How bad should it be to consider BHR?

[jsblock11]

I realize this question is entirely subjective, but for those who have had the procedure how much pain and/or quality of life impact would you accept before doing the procedure? I'm 38 yrs old, Dr. Ball from UCSD has told me I'm a good candidate for BHR based on my "severe arthritis" (according to X-ray) and I'd be overjoyed with the results.


The activities I like to do are hiking and backpacking, biking, and I can do those things pretty well with mild pain in the hip (although i do sit very upright on the bike).  I sleep okay, and have learned how to avoid the hip when doing day to day things like playing with my kids and yard work so I can walk, sit, drive, etc. mostly without pain.


I probably differ from most in that I've had FAI since childhood, so I'm not really "getting back" what I had before since I haven't been able to do things like skiing and weightlifting for over 20 years, but perhaps gaining ROM and pain relief I've never known and opening up the possibilities of life. I have a very stiff back, and back pain in general too so I'm wondering if the BHR would help improve some of the back pain or if I'd go through the pain of surgery only to realize I still can't be super active because of the back.


I'm a bit scared I'd end up with more pain than before and not be able to do the things I do currently, such as hiking 20+ miles in the mountains with a 30 lb backpack. Very afraid of "checking out" of playing with my kids and enjoying them for the recovery period too.


The question is, unless my arthritis stops getting worse and stays constant for the next 20 years, which i doubt, then I'll probably need the BHR eventually anyway so why not now?

[karlos.bell]

    Hi JsBlock11 Wo!!!! if it works out well you will be in for the shock of your life!!!!!!!!!!!!!!

Male or Female?

Probably soon go for my 5 K run soon with my dog and do want I would like today.
Yep I had the FAI. Yep it was a slow progressive disorder. It took me from crutches on 8 years back to doing half marathons in 1 year. Dont leave it too long the bone quality changes and then your not a candidate.

Your choice I wont spend too much time waffling on because I can see that dogs tail waggling.
Cheers K

[jsblock11]

Thanks for the feedback and glad it is going well for you! I'm male, 6'2" 170lbs, Dr. Ball says I'm definitely a prime candidate.  They are making it seem like a no brainer for me to do it, so I definitely want to hear dissenting opinions before jumping into something like this :-)

[catfriend]

It sounds like your life is already impacted by your hips, and your doctor has suggested/recommended resurfacing. Are you going to get better without surgery? Are you going to continue to get worse? Sooooo..... there's no time like the present. If you have the surgery now all the pain that your hips cause you now will be gone. This includes the pain while hiking, backpacking, biking, playing with the kids, etc. You won't have to use the avoidance techniques you refer to.

I can't speak to anything FAI related, but there are plenty of others on this board that have had that issue. I can't guarantee anything about your back, either, as I don't know the specifics of it. However, it may be that some of your other problems are caused/exacerbated by your workarounds for your hips. For example, my hip was causing pain in my lower back and legs, and I didn't realize the hip was the cause of it. Resurfacing ended those problems. If your hips are aggravating/causing your other problems you can expect improvement there as well. But if your back problem is because, say, you had an accident and a spinal fusion or something like that, well, you know, let's not be ridiculous in expectations.

It's possible that you may have other problems which will affect your lifestyle. However, the hips are a problem now. They're impacting your life now. They're not going to magically get better. If you can get rid of that pain and improve your life now, then what are you waiting for? I say choose a good surgeon and go for it.

[catfriend]

Just read your response typed while I was typing mine. If you want dissenting opinions you could go see and old-fashioned traditional orthopedist who may have never heard of resurfacing, or tell you they are terrible and that you should wait until you are nearly crippled and then have a THR. Here, not so much, although there have been a few posters with less than optimal results.

[Ernie]

If your x-rays are showing severe arthritis you probably don't have that much time until you will need to do something.  For me with both hips I went very quickly from years of managing as you are, to having to hobble painfully around with a cane.  It was like the wheel came off the bus.  Both times I wished I'd done it sooner.  Primarily because with both of my hips now resurfaced I'm able to do things physically that I hadn't been able to do for a decade, from the mundane like easily picking something up off the floor to the exhilarating like running a hilly 10k. Resurfacing has given me back my active life.

[blinky]

I agree this sounds like the perfect time to do it. You have pain, you are impaired, but you aren't losing sleep or using a cane yet. You are in good shape, so you will bounce back quickly.


Be aware that if you wait too long you could wear away your femoral head and no longer be a candidate for BHR. It almost happened to me. I have a high pain threshold and was good at work arounds so I was in the waning days of being a candidate when I went in. (Not to mention I couldn't sleep at night and limped. I waited too long.)


