THR vs. BHR thoughts and advice sought

[whiteshoecovers]

I'm in the market for a THR and am shopping around for a surgeon and device.  I am attracted to the BHR but have my concerns.  After reading extensively on this forum, it seems like the default response for all BHR failures is basically an inexperienced surgeon.

Question: One of the contenders in my search has a rebuttal to the BHR in the FAQ section of his practice's website, it's Peak Ortho in colorado if you want to find their site.  I've pasted the most of it here since I can't post the link:

Note by Patricia Walter -  I am removing this quotation since it is only the non-experienced hip resurfacing surgeon's opinion which seem NOT to be based on any facts about the BHR.  Just info based on the ASR, which was not used much and certainly by any of the top experienced hip resurfacing surgeons.  When the BHR is placed by one of the experienced hip resurfacing surgeons on my list, there are very few problems.  Certainly not early failures from femoral neck fractures or metal ion problems.  I have medical study after medical study and personal interviews from the top surgeons that explain why a BHR is successful when placed by an experienced surgeon.  The overall retention rate at 10 years is 94% - the same or better than THRs.  Also for the individual top surgeons it is in the 98 to 99% retention rate.  The overall rate is from the national registries and includes surgeon from all experience levels. 

I am sorry, but I don't like info in print on this forum that is not based on medical studies or national registry info or information that only uses a small part of his resurfacing history like the ASR.  By the way, there are ASR patients on this forum that have had good results.  The design of the ASR is different than the BHR and was much more non forgiving if placed at the wrong angles.

I do not like new people to read info that is a non hip resurfacing surgeons opinion which is not based on facts.  Anyone wanting to read the info from above can go to the website.  Meanwhile, read the national registries here  http://www.surfacehippy.info/nationalregistries.php

the information by the top surgeons about why hip resurfacing is an excellent surgery
http://www.surfacehippy.info/positive-results-hip-resurfacing-2012.php

Personal video interviews with experienced hip resurfacing surgeons
http://www.surfacehippy.info/shvideos/doctor-interviews-Patricia-Walter.php

Doctor chat info

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

Hundreds and hundreds of personal hip resurfacing stories

http://surfacehippy.info/hipresurfacing/index.php

That information will give you honest information based on medical studies, national registries and top experienced hip resurfacing surgeons.

Good Luck with your hip solution.  I would really take time to review the info above and talk with the over 400+ folks here.  My BHR is 8 years old and going strong.  I was a 61 year old woman when I had mine done.

Pat


I would value this forums input on their note.

Statement: I've previously had my labrum reconstructed by Dr Brian White in Denver.  He is basically "the man" when it comes to this surgery.  He is well aware of the BHR and Dr James Rector nearby in boulder, but recommended a ceramic on poly traditional THR for my implant.  Please note that he will not be doing the surgery so has no skin in the game.  Also, I'm young (39) and would love to be very active again, and he is well aware of this as well.  It concerns me greatly that someone of his expertise and knowledge does not recommend the BHR.

[Tim Bratten]

This is someones opinon that is not an experienced hip resurfacing surgeons and just don't know the facts.  New perspecitve patients should not accept this info as truthful and useful.  Real real nation registry info, real interviews from actual hip resurfacing surgeons and hundreds and hundreds of real patient stories with EXCELLENT outcomes.  Pat They say: "We would have significant worry about a neck fracture in younger more active patients with a resurfacing device. In various joint registries around the world (i.e.. Australia), we are seeing increased complications from BHR including fractures and early failures"

I honestly believe this is absolutely false (the data from the 2012 Australian National Registry is in a thread here and I recall posting on this). At any rate, observe that the claim you quote is not backed up by exact figures or references. The BHR may be more problematic for women and smaller hips, but adjusting for that it performed better than THR  in the 2012 Australian National Registry (do a search here).

McMinn´s data at 15 years is this:
"In this lecture Mr McMinn talks about his results with the BHR at 15 years. The results are based on a cohort of the first 1000 BHRs (886 patients (598 Men, 288 Women)). These patients have had their BHRs 12-15 years and were operated on between July 1997 and August 2000. All of the procedures were done by Mr McMinn.

This cohort of patients are producing a survivorship of 95.8% at 15 years (both genders, all ages, all diagnoses). When broken down male survivorship is 98% and female survivorship is 91.5% at 15 years. These results are then broken down by gender and age and into diagnoses and head sizes also."

Also search Gross's data on this site (for different sorts of implants), which doesn't verify this claim.

