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Author Topic: Brand new to the forum- Brian- 33yo male, considering HR. soccer, weightlifting?  (Read 7689 times)

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briandb

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Hello all,
My name is Brian.  I am brand new to this forum.  I am a very active 33yo male considering a hip resurfacing.  My Background:
My father and grandfather both received bilateral THR's relatively young- my dad's first one was around 50.  I started having lots of hip pain about 20 months ago. After my first ortho saw my X-Rays he said I had very bad OA, told me I needed to stop any impactful exercise, that I should never run again, play soccer again, etc and that I was going to need bilateral THR's young.  My left hip is the only one that is very painful, but XRay's in my right hip also show degradation of cartilage.  He said he didn't want to do my THR until I was 40, so that I should take naproxen, lay low and get cortisone shots when necessary.  His exact words to me were that he wouldn't give me a THR until I absolutely couldn't bear the pain anymore physically or emotionally.  Awesome.  I am a very active person- I played soccer competitively since I was 6.  I also coach soccer camps.  For my job, I am a small business owner, owning, managing and coaching at Commonwealth CrossFit, a small gym, in Somerville, MA specializing in private and group training, utilizing CrossFit's methodology as well as standard strength and conditioning methodologies.  We are a pretty tame CrossFit gym.  We downplay the competitive side, and focus on training our athletes to be healthy for their whole lives (not just their 20's and 30's!). 


So, basically, my job is to teach people to run, row, bike, jump, squat, deadlift, press, clean and jerk, snatch and performa a variety of bodyweight movements.  As you can imagine, it is extremely frustrating to have painful OA that limits me to about a quarter of a squat. I cannot even reach a barbell on the ground to deadlift it without having to sacrifice my spinal positioning (round my back) just to reach it. 


I had a second opinion orthopedic surgery appointment to see Dr. Scott Martin at Brigham and Women's.  He was referred to me as being one of the best hip surgeons in Boston.  At that time, I was hopeful that I might be able to receive a surgery for FAI.  Upon meeting with Dr. Martin, he told me that my right hip was too far gone for any FAI procedures and that my left hip was close to being too far gone for FAI.  He mentioned Hip Resurfacing metal on metal, but he doesn't perform these, only his colleague Dr. Ready performs these. I hadn't really looked in the the hip resurfacing because I was totally scared by the metal on metal shedding ions into my body warning I had received. 


Recently, my hip has become so painful, I feel like I must do something.  My quality of life is awful (for me).  If I were a relatively sedentary person, I suppose I could go on like this for awhile, but being that my work is in a gym, every day, I find myself painfully trying to demonstrate unweighted movements I can't really demonstrate at all.  On tope of this, I have been gaining a lot of weight.  My family has massive history of heart disease (both grandfathers mad multiple heart attacks and died pretty young from heart disease, father had heart attack at 58, etc.)  So, I feel like it is a greater risk for me to sit around and risk heart disease than to seek out some option for my hip. 


I found this forum just last week and have been so encouraged.  I literally started crying at my desk watching videos of people who are running, playing tennis, even soccer after their HR surgery.  I feel hope for the first time in about a year and a half that I might be able to return to at least jogging without pain, and at most, return to soccer or weightlifting without pain and without breaking down my THR too soon. 


When I look at the pros and cons of Hip Resurfacing vs. Total Hip Replacement, the largest thing that stands out to me is the preservation of bone.  If we look at what surgery looked like 30 years ago, it is so hard to imagine the progress we will have in medicine in 30 more years.  In the last 10ish years we have seen the introduction of Hip Resurfacing, the Superpath procedure for THR without dislocation and many other advances.  I feel like if I can preserve as much bone as possible for as long as possible, medicine might come up with new and better ways to treat me.  Once the cut off your femoral head, drill it out and jam a metal spike down into your femur, there seems to be not much left for future surgeons to work with.  The opportunity to make the most out of future medical advances seems like reason enough for me to pursue a Hip Resurfacing rather than Total Hip Replacement.  My current inability to perform normal (for me) activities like walking for 30plus minutes, hiking, running, performing squats and deadlifts and (hopefully) playing soccer in some way in addition to my constant pain, is my reason for wanting to pursue the procedure sooner rather than later.  Do those of you who have done the procedure think I should hold off as long as possible?  How would you characterize your quality of life after recovery compared to before surgery? 
I am interested in pursing Dr. Gross as my surgeon.  I have seen people mention that they hesitate going to him because he doesn't use the birmingham thing (I only ever heard of all this stuff 5 days ago, so bear with me!!).  What device does he use?  I am also interested in Dr. Marchand (he is close to Boston and I could actually see him with my current insurance plan.  Finally, I have read amazing things on here about Dr. Su, but he doesn't seem to accept any insurances I have access to. 