Reasons not to do it? I'd give the usual ones doctors give. 1) You only can have a certain number of joint replacements in your lifetime. Since you are young, you want to wait to start having them as long as you can. 2) BHR is a more niche-y procedure. I won't say bad things about the procedure per se, let an orthopedic surgeon say them, but will offer that if you get this procedure done, this super specialty operation, it will be harder to find revision surgeons down the road. There just aren't that many of them. As opposed to THR docs/revision docs, which are easy to find.


I agree with cat friend that the best way to hear the negatives would be to go get a second opinion from a doc who doesn't do BHR, preferably an older guy who will tell you not to run and that you will need a revision in ten years no matter what.


If you really want to get in weeds, find an anti resurf FB page or website and lurk there for awhile. I can recommend a few. You will get an earful. (I do think it's worth hearing the worst case scenarios, but bear in mind you are unlikely to be one.)

[jsblock11]

Great feedback to consider, thank you all! I'll definitely ask Dr. Ball when I see him next, but what is the general consensus on the # of joint replacements you could get on a hip in your lifetime?  I am wondering about the very long term, 40+ years from now (though hopefully science will have it all figured out by then).


The way I understand it, it would be something like:
Age 38 - BHR good for ~20 years
Age 58 - Perhaps a BHR revision (is that possible to do a second one?) or straight to a THR?
Age 78 - Have I now reached the joint replacement threshold? If so, what then? Wheelchair? Amputation? :-)


I come from a line of people living relatively active lives into their 90s, so I can only plan so much but I definitely want to understand what the options might be as we know them today. I feel like we all missed out on cartilage growth therapy and cool stuff like that by a generation or so, but sounds like most are fortunate that the BHR has been a life changer for them.


I'm probably 90% leaning toward just doing it now, and taking each day of the next 3 weeks to pay attention to various things that are limited, or cause pain with the hip, to imagine what it could be like. I had the hip opened up in 2006 to remove bone spurs causing the FAI, which i thought would fix it for good so the disappointment from that surgery is probably causing some hesitation now.

[blinky]

I don't think anyone really knows how long it will last. There is BHR data for what, twenty years? So you can assume twenty, but you will benefit from all the knowledge gained in how to place and perfect these devices since they hit the scene, so yours may last longer. Your doc will know more and have more experience implanting the BHR than the docs twenty years ago did.


To get real nerdy about this, and I am not a doctor or engineer, so I hope even bigger nerds will join in, there are two problems with the longevity of the device: 1) the device itself, and 2) aseptic loosening, the device's adherence to bone. The devices are getting better and better all the time, both resurf and THR. Whereas they used to wear out in ten-twenty years, now they can last much longer. But that biological part, the loosening, I don't know how much that has changed. Resurf is supposed to do better with loosening. Because the forces are distributed down the bone and in the body in a more natural way, the devices are supposed to stay stuck better and longer.


For a young person like you, this is the leap of faith. You can get worse and worse and put off the operation as long as you can, sacrifice the quality of life you have now hoping it will be better down the road. Or you can go for it. Be better now and choose an uncertain future. Hope that your device lasts thirty-forty years, hope there are improvements when you need a revision. Of course, you also have to consider that you won't live to be ninety. Maybe you get cancer or are in a car wreck. Or to be less dramatic, maybe by allowing yourself to become more sedentary to preserve the hip, your health declines. Your BP goes up, you gain weight, you get diabetes, and so again, you don't live to be ninety.


I was older than you, 53, but a less good candidate as a woman (but a muscular woman). I saw that Dr Gross, my doc, had about eight years of data on patients like me. Eight years out, patients like me had a high 90% rate of success. Those odds looked good. I thought, let's say I get ten years. That puts me in my mid sixties for a revision. In the meantime, I have been very active and been out doing the things I want to do. Mid sixties I am still young enough to do well in a revision, maybe willing to slow down some by then. I do not enjoy the good genetic heritage you have so doubt I'll make it to ninety.


Best of luck. It is a heavy decision. Don't rush into it. Take your time and be sure.

[karlos.bell]

  JsBlock Ok now you got the idea. 95 % if they are fitted right after 20 years. At this point know one can say. But wear rate on mine is  0.2 ppm ppm bilateral. Normal= 0.6ppm I am so I will probably die of some thing else...........

Again your choice i will say it again I had FAI and wen t through all the ops and hoops. 10 years off my life basically wasted. Don't rely on science because from what I have seen they only research. Surgeons do....  Cheers K   

[jsblock11]

Got thrown a curveball by my Dr. at the pre-op appointment. Despite being a perfect candidate for BHR - 6 foot 2, 38 year old active male with seemingly strong bones, my surgeon's view is that a THR would be a good option for me as well, and maybe even preferred (though he wouldn't confirm whether one or the other would be better for me), since I'm active (hiking/backpacking/biking/yoga) but not a marathon runner or hardcore basketball player.

