Durability of Hip Resurface v. THR

[Brian]

I am trying to decide between a Hip Resurface and a THR. Some of the orthopaedists I have seen claim that the THR is stronger and more durable and will be a better choice for a "younger" (47) more active guy (judo/jujitsu player) due to the length of the stem into the femur as opposed to just relying on the strength of my own femoral neck after a hip resurface.  I am not aware of having any bone density or mass issues.  I am very eager to get back to my activities.  Thoughts?  Thanks, Brian

[Pat Walter]

Hi Brian

I have been learning about hip resurfacing for more than 5 years.  I have never heard a doctor tell a patient a THR is stronger.  A resurfacing does much less damage to your natural bone.  When you cut off a large hunk of your femur bone and then drill a long hole into it - it weakens the bone.  The bone knows it is not in a normal state.  If you listen to Dr. Brooks video interview - he will explain it in terms you can understand   http://www.surfacehippy.info/doctorinterviews/brooksinterview.php  You never want to cut off bone or drill into it if you can help it.  I don't know where this doctor is getting his info

I can also tell you that the long stem from the THR can cause problems and act as a lever and break your femur bone apart.  Schwartzenager had that happen to him when he was skiing - I believe.  You body is not use to having long metal parts placed in it.

I would suggest you listen to more of the doctor videos where they explain the advantages of a hip resurfacing  since you are very young.  http://www.surfacehippy.info/shvideos/videosdoctor.php

Is the surgeon giving you advice on of the top experinced hip resurfacing surgeons?  If not, you will not get the truth about hip resurfacing from him/her.  When a doctor does not do resurfacing, the seldom understand it and are normally not able to do the diffiuclt surgery.  It is a much more diffiuclt surgery than a THR.

I have medical studies showing that you have a more natural gait with a resurfacing since you haven't  removed a large hunk of your femur bone.

You can see all the athletes that are now active again with resurfacing here  http://www.surfacehippy.info/athletes.php

One of the reasons you want to conserve your femur bone is that you are young and when you get older, you might need a revision at some time.  A revision from a resurfacing to a THR is much easier than a THR to THR.  They have to break your bone apart with a THR to get that long stem out.  Then they have to drill a larger and longer hole to put a larger stem in and wire the bone back together.  Each revision gets more diffiuclt.

Take time before you make a decison that will affect you for the rest of your life.  Contact several of the most expeirnced hip resurfacing surgeons to find out if you are a candidate.  Use the surgeons that have done 500 or better over 1000 resurfacings.  Experince is one of the most important factors in choosing a surgeon. The other is whether they are the doctor you feel comforatable with.

http://www.surfacehippy.info/listofdoctors.php

I was 61 when I had my resurfacing and felt I was still too young for a THR.

Pat

[Brian]

Hi Pat:  Thanks for the great reply.  I am definitely leaning towards a resurface and just trying to sort out the details.  I saw one doctor who has done 150 procedures and another who has done 100.  Neither of them thought the THR was more durable then a hip resurface.  I think you are right that the doctors who told me about the durability issue just didn't know enough about resurfacing.  I didn't see any Boston doctors in your list of experienced surgeons.  Any suggestions?  Brian 

[Bionic]

I am trying to decide between a Hip Resurface and a THR. Some of the orthopaedists I have seen claim that the THR is stronger and more durable and will be a better choice for a "younger" (47) more active guy (judo/jujitsu player) due to the length of the stem into the femur as opposed to just relying on the strength of my own femoral neck after a hip resurface.  I am not aware of having any bone density or mass issues.  I am very eager to get back to my activities.  Thoughts?  Thanks, Brian

That sounds like bullshit to me.  As long as you have good bone density, your risk of femoral neck fracture is very low, and it reduces to near zero (that of the general population) by six months post-op.  The fact that you're young makes resurfacing more reliable, not less.

People with low bone density can sometimes do better with THRs because they're at risk of breaking their hips.  Not because of the surgery, necessarily; it's just a risk that the frail and elderly face.  Of course, you can't break your hip if you have no femoral neck to break.

Over time, the resurfaced hip is likely to be more durable.  First, it will almost certainly never dislocate, whereas dislocation with THR is a significant failure mode.  Properly installed resurfacing implants wear very slowly.  It's unlikely that wear alone will ever require them to be replaced.

Wear debris is very small, and adverse tissue reaction is very rare.  If you have an experienced surgeon install your implants correctly, you'll almost certainly never have a wear debris problem.

I suppose a THR with a metal-on-metal, anatomically sized bearing might be a close second to a resurfacing, but there's still the problem of the stem extending down the femur and loading the bone in an unnatural way.  I still haven't heard of doctors allowing their THR patients to run and jump, whereas doctors typically give no restrictions to resurfacing patients after the first year.

