Quid question why do surgeons prefer to do hip replacement rather than resurface

[Jaks111]

Why when having a consultation the surgeon does not discuss the alternative as in resurface, is it a more complication operation, can't seem to find the answer to this, I'm booked for my resurfacing on 11 th sept with mr treacy, who is happy to do the resurfacing where as other surgeons were not.
Any comments would be great.
Jacki

[Dannywayoflife]

It's cos thr is easy to do in comparison. So basically they are not good enough to do hr and don't want to admit it.

Your in great hands!

[hernanu]

Pretty much what Danny said.

I went to two surgeons who promoted only THR and advised against HR when I brought it up. This was at two of the more prestigious medical centers in Boston.

They said that at one point they did HR, but no more because of the metal ion problems. That is a valid concern, for those of us who develop it, but it is a small part of the results of an HR procedure.

What they also didn't mention was that the results from HR were equivalent in the short term to THR and I believe in the long term, better for active people.

They were also talking about traditional THRs, not large head THRs. They mentioned all of the things I would not be able to do, which sealed the deal for me. They were older and probably more practiced in doing THRs (my own editorializing).

I found my doctor after that. He looked me over and said I was a perfect candidate for HR. My thoughts were then and now, that after looking at the statistics, the results, etc. I still felt in my gut that preserving as much bone stock as possible and keeping the device to as small a body footprint as you can is the right way to go when it is possible

THR is a great alternative, I think when an HR is not possible. We have some great and active hippies with THRs who are living their lives joyfully. An HR does require more skill from the surgeon not just in the operation itself, but in selecting the patients, addressing any conditions that need to be ameliorated before doing the procedure.

So it's more work, and in the corporate health care monoliths that we deal with now, that kind of extra attention may not appeal when you can address the same condition with something both more expedient and that more surgeons with less training can do. (Again, my editorializing).

It's why one of the measures of success is finding a good surgeon. Not just skilled, but well practiced and with at least a couple of hundred procedures under their belt.

Just my opinion. I am closing in on three years on my hips and am thrilled with the results.

[podgornymd]

Hey Jaks,

I just had a BHR 4 months ago after doing alot of research and having orthopedist recommend THR. I am actually an emrgency physician and had to find out on my own abour HR.

I can tell you from a physician perspective that reasons are multifactorial for them not recommending it.

1. They never did it in their training and dont feel comfortable with it. We are so pressed for time and trying to keep up with all the new technology every year it is almost impossible to go back and learn something totally new and time consuming. I deal with it every year. Not only that they have to do so many to become proficient at it. Hern is correct ,they are having success with THR and doing 100's with good results why change.

2. Once something in medicine gets a bad rap such as the earlier BHR's it is difficult to look past it especially with lawsuits that follow. That causes a snowball effect which means it is not being taught in residency and once that happens they get out to pracitce or teach other residents and cant because they never did it. A vicious cycle!!

3.Europe is always light years ahead of us with most of these things because they dont have the FDA taking 10-20 years to approve something that really works and they dont have the medical liability we have here.most trials are done in europe or canada and after a good track record come here to the states.

4.The limited few doctors who went back and took the time, money,patience to learn something new are really passionate about it and feel like it would benefit people like us. They really have to believe in it to want to do it.

hope that helps.

eman

[Jaks111]

Thank you so much for the above comments.

[oldsoccerplayer]

I'm with hernanu: I first went to a traditional Replacement surgeon who gave me a list of things I would never be able to do again after surgery. Seeing my sad-puppy look, my chiropractor referred me to Dr. Gross who looked at my x-rays, age and physical condition and without blinking told me I should get a Resurfacing. I'm still in early stages of recuperation but based on how I feel and what I've read and heard from others I'm confident that this was the right decision.

[Granton]

2. Once something in medicine gets a bad rap such as the earlier BHR's it is difficult to look past it especially with lawsuits that follow. That causes a snowball effect which means it is not being taught in residency and once that happens they get out to pracitce or teach other residents and cant because they never did it. A vicious cycle!!

Hi Eman,

I don't think any BHRs got a bad rap, did they? The design hasn't changed.

Are you using "BHR" generically for hip resurfacing?

David

[hernanu]

I don't think that most HR devices deserve a bad rap but they certainly got one in the public image from all of the negative press during that feeding frenzy (that seems to have died down).

It is often perception that shapes public and corporate policy, and in this case the failure of a couple devices and the undoubted bad consequences of metallosis shaped the public and corporate discussion.