In my case De Smet is very happy with his THR system, but I honestly think for someone your age he would recommend resurfacing for bone conservation ( I can personally verify that revision from resurfacing to a THR for me was no more complicated than a primary THR surgery)

Anyways, good luck with your choice. The BHR is not the only good option, but if you go for resurfacing, I recommend you choose a surgeon who specializes in this procedure.

[Dannywayoflife]

Honestly go see a proper resurfacing specialist. The top surgeons are seeing retention rates in the 97-99% range at over 10 years. The same cannot be said in active young thr recipients.

[3Chords]

 I'm just 7 weeks past my BHR and I went through all the same concerns that you've posed. I'm 62 but I'm really active, and tennis plays a big part in what I do when I'm not at work. Any solution would need to be a best-fit for an active lifestyle.

 After two years of "it's your back, do these exercises", a physical therapist got the x-rays and suggested that I talk to a surgeon. The surgeon recommended a THR, so I did a bunch of research and decided that a resurface was a much better solution. Both of the "traditional" hip surgeons only did THR, and neither had a good opinion about the resurfacing. There was one other surgeon locally who did the BHR, so he's the guy I spent some time with.

 In the Boulder area, there are at least 5 different surgeons who do the Birmingham system. If nothing else, I'd talk to one or more of those people and see what type of success they've had. My surgeon does around 300 hips per year, 50 or so are resurfacing. He had all the numbers for revisions (1 since 2006), recovery times, return to sports, all that data. Those surgeons with experience with both procedures are probably better qualified to recommend one or the other. (The BHR web site has a physician locator.)

 For me, only, I felt that a resurfacing was the better choice, because I could return to full activity in a reasonable time, the recovery was quicker, and it gives me a fall-back option should a THR be needed in the future. Hopefully, at that point, I'll be ready for the compost pile! (what happens to a chrome cap and socket when you are cremated? Can you use the remains for jewelry?)

 The surgery is a little more complicated, so having a surgeon with a lot of them under his/her belt is a plus.

 An aside - my mother-in-law had a THR 2 years ago, and exactly at 1 year, suffered 2 dislocations one week apart, and is now recovering from revision surgery. That made my decision pretty simple. 

 Best,

Jim

(FWIW - 7 weeks, post, riding road bike 20 miles 3 X/week, beginning to hit tennis balls, no restrictions, no pain...)

[Pat Walter]

I am removing the quotation in the original post since it is only the non-experienced hip resurfacing surgeon's opinion which seem NOT to be based on any facts about the BHR.  Just info based on the ASR, which was not used much and certainly by any of the top experienced hip resurfacing surgeons.  When the BHR is placed by one of the experienced hip resurfacing surgeons on my list, there are very few problems.  Certainly not early failures from femoral neck fractures or metal ion problems.  I have medical study after medical study and personal interviews from the top surgeons that explain why a BHR is successful when placed by an experienced surgeon.  The overall retention rate at 10 years is 94% - the same or better than THRs.  Also for the individual top surgeons it is in the 98 to 99% retention rate.  The overall rate is from the national registries and includes surgeon from all experience levels. 

I am sorry, but I don't like info in print on this forum that is not based on medical studies or national registry info or information that only uses a small part of his resurfacing history like the ASR.  By the way, there are ASR patients on this forum that have had good results.  The design of the ASR is different than the BHR and was much more non forgiving if placed at the wrong angles.

I do not like new people to read info that is a non hip resurfacing surgeons opinion which is not based on facts.  Anyone wanting to read the info from above can go to the website.  Meanwhile, read the national registries here  http://www.surfacehippy.info/nationalregistries.php

the information by the top surgeons about why hip resurfacing is an excellent surgery
http://www.surfacehippy.info/positive-results-hip-resurfacing-2012.php

Personal video interviews with experienced hip resurfacing surgeons
http://www.surfacehippy.info/shvideos/doctor-interviews-Patricia-Walter.php

Doctor chat info

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

Hundreds and hundreds of personal hip resurfacing stories

http://surfacehippy.info/hipresurfacing/index.php

That information will give you honest information based on medical studies, national registries and top experienced hip resurfacing surgeons.

Good Luck with your hip solution.  I would really take time to review the info above and talk with the over 400+ folks here.  My BHR is 8 years old and going strong.  I was a 61 year old woman when I had mine done.