I am so appreciative for everyone on here who has shared their experiences.  Thank you for taking the time to share with this weird community of bionic hips.  I am so encouraged by you all.  Might I actually play soccer or run again?!?!  Thanking God for you all. 


Brian

Comfortably Numb

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Welcome to the discussion, Brian.  As of today, I am exactly 5 weeks post-op with Dr. Gross.  My recovery has gone remarkably well, and I can't say enough good things about Dr. Gross, his staff, and Providence NE Orthopedic Hospital.  He has performed over 4000 resurfacings to date, and often accepts patients with difficult conditions that other doctors have turned away as far as hip resurfacing is concerned.


I had all of the concerns that you have expressed.  I saw Dr. Gross three times over a 2.5 year period as I took injections and waited for my groin pain to get bad enough to pull the trigger.  During that time interval, I was forced to go on Medicare which meant that I would have to pay Dr. Gross out-of-pocket (he doesn't accept Medicare patients).  The hospital (Providence NE), however, does accept Medicare so all was not lost.  I was also concerned about his "off label" use of hip prostheses until I learned his tremendous success rate and that he designed much of what he uses
http://www.grossortho.com/doctor.htm


You first need to determine whether or not you are a candidate for resurfacing.  It won't cost you anything to contact his PA, Lee Webb, and have your Xrays evaluated.  She can be reached at: LeeW@midlandsortho.com  Also, insurance concerns can be addressed by contacting Midlands Orthopedics : http://www.midlandsortho.com/forms/index.html
Insurance concerns with the hospital can be addressed by calling Providence NE: https://www.providencehospitals.com/locations-directions/providence-orthopedic-hospital-%28northeast%29/


You are already way past where I was in terms of pain when I finally set up a surgery date.  I don't see anything that can be gained by waiting for resurfacing.  On the other hand if total hip replacement is your only option, then knowing that it may have to be redone in 15 years would cause me to wait a long time. 


I hope this works out for you.  Keep us posted.
Right HR, April 29, 2015, Dr. Gross and Lee Webb; Uncemented Biomet Magnum 60/54 and Recap AHA 54;
30 degree angle

chuckm

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Hey Brian, welcome to the site! You are correct, you are so lucky to find this forum and website.
Dr. Gross uses the Biomet Magnum and Dr. Su uses the Birmingham hip resurfacing system.
In the US those are the top two devices. What your research will show you is that if a surgeon implants these correctly in a properly selected patient (especially a healthy male), it is nearly a sure thing that it will be successful. Implanting a hip resurfacing device (correctly) is a very difficult surgery - a surgery beyond the skill of many surgeons. So you want to choose a surgeon who has demonstrated that he/she can, and has, implanted thousands without problems. You don't want a surgeon who gets it correct only 9 out of 10.
Most top surgeons won't perform resurfacing until the arthritis has reached a bone-on-bone condition. The bone has gone through changes at that point that will allow it to better support the device. If both are that way then both can be done together.
The surgery is so life-improving that even out-of-pocket money should be considered to get the best surgeon (in my opinion). You should contact Dr. Su and ask his assistant to go over expenses and coverages.
You will return to all your activities to the same level as pre-arthritis if you are patient and work at it.
Good luck,
Chuckm
Left BHR 11/30/12
Hospital for Special Surgery
46 years old

bluedevilsadvocate

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Brian -


You might also consider Dr. Brooks at the Cleveland Clinic. Dr. Brooks uses the Birmingham device, and has performed over 2,300 resurfacings. He offers free email consultations, and accepts many insurance plans. Here is his information on the Surface Hippy website:


Free Email Consultation[/size]Peter Brooks MD, FRCS(C) - BHR trained McMinn 2006, Treacy 20072300 Hip Resurfacings to date ***Cleveland Clinic9500 Euclid AvenueCleveland, OH 44195Phone 216-444-4284 (toll free 800-223-2273)Email:  [/size]brooksp@ccf.org[/b][/color]Cleveland Clinic Website


