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!