Resurfacing versus Mini-hip

[Hbing1967]

Hi all,

I'm a 43-year-old woman in the Boston area with very severe arthritis in both hips. Otherwise, I'm active and in good physical shape. I met with Dr. Snyder at Newton Wellesley Hospital this morning to discuss my options. I'd chosen him based on recommendations on this site, and he seems to be one of the few doctors in this area who has done of lot of resurfacing.

He told me that women are not as good candidates for resurfacing because of issues with metal on metal--I think bone size can also be an issue, but as I am six feet tall, that would not be an issue for me. He said that at my age, THR isn't a great option either, but that he felt I was a very good candidate for the Corin Minihip. He tells me it preserves bone, compared to the THR and gives great range of motion (a little better than resurfacing). This all sounds great, but I'm also finding next to nothing about this procedure online. He told me it is very new in the US and he is one of the only surgeons doing it. He trained in Wales where they have been doing it for quite a while.

So I'm wondering...a) how do I find out enough about this to really feel confident that it is the right thing to do, and b) how serious is the metal ion issue for women, and is that really the biggest issue women face (or is bone size the bigger issue)? It seems like there are plenty of women on this site who have done resurfacing, so I'm a little confused by that. I think that resurfacing is really my only good option if I don't do this minihip, but I want to know all I can if I'm putting myself at some extra risk by doing it as a woman.

[moe]

Welcome to the site. My first reaction is to be skeptical of any procedure that doesn't have a 5 to 10 year record of success with the registry numbers to back it up. I don't know anything about the Corin Minihip but there have been other newer/better products or procedures that didn't work out so well in the end.

I would get more opinions from other surgeons before proceeding. My surgeon Dr. Marchand at South County Orthopedics in RI is excellent and has had success with many women.

Good luck, moe

[Pat Walter]

Hi Welcome to Hip Talk.

I would suggest that you get an opinon from Dr. Su of NY and Dr. Clarke of NY.  They are amoung the best hip resurfacing surgeons in the US.  They do a large amount of resurfacings and have very good outcomes.

I personally would not want a device that is not well accepted and used in the US and overseas.  The BHR has been used since 1997 and there are way over 100,000 people with them.  You can talk to hundreds just on this site about their BHRs.  The Wright C+ and Biomet are also great devices.

Some of the surgeons have a mix of good and bad reviews on this site and on the Yahoosurfacehippy discussion group.  You might want to do a search for your doctor and see what others have to say.  There has been a mix of reports that you might want to read.

I always suggest staying with the most experinced surgeons that use the device with the best outcomes.  The BHR is the best with the Wright C+ and biomet coming in behind.  I would not want to be a guinea pig for a new device that is not used very much.  Just my opinon based on reading thousands of stories and learning about hip resurfacing since 2005.  Stick with the best surgeons and devices and you will have the best chance of a great outcome.

Pat

[Lopsided]

One of the surgeons I contacted before my operation suggested I use a mini hip, the little know Mitch Per, instead of a resurfacing. He could give me absolutely no information about the device, even though he was supposedly involved in the design of that device. So I forgot both him and the mini hip.

[jjmclain]

Hi,

I agree with everyone else...get another opinion. I had a left BHR 3 1/2 months agon and I am a 49 year old small female. I had end stage arthritis, AVN, and a very large cyst. It is riskier to do the surgery on women, mainly due to bone density and women do seem to have a higher incidence of metal allergies (not sure why, but that is what I was told.) That is why it is imperative to use an very experienced surgeon. Luckily I had a very competent surgeon and have very strong bones due to being an athlete, so my surgery was a success.

Good Luck to you!
June

[Anniee]

Hi,

I am a 64 year old woman scheduled for hip resurfacing with Dr. Gross next month, when I will be 65!  Obviously, I have not yet had the surgery, but after talking with Dr. Gross about my situation, he had no problem with performing hip resurfacing surgery on me, in spite of my age and the fact that I am a woman.  He looks at each person as an individual, not just numbers.  I have no clue what a "mini-hip" is, but I definitely think you need a second opinion.  Dr. Gross said nothing about metal on metal being a particular problem for women, and I have a female co-worker who had metal on metal resurfacing by Dr. Gross 7 years ago at the age of 39.  She is fine and does everything.  She is an aerobics teacher and competitive cyclist, and also runs quite a bit.  She has had no problems.

[hernanu]

I'm a satisfied patient of Dr. Snyder's and I would talk to someone else.

