

Good luck which ever road you choose.

Chuck

Quote from: kmminer4 on July 27, 2009, 08:18:04 PM

Hi Have any of you used a doctor that has not had 100 or more BHR and had success with the results? My Doctor comes highly recommended(but has done less than 100 BHR) and has never had a patient that needed a revision but I'm a little nervous on whether he is experienced enough for the BHR.Everything that I have read,people say to use a doctor that has at least 100 BHR's.I'm trying to be open minded because I was new out of college and was highly recommended for my job over people who had more experience and I worked in a hospital in the Labs.I'm trying to have the same way of thinking and give the guy a chance if he has had success with his former patients .Please let me know if any of you have had doctors who were not quite as experienced as recommended.I have surgery in 2 weeks.
Kelly

Pat Walter · « **Reply #2 on:** July 27, 2009, 10:33:09 PM »

Hi Kelly

Resurfacing experince is earned and not learned from THRs. Using a surgeon that has done less than 100 does not mean you will have problems, but that you could have problems. I have medical studies posted showing the steep learning curve. http://www.surfacehippy.info/medicalstudies.php

Placing an acetabular cup properly is not learned by the book, it is learned as basically an art thru repetition and more repetition. I don't know what you have done in your life - but if you tried to learn an instrument, a tennis stroke, a golf stroke or ice skating - it is not something to read how to do technically, then go and do it. They, along with thousands of other skills, are learned thru a great deal of repitition and experience. That is why the top athletes are paid so well and very seldom come right out of the college ranks. You can't buy or read about experience - you earn it doing something over and over and over.

If you read the medical studies on my website you will read they normally recommend using a surgeon that has done at least 100 resurfacings. That however, in more experienced hip resurfacings surgeons minds - is not enough. If you ask the surgeons that have done thousands they will tell you about the very steep learning curve. If you look at the survivorship of the BHR before the US surgeons in 2006 entered the picture - it was about 99.9% Then the new US doctors started doing resurfacing and it has dropped to 96% survivorship. http://www.surfacehippy.info/bhrhistory.php]http://www.surfacehippy.info/bhrhistory.php]http://www.surfacehippy.info/bhrhistory.php This is not made up - it is fact. So if you use a less expeirnced surgeon, your odds of having a problem are 4 out of 100 people. If you are willing to live with that - it is fine to use one of the newer surgeons. After all, 96 out of 100 people did fine. So I never say don't use the less expeirnced surgeons because you can have a good surgery - but the odds according to the statistics are that a few people will have problems, revisions or a slower recovery.

I just wanted to talk more about the experience factor. Because a surgeon is very experienced in THRs does not mean he is experienced in resurfacing. A great quarterback is not necessarily a great pitcher just because he plays ball and is a great athlete. Each sport is a different activity which requires different expeirnce. Even the greatest musicians that play similar instruments like a trumpet is not necessarily a good french horn player - both are wind instruments with similar mouthpieces. The experience from one instrument to another does not follow. So it is with THRs and resurfacing.

Pat

Tekka · « **Reply #3 on:** July 28, 2009, 01:00:08 PM »

Kelly,

Pat and Chuck are spot on, I appreciate a surgeon has to learn his trade but do you really want to be that stat on the wrong side, things can go wrong with all surgery, so you really want to keep the odds on your side.

Do not feel pressured just because your surgery is two weeks away, think about it and then think some more, this is your chance to be pain free and to have an active life.

If I think back about my surgery and my expectations, I can honestly say I would not have changed a thing, be 100% comfortable with you decision because when your being wheeled down to the operating table you are then in the hands of this man...SO BE SURE.

I hope you find your way.

Best wishes

Terry

UPwingnut · « **Reply #4 on:** July 28, 2009, 02:05:14 PM »

I sincerely understand the thought process that everyone wants someone with over 100 surgeries, but no one wants to see someone with less than 100. The obvious question is if you don't have 100 and no one wants to see you, how do you get to 100. Again, I understand the thought process and the numbers, but 100 is NOT magic. I had already seen my surgeon for other procedures and totally trusted his judgement and abilities. He had not done 100 yet, and offered up another surgeon in their practice that had done more. I went with him anyway, and am very happy with everything to date.
Bottom line... no hard and fast rule, data says over 100 is better, but that still doesn't mean that every surgeon with more than 100 procedures is going to be better. I'd talk it over with my surgeon, as I did. Mine had no concerns about being able to do the procedure well, but was willing to defer to his colleague if that was where my comfort level was at.

stevel · « **Reply #5 on:** July 29, 2009, 11:39:56 AM »