And here is a recent study that he co-authored, which I believe reflects the success of his surgeries:


http://www.surfacehippy.info/positive-results-1333-patients-dr-brooks-2015-study.php


Much success to you.[/size][/font]
LBHR 10-20-2010
Dr. Brooks - Cleveland Clinic
Age 62 at time of surgery

hernanu

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Hey Brian,

I've been bilat for almost five years now. I had mine three months apart, was very active before the HR's (35 years of full contact Tae Kwon Do, soccer, league basketball, weight lifting and chasing kids around). Had to stop all of those (except the kids, no dispensation for that) before the surgeries.

After the surgeries, I eventually picked up on all of those, some (basketball) at a lower speed, but the rest, especially the Tae Kwon Do and the weights, back up fully. Soccer recreationally now.

Of course after the right wait, which for me seemed to be about a year post surgery.

You've gotten the names of some great surgeons, Dr. Gross, Marchand and Brooks have great success.

Another name to consider, especially since you're in the area is Dr. Su in New York City (Manhattan, I think). Apparently there's an arrangement for stay at a hotel nearby for patients and family. He has a great reputation and seems to work well with athletes.

Good luck - although there's no guarantees, there's several people on here who had an HR young and are doing well.

BTW - I'm in the Boston area as well (Franklin).
« Last Edit: June 03, 2015, 02:08:27 PM by hernanu »
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

briandb

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Thank you all so much for your immediate feedback and thank you for taking the time to read my ramblings.  I feel like it is hard for me to share all of this with most of my friends and it is so helpful just to be able to share what I've been going through with people who understand and empathize.  I am so grateful for you all!  Thank you for taking the time to write me back.  I am still learning so much about this procedure.  It is scare to advocate for myself to receive a surgery that so many surgeons seem so hesitant about, but the reasons I mentioned about saving bone for later potential THR's and revisions is completely compelling to me (especially given my age). 


I will reach out to Dr. Su as well and try to see if maybe I can even switch insurances (my policy renews on July 1), so I have some work to do before then.  Maybe I can get myself on an insurance plan that Dr. Su or Gross accept. 


Thank you thank you thank you and please keep the thoughts coming! 

moe

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Hi Brian, welcome to the site. There is no advantage to waiting any longer, things only get worse and may negatively effect your chance at resurfacing. I had bilateral BHR's almost 6 years ago by Dr Marchand, both at the same time, best decision ever. I basically was becoming a cripple at the time. Now I hike, road and mountain bike, lift weights, kayak, I don't run but I could if I wanted to. I broke my femur in a mtb crash last year and the BHR is still going strong. I also had a demanding job but I am now retired. I have no issues whatsoever. I recommend you make an appointment to see Dr Marchand for a consult. Boston is not exactly known as a hotbed for resurfacing in spite of the great hospitals there.


Good luck, moe
Bi-lateral, BHR, Dr Marchand. 7-13-09

MPH

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Welcome Brian, I can only echo what's been said by the others. I'm 5 months post op with a Birmingham device, walking, cycling, swimming, weights all pain free. More importantly, range of movement is the same as the natural hip and PT tests show it's as strong. I can't vouch for surgeons with you as I'm in Australia but don't delay. My quality of life is now awesome, I'll be running in 3 weeks (tested it a few times already and it's fine!) and my fitness levels are better than they've been for 4 years. Sprint triathlons start in Nov here so that's this years goal. Get it done as soon as you can and reap the benefits. Sincere good wishes and luck when you make the only choice!💪
« Last Edit: June 04, 2015, 03:08:40 AM by MPH »
RBHR 13th Jan 2015 Andrew Shimmin, Melbourne AUS. 52mm head/58mm cup.

einreb

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The tolerances, metallurgy and geometry of the Biomet and BHR are very similar.  The main difference is that the Biomet ball (as used by dr Gross) is porous ingrowth rather than cemented like the BHR.  Both have been shown to last a long time.  The BHR has been out longer, but the track record of the Biomet has been very good and seems to be trending very reliable.


You're on the right track... go to a top surgeon even if it means traveling or some out of pocket money if you can manage it.  I was 40 when I had mine done (traveled to dr gross) so a bit older than you but can relate to being younger than the average resurfacing candidate.


