Doctor doesn't do resurfacing anymore, recommends THR

[JMP8888]

This is my second post on this site...I went to the doctor Hozack (I got his name from this site) yesterday fully prepared to make my appoinment for bilateral resurfacing. I figured I was a great candidate, 42 year old male in excellent physical shape...I was ready to do this.

After looking at my x rays, the first thing the doctor says is he doesn't do resurfacing anymore. He says that there has been problems (none with his patients) with the metal on metal resurfacings...He immediately suggested replacement, and said it would be equal in terms of limitations, strength, etc. He also said it was a somewhat less invasive surgery, releasing/cutting less muscles, which made for better recovery. He said he would return to resurfacing when a better material was found....

I am somewhat lost now. I am wondering if he is just doing THR instead because it is easier for him, and he can do more surgeries? I am looking for some input on this.

[Neild5]

I had resurfacing on my left hip in Feb 2011 and my recovery was much faster than a friend who is the same age (49) who had THR.  I also have no restrictions where as he will never be able to cross his legs or put his foot on his knee.   I would think about finding another doctor for a second opinion.

[JMP8888]

Thanks for the quick reply. I am going to get another opinion on this for sure.

[FlbrkMike]

It doesn't sound like he's being very honest.  If the THR was equal in terms of limitations, strength, etc., plus a less invasive surgery with easier recovery, why would he ever go back to doing resurfacings even if they improve the materials?

[Wattsboss]

JMP,

I'm a newbie here who has been investigating hip resurfacing. I live in Philadelphia and have heard great things about Dr. Hozack.

I am intrigued that he is not doing resurfacing for now.  I would love to know what kind of total hip replacement he recommends, what devices, what materials, ball sizes, etc., for the highly active patient. Also curious if he literally gives hip replacement patients the green light on doing all that patients with resurfacing can do.

I wasn't looking at him for resurfacing per se, as I probably lean towards a doctor whose done more resurfacings than he has done.  But from reading around, I sense that in the Philadelphia area, he's considered an excellent surgeon.  And there are a number of people who say he's great with direct anterior hip replacement.
 
Thanks for sharing that info. Hozack is definitely big time in the Philadelphia area.
 

[JMP8888]

Yes, He seems to be one of the top guys in this area for hips. Actually, I spoke with a friend of mine yesterday, who had his hips (replacement) done by him last year. He was very happy with the surgery. He was able to resume his active lifestyle pretty quickly. As for myself, I weightlift  and play ice hockey, and Dr. Hozack assured me that I would be back to these things once I recovered. His exact words were, "No limitations" on the implant. He is using a metal and polyethelyne (I'm pretty sure I got that right?) device.
I still may go speak to Dr Brian Kelly in NY. He is the top guy there.

[Lopsided]

"No limitations" on the implant. He is using a metal and polyethelyne

Metal on plastic. Amputate your bone. Remainder of bone shielded from stress.

How can this compare to resurfacing? Serious limitations.

[JMP8888]

Yes, I have the same opinion on the THR versus resurfacing. I am still talking to doctors and such. I just can't see how this device can withstand the same shear forces and punishment that your bones can. I didn't want THR and was really sold on resurfacing, so this whole situation puts me back to square one.

[Lopsided]

I just can't see how this device can withstand the same shear forces and punishment that your bones can.

Resurfacing does not withstand shear forces. Your bone does.

[Wattsboss]

JMP,

I think Hozack is an editor at some top ortho journals.  I think you would do well to go ahead and call him and ask him about this "no limitations" stance.

Ask him why his stance differs so strongly with most ortho surgeons. Is there some new data that he is basing his recommendations on.  Go ahead and ask him about stress shielding (the implant taking up the stress in place of the bone, thus weakening the bone) that occurs with hip replacement.

And is he using a big ball instead of the standard small hip replacement ball? ... I'm guessing that for this "no limits" policy, he's using big diameter balls. 

I urge you to engage him (I don't think he's an idiot by any means) and I would love for you to report back here.  I read someone online who said he was quite gracious over the phone.

[Tin Soldier]

I know I'm a touch behind on this thread, but we see these questions a lot about the diff between THR and HR and I wanted to offer my thoughts.  I'm with Lop and the others here.  My biggest concern with THR is the shear stress (warbling-out) issue.  This shouldn't be a big deal if you take it easy on your joints, but that's not generally the desire of the HR patient.  I also think asking more detailed questions is a great idea.  Heck maybe Stryker or other THR manufacturer has been trying to address the shear stress issue.   I wouldn't know, I'm so buried in HR topics that I know very little about THR.  Maybe the MoM FDA questioning has some of the surgeons stepping away from HR, who knows?  Interesting topic though.

[JMP8888]

JMP,

I think Hozack is an editor at some top ortho journals.  I think you would do well to go ahead and call him and ask him about this "no limitations" stance.

Ask him why his stance differs so strongly with most ortho surgeons. Is there some new data that he is basing his recommendations on.  Go ahead and ask him about stress shielding (the implant taking up the stress in place of the bone, thus weakening the bone) that occurs with hip replacement.

And is he using a big ball instead of the standard small hip replacement ball? ... I'm guessing that for this "no limits" policy, he's using big diameter balls. 

I urge you to engage him (I don't think he's an idiot by any means) and I would love for you to report back here.  I read someone online who said he was quite gracious over the phone.

