During HR surgery is it possible that the dr. determines THR maybe only option?

[Chris F]

Got a consult yesterday.  Dr was extremely helpful and answered many questions. Looked at my x-ray and in conjunction with my age and other factors determined hip resurfacing would be best option.  Discussed so many things I may have misunderstood what I'm going to say next. Thought doc might have said that during the surgery if issues came up that would not make the resurfacing viable that he would go ahead and do the THR.  Does anyone know if that sounds right?

Been putting this off for so long but I've got to do it.  Reason I'm stressing it is a hip resurfacing is fine but a THR will require a lot more paperwork, effort, and luck to get me back to my career as an air force pilot.  Already left a message at the office but any advice will help till I hear back.  Thanks.

[kimberly52]

Sounds right to me.  When I signed my consent it stated "left BHR vs THR Stryker". Meaning that if when he got in there and found that for whatever reason he cold not do the BHR, then he would do the alternative THR. 

My surgeon explained that he needed to take some pathology of my bone or something like that. And that would determine whether he could go ahead with the BHR.

So basically my BHR was never a sure thing until he got in there.

Kim

[hippy hippy shake]

From what I gather, this is pretty standard.  However, when I discussed this with Dr. Su before my surgery, he clarified that he'd only had one case (I think it was one) where he could not do the resurfacing.  Depends on whether you've had previous work, bone quality, overall degeneration of the bone, or something else that the surgeon sees when they open you up, rather than what was expected from the x-ray.   Both HR and THR procedures are referred to as hip arthoplasty, which is what my contract stated. 

Talk to your doctor or their office and I think you should find some reassurance that they will do everything they can to do the resurfacing. 

[obxpelican]

Most doctors (this is going to sound harsh) that are well versed in hip resurfacings will tell you that it's only a tiny tiny percentage that they will have to switch to a THR.

When Dr. Gross did me in 2008 in the 3,000 + surgeries at that point I think he said he only had to change midstream once.

Doing hip resurfacings is much more difficult to do because they have very poor access to the acetabulum to set the cup properly and at a good angle.

Some doctors will switch you to a mid hip which is essentially a total hip since the head and a lot of the femoral neck is cut out.

Make sure you are dealing with a surgeon who has performed a lot of hip resurfacings, make sure to ask how many cups he's had to revise and how many times he's had to revise to a THR.

With this type of surgery experience counts and you want a doctor with lots of experience with good results.

My apologies if this sounds harsh but you only want to have this surgery done once.

Chuck

[obxpelican]

This is too funny, as I posted the below was being posted.

And yes, I am sure with Dr. Su it would be rare for him to have to switch to a THR during surgery.

Pick experience and you'll have a great outcome.

Chuck

From what I gather, this is pretty standard.  However, when I discussed this with Dr. Su before my surgery, he clarified that he'd only had one case (I think it was one) where he could not do the resurfacing.  Depends on whether you've had previous work, bone quality, overall degeneration of the bone, or something else that the surgeon sees when they open you up, rather than what was expected from the x-ray.   Both HR and THR procedures are referred to as hip arthoplasty, which is what my contract stated. 

Talk to your doctor or their office and I think you should find some reassurance that they will do everything they can to do the resurfacing.

[Pat Walter]

Normally, the top experienced hip resurfacing surgeons will tell you the percentage chance that you will get a hip resurfacing.  They are able to read the x-rays and should know going in what they are going to do.  Dr. De Smet would tell you that he will give you a hip resurfacing, but he did have a problem or 2 after doing 3000, so even he now tells you there is a very, very small chance of a THR.

Things can happen during surgery, but for the top experienced surgeons, they seldom do.  They know what they are going to do.  It should not be a decision made in surgery.  The less experienced surgeons will not be as sure about the results since they are "not very experienced."  You want to use the surgeons that have done a thousand or better yet, several thousands. 

Use the top experienced surgeons and you have a pretty good idea of exactly what is going to be done.  If your career depends on a hip resurfacing - don't take chances.  Only use one of the surgeons that have done thousands.

Also you should know what THR would be used if this surgeon is not sure what he is going to do.  I would not be happy approaching surgery without a decision about what is going to be done, but that is me after reading thousands of hip resurfacing stories.  You don't want surprises.  Unless you get a large ball THR, you will have restrictions.

Get several opinons before accepting only one surgeons guess that he is not sure what he is going to do.

Dr. Gross of SC, Dr. Brooks of OH, Dr. Rogerson of WI, Dr. Bose of India or Dr. De Smet of Belgium are a few that will give you a free email consultation.  Dr. Gross will actually call you after a few weeks.  Get several opinions and find out what the top doctors think so you can make an educated decision about what surgeon you want to use and what you will receive as far as hip resurfacing or THR.

http://www.surfacehippy.info/listofdoctors.php

Pat

[obxpelican]

Kim,

Many doctors take a number of x-rays and they have you take a dexascan to check bone density so that they know whether or not you will be a good candidate before they do the surgery. 




Chuck

My surgeon explained that he needed to take some pathology of my bone or something like that. And that would determine whether he could go ahead with the BHR.

So basically my BHR was never a sure thing until he got in there.

Kim

[obxpelican]

In the end it's important to ask a lot of questions before you pick your surgeon.

Ask how many cups he has had to revise, ask how many surgeries he has had to switch to a THR or mini hip midstream during surgery.  Ask about infection rates at the hospital he practices in.  Ask about his pain protocol.

Most of all pick an experienced surgeon with good results. 

One good example of not asking questions is my neighbor, he ended up with a THR with a small ball, he's now limited severly the rest of his life because he would not ask questions.

Most of all when you end up finding an experienced surgeon listen to him, don't be an idiot and push it too hard, your doctor wants and knows what is best for you.


Chuck

[Mike D]

Hi Chris, It sounds like the standard cautionary warning that you got and it does seem to be the norm.
I was told before my surgery by Mr Treacy that I was 70/30 against being able to be resurfaced, but this was due to  previous hip problems in my teens.
He was honest and wanted to do the resurfacing but it just wasn't possible and I'm happy with my THR . If you're under a very experienced surgeon, he will give you what you need-just make sure you go to the right one, first time.

[Chris F]

Just wanted to say thanks for the responses.  I'm on board with this and I'm trying to schedule the surgery.  Great to be able to find this board and read up on people with similar situations.  As much as I'd love to be able to run again and play sports, I would be happy with just getting a good nights sleep, and not having people I don't know very well asking me what's wrong with my leg =)

[kimberly52]

Hi Chick,

Yes he had my bone density before surgery.  It had something to do with bone pathology.  I will ask at my 6- week checkup.

Kim

[obxpelican]

To sum this thread up, most of the experienced surgeons can tell you whether or not you will wake up with a HR or not.

I do realize that some surgeons will cover themselves and tell you that you have a very small chance of waking up with a total hip.

I cannot say this enough though, ask lots of questions before you choose your surgeon we've seen way too many hippys end up with a less than positive experience.



Chuck