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Author Topic: Is Resurfacing a better choice for me than Replacement?  (Read 1752 times)

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dmshiff

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Is Resurfacing a better choice for me than Replacement?
« on: June 27, 2011, 07:16:07 PM »
I have known for over a year that my left hip was failing, and that the pain I was experiencing would only get more persistent and more intense.  Nevertheless, I have been engaged in cardio training for almost 3 years, and in intense training for two of those three years.  I have diabetic neuropathy (numbness) in both feet and part of both lower legs, which makes running, or even walking outdoors, problematic, so my exercise is confined to a gym, where I use machines that offer a way to keep my balance.  My type 2 diabetes was diagnosed six years ago, and after two weeks of monitoring my glucose I began a low-glycemic diet that has reduced my glucose and A1c to NORMAL levels, and maintained it WITHOUT ANY DIABETES MEDICATION. 


I started exercising August 1, 2008, with a treadmill (15 minutes at 3.0 mph, with a 10 minute rest afterward) and as my endurance increased I had to lower some medications - 10 mg Quinapril instead of 20, 25 mg Metoprolol instead of 50, and 10 mg of Lasix instead of 20.  I went faster and longer, and some pounds and inches came off.  I switched from Lasix to THCZ, and stopped the Metoprolol completely, which let me really increase speed and distance, and add some incline as well.  Now I was losing at least a pound every week, and the training staff insisted that I add some strength training and various elliptical machines, to create a more balanced training regimen.  And by the way, for better pain relief I went from 1 Celebrex daily to 2. 

I developed a meniscus tear in my left knee sometime in April 09, and had to give up the treadmill.  Fortunately, I now had other machines that offered me just as strenuous a workout without the impact, and I easily moved my workouts to them.  I reached my goal of 160 pounds (75 pounds less than 235) the day before Thanksgiving '10.  I cut one workout a week from my routine, and have stayed below 165 ever since.  When I have approached 165, I add extra workout days until I return to 160. 

But now my left hip hurts almost all the time, and my left knee pops, clicks, and frequently is quite painful.  I tried to make a new appointment with my Ortho-Doc, but his group would not accept my IBM-Aetna open PPO insurance and I had to find a new Doc here in Memphis.  I searched, and finally located Dr. Peter Lindy.  He took an AP Xray, looked at the record from my old Doc, and told me I needed a new hip.  He could treat my knee, but warned me that the now 1/2-inch shorter leg would likely cause further injury.  We have, in fact, set THR surgery for July 12, but I am having second thoughts about it.

I pause here to include an entry from the THR talk

I have submitted my request for an evaluation of whether I might be a candidate for BHR instead of THR.  I sent the necessary Xrays, forms, and personal information to Dr Rogerson's office, and hope to hear from him very soon, because my local Ortho-Doc has me scheduled for THR on Tuesday, July 12.

BHR might be a better choice for my particular case because I am quite active physically, but only in the gym. In fact, here is a list of potential DIS-qualifiers, and my reasons why I believe they do NOT apply in my case.

1.  At 71 1/2 I am more than 11 years older than the target age range for BHR, and would need to fall under the "activity level" exception to advanced age.

2.  I have been diagnosed with type 2 diabetes, but have controlled both Glucose and A1c to NORMAL levels, using NO medication other than intense exercise and a low-glycemic diet.  However, I do suffer from diabetic neuropathy (numbness) in both feet and lower legs.

3.  I have suffered from depression at times in the past, but the exercise that accounted for losing 75 pounds in 16 months (and keeping it off for 18 more months) has also been a very effective treatment for that problem.

4.  And this might be the decider - I have looked at my own Xrays, a task for which I have no qualifications whatsoever, but even I can see that I have no cartilage at all in my left hip; my pelvis is lower on the left side; my left femur "ball" appears more or less intact, but is clearly much higher than the right side.  To me, this indicates that the upper part of the acetabulum socket has been very severely damaged.  This might not matter, but it could indicate that the bone is too weak for proper mounting of the new (large) shell.
I could ask my PCP to schedule a DEXA scan to determine bone quality.  He has checked everything else he thought relevant and cleared me for surgery. 
« Last Edit: June 27, 2011, 08:12:17 PM by dmshiff »

einreb

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Re: Is Resurfacing a better choice for me than Replacement?
« Reply #1 on: June 27, 2011, 07:39:09 PM »
Wow.  First, congratulations on getting the weight off and the diabetes under control. That is VERY impressive.

My interaction with Dr Rogerson leads me to believe that he is pretty conservative in his candidate selection.  I would bet that he would not suggest a BHR based on your age alone, but I have been wrong many times before.  The DEXA scan may be a deciding factor.  I had poor bone density, but at only 40... it was worth the risk for me.

You may very well want to also contact other resurfacing doctors just for the additional feedback.   If you are not shown to be a good candidate, do you have confidence in your current THR doctor?  What device does he suggest?  You realize that a THR may very well last you the rest of your life?  Large ball Metal on Metal and ceramic THR devices allow for very active lifestyles.

