+-

Author Topic: BHR vs. THR, that is the question  (Read 14895 times)

0 Members and 1 Guest are viewing this topic.

Kaiser Girl

  • Newbie
  • *
  • Posts: 7
BHR vs. THR, that is the question
« on: May 08, 2011, 03:01:52 AM »
I am 49 y.o. active female with osteoarthritis in my left hip.  My Kaiser doctor recommended a BHR so I scheduled a surgery for June 14th.  Then I got a second opinion outside of Kaiser who said "no way, I would never give you a BHR.  What you need is a THR!"  Mostly because he believes that BHRs are for large men engaged in weight bearing activities. I tell my Kaiser doctor and he says that in 20 years if I need another replacement, a second THR is never as good as the first, so why not do BHR now then THR later.  Then he says there are many diverging opinions amongst orthopedists and that I can decide if I want a BHR or THR.  I am going to get a third opinion, but still, how do I make this decision?  There is so much info out there.  Plus, my Kaiser doc has only performed 110 BHRs, though I hear he is quite meticulous and has only had problems in two cases.  Please advise.  I'm open to all feedback.  Thanks!  Signed, Limping in Los Angeles
« Last Edit: May 08, 2011, 03:03:11 AM by Kaiser Girl »

Dannywayoflife

  • Hero Member
  • *****
  • Posts: 2507
Re: BHR vs. THR, that is the question
« Reply #1 on: May 08, 2011, 05:24:43 AM »
Hi there Kaiser girl,
                           Im sorry to hear about your situation. If I were you I would get as many opinions as possible by as experienced surgeons as you can find.
Having said that it sounds like you may be a candidate for HR so going for that will leave you with more options in the future.
It seems that some orthopaedic surgeons are really against HR for some reason as far as I can tell this is largely due to early trials which obviously weren't as successful as they might have been but that's was back then not now!
I am yet to have a HR I'm currently looking for a referral to a surgeon but my understanding is that a HR leaves you with the ability to have a primary THR later on. Also it
Means that you can live a life without restrictions in the mean time.
If it were down to THR vs HR for me I would go with HR everytime!
Also it seems the old accepted trend that HR wasn't for petite women is generally disregarded by the top surgeons so anyone saying otherwise is Likely to be out of date. 
All the best danny
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
60mm cup 54mm head
Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England
;)

Lopsided

  • Hero Member
  • *****
  • Posts: 595
Re: BHR vs. THR, that is the question
« Reply #2 on: May 08, 2011, 07:39:55 AM »
It is quite simple, K girl. Do you want the top of your thigh bone cut off and thrown away?

Didn't think so. Get resurfacing!



Proud To Be Dr. De Smet's First Uncemented Conserve Plus, Left, August 2010

phillwad

  • Sr. Member
  • ****
  • Posts: 326
Re: BHR vs. THR, that is the question
« Reply #3 on: May 08, 2011, 07:43:58 AM »
Limping Kaiser Girl

Welcome - you will get plenty of advice and suggests that will help from this forum - it is great.  Experience of the surgeon is key; my Dr has done about 1000 BHR.  

Also - my limp has almost gone - 7 weeks post op - Cheers - Phill

Lori Cee

  • Full Member
  • ***
  • Posts: 141
    • My Bilateral BMHR
Re: BHR vs. THR, that is the question
« Reply #4 on: May 08, 2011, 08:03:54 AM »
I have what my surgeon called petite bones and I was still able to avoid a THR.  I am in no way an athlete as I've had reasonably severe arthritis since I was a child.  The reason I'm such a fan of resurfacing and the BMHR is that they are more bone conserving and I know that in my lifetime I will need a revision that will be that little bit easier than a TH revision. There are other reasons but that's the big draw for me.

