So many questions

[Dave H]

Hello,

I'll be 44 in March and I have hips in need of replacement.  I'm a very active person and compete in long distance trialthon, competitive cycling, running, skiing, hiking and playing with my 9 and 7 year old kids.
In Feb 2012, I got a twinge in my left glute while running and it was followed by weeks of quad, groin, hip flexor and lower back pain.  I treated it with PT or months until my chiro suggested an x ray which revealed arthritis.  Apparently, the femoral head never formed correctly and it finally wore away the cartilage in the left and will also eventually do so in the right.
I've seen 4 ortho docs and have had cortisone shots but they no longer work.  I scheduled surgery for Jan 15 and am still not sure about my decision and have so many unanswered questions. I've lurked on this sight for a few month and finally decided to post.

I've talked with fellow cyclists who have had HR with Drs. DeSmet and Gross.  The two surgeons I've seen have both gone away from HR and do mostly THR and have also told me that there are no limitations with today's THR, but from what I read it seems there may be.

The pain I deal with is tolerable, but not optimal.  I would like to return to competitive age group athletics, but most of all I want to chase my kids around, play hoops and be able to bend over to pick up the ball, and get up from sitting without feeling like an 80 year old.

So, my questions are:
Are there activity limitations w/ a THR vs. an HR?
Is there a minimally invasive technique for the H

I've read Dr. Gross's rebuttal to the Lancet article re: HRs, but I was hoping to get some responses from patients.

Finally, I live north of Boston, MA so any recommendations of Drs. in MA would be appreciated.
Quite honestly, I'm frightened.  I want to get it fixed, but am afraid if I don't do my due diligence and something goes awry, I'll only have myself to blame.

Thanks,
Dave

[Marco Polo]

Dave:

I can certainly appreciate your dilemma.  I am older than you but have similar challenges in terms of my hip pain interfering with my ability to engage in certain physical activities.  Further, even though I no longer feel the need to run marathons, staying physically fit is very important to me and I want to continue to run for fitness, downhill ski and golf.

None of the doctors where I live (Grand Rapids, MI) do resurfacing and I was told my only option was a total hip replacement (THR).  Fortunately, I have a good friend who is a triathlete who had his hips resurfaced in 2007 and he let me know about resurfacing. Through this website and others I am convinced of two things:  (1) the likelihood of a successful outcome with hip resurfacing is at least as good as a THR if you have the surgery performed by a surgeon who is very experienced with hip resurfacing; and (2) While THR is a good option for older patients who do not want to engage in impact sports, it is not a good option for younger patients like you who want to return to a high level of physical activity, particularly impact sports like running or basketball.

I am scheduled to have my right hip resurfaced by Dr. Gross the first week of April.  As I am sure you are aware, he caters to out of state patients.  Other experienced surgeons that are close to you are Dr. Clarke in Syracuse and Drs. Su and Marwin in NYC.

This is major surgery (definitely not minimally invasive like hip arthroscopy), so it is definitely wise to proceed carefully and with full knowledge of the risks/rewards.  Based on the many positive experiences of others who post on this board regularly, I am comfortable that (at least for me) the balance tips decidedly in favor of hip resurfacing.

I hope this helps and I wish you all the best.

Marco

[hernanu]

Hey Dave,

Welcome to the site (posting). I'm from the Boston area, had both hips done by Dr. Snyder at Newton Wellesley. I've had a great experience with him, along with several other hippies here, but there are a couple of folks here who had issues from being treated by him, so despite my full trust in him, have to let you know that for your research.

There's a good HR guy in Rhode Island, Dr. Marchand, who has done good things as well. If you want to get back to that level of activity, you might want to check Dr. Su in NYC out. He seems to do well with athletes and has probably the most experience in this area. Woodstock's doctor Dr. Marwin is another who has a lot of experience.

To me, the choice at 44 would be clear. An HR gives you minimal loss of bone stock, is structurally more like the original equipment, and is likely to hold up better under the types of stresses that we put it under.  I just finished a full 45 minutes of kicking the heavy bag at full speed. At the black belt level, that's a lot of pressure, but stepped away from it without anything other than exhilaration.

