Synovo, and how much metal is too much?

[jss]

I know we've all seen Dr Pritchett's videos of the Synovo.  As I feel like I have a few more Ironman races in me, and as from what I've seen, the Synovo looks to be the most high impact friendly, I've been trying to find information on that device.  The only things I can find online are Dr Pritchett's videos and advertisements for the Synovo.  Can anyone point me to a resource not associated with Dr Pritchett or the manufacturer?

Another question.  I already have three artificial joints (two cervical discs and one metatarsal/philange), one metal plate and four screws (in the cervical spine), and metal pins that were anchors to reattach my right achilles.  I am aware that wear debris from metal-on-metal devices can cause problems in some people.  Are there any thoughts when too much metal in the body becomes just too much metal in the body?

Make sense?

[shabbis]

I asked Dr. Pritchett about the Synovo during my last consultation with him, he recommended the traditional MoM BHR implant for people like me who do a lot of running.

[Dannywayoflife]

The synovo is VERY VERY new. The BHR is 17+ years old with the best track record in the world. In theory the asr was better than the BHR and we all know how that ended. When put in correctly the BHR wear rate is incredibly low. Were talking less than a micron per year of wear! A micron is 1mm devided by 1000! The human eye cannot register that small!

If it were me ( and if was 3 years ago & will be again next year) I would choose the proven BHR over any other device.

[jss]

That would explain why I can't find any more information on it.  From what I've seen it seems like it came out this summer or fall.

I was thrown a curve ball Friday and am not sure what to do with it.

I was told two weeks ago by a renowned arthroscopic hip surgeon that he could fix me with a scope, but it wouldn't alleviate the pain.  He referred me to an associate to be evaluated for hip resurfacing.  After he reviewed my images I heard back from that associate Friday.  He said that he won't perform resurfacing or replacement unless the patient is bone-on-bone.  I have half the joint space in my right hip as I do the left, but it is not bone-on-bone (yet).

I've also sent images to Pritchett, Gross and Rogerson, and expect to hear back from all of them before Thanksgiving.  I'm concerned that they'll give me the same line; come back when you're worse.  I'm in enough pain that I can't run or cycle, and that it's difficult to sleep, ride in a car (or do anything else), and that I never know what's going to happen with the next step I take.

Is it common for these three guys to turn you down because of images even though your in life-altering pain?

[Woodstock Hippy]

The top HR surgeons will not make you wait until you are bone on bone.  In my opinion, that is an old-school view that's based on the fact that a Total Hip Replacement will only last for around 15 years and you have to wait as long as possible.  I think it's almost comical that your first hip doc said that he will fix everything but it won't take away the pain.  Pain is caused when something is wrong.  What's he going to fix that leaves you in pain?

You've had a lot of work done already and I think you should really think about leaving long distance behind and embracing speed.  I raced long distance for years but since my surgeries, both knees, both shoulders, and bilateral hip resurfacings, I race Sprints and Olympics and I love it.  I can race every month and I can still do those long endurance building bike rides but I don't need to do them over and over.  This year I will be stretching it out to do American Zoffingan F1 (5run, 29bike, 5r, 29b, 5r), all up and over the mountains in New Paltz, NY, but I'm only doing it once, then going back to short course racing.

Good luck with you hip.  Keep looking for the RIGHT doctor for you.  Also contact Marwin and Su in NYC.  Maybe some day I'll be seeing you at Olympic Distance Nationals!

[Dannywayoflife]

It might be worth you having an MRI mate. My plain X-rays show very little OA in the joint and a healthy joint space but the MRI showed I have zero cartilage on my femoral head and very little in the socket. I had the same on my left side also.

[jss]

Comical?  Well, I chuckled a little too.  However, the first surgeon was an arthroscopic guy who doesn't do resurfacing or replacements.  He said that he could fix the destroyed labrum and cam FAI, but not the osteoarthritis; which he thought was the pain generator.

By the way Woodstock, I'm sitting here watching the guys come in off the bike at IMAZ; and it's KILLING me.  I haven't resolved to resume running if I have a successful resurfacing.  but it is going to take some restraint.  Perhaps that demon will be dead by the time I recover from the surgery?  A resurfacing will leave me with four artificial joints.  Do you have six???  2017 Olympic Nationals? ... Deal! See you there.

Danny, I've had an MRI and an arthrogram.  That's what the first guy used to conclude that fixing the labrum and cam wouldn't fix the pain.  The second guy said that the arthrogram and MRI were too blurry to get any info from.  I don't know.  I'm not as bad off as you were, but the right hip has less than half the joint space of the left.

Guys, thanks for the feed back.  I've only posted two threads, but the info I've gleaned from trolling this site has been very informative.

[Dannywayoflife]

Were here to help mate! hope you get sorted out

[Woodstock Hippy]

Trust me, if you get an HR from one of the top guys, you will be running again.  And you will be running better than you have been for years!  I started running again at 6 months and it felt great!  I did some 5k races that year then did my first tri at the Haliewa Sprint on Oahu. It was a great place to return to triathlon.  I've been racing, one sprint or oly, every month through the season and absolutely loving being back!

Not 6 artificial joint, six surgeries.  Knees: left one was a ruptured patella tendon and torn meniscus and right was a large flapping tear in the meniscus.  Shoulders:  right was a torn rotator cuff, torn labrum and a detached bicep tendon, left was a small tear in the labrum that I had to have fixed before I retired from work.