I went to him for an HR when someone else suggested a THR, trying something new would not be what I wanted. From what you've seen on this web site, there are many good experienced doctors who we have access to, get a second, a third opinion to make sure you're doing the right thing. It's your body and you should take the highest percentage procedure that lets you get to where you need.

Like I said, I've done two hips with Dr. Snyder, I'm very satisfied with everything, but if you're not comfortable or you're not hearing what you want, talk to another experienced doctor. Someone (can't remember who) in Rhode Island posted that they found a good HR doctor there, you may want to check with them, or go to the NY doctors suggested by Pat.

Good luck, once you get the right procedure done, you'll feel much better.

[dbhearts]

I can not speak to your condition regarding resurfacing.  I can speak regarding the mini-hip and Dr. Snyder.  I went with him with high regard after some research for a hip resurfacing seeing the many happy recommendations for him for resurfacings.  In my case, my femoral head was quite deteriorated and the resurfacing cap would not adhere so Dr. Snyder installed the minihip.  I have seen the details of this prothesis and I am very satisfied.  I am six months post-op and my recovery was quick and my new hip feels seamless.  The femoral neck is cut just below the femoral head so this is a bone conserving method as compared to a full THR although not as much as a resurfacing.  There is a metal cup, bone growth, with a large diameter ball and a small stem that seats into the femoral neck and a small part of the shaft with bone growth.  I understand this is a new device.  I found a report of one installed in Johnny Bench, of the Cinncinnatti Reds baseball fame early last year and he is acting as a spokesperson for this device.  I like what I have researched on this minihip.  You are welcome to contact as reply to this post or outside the site at my email address dbhearts@gmail.com.  I also think as many opinions as possible are most helpful.  I sought many before I made my decision.  I hope that I have been of help.

[Tin Soldier]

This is very anecdotal, but it seems like the idea that woman aren't good candidates for HR is prevalent with surgeons that have not done lots of HRs.  I don't think you'll hear that from Gross, Su, Pritchett, McMinn, Bose, DeSmet,... My local orthopaedic clinic in a very sporty town of 200,000 in Oregon also doesn't think HR is good for woman.  I think outright generalizing like that is not something the really experienced surgeons do

Granted everyone will have their own specific circumstances that will drive the surgeon's decision, much like what dbhearts just said.

If you have good bone stock, you're 6 feet tall, young (I know that's relative, I feel like I'm 60, but actually 41), it seems to me you'd be a good candidate for HR.   

[Hbing1967]

Thanks for all your replies, I've been researching this like crazy over the past several weeks, speaking to family friends who are orthopedists, radiologists, googling, etc. Today I had a second opinion with a doctor who does Birmingham hip resurfacing. He actually echoed much of what Dr. Snyder said about women and resurfacing. He said that many doctors stopped doing them in women altogether because of fear of metal ions and issues with smaller frames, but that now they are cautiously doing them again in certain cases. I found an FDA warning about the metal on metal from last month backing that up. He said that if I pushed for it he would do it in me, assuming I was not planning on having more children (I'm not), as I have a plenty strong and large frame. He told me that all things considered though, he recommended the total hip replacement for me. He felt I would actually get greater range of motion with the version he would give me and that I would have a smaller scar and an easier recovery with the anterior approach he'd use. I am left feeling rather confused all around.

I have also done a lot more research in the past few weeks about Dr. Snyder and his approach, and I am very impressed with what he is doing in general. I'm wary of the newness, but I am actually leaning toward the Corin Minihip at this point. Thank you to those you you who weighed in with your experiences with him. I've heard other very positive outside reports about him as well and feel he knows what he is doing. Still this is a very big and scary choice to make!

[einreb]

I think that many doctors leaned towards using the ASR for women for sizing issues.  (I know Dr Bose was very clear as to the that fact and that at one time it made up for 50% of his resurfacings and that he liked the sizing options for women.)  This may have influenced the generally bad attitude regarding women and resurfacings. 

You don't seem to be special in your situation that would push you away from the MOM resurfacing... especially at 43.  Its my understanding that the corin mini stem doesn't actually provide much of an advantage to a traditional short-stem in the event of a revision and it has a short history/track record.

As for recovery... I suspect that the posterior/anterior difference also really depends on the surgeon.  I'm at 4.5 weeks out from posterior with Dr Gross and feeling great. 

