Dr. Robert Gilbert of CA

[BerkeleyGirl]

Hi Pat. I want to recommend Dr. Robert Gilbert at the California Pacific Medical Center in San Francisco. When I first met him a month ago, he said he'd done 280 HRs, all BHRs, and he's been doing a few a week, so rapidly growing this part of his practice. He's known as a senior surgeon at CPMC and has won a "patient choice" award. I think he has been the head of orthopedics at CPMC. He hasn't advertised resurfacing operations as some docs do, but now he's doing LOTS of them. Right away he told me the number he'd done, the failures (2), the reasons why (femoral neck fractures, women), and what he did about them (both revised to THR successfully, keeping the acetabular cup). He uses spinal anesthesia, which worked very well for me.

He's no-nonsense -- precise, clear, concise, very focused in his demeanor, just what you want in a surgeon -- but I wasn't intimidated; he was friendly and available for questions. In fact after my first appointment he told me to call him because surely I'd have more questions after I reflected on everything. We ended up talking one evening, and though he's a busy man (he had done a few resurfacings that day) and I didn't want to dally, I felt I could ask all my questions.

He also told me how the operation itself worked, for instance how the bruising and swelling in my groin and inner thigh were from the machine that essentially squeezes my body when it's lying on its side so I'm held absolutely still as they do the operation. Afterwards I saw all kinds of lines drawn on me... this surgery is like geometry.

Also important is the overall surgical team. The nurse who pre-admitted me over the phone spent a ton of time was me and was so friendly. The anesthesiologist spent lots of time with me the morning of the surgery. The PA (?) who held my hand and steadied me as they did the spinal anesthesia was calming and gentle. The nurses during my 4 days post-op (at my request and surgeon's recommendation I stayed an additional day for more PT) were extremely attentive. I never had to wait more than a moment after ringing the call button. Really, every  CPMC person I dealt with -- and there were a lot -- was terrific.

Two days ago, on a rainy Friday, Dr. Gilbert's assistant, Alisha, personally brought me a new prescription (for narcotics, so couldn't be called in) on her way home since she was driving to Berkeley to get her kids, so I wouldn't have to find someone to drive into San Francisco or wait the entire weekend for a different pain med.

When I walked into the operating room and looked around at the blinking machines, equipment, and several people preparing for the surgery, I thought WOW... I can see why this operation costs so much, and it's worth it... and I realized I would be so nervous if I didn't trust the surgeon and team. But I felt quite calm because I DID trust them all.

So, another suggestion for your list!

Berkeley Girl

[debkakes]

Thank you a million times, Berkeley Girl! I have my first consultation with Dr. Gilbert on Monday, and this post has put me SO at ease! *breathing sigh of relief* I hope he accepts me as a patient and books me for this surgery SOON so I can be free of pain -
Best,
Deb

[hernanu]

Oh, good, Deb - glad you found one.

[OtterDriver]

Dr. Gilbert?

Unless he has changed his mind...Dr. Gilbert told me (maybe nine months ago) that he wasn't performing the surgery anymore!?  In his early 70s and calling it quits supposedly.  He was highly recommended by one of his patients I spoke with here in Alaska however.

Be curious to hear what you find out!

Good luck, Bruce

[debkakes]

Had a consultation with Dr. Gilbert yesterday. Not only is he NOT doing surgeries any longer, he is no longer really recommending the BHR. There is apparently a LOT of concern about metal ions in the bloodstream of BHR recipients, as mapped by countries like Australia, and more and more evident in the USA. So....back to the drawing board....

[hernanu]

Hi Deb, you might want to look at the Australian results yourself. They are in the National Registries page of the main site, here are the latest results: http://www.surfacehippy.info/pdf/aoanjrreport2011.pdf it takes a bit to load, but it's the full 2011 study.

Quoting from it, (Pg. 105):

"Reasons for Revision
The main reasons for revision of primary resurfacing hip replacements are loosening/lysis (34.8%), fracture (32.3%), infection (8.0%), metal sensitivity (8.0%) and pain (5.6%) (Table HT63).

The five most common reasons for revision are shown in Figure HT36. The incidence of revision for fracture increases rapidly in the first year, however after this time the incidence increases at a slower rate. Loosening/lysis shows a linear increase and at just over five years exceeds fracture to become the most common reason for revision. The remaining reasons for revision have a low incidence.
Type of Revision

The main types of revision of resurfacing hip replacement are isolated femoral (48.2%), total hip replacement (41.7%) and acetabular only (6.8%)"

A couple things strike out at me here:

• Of all revisions done on HR patients, 8% were from Metal issues. The largest bulk were from loosening/lysis and fracture (femoral neck, I assume) which made 67.1 % of the reasons for revision.
• The revisions done involved mostly revision to still keep an HR (femoral or acetabular) 55%, with THR being done 41.7% (don't know where the other 2.3% went  )

None of us underestimate the metal ion issues with HR, but there are ways of minimizing those by choosing both the prosthesis and the surgeon carefully. I just think we need to keep perspective here, and do as much research as is possible.