HR or THR, That is the question.

[Zephyr]

Hi everyone,

First I would like to thank Patricia Walter for this wonderful site and activating my account today.

I'll begin by giving you a brief introduction. I am 49 and had been very active until last year. My passion is playing softball, skiing and riding my Harley Davidson around the country. Something I am proud of is that I have ridden my motorcycle in all 48 contiguous states.

In the year 2000 I was having groin and hip pain that seem to occur mostly after playing tournament softball. I controlled this with Ibuprofen. When the season ended I finally worked up the courage to go see the doctor. I was diagnosed as being a candidate for THR in both hips. I was 39, one month shy of my 40th birthday. The doctor reviewed the X-rays with me then said “when do you want to schedule your right hip?” My chin hit the floor. I responded in a matter of fact tone, that I am too young for this; he agreed but held his ground. At that moment in the office I informed the doctor that I wasn’t ready and needed time to do some research and think this through. His parting statement to me was “You’ll know when it’s time”.

Fast forward. Thru the years the hips slowly degraded and I dealt with it. In the spring of 2009 I attempted to play softball but had to retire after 3 games. Ibuprofen no longer worked and I am not one to take narcotic pain meds. Plus I lost the ability to run. To occupy my time over the summer I rode my motorcycle across the country with a few friends. However I quickly discovered my inability to get off the bike and go site seeing. I was having trouble walking without using my cane. I really noticed my problem while trying to negotiate the Grand Canyon. I quickly learned that I could walk down, but getting back up was a serious challenge even with the cane. I was reserved only to the scenic overlooks and I felt bad about the handicap I placed on my posse not being able to enjoy the full beauty of this magnificent place. This really depressed me.

After a few days visiting the canyon we were back at the hotel enjoying a few beers when we decided to head somewhere flat in the morning, Las Vegas. It seemed like a good idea at the time to make it easier for me, but after 20 min of walking around in Vegas, every step I took hurt. My epiphany was it’s time.

I have seen three surgeons over the past couple of months, each being skilled in their own technique. I have narrowed down my options to two techniques, HR and THR done with new cutting-edge hip replacement surgery that doesn't cut any muscle offering faster recovery time, less pain, less tissue trauma, smaller incision and less risk of dislocation. This is done utilizing a special operating table called the Hana table. But the problem I face is the same as many of you did and that is making the decision for HR over THR.

If you are willing to share, I am curious as to what tipped the scale for you in making that decision.

Thanks,

Zephyr

[sroberts]

Hey Zephyr,

You are going to get biased opinions on this site because we all opted for not amputating our femoral necks. In addition all the muscles are reattached (at least by the top surgeons). Once you get the go ahead from your surgeon, there are no restrictions in activity and movements. My choice had more to do with continuing the activities I love, such as running, biking, swimming, weight lifting, and playing recreational sports.

Make sure you get your resurfacing info from a top notch surgeon. There are many listed on this site.


take care,

spencer

[obxpelican]

Dislocations are not that common now, don't narrow down your doctor's approach or by how they cut or do not cut muscles.

The posterior approach has been the gold standard in surgery.

If you get a THR, you will lose your femoral head and neck, the HR surgery you lose some of the head but retain your neck, many say the HRs feel a bit more natural.  Getting a HR you end up buying time as you can revise to a THR more easily than you can a THR back to a THR because your doctor may have to crack your femur to get the femoral component out if that fails.

IMHO, I would shoot for the hip resurfacing everytime if I could.

Most of us realized we're buying time opting for the HR.

Since my surgery in August of 08, I was able to golf 8 weeks post-op (I still slice), white water rafting, water skiing, mountain biking and many other activites without a hitch.

Chuck

[bothdone]

Hi Zephyr

BHR:
* as already said, preserves the hip.  Leaves the option for a later revision to THR if needed.
* lets you be more active
* potentially much longer before a revision than a THR.  (not enough data in yet to say how long)

With two BHRs I have no regrets.