[Pat Walter]

Hi

You are close to two very expeirnced surgeons in NY - Dr. Su over 1100 resurfacings and Dr. Clarke over 800 resurfacings  http://www.surfacehippy.info/listofdoctors.php#New_York   Both very experienced with many patients on this site.

Pat

[halfdone]

Hi Brian
I am also researching orthopedists in New England for my second hip replacement.  You will of course find many good doctor recommendations on this site.  Two in the New England region who were mentioned to me by others on this site are Dr Snyder in the Boston area and Dr Marchand in RI who you may wish to include in your research.  If you search the posts you will find references to them.  I am still at an early stage so I have not yet have any personal contact with either.  (My first resurf was done in the UK but my surgeon is about to retire, so in any event I need a new choice.)
Good luck in your path back to enjoying an active lifestyle.
(LBHR 2006 at age 47)

[dw]

Hi Brian
I am also researching orthopedists in New England for my second hip replacement.  You will of course find many good doctor recommendations on this site.  Two in the New England region who were mentioned to me by others on this site are Dr Snyder in the Boston area and Dr Marchand in RI who you may wish to include in your research.  If you search the posts you will find references to them.  I am still at an early stage so I have not yet have any personal contact with either.  (My first resurf was done in the UK but my surgeon is about to retire, so in any event I need a new choice.)
Good luck in your path back to enjoying an active lifestyle.
(LBHR 2006 at age 47)

There are a few docs in the Boston area - and there are a few people who post on the board that have utilized them. Hanmer and Snyder both work out of Newton-Wellsely - they are good options!

Oh, and the  replacement being more durable than the resurface is a bunch of Hooey (technical term)

[Bionic]

Brian, I live in the Boston area, but I traveled to S. Carolina to have Dr. Gross do my surgery.  I got turned off by the Boston/MGH crowd when their star surgeon told me in 2005 that hip resurfacing is "a disaster," which he would never recommend.

It turns out that, now, he's doing them, although he still reserves some negative comments.  Even though this guy is an outstanding surgeon, I decided I wanted to go with someone who was more positive about the surgery.

Dr. Gross's uncemented femoral implant, 4" incision, low infection rate, and low complication rate, as well as the general hospitality of his staff and the people at the hospital, made this a good decision for me.  My total travel costs were under $1000.  Looking back, I consider the travel component to be a relatively minor factor in my decision of surgeon.

[B.I.L.L.]

Brian, I live in the Boston area, but I traveled to S. Carolina to have Dr. Gross do my surgery.  I got turned off by the Boston/MGH crowd when their star surgeon told me in 2005 that hip resurfacing is "a disaster," which he would never recommend.

It turns out that, now, he's doing them, although he still reserves some negative comments.  Even though this guy is an outstanding surgeon, I decided I wanted to go with someone who was more positive about the surgery.

Dr. Gross's uncemented femoral implant, 4" incision, low infection rate, and low complication rate, as well as the general hospitality of his staff and the people at the hospital, made this a good decision for me.  My total travel costs were under $1000.  Looking back, I consider the travel component to be a relatively minor factor in my decision of surgeon.

I'll 2nd that. Go to a doctor who has done hundreds, plural, like in "several hundred" and is PASSIONATE about resurfacing.  If you have to travel, travel, so what. You really don't want to deal with an implant that isn't positioned P.E.R.F.E.C.T.L.Y.  You really don't. Trust me on this one grasshopper, go with the most experienced Dr. you can, period. End of story. No matter what you have to do to get there. I can't stress this enough.  That's my $.02. ($.03 maybe ?) haha.
Use an experienced RE-SURFACE SPECIALIST.







ps.     Don't forget.   

[mari]

I agree with the others.  I also traveled far - I travelled from Minnesota to have Dr. Gross in South Carolina do my surgery and I am so glad I did.  I just went back to SC for my one-year check up and everything is going great.  Go with an experienced surgeon!

[Brian]

Thanks for all the responses.  I'll check out Dr. Snyder locally here in Boston.  I am now leaning towards Dr. Ready at Brigham Women's.  He seems very passionate about resurfacing and claims to have several hundred under his belt. I also had a friend upon whom Dr. Ready operated about a year ago and so far so good with his procedure.  I appreciate the suggestions about traveling to a more experienced surgeon but that seems difficult.  How do you go back for check ups etc.  If you have complications, that would make travel that much more difficult.  But maybe I should get over this reluctance?  At least NY (recommended by Pat) is only a 4 hour car ride away.  Still thinking about this.......

[B.I.L.L.]

Thanks for all the responses.  I'll check out Dr. Snyder locally here in Boston.  I am now leaning towards Dr. Ready at Brigham Women's.  He seems very passionate about resurfacing and claims to have several hundred under his belt. I also had a friend upon whom Dr. Ready operated about a year ago and so far so good with his procedure.  I appreciate the suggestions about traveling to a more experienced surgeon but that seems difficult.  How do you go back for check ups etc.  If you have complications, that would make travel that much more difficult.  But maybe I should get over this reluctance?  At least NY (recommended by Pat) is only a 4 hour car ride away.  Still thinking about this.......

