Surgery with Dr. Heinrich for ARS in Texas Scheduled

[Showbart]

New here, 1st post, very helpful site.

48 yo male & going in 3/10 (actually this is a reschedule from 2/6) to resurface OA right hip with Depuy ASR by Dr. Matt. Heinrich. Reason for reschedule was for a few reasons, one being incomplete info, another was timing;Mon 3/10 is spring break, so easier on wife/small kids.

I couldn't have completed my info without this site. Much other important info was gathered elsewhere as well from JRI and Depuy. The Depuy info was not thru the general site but another one maybe for professionals. Alot of very technical info but there's patient downloads there too.

Amstutz goes on quite a bit recently singing praises for the Wright Med Tech Conserve Plus. In fact, Schmalzried was in on the design of the Depuy ASR and is currently installing them. It's exactly as described by the Dr here in archives as an improved BHR. A 4th gen redesign that to me doesn't appear to be lacking in the least when compred to the WMT C+. It has 14 size combos in 2mm increments including Unipolar femoral implants, whatever that is, in the same sizing range. This all meaning that there are alot of size options. All moot as the C+ does not have FDA approval yet, even tho it's being used for some years now in Europe. And in an odd move, WMT moved to block Johnson & Johnson/Depuy from getting FDA approval on the ASR. Very interersting.

Member(?) Beverly here had hers done by Dr Heinrich as well and was very happy. On a side note she offered to those here to drop here line but I don't see any Beverly in the member list and she posted no email address. Anyway, she said she exhausted her research, like I have now done, and came to the conclusion that Heinrich is tops. He consults with J&J (owns Depuy) and teaches the technique, as she mentioned.

I will be very staightforward here and say that Dr Heinrich threw me for a loop when I first saw him and this is one of the other reasons I postponed then rescheduled surgery. He told me that even tho my bone was in good shape that if he did a THR that he could practically guarantee that he would not have to ever revise due to wear or install failure. That the THR implant he uses and the way that he installs it would likely last my lifetime. To put it another way, if he did a resurface, a revision to THR would be a given in my lifetime. He may be basing this on average life expectancy, I don't know, and will be asking more about it this Tue in my preop. This may just be the cold, hard truth as professionals see it, but it is obviously contrary to why resurfacing exists in the first place. But also this is new technology and the data is coming in but is not all there, going out 20-30 years. This and the industry wants to sell us this new technique and if we need another operation down the road, well that's fine with them, they'll be happy to sell us the implants.

I know this has become a little cynical but really, I think Heinrich was telling me the truth. These things are personal we become very emotional about this stuff. But I got over it. He said that that final decision was with me and that barring anything clinical to divert to THR that he'd be happy to do the resurface. I will ask for the resurace for the obvious reasons, bone preservation, equals easier & faster recovery, natural body geometry retained and natural ROM. This all driven by the fact that I'm very active and have great demands of my body still.

If I learn anything new in my preop I'll post it. In the meantime I'm going to post a link here in the appropriate place to Depuy, I think it's a pro web portal, and there is a ton of info here on the ASR. The ASR doesn't seem to be as well covered as other devices IMO so this site was very important to me. Also everyone needs to reed Dr Amstutz's lates article at the JRI archive.

Best to all

[Vicky]

I would be very leary of going to a doctor that does not appear to believe in resurfacing as much as he believes in THR's.  To me that is a chicken way of telling the patient that he might just convert to a THR when he is inside.  I know of several people that this has happened to and i certainly would not risk being another one.  If you are willing to take that risk then go for it.  Dr. Amstutz is responsible for developing the C+ device, that is one of the reasons he speaks so highly of the device, he has a stake in it.  All devices claim to have a better design than the proven BHR device, but only time will tell on that subject.  Here is an email that I received from my doctor when I was doing my research.  Keep in mind that Dr. Bose has no stake in ANY device company and he chooses to use the BHR device for the following reasons.

"We orthopaedic surgeons find it difficult to weed out commercial promotional jargon from scientific data. I sure appreciate how difficult it would be for patients! Regarding the comparison of devices, the BHR was the original devise and the others are copies of it.
The BHR presently has a 9 year clinical history.
The 35 yr history of some metal on metal hip replacements  ( Ring & Mckee  Faraar) was the major catalyst that  led to the development of the BHR  and the Birmingham  designers took great care to duplicate the metal and clearances of the historical devices so that they can draw on the 35yr history. All other devices are deviances from the historical metal on metal THR devices and thus cannot draw on that history.
 