Whichever doctor you choose, interview them, ask them the questions on this site and get yourself fully comfortable. It is scary, but I can tell you from personal experience that it is the best personal decision I've ever made.

Good Luck...

[Limper]

I am in a similar situation.  I just turned 43, and my left hip is a mess.  The pain varies between annoying and debilitating, but it is always there.  It often wakes me up at night, which is particularly annoying.  After several years of ibuprofen, surgeon consultations, x rays, MRIs, and lots of poking around on the internet, I have come to the conclusion that resurfacing is the best strategy for me.  It's not easy to find good information, and much of what is available is offered by parties with an obvious bias, like the companies that make the various appliances.  Having said that, there seems to be some consensus that when installed by an experienced surgeon, the failure rate of resurfacing in men is about the same as the failure rate for hip replacement, possibly lower.  While disputed by some, there also seems to be some reason to believe that resurfacing permits a patient to engage in more vigorous activities.  So, where I come out is this -since the failure rate is roughly equivalent, I may as well have the surgery that might permit me to engage in more running, skiing, etc.  If the claim that resurfacing is more durable turns out to be false, I'm no worse off than if I had a replacement instead.  Basically - same risk with either surgery, and a chance at more upside with resurfacing. 

I'm booked for January 11.   Good luck to you. 
 

[hernanu]

That's right! Yours is coming up. Good stuff, now you'll just have to come up with a different handle afterwards. Limper won't be right for long.

[patrick_d]

Hey Dave -

My story is very similar to yours, as are several others on this forum, and I have just rolled past 6 weeks post-op.  I live a 4 hr drive away from Dr. Gross and would have gone MUCH further to have him be my surgeon.

My pre-op story and discussion is here: http://surfacehippy.info/hiptalk/hip-stories/countdown/

And my post-op story and discussion is here: http://surfacehippy.info/hiptalk/hip-stories/countdown-complete-on-to-recovery/

Read through and feel free to ping me (PM or post here) with any questions.

Best of luck.....Patrick

[Dan L]

Welcome Dave;

There are many high drive athletes of all varieties and ages here who have great stories about return to what they love to do after HR, and many also know the science around THR and HR to a very deep level of detail, Hernanu for example.  Most seem thrilled about their new hip(s).

After 12 months with the anterio-lateral (side of hip) approach, I have no restrictions after BHR.  Other surgeons have restrictions of less time, but may or may not also include a 90 degree restriction to avoid risk of dislocation.  There are different approaches to the HR, some of which have larger incisions (see this pic for example http://surfacehippy.info/hiptalk/gallery/?sa=view;pic=14 )  some smaller, but none are considered as "minimally invasive" as far as I'm aware.   It pretty serious "hammer and chisel" work at the end of the day.

As far as general feedback, although I'm not an athlete, I am active ( walking/hiking) and hope to remain so for a very long time, and after 2 HR's, my 2 cents is the improvement is just short of magic afer 14 months/10 months, and continuing to get better.  An experienced surgeon who has done many hundreds/thousands seems to be the most important variable in a successful outcome.

Dan

[dwbitt]

Hi Dave,

I can't attest to the lack of limitations with THR, the folks I know with the Total Hip procedure are all cautioned by their Doc's to avoid impact activities to prolong the life of the their device.

I just turned 67 and and Dr. Su did my LBHR 14 months ago. Not only is he one of the most experienced in the country he also performs the procedure at arguably the best facility in this country. HSS has an excellent reputation for the lowest infection rates and the best outcomes for their patients.

Minimally invasive and Hip Resurfacing are probably mutually exclusive, my scar is 8". In order to perform the necessary remodeling of the Femoral Head it's necessary to have unrestricted access to it. The amount of muscle cut is minimal, I doubt it's any greater than with a 'Minimally Invasive' procedure.

After my surgery I was back on the Trainer in 7 days and back on the bike in 3 weeks, I can't imagine a 'Minimally Invasive' technique would have been significantly better.
Most important at your age is the possibility of a revision in the future. Should my BHR eventually fail it would be a relatively routine procedure to perform a Total Hip Replacement, the BHR preserves the femoral head and does not drive a spike into the Femur which often must be removed/replaced in order to revise a Total Hip procedure in need of revision.
There is also a more normal 'loading' of the Femur which keeps the existing bone stronger then it would be with a Total Hip Replacement.

