Cemented vs. Uncemented?

[23109VC]

I am 38 and have been dealing with hip pain for the past ten years... It's been a gradual onset..and hte past year or two have been pretty bad...  Like many of you, I'm at the point where if I walk any major distance, I usually have tons of pain in the bad hip...  I have a pretty restricted range of motion with the bad leg and getting pants on, or putting on / tieing shoes is a real challenge...  at least on my bad side...

I've been to see two doctors recently.  One told me aobut resurfacing, but admitted he did not do them.  I was referred via my HMO to a specialist who does both THR and resurfacings, and after he looked at my xrays, he told me I was a candidate for resurfacing.  he had only done 30 resurfacings and I didn't feel comfortable with him based on what I perceived as a lack of experience.

I recently went though "open enrollment" with my employer and decided to change from the HMO plan I was on to the PPO plan.  So come Jan 1 I can go to see anyone I want..

Dr. Gross is one of the doctors who is on the list of approved providers for my new PPO...so I could go see him and only have a small out of pocket expense...

I know he does the uncemented procedure, which I"ve read about here.  In theory it sounds like a great idea, but I wanted to know more about it.  Anyone here care to point me in the right direcitonw tih links to things I can read, or othe rinfo that would help me decide if uncemented is a way to go?

I am in the proces of setting up a consult with him via phone...  I live in so cal so there are other docotrs here I can go see or consult with too..

I just wnat to make sure I see someone who is experienced....and that way, at least I know I let someone who is well trained do the surgery.  if something went wrong, at least I would know it wasn't because I let a newbie "learn" on me...

i guess it sounds like the cement can be a failure area long term.. at only 38 years old..I 'm assuing there is a good chance I may need revision surgery to a THR down the road... the longer my resurfacing lasts...the longer I can put off revisions urgery...  if/when I ned it, I'd hope to only need ONE revision..before I "check out"...
i'm hoping the resurfacing lasts a LONG time...

any info is much appreciated... thanks.!!

[John C]

It sounds like you are very much on the right track, and doing a great job of doing your research. I suspect that you will find that personal opinion on cementless will be in line with whatever each person chose for themselves. As far as research to read, since Dr. Gross has been the lead surgeon developing cementless, his web-site contains the most info. Mr. McMinn did a series of cementless back in the 90's that he has written negatively about, but since I do not believe that these had an ingrowth surface on the inside of the cap, I do not think that study is relevant to the current options. If you look up the 30 year study published by Dr. Pritchett (its on Pat's site), they did quite a few resurfacings back in the 70s, and some of these were cementless. If I understand it correctly, among the few that were metal on metal, they are claiming a zero percent failure rate at 30 years, and some of these were cementless.
Dr Amstutz in California, who has been doing resurfacings for longer than most anyone, has started doing some cementless for "young people that want to run marathons", as I was told second hand by one of his patients. This would seem to support the beginnings of a trend. Dr DeSmet is also doing some cementless now.
I did choose to go cementless myself, and my advice would be that if you do choose to go cementless, I would strongly recommend Dr Gross, since he has put the most time and effort into developing this approach. Obviously there is not enough data yet to make a firm prediction, but Dr. Gross did tell me that he expects my cementless resurfacing to last a lifetime, so just maybe you can avoid that revision surgery.
Good luck on the journey.

[Lopsided]

I also had uncemented. It was my choice.

As much as resurfacing has been proven, there is very little data about the very long term. Bone is a live material, and is continually regrowing. Although cement can stick well to bone, as bone regenerates, I do not know if it can stick to cement. But bone can grow into a porous surface of an implant.

So in my mind, getting uncemented was as important as getting resurfacing at all. This was maybe more important for me than the choice of surgeon. Luckily I chose by Dr. De Smet who was willing to do uncemented, and I would highly recommend him.

I am not sure where you would look for specific information about the pros and cons of cement for resurfacing. I have already trawled the internet and did not find much.