-B
40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

JHippy

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Brian, hip resurfacing is tailor made for you. THR will impose restrictions, and, you'll surely wear it out in your lifetime -- outcomes of THR revisions are not so great in comparison. I'm approaching 6 months after HR surgery with Dr. Gross and could not be happier. Dr. Gross is an amazing surgeon and I highly, highly recommend him. You can send your X-rays and he'll do a phone consultation with you. Dr Su was on my short list as well. I'm not familiar with Marchand.


I concur with all the replies above.


THE most important thing by FAR is choosing the right surgeon. If that means going out of pocket for some of the costs, then so be it. If that means traveling, then so be it. Especially at your age because you want 20+ years to possibly a lifetime of unrestricted use out of your new hip. In choosing a surgeon find out these things: 1. How many resurfacings have they done in total (you want a number in the thousands), 2. How many resurfacings have they done recently (you want someone who is currently active and performing 100's a year), 3. How many cases like yours have they done, especially if you are a difficult case, and 4. what is their track record (preferably published results in great detail).

I hadn't really looked in the the hip resurfacing because I was totally scared by the metal on metal shedding ions into my body warning I had received.


Yes metal ions are one of the big topics. There's a lots of info here, do read up. Note that all devices shed particles -- plastics shed plastic, ceramics shed ceramics, and metal sheds metal.


The plastic debris stays in the body and in excess destroys the surrounding bone. The more you use it the faster it wears out. The bone destruction makes revisions problematic.


Ceramic sheds less but it is more brittle. The debris stays in the body as well. And if you happen to shatter a ceramic implant the tiny particles are impossible to remove completely. They can get in the way of a new implant and they destroy plastic so you wouldn't be able to replace a ceramic with plastic.


Metal debris, namely cobalt and chromium, are removed by the body via the kidneys. Both elements exist naturally in the body and are even found as an ingredient in multi-vitamins. The problem is when the volume of debris is excessive, the body can't get rid of it all so the debris lingers together and forms a mass that irritates the surrounding soft tissue. This is referred to as metalosis or a pseudo-tumor.


The metal debris problem came to surface during the resurgence of hip resurfacing in the mid-2000's. Two separate things happened to cause this. One was incorrect placement of the acetabular cup in surgery. The other was a new product that was released that was inherently defective. At that time surgeons weren't aware of the importance of the amount of coverage the cup needs to have over the ball. Too shallow and edge wear develops and presumably allows the sinovial fluid to escape preventing the positive effect of having the two components hydroplane. Surgeons were using the loose guidelines from THR and the patients own anatomy for clues on how to place the cup. The said manufacturer designed a shallower cup which made that problem much worse.


The experienced surgeons were still getting great results, however, probably because they instinctively knew how to place the components correctly. Those that used the defective device, however, had very high failure rates. In both cases, the smaller that the components were the more crucial placement becomes, so what happened is larger people (therefore most males) had better results and people with smaller implant sizes had poorer results.


Dr. DeSmet was the first to figure out this correlation of inclination angle and metal wear and published his findings along with a recommendation that the angle not exceed 50 degrees. His findings were groundbreaking. A few years ago Dr. Gross published a refinement where he identified an optimal range of inclination angles broken down by component size. As a result Dr. Gross' current women patents are approaching the results of men now, though we're a few years a away from conclusive data.


In the mid-2000's, many orthopedic surgeons were jumping on the bandwagon and we had many surgeons with little experience performing the surgery. One large study was done that showed dismal results, but the surgeons in that study averaged only a handful of surguries each. All it really proved is that you don't want an inexperienced surgeon doing this kind of operation. (And by experienced I mean specifically experience with resurfacing, not total experience.) Still this study is often cited as reason not to do HR. Unfortunately for many people in that study that had developed metalosis, the surgeons caused a lot of permanent tissue damage trying to remove the metal from their bodies -- and some point to this as an example of how destructive the metal debris is. However Dr. Gross told me that he's revised many, many patients like the one's in the study and was able to excise the excess debris with zero tissue damage. He frowns very hard at that study needless to say. What those patients experienced was completely unnecessary.


Also around that time may surgeons adopted the later to be found defective implant. People with larger implants and well placed components got lucky but a good 25% of them had to be revised.


