Hip choices

[Daytona Dave]

I have been thinking about choices and the lack of choices I received when going through the consultations I recently went through for my second hip resurface.

After the consultation it was concluded that I needed a THR. I pointed out that I did not want this and that what I needed was a BHR. This was met with a 'no can do attitude' and backed up with examples of young people who had recently had THR with this hospital. And that my hospital no longer did BHR's. ( with no explanation why).

So I pushed and I finally got what I wanted. But I feel for the people who may not have heard of the BHR and were only offered the THR ( great that it is) but not given the option.
Great as the NHS is, its not perfect.
Whenever possible I try and spread the words...BHR!   

[oldsoccerplayer]

Agreed. All us Hippies need to be advocates for HR whether it be BHR or other devices. After my annual checkup last week I contacted my physiatrist - the Dr. who had been treating me with steroid shots for a couple of years before it was no longer effective. He had referred me to  a THR surgeon and didn't suggest HR as an alternative. The last time I saw him I told him I'd opted for HR based on my chiropractor's recommendation and he asked me to let him know how it went.
I wasn't able to talk to him directly but he asked his secretary to follow up with me. I told her politely but in no uncertain terms that I was disappointed that he did not at least suggest HR as an alternative and he should consider it for future patients who need surgery but want to stay active. In my case, thanks to the HR I am back to playing soccer, which would have been forbidden with a THR, so I'm happy I didn't go with his referral.

[Dannywayoflife]

Many in the NHS are VERY VERY anti hip resurfacing. And it can be a problem getting to a decent surgeon. But it all depends on if you have a decent gp or not from what I can tell! Hip resurfacing is the best option for many people but it's not for every patient and for those who are kit suitable for a resurfacing the new thr's are an excellent option and you can be very active with them also.

[Daytona Dave]

I do agree Danny.

What I mean is in my case, and I guess in some other peoples cases, it was not offered. It was not offered to me and yet I am a perfect candidate. It was only on offer after pushing.
How many other good candidates might have missed the option?

[Ken B]

I've met people with bad hips that were adamant about going for a THR rather than a HR even though they were in a demographic that screamed HR. I suspect that Dr. bias at the GP level could have had something to do with it in at least some cases.

I'm glad that I became aware of the HR option early on and did not abandon it during all the MoM and lawsuit hype that occurred but the more you research the more you learn all the pros and cons of the choices in that category and it seems like you can always find the next question to torture yourself over.

For me I thought I was totally up to speed for my situation once BHR became the only "FDA on label approved" device. Then, one month before my operation I re-visit the cement/cementless argument and I really feel like I missed something. In my case it ended up being moot as it would have required going through hell and highwater and then more highwater to go that route but I at least asked if my surgeon had any interest in the Biomet cementless device. It seems that the number of surgeons for that are pretty limited at this point but it also seems so promising long term - at least in theory, especially for high impact types where cement breakdown and femoral loosening make up the huge majority of failures at the far end of the current time scale. I think Dr. Gross's ongoing data is at about 7 or 8 years right now so if the next data dump shows good results maybe others will begin to show interest. For those going Biomet cementless these days I'm rooting for this to be the protocol that can really go the distance for you folks.

Oh well - I still have high hopes for my upcoming BHR as it does have a very good track record and I know I have chosen a great surgeon. I plan on giving it a good workout and hopefully I'll get many decent years out of it before it ends up on a lab bench somewhere.

[Dannywayoflife]

I agree Dave I've met several people who were perfect HR candidates but surgeons push them towards thr as that's what they do. It's terrible really but that's just the way the system is. Hence why I never take a consultants word as gospel and I only go to the top surgeons! And ALWAYS do my own research.

[Some Dude]

during all the MoM and lawsuit hype

"Hype" ?   Until you're the guy laying on the table getting a revision I guess, then it seems like a little more than hype...

BHR's are a great option, just make sure your surgeon is very well versed installing them. All those MoM problems and revisions didn't just come out of thin air, they were real people who believed in the BHR and their surgeons, and then got the short end of the stick.  You can downplay the problems as hype I guess since it hasn't happened to you, but not everyone has that luxury. Choose your surgeon wisely ! Good luck ! Hope everything goes perfect for you, I wouldn't wish a failed one on anybody 

[Dannywayoflife]

Ken the "cement loosening" with the bhr is a moot point. The guys that have been doing it the longest McMinn and Treacy have not had any femoral loosening as yet. The bhr is line to line unlike most other "cemented" resurfacing devices which have a "mantle".