Kelly,

Find out if your Doctor has been trained by Smith & Nephew, the manufacturer of BHR. Also ask if he scrubbed in with any of the leading hip resurfacing surgeons. Dr. McMinn once stated that he and Dr. Traecy cannot do all of the hip resurfacings to meet demand, so more Doctors must be trained. Also look for the frequency of hip resurfacing surgeries (e.g. 50 per year rather than 50 total). One Dr. says he has done over 500 but most of these were for devices prior to the modern BHR type device, and these devices had an unsatisfactory performance record. Ask what is his complication rate for the cases he has done.

obxpelican · « **Reply #6 on:** July 29, 2009, 01:12:56 PM »

You might very well see that even doctors who have done 100 are not fully up to speed on hip resurfacings.

Personally and looking back at all the posts I've seen and the many people who regretted their decision to go with an inexperienced surgeon I would look for a surgeon who has done at least 500 surgeries, not surgeries that they have "assisted" but rather surgeries where he/she actually was the lead surgeon.

Chuck

kwarendorf · « **Reply #7 on:** July 29, 2009, 01:55:12 PM »

This may be heresy, but the 100 surgeries milestone seems rather arbitrary. What about the surgeon that has done 101 but still hasn't gotten it quite right? The other side of the coin is the surgeon that has done 32 but can now do it flawlessly? I have no idea how many resurfacings my surgeon preformed before or since mine.

obxpelican · « **Reply #8 on:** July 29, 2009, 02:51:38 PM »

Quote from: kwarendorf on July 29, 2009, 01:55:12 PM

This may be heresy, but the 100 surgeries milestone seems rather arbitrary. What about the surgeon that has done 101 but still hasn't gotten it quite right? The other side of the coin is the surgeon that has done 32 but can now do it flawlessly? I have no idea how many resurfacings my surgeon preformed before or since mine.

That is when you flat out ask the doctor, how many have you done? Not just assisted mind you. My next question is how many cups have you had to revise? How many implants have you had to revise to totals?

We all need to be the best possible patient advocates, no doctor is going to give you his negatives, we need to be informed and we need to give ourselves the best possible possibility of being buried with our implants.

Common sense needs to rule, who will you get the best possible outcome with? A doctor with <100 HR surgeries or with someone with >600?

Chuck

Pat Walter · « **Reply #9 on:** July 29, 2009, 02:58:59 PM »

Hi All

The 100 resurfacing benchmark is not heresay or a guess or a maybe it sounds good to me - it is based on:

1. Medical studies check under Doctor Experince and learning curves section here http://www.surfacehippy.info/medicalstudies.php

2. Based on the opinions of a number of very expeirnced hip resurfacing surgeons who understand the skill it takes to do the surgery consistently.

Anytime a company, team or person is going to train someone to do a new job, they decide on how long they think it will take to train the person. Hip Resurfacing is no different except your health and well being are at stake. You are correct that some surgeons are doing great at 10 resurfacings while others are stil having problems after 250. I have read about both. The medical studies and most scientific information is based on statistics - not made up information if possible. They tracked the learning curve of new surgeons. You can choose to believe it or not, but it is as scientific as it gets.

If you would like to read about the trip thru the learning curve by an excellent surgeon that was willing to talk about the expeirnced, read Dr. Rubinsteins article http://www.surfacehippy.info/firsthundred.php The First Hundred Surgeries.

I personally sat thru the training course for new hip resurfacing surgeons in LA in Nov. 2008 and listened to the misplaced acetabular cup problem over and over. It is the largest problem amoung new hip resurfacing surgeons. The experinced surgeons are talking about how to solve the problem. It was thought femur neck fractures were going to be the biggest obstacle to hip resurfacing, but now it has become acetabular cups not placed at the proper angle. The angle of the acetabular cup is up to the surgeon to place properly so the bearing surface of the metal cup and cap are rubbing together properly as a bearing surface as they were designed. If they cup is not placed at the proper angle, the bearing surface is not spread evenly, resulting in high metal ions and a number of revisions to THRs. You can read my personal articles here http://www.surfacehippy.info/2ndhipresurfcourse08.php and here http://www.surfacehippy.info/highmetalionswalter.php

So once again we can't always argue how we all feel forever - we each develop our own opinions. The reason I keep posting since I am the owner of the website - is so new people get the information to read about the learning curve and how difficult the surgery is. Then it is up to them to decide if they will be the 4 out of 100 patients that could have problems based on actual statistics of the useage of the BHR in the US. Do you want to take that chance? It is not bad odds, but I am not a gambling person and wanted to know there would not be a problem based on my surgeons experience of over 3000 hip resurfacings. It is an individual choice - but there is real information available to study before that choice is made.