All other devices have a very short clinical history. Every manufacturer naturally will claim that their devise is the best and will quote varied reasons substantiating their claim. However , in any kind of joint replacement surgery , the track record is the most important feature and must be given exceptional importance. It is quite opposite of choosing a car, where the latest model is probably the best. The performance of a prosthesis when implanted may be quite different from lab tests. One can always exchange the car if it does not perform well but unfortunately in joint replacement  things are not so simple!
The ASR ( as all other prosthesis ) have claims of superiority on lab testing. This is completely different scenario from how the implant behaves after implantation in a patient. Only time will tell as to which of these will work and which will fail.
 Depuy ( manufacturer) claims that the ASR is better because it is  thinner than the BHR. Another manufacturer claims exactly the opposite  i.e. that their product is thicker than the BHR and hence superior. Their opinion is that the thicker component serves the resurfacing cause better. The same goes for stem. Some of the new designs have smaller design claiming less stress shielding and some other have longer and thicker stems claiming to  splint the neck of femur avoiding a fracture risk.
Thus you will find people changing some characteristics of the gold standard BHR and claim superiority.  Some of these changes may indeed be good. However only time will tell whether they are desirable changes or fatal mistakes.
The history of orthopaedic surgery is littered with similar cases. One of the most important and well known is the Exeter THR stem which currently has  the best results of a cemented hip replacement and can be considered to be the Gold standard. The manufacturer/developer surgeons decided to alter the surface treatment into a matt finish from a polished one. This resulted in a  very high failure rate but it took 6-7 yrs for someone to work out the association. The Exeter stem then went back to its original polished stem. Who could a guessed that a surface finish of a non articulating part of a prosthesis would cause such a drastic change in results?
The responsibility of the surgeon is not confined to the surgery alone. Post op performance of the implant is also a surgeon's responsibility . This makes me cautious.
 
 I am not a gambling man, hence I stick with the BHR. However, when the choice is not made by me , I do use other devices.  Patients have requested specific devices and i have used them. In other instances surgeons have asked me to use other  implants when i have gone over to  other centres to help them do resurfacing surgery and I have complied. I have nothing against other implants but no one can deny that they are a bit of a gamble.
 
I hope this helps.
 
with best regards
 
vijay bose
Chennai"

Vicky

[Pat Walter]

Hi Again

I made a response to your your other post.

This is a website for people to post their opinions and information about hip resurfacing.  There are many types of Hip resurfacing devices and only several are actually used here in the US.  Only 2 are FDA approved. That doesn't mean that the others are bad, they just are not as popular as the BHR which is used world wide.

I hope you will keep us posted about your surgery and info about the ASR.  I will revisit the ASR page and see if I can expand my webpage about it.  http://www.surfacehippy.info/hipresurfacingdevices.php At the time I made the page a few years ago, there just wasn't much available.  What I got was from Dr. Amstutz site.

Some of the experienced surgeons just don't want to go with the ASR because they is a much greater track record for the BHR.  Dr. Bose (over 1000 hip resurfacings)  and De Smet (over 3000 hip resurfacings) are included as 2 who don't use the ASR. Dr. De Smet told me 2 years ago that he would not use the ASR on me because some of his peers had been using it and had too many failures. So he would stick with the BHR. So I got a BHR.  I had asked if I should be getting a ASR.

Maybe things have changed some in the last 2 years. 

If you have some good info and want to make up a page about the ASR, I will be happy to post it with you as the author.  I like to have as much info as possible for people to read.  Or you can send more info to me to post.

I think many aspects of hip resurfacing are still being learned.  Many of the experienced doctors overseas expect their patients to keep their BHRs for their whole life.  It is never the device that fails, normally, it is the bone stock around the device.  We are at the mercy of our bones and how well they hold up.

I am very happy to have you as part of the Hip Talk group and will be interested in your experinece with Dr. Heinrich and your new ASR.

Pat

[Showbart]

I was and still am leary, comparatively, of a device with a 9 year history vs one with a 30 year history. He was pointing out the facts as he knew them. AND he has an interest in the device. I'd say that was an honest approach and not a chicken one. One thing I've learned for myself, and continue to make myself do, is to check my emotions at the door. Once I did this (yet again) after 1st visit, I realized that this doc was telling me something or saying it in a way that most docs wouldn't.

No one anywhere can say with certainty that a resurface will last 30 years. That can be said of a THR. Anyone middle aged or younger who doesn't think that they aren't taking the chance of revision later in life after a resurface is IMO kidding themselves. I'm willing to take that chance because of reasons I've already stated.

There's a big learning curve for this procedure and that, as evidenced by doctors responses posted here, mistakes made during installation are overhwhelmingly linked to failure rates of all devices. Given the ASR is new I took this into consideration. Schmazlreid at JRI (yes he has an interest) is using it apparently with great success. Failures with the BHR, again early in the BHR's US history and JRI's learning curve with it, have been identified by them and hopefully corrected with the ASR. Dr Pisani states as much here on this site. Also I think all Dr posts here have said it's the Dr not the device. I have every confidence in Heinrich, so far, and he didn't pull a switch on Beverly here. He wouldn't have racked up the #'s of resurfacings he's done or would he be teaching the procedure if he were doing some "chicken" bait and switch to a THR once he'd gone in.