Resurf. vs. THR , a recent visit with a surgeon

[Matt]

A few weeks ago I saw Dr. Greidanus in Vancouver. The X-rays for my left hip showed end stage OA , bone on bone. We went through the various devices available and Dr.G. strongly recommended the use of a highly cross linked poly lined THR.  His reasons were: less invasive surgery ; reduced potential for persistent groin pains because a smaller ball has more space in the groin and offers a larger range of motion; bone loss once by once is about the same as you have to use a larger cup in resurf.; potential of pseudo tumors in MOM devices. He also said he would do a resurfacing on me , if I insist, as I would be an ideal candidate (male, under 55, normal weight, active, fit)
I took his advice to do a THR, he is a surgeon after all who wants to have successful outcome. I was pretty down for several weeks including persistent nightmares, just could  not get my head around a THR. A resurf. appears to me a good solution from a design standpoint, it rebuilds the joint more naturally and has a smaller risk of dislocations later on.
I requested and got a second appointment in 6 weeks or so.
My subconsciousness was sending a message and I will insist on a resurf.. . and once I made up my mind with that, the nightmares stopped.
Time will tell..

[dmather]

Hi Matt,

I'm not a Dr. but from my own research I think several of the arguments your Dr made for a THR don't stack up. First off I can't see where THR is less invasive, less technically complex yes, but less invasive I don't think so considering you're loosing a lot more bone. I don't know about the groin pain, I am on my second resurfacing, still early in the process, but I have had no groin pain at all. I think the range of motion issue is totally incorrect, with  the smaller ball sizes you always have 90 degree restrictions that are not present with a resurfacing or a large head THR. I believe the bone loss argument doesn't stack up at all (one of the reasons I chose resurfacing). And finally I hear all the talk of pseudo tumors from MOMs but the FACT that the plastic inserts are known to release plastic particles that destroy bone seems to get left out of that argument.

Like I said I'm not a doctor but my response is based on my own research and it's why I chose resurfacing.

Dale
RBHR Dr. Clarke 3/17/2010
LBHR Dr. Clarke 5/5/2010

[Lopsided]

Hi Matt,

My orthopaedist does not recommend resurfacing either. But I want it. It is my decision, not his. So I am booking the operation now, but not with him.

Why don't you send your x-rays to one or more of the surgeons listed on this site and get their opinion.

D.

[Pat Walter]

Matt

Why don't you see Dr. Antiniou in Canada.  He is one of the top resurfacing surgeons.  Personally, I would not want a plastic/metal small ball THR.  They have the worst record of dislocation and poly debris.  I don't know why any surgoen would recommend such a device for a younger person - my opinon and I am not a doctor.

I was 61 when I had my resurfacing because I wanted nothing less.  I was still young and active.  The MOM issue is more a hype from the press and surgeons against resurfacing.  Read the new information - both my summary and the press conference about the BHR.   The read the national registries.  The BHR has the same track record as a THR for people in the same younger age range.  An overall retention rate of 96% at 12 years follow up.  PLease do some reading  http://www.surfacehippy.info/bhrpressconference2010.php    http://www.surfacehippy.info/BHRsafetyeffectiveness.php   http://www.surfacehippy.info/nationalregistries.php

Look at the revision rates for small ball plastic/metal THRs in the national registries!

This negative press quoting information from the devices that have been withdrawn from the market is terrible.  Also the Oxford study quoting the pseudotumors from MOM devices is from 7 surgoens and 30 trainees.  Who would want a doctor in training to place your hip resurfacing - no wonder they had such terrible cup placement and problems.

Check with a surgeon that does a lot of resurfacing and get the right information.  I personally would never want a plastic/metal THR.  The least I would accept is a MOM THR or a ceramic on ceramic.  They have the large ball sizes.  If you go with the small ball THR - you wil lhave all kinds of restrictions.  I know lots of people that have them - they can't even cross their legs!

John Antoniou MD, PhD, FRCSC
700 Hip Resurfacings to date***
Jewish General Hospital
Orthopaedic Department, E-003
3755 Cote Sainte Catherine West
Montreal, QC H3T 1E2
Canada
(514) 340-8222  ext.4615
fax: (514) 340-7595
www.shoulderhipknee.com
e-mail:  malevisatos@jgh.mcgill.ca


Pat

[LOGAN13]

Since I am a fellow Canadian I thought I would chime in. I cannot give any advice, just share my experience. I am a 43 yr old male & also had OA...severe bone on bone.

I had my left hip resurfaced on April 19th. After 3+ yrs of research & stress...not to mention procrastination/pain, I chose a BHR. I had my surgery in London Ontario...Dr McCalden. He was the third surgeon I saw over my 3+ yrs of research. Getting more than one opinion gives you options.

I am more than happy with my choice thus far.

Research, but don't overthink it....It will drive you crazy...trust me lol

Then.....