I had doctors try to warn me against HR for reasons like the ones outlined above. But those opinions are based on outdated information. The fact is right now almost all of the issues have been addressed, and the outcome -- WHEN performed by an EXPERIENCED surgeon -- is as good as or better than a THR with the added advantages of being able to do any activity and preserving the bone.


HR is tailor made for you. Do your research and feel good about your choice of a surgeon.


Good luck and keep us posted!
« Last Edit: June 04, 2015, 06:40:57 PM by JHippy »
Left HR; Dec. 17, 2014; Dr. Gross and Lee Webb NP;
uncemented Biomet Recap/Magnum; 50mm/56mm.

oldsoccerplayer

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Hey Brian, I'm one of the soccer-playing Hippies, not as good as I was 40 years ago, but better than how I was 2 /12 years ago prior to the surgery.
I think it's worth learning more about Dr. Ready. If Dr. Martin is one of the best THR surgeons and recommends Ready, I'm assuming there's a good reason. Ask the questions the others have described (# of procedures done, success rates etc..). Maybe there's another good option that we on the forum haven't heard about.
Best of luck with whatever you decide to go with.
BioMet Left Hip Resurfacing, Dr. Gross, 07/2013

briandb

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Thank you all again for your replies.  JHippy- thank you for taking so much time to share all of that information!   Moe, thanks for your information about Dr. Marchand.  I just got off the phone with his office and the earliest he can even see a new patient for the first meeting is November!  I have talked with BCBS inquiring about getting myself on a PPO plan for July 1 and am waiting for their reply.  I am under the impression that I will be able to see Dr. Gross with BCBS PPO.  If anyone has seen Dr. Gross with PPO from out of state, could you let me know how it was working with insurance?  About how much did you pay out of pocket? 


Brian


JHippy

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Yea I am out of state and used Blue Cross / Blue Shield PPO. Dr. Gross and Providence were both considered in network so my insurance covered 90%. My max out of pocket was 3500 and that's about what it came out to all said and done.
Left HR; Dec. 17, 2014; Dr. Gross and Lee Webb NP;
uncemented Biomet Recap/Magnum; 50mm/56mm.

Snowbound

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Brian, definitely push for hip resurfacing as soon as possible and I would recommend doing them at the both same time. I'm 55 and had bilateral hip resurfacing in January. It's not that much harder than doing them one at a time and you cut your rehab time in half. The biggest challenge was sleeping since I didn't have a good side to lie on. I had to sleep on my back for the first month which was hard, but sleeping in a recliner helped a lot.



It's also better for rehab if you're working on both sides at the same time. I'm now 4 1/2 months post surgery going to the gym every day and biking. I'm not lifting heavy weights yet, but I'm slowly building up to it. My hips and core are still weaker than before, but at the rate I'm improving I fully expect to be back to hockey by the end of the summer.


I started doing a twice weekly cardio fitness class at the gym last week. It's hard but feels good to be pushing myself. I've also been doing a yoga class twice a week to try to improve my flexibility and I'd highly recommend that.


The lack of pain in the hips is life changing, the pain is gone, I can stand up straight and I'm slowly improving my flexibility. Before surgery I could open my knees 18", I'm now up to 25" and expect to go further. My hip problem was genetic, the ball joints weren't fully formed (flattening of the femoral head) so I've now got better hips than I was born with and really looking forward to skating again.








karlos.bell

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 :) Hey Brian. Lots good stuff happening on this post. 7 weeks post op and I have past my old hip level in 7 weeks. Good surgeon good placement will do you well in life.
What else then could you do about it? This is an awesome site for help.... these people are very helpful. The metal the body does expel it well in most cases. Plastics or Ceramics do not expel well if they shed. There are worse metals>>>>. There may be more information to read about heart stuff as well email me if you want, I am not going to sell you a product or anything it is just information. Here to help. Good luck Cheers K
2019-2020 THR Left & Right COC Revision Zim Continuum cup with Biolox Delta Cer Liner, Biolox Delta Cer Head 40mm 12/14 Taper, CPT Stem Cem.
2019-2020 removal of Hip Resurfacing due to Metal Toxicity Cobalt - Chromium.
2015 MOM Conserve plus
2011-2013 FAI hip surgery failure
2007-Injury wakeboarding

