Would this initial diagnosis qualify me for a resurfacing?

[Cutter3]

Howdy, all.    I've got some questions...


First of all, I'm a 39 year old male who had hip surgery when I was 17 years old (I had a cyst in the head of my right femur - the surgery involved burrowing into the next of the femur, moving up into the head and hollowing it out).   In any case, I have now had arthritis in the hip for 4-5 years, and it's getting progressively worse (pain, discomfort, inability to do lots of things without consequences, etc).   I recently had an x-ray of the hip, with the intent of discussing my situation with an orthopedic surgeon (my coverage is Kaiser Perm. in the Sacramento area).   I've read up on Dr. Klug, and it seems like he is quite proficient in the hip resurfacing.

In any case, here's the report from my x-ray...

AP pelvis and the lateral view the right hip were obtained. There
is a 4.4 cm x 2.4 cm bilobed lucent area with sclerotic margin
involving the medial aspect of the right femoral head. This is not
the typical appearance of avascular necrosis but made represent
large degenerative geodes. Both hip joint spaces actually appear
well-maintained without significant degenerative narrowing. There
is no flattening of the right femoral head but there is minimal
early bony buttressing involving the right medial subcapital area.
SI Joints are normal.
There is partial sacralization of L5 on the right side, a
developmental variant.

For those in the know, would this be a valid case for resurfacing?


Chris

[Pat Walter]

Hi Chris

No one on this discussion group is medically trained or a doctor.  Only a very experinced hip resurfacing surgeon can tell you if you are a candidate.  They need to look at your x-rays.  We are only patients and wanna be patients here.

The more diffiuclt your case, the more reason to use the top resurfacing surgeons in the US, if that is where you live.  Look at my list and choose the surgeons that have done a thousand or more.  At least 500 or more if you can't use one of the top surgeons.

You can get a free email consultation from Dr. Gross of SC, Dr. De Smet of Beligum and a few others.  Dr. Gross will call you after he views your x-rays.  They are among the best in the world and you can have them tell you if you are a candidate for free.  Can't get any better than that.

Dr. Klug is an excellent surgeon as is Dr. Schmalzried, Dr. Amstutz and Dr. Ure.  You can look at my list here  http://www.surfacehippy.info/listofdoctors.php

I hope you will stay in contact after you find out if you are a candidate for resurfacing.

Good Luck.

Pat

[Cutter3]

Thanks, Pat.    I understand that this is not a hangout for surgeons who perform the resurfacing, but I thought I'd throw it out there.

I live in the Sacramento area, and unfortunately, am limited in my options by my current health coverage - Kaiser Permanente.    Klug is the one who is closest to me, and I've done some research into him and his work.    I'm waiting on a consult with the orthopedic department in the Roseville office and will go from there.

thanks for what you do here.

[trumpetman]

Chris,
did you see Dr. Klug?  I'm scheduled to see him next month after waiting 3 months for an appointment.  they have already rescheduled once.

Did you have your OP?  I'd be interested in what you think of Kaiser (i'm a member too) and this Dr. Klug. 
I've seen another Dr. in Oakland that does the BHR, Dr. Barber. He seems very nice and knowledgeable.

thank, stephen

[andybc]

I'd be interested to hear, too. I would have thought that as there was no evidence of significant degenerative change there wouldn't be a case for resurfacing. However, as always, one treats the patient not the Xray. Next step should have been mri.
Andy BC

[Cutter3]

Andy and Stephen - 

I had my HR through Dr. Klug on September 21st this past fall.   I'm now nearly 4 months post-op, and feeling good.  My initial wait to speak to Dr Klug was about 2 months, and I had my appointment rescheduled once as well (turns out that Dr. Klug had opened up another half-day on his schedule, so my appointment was pushed out to accomodate that).   After that, I was lucky enough to speak to his surgical scheduler on the same day that the OR opened up a bunch of new spots for his patients.   My wait time between initial consultation and surgery was about one month (his average wait time is quite a bit longer).

Dr Klug is very relaxed and confident, but not so much that he thinks he walks on water. He'll answer your questions, listen to your concerns, and give you his opinion.   Unllike other aspects of Kaiser, where it can feel like they take a get-you-in-get-you-out approach, he'll take as long as he needs to to make sure that you're comfortable with what's going on.   He will also spend time answering your emails when you have questions.  He's young, too.  For someone with such a great reputation, it's shocking to finally meet him and realize how young he is (even for me - I have yet to turn 40...  .   At the point when I had my surgery, he was close to 500 resurfacings.   

Andy - when Klug looked at my x-rays, we discussed that there was not a significant change from the previous set of x-rays, but there were still things that were of enough concern to him that he recommended the resurfacing.  He could see that much of my cartilage on one side of the hip socket was gone, I had bone spurs on both the top and bottom of the femoral head, and there were potential signs of avascular necrosis (and it turns out that I did have AN, which had to be cleaned out).


Overall, we (my wife and I) were very happy with the overall experience - both with Dr. Klug, and with Kaiser Perm. in general.   I had my surgery on Tuesday night (Dr. Klug works LONG hours), and went home on Friday afternoon.   There was a little glitch with room availability that was pretty annoying (they were really crowded when I had my surgery, and had to wait around 24 hours before I made it to my room - I was in some sort of transitional room with a bunch of other people...).   If I had to go through this again, I wouldn't hestitate to work with Dr. Klug.

[andybc]

Thanks for the feedback, Chris. That all sounds great.
It seems your surgeon's interpretation of the xray was a bit different from the report you reproduced, as he thought there was cartilage loss i.e. there were signs of degenerative change. Presuming the first report was from a radiologist, the surgeon had the advantage of the exact clinical state of your hip, which is very helpful.
aanyway, your surgeon sounds excellent and I'm delighted it's all going well.
As regards him looking so young -this is all very subjective and I say this as a sixty year old!
I think you only need to worry when the Pope starts looking young.
Andy BC

[Cutter3]

The first report was a copy-paste from the online results report from Kaiser's report on my x-rays.   It sounds a lot like other non-Kaiser results I've seen, particularly re: the avascular necrosis.   I've wondered for a long time if there's a standard menu that radiologists pick from...