Best wishes with your decision, whatever you choose.

Ed

[Pat Walter]

Hi

I am sure you realize you are on a hip resurfacing disucssion group.  We have all choosen that options or are about to.  I had my hip resurfacing 4 years ago at 61 years old and would not accept an old fashioned THR that was going to mean a large portion of my femur bone would be sawed off.  A long hole drilled into what is left of my femur and a long stem pounded into it.  A hip resurfacing not only conserves your bone but gives you a more natural gait than a THR.  See the medical studies on the website.  There are normally no restrictions with a resurfacing if you don't have some kind of special problem pre op.  People have good recoveries normally.

I was on one crutch at 2 1/2 days post op, sight seeing in Belgium at 5 days post op and walking over 1 mile a day when I got home 10 days post op.  Used one crutch for about 3 - 4 weeks.  Required no heavy pain meds after leaving the hospital except for Advil.  I had a very quick and easy recovery with a normal posterior approach of my BHR by Dr. De Smet of Belgium. In my opinion which is based on 5 years of reading thousands of personal stories, the recovery depends much on the surgeons skill - not the approach or size of the incision. 

A hip resurfacing is much prefered to a THR by the very experineced resurfacing surgeons.  They will always try to give a patient a resurfacing instead of a THR.  If you visit surgeons that are not very experinced or don't do resurfacing, they will suggest a THR since they can't do the surgery and are not up to date about the modern outcomes of resurfacing.

You can read hundreds of personal stories on the website about regular people and athletes that had great outcomes.  That is the best way to learn about resurfacing and what a great option it is.

Good Luck and stay in touch.

Pat

[halfdone]

Hi Zephyr

IMHO: Athlete, younger person --> Resurfacing unless bone deterioration prevents, otherwise MOM THR.
Choose surgeon as expert as possible in all options.
Be cautious about the "minimally invasive" hype.

Good luck with your decision.

[obxpelican]

I would somewhat disagree with you on who should think about a HR.

You have so many postives with an HR, assuming the HR takes, you get a more natural motion and gait, you can always revise more easily to a THR.

Besides, our site's owner got a HR and she's real old  <JK>    ;-)


I like the idea of being able to buy time, I was 49 when I got mine, I am not a huge athlete but I love being active.


Chuck

Hi Zephyr

IMHO: Athlete, younger person --> Resurfacing unless bone deterioration prevents, otherwise MOM THR.
Choose surgeon as expert as possible in all options.
Be cautious about the "minimally invasive" hype.

Good luck with your decision.

[Pat Walter]

Hi

I have to make sure everyone understands Hip Resurfacing is NOT ONLY FOR ATHLETES, Younger people or just active males.

I have plenty of medical studies and personal stories that show older women, older men and people that just live normal lives are all great hip resurfacing candidates.  Each person should be considered as an individual.  Some of the more recent medical studies show both men and women who are small have more of a chance of possible problems - slim, but possible.  So it is no longer just a young man's option.

Hip resurfacing is for anyone that is active and a good candidate.  I know peope in their 70's with sucessful hip resurfacings, teenagers, small women and men and large men and women.  All are possible candidates.  Don't try to categorize who is right and wrong.  It is up to an experinced hip resurfacing surgeon to determine if you are a candidate.  Dr. Bose of India does a large amount of hip resurfacings and half are small Indian women who are sucessful hip resurfacing patients.  The skill of the surgeon is most important in resurfacing.

Let's not generalize about who hip resurfacing is for - it is for anyone who is a good candidate!