karlos.bell

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 :) Hi Brian again it may be comforting to know "why your hips packed up" so early in life as well. Ask the doctor (has to be a very experienced hip doctor if you have (Coxa Profunda). Google it and you may understand it. It helped me make the decision to get my hips done it was not just my body phasing out there was an actual issue as well (on top of injury). After the op my internal hip rotation is about 80 deg I could only ever get about 20 deg. I was 40 when my hips packed up are now 49. Just an idea. Cheers K
2019-2020 THR Left & Right COC Revision Zim Continuum cup with Biolox Delta Cer Liner, Biolox Delta Cer Head 40mm 12/14 Taper, CPT Stem Cem.
2019-2020 removal of Hip Resurfacing due to Metal Toxicity Cobalt - Chromium.
2015 MOM Conserve plus
2011-2013 FAI hip surgery failure
2007-Injury wakeboarding

briandb

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Brian -


You might also consider Dr. Brooks at the Cleveland Clinic. Dr. Brooks uses the Birmingham device, and has performed over 2,300 resurfacings. He offers free email consultations, and accepts many insurance plans. Here is his information on the Surface Hippy website:


Free Email ConsultationPeter Brooks MD, FRCS(C) - BHR trained McMinn 2006, Treacy 20072300 Hip Resurfacings to date ***Cleveland Clinic9500 Euclid AvenueCleveland, OH 44195Phone 216-444-4284 (toll free 800-223-2273)Email:  brooksp@ccf.orgCleveland Clinic Website


And here is a recent study that he co-authored, which I believe reflects the success of his surgeries:


http://www.surfacehippy.info/positive-results-1333-patients-dr-brooks-2015-study.php


Much success to you.


Thanks for your suggestion of Dr. Brooks.  I am trying to set up an email consultation with him.  I appreciate your suggestions everyone!!

maquino20

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Brian
Had a very similar case. I'm exactly your age and suffered with pain on my right hip for many years. My pain level was definitely worse than yours, I was at the limit of pain, trying to figure out the best solution for me. Searched everywhere for a solution here in Brazil but basically no one knows about hip resurfacing down here. All top surgeons in Brazil said I needed THR, and I was actually 1 month away from having a THR when I met a dude who had done HR and was fine, surfing, playing soccer and doing all kinds of stuff.


That's when I started my research, found this website and decided to have surgery with Koen De Smet in Belgium. I'm now 5-months post-op, doing as well as I could hope, swimming, biking, weights, SUP, and feel absolutely no discomfort at all. Koen said I could run and play soccer again one year after surgery, so this is the ultimate goal for me since I am nuts about soccer and haven't played in almost 4 years.
Anyways, good luck and hope all goes well for you.


Marcio


     

BAM

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Hi, Brian -- welcome and I echo what everyone else is telling you:  get the best surgeon you can!  I've had both hips done by Dr. Gross and it was worth every penny of the out of pocket - max about $7,500 for me but that included two first class round trips for the husband and I both to travel from Alaska to Dr. Gross. 


I'm a runner, horseback rider, hiker, etc. and have returned to everything 100% except pavement running -- I have no restriction for that, just decided I didn't need to do it any more.  I work with a personal trainer who is huge into weights and plyometrics, she's got me back to heavy weights and I can do a full squat again.  I'm 8 months post-op the second hip. 


When I started looking into HR I settled on Dr. Gross because of his success rates, which he publishes and is willing to freely discuss, and especially his successes with small framed women with severe bi-lateral dsyplasia.  I believe in the Vegas method of success:  I stacked the odds as best I could in my favor. 


If I changed anything, it would be to have it done sooner; I started having issues with my hips in my late 40s but held off until 51 to do the first one and by then the pain was interfering significantly with my quality of life.  The last year I could just barely ride a horse and it was excruciating.  Plus the grinding noises when I got off and on were ... special, so I've been told. 


I've posted stories about pre- and post-op both surgeries here and there is a wealth of information on this site. 


Good luck!

jschoef

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Brian,
I would say with the symptoms' and restrictions you are experiencing, it is time to have it done.  I met Dr. Su and had my surgery performed by Dr. Marchand back in February.  Subsequently I had the strongest summer (cycling, hiking, playing with my kids) in 8 years!
Josh
BHR Left Hip, Dr. Marchand 2/15

 

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