Pat

[whiteshoecovers]

I am removing the quotation in the original post since it is only the non-experienced hip resurfacing surgeon's opinion

Why the heavy censorship? I think the opinion of an experienced orthopedic surgeon who used to perform BHR but stopped due to his concerns of its efficacy is very relevant, and at least as valuable as yours, who the best I can tell is a patient that now runs a for-profit pro-BHR website. 

[obxpelican]

I am removing the quotation in the original post since it is only the non-experienced hip resurfacing surgeon's opinion

Why the heavy censorship? I think the opinion of an experienced orthopedic surgeon who used to perform BHR but stopped due to his concerns of its efficacy is very relevant, and at least as valuable as yours, who the best I can tell is a patient that now runs a for-profit pro-BHR website.

It's not censorship when we remove silly remarks.  If you read this forum you will find that if you choose an experienced HR surgeon your results will be stellar, you will end up with a natural feel and in most cases unlimited use of the HR, unlike THRs.  Obviously your surgeon does not have the skills to perform HRs, it's much more difficult to set a cup when you have the head of the femur in the way, it takes great skill and not every surgeon can do that.

And I hardly think Pat is making anything on this site given the time she puts into it, the travel she's paid out of her own pocket.



Chuck

[John C]

Hi whiteshoecovers, and welcome to Pat's site. I know that you came here in search of answers and opinions, as most of us did. However, I think that you were a little harsh on Pat, and might consider a tactful apology. I know that Pat is very sensitive to the fact that people new to this field of discussion may have trouble separating facts established by published studies from opinions that may lead to confusion for newcomers. To honor your original intention, I did go to the web site you mentioned and read through the section on resurfacing. Having read it, I can understand why Pat would not want it published on her web site, since much of what was said contradicts or confuses the data. In response to your request, here are some of my thoughts (as a patient) to some of the statements in quotes from the web site:
1. "There have been a tremendous number of early failures with these large diameter metal on metal bearing (i.e. Durom and ASR)." First it is good that he pointed out that a high percentage of the failures were associated with these two brands that have been recalled, and not with the BHR or other successful brands. What is made less clear is that the next sentence implies that he is referring to failures in metal on metal THRs. He goes on to say that "One primary concern is the possibility that this problem we have observed may extend to these resurfacing bearings." Published evidence so far shows that the problems with some metal on metal THRs do not extend to well designed and placed resurfacing bearings.
2. His point is valid that preserving acetabular bone is at least, if not more, important than preserving femoral bone. This has sometimes been quoted as a concern for resurfacing. However there are studies published that show the same or less acetabular bone loss in resurfacings than in THRs, particularly among the more experienced resurfacing surgeons. One such study from 2013 appears on Pat's site.
3. The concern about femoral neck fracture is mentioned at length, but correctly points out that this is usually due to surgeon error, and is only common early in a surgeon's learning curve with resurfacing. It rarely can happen if a patient is too active during the first few months after surgery while the femoral bone is remodeling. For most skilled resurfacing surgeons, this risk is less than 1%, and becomes even less as their experience increases. My memory is that Dr Gross who has done thousand of resurfacings has never had a femoral neck fracture after the risk period during bone remodeling that extends six months post surgery, and many of his patients (like myself) are extremely active in high intensity sports.
I have no doubt that the procedure that the surgeon you referenced prefers is excellent, and would trust that he would be a great source of information on that procedure. However, I would look to top resurfacing specialists for up to date and accurate information on hip resurfacing.
Good luck in your quest for information and understanding in a complicated field. Most of us here on this site have gone through a similar quest and process, and have found this site to be a welcome and valuable source of information. We feel deeply indebted to Pat for her dedication.

[bluedevilsadvocate]

John C -

Very thoughtful and logical response.

I sometimes wonder what the failure/revision rate was for THRs during the 20 years after they were first used, when surgeons were going through the learning curve and devices that were poorly designed and/or manufactured were included in the statistics. My guess is that the HR statistics from the various registries and surveys --- which include results from all surgeons (regardless of HR skill level) and all HR devices --- compare very favorably to the early THR statistics; and the statistics for skilled surgeons using good HR devices are probably far better.

[chuckm]

I visited that website for Peak Ortho in Colorado and as you surf the site everything is quite positive about hip resurfacing.

But, if you stumble across that FAQ section you will come across that rant about resurfacing which contradicts the rest of the information on their site.

They really should remove that section because it is misinformed. In fact, I think the writer is being a bit dishonest too when he cites the performance of the BHR in national registries.

It is a very small orthopedic group so it is probably just as well that they dropped out of the hip resurfacing business - especially if they were having problems.

Chuckm