Pros to resurfacing MOM
Unbreakable
Maximum bone preservation (I think that is a huge issue at 'our' age)
Long track record and good results (even in women! with good devices and good surgeons)

Cons to resurfacing MOM
Potential metal issue (Dr gross has had 3 in 3000 MOM implants as a reference.  If it goes bad... you can revise to a thr or short stem)

Pros to Corin mini stem Ceramic
Low wear

Cons to Corin mini stem Ceramic
ceramic can break, revision after a broken ceramic is often difficult (shattered parts of ceramic)
short history on the Corin mini stem
more bone loss than resurfacing

I'm really hesitant to push this issue with you, but I was told by a 'top doc' that I should get a THR.  At my age (40) i was convinced that the bone sparing resurfacing was worth the risk.

Regardless, I wish you the best of luck in your decision process. 

-Bernie

[Pat Walter]

Hi Hbing1967

I wonder what hip resurfacing surgeon has given you a second opinon?  Has he done a thousand or more resurfacings?  If you don't use the surgeons that have done a thousand or more, they will most often suggest a THR.

I would suggest that you do some searching on the Yahoo surfacehippy discussion group about the surgeons you are using and the anterior approach.  Nothing wrong with the anterior approach for THRs and from a surgeon that does hundreds, but with an inexperinced surgeon for a resurfacing it might not be the best approach.

One interesting story is posted here  http://www.surfacehippy.info/hipstories2010/andrewsnyder10.php  There are more stories on other sites.  Just thought you might want to search a bit more.

There are excellent hip resurfacing surgeons in the US that have done 2000 or more resurfacings.  I would check with them before you make your final decision.  Get some info from the top surgeons - use the major league doctors, not the minor league surgeons. You only get one chance to have your hip done properly, make sure you use a surgeon that does thousands and thousands - they are the best in the business.  You don't want problems since you only have two hips.  Read the revisions stories and then use the top surgeons so you are not a statistic.  It is easy to see who the top surgeons are.

Pat

[einreb]

this is a very big and scary choice to make!

Keep researching.

http://resurfacingscan.be/drforeign.htm

Is an interesting list of surgeons done by someone outside the US.  Snyder is on the list, scan to the far right for some anecdotal feedback on him.

My understanding of the anterior approach is that it is a solution to a non-existing problem with resurfacing.  Typical small ball THR's are very prone to dislocation.  This isn't nearly as much of an issue with large ball THR or resurfacing due to the size of the component.  Posterior approach does require that you not cross you legs for a while during recovery, but my own research on my decision for a posterior approach was that the higher risk of nerve damage from the anterior approach was not worth the small benefit.

This study was for anterior THR's.   http://www.orthosupersite.com/view.aspx?rid=65572  Note that it is generally assumed that resurfacings require a larger incision than a THR or 'mini hip, because the top of the femur hasnt been removed to allow access to the acetabular work required. 

Please note that in your search for the device and surgeon that traveling a bit may be worth the effort and cost if you can manage it.

[Rolls]

Hi Hbing,
I would run from Dr. Snyder if I were you.  I am 4 yrs post op with RBHR and he still has not spoken honestly with me.  I sent my xrays to two foreign surgeons on this website and they replied to me within 12hrs and explained to me more than he EVER has.  I got all my office reports from him and some of my concerns were never written down.  He did the GANZ on me without telling me before or after.  Now he tells me I am not a good candidate to have BHR on my left hip...why?  Because he wasn't experienced enough or cared enough.  I was athletic as they come, played multiple sports in HS and college, ran everyday (well not everyday but...).  He says..."you were very muscular", well if you couldn't notice that before surgery maybe you are in the wrong Sports Medicine/Orthopedic business wouldn't you say?  I just want people to know...do your research, get the most experienced doctor that you can, and if it doesn't sound right...it's not.  Are there more of Dr. Snyder's out there?  I know there are worse off people out there than me, but I went with this procedure based on my own research and he was even on television; in a news report, he had to be good and experienced.  I will make it though...one way or another.

[Hbing1967]

Just thought I'd give an update on my hip and what I did. I chose to go with Dr Snyder and the corin mini hip, based on some very positive reviews here of Dr Snyder and his experience level ( taking a few negative ones into consideration, though I really felt they were outliers, as my research showed that he is very experienced in HR and THR), and also from talking to experienced professionals in this area. I had my right hip done on Monday, May 9th, and I am very happy with my recovery so far.  I left the hospital yesterday to go home on Tylenol only, I had a bit of heavier stuff the day after surgery, but it made me faint and I honestly never really needed it. I'm really amazed. Today I am getting around the house well on crutches, and have even found it easier to use only one, though the doctor suggested waiting till Monday for that.