When I met with him, he was very nice, and answered my questions. I just wasn't really prepared for him to recommend replacement over resurfacing, as he has done so many succesful resurfacings.
 He is using a larger diameter ball, that I know. He didn't really seem dead set against not doing resufacing again, he just said that there were problems with the metal on metal that were starting to surface. His office is quite close to me, so I will be asking him about stress shielding when I see him. My femoral heads are pretty beat up, which was another concern of his for resurfacing me. If there are any other questions you think I should ask, please let me know.

[Lopsided]

If there are any other questions you think I should ask, please let me know.

Yes, does he realize that any device made from any material if placed badly sheds debris? And does he know that the trunnion, the part of modular a THR that joins the stem onto the ball, sheds metal debris even if the device is placed well?

D.

[Wattsboss]

JMP:

You live in Philly?

Here are some suggested questions... just to flesh out this "no limits" line on hip replacement

I'd be direct in intro: doc I'm stunned and a little confused by your statement that you would recommend no limits on my activities after a hip replacement. Did I hear you right: you think it would be ok to run and jump and play hockey with a replacement?  This contradicts everything I've heard about hip replacement and wearing down the replacement too fast and the dangers of dislocation.

1.) How long have you been lifting all restrictions on replacements?

2.) What has changed such that you are comfortable placing "no limits" on replacement?

3.) What new data or information are you basing this new recommendation on?

4.) Aren't you among a small minority here?

5.) What devices are you using for this?

6.) Has there been some breakthrough in device longevity and stability that I haven't heard about?

Those are just my suggestions ... I really want to hear his answers ... not in a "challenge" way but in a "I'm really curious" way.

Robert (from Philly)

[JMP8888]

Whattsboss,
I live in S. Jersey, just outside of Philly. I was at Dr. Hozack's Vorhees, NJ office. Thank you (and everyone else on the board) for your input on this. I am really grateful to hear these suggestions and questions that I will be asking the doctor when I see him again. You can never be too informed, especially on  a decision like this.

[silky]

Thought I would share my experience.  I am now 8 days post Hip resurfacing by Dr Su in NYC.  I am from Philly and had 2 opinions by orthopedic surgeons in Philadelphia both of whom were quite different.  The first told me I had AVN or a stress fracture.  The second one was Dr Hozak.  A week before my appointment with Dr Hozak I spoke to a friend whom I had played golf with and had had hip replacement surgery.  I did not know the details when I had golfed with him previously.  I called him and asked him about his experience.  We were both very athletic prior to surgery.

He told me that he had had a hip resurfacing by Dr Hozak that had failed and he had to have it converted within the first year to a THR surgery also done by Dr Hozak.  He also told me that he felt the the resurfacing had not been done correctly but that the THR had ultimately worked out and he was back to golf. 

When I got to my appointment with Dr Hozak he told me that hip resurfacing had "grown out of favor" and that my anatomy did not lend itself to resurfacing.  I was ultimately sent to his surgical scheduler and I asked her if Dr Hozak was still doing resurfacings and she told me not for the last 6 months.  My friend directed me to seek out Dr Gross in South Carolina and then I found this web site.  I ultimately went to see Dr Su in NYC at HSS  for a consultation (only a short ride form Philly). 

Dr Su told me I that was an excellent candidate that he didn't think I had AVN and after his consultation I decided to schedule surgery with him.  He is soft spoken articulate and very genuine.  The Hospital for Special Surgery had the reputation as the # 1 hospital in the US for orthopedics.

As I said I am post op RBHR 8 days and can only say Dr Su was wonderful.  Professional and emapathetic.  When he came out of surgery he told my wife that I was a perfect candidate for resurfacing.  HSS was fantastic and the nursing care there was amazing.  The 2 night nurses that i had were unbelievably attentive and truly kind.  They were essential in my doing well.  I was discharged on the 2nd post op day.  I am on crutches doing PT at home and managing this phase. 

Philly is a wonderful city and has great medical care for the most part but I would urge you to seek out Dr Su for a second opinion and you won't regret it. 

By the way my wife and I stayed at the Bellaire hotel next door to the hospital.  They gave us a king sized bed in a 1 bedroom suite with parking only $ 15 a day.  I took all the angst out of it for my wife as she walked literally next door to visit and could stay late without having to cab it anywhere.  If yo have any questions just post them and I will be glad to help.  Good luck

[David]

Silky, I second all you said about HSS and Dr. Su. Glad all went well for you.
By the way JMP, if you are still seeking a second opinion at HSS regarding your replacement/resurfacing make an appt w/Dr. Su.  Dr. Kelly only deals with arthroscopic repairs and soft tissue injuries.

[silky]

I actually sent my films, MRI's, etc to Dr Kelly, Edgardo Santana is his PA and was great.  After reviewing my information, Dr Kelly was kind enough to call me and told me that he could not help me and referred me to Dr Su.  Worth exploring as Dr Kelly is an expert on arthroscopic surgery of the hip and if he can help you then that is the way to go.  Good luck!

[Jimt]

If this topic is still alive.  I am 9 days post op from Dr. Su and flew from Indiana.   I think Dr Su is the best surgeon in the world.

I too was told in Indiana that resurfacing had lost favor, THR was just as good, etc..... But at 45 I wanted to find a better option.   Thank god I found Dr. Su.   

Good luck!