[23109VC]

thanks for the input!  It was a big deal to just make up my mind that I NEEDED resurfacing in the first place.  for the first several years - my hip pain was "tolerable"...  I used aleve, didn't do as much activity, and just dealt with it...  gradually I gave up  more and more.  I used to play racquetball 3-4 times a week - I gave that up 5-7 years ago as it just caused so much pain after I played.. today..I wouldn't even try to play for a few minutes....  just chasing my 3 year old is hard...he can outrun me..     in hte past year I've noticed more of my coworkers notice mylimp.. I get a lot of "hey what did you do this weekend - hurt yourself playing sports???" type of commments...  I explain i just have hip pain... but my point is that people who don't really know me, or know of my hip pain can see it...  the pain has always been there, it's just that now it affects how I walk...and i'm a desk guy..I  walk tow ork, sit at a desk, walk to the printer....  etc... I am not walking much at all in my daily job duties..so the fact that they can notice it at all is a testament to how obvious it is...  just putting on my pants is a PITA now... 

i'm tired of not being able to do the stuff I want..and I'm made the conscious choise that 2011 is the year I do the surgeyr.  I specifically changed my health plan at work to a PPO so I coudl see whoever I wanted.  Dr. Gross is at the top of my list as he has so many under his belt and shoudl I choose to go cementless - he would be my choice.  it's al ong way to go to see a doctor... but so few people in the country have major experience with these surgeries that it makes sense to travel to get the right dfocor.

thanks for the input.  i'll keep doing research.. i have a few months befoe the new ins plan kicks in and I can schedule it... but my goal is to do it such that I have the best chance for long term success. if the surgeyr turly would last until I die.. hopefull well ito my 80s or 90s..that would be wonderful.  if I need a revision in my 60s or 70s... and wind up with a THR at that age..I can live with that too.. i doubt I will be playing competivie racquetball in my late 70s...  at that age, I'll be happy to walk aroun, paly with my grandkids (if I have them..) and be able to drive stick in a sports car... 

[Dayton96]

Dr. Gross would be an excellent choice for a hip resurface.  Let me warn you though, in case money is an issue, he does charge $1200 for a nurse practitioner to assist him in surgery.  He also charges an additional $1000, called a "supplemental fee for Minimally Invasive Technique."  You may want to check to see if your insurance company would cover those two fees, I understand that not all of them do.

Next, since you have the time to do your research, I suggest you go to the yahoo surface hippy group and read through some of the debates on cement vs. cementless, as well as the BHR vs. "every other device" debates.  They are informative and confusing at the same time, but you will be better informed on hip resurfacing once you spend a few hours going over some of the debates that have occurred on the yahoo site the last six months or so.

Finally, there have been comments here, and on the yahoo site, concerning surgeons on the West Coast and in the NW and in Colorado, who are doing some good work.  Their patients seem very happy with them.  I have found that people who post on this site, and on yahoo, are more than happy to exchange emails and discuss their experiences concerning surgeons and devices. Don't feel shy about emailing them questions directly.  They are all very nice people and almost all will respond to questions you might have concerning their surgeons.  Don't forget to ask how accessible the surgeon's staff is after the surgery.  You want to make sure that if there are any issues post op, that you have someone who will return your phone calls. 

Having said all that, let me also state that even the strongest supporters of the BHR, will also admit that Dr. Gross is an outstanding surgeon.  I've been doing my own research since last Spring and I have not spoken to anyone, or emailed anyone, or read anything, but positive things about Dr. Gross and his staff and the follow-up support they give their patients.  There are two issues with Dr. Gross though:

(1)  How good are the Biomet devices, in comparison to other implants, particularly the BHR?

(2)  Will cementless survive a lifetime without failing (only time will tell)?

So good luck on your search.  Please share what you find out and let us know what your choice is.

Mac

[Pat Walter]

Hi

I have done 2 video interviews with Dr. Gross where he talks in depth about cementless resurfacing.  http://www.surfacehippy.info/doctorinterviews/grossinterview.php

Here is his 7 year follow up   http://www.surfacehippy.info/uncemented7yearstudy.php

No one can tell you which is better, cemented or cementless.   Right now the stats for cemented are for a longer period and there seem to be few problems with cemented BHRs according to to   Registries. 