The bone quality on the femoral head wasn't good enough for BHR but a BMHR was fine.  This has a lot to do with me waiting 10 years putting up with the pain and restricted ROM, so I'd suggest not waiting that long!  I'd suggest seeking the opinion of a surgeon with greater resurfacing experience before making a final decision.
Bilateral Birmingham Mid Head Resection (BMHR): 8 April 2011 (Dr Simon Journeaux at Mater Private).
To follow my progress visit my blog: Bilateral Hip Replacement

Pat Walter

  • Patricia Walter
  • Administrator
  • Hero Member
  • *****
  • Posts: 3862
  • Owner/Webmaster of Surface Hippy
    • Surface Hippy about Hip Resurfacing
Re: BHR vs. THR, that is the question
« Reply #5 on: May 08, 2011, 10:05:14 AM »
Kaiser Girl

Welcome to Hip Talk.  You are sooo young - don't even think of a THR.  Why have any restrictions to your activities and life.  Hip Resurfacing is for the young, active person.  You will keep your femur bone and "IF" you ever need a revision, that would be much easier starting with a hip resurfacing.  Many times a patient might only need half the revision surgery if they only need the femur portion instead of the acetabular cup and femur component.

You will have a much more natural gait with resurfacing and your body will remain much more in balance since no large portion of your femur bone will be sawed off.  You bone will remain active in it's normal state since it will not be sawed off and have a large, long hold drilled into it.  Please listen to Dr. Brook's two videos.  He explaines how having a long foreign rod placed into your femur bone changes the way your bone reacts and regenerates.  THR change the whole balance of the femur bone. http://www.surfacehippy.info/shvideos/videosdoctor.php

Your first surgeon is correct and at your young age - you should have a resurfacing if possible.  Can you see another Kaiser surgeron?  Dr. Klug is very experinced.  Please understand that many orthopedics can't do the surgery since it is very diffiuclt and will bad mouth it and push for a THR.  Many base their information on negative press and one medical study in Cambridge UK where only assistants performed the surgery and had a very bad record.  If you look at the national registries - you will see the BHR has a retention rate of 96%, similar and in some cases better than a THR.  Every hip device is foreign to your hip and it depends on your bone stock to remain strong to keep the device solid.  Either a THR or a resurfacing can become loose with time.  It really depends on your bone.  So there is no guarantee that you will not ever need a revision with a THR either.

Stay with the resurfacing if possible.  There are no restrictions and your gait will remain normal.  You won't know you even have a hip device placed inside you after you have healed.  Many THR patients are very aware of the device in their hip since it is also a foreign part.
 
Please read the many personal resurfacing stories  http://www.surfacehippy.info/hipstories.php  and listen to the doctor interviews.  It is an easy way to learn.  Take time to learn now so you won't be dissapointed after your surgery.  You can't go back after they place a THR in your hip.

Good Luck.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

jjmclain

  • Sr. Member
  • ****
  • Posts: 294
Re: BHR vs. THR, that is the question
« Reply #6 on: May 08, 2011, 10:52:08 AM »
Kaiser Girl-

I am a petite, 49 y.o. athletic female (48 at time of resurfacing), 6 months post-op LBHR. I also had AVN. I got my life back!!! Prior to surgery, my hip had totally collapsed and had some rather large cysts along with the AVN. My surgeon was able to handle it and due to my strong bones (even though I am small!!) the surgery was a success. I too was limping prior to surgery.

No limp after surgery and completely normal gait...it is amazing! I find myself smiling everyday. Please get another opinion and find an experienced surgeon and you will get your athletic life back!!!

If you have any questions of me, you can write me!! Take care.

June

nekko

  • Full Member
  • ***
  • Posts: 101
Re: BHR vs. THR, that is the question
« Reply #7 on: May 08, 2011, 11:41:51 AM »
Hi Kaiser Girl,

At 50', I have been diagnosed with OA. The two first surgeons I met pushed me for a THP. They do not want to hear about hip resurfacing. Perhaps they were not experts in this technique. The third surgeon I met was a real expert about resurfacing and he gave me a lot of details. One of the advantage for people of our ages (!) is that it should postpone the need for a THP for at least 10-15 years.

