newbie - another femoral neck fracture question

[northwiz]

Hi all - I read Peggy Gabriel's book and I've been poking around this wonderful site a bit for several weeks.  I have osteoarthritis, I am female and just turned 56 years old.  I was fine until about 10 months ago.  Now I am in lots of pain every day.  I was told that my right hip was bone-on-bone and I needed to have a THR.  At the first ortho doctor, I asked about resurfacing instead - he said I was not a candidate - "too much bone loss".  Then I learned how few doctors can do resurfacing, so I determined to see one who actually can do them (the doctor I had seen cannot).

Today I saw an ortho at a "joint replacement" institute – and he is listed on the Smith and Nephew site as doing BHR in my area - but notably he is not listed on this site’s (surfacehippy) list of doctors, where I also get to see a count of operations so far for the doctor.  Today he cited an Australian study (I just found on the web he means the one from 2005) about femoral neck fracture.  He said it was 1% overall chance but 5 to 10% chance on me because: 1) my femoral neck is not very wide; and 2) the outer bone on my femoral neck is very thin -- both as pointed out by him on the x-ray they had just taken – but how would I know what it *should* look like?  I asked about a bone-density scan - he said it wasn't needed.

What I just read here on this site and around the web about femoral neck fracture makes it seem to me like he was being pessimistic because BHR is not really what he does after all.  So now I will go have the same talk (again it will take several weeks) with a doctor who *is* listed as having done at least 100 hip resurfacings here on surfacehippy - and if it goes well, I will have learned my lesson about the Smith and Nephew list of doctors.

While I wait for that - hello!  And what do you think?  Do people get turned down for BHR because of expected femoral neck fracture -- based on one look at an x-ray?  Or was he seeing me as THR because THR is what he really does?
TIA,
Cathy

[Pat Walter]

Hi Cathy

Welcome to Hip Talk.  I will tell you that my exprience of reading posts and information for about 3 years is the newer less experienced doctors are very conservative.  They will often opt for a THR instead of a hip resurfacing just to make sure they don't have problems.

Even 100 or 200 resurfs don't make a doctor really experienced in the world of hip resurfacing.  If you have a difficult or more advanced hip problem, the more reason you need to get to the really experienced hip resurfacing surgeons.  I don't know where you live, but it is often worth traveling to make sure you get what you want.

Here is the most recent Australian study and you can see the revision rate for the BHR was 2.5%     The over all revision rate for the BHR since the US jumped in is 4%  You can see that at the top of this page   http://www.surfacehippy.info/vmbhrhistoryinfo.php

You never know where these doctors get there statistics. 

My best advice is find a really good experienced surgeon if your femoral neck is narrow.  That is one reason I went to Dr. De Smet in Belgium.  I was older with a loss of bone density and a cyst - he had done over 2400 hip resurfacings at the time. He is now over 3000.  I wanted experienced.

You can get some pretty good exprienced doctors in the US now with Dr Gross in SC over 1300, Amstutz in Ca and a few others.  Check out my list.

There is definitely a steep learning curve and the problems usually come in the early experiences of the surgeons.  If you have a special problem, go to the most experienced surgeon you can find that you like.

You don't need a bone density test to determine your bone density.  Dr. De Smet only uses x-rays, he doesn't use bone desity test.  Pretty much the US doctors use them to cover themselves.  Our health system is quite different than overseas.  Doctors are always conservative here and trying to protect themselves from lawsuits. That is why many won't even do women over 55.  De Smet and overseas doctors do much older women.  I was 61 when I was done.  I know of several that were 67.

Pat

[northwiz]

Thanks Pat!

I am belatedly reporting back in.  Dr. Crofford in Ft. Worth looked at the exact same x-ray and said my femoral neck is not narrow.  He says there is nothing in the x-ray showing my bone is weak or thin.  And he said he has done many hip resurfacings where the bone looked just like mine.  (In fact he said he has over 200 now, where I think he is still listed as 150 in your doctor list). 

So I am scheduled for BHR with him the day after my son gets out of school for the summer (so June 6).  I already have had a bone density - it came out OK -- the right femur neck had a 92% Z-score.  My cardiologist already faxed his clearance.  I have a few more to-dos to chase down.  Now I'm scared but on my way.

Thanks,
Cathy

[Pat Walter]

Hi

Dr. Crofford is a very good surgeon.  He wrote to me yesterday to get his stats updated.  He told me personally he is at 150 give or take a couple.  He's done 85 Wright C+, 35 BHRs and now using the Cormet from Stryker.

I am glad you kept looking until you found an experienced surgeon to give you what you want.  Many of the newer surgeons, just own't gamble on giving a hip resurfacing if the conditions are not perfect.  It takes a great deal of skill and some just haven't acquired it yet.

Good Luck and keep in touch.

Pat

[northwiz]

Pat, thank you so much for the words of encouragement.  That is good to hear about Dr. Crofford.  I will certainly keep in touch - I intend to be a success story.