Deciding on a Doctor

[bstayton]

Hi Folks: I have been reading your site on and off for well over a year. I live in Boston area - where the pickin's are pretty slim for resurfacing. I am a 53 y/o male in pretty reasonable shape (5'11'' 170, run once per week, ride something with wheels 150 - 250 miles/month and lift light weights a couple times per week). I have seen three orthopedic doctors and actually scheduled surgery last winter with a highly skilled surgeon, (Dr. Stephen Murphy) who came highly recommended, to have a ceramic on ceramic THR. Despite watching my friend (a patient of Dr. Murphy) recover wonderfully and continue to rave about him and New England Baptist Hospital, I just couldn't do it. Even though I have had some difficulty sleeping since I was bone on bone, a hard time keeping up on a soccer field with my six year old, and the desire to do more than one pre-medicated run on the soft woods trails per week, I opted to put off the decision hopefully for another year.

Well, I made it another year - and, interestingly, I don't feel that my hip has gotten much worse (I still have bad days and a few good ones). I have done more research this fall (much of it on this awesome site) and, much the same as last year, I have gotten very mixed messages. Through a friend I got input from an old timer rep from one of the device companies that delivers components for THRs and resurfacing - he said he would do the ceramic. After sleeping on it, I got up on Friday morning and called to schedule surgery for a ceramic on ceramic THR. The scheduling nurse was off that day - they told me to call back on Monday. I never did. Was this an omen or what?

Here's where I am - maybe some of you folks out there will be kind enough to get me home:

I figure, given my activity level, I will need to revise whatever I do before I end up on the other side of the dirt. I figure, like most folks these days, I 'll not be able to retire before 70. I'd like to be able to walk and play after that date - so, resurfacing makes the most sense to me - do a THR when I am 68-75 if necessary.

Based on what I have read, I have picked out three docs. Dr Snyder (local, insurance eligible) who has apparently done over 300 with several positive stories on this site and others - but I have seen a couple patient stories that scared the hell outta me. Dr. Su (NY, not insurance eligible - will cost me several thousand $) is treated like royalty on this site and based on my reading, certainly seems to deserve it. And Dr. Mont (Baltimore, insurance eligible) who seems to be very highly regarded on this site - I liked his interview.

I was intrigued by Dr. Bob Arnot's story under Dr. Su. He said he contacted the inventors about flying to Birmingham to have the surgery - but they recommended Dr. Su. I am sure they did this because he is obviously quite talented - but is he the best in the US or might it be because he is the best option if the patient was from close to NYC (this is a question - I don't know where Dr. Arnot lives)?

Getting in and out of NYC is a hassle and I would certainly like to avoid a large out of pocket cost if I can help it (without skimping on competence).

I have a sister in Baltimore that could get me to and from the hospital and put me up for a few days until I was up for a the train ride back to Boston if I opted for Dr. Mont. He seems to get great reviews on this site.

There it is -in a nutshell. I figure there are a lot of you hippies out there who have had to make similar decisions. I would value your experience and opinions - if you care to offer them. Many thanks in advance and thanks to Pat and all the veterans for helping us all find our way home!!!!

Brad

[obxpelican]

Brad,

Give those choices, with Dr. Su being not in the loop with your insurance, I would take Mont everytime.  Dr. Mont and Dr. Gross were on my short list when I was looking.

I've not hear positive things about the choices you have in Boston.

Travel if you have to, in the end it's worth it.

Chuck

[pamela1130]

Hi, I live in the Boston area and I will tell you how I picked my doctor who was Dr. Hanmer out of Newton -Wellsley.  My best friend is good friends with a woman who is the head of Human Resources at our local hospital.  She is also the mother of two doctors herself.  She did not want to have a THR herself.  She is very athletic and in fantastic shape.  (well she was until her bad hip got the best of her) .  She and her children did hours and hours of research and it led them to Dr. Hanmer.  So basically  I trusted by friend's judgement who trusts this woman's judgement  lol.  Everything went great for both her and myself.  She has had a much faster recovery than I have, but I would categorize her as an athlete.  I have heard that him and Dr. nyder have done the most resurfacings in New England.  I hope this helps and good luck!!  Pam     

[stevel]