Pat

[DirkV]

Hi, Your story sounds a lot like mine. Very active, then some degree of hip pain. Denial that it's anything serious - ibuprofen makes it feel ok  
Then finally the doc checkup and xrays reveal arthritis. Not me, not in my early 40s! I too resisted initial suggestion of THR, researched the matter, and ended up with resurfacing.
You might want to read the story I wrote in Pats "hip story" section (http://www.surfacehippy.info/hipstories08/dirkvandyke08.php)
Two years later, and it's really a case of getting my life back. Riding (bicycle for me) was the last thing I could do as capacities diminished pre-surgery. That came back quickest, but now things like softball, basketball are all do-able.
I've mostly been lurking on the site lately (lost my password), but your post prompted me to reset pw, and give you the good advice to research resurfacing. I keep checking because it's such a blessing to get back those activities you gave up, that I enjoy keeping up with the community.
Best of luck, and by the way, I think it was less than a year post surgery that I went for a couple hour hike into and out of the Grand Canyon (not all the way to bottom in that time   ), but it was about all my 15 yr-old son could do to keep up. It's sad that you had such a struggle, but optimistic to think that next time you'll be able to do some hiking (and not have a struggle just mounting/dismounting your bike).
-Dirk

[Zephyr]

Good morning,

Thanks for all the reply's. I've got plenty to think about. The past few days I've been busy surfing the web and reading this site for as much info as I can ingest. From what I've read  most stories end with successful outcomes except for one that I can't seem to get out of my mind, Steve's aka. daddys_hip. I think the reason his story has hit me so hard is that we have Dr Mont in common. I have met with Dr Mont several times and believe him to be a very experienced surgeon. The other thought in my mind is the risk for infection. Reason being, that over the past two years I've watched my Dad fight MSR unsuccessfully in his replaced right knee (Sept 07) until Dr Mont. The good news is that Dr Mont was successful in defeating it and replacing his knee mid Jan of this year.

Thanks again.

[stevel]

I agree that daddy's_hip (aka Steve) recent posts are unnerving for those contemplating hip resurfacing or even total hip replacement.  Especially since he went to Dr. Mont, perhaps the most experienced hip resurfacing surgeon in the US.  I also was unnerved after reading Kevin H hip resurfacing problem posts with Dr. Su, a couple of weeks before my scheduled surgery.  Go to member profiles and click on Kevin H's last posts to read what I am talking about.  Kevin H never posted about the resolution of hip problem (THR?) during the Fall 2008.  After doing all the research, I proceeded with my hip resurfacing surgery anyway.  The rest is history.  Maybe the safest time to fly is after a plane crash or security breach when everybody is attentive to detail.

[halfdone]

Pat, Chuck, my comment was responsive to Zephyr and his post, not a general comment on the choice.  Zephyr is an athlete, younger, male making HR IMHO a virtual no brainer, unless his condition prevents it. With respect, I made no generalisations nor an implication that HR is not a good choice for others.  I will leave wider comments to those, like you, with the broader perspective.  But as a younger, male, athlete with an HR I couldn't be happier with it and recommend it to Z.

[medgerton]

I want to comment on the infection question. I am somewhat knowledgable about this because I had an infection after my resurfacing. Here are a few points:

1. I was told by 3 ortho surgeons that it does not matter what procedure is done (HR or THR) infection risk is the same.

2. My surgeon made point that a HR has less intrusive device to bone area for an infection to find a home. In a THR the metal stem enters the top of the femer creating an entry point. Give me a little leeway here since I am not a MD. That is how I understand it.

3. My infection was a staff but not MRSA. It was an intensive effort to clean it out and kill it with antibotics. However, my HR surgeon gave me the option to keep my HR and clean the infection out of the site and do heavy duty antibotics for 6 weeks afterwards..

4. Two ortho surgeons who do THR but not HR said that the HR would have to be revised to a THR during the infection treatment. I take from this that the standard of care for THR infections is to do a revision.

5. They say that the risk of infection is less than 1%. If you regularly win the lottery maybe you should worry about infection. If not, worry about the other stuff.

[Zephyr]

medgerton,

Good point, I tend to worry about the things that get my imediate attention.

Zephyr.