A lot is going to depend on how you personally feel about the situation.  I don't think you can find any longer term information about cementless Biomet.  Dr. Gross patients are convienced cementless is the way to go.  There are a few other cementless devices being used overseas.  Dr. De Smet has done a Wright C+, but not many.

The BHR has the longest usage with postive record according to the National Registries.  So again, you need to decide on the surgeon and that will pretty much dictate what device you will get.

Here is a further discussion by some of the top surgeons http://www.surfacehippy.info/faqcementcomponents.php  The top BHR surgeons believe cemented is the best. The cement technique determines how long the femur cap remains.  Too much or too little can affect the outcome.  Another reason to use the top surgeons.

Read, study and then listen to that little voice inside.  You will know which way you want to go.
Good Luck.   

Pat

[Lopsided]

Dr. De Smet has done a Wright C+, but not many.

I wrote to Dr. De Smet two weeks ago and amongst my questions I asked, "How often do you expect to be doing uncemented, just by request or regularly?" And Dr. De Smet replied, "Regularly once insurance in Belgium pays for it."

I think this says a lot.

[lori.36]

I just wanted to say that I am right there with you.  I am 36 and thinking that the cementless would make the best sense for me and my age.  I need to email Dr. Gross and get some more information about the two charges that someone mentioned in the above post.

Thanks for posting this, I really enjoyed reading all of the responses.

[stevel]

Mr. McMinn has installed 3095 cemented BHR's since 1997 and has had 0 loosenings of the femoral cap.
The BHR device also has the best short term and long term performance for a metal on metal resurfacings compared to all other devices.
It is speculation to assume a cemented BHR will or will not loosen in 15, 20, 25 + years or an uncemented Biomet will or will not loosen in 5, 10, 15 + years.
The hard data has not accrued yet.
It is also speculation to assume a Biomet device, cemented or uncemented, will perform OK in 5, 10, 15 + years, and not have problems similar to the Durom and ASR devices.
The Biomet total resurfacing device, cemented or uncemented has not been approved by the FDA.
The Conserve plus cemented device has been approved by the FDA, but I believe the uncemented Conserve plus device is unavailable in the US.
Check with Dr. Amstutz who practices in LA and is the inventor of the Conserve Plus device and is near your location in Southern CA.
I went with the cemented BHR device, because of its unmatched long term performance.

[Pat Walter]

Hi

The Wright C+ is being used by US surgeons.  Many took part in the FDA trials.  If you click on the manufacturer's ad or search page, you can find a surgeon locator.

The Biomet components are both FDA approved.  They have not been approved as a system together.  That is how the doctors can use them off label.

I agree that the BHR has the best track record. That is why I choose to have one placed by one of the best surgeons in the world.

We don't know about any device at 20 years out.  There are some people with BHRs that have had them 17 years - very few.

Steve is right that only time will tell what devices and techniques will be the best long term. 

Pat

[23109VC]

it is very frustrating to know that there are so many options - and everyone has a different point of view as to what is better. 

I know that with any profession - even the best minds in the field can have very different opinions... 

it sounds like cement is not necessarily a bad thing.  but cementless *could* be better - too bad my hip wasn't going bad later and I had more time.. although I found myself thinking how lucky I was that my hip lasted as long as it did, or that I had this problem n ow, vs a couple decades ago...  if I had this problem in the 1960s or 1970s, or even the 80s... I wouldn't have nearly the options Id o today... i'm sure in 2050 they will have some noninvasive techinque or a pill they give you that fixes this...    hope i'm around in 2050 at all.. 

i'll do more research, talk to more doctors, and try tomake up my mind.  my hip kills me.  today it was cold/rainy where I live and I really noticed how much more it hurt.  the cold weather really does affect it...  when I heard old people talk about cold hurting their joints..well know I know what they mean...