So, you really must have a third opinion before taking this (very) important decision.
Hope it may help you.
Conserve+ cemented, May 12-2011, Pr Migaud, CHu Lille

katekosar

  • Jr. Member
  • **
  • Posts: 76
  • Disney Olympic 2006
Re: BHR vs. THR, that is the question
« Reply #8 on: May 08, 2011, 12:30:36 PM »
Here's another vote for resurfacing if possible.  The first surgeon I visited was a real butt.  Insisted that only a THR would do and that I couldn't do a resurfacing because I'm a female.  I dropped him like a hot potato just on the butt factor alone.  Turns out I was in fact a good candidate for resurfacing.  Had it done a week ago Wednesday with a doc who's done over a thousand of 'em.  It was kinda/sorta rocky for the first week or so, but it's going well now.  I'm mobile, out of the house, and relatively content with my progress.

Take your time, consider your alternatives, and choose what works best for you.

Kate

hipnhop

  • Sr. Member
  • ****
  • Posts: 479
Re: BHR vs. THR, that is the question
« Reply #9 on: May 08, 2011, 12:35:19 PM »
I was the first HR for Kaiser Mid Atlantic. My doc did mine under the supervision of a more exp HR surgeon.  All went well. I am almost seven weeks post op and loving it. Dont do THR if you don't have to.
3/2011 and 2/2012 HR Dr. Craig Thomas

Dannywayoflife

  • Hero Member
  • *****
  • Posts: 2507
Re: BHR vs. THR, that is the question
« Reply #10 on: May 08, 2011, 01:49:56 PM »
Pat,
      Am I right that most revisions are due to loosening? As opposed to wear?
Thanks danny
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
60mm cup 54mm head
Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England
;)

Marymk

  • Newbie
  • *
  • Posts: 4
Re: BHR vs. THR, that is the question
« Reply #11 on: May 08, 2011, 02:01:32 PM »
Hi Kaiser Gal,

I am older (58) and not petite...however not large boned either. I was told I was a candidate for either surgeries. The differences we're based on being female primarily (femoral head size) and age. I was told if I was younger resurfacing would be my only option in the opinion of my HR surgeon. You're that much younger. The other difference was the cup. It seems women are more prone to metallosis from metal-on-metal (although, it's not real common either way). I was told by both docs that at 58 a THR would need to be tweaked certainly. That's why I chose HR. However I have a polyethylene cup so I will probably end up with a tweak anyway. Ha!

I am 6-days post-op and have been walking unassisted all day today and started going unassisted at times by day 4 post-op. I am very happy with my resurfacing.

By all means get another opinion. But regardless, you will feel better with surgical result. I was also told those docs on the cutting edge of THR use better components now(larger balls) and recovery is subtle between the surgeries where it used to be huge. Also the new components are good for all but jumping exercises...but I'd research that more. Good luck.

Anniee

  • Sr. Member
  • ****
  • Posts: 343
Re: BHR vs. THR, that is the question
« Reply #12 on: May 08, 2011, 02:13:59 PM »
Hi Kaiser Girl,

I am older (65!) and not petite.  I had resurfacing done a little over two weeks ago, and I feel great!  When I first consulted my resurfacing surgeon (Dr. Gross) he told me it was up to me to decide whether I wanted a total hip replacement or resurfacing because he could perform either one.  As Marymk says, the newer total hip components are much better than the older types, and, per Dr. Gross, the recovery and activities allowed after surgery are about the same either way.  I decided on resurfacing for two reasons:  1) I did not want to have a big piece of my thigh bone amputated and a great big hole drilled into what was left of it, unless absolutely necessary, and 2) people in my family tend to live a long time, so I may need a revision later - revision of a total hip replacement is a lot more difficult than revision of resurfacing.  At the time, I was not aware of the other issues with THR discussed by Dr. Brooks in Pat's recent interview with him.

Please get at least one more opinion, and gather as much information as you can before making your decision!
Annie/ Right Uncemented Biomet 4-20-11/Left Uncemented Biomet 10-12-11/Dr. Gross

Eitan

  • Newbie
  • *
  • Posts: 31
Re: BHR vs. THR, that is the question
« Reply #13 on: May 08, 2011, 08:21:09 PM »
Isn't there a song that goes "I'm a Kaiser girl in a Kaiser world" or something like that?