To your original question... with the added fall risk due to your numbness in both feet and your age.  I *think* that in your shoes, I would lean towards some sort THR.  I'm not sure of the metal, ceramic, poly decision based on the higher risk of falling and the odd acetabular shape that you mention.  Sounds like getting more opinions from Doctors is a good move.

Regardless, good luck with any decision you make and that you can continue that new healthy lifestyle.

« Last Edit: June 27, 2011, 07:47:09 PM by einreb »
40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

Anniee

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Re: Is Resurfacing a better choice for me than Replacement?
« Reply #2 on: June 27, 2011, 10:43:27 PM »
At 65, I'm 15 years older than the target age for resurfacing on women for most doctors. Still had it done, and I'm doing great so far. So age alone does not have to be a limiting factor.  However, as Einreb says, a large metal on metal THR will also allow you to stay veryactive.  I am very impressed with what you have achieved, and wish you the best of luck with getting your hip fixed, regardless of the method!
Annie/ Right Uncemented Biomet 4-20-11/Left Uncemented Biomet 10-12-11/Dr. Gross

rbt2011

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Re: Is Resurfacing a better choice for me than Replacement?
« Reply #3 on: June 28, 2011, 01:14:53 AM »
dmshiff,

While I don't have an answer for you, I felt compelled to respond.  That is quite an accomplishment.  Congratulations on the weight loss!  Losing 75 lbs in spite of the pain and discomfort you must been feeling everyday says a lot about your character.  Whatever you decide to do, BHR or THR, I am confident you will continue to make great strides.  Best of luck !
Right side BHR 11/29/2011

DGossack

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Re: Is Resurfacing a better choice for me than Replacement?
« Reply #4 on: June 28, 2011, 03:18:21 AM »
Dmshiff-

You are certainly an inspiration and an excellent example.  To make your health your responsibility by bringing your diabetes under control with weight loss instead of drugs is exemplary.  My hat is off to you.

Best wishes on the decisions ahead.  I know that you will make the best use of whatever device you have implanted.

Keep us posted.

Dan
LBHR, Dr. Pritchett, 8/1/2011
fullmetalhip.wordpress.com

dmshiff

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Re: Is Resurfacing a better choice for me than Replacement?
« Reply #5 on: June 29, 2011, 06:14:54 PM »
To all who commented, and all who are interested in my decision

I received a phone call this morning from Dr. Rogerson.  I must say that I was impressed by the friendly, but very informative and direct presentation of his evaluation. 

I am NOT a suitable candidate for resurfacing, for reasons I had read about but really had not considered.  As I understand it, my concern about the acetabulum was misplaced.  The real problem is cysts in the femoral "ball" that would almost certainly not leave enough bone to support the HR femoral implant.  In addition, that damage might also indicate a greater likelihood of poor circulation in the femoral head and early failure of the neck.  I actually do need a total hip. 

He asked me about what the Memphis surgeon planned to install.  I told him that Smith & Nephew is a local company in Memphis, and seems to be very popular with local doctors.  Dr. Lindy plans to use cementless (S&N) Synergy femoral component and (S&N) "R3" socket in the largest available size that can be accommodated.   Unfortunately, this will be significantly smaller than the HR components.  The R3 socket requires a PE or XLPE plastic liner, and can accept a ball size range of 22 to 36 mm.  However, the Synergy femoral implant system offers a range of 22 to 28 mm in Zirconia (ceramic) or 22 to 32 in metal. 

Dr Rogerson told me that his first recommendation would be a metal-metal bearing surface in the largest workable size.  Next choice would be ceramic-XLPE or metal-XLPE, also the largest workable size.  I will pass this info to my local doctor, but he will make the final decision.  This will be a significantly smaller ROM, and will result in some activity limitations... but I already have that!

I don't know what I will do yet, but since HR is no longer an option, all of my future postings will be on the THR board.  Thanks to all for your comments and encouragement. 

Dave Shiffman
Memphis

Jeremy76761

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Re: Is Resurfacing a better choice for me than Replacement?
« Reply #6 on: June 30, 2011, 01:49:38 AM »
Hi Dave,

Just my two cents worth, but did you get other opinions about your candidacy? Why not send your test results to Dr. McMinn's office, Dr. DeSmet, and others? This is such a huge decision with no going back. Seems surgical skill plays a role in what is possible. And fact is, HR uses less bone for use in the long term. Once it's gone, it's gone.

Also, what about the mini-hip option? From I am told, the mini-hip can be used as an intermediary step between HR and THR. So, a mini-hip could preserve bone, giving you extra decades with barely any restrictions at all. You could go from mini-hip to THR later; but not in the reverse direction.

The mini-hip has a 5 year track record in Europe; only one year in the USA. But, do you owe it to yourself to look into it?

Jeremy

 

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