This is a group to share opinions and also to share medical studies and facts. We need all the information before we make serious decisions about our health choices.

Pat

kwarendorf · « **Reply #10 on:** July 30, 2009, 06:03:26 AM »

The heresy I was referring to was mine, questioning the 100 procedure criteria

I understand that experience is invaluable. I see it as a part of the selection process. When I met with my surgeon, David Mayman @ HSS, we talked about my hip and my options. He listened! I was also at arguably the # 1 orthopedic hospital in the country. I figured they didn;t let dopes work there

. I had been to this site many times prior to making my choice, but it didn;t seem important to ask how many. I was comfortable with Dr. Mayman and knew the facility was as good as it gets. Just one man's opinion .
Kyle
PS I asked him last night, 6 months post op. He has done over 200

stevel · « **Reply #11 on:** July 30, 2009, 11:40:04 AM »

Are you talking about heresy or hearsay? At the pre-op hip replacement/hip resurfacing class at the Hospital for Special Surgery (HSS), they mentioned Dr Su, Dr Boettner and Dr Mayman, as doing hip resurfacings. I had already scheduled Dr. Su and that was the first time I heard about the other Doctors.
You are correct regarding the HSS as arguably the no. 1 orthopedic hospital in the US. For 2007 & 2008, U.S. News and World Report rated them No. 1 and the Mayo Clinic No. 2, but in the August 2009 issue, they rate the Mayo Clinic No. 1 and the HSS No. 2. There is a narrow separation between the two. Nursing support, anesthesiology, infection rate, key technologies (diagnostic equipment) are important factors to consider. When I researched my surgery options, I didn't find any experienced hip resurfacing surgeons operating at the Mayo Clinic. Selection of an experienced hip resurfacing surgeon is one factor. Another is a highly rated hospital. Another is if your insurance will pay for most of the operation or will you have to copay a lot. For about $80,000 operation, including 5 1/2 months of PT, I only had to copay about $500. Another option is the hip resurfacing device and whether it has full FDA approval in the US and whether it has a long successful track record such as the BHR (since 1997, worldwide). Another is the surgical appproach (posterior, anterior-lateral, direct anterior, etc.). I'm conservative for a major hip resurfacing surgery and all factors lead me to select Dr. Su and the HSS.

kwarendorf · « **Reply #12 on:** July 30, 2009, 03:36:27 PM »

I am talking about heresy

her·e·sy
Pronunciation:
\ˈher-ə-sē, ˈhe-rə-\
Function:
noun
Inflected Form(s):
plural her·e·sies
Etymology:
Middle English heresie, from Anglo-French, from Late Latin haeresis, from Late Greek hairesis, from Greek, action of taking, choice, sect, from hairein to take
Date:
13th century
1 a: adherence to a religious opinion contrary to church dogma b: denial of a revealed truth by a baptized member of the Roman Catholic Church c: an opinion or doctrine contrary to church dogma
2 a: dissent or deviation from a dominant theory, opinion, or practice b: an opinion, doctrine, or practice contrary to the truth or to generally accepted beliefs or standards

The accepted belief in this case would be the 100 procedure bench mark and the deviation is my questioning it. Dr. Mayman rocks!

I went to Boettner for a second opinion. The choice of hospital was made even easier for me as I live 20 blocks straight up York Ave!

kmminer4 · « **Reply #13 on:** July 30, 2009, 07:18:06 PM »

Well after asking a question that seems to have become a debate,I went for my pre-op apt. today w/my doc. and after having another x ray to compare to the other (5 months ago),it seems that I now have a rather large cyst on the femoral neck that was not there 5 months ago.(this may explain the reason for added pain that I have obtained)So after a long discussion w/ my doc. he felt that I would not be suitable for the BHR. He had stated that if it was on another place on the femoral head he could possibly do it then .Has anyone heard about having the BHR done if they have a large cyst on the femoral neck?
So I am coming to terms with the fact that I will most likely be having a THR,which I am content with as long as I have positive results and as long as I dont have to hear my 4 year old say "Mommy,Does your Hip Hurt". I do not want this to define me,so I'm going for something else to define me .....A Totally Hip MOM.
Thanks for everyone's input.You have helped me tremendously.
Kelly

stevel · « **Reply #14 on:** July 30, 2009, 08:00:28 PM »

Kelly,

I had bone spurs or osteophytes on the femoral neck which were not a problem. A cyst is more like a cavity and I'm not sure about the contraindications for hip resurfacing. You can send your x-rays to a really experienced hip resurfacing surgeons such as Dr. Su, Dr. Mont, Dr. Gross, Dr. DeSmet & Dr. Bose and they will interpret the x-ray for free and determine if you are a candidate. Because of their experience, they may tackle a more difficult case.

obxpelican · « **Reply #15 on:** July 30, 2009, 10:43:20 PM »

Kelly,

Listen to Steve---- Cysts & Bone spurs do not always negate you from getting a hip resurfacing, DON'T GIVE UP!!!!!.

