Dr. Klapper and hip resurfacing

[Keith]

I made serveral posts a few months ago regarding my hip problem and am posting this about my current progress and as a point of information for people like myself that are still searching for the very best solution to their hip problem.  After several years of hip pain and tests, my regular orthopedic doctor told me about 6 months ago that it appeared I would need a hip replacement if arthroscopic surgery was not a possibility. Since only a few surgeons actually do arthroscopic surgery, he sent me to Dr. Guanche in Southern California who is supposed to be an excellent arthroscopic hip surgeon.  He took new x-rays and said there was not enough room left to get in the joint for arthroscopic surgery so he recommended three doctors who he considered some of the top hip replacement surgeons in the US. After his diagnosis, I was pretty much resigned that I would have to have hip surgery and was leaning toward hip resurfacing with either Dr. De Smet or Dr. Bose.

I decided to get a second opinion on arthroscopic surgery so decided to go to Dr. Robert Klapper who is a world famous hip surgeon at Cedars Sinai Hospital. I knew from research that he has written several books on hip surgery and prevention and rehabilition programs. He is the Doctor for many movie stars and famous athletes so I figured if people who have all the money in the world go to him then he must be very good at what he does.  One of his hobbies is stone sculpture which is a plus in my eyes for a orthopedic surgeon. Much to my surprise, he did not totally rule out arthroscopic surgery but wanted me to first spend three months doing physical therapy in a swimming pool doing specific hip rehab water exercises and then he would reevaluate if and what should be done with my hip. I was extremely impressed by him as it was obvious that believes that everything should be tried to save the hip before resorting to hip surgery. I did mention to him that I was consider hip resurfacing if all else failed and was quite surprised at his negative reaction as he said it is an over hyped procedure which he does not think is as good a solution as minimally invasive hip replacement for reasons that I did not have time to totally discuss with him. My initial opinion is that he is a doctor of very high repute and one of the most honest and straightforward surgeons that I have ever spoken with so I do not take his opinions lightly. On my next visit to him in about three months, I plan to have an in depth converstation with him regarding the pro and cons that he sees between the different types of surgery. I am keeping my mind open on the question of which procedure would be best for me and in about three months. when I have my next visit with Dr. Klapper, I will pass the information that I get on to the readers of this forum. I would also like to hear from any readers if they had heard arguments from world class doctors who also are not in favor of hip resurfacing as a long term alternative and what were their reasons.

[Keith]

Vicky--Thanks for your reply. I was well aware of Dr. Bose's answer to Dr. Klapper however I am interested in hearing Dr. Klapper's rebuttle to Dr. Bose's arguments when I have my next appointment in January. I am planning on also presenting him with several other arguments for hip resurfacing that I have gotten in my hundreds of hours of research in the medical journals and internet.  I will be interested in hearing his answers as I am a pretty good judge of character and he appears to be a very honest and straightforward guy. I do not buy into the argument that he promotes THP because that is the operation that he does.  The fact is that he already has more money than god so he does not need to do my operation to make a few bucks. The fact is that he tries to get people like me to build up my supporting hip muscles by sending me away to physical therapy so I might be able to delay or never have the operation that he performs. Quite frankly I think he is the type of guy that presented with the facts as I know them will be honest enough to answer the arguments with the best of his knowledge.  I am still currently strongly leaning toward hip resurfacing however I am open enough to wait to hear his answers to the tough questions that I am going to present to him. Obviously I am not alone in this conundrum since some very wealthy and talented  guys like Jimmy Connors and Chuck Norris who could go to anyone in the world recently chose THP over BHR so I am looking for the answers to the question of why they went the way they did.  In any event, I will pass on the answers on to the forum as I learn them since I think the answers might be interesting in helping people make a wise decision while  being confident that the route they choose is best for them. Medical science is constantly changing so it is only by asking the tough questions that us as laymen can keep abreast of the currrent best treatments available for our problems.

[Pat Walter]

Hi Keith

We have had a few discussions on the large Yahoo Surface Hippy Discussion group about why all the famous people are going with the MOM's and not hip resurfacing.

I personally feel that the surgeons working with these people know they are going to be in the public eye and certainly don't want anything bad on their records or in the media.  So I think they are playing it very safe and sticking with what they know best - THR.  They don't want to take any chance of a problem with a hip resurfacing.

Personally, I feel it was an injustice to these people by not telling them about hip resurfacing.  Maybe their hips were too bad for resurfacing, but they should have been presented the option.  We will never know.  I think Marth Stewarts surgeon also did hip resurfacing. But most US doctors won't do older women.  Fortunately, the overseas doctors will.  I was 61 and I know others that were 67 give or take a year or two.  So it is doable if your bone stock is good. 

The most important point is that if and when these people need revisions - the next step will be more difficult with a THR than a resurf.  I could have received a free or almost free THR in the US due to our financial situation, but I choose to pay the $18,000 to go to Dr. De Smet and get a hip resurfacing.  Even at 61, I was too young for a THR.

Just wanted to throw a few of my opinions your way.  I don't want to argue over any of it - just thought it was interesting.  There have been a lot of hippies question why the rich and famous don't get hip resurfacing.

Of course, Floyd Landis did because he still wanted to stay active in racing.

Maybe we will get someone famous to get one pretty soon.  Some of them must have inquiring minds and do some thinking for themselves.

Pat

[Keith]

Hi Pat,
I agree with you that it appears that many people are doing THR merely because it has been around the longest and is the most proven technique but that does not necessarily make it the best technique. This is the reason when I go back to the Doctor, I am going to hit the Doctor with some really tough questions and make sure that the answers I get make some sense and that the evidence backs up the answers.  I have not paid much attention to prices of surgery as I have full coverage even overseas regardless of what I choose to do however I do remember my local orthopedic doctor here in Santa Barbara telling me that the total cost of surgery, hospital and everything for a THR would be about $70,000. I do not know if that is comparable to THR prices or hip resurfacing prices here in the rest of the US but I do know it is a far cry from the inexpensive cost of surgery by Dr. DeSmet and Dr. Bose.  As I mentioned in another post, I do not have to make my final decision until how I find out how my hip feels after 3 months of the water PT program however I am looking forward to getting some answers to the questions I am most concerned about.
 Keith

[avid]

Here is an article http://www.theglobeandmail.com/servlet/story/RTGAM.20070912.wsptmaki12/GSStory/GlobeSportsHockey/Stars  about a Tampa Bay Lightning NHL player who had resurfacing and intends to return to the NHL next year. Try that with a THR.

The one thing that got my attention about Dr. Klapper was he will only do arthroscopy on a patient if they pre-sign a release allowing him to do a THR if he decides that what is needed. At least that was the policy stated in my copy of "Heal your hips."

avid

[Keith]

Avid,
  Thanks for the link as this is the type of information that gives me ammunition for additional questions to ask the doctor at my next appointment.
      Keith

[Vicky]

Hi Keith,

I really look forward to hearing back from you on the responses you receive from Dr. Klapper.  I agree with his points of avoiding surgery with PT, etc. if you can.  But I also know that with OA, it only gets worst and you might be able to postpone surgery a few months or so, but you also want to make sure that you do not do further damage to the bone.  If he looks at only doing THR if surgery is needed then damage to the bone doesn't matter, but if you are looking at preserving the bone with resurfacing then this does matter very much. 

If he is so conservative with avoiding surgery, it doesn't make sense (at least to me) why he would not opt for a more conservative approach to surgery in preserving the bone rather than amputating 30 - 45% of it which is what a THR does.  Can't wait to hear his responses.  Thanks Keith for agreeing to share this with us once you ask him.

Vicky