Concern about not finding Dr. on BHR list

[joedb123]

I am scheduled for surgery on March 25th. For some reason I cant seem to find my Dr. on any of the published lists. Is this something to be concerned about?

 

[obxpelican]

Normally Pat does not put a doctor on her list unless 1) The doctor or someone on staff asked to be placed on the list or 2) The doctor is inexperienced.

We've seen many a person post after a failure that they wished they had chosen more wisely.  Most of the time (not always) surgical error on a hip resurfacing requires a revision which is not fun because it's a revision to a THR.

I know Pat takes a lot of heat from people about #2 but that is how it is, you stand more of a chance at issues post op if you use an inexperienced surgeon.  I went to a surgeon here in Pgh, he told me at the time that he had done around a hundred, that included surgeries that he assisted and cadavers --- to this day I wonder how the cadavers made out ;-)  I ended up driving many miles to get my surgery, I do not regret it.

Hope that helps.

Chuck

[Dayton96]

Joe,

Did you ask the surgeon how many HR he has done by himself?  How many does he do a week?  What is his infection rate?  What is his failure rate?  Have you talked to some of his former patients?

Mac

[joedb123]

I am embarrassed to say I have not asked yet but did intend to. There are many sites where the number of procedures are listed but could not find this particular information about my physician. having said that he has a excellent reputation as a physician and has 28 years experience as an orthopedic surgeon. I also found that he has had a malpractice suit within the last 5 years, but in this litigious society I don't want to make may decision based on just that. I also thought it odd that he was not listed on the Smith & Nephew website.

Am I over-thinking this? I don't want to make the mistakes referred to by Obxpelican. There is one name that continues to come up as the most experienced here in NYC and that is Dr. Edwin Su. Unfortunately when I called it was 2-3 months to get an appt.

THANK YOU for your posts- Joe

[obxpelican]

You really need to talk to your surgeon and find out the questions we posed, if it takes a few short months more I would do it.  Dr. Su is an excellent surgeon, Pat has lot's of happy Dr. Su patients on this website, he was on my short list but I just am not into NYC, I am a country loving guy so I went South.

28 years as a doctor is great, but if he's inexperienced doing hip resurfacing that's NOT a good thing, a hip resurfacing is not an easy procedure for the inexperienced surgeon.

Chuck

[Dayton96]

Joe,

There is a reason why certain surgeons are booked up three or four or five months in advance.

Mac 

[joedb123]

Thanks guys. Got the message. I will be making the call tomorrow. Can't afford any mistakes. I know i should have cleared these particulars earlier but just procrastinated.

This is a great website!

[lori.36]

Hi Joe,

I was just looking at this post after I read your reply from the other one.  I really think you should consider making an appointment with Dr Su.  I know that you are all set to cross the bridge on Friday, but if he is unrecommended, I would wait.  I say that because you stated that you are able to exercise and still be somewhat active.  I called Dr Su, because I was thinking of using him too, and they are scheduling surgeries for August now, that is not that far away.  Maybe you could do this at the end of the summer instead.  Just a thought, I want you to have a good experience.
My Doc is on both resurfacing sites and has done over 450 of them.  He also has a website and I have spoken with a dozen people that only have great things to say. 
Best of luck with your decision.

[Tin Soldier]

Joe -

I originally planned on going with a surgeon that 600 HRs who studied with Amstutz (father of the Conserve), and then being fussy with numbers I went with a surgeon that had 2600 HRs who began researching resurfacing in the 80s, and some of his research was used by McMinn in support of the BHR.  I consider my surgeon to be one of the most expereinced in the world.  After the fact, I think I may have gone a little over the top on fussing about numbers, but I am very happy and confident with the work he did.  Confidence is huge here and if you're going to be reading the very occassional story about a HR going bad, then you might as well go for the most experienced surgeon, if for nothing, than simply for the confidence.  I'd wait for Su or see about travelling to see one of the 7 or so top surgeons you read about here all the time (BTW - Su is one of those).  Good luck.

[joedb123]

Thanks Tin and all others. I have a meeting with my Dr. (Justin Lamont, NYU hosp for joint disease) tomorrow. I sent a list of questions based on what I've learned from this most excellent website to his assistant. To my satisfaction I received a call from her within 15 minutes to come in and discuss all issues of concern. I am finding this to be the most difficult decisions I have ever had to make even in the face of the inevitability of it.

Dr. Lamont has an excellent reputation and is Senior at NYU hospital but I need to verify his level of experience with this procedure. As someone said to me today " You have to be your own advocate".

Thanks again.

[obxpelican]

Good luck, ask LOTS and LOTS of questions, the ones I would be concerned with is:

1) How many HR surgeries have you done (not assists)?

