Doctors using the direct anterior approach

[Beaglebuddy]

What is needed is a database indicating which Doctors use which approach.
Specifically, after some research I have decided the direct anterior approach will be the one I prefer and since I will be paying for this myself I will probably need to go outside the US for it to be affordable.
So, DAA outside the US anyone?

[John C]

Hi Beaglebuddy,
I read your other post, and am sorry to hear your story regarding the injections and follow up problems. It sounds like you are now on a good track of doing your research.
I have one thought to offer. While the anterior approach does have appeal and is becoming more and more common in THRs, I have observed that most of the top resurfacing surgeons prefer the anterior approach for resurfacing. In balancing your priorities in our search, consider whether the approach used or the surgeons experience and success with resurfacing should be most important. From my own research, I would be very leery of using a surgeon who was very skilled at using the anterior approach in THRs, but had not done at least 500 to 1000 resurfacings through that approach with a high success rate.
If you want someone local to talk to, there is a fellow on Kauai who had his hip resurfaced about six years ago at the age of 43. He used to be very active on this site going by the name of "hawaiieric". You might be able to PM him if you wanted someone on Kauai to compare notes with.

[chuckm]

Hi Beaglebuddy, I think you should continue your research on hip resurfacing and settle on the best surgeon instead of technique. DAA is an approach that evolved from surgeons doing total hip replacements. It is a quite different surgery than hip resurfacing. I think you will have to go pretty far down the line up before you find a DAA resurfacing surgeon. There are some top surgeons on this site who you can read about who have used the DAA approach only to abandon it because it was even harder to do and the patients recoveries were no better. One of the most visible DAA surgeons was Dr. Stefan Kreuzer from Texas. He has lots of videos on youtube. Someone on this site recently went to see him and he told them he has stopped doing resurfacing.

Chuckm

[toby]

John,
Just a little correction to your post..You stated..
'I have observed that most of the top resurfacing surgeons prefer the anterior approach for resurfacing. '
I think you mean most HR surgeons prefer Posterior Approach.
Regards
Toby

[John C]

Whoops, thanks for catching that Toby. You are of course correct that I meant that most top resurfacing surgeons use the posterior approach. From his reply, hopefully Beaglebuddy got my meaning.

[hernanu]

You might also consider Dr. Bose in India.

He is one of the best HR doctors in the world. People travel from all over to be treated by him, and may be very affordable compared to doctors in the mainland.

He also does free email consultation if you have your xrays and such digitally. I know he has a great reputation, and the trip to Chennai from Honolulu may cost about as much as one to the east coast on the mainland.

Just an option, especially if you're paying it yourself. He has done over 1400 HRs and is committed to the work.

[Granton]

So would you choose a less experienced, less successful surgeon who uses a direct anterior approach over a world-leading surgeon with great results who uses the posterior approach?

I know you said you didn't want this to be about the pros and cons of the technique, but I am fascinated about what research could lead to such strong feelings about something I would simply  leave to the expert.

I don't even know which approach was used for my two. Shows how much research I did!

[TheMcMinnCentre]

Hi

As other users have said, surgeon experience is key to a successful Hip Resurfacing. I agree with others and say you should look at surgeon experience & numbers rather than approach. Surgeons will do the approach they think will get the best results for the patient. The results of our first 1000 BHR at 15 years show a 95.8% survivorship (all sexes, ages, diagnoses). Looking at men only it rises to 98% survivorship at 15 years!!

If you are self funding your operation, as you know the US has staggeringly high charges and fees. The fee for surgery with Mr McMinn in the UK is £13,050 (All costs pending satisfactory pre-op assessment) and around £380 for the initial consultation and x-rays. I think you will agree it's a lot cheaper than in the US and you will be operated on by Derek McMinn, the inventor-surgeon behind the BHR. There is more info on our website for overseas patients...

http://www.mcminncentre.co.uk/overseas-patients.html

If you have any questions please just ask

Tom

[oldsoccerplayer]

BeagleBuddy,
I want to add my vote to those saying that the surgical approach is just one of the criteria you use when choosing a surgeon, and not necessarily the most important one. I'm embarrassed to admit that I did next to no research, I was referred to Dr. Gross because he is the closest geographically so I went to him.
A cousin had told me to get the Birmingham HR but the Dr. told me he doesn't do those, but he has done 3000 HR's so I didn't look any further.
As for cost, there was an in-depth article in the NY Times a couple of months ago about a US patient whose insurance wouldn't cover - in his case -  a THR. (Say what you like about Obamacare, but at least it does away with the pre-existing condition clause that hit this guy.) He had it done in Belgium for a fraction of the cost of the US equivalent. Apparently the device manufacturers charge much more in the US than overseas, even though they are manufactured here, not to mention the astronomical hospital fees.
The question came up about why these providers charge so much and the answer boiled down to "because they can."
Enough ranting for now, good luck with whatever you choose.

[chuckm]

Hi Beaglebuddy, your topic has us hippies getting feisty now. On this forum there are plenty newbies like yourself who have yet to get the procedure and there are many like me who face the aspect of needing their other hip resurfaced in the future. So sharing and discussing information is the purpose.

In my opinion, you shopping around for a DAA surgeon is a bit like a baseball manager shopping for a right handed first baseman. Sure there are plenty of good first basemen who are righties but generally speaking if you are searching for a quality first baseman, you are likely to end up with a lefty.

What is it about the DAA that has got you asking us where the surgeons are but not explaining? We are all just trying to help each other here.