I hope this provides some food for thought.

Best of luck,
Dave

[obxpelican]

IMHO I would choose one of the following in no particular order:

Dr. Gross
Dr. Su
Dr. Brooks

This forum has many many happy hippies from these doctors, personally I chose Dr. Gross based on talking with him on the phone and the posts that I saw from Dr. Gross's other patients. 

Chuck

[Ross]

Dr Gross and then Dr McMinn.  If there using cement I would want McMinn way longer track record than any other cemented femoral BHR surgeons.

[einreb]

I'm a very active person and compete in long distance trialthon, competitive cycling, running, skiing, hiking and playing with my 9 and 7 year old kids.

it all sounds so very familiar.

i'm almost at my 2 year post resurfacing with Dr gross.  did an easy/cold 60 miles today on the bike and will be doing a brutal 90 minute compu-trainer session tomorrow.  my resurfaced hip is the only thing that wont hurt... will come home and play with the kids.

its not an easy decision and a tough process to get to that decision point.  its good to question, so keep asking...

-Bernie

Edit:  i'll touch on the minimally invasive question.  this is MAJOR surgery.  thr may advertise as being minimally invasive, but the chopping off of the top of your femur is serious business.  for what its worth, my resurfacing scar is 3.5 inches long.

[stephen1254]

You've received a lot of very good suggestions here, particularly with respect to doctors. If you go back to your original two questions, yes you have physical limitations with a THR that you don't have with a HR, and no you can't get away from the invasive nature of the surgery. A key for me was that a revision to a THR was possible after a HR, but not the other way around.

However, 9 months post-op, I am not concerned about a revision to a THR. My new hip is fine, and works better than the other one. I am convinced that this is the best possible long-term solution for me. I think if you dig into the studies you will find that there are a number of factors that work in your favor. Men do better than women, as they have larger bones, Athletes do better than non-athletes, as they have denser bones. Younger patients do better than older patients as they haven't experienced as much bone loss. Put that together with an experienced surgeon who knows what he is doing - and you've been given the names of several - and I believe your odds are better for long term survivorship of the HR implant than with a THR.

It's a bitch to have to make the decision period - it would be so much nicer if we didn't have a joint failure. Having said that I would not get a THR without talking to one of the doctors recommended to you.

[Woodstock Hippy]

I'm a little late to the conversation but I've been busy putting up the stonework on the fireplace in my new addition.  Also, I ran 5 miles in the snow this morning.  Yesterday I did 1600 in the pool than an hour on the Computrainer.  I can tell you that with HR you will get back to whatever level of activity you want.  The doctors that say there will be no restrictions with a THR don't realize what we want to do.  I talked to a lot of doctors in NYC before I had my surgeries with Dr Marwin and most were against HR.  My first hip doctor, Dr Boetner at Special Surgery, treated me with cortisone until like you it just didn't work anymore.  He's listed here as a HR doc and he's the one who first told me about HR.  When both hips were killing me and I told him I was ready for surgery, he told me the HR would be no good and that I should have a THR on the right, keep getting cortisone on the left and learn to take it easy.  That afternoon I made an appointment to see Dr Su, also at Special Surgery but it was going to be about a month off.  I was seeing two other orthopeadic surgeons at the time, one for my shoulder and one for a broken tow.  They both told me that I could get a Mini-Hip or ceramic THR and have almost no restrictions.  The shoulder guy said that one of his patients now plays golf all the time and has no problems.  I told him that I wanted to run and race the mountain bike.  He said well..............I made an appointment to see Dr Marwin, who I found here and he explained hip resurfacing so well to me that I left his office pretty sure that he was my guy.  He said that the doctors who turned against HR didn't put the time to learn the procedure, to learn from the experienced surgeons, he studied under McMinn, to do the cadaver work and get it right before working on live patients.  HR is a very technically demanding surgery for the doctor.  THR is easy compared.  On a HR, alignment is crucial, it's steel on steel.  If it's not right, it will cause problems.  A THR has a poly liner in the cup and has room to blend in
So, to fast forward, I had bilateral HR on 11/15/2011 at NYU Joint Disease Hospital.  Stayed there for nine days and walked out there using only one cane.  It's been a great recovery.  I started running again 6 months after surgery with no problems.  I put two additions on my house this summer; framing, roofing carrying my own shingles, sheetrock, and now stone work.  I started running races again this fall and I'm ready for a full schedule of multisport racing next year including American Zoffingan Duathlon in New Paltz which I've wanted to do since it started but was too broken down to do. 
You already have a good list of experienced HR doctors to chose from.  Talk to them all and decide which one you trust the most.  Keep doing you homework,  ask the THR doc if you will be able to run.  Make your choice and next year when you are chasing after your kids with no problems you be glad you got it done.

