BHR newbie to be

[Patches49]

Hello all,

Let me begin by saying this site has been a blessing for me reading about how life changing the BHR resurfacing device has been for people. This being my first post to this forum, I will need to work out the bugs a bit. To make an extremely long story short, I am slated to have my left hip resurfaced in April at Twin Cities Ortho with Dr. Thomas Nelson. I played football in high school and college and developed mild hip impingement and arthritis, and for several years continued to be physically active. Some freakish way I contracted two strains of staph in my hip last February and for a month thought it was just arthritis. I saw two orthopedic surgeons and a chiropractor who did not know I had the infection, fortunately after a meeting with Dr. Nelson he knew right away that my pain levels were too severe to be related with hip impingement. Not being prepared to have surgery that day to I&D my hip, it was fairly traumatic, only being put under for wisdom teeth removal prior. Unfortunately the infection had already had such a hold in my hip that it destroyed the remaining cartilage and I went in the following week to have a trial hip spacer put in with antibiotic beads. I was in the hospital for 3 weeks for PT & OT. Then spent 4 months doing more aggressive PT in Stillwater.

So now being about a year later I am anxious to get my active lifestyle back and be pain free for once! So my skepticism about this BHR is how well it will last in a person at my age and withstand a few more years of abuse. I was told to wait as long as I could so that I could finish school and graduate. That being done now, I see no reason to wait. Thanks y'all!!

Patches49

[hernanu]

Hi Patches, welcome to the site. I see you're 24 - we've had several other people who have had the bad fortune to lose cartilage at a young age. 

Dannywayoflife was 28 when diagnosed, had his done at 29 (pretty sure), he can fill you in on his thoughts and feelings on the matter. Several others have also had theirs done at a young age, one I remember (whose Mom was on here) was 12.

As to the longevity, we are the first generation of large scale users for this type of device, so all I can point you to are the national registries, the most reliable of which (to me) is probably the Australian registry.

Their record of success, as measured by not needing to be revised to a total hip replacement (THR), is on the order of 96% at the ten year mark.  Ten years are as far as they have measured, so at that point, with all doctors good and bad, with devices, most of which have been good, but a couple that had flaws and were recalled, that is the overall rate of non-revision.

No one can predict the future, but given the statistical results so far, it is encouraging to see strong performance from the HRs that folks are now using. There are anecdotal stories from people who were really ahead of the game and have had a an HR for 20+ years and are going strong, but they are not something you can bank on when you are looking at statistical results.  Nice stories, though.

I've treated it as something that gives me back my life when I can use it, and if the time comes when I need to revise to another HR or a THR, I'll be thankful for the good years I've had.

[Tin Soldier]

Welcome, also.  As usual a great response from Hern.  I like what he says about the perspective many of us have on the idea of longevity and waiting for something "better" to come along.  It's definitely a popular topic here.   I do think its a harder decision at a young age like 24.  For me at 43, I was thinking I could wait through the pain, but for 5 years or even 10 years to maybe have a better solution?.  I think it's unlikely that there will be a much better device or procedure in that period of time.  It wasn't worth the wait.

The stats for revision show a higher number of revisions in the first 4 years and that if you get past that timeframe you are more likely to not have any problems for 10, 15, 20? who knows how long.  Keep in mind the average success is 96% for ten years or so.    I think McMinn's recent dataset showed 98% success in 14 years.  There is also no obvious drop in longevity at 10 or 15 years, so there's really no reason to believe that the device won't last longer than that.  Those long term data are just not available yet.   

Danny will probably chime in here. It would be good to hear from him on this.  We've certainly discussed this topic a bit here.  I really think it's good to have the perspective from a younger person. 

BTW - that is a crazy story about your hip.  Good thing the infection didn't get worse. 

[Dannywayoflife]

Hi and welcome please excuse my short reply as I am currently in the middle of preparing a presentation.

I assume from your tag you are 49? If that's the case then what's to worry about? If you go see a TOP SURGEON then there really is VERY little to concern you. Obviously you are concerned about longevity. Let me put it this way. McMinn and Treacy in Birmingham both have patients at 20 years ( obviously on the earlier deceives) with no problems. Treacy told me he has reviewed patients wih the current BHR at 15 years with phernominal levels of activity with no adverse results. Now when I asked him about the BHR's longevity he was very diplomatic. He would onu tell me facts really. He stated that in my demographic( no offence but I wasn't right interested in other demographics at the time) was as near dam it 100% I think it was around 98-99% @15 years! I managed to get out of him that he didn't see that changing significantly at 20 years and be said that at 25 years they all won't just fall out! Realisticly someone around 50 I susspect will never need a revision.

Danny

[hernanu]

I think Patches is 24, Danny, which is why he was interested in the longevity of the procedure / device. Maybe his handle should be Patches24 

All that you said holds well, though - pick a top surgeon, let yourself be healed for the foreseeable future and let realistic analysis, hope and the good results currently available guide you beyond what we know now.

It is a hopeful thing since we don't have results beyond a certain point, but we are seeing good things, so for me that was enough. Not doing anything was not an option, so to continue being active, the choice was clear.

[Dannywayoflife]

Like I say I am not personally worried about the longevity issue of these devices now. Do I think at my age ill take this to the grave? No I don't but I do expect this to last me probably 30+ years. It's not realisticly possible to wear the device to the point I won't work. If that we're the case the guys like the iron men and pro cyclists aka landis etc would wear out the device very very fast. A pro cyclist aparently averages 30+ million hip cycles per year that's ten times the average person so in effect ten years of normal wear per year in situ.
I personally think the positioning of the device and the long term bone health are the most crucial factors of longevity

[Patches49]

Thanks for all the information. I had an appointment with my doctor last week and he said that he has done 150 hip resurfacing procedures with 3 failures. Two of which the patients were at fault. He has earned my trust from the previous procedures he has done for me, and he must be fairly competent for the fact he specializes in orthopedic cancer treatment and hip and knee replacements.

 As for the longevity questions, I am going to be as active as possibly without overdoing it. I don't have to worry about two a day practices anymore so that is a relief. Have a goal of competing in the Warrior Dash in July so I hope to be ready for that. Any of you guys ever rode bucking bulls? I am wondering how a hip would hold up. I have an itch to get involved in that. Let'er buck.

Patches49

[Tin Soldier]

Bull riding?  Yikes, I suppose if you didn't fall off and have a huge animal step on your pelvis, you'd probably be fine.  I haven't seen any posts about bull riding, but that doesn't mean someone out there isn't it with an HR. 

I don't think the bucking on your butt would be too much more intense than some of the forces one receives from other fairly intense sporting activities like skiing, hockey, soccer, motor cross, snowmobiling, horseback riding,... The jerking back and forth does seem to be a little more intense, but it's a short duration.  I've only watched bull riding, looks like the more intense joint action is in the vertebrate and shoulder.  I guess the main concern would be the obvious - falling and getting stepped on.  I think that would be an easy way to ruin a good HR.

I'd ask your surgeon and see what he says.

Maybe you can get a full pelvis protector that's articulated, maybe a steel jock strap that has wings or something to cover the hip area.  Actually, that might be more dangerous, than nothing.

[tedroberts]

Patches, Dr. Nelson replaced both my hips with BHRs in Jan. of 2009.  I feel hip resurfacing and BHRs in particular is the most robust way to replace hips.  I hope mine last my lifetime.  I was 50 when they were replaced and expect to live past 90.  I downhill ski race, golf,
inline skate, lift weights and basically stay active (no bull riding though).  I think  you have made a good decision.  Good Luck!