Anyhow, so far I couldn't be more thrilled. I'm amazed at how little pain I've had. The staff at the hospital was telling me that many of Dr Snyder's patients manage to go home never needing more than Tylenol, so I guess I'm not all that atypical. I'm not sure if it's my youth, being in decent shape, or the anterior approach ( no muscles cut) that make the biggest difference here, but I am a happy customer.

I am wondering if I should post in the THR section to give people more info about this who might not have the bhr as an option. The mini hip is really somewhere in between the THR and resurfacing, as there is far less bone removed than in THR. The trick is that ther aren't many people doing this yet in the US. The hospital staff told me Dr. Snyder was one of four in the US doing this particular procedure.

[hernanu]

Happy that you had a successful procedure and you're feeling well. I had the same experience as you, with two resurfacing operations - low pain, tylenol and none of the previous pain. Best of luck with your new hip.

BTW - I loved the staff there, who did you have for PT and Occupational therapy?

[Rolls]

Glad to hear all went well with your surgery.  Maybe Dr. Snyder is more experienced now after "he did his own thing" with myself and others back in 2007.  Got to start somewhere, right?  When things go right, he is a wonderful doctor...of course, but when things aren't well...is he honest, have the answers?  I am just a statistic, and probably not even mentioned as a "bad outcome", and that just isn't right.

[Jeremy76761]

Rolls,

You are far more than just a statistic. A lot of people read these posts. I find it very difficult hearing of people's very difficult experiences and everyone matters a great deal. One person with a poor result is 1 far too many. Good Luck with your recovery.

Jeremy

[Rolls]

Thanks Jeremy.  I am way past recovery, I am basically just living with it right now.  Going to get my left hip done probably before Winter.  Going to try Dr. Marchand from RI this time.  I am really hoping it goes well, as I am putting a lot of faith in the BHR MOM, as it makes a lot of sense to me.  My RBHR still does not have the strength of even my bad left hip, but I have to hope it will work out and believe it was just the surgeon not being experienced enough.  I will keep you all posted regardless.
Rolls

[Arrojo]

Just thought I'd give an update on my hip and what I did. I chose to go with Dr Snyder and the corin mini hip, based on some very positive reviews here of Dr Snyder and his experience level ( taking a few negative ones into consideration, though I really felt they were outliers, as my research showed that he is very experienced in HR and THR), and also from talking to experienced professionals in this area. I had my right hip done on Monday, May 9th, and I am very happy with my recovery so far.  I left the hospital yesterday to go home on Tylenol only, I had a bit of heavier stuff the day after surgery, but it made me faint and I honestly never really needed it. I'm really amazed. Today I am getting around the house well on crutches, and have even found it easier to use only one, though the doctor suggested waiting till Monday for that.

Anyhow, so far I couldn't be more thrilled. I'm amazed at how little pain I've had. The staff at the hospital was telling me that many of Dr Snyder's patients manage to go home never needing more than Tylenol, so I guess I'm not all that atypical. I'm not sure if it's my youth, being in decent shape, or the anterior approach ( no muscles cut) that make the biggest difference here, but I am a happy customer.

I am wondering if I should post in the THR section to give people more info about this who might not have the bhr as an option. The mini hip is really somewhere in between the THR and resurfacing, as there is far less bone removed than in THR. The trick is that ther aren't many people doing this yet in the US. The hospital staff told me Dr. Snyder was one of four in the US doing this particular procedure.

Very interesting stuff hibing. I saw Dr. Snyder today and he told me I was a good candidate for Corin Minihip.  He also told me he has performed 850 RESURFACINGS!  Maybe that's not quite experienced enough to get listed on this website, but its far more than many others who are listed.

Anyway, my concern isn't with the good Dr. but whether the Corin Minihip will provide me with a better chance to regain my former running (National ranked sprinter, as well as marathons) ability.

I asked Dr. Snyder point blank why would one choose Corin Minihip (he has done 350 of these) vs BHR.  He cited three things:

1. No metal on metal ion issues.  I know long-term issues with that are controversial, but apparently 3% of people do have some kind of bad reaction after BHR.
2.  Success rate - BHR is 90-91% (his statistic) due to various reasons.  Corin Minihip has a 98% success rate, although I pointed out there is a much smaller sample size.
3.  Recovery is much faster with the minihip because far less muscle is cut away.

None of that answers my question about returning to be the runner I was....