2) How many of those surgeries have resulted in revisions?

3) What do you consider the optimal cup angle?

I think if #1 was 500 or better I might be happy, of course #2 would have to be a VERY low percentage.  If he cannot answer #3 RUN don't walk out of there.


Chuck

[joedb123]

Thanks Chuck!

[einreb]

3) What do you consider the optimal cup angle?

I think a good follow up to his answer to this question is how does he ensure that he has the correct angle before he closes you up? Inter-operative x-ray? Its actually several angles that they have to get correct.  Inclination angle is the most common one cited, but the antiversion angle  is important to reduce the chances of impingement.

It took my surgeon 3 tries and looking at inter-operative x-rays (hammering and then removing!)  to get my cup at an angle that he decided was 'perfect'.

One thing that I noted about some of the surgeons that I 'interviewed', was that they were very interested in the tech talk.  On one hand, they do have to be part salesman.... but it was obvious to me the ones that were absolutely passionate about resurfacing.

[joedb123]

Einreb, thanks for that. If knowledge is power I feel well armed. I am seeing him at 2:30 today. Can't wait!

[joedb123]

So here is the Story: the Dr. has done 150+ resurfacing's himself, Birmingham only. The reason , he explained that the number is not higher is that a number of patient's aware of the MoM issues where not willing to take the chance. He trained with Dr. McMinn in Engalnd and is in frequent contact with him. There have been no revisions except for two falls where the femur fractured. More importantly he seems extremely well informed about how the BHR works and understands and explained any and all of the potential complications that could occur. I did not need to ask him about cup angle as he brought it up without my asking. He said " I am very conservative with my cup angles" and stressed how important it is.  This Dr. is one of the Senior surgeons at NYU. I walked away feeling good and am going to go for it.

Gulp............

[obxpelican]

Just my opinion, and only my opinion, knowing what I know I would not have chosen him, I would have called Dr. Su and had him or another surgeon do it.  150 is simply not enough experience.

Again, don't take this wrong, I am sure I can speak for everyone on this forum we wish you only the best and I am sure all of us never want to tell you I told you so either.

I hope all goes well--- BTW what did he say were the optimum angles?


Chuck

[einreb]

I walked away feeling good and am going to go for it.

Gulp............

Sometimes you just have to go with your gut.  I interviewed 5 surgeons and the #2 preference on my list only had 150 at the time and I would have felt OK going with him.  I've heard interviews with several of the top surgeons where they are a little dismissive about just focusing on #'s.  Some surgeons are just skilled and that is the key. 

[lori.36]

HI Joe,
Glad to hear that you are doing well.  I think you made the right decision for you, but happy that you asked the questions.

The surgeon I am using only has completed 460(?) I have no idea about the exact #, which to me is close enough to the new 500 benchmark.
For me it was talking with his patients and meeting him that sold me.  I know that he does hip resurfacing to help the patient, he also called me multilple times on the phone.
Please keep us posted on your recovery.
Lori

[joedb123]

Hi Lori,

Thats a good number.... 1000 is better though and 2000 better than that. That was my dilemma, you can get hung up by the numbers and while I agree it is important, it is clearly not the only factor when making this important decision. My surgeon had only done 150+ but had a reputation as a top OS in NYC and when I spoke to him he really knew what he was talking about. I had some contacts I used to verify his reputation and it stood up. I guess my point is as you said, go with your gut. I believe it was on this website that Dr. Su was asked about the potential for problems of this procedure being performed by less experienced surgeons. His answer was (not verbatim):" I would not worry too much about that as all surgeons are trained to a very high standard before being approved to utilize the device". My surgeon had trained with Dr. McMinn  himself in England and that mad me feel very good. The reality is only time will tell the whole picture but I can say right now I feel better and better every day. This website really helps you become your own advocate and all of the questions are the right ones. Sooner or later though, you gotta pull the trigger.

I wish you all the best and no matter what, the odds are in your favor. Do you know when you are going in?

All the best!!!

[lori.36]

Hi Joe,
Yes I am going in on May 11th.  I picked that day, because I wanted to enjoy Mother's Day and son's 4th birthday.  I am going the day after he turns 4.  I am very lucky because my in laws are going to come in to help us.  We have two little ones, which makes everythings more complicated, but now is the time.  I am really excited about the surgery, but not looking forward to the first week of pain.

Time will tell, but intution goes a long way in my world.  My intution told me that Dr Rector is my surgeon.  I am going to stick with that.

Keep us posted on your healing.  I think the reason that I am not so intmidated by the surgery is because I am followin all of the progress that you and others have made.

Lori