[Tin Soldier]

The "hype" is the misinformation presented by ambulance chaser attorney's and people like Barry who write for the New York Times.  However, the risk of metallosis is not hype.  Its attached to some really solid data (2 to 4% revision) with most of the best surgeons.  Generally higher with less experienced surgeons.  I don't know how many of those are metallosis-related revisions, but some are.  So the risk is very low and I believe much of the un-informed ortho community makes a bigger deal out of it.

On the flip side, I would be very sensitive to dismissing the risk of metallosis if I had metallosis, as Some Dude pointed out.  I guess for Ken's benefit, I think the BHR is an excellent option as long as the surgeon has lots of experience.

[Dave Like Festus]

Great comments. My orthopedic surgeon never mentioned resurfacing to me, nor had I heard of it. It was just assumed I would get a THR when I knew the time was right. A good friend mentioned the BHR and Dr. Brooks and thus my research took a turn. Glad that my friend pointed me that way and now 3 weeks post-op, I can say I am really impressed.

Dr. Brooks and his team at the Cleveland Clinic - Euclid Hospital in Ohio were simply great. My recovery has exceeded my expectations. Talking to friends and family who had both types of surgeries reinforced the decision I have made!

Maybe there is some friction between the resurfacing docs and THR docs? Wow do we get the word out that this is an option?

Yes it does pay to do your own research and make an informed decision. A number of other coworkers are considering hip surgery AND none of them ever heard of resurfacing...just saying.

Wishing all of you hippys great results. Be informed.

David

[Ken B]

Thank you for that info Danny. No femoral loosening to date is a good record by those surgeons. Beyond the line to line issue I wonder if they're post install instructions play a role. My ham handed research abilities have me wondering what the role of formation, reduction, and stabilization of something called the "interface membrane" might be but perhaps that is getting too deep in the weeds for my own good.

And yes the use of the word "hype" without qualifying was a bad choice. I recognize that metallosis is an issue that I might have to deal with and sympathize heavily with anyone who has had that result.

[Some Dude]

Thank you for that info Danny. No femoral loosening to date is a good record by those surgeons. Beyond the line to line issue I wonder if they're post install instructions play a role. My ham handed research abilities have me wondering what the role of formation, reduction, and stabilization of something called the "interface membrane" might be but perhaps that is getting too deep in the weeds for my own good.

And yes the use of the word "hype" without qualifying was a bad choice. I recognize that metallosis is an issue that I might have to deal with and sympathize heavily with anyone who has had that result.

I was just trying to emphasize how important the surgeon is. You only want to do one per side if you can help it. "Never time to do it right always time to do it over" as my Dad used to say . Use the guy who is most likely to do it right !

[Dannywayoflife]

The surgeon is probably the biggest factor in weather a resurfacing will be a success.

[Some Dude]

The surgeon is probably the biggest factor in weather a resurfacing will be a success.

I think so. Wayne-O got 2 of the recalled asr's put in perfect, he's doing fine. I got the bulletproof bhr, put in wrong, 5 years later it came out. Sometimes when I look in here I see someone who is going to have a hr by a surgeon who "They like" or "seems like a good guy" or whatever and I cringe and cross my fingers for them. Even the "Gurus" get them wrong once in awhile. Law of averages says they can't all be perfect, why risk it with a less experienced surgeon ?     

[Dannywayoflife]

That's right mate it's best to go to a top surgeon and then your chances of a great outcome are very very good.

[dfox]

My experience was similar. Went to two hip specialist and neither one mentioned hip resurfacing. They suggested waiting as long as possible for a total hip replacement so it would last my life time. I love running so I was researching running after a total hip replacement (which doesn't appear to be recommended). I came across a post that mentioned hip resurfacing so I goggled it and found this website. I quickly became comfortable with the idea of hip resurfacing and realized there was no need to wait. I have recommended this website to a person I know suffering with bad hips.

Now I'm 14 weeks post BHR with Dr. Brooks and very pleased with the results so far.  Can't wait to start running again after the required 1 year healing period.

[Pat Walter]

Dave

Great to hear your story.  Dr. Brooks is one of the best!  Looking forward to hearing about the rest of your recovery and anniversary posts!

Good Luck.

Pat