I changed my insurance from an HMO to a PPO so that I"d have the option to go to whoever I wanted to.  My HMO gave me very limitd choices in my surgeona nd I wanted the ability to pick whoever I wanted.  the new insurance wont kcik in until January...so I have several months to get more informed.

thanks for the info.  sounds like I have much m ore to decide than cement vs uncemented.  I have to decie if I want a BHR, or a different device.  the devices "look" very similar but I guess there are small differences.

are most doctors still using BHR or are most switchign to something different/newer?  they all look to have the same basic design/concept...but maybe they have different materals or different sizes?  there must also be some relationship between the doctors skill and experience with a particular devide.  if doctgor A uses devic X and doctor B uses device Y.... it might be a good idea to stick with the devie THAT doctor knows... as there could be differnees in how they put it in?  just an idea...  or do they all pretty m uch get "installed' the same way?? 

[Lopsided]

it is very frustrating to know that there are so many options - and everyone has a different point of view as to what is better. 

it sounds like cement is not necessarily a bad thing.  but cementless *could* be better

Yes, that is about the size of it. But why be frustrated?

[23109VC]

i mean frustrating in that it's not a simple easy choice.  it's not as if every doctor agrees that device X is the ideal way to go...using procedure Y.... 

if that were the case, the decision would be easy and I woudl only have to worry about getting it done.  I'm thankful that there IS a procedure available that will likely solve my hip pain problems...  BUT...  the frustration is knowing that no matter what doctor I pick, and what device I pick...  I can't be sure it will be the best choice... as the docs all have different opinions...

maybe I"m looking at it the wrong way...  maybe they are all "good choices...  wtijh just different "good" outcomes..   no more hip pain will be good!

I guess it's like if I had to decide what luxry car to buy and I was cross shopping a BMW, M/B, Lexus, etc etc.. ..they are all great.. but diffeent.. boy would that be a hard decision!!  I'd want them all!!  plus a 911 turbo!    if you don't know,I have a "thing" for cars...     I actually have a fun "weekend" toy car that is stick shift..and honestly, sometimes it's hard to drive it b/c of my hip... i'll look forward to pain free shifting in my near future!!!   

I'm leaning toward cementless / Dr. Gross based on what I have read... .but wat do I know.. I'm not a doctor...  I definitely have NOT made up my mind yet...

I am plannig on consulting with at least one more local doctor to get a additional opinion before I  make up my mind. 

thanks again for all the ifo everyoe.  i'm glad I found this site and really apreciate the help / advice / support!!

[Pat Walter]

Don't be frustrated.  The most important decision is what surgeon to choose - then they choose the device.  If you stay with the top surgeons - you can't go wrong.

If you don't feel comfortable with Dr. Gross and cementless, then go with the top BHR surgeons like Dr. Su.  In the hands of the top surgeons, there is little difference between the BHR, Wright C+ and Biomet.  They are the top devices.  Just don't go with the less expeirnced surgeons who use devices that are not among the most popular. 

Again, it is the surgeon's skill you have to rely on.  In their hands, they can place most devices properly.  They choose to use the approach that is more comfortable to them and the device they are most comfortable installing.  There are instruments to help and they vary.  Some are not available in the US, so that changes how the surgeon works.  One reason Dr. De Smet liked the Wright C+ was the instrumentation - which he helped design.  It is not FDA approved in the US.  But the surgeons using the Wright C+ in the US are skilled and can place it properly.

You can't go wrong with any of the top expeirnced surgeons or the top hip devices.

Pat

[Bionic]

I don't have much to add to the comments above, except to say that I was in the very same position as you and decided to go with Dr. Gross and the uncemented implant.  I was 47 at the time.  My decision was based on the hope that the resurf could be my last hip surgery.

Dr. Gross published 2 year follow-up data on his uncemented implant showing that it's short term failure rate is no better or worse than the risks for cemented implants.  That is actually very good news for uncemented patients, since it appears we are not trading short term risk for long term benefit.  Nobody knows what the risks will be over the long term, but there is at least a theoretical reason to believe long term risks are less than with cemented implants since there is no cement to break down.  Time will tell.

I am very happy with my results now.  Dr. Gross and his team did a great job, I had an easy recovery, and at this point whenever I feel a twinge in my hip, I am still surprised to realize it's usually coming from my non-operated side.