wrong choice?

[pamelaj]

Here's my dilemma. Perhaps you could help me.   I   found a 
well-respected hip doctor here in nyc --Justin LaMont  at NYU
Last year at this time when I first went to see him    he had done about 30   
BHRs but he said he went to England to train on them .

I chickened out and figured  I would wait  another year.   My
hip started getting worse. I went back to him an d he said   I should
do a total hip replacement because  I had   a few cysts in my femus
head. He said the rates of fracture were higher with the   BHR than with
THR and they didn'tknow why/They  figured that 
the problem was bone quality and since I had teh cysts the quality of my bones was compromised.
But a friend who got two BHRs had lots of cysts.

I am really concerned about range of motion and  he told me
the difference is now negligable between That with the BHR and THR
because it's not the size of the ball bbut the shape of the neck
that goes to the ball. 

He is also now doing anterior surgeries where he goes through the front and
doesn't cut any muscles, rather than going through the back , which
is supposed to make recovery much easier, which sounds great. But he said to do the BHR he had to go through the back. 

I believed all this and my surgery is now scheduled for July 28/. But now I'm having second thoughts, a friend who went our of the country to have her surgeries said she had lots of cysts and still got a bhr
and that it was better in all ways.

What do you think? What should I do ? SHould I ginsiste on getting the BHR ?.
I don't really want to put this off again.
Desperately seeking advice





 

[lisae]

Pamela,

I had a THR.  My surgeon used the anterior approach so my recovery was easy and I am quite happy with the results.  My range of motion is good and I have resumed hiking and climbing.

I would have preferred to have a resurfacing.  But I had AVN and the head of my femur had crumbled.  I consulted with several surgeons who said that I was not a good candiate for resurfacing.  Having seen my MRI, with a blank space where the head of my femur should have been,  I was comfortable with that assesment. 

So, get a second opinion & third opinion regarding resurfacing.   Be sure that it is not an option.  If it is not an option, find a surgeon who uses the anterior approach. 

[stevenp]

Pamela,

I strongly recommend a second consult. In particular, because you're here in  NYC, contact Dr. Edwin Su at the Hospital for Special Surgery. There's more info about him on this site. He's done over 700 resurfacings, and comes highly recommended (by me too!). He does deal with difficult cases, such as cysts.

Also, Dr. Su uses the posterior approach. From what I've read (and been told), this is the approach that preserves the muscles better, and requires only one tendon to be cut (which is later re-attached). I had my RBHR just 6 days ago, and today feel like I am actually beginning to walk around. I already have good range of motion, and am starting to feel better when putting most of my weight on my right leg.  More of my details are in the "crazyness in NYC" post in the "Hip Stories" section.

This is a major decision (although the operation itself was painless!). It doesn't hurt to get a second opinion.  (Admittedly, I didn't    but that's because of all the info I got on Dr. Su, and  because his assessment was entirely consistent with my previous diagnoses and what I expected based on all that.)  GOOD LUCK!

BTW, for many reasons, I would strongly recommend a BHR over a THR, if you are a candidate. Get in to see Dr. Su if you can. He's probably the best local Dr for the BHR.

[Pat Walter]

Hi Pamela

You should always feel at ease with your decision to have any major surgery.  Most people have cysts on their femur head and an experienced surgeon knows how to handle them. They will also tell you up front what your odds are that you won't get a hip resurfacing. 

It takes a great deal of experience to do this difficult surgery and that experience includes knowing what to do in difficult situations.  The less experienced surgeons will opt for a THR if the problems become difficult.  You need an firm answer from your surgeon as to your odds.

I had a loss of bone density but was still able to get a resurfacing at 61.  Again, the less experenced surgeons won't do older women or even many won't do older men.  They don't have the experience to do so.

The feumur neck fracture is not more of a problem. That is what doctors tell you that don't want to do hip resurfacings or are not experienced.  Here are answers to the question from 3 very experienced surgeons:  http://www.surfacehippy.info/faqsmallheadneckration.php

Again, you need to listen to your own voice.  It sounds like you are not sure about your decision yet.  If you want a second opinion, I would contact Dr. Su in NY.  He is a very experinced hip resurfacing surgeon and does use the posterior approach with the BHR.

Check out this post by Steven  http://surfacehippy.info/hiptalk/index.php?topic=544.0  He is 6 days post op from Dr. Su.

You need to be comfortable with your decision to have surgery and your doctor.

Many of us cancelled THRs to have our hip resurfacing when we learned more.  No one can tell you what to do.  We only know that you should feel good about your decision.  If not, you need to find someone that you feel confident with.

Pat

[stevenp]

Pat, I also responded right before you here! 

One significant indicator to me for preferring a BHR over a THR (when possible) is the recovery process. For a BHR (with Dr Su), there are NO movement restrictions. None. Just do what's comfortable, and don't strain anything.  For a THR, there are all sorts of scary limitations: don't bend your hip more than 90 degrees, don't cross your legs, don't point your toe inward, etc. With a THR, it's necessary to have a high bed, high chairs/seats, a raised toilet seat, etc., to maintain the "90-degree rule." With the BHR, I've been using my same old furniture as usual, with no real worries. 

I even educated my in-home PT on her first visit yesterday (day 5). Most therapists are unfamiliar with resurfacings, and are well-versed in the hip replacement motion limitations. I showed her the info I got from Dr. Su, and we discussed it a bit.  She thought the BHR was cool, and after watching me get in and out of bed, do he basic exercises, get in the shower, walk around on crutches, etc., she said I really didn't need home PT visits in her opinion!

[lisae]

One significant indicator to me for preferring a BHR over a THR (when possible) is the recovery process. For a BHR (with Dr Su), there are NO movement restrictions. None. Just do what's comfortable, and don't strain anything.  For a THR, there are all sorts of scary limitations: don't bend your hip more than 90 degrees, don't cross your legs, don't point your toe inward, etc. With a THR, it's necessary to have a high bed, high chairs/seats, a raised toilet seat, etc., to maintain the "90-degree rule." With the BHR, I've been using my same old furniture as usual, with no real worries. 

You do not necessarily have movement restrictions if you have a THR.  I had a THR using the anterior approach.  I had only two movement restrictions:  do not sit in lotus posture or half lotus posture and do not bring my leg behind me, as in warrior pose. That was it.  These restrictions were lifted after 6 weeks.  I did not need a high bed, chair, a raised toilet seat or anything else.

I think the reason for preferring a resurfacing over a THR is that a resurfacing allows you to conserve your bone and the replacement is closer to your anatomy.

[xocy]

Dr. Gross will give an opinion if you send the xrays to him by email, fax, or snail mail.

Mike

[pamelaj]

thank you all so much for your helpful responses.

I did go to see dr. su first but he's not covered by my insurance. there are two guys listed on this site that are covered both on long island---zelicof and Macaulay I think. What does it mean if there are three stars next to the name?

Also can any of you tell me the difference in range of motion between THR and BHR?

Thanks,
pam

[Pat Walter]

HI Pam

The ***  mean the doctors have talked to me themselves, so I know their stats are correct.  Without the ***, means patients are forwarding me the info and I have no way of knowing if it is correct.

The range of motion, ROM, for a hip resurfacing is usually a little better than a THR.  Here is a short answer  http://www.surfacehippy.info/montchat708.php  There is no reason for it to be limited unless you had a previous ROM problem from your muscles, back or short leg problem.

Hip resurfacing works as close to the original equipment as any type of hip replacement since it loads the hip normally.  The long stem of the THR does not load the hip like the orignal hip did.

You can see Macauly and Zelicofs interviews here  http://www.surfacehippy.info/montchat708.php  They are pro-hip resurfacing and each have done 100 resurfacings.

Dr. Clarke is also in NY and has done over 500.

Pat

[Vicky]

You absolutely want to get resurfaced if at all possible.  Why chop off more bone that you need to?  It just does not make any sense to me, unless your cysts happen to be at the neck of your femur or if you have advanced AVN where the femoral head has collapsed.  Just take a look at this animation video that shows you the difference in amount of bone removed.  It is never too late to postpone surgery, once you have the top of your femoral head amputated, THEN it is too late.

http://www.hip-clinic.com/en/html/bhr_versus_thr.html

Vicky

[CITY2SOUTH]

I second that Vicky..KEEP AS MUCH BONE AS POSSIBLE!!!!!

Come down and visit us in the South

Dr.Gross WWW.GROSSORTHO.COM

Good Luck with your decision

Lisa

3 weeks post-op and feeling good!!!!

[Big Bill]

Hi ... the correct choice is what is better for you....hopefully not to wait until it is not possible to have resurfacing. My hip had progressed to having multiple bone cysts, very visible on x-ray and had me worried. It was getting worse and I was limping and in alot of pain. My surgeon, Dr. Stefan Kreuzer in Houston, specializes in hips and I had to trust his ability. Glad I did ! I am 9 days post-op and began "cane training" today. It is an amazing procedure that can change your life! Do your homework,find a talented surgeon that is pro resurfacing and has lots of experience! Best of luck!

                Big Bill, Cormet Anterior Surface Hippy... aka C.A.S.H.

[DMCCREIGHT]

Hi Pam,

I have been to two different doctors to discuss thr versus bhr.  I too keep hearing the it is better to get the thr because of the higher possibility of fractures mainly in woman. I of course do not want to have the thr if I don't have to either and would prefer the bhr.  I will agree with everyone's comments.  Why have your femur chopped off if you don't need to??  I am going to go to Dr. Raterman in Tampa to inquire about this as well and to ask my "millions" of questions about ROM and activity level after surgery.

deb

[Big Bill]

DEB...if you have good bone quality/density you will most likely be a good candidate for resurfacing. Find a Dr. that is pro resurfacing...a THR is definitely the latter of choices. Do more homework and "interview" doctors until you find one that you trust ! 


        Big Bill, C.A.S.H.  ---Cormet Anterior Surface Hippy   

[wayne-0]

Pamela, I am waiting to have bi-lateral hip resurfacing and have a fair amount of cysts as well.I have met with several surgeons and there was one who tried to talk me into a thr instead of a bhr. He told me the amount of cysts I have make me a bad case for bhr. I left his office pretty bummed out. I went home and did my research about cysts and bhr and found there are alot of doctors who will do bhr with cysts. I happened to find one in san diego. From most info I,ve read cysts on the femur head are fairy common  and the cysts on the femur neck would be the ones to cause concern. My view is get bhr first and if for some reason that does not work you can always get a thr later, save your bone if you can and find a doctor who believes in bhr ( there are many out there that believe in the new technology and are not stuck in the seventys mind set) good luck
                                          Wayne-0

[Pat Walter]

Hi

Wayne is correct in that many of us had cysts.  The surgeons are use to working with them. Often they fill them with a bone cement and bone from the shaping of the head - I think.  I am not a doctor, but that is the laymans explanation that I have heard.

You just need to make sure you get to a doctor that is use to hip resurfacing and they will know how to handle the cysts.

If a person waits too long, the cysts can become so large that only a THR can be used. THat is the one reason to get x-rays and monitor the condition of your hip if you want a hip resurfacing.

Occasionally, I know Dr. De Smet has told a person to come to Belgium immediately to have their hip resurfaced or he won't be able to do it.

So again, use an experienced surgeon and ask how they will handle the cysts. That will give you peace of mind.

Pat