Chuckm

[Jon]

My two cents on this one:

Met with John Keggi and spoke with his uncle Kristaps Keggi regarding anteriors.  Both were early proponents of anteriors.  I felt that it might be better for me given age, sports and recovery time. Also tried to find and assess some of the data with respect to results.

For me, decided that it was not going to be the silver bullet and I saw no compelling reason to go for it.

Went to McMinn.

Little over two years later, I'm biking, swimming, skiing, skating and running (5 miles yesterday) with little limitation. Triathlon season coming up in the spring and I'm hoping be be modestly competitive.

I'm obviously a big believer in going to the right guy with best track record.

 

[Pat Walter]

The top very experienced hip resurfacing surgeons use the posterior approach.  They have very excellent retention rates.  Only a handful of surgeons use the anterior approach for hip resurfacing because it is very difficult.  I personally don't think the anterior approach offers a faster recovery than the posterior approach for most people.  I had the posterior by Dr. De Smet with a a large incision.  I took no pain meds other than Advil after leaving the hospital and was out sight seeing 5 days post op in Belgium.  I never had the need to ice for swelling and neither did the other 6 patients there with me.  A lot depends on the surgeons skill if you have a fast recovery.  Sometimes it is just your body that makes a slow or fast recovery.  Our minds can't make our bodies heal faster.  The body has it's own timeline. 

Here are a lot of articles by the top surgeons about the surgical approaches

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

I always tell people that based on my history of reading personal stories since 2005, my interviews with the top surgeons and the national registry info - pick the most experienced surgeon you can and let them decide what device and approach is the best.  Each surgeon uses what approach works best for them.  It is that simple. 

We as patients really can read everything available, but until you place a couple thousand hip resurfacing devices into patients - you can never have the insight, knowledge and experience those surgeons have.

Choose a very experienced surgeon and let them suggest what is best for you.  It is like flying - you get on the jet plane and then your life is in the hands of the pilot.  You can even read everything on flying and be a pilot - but you are now in the hands of the plane's pilot.  You have to choose and then have faith.

Pat

[Pat Walter]

I said in the previous post that the top experienced hip resurfacing surgeons  - those that have done 1000, 2000, 3000+ use the posterior or anterolateral approach as Dr. Brooks does.  The few surgeons like Dr. Matta and Dr. Kreuzer simply have not done a thousand hip resurfacings with the anterior approach.

You will not find a hip resurfacing surgeon using the anterior approach that has done a couple thousand hip resurfacings.  I know that because I have been to almost all the hip resurfacing courses that the top surgeons attend. That is how I am able to do most video interviews - at the courses.  They discuss surgical approach, but the most experienced hip resurfacing surgeons use the posterior approach - period.

Look as much as you want - there are none that have done thousands or they would be on my list.

If this discussion gets too heated - I will lock it down or remove it.  I want to have  different opinions shared - but there is only so much one can say about surgeons using the anterior approach for hip resurfacing.  I have met Dr. Matta and Dr. Kreuzer personally.  I don't believe Dr. Kreuzer is doing hip resurfacing at all currently.

By the way, not all anterior approaches are used with the Hanna Table.  There are several ways of doing anterior without the table and I have watched the videos in the hr courses.

There is a much greater chance of nerve injury with the anterior approach and it is difficult to get good exposure for the acetabular prep and placement with the anterior approach. 

The surgeons are not lazy and willing to change their techniques if they feel there will be better positive outcomes.  That is how several ended up learning and doing the anterior approach. I listened to their stories about how difficult their first few surgeries were.  Some changed and some didn't.   I have listened to their journeys and how they have changed their surgical techniques thru the years since 1997 and how they have developed better instruments for the same reason.  The hip resurfacing surgeons are some of the best in the world.  Hip resurfacing is a very difficult surgery and most surgeons simply choose not to learn.  These are not lazy people that stay with old techniques because they don't want to work hard, they are constantly learning and changing.

Pat

[chuckm]

That's cool Beaglebuddy. The fact that you agree to find an experienced hip resurfacing surgeon lets us hippies who post on this forum know you are likely to have a good outcome.

But, as I suspected from when you first chimed in here, your reasons to pursue a direct anterior approach surgeon are all flawed.

From your description, I think you are taking TOTAL HIP REPLACEMENT research and using it to form your opinions about hip resurfacing. Total hip replacement and hip resurfacing are very different surgeries - not similar like you say. You don't go to Yale to learn hip resurfacing surgical technique.

One example of a mistake is " no cutting of muscles just spreading some out". That is factually wrong for hip resurfacing. You are right for total hip. But in resurfacing at the very least the pirifomis muscle has to be released otherwise the hip cannot be dislocated to perform the surgery.

Make sure your research is specifically about the resurfacing technique and not total hip if you want to understand why us hippies are so vocal here.

Chuckm

[bkeers]

hey,
I used Dr keggi in ct. for my right bhr. Was recommended to him by a climbing friend.
The surgery was in st francis hosp. in hartford ct. He has over 500 daa surgeries and
developed his technique at Yale university. So far things have gone great. Never needed
crutches and was back to work in 3 weeks. I also did a lot of research on this including the
device, procedure and doctors. I think my ranking was hardware first an foremost since
I'm an engineer I could wrap my head around that end of it. Then I was sold on Keggi which
was the 3rd doc I consulted.

Best of luck in you search.

[Pat Walter]

Thanks for every ones input.  If you have a story about your anterior hip resurfacing or any other hip resurfacing story, send it to me and I will be happy to post it.