I'll see you at the races.  I plan on having some great results in the 60 to 65 age group before I hang it up!!

[Miguelito]

Hi Dave,

Plenty of info on here for you to decide on THR vs HR, but as I am from just south of Boston I wanted to chime in on Boston-area considerations.

I did the research and felt HR was the way to go. I met with a doctor at the Baptist who supposedly did both, but that was BS. He told me that he only did HR when a femur was deformed enough that he couldn't jam a spike for a THR down it. He also lied to me about a couple of other things. Worst medical experience of my life. His last name begins with a T. Maybe he was one of the ones you consulted.

I was very surprised that there did not appear to be a first-rate option for an HR in the Boston area. I know, a little snobbish. From internet research Dr. Snyder appeared the best Boston-area option. What Hernanu wrote about him is exactly what I read. I had an appointment with Dr. Snyder (and would likely have gone with him) when I had the terrible consult at the Baptist with Dr. T. It turned out to be a blessing in disguise though, because I was so disillusioned that I decided to do what most here recommend; go to the best surgeon you possibly can.

I thus decided to look out of state, consulted with Dr. Gross and wound up going with him (as you will if you talk to him). I never regretted it for an instant (well, maybe while being frisked by TSA at the airport, sigh...). My brother is a nurse who used to work at the Baptist and he told me that it is surprisingly common to have to travel for certain procedures, and that vaunted Boston is not the mecca for all surgeries or treatments.

I had the exact same qualms that you did. Deciding to go with one of the widely acknowledged best (there are several) in the world decided me, and removed those qualms. I consider myself extraordinarily lucky to be able to go to one of the best in the world, and to have had, at least to this point, a very successful result.

Good luck with your decision and your hip!

Mike

P.S. Dr. Gross does minimally invasive (I'm pretty sure). My scar is like 3.5 inches long. Unbelievably small. I'm not sure the recovery is shorter or anything, it's major surgery, but it is technically minimally invasive.
Plus, I heard that there is now a nonstop from Boston to Charleston SC, on JetBlue (there wasn't this April when I went down there). Jet Blue does a wonderful job catering to people post-surgery. I could not be a bigger fan of an airline. Or a surgeon.

[Ross]

Dave,

Like many others here you have to research for yourself and find someone that you are comfortable with changing your body for the rest of your life.  If distance to travel is your biggest concern then Dr Su would probably your best bet as he is in NYC or Dr Marwin.  Your options are limited to a handful and if someone tells you that they can do it and they have done less than 500 to 700 I would run or limp whichever is easier.   The biggest thing is you coming to grips with the fact that you are going through with it.

[B.I.L.L.]

Dave,

 Your options are limited to a handful and if someone tells you that they can do it and they have done less than 500 to 700 I would run or limp whichever is easier.   

Run, limp, crawl, roll, whatever you can do the fastest. Best advice so far, do not use anyone but a resurface SPECIALIST. It's a more complicated surgery, and the angles are critical, get it right and you're a happy camper, get it wrong and you'll wish you'd never heard of resurfacing. It's all about the doctor, if you have to travel then travel. Just my $.02 
Good luck !