GO WITH YOUR HEART & GUT

Good luck EH lol   

[Margie]

 I was contacted by a woman who had heard about my resurfacing. She was told by a doctor that does not do the procedure that she would not be a good candidate for it. Thank God my orthopedic doctor (who also did not do the resurfacing) directed me to Dr. Clarke. I knew nothing about it until he explained how much better it was for younger and more active people. He even had his office book the appointment for me. I made sure after the operation was done that I called him and let him know how much I appreciated his care. That to me is a true doctor, one who thinks of the patient first, money second.
I now try to be sure I tell everyone the difference, you never know who you can help.
Margie

[stevel]

A local orthopedist also recommended a conventional THR and not a hip resurfacing.  I didn't want a conventional THR since I am a downhill skier and I didn't want to worry about dislocations because of the small diameter ball for the THR.  Fortunately I found this website and the rest is history.  Do your research and be proactive e.g. select your Dr., method of surgery, device, hospital, etc.  I view the Dr. as a mechanic for humans to fix the problem to your satisfaction as you are the customer.  As the customer, we want the procedure done right the first time with no returns.

[DonC]

I had two consultations before speaking with Dr. Gross. I was told that a THR would have an expected life span of approx. 15 to 20 years. I asked, what happens then when the THR eventually fails? I would then need a major revision.

I am currently 59 years old. I did the math and figured somewhere around mid to late seventies I would be subject to a major reconstructive surgery. The option of hip resurfacing (done properly) should last near the same time frame as a THR. If my resurface fails in 15 years and I'm in my late seventies I will instead be subject to a normal THR due to bone preservation.

For me this was an important consideration in making a decision.

Get the best doctor you can find since it's the most important element. I'm amazed how many people try to find the closest, most conveniently located doctor and don't focus on going to the best surgeon they can find.

Good luck and do your research!

Don

[moe]

Matt, all the above replies are excellent. I'm about your age and I personally think you would be crazy to get a THR when a resurf is available. Get the right surgeon and trust your instincts. It's ten months for me and I feel better than I have in a very long time. I'm a cyclist and a year ago I could barely get on and off my bike, now, no worries mate. Good luck, moe

[Matt]

Thanks everybody for the excellent replies.
Different people will come to different conclusions facing the same problem. What I personally learned : Make yourself knowledgeable about the planned procedure , devices , down falls of each variation, good and bad outcomes. Ask your surgeon about his or her take on things and go to the meeting with your  list questions on paper and don`t leave before you get all answers needed. Be prepared to see an other surgeon. That does not mean that you disrespect your surgeon or do not trust his abilities . At one point you need to make up your mind about who will perform what procedure and then stick with your decision. We are blessed that we have options today.
As I said before: This is my opinion and someone  else may say something different for good reason. Good luck to all.

[B.I.L.L.]

A guy I know has a 2-1/2 year old thr and recently found out that the post in his femur has come loose. They told him to take it easy and hopefully the bone will grow back onto the post. Not sure what the fix is if that doesn't work, a longer post I guess ?
Just something to think about if your weighing thr vs bhr.  Remember if your bhr goes bad you can always get a thr replacement because you still have enough bone left. It's one extra step you don't get with a thr. 

[John C]

At the risk of sounding too conservative, I think that any talk of easily revising a resurfacing must be tempered by looking at recent reports. High metal ion levels are rare, but if they continue over a long period, their is a high likelihood of both bone and soft tissue issues that can make a revision extremely challenging, and lead to uncertain results. I think that potential candidates for resurfacing need to be educated on this possibility, so that they can take it into account when choosing their surgeon, prosthesis, and post surgical protocols such as x-rays and blood ion testing to avoid worst case scenarios. Taking a look at a number of recent reports and case histories is making it clear that while successful resurfacings are wonderful outcomes, easy revisions from a resurfacing can no longer be presented as a given; and high metal ion levels over longer periods may be indicative of extremely challenging revisions with questionable outcomes.
Fascinating study recently published by Koen DeSmet on BHR vs Conserve Plus.

[DonC]

All artificial bearing implants give off wear particles. Adverse reaction could occur in ether THR or a resurface. If it were to occur I would still prefer having my bone stock available if a revision were needed.

Could you provide a link to the study by Dr. DeSmet?

Thanks

Don

[Pat Walter]

http://www.surfacehippy.info/pdf/bhvsrconserv.pdfhttp://

De Smet BHR vs Wright C+ Study

[DonC]

Thanks Pat.

Indeed an interesting article. I can't help but wonder how the Biomet device would fair within the tested group. The small angle changes as well as the metal composition all add up to make a difference.

Don

[Lopsided]

http://www.surfacehippy.info/pdf/bhvsrconserv.pdfhttp://

De Smet BHR vs Wright C+ Study

I have already read that article. After deciding to get done by Dr. De Smet, I am happy to get the C+. He said he could do the Biomet if I wanted, but I do not think he has done too many of them.

Dan