The theory is if you go to an experienced surgeon you won't have complications. 
If I could go back in time before my surgery I'd kick myself square in the nuts and make me travel to a specialist.
You can do whatever you want but remember it's not an oil change.
Think Craftsman vs Carpenter, wich do you want ?

[dw]

Thanks for all the responses.  I'll check out Dr. Snyder locally here in Boston.  I am now leaning towards Dr. Ready at Brigham Women's.  He seems very passionate about resurfacing and claims to have several hundred under his belt. I also had a friend upon whom Dr. Ready operated about a year ago and so far so good with his procedure.  I appreciate the suggestions about traveling to a more experienced surgeon but that seems difficult.  How do you go back for check ups etc.  If you have complications, that would make travel that much more difficult.  But maybe I should get over this reluctance?  At least NY (recommended by Pat) is only a 4 hour car ride away.  Still thinking about this.......

Snyder and Hanmer (same practice) both have lots of experience with resurfacing and work out of Newton-Wellsely. There are surgeons around just as skilled as Gross, Su et al  even if some folks haven't heard of them. I believe Newton-Wellesley also has a new ortho wing.

As in anything, your milage may vary, picks what's best for you.

[Pat Walter]

The doctors you mention are not as experienced as Dr. Su with over 1100 resurfacings and Dr. Gross with over 1800.  PLease don't make statments without adding the statistics when it comes to experinced surgeons. You opinon doesn't count in that area.  It can be your opinon that they are good, but not that they are as experinced - they are not.   I want to make sure people understand that.  I would also suggest you join the Yahoo Surfacehippy Discussion Group and do a search about these surgeons.  There are both good and bad stories.  When it come to someone operating on my hip, I want the most experienced surgeons that have not had problems. 

Pat

[Eitan]

Brian,

I would really like to communicate with you.  Are you still active in Judo/Ju Jitsu?  I have been up until a few months ago when I had to stop because the hip pain just got to be too much.  I was competing in regular (non-age classified) no gi ju jitsu tournaments and doing pretty well.  I have this fantasy that I will go back to that after surgery.  (And maybe it is just a fantasy).  I have read many posts from people who are pain free and can walk, but very few posts from REALLY active people who got back to those activities after surgery.  If my goal were only to be pain free and walk I would probably get a THR.  Have you made a decision?

Eitan

[Brian]

Hi Eitan:

Sorry for the long delay in my response.  I continue to be quite active in jujitsu and grappling but it sure doesn't make my hip feel any better. I still haven't decided about getting the hip surgery but I have an appt. with Dr. Snyder coming up.  I am worried about my ability to get back into grappling after surgery - can the device take the punishment?  I am getting to the point though where I really can't grapple effectively anyway so I'm not sure I have a choice - will likely need the replacement.  Still considering the options..... I am doing acupuncture weekly in the hope that it may help.    Inconclusive so far.  Brian

[resurface]

Hi,

I I just had my hip done by Snyder at Newton Wellsley on May 6, 2010.  I can tell you that he is awesome.  The care at NW was first rate along with the at-home PT for the first few weeks.  We are about the same age, and I am also quite active.  Snyder may not have as may procedures as some but at some point it does not matter.  You either know what you are doing or you don't.  IMHO, Snyder has long passed that point.  He trained under McMinn.

He is a dedicated technician which means that he knows how to do the procedure correctly and precisely.  He and I discussed implant position at great length.  Further, he has experience with the BHR and Cormet.  He is meticulous right down to the incision and its closure (4.5").  He is also quite selective about his patients.  He and I also discussed resurfacing vs. THR.  I felt that it was prudent to do so.

I can also say that few on this site have had a anterior-lateral entry incision that he prefers (based upon what I have read on the site), and I can tell you it has been a great recovery for me.  That said, I know nothing about his partner Hammer. 

Snyder put a BHR in a friend about 3 years back, and he had a great experience and outcome.  In fact, this is what led me to Snyder.  He is not as widely known on this site as Su, Gross, Smet, Mont who are the surgeons typically referenced.   I know a great deal more about Snyder if you wish to know.  I can be reached via email at resurface1@gmail.com.

I wish you all the best....

[jack]

Brian,

In my opinion, resurfacing is THE way to go. I feel it will provide you with no restriction in movement and allow one to pursue impact sports again. This has been demonstrated many times. I really would not do that myself though. I figure I am going to take it easy and make mine last as long as possible but then I was never a contact sports guy either.

I also think that you can wait too long. If you are bone on bone, you can wear your joint down to the point that makes a resurfacing not an option and the only route available at that point is a THR. I say, don't wait and suffer with that pain any longer than you have to. You will have to go through it at some point so I say just get er done! Once on the other side things look a whole lot brighter.....