Seriously:  For another opinion try Dr Thomas Barber, Kaiser Oakland.  Does resurfs, don't know how many he has done.  Good solid guy, straight shooter.

Best of Luck.

John C

  • Hero Member
  • *****
  • Posts: 855
Re: BHR vs. THR, that is the question
« Reply #14 on: May 08, 2011, 11:16:01 PM »
To Danny's question; my understanding is that the answer is yes and yes. Many revision are due to loosening, but the next question is what caused the loosening. Often the cause is osteolysis, meaning that the bone is being eaten away. If the deteriorating bone is near the prosthesis, it starts to loosen. Osteolysis is often caused by the bodies reaction to wear debris. As the body tries to clean out the wear debris, one of the unfortunate side affects is that chemicals are released that attack the bone. The amount of wear debris is a large factor in determining how much osteolysis occurs, and therefore the odds of loosening. So I think the answer to your question is that many revisions are due to loosening, which in turn is due to wear particles.
On a side note, sometimes with the older plastic cups, the plastic would wear out to the point that it needed to be replaced. If you were lucky, they could just replace the plastic liner, rather than doing a revision. The real problem, is that by the time that there is this much wear, the odds of osteolysis would be pretty high, and this might lead to a revision.
The good news about MOM resurfacing, is that there is a lot less wear debris than with the old plastic liners. A well placed HR is not likely to wear out in anyones life time, and hopefully the persons body will not react to what wear debris there is, in a way that will lead to significant osteolysis leading to loosening.
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

Dannywayoflife

  • Hero Member
  • *****
  • Posts: 2507
Re: BHR vs. THR, that is the question
« Reply #15 on: May 09, 2011, 02:30:15 AM »
Thanks John that's pretty much what i thought (well that's what I took from the mark Bloomfield interview I saw!:-))
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
60mm cup 54mm head
Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England
;)

Kaiser Girl

  • Newbie
  • *
  • Posts: 7
Re: BHR vs. THR, that is the question
« Reply #16 on: May 09, 2011, 02:41:52 AM »
Dear Hip Vets,

Wow.  I feel grateful for all your responses.  Indeed this is a serious operation and I must be thorough before I allow anyone near me with a sharp utensil! 

Thank you, Pat, for that specific link.  Now I understand the value of the femur.  I also find it amusing that this 2nd opinion M.D. was so quick to dismiss it's utility.  "Who needs it anyways?  You won't even notice it's gone."  Consciously maybe not, but apparently from what you all are saying femurs play an important role in leg length, balance, and future revisions.

I did call Dr. Klug's office, and he's so busy I can't even get an appointment to meet him until July, let alone a surgery date.  Plus, he's in Roseland, North of Sacramento.  I'd have to travel back to L.A. post surgery and that cannot be comfortable...  Plus who'd do my follow up?  The L.A. surgeon?  I'm sure that would be an ego jolt for him.  So then what kind of aftercare does he give me?  These are my concerns about travelling to get a more experienced doctor.

Eitan, I think the song is: "I'm a barbie girl, in a barbie world. Life in plastic, it's fantastic!" I could change it to Kaiser Girl and after the surgery I hope to say "life in metal is fantastic." I will check out Dr. Barber, though, and find out how many he's done. I'll still have the same travel issues, though, but it's worth a look.

Marymk thanks for pointing that out.  I had heard that recovery and surgery was more brutal with the resurfacing, but if the differences are decreasing then that removes those objections.

Kate, HipnHop, Ainee sounds like you guys are doing well fresh out of surgery.  That is inspirational.

Lori, what is the difference between a BHR and a BMHR?  (Birmingham Metal? Hip Replacement?)

Thank you Danny, Lopsided and Phil.  I can see that experience makes a difference with the surgeon.  My Kaiser doc has given me #s of satisfied patients, but how do I know if his work is good enough?  They say they are happy.  One lady came into his office post-op one year later and did the splits right there in front of him!  That impressed me.