I was a bit surprised as I thought it would be a no brainer for me to choose the BHR over a total replacement, especially considering Dr. Ball is very experienced with resurfacing. From what I could gather he gave me the impression the THR would be just as durable as BHR for me, with the only pro for BHR being that I preserve more bone but in turn inherit the possible risk of inflammation/pain in the soft tissues due to metal ions over the years.  Of his bilateral patients who've had BHR on one side and THR on the other, ~70% have preferred the THR.

 I'll probably get a biased answer toward resurfacing on this website, but would any of you have any reason to have a THR rather than a BHR, assuming you are a perfect BHR candidate with a skilled surgeon?  I'm a little scared now and wondering if I should just wait it out longer, since I can still hike and ride a bike without trouble.

[MattJersey]

I went to talk with surgeon locally, good hip surgeon, primarily to hopefully get a clean up and wipe down like you had in 2006. He said I was too far gone for that, he could have done it ten years back, and I would have ended up where I was at that moment. So, the expectation of FAI clean ups is not permanent just a medium term fix. I don't think you should feel disappointed because of that.


The surgeon's advice was I will know when it is time to consider resurfacing or replacement. He said he sees lots of young active people like me, and can help etc. The main point he said was that when you start to have your sleep disrupted, or it is seriously adversely affecting your life with pain, then that is a good indicator.


My problem started when I was 26 years old after a football (soccer) injury. And I was in pain but managed for 20 years. My personal view is that if you can still hike and bike, and you're worried about implant longevity ... then put it off. Enjoy that stuff, see if you can make it another ten years. (By when you will hopefully see that some members on here have had their resurfacing so for nearly 30 years!) But if your hip stops you sleeping properly or has you taking a lot (more than one tablet a week!) of pain medication, maybe sooner ...


As for THR, if you're a big guy, plenty of bone in your pelvis for reaming in a revision ... I wouldn't consider THR based on my experience of resurfacing. But it is just an opinion. Given what little I know of your situation really, and primarily from your aspirations, to me resurfacing by a top doc is the only sensible choice. Go and see the best in the business and get their advice (Gross in the US would be my choice, or McMinn in UK)


Matt

[einreb]

From what I could gather he gave me the impression the THR would be just as durable as BHR for me, with the only pro for BHR being that I preserve more bone but in turn inherit the possible risk of inflammation/pain in the soft tissues due to metal ions over the years. 

At 38, bone preservation is HUGE.  You may get a lifetime out of the resurfacing.  At 38, any sort of THR stem failure/replacement becomes a slippery slope.


I don't get the "possible risk of inflammation/pain in the soft tissues due to metal ions over the years" comment. There are lots of possible things that could happen, but that specific issue is not really a concern for a well placed quality device.

[packman]

Simple questions for me
Am I getting bone on bone debilitating pain jolts?
I was getting them on my right hip every 75-200 yards of walking - never knew when that jolt of pain would stab at me and then got scared to even walk as the pain recovery was 30 seconds
Is it impacting any of my sports competitiveness? Who wants to go downhill and be grouped in less competitive flights vs what you think you can do
Can I exercise? I was seeing weight gain a bad side effect to long term health and I like my food so very hard to say compensate by diet and less intake
Can I sleep comfortably? I was rolling over like a fish trying to get that right position- I would wake up tired impacting work performance and energy
Some of those quality of life questions told me in the Bruce Buffer UFC voice "ITS TIME...."

[pmonko1]

The way I understand it, it would be something like:
Age 38 - BHR good for ~20 years
Age 58 - Perhaps a BHR revision (is that possible to do a second one?) or straight to a THR?
Age 78 - Have I now reached the joint replacement threshold? If so, what then? Wheelchair? Amputation? :-)

If you're worried about revisions to a THR, take a look at this paper by Dr. Pritchett:
http://seattlejointsurgeon.com/pdf/journals/revision-hip-resurfacing.pdf

[packman]

The way I understand it, it would be something like:
Age 38 - BHR good for ~20 years
Age 58 - Perhaps a BHR revision (is that possible to do a second one?) or straight to a THR?
Age 78 - Have I now reached the joint replacement threshold? If so, what then? Wheelchair? Amputation? :-)

If you're worried about revisions to a THR, take a look at this paper by Dr. Pritchett:
http://seattlejointsurgeon.com/pdf/journals/revision-hip-resurfacing.pdf

Excellent post and reference - thank you!