[Mr.Box]

I'll add my 2 cents. Dr. Su or Dr. Gross are both excellent and worth the trip to see either. I'm not saying that anyone else local isn't worth it, but experience ( # of surgeries ) and training seems to be the way to differentiate between surgeons and outcomes.

I'm about to go ice skating again for the second time this month and I'm 3 and 1/2 months post op. Dr. Su is very aggressive with patients getting back to their intended activities. I'm cleared for return to Ice Hockey at the 6 month mark. ( Goalie ) That's saying alot when you realize the strain, pressure, and pounding the joint takes while playing that position.

There are a great many patients on the site from Dr. Su and Dr. Gross. Both will let you know their experiences.. but as a person who is able to break away from his own personal experiences I'll tell you this:

Not many people on this site wouldn't do the operation again. From what I've observed in the months here, everyone has regained activity levels previously unattainable with PT. Do your research, see the doctors and post many questions to this forum. It's been said numerous times by most of the posters here... Without this place and the support of the people who post, some of us would have been very lost. 

[Mike D]

Hi Dave, I'd go for HR every time but do make sure you're a candidate for it before any assumptions .
I found it quite hard to accept that I couldn't have HR but mine was due to a childhood slipped femoral epiphysis that required pinning for a year.
Thankfully, I found this forum and slowly got my brain around the facts. I got a Ceramic/Oxynium THR in August this year which I am completetly happy with but if I could have chosen it would have been HR -mainly because of the bone conservation and easier revision should it occur.
Take your time, research deep and you'll make the right decision, best of luck and keep us posted, Mike.

[Tin Soldier]

I don't think there are many HR surgeons who believe that the THR wouldn't need restrictions forever.  That's not just to make you go wtih the HR, there really are a lot of good reasons to go with an HR, all of which have been posted.  I think the big issue with the THR is that the shaft that goes into the femur will cause excessive lateral forces on the femur when running, jumping, side to side cutting,...over time that will cause the femur to fracture and the shaft to loosen.  I haven't heard on a new THR system that would not cause this same type of stress to the femur.   Keeping a native femoral neck (presumably with a little flex) will allow one to do the same type of impact motions without worry of having the component loosen. 

Good luck Dave - I totally understand the position you're in.  This site is a great a resource, so keep asking questions if you need to. 

[Dave H]

Thank you all very much for your thoughtful and informative responses.  After reading them all, I was convinced I was going to cancel my surgery and consult with the recommended Drs.

Yesterday I made an appt w/ Dr. Su and I can't see him until April 15th!  Then I went sledding with my kids and afterward I was ready to keep my Jan 15th surgery date.
I couldn't imagine waiting another minimum of 5 months to have surgery.  I asked to be put on the cancellation list.  I will call Drs. Gross and Marwin tomorrow.  Is there any surface hippy secret code to get to see Dr. Su sooner?   

It's a small window of time, but how do you suggest I get more information on my local surgeon?  He did tell me HR was an option and it was my decision to make, but he'd recommend the THR if it were up to him.  I don't have AVN, so getting the HR is an option.
I asked him for patients I couldd speak with and he gave me three.  2 THRs and one HR.  I got one call back, but when I didn't hear back when I left a message.  That was mid December and I tried again yesterday.  I find it very unsettling they wouldn't call me back.

After reading all your replies I was excited to know that I could have my active life restored.  Then after 5 climbs of a substatial sledding hill, I was right back to 'f*&% it, I want it done now."  I also look at putting it off until I can get one of the best to do it as an oppurtunity to regain some lost fitness and really commit to 'training for surgery'.  IOW, do the things I can and will help me such as swimming, cycling (mostly on the trainer now), and all the hip strengthening and core I can tolerate.  Then, when I can't tie my shoe, that all becomes just nice thoughts.

One final thought.  I asked two of the surgeons I've seen why I wouldn't be better off going to a more well known facility in Boston.  They both told me they had opportunites to work at one of the well known hospitals in Boston, but didn't want the life that went with it and preferred living north of Boston for quality of life reasons.  So, how the hell can I determine if they may be excellent, qualified, and skillful physicians but they just happen to quietly go about their practice?  My google searches have not come up with anything substantial.

Again, thanks for your help.

Dave