Doctors who are NOT experienced will shy away from a case that has an added issue to it, get your X-Rays to an experienced doctor, Gross, Su, Mont, they will ALL give you a phone call and let you know what is going on.

I had bone spurs and a cyst, Dr. Gross had no problems taking me on, I golfed 7 weeks post op, now a year later I've been whitewater rafting, water skiing and tubing and I do not have any limitations.

AND I REPEAT, DON'T GIVE UP UNTIL A COUPLE OF EXPERIENCED DOCTORS TELL YOU THEY CANNOT DO A HIP RESURFACING.

Chuck

Quote from: kmminer4 on July 30, 2009, 07:18:06 PM

Well after asking a question that seems to have become a debate,I went for my pre-op apt. today w/my doc. and after having another x ray to compare to the other (5 months ago),it seems that I now have a rather large cyst on the femoral neck that was not there 5 months ago.(this may explain the reason for added pain that I have obtained)So after a long discussion w/ my doc. he felt that I would not be suitable for the BHR. He had stated that if it was on another place on the femoral head he could possibly do it then .Has anyone heard about having the BHR done if they have a large cyst on the femoral neck?
So I am coming to terms with the fact that I will most likely be having a THR,which I am content with as long as I have positive results and as long as I dont have to hear my 4 year old say "Mommy,Does your Hip Hurt". I do not want this to define me,so I'm going for something else to define me .....A Totally Hip MOM.
Thanks for everyone's input.You have helped me tremendously.
Kelly

kmminer4 · « **Reply #16 on:** July 31, 2009, 04:50:39 AM »

I am calling Dr. Mont,Gross today.The one thing that I am concerned about is because I am a female and the chance of a femoral break is double to men and now with this cyst will this weaken the neck more?Thanks for your replys.

kwarendorf · « **Reply #17 on:** July 31, 2009, 05:04:03 AM »

I agree with Chuck and Steve. Before settling for THR talk with other doctors. You may still have THR, but at least you will know it was the best solution

Pat Walter · « **Reply #18 on:** July 31, 2009, 09:57:29 AM »

Hi Kelly

I would definitely check with Dr. Gross of SC and also Dr. Mont of MD. Both are very experinced and closest to you. If you really want a resurfacing, sometimes you have to travel. You can also send your x-rays to Dr. De Smet of Belgium and Dr. Bose of India and get a free consultation. All of the contact info is on my doctors list http://www.surfacehippy.info/listofdoctors.php They are listed in the doctors over 1000 resurfacing section.

Many time the less experinced surgeons will not do a resurfacing when the more experinced surgeons will. The more expeirnced surgeons will not take chances, but they have a lot more knowledge about what works and does not due to their thousands of resurfacings.

I will also mention that a MOM THR is not a bad solution to hip problems, but they do cut off a large portion of your femur bone to install the THR. Also make sure your surgeon is going to give you a MOM THR or a ceramic on ceramic - don't let them give you an old fashioned small ball metal/plastic THR - that would definitely limit your activities.

Good Luck and stay in touch.

Pat

obxpelican · « **Reply #19 on:** July 31, 2009, 10:12:55 AM »

Quote from: kmminer4 on July 31, 2009, 04:50:39 AM

I am calling Dr. Mont,Gross today.The one thing that I am concerned about is because I am a female and the chance of a femoral break is double to men and now with this cyst will this weaken the neck more?Thanks for your replys.

Both Mont and Grosss have VERY good results in resurfacing women, even with issues.

Those cysts will not be in a area of the neck, your cysts are at the head. An experienced doc like Gross will take some bone and implant it into the cyst so that it heals faster.

I will agree with Pat that a MOM THR is not a bad option BUT ONLY if you cannot get a hip resurfacing.

Just because an inexperienced surgeon tells you that you are not a candidate does not mean it cannot be done, it just means your doctor could not do it. Some inexperienced docs will shy away from anything other than an easy surgery.... they don't want failures on record.

Be patient, the doctors that you have been refered to are very busy guys. Let me know if Dr. Gross does not get right back to you.

Chuck

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Author Topic: Dr. that comes highly recommended but has not done 100 BHR (Read 6682 times)

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