HR was with Dr Scott Marwin at NYU Hosp for Joint Disease three years ago and I don't feel them at all.  I was not bone on bone on my left side, but my pain was equal.

[jss]

Well fiddlesticks.

In the last 24 hours I've heard back from Rathjen (a Dallas area resurfacing surgeon), Pritchett, and Rogerson's PA.  None think I am a good candidate for resurfacing.  One says I won't have enough cortical bone on the femoral neck after the cam impingements are removed, and all three say I don't have enough good bone in the femoral head to support the BHR cap.  Two of them will do the BHR if I insist; but that seems ... unwise.

My problem is this.  In 1973 (I was 10), I was hit by a '61 Plymouth on my bicycle.  I couldn't walk for weeks because of right hip pain.  The doctors said there was nothing wrong with me.  What seems to have happened is that the epiphyseal plate of the right femoral head was damaged such that the head quit growing, and the neck only grew in diameter, not length.

So a THR seems in the cards for next year; I want to get it done before the unknowns of the ACA (Obamacare) are realized.  I've managed eight marathons, one IronMan and a total of a little better than 9000 miles covered on swim, ride and run since 2007; so I've had a good run.  I'll concentrate on the bike and probably do some full aqua bikes, and will continue to volunteer at races; but don't see ever running more than a mile or two at a time.

So, I'll be off to research THR.  Any words of wisdom would be appreciated.

[Dannywayoflife]

Really sorry to hear that buddy! A thr isn't the end of the world buddy. However the same mantra still applies with surgeon selection! Find the best surgeon you possibly can, bear in mind decent resurfacing surgeons are also top thr guys as well because a resurfacing is far more technically challenging than a thr.

Stay in touch and let us know how you get on buddy

Danny

[shabbis]

THR is still a good option and will last quite a long time. A guy I surf with has a THR and he still rips it up!

[Woodstock Hippy]

Sorry to hear about the bad news.  I would still contact the other hip resurfacing doctors and tell them that you've already been told that you don't have enough bone.  As an alternative to HR though, what about a large ball, metal on metal total hip replacement.  I think Smith and Nephew, the makers of the Birmingham HR that we love so much, makes one of those.  It would give you most of the benefits of the BHR except you lose a little range of motion.  You still lose a lot of bone but any THR is going to do that.  Even a large ball ceramic.  They are all better than the typical small ball THR.  Nobody likes having small balls

[jss]

Guys, thanks for the encouragement.  I've yet to hear back from Gross, but with what I've heard so far, I can't imagine him telling me anything that would make me want to attempt a resurfacing.  We'll see.  And yes, I've started researching THRs and the diversity of products there is greater than with resurfacing implants.  With all I've learned about the importance of large head size with resurfacing, I assumed it would be important in THR also.

I'll update this thread when something interesting occurs.  Hopefully something in it will help someone down the road as their trolling the forum like did.

[Woodstock Hippy]

Good luck JSS, don't give up on running again.  I'm still counting on seeing you at the starting line!

[Dannywayoflife]

Have a look at hiprunner.com

[einreb]

In the last 24 hours I've heard back from Rathjen (a Dallas area resurfacing surgeon), Pritchett, and Rogerson's PA.  None think I am a good candidate for resurfacing. 

Four years ago, Rogerson was very hesitant to resurface my hip when I first went to see him.  Gross barely flinched and thought it was definitely the way to go.  Mine was difficult (he said), but the outcome was outstanding.  This is a little awkward of a situation because you don't want to shop for the answer you want, but you should make sure that you fully investigate your options with those that have experience with difficult cases.

I'm coming up on 4 years and the last three years have included a ton of road racing and cyclocross. 

[Dannywayoflife]

In the last 24 hours I've heard back from Rathjen (a Dallas area resurfacing surgeon), Pritchett, and Rogerson's PA.  None think I am a good candidate for resurfacing. 

Four years ago, Rogerson was very hesitant to resurface my hip when I first went to see him.  Gross barely flinched and thought it was definitely the way to go.  Mine was difficult (he said), but the outcome was outstanding.  This is a little awkward of a situation because you don't want to shop for the answer you want, but you should make sure that you fully investigate your options with those that have experience with difficult cases.

I'm coming up on 4 years and the last three years have included a ton of road racing and cyclocross.

Excellent point mate. If you got to the reall top of the tree of surgeons and they say no they you can rest assured that it can't be done.

[jss]

Guys, I do appreciate the continued input.

Hmmm...  Pritchett said that I was neither a 'great' nor 'good' candidate.  Rogerson's office said that I was not a good candidate.  I've heard stories of children that were resurfaced where the surgeon thought they didn't have a chance of success, but the implant was still in place years later.  Gross is the only surgeon I've contacted that I've yet to hear from.  If he 'barely flinches', that will create a real dilemma.

einreb, what reason Rogerson give for not wanting to resurface?  What was Gross's reason for not having that same issue?  And congratulations on the excellent outcome.

[jss]

A dilemma in the making.

Last week I spoke with one of Dr Rogerson's PAs.  They said he would call me later but believed I was not a good candidate for resurfacing.  I just hung up with Dr Rogerson who believes that though my anatomy is unusual (because of an accident when I was 10), I have plenty of bone in the head and neck to support a BHR; even possibly returning to high impact activities.

I have opinions from two of the top guys.  Both will do the BHR, but one thinks I'm not a good candidate and believes I am.  Maybe Gross will break the tie.