Truth suffered in this in my opinion and it was in fact the lack of credible evidence against HR as a dangerous procedure that rankled me. The success rate of a BHR, Corin, etc. devices were not considered or thought relevant.

If you ask some of the journalists who were involved, they lumped all devices in together. Both THR and HR, recalled devices and those that had functioned well over the years. So actual facts and experiences that did not fit a desired sensationalistic result were discarded or ignored.

So yes, I think the BHR and other devices did suffer an undeserved black eye in public opinion and the results will be that folks who could have benefited from one won't.

[chuckm]

I had been seeing the same orthopedic surgeon for almost a decade. He did some knee surgeries on me and did a fine job managing my arthritis related issues over that time.

But when my hips started to become arthritic at 42 years old, he basically told me to deal with the pain and when I'm in my 50's to then consider getting a THR.

I did lots of research on hip resurfacing and THR. I went back to him six months later and flat out asked him why he didn't get trained for resurfacing so he could resurface my hip. His reply was that he has no time and already had a full plate as a surgeon.

But to my surprise he then he advised strongly NOT to get THR or resurfacing. He ended by simply saying "just don't do it". But I sensed that if his medical group offered resurfacing that he would have recommended it. It was a that moment when I realized...although it is my surgeon, it's still a business too.

From then I was an empowered consumer, I researched even more, ended up at the Hospital for Special Surgery and got myself a BHR.

I haven't told him yet that I went elsewhere and the success that I had.

Chuckm

[Arrojo]

Truth suffered in this in my opinion and it was in fact the lack of credible evidence against HR as a dangerous procedure that rankled me. The success rate of a BHR, Corin, etc. devices were not considered or thought relevant.

If you ask some of the journalists who were involved, they lumped all devices in together. Both THR and HR, recalled devices and those that had functioned well over the years. So actual facts and experiences that did not fit a desired sensationalistic result were discarded or ignored.

So yes, I think the BHR and other devices did suffer an undeserved black eye in public opinion and the results will be that folks who could have benefited from one won't.

Well put.  When I first inquired about hip resurfacing to one of the most well known Sports Orthopedists in Boston, I was told about recalls, lawsuits, horrible pain and that I should never, EVER consider a hip resurfacing.

As I did more of my own research I learned that the recalled device and lawsuits had nothing to do with the BHR.  But many so-called learned and respected doctors don't seem to care about distinctions among devices or the experience of the surgeon when they talk about the 'horrors' of hip resurfacing.

They told me I would never run again.  Yet here I am, winning medals at track meets and running without pain.  But don't believe us; do your own research and convince yourself about the differences in safety of resurfacing implants and the differences in safety of metal devices between THR and HR.  And after you have educated yourself, find yourself an experienced surgeon and live a long and healthy, active life! 

Good luck!

[oldsoccerplayer]

Thinking about this some more, my Physiatrist (saw that word for the first time today) referred me to the traditional replacement surgeon and never suggested resurfacing. When I told him I'd chosen the resurfacing, he'd heard about it and asked me to let him know how it goes. Given that he knew that my goal (excuse the pun) was to go back to soccer, I don't know why he didn't.

[podgornymd]

yes my mistake. Not BHR but resurfacing.sorry

[podgornymd]

Just to reiterate from my previous post in terms of doctors not wanting to keep up with new research and technology or not having the time, i live and practice in the orthopedic capital of the world in vail colorado and am very close to the world renowned orthopedists that live and practice here and one of which is the "hip guru" of scopes and not one of them recommended Hip resurfacing. They still are living with the info from 20 years ago. They warned me about metallosis and there isnt the long track record of conventional HR,etc. I did my due diligence and found out about BHR and thought it was the way to go. Some of my ortho friends here still dont think it was the right choice. Oh well.Hopefully i will be skiing and biking past them when i get my fitness back.

eman

[hernanu]

I've got a feeling you will, eman... 

[podgornymd]

Thanks Hernanu. I will keep you posted as to when that happens.

Another analogy i like to use  in the medical world, there are great older inexpensive medications that we have used for years that work great but if 1 person out of million has a untoward reaction the FDA panics, steps in and puts a black box warning on it and it goes into hibernation and a newer much more expensive drug gets marketed by the pharm company and everyone starts prescribing it but usually 10 years down the road that cheaper drug we find out isnt so bad and it is back in full force. Like you said it causes a panic and gets a bad rep. Just like with HR. These orthopods are living on info from 20-30 years ago.

My 2 cents worth.
eman