Hi Brad,

Did you talk to Laura at Dr. Su's office regarding insurance?  Their website says to let them take care of insurance coordination at www.hipresurfacingnewyork.com.  I could have went anywhere in the World and my insurance would have covered the operation.  I also read Bob Arnot's story.  I decided if I'm going to get on a jet and travel for surgery from Douglas, Alaska, I might as well go to the best choice in the US, which was Dr. Su at the HSS (Hospital for Special Surgery, NYC).  The HSS was rated no. 1 in orthopedics for two years in a row (2007 & 2008) by US News & World Report.  This year the Mayo Clinic is no. 1 and the HSS is no. 2.  They switch back and forth over the years.  Interestingly, I didn't find a experienced hip resurfacing Dr. that operates from the Mayo Clinic.  Former President George H.W. Bush had his hip replaced at the Mayo Clinic a few years ago. The HSS has a very, very low infection rate of 0.1 % or 3 surgical site infections of 3617 hip joint replacements in 2008.  Check out the infection rate report at the HSS website www.hss.edu.  The anesthesiologist is an important factor during the surgery and my surgery and recovery went seamlessly.  It was like somebody turned the light switch off and a couple hours later they turned it back on in the PACU (post anesthesia care unit).  Of course Dr. Su is very skilled and has done over 900 hip resurfacings and installs the BHR device which is the gold standard hip resurfacing device with the longest and most successful track record.  

[moe]

Brad, I am 56 years but about the same activity level. I had bilateral BHR on July 13 by Dr Robert Marchand at South County Hospital/So Co Orthopedics in Wakefield RI. There is a train station nearby. It is a small community hospital with a state of the art ortho wing. Dr Marchand trained w/Dr Su. He is very well known and respected in this area. My experience with his team was amazing. I am back to hiking, road riding, lifting weights, tomorrow I start mountain biking again. Just wanted to add another choice in the Southern NE area. My Tufts Health Plan paid everything. BTW, Dr Murphy is very negative on resurfacing. Good luck, moe 

[siamac]

A couple of years ago, when I did my resurfacing with Dr Mont in Baltimore, there were no doctors doing it in Boston. Dr Mont would still be my own first choice, if I had to do it again. However, Dr Snyder at Newton Wellesley has now done over 3 or 4 hundreds and a couple of my colleagues have just had resurfacing done with him and are in great shape. Therefore, that would be my only pick in Boston at the present time. All others (e.g. at Baptist, Mass General, etc.) are either inexperienced and/or very pro THR and anti resurfacing; some are even unethical and give you misleading information on resurfacing. Hope this helps!

[stevel]

Misleading, you betcha!  During my first visit to the local OS in August, 2007, he sketched bone spurs on the femoral neck and acetabulum and said I didn't qualify for hip resurfacing.  A year later in July 2008, he admitted he didn't do hip resurfacing and didn't know if I was a candidate or not.  He also did not do full sized metal THR's.  Thank God for this website, Vicky Marlow's website and others so a patient can sift through all the facts and jargon and decide for themselves.  By providence, a coworker was returning from San Diego for shoulder surgery and sat on the jet next to a guy who had his hip resurfaced earlier by Dr. Gross, South Carolina (we have a local OS named Dr. Gross and he does not do hip resurfacings - he wasn't the local OS I went to).  They talked about my hip problems.  He told my coworker that I should talk to him before doing any hip surgery.  So I did and he gave me several websites (including this one to research) and mentioned several prominent hip resurfacing surgeons such as Dr. Gross and Dr. Amstutz).  The rest is history.

To minimize the risk of complications such as misplaced cups, leg length discrepancies, groin pain, bursitis, heterotopic ossification, femoral neck fracture, infection, I recommend going to the most experienced surgeon, the most experienced hospital and using the most experienced device you can afford.  So what if you have to get on the jet and travel.  Your health is priceless.

PS:  When Vicky Marlow stated on this website, that she would go to Dr. Su if she had to stay in the US, I did not take this lightly.  I wonder who Pat would go to if she stayed in the US?
       After all my research, I believed I didn't need to go overseas to a more experienced Dr. (similar to Dr. Bob Arnot's conclusion, who also went to Dr. Su).  My insurance paid for nearly the
       entire amount of my surgery.

[mpschrader]

Before committing to Dr. Mont in Baltimore, check out Dr. Jacobs (Good Sam hospital) in Baltimore.  He has done near 1000 resurfacings and his success stats are as good as anybody's.  He's one of few Dr's that do a minimally invasive anterior approach.  His patients have experienced faster than average recovery time and shorter incisions (Mine is only 5 inches.) Good Sam hospital has a new joint center that has the feel of a nice hotel.  My recent experience with Dr. Jacobs was amazing. Don't take my word for it, do a little research.
Mark

[moe]

stevel makes an excellent point when he mentions "the most experienced device". There are differences in the design, metallurgy, longevity, and success rates in the different devices. Just like surgeons they are not all the same. The Australian Registry results show this clearly.