I am going to look at the list of local doctors on this site and get a 3rd opinion.  If anyone has any other Kaiser connections, please let me know.  Could a Kaiser group be started on this site so we can share info re specific docs?  Just a thought.

Today it was obvious that I cannot delay this surgery much longer.  I went to the Getty museum with my family for Mother's Day, but I could barely get around, dragging my left leg like a deadweight.  Someone wrote on this site that osteoarthritis is a very slow, imperceptible change over years.  That's me. I couldn't even go down to the beautiful English garden where I used to do somersaults on the grass with my kids... My time has come.  Thanks again for the warm welcome to the Hip Club.

Dannywayoflife

  • Hero Member
  • *****
  • Posts: 2507
Re: BHR vs. THR, that is the question
« Reply #17 on: May 09, 2011, 02:57:10 AM »
Good luck and keep us posted!
My OA deffinatly wasn't a slow change tho I went from being mega fit training literally hours a day to not been able to move my leg in about 6 months!  ???
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
60mm cup 54mm head
Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England
;)

Lori Cee

  • Full Member
  • ***
  • Posts: 141
    • My Bilateral BMHR
Re: BHR vs. THR, that is the question
« Reply #18 on: May 09, 2011, 03:16:01 AM »

Lori, what is the difference between a BHR and a BMHR?  (Birmingham Metal? Hip Replacement?)


The BHR is the Birmingham Hip Resurfacing which is the standard Birmingham device that is used in the US.  There is a newer one that isn't yet FDA approved yet called the Birmingham Mid Head Resection which is kind of like the next step along the path from a BHR (picture and info here: http://www.mcminncentre.co.uk/birmingham-mid-head-resection.html) and is still significantly more bone conserving than a total hip.  It is a solution for people like me that aren't suitable for the BHR due to bone quality of the femoral head and aren't keen to go total hip for all of the reasons that the rest of the crew have spoken about here and the reasons that you'll find in the rest of information on this site.  

We've all been where you are and have done the research and gone to a whole bunch of doctors and decided that this is the way to go for us.  Ultimately it is your decision and you need to work out what is right for you but before you do - please do get another opinion now you have a bit more information up your sleeve!  Good luck!


Bilateral Birmingham Mid Head Resection (BMHR): 8 April 2011 (Dr Simon Journeaux at Mater Private).
To follow my progress visit my blog: Bilateral Hip Replacement

Pat Walter

  • Patricia Walter
  • Administrator
  • Hero Member
  • *****
  • Posts: 3862
  • Owner/Webmaster of Surface Hippy
    • Surface Hippy about Hip Resurfacing
Re: BHR vs. THR, that is the question
« Reply #19 on: May 09, 2011, 01:52:07 PM »
Hi Danny

Quote
Am I right that most revisions are due to loosening? As opposed to wear?
Thanks danny

Revisions are generally due to acetabular cups placed at wrong angles.  The edge wear occurs because the acetabular cup is rubbing on the femur cap in one or more concentrated areas which cause high metal ions.  When the cup is placed correctly, the wear between the components is spread over the surfaces of the two components rather than in just one area. 

Some cups and a few femur caps have become loose due to bone loss or bone never growing into the component properly. 

Some revisions are due to actual metal allergies of the patients to the cobalt/chrome/molybedum.  It is very rare, but there are a few cases listed on my Resurfacing Problems Page.

A few revisions are sometimes from femur neck fractures - some due to surgeon error and others from patient falling or doing something they most likely should not have been doing so soon.

So there are a number of reasons for revisions but many currently are from misplaced acetabular cups causing high metal ions from edge wear.  I don't have any statistics at hand about the various reasons.  If I find them, I will post them.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

 

Recent Posts

Advertisements

Donate Thru Pay Pal

Surface Hippy Gear

Accordion Player Pat Webmaster/Owner

Owner/Webmaster of Surface Hippy

Statcounter

View My Stats

Powered by EzPortal