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Author Topic: Choices choices... flipping a coin is NOT an option  (Read 596 times)

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Sboon

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Choices choices... flipping a coin is NOT an option
« on: April 27, 2019, 04:18:47 AM »
Hello,
I am now past the denial phase where I thought it was just a pulled abductor and thought the xray showing no cartilage was just a bad exposure...and am almost ready to commit. But I need some help deciding... It is a choice between Dr Gross and Dr DeSmet.

Here are my questions followed by backstory. I would REALLY welcome any and all comments:
1) the published data by all doctors always seems to be a selected subset of the numbers claimed done - and much lower. How do you know what the validated real numbers are for total, done with a particular implant, % revisions for each year post op for each device, etc? And how can you interpret the data when it includes implants done by less skilled sugeons or more compromised patients?

2) has anyone seen validated data on ALL (not just a little selective sampling) the cemented vs uncemented outcomes by any surgeon (I would love to see a published paper including all the patients Dr Gross did but cannot find). Gross has been doing it since 2007 but how many, how many needed revisions? Were they the early 'learning' ones and if so will the later ones be better? I saw one paper with a few hundred but he indicates thousands done I think.

3) with all the ownership changes (Adept was made by Finsbury who had made the BHR but now is sold to DePuy - THAT DePuy of the bad implant - but they PROBABLY have better quality control now - the Conserve + would have fit but now is Chinese owned and lost its CE certification), and 'advancements', how can you be sure that implant data is valid year to year and what can you trust?

4) what are your thoughts on a very skilled Dr like DeSmet working with multiple different devices (some fairly new) vs Dr Gross (also very skilled) working with just the device he has developed? I could envision less familiarity if you are always switching from one device to the next or not accepting issues that come up with 'your' device. I seem to dwell on the scariest possibilities...

5) I cannot get a sense of a post-op recovery compilation of all the patients of the two (I have tried putting one together) - that is how long each group took to get to the various stages (one crutch, no crutch, walking a mile, running, etc), and the pain levels at each. I have to think that one measure of surgical 'quality' is recovery timelines. Can anyone out there weigh