Choosing a resurf expert for your THR

[horse doc]

Is it a waste of time to go to a resurfacing specialist if you know you need a THR?

I'm thinking that a surgeon who has the skill to resurface would also have the skill to THR. 

But then I think that surgeons who don't do resurfs would have more actual THR experience.

I'm from northern Virginia and there are many THR surgeons to choose from locally.  a few people I've talked to rave about their anterior approach THR docs and wonder why I just can't get on with this process.

I'm still drawn towards Dr Gross because he seems to know the ins and outs of metal on metal implants and proper positioning, which are probably crucial in successful THR placement, too.  But in driving 7 hours to get to him, I'm probably driving past dozens of good THR surgeons.

[chuckm]

To know you need a THR I think would mean that a resurfacing surgeon has ruled you out as a candidate for a hip resurfacing?
Resurfacing surgeons also do THR. So if you go see one he or she will make that determination and advise you from there.

Chuckm

[LMS]

Did the surgeon explain why you weren't a candidate for a resurfacing?


Back in 2008 or '09, I was a candidate for resurfacing.  Fast forward to now, 2016, I no longer was a candidate because the bone quality was no longer there, so, yes, if I pushed the issue, he could've done a HR but it would not have lasted & an early revision was inevitable.


It didn't make sense to look elsewhere as my surgeon is very good, I valued & respected his decision to go with a THR.


I too am an equestrian (intermediate level because of my hip) & yes getting a THR means I'd better not fall if I decide to get back in the saddle.  I'm 1 week post op.




I noticed you've been looking into this for at least 4 years now?  Once you get your surgery, please take whatever time is needed  to recoup.  This advice is not only passed on from me but from every medical personnel I've spoken to.  They asked me how anxious was I to get back in the saddle?  And when I said whatever time frame they recommend to guaranty a successful outcome long term, that I was willing to wait one year, it was like music to their ears. 


I also had the anterior approach, which shows better recovery as well.

[catfriend]

Question: How do you know you need a THR? Or, to put it another way, as asked above, have you been ruled out as a hip resurfacing candidate? Or is this just a guess on your part? In my case I wasn't sure I was a resurfacing candidate. In fact, I suspected I wasn't (female, hip dysplasia), and that I would need a THR. However, I chose to consult with Dr. Pritchett specifically because he did both THRs and resurfacings, as well as other joint surgeries, and has an altogether excellent reputation as a surgeon. (Also, I live in a suburb just outside of Seattle.) It turned out that I was a resurfacing candidate (Dr. P made it clear that I could have either a THR or HR, that I was a candidate for either, and the ultimate decision was mine alone; I knew what I was going to do before I left his office.) If you just suspect you're not a candidate, but you're not sure, I advise a consultation with a resurfacing surgeon. Many will do them via email. You won't know if you're a candidate until you consult with a resurfacing specialist. As for a seven hour drive there and back IMO that's a small price compared to the lifetime you should receive from the resurfacing vs. the potential revisions of a THR. That should be a logistical consideration only, not a determinant of the type of surgery you have. OTOH if you have already investigated resurfacing and you are not a candidate then no, there is no point in driving 7 hours for a surgery you can have near your house. As you noted there are many excellent THR surgeons in the NV/DC area.

[horse doc]

Yes I've been limping around for 5 years, driving everybody crazy. 

In 2012  I emailed xrays around and was told that I have AVN, precluding me from resurfacing.  My local orthopod was walking me down the road towards a metal on metal THR he was comfortable using.  Between consults he attended a conference where metal ion problems were on the agenda and he returned with the news that he and his group will no longer offer the biomet magnum MoM THR.  He offered a metal on poly THR.

I also saw a local surgeon on the "over 1000 resurf procedures" list.  I guess he had recently stopped doing them and told me to come back when I can't stand the pain for a metal on poly THR. His practice is probably the best regarded in the area but I was disappointed that he sort of disavowed hip resurfacing. It also didn't help to overhear the discussion of metal ion levels in another room...

My back up plan was to go to Mc Minn for a BMHR.  That entailed me having my fixation screws removed for 6 months before a final Yes, No, Maybe answer.  This step was ultimately too easy to put off and the BMHR option has been withdrawn in the meantime.

So now I'm basically back to square one.  The things I've learned on this website still have me thinking I want a metal on metal prosthesis.  Even though I can't get the benefits of HR bone sparing, I can still get the benefits of the large head diameter of MoM and possible longer component life. Aren't these things still worth pursuing?  Perhaps the risks of MoM articulation outweigh the benefits when you subtract the bone sparing aspect of resurfacing.

Most of the people I talk to about their recent THR experiences don't know what device they have implanted but speak glowingly about having the anterior approach.

[blinky]

Some people with AVN can get resurfacing. It depends on how much femoral head you have left. Could you send current X-rays to Drs Gross or Su or Pritchett or Brooks, one of the docs who still believe strongly in resurfacing, and see what they say? (And there are others.) If you have had this issue since 2012, it may well be that you don't have enough good bone left, but worth a shot, and worth having a conversation with a doctor who has a lot of experience with resurfacing. Even if you don't end up traveling to one of these doctors, you could consult with them on the best device for your situation.


IDK if any US doctor is doing metal on metal THR anymore. IDK if you can get those devices in the US.


FWIW THR devices are better than they used to be in terms of both materials and ball size.

[Saf57]

If you haven't as of yet, I would send your x-rays to Dr. Gross. He is a huge proponent of resurfacing and often is willing to take on cases that others won't touch. You're relatively close to him in the event he thinks he can do it.

[kwarendorf]

Is it a waste of time to go to a resurfacing specialist if you know you need a THR?

In my experience they are not mutually exclusive.  The same surgeon who resurfaced my left hip 7 years ago, David Mayman at Hospital for Special Surgery in NYC, replaced my right hip 7 weeks ago.


Kyle

[Saf57]

Kyle--may I ask why you had a THR done, rather than another resurfacing?

[horse doc]

OK, I now have fresh xrays, waiting to hear back from Dr. Gross.....

xray looks terrible.  Back in 2011, Vicky Marlow sent my images to several experts for me, very generous.

[LMS]

I have the metal on poly THR device btw.  5 weeks post op & doing great.

[horse doc]

I have the metal on poly THR device btw.  5 weeks post op & doing great.

Glad to hear you are making progress in your recovery thread.

As for me, I'm reluctantly excited to be scheduling for surgery with Dr Gross.  He thinks that I have 70% chance of waking up with a resurf instead of THR.  Did say I'd be the worst one he's attempted, though!

[blinky]

Hey, there is a distinction: being Dr Gross' worst hip.


Wishing you the best.

[Mike D]

Hi horse doc,
 Ronan Treacey  gave me the same odds as you but mine was 70% for a THR,  which is how it turned out.
Although I was beyond disappointment at the time, I figured that if a surgeon of his skill could not give me a HR, then it simply wasn't possible.
At least I had been told by one of the world's best and I think the same applies to you- if it's possible to resurf your hip, Dr Gross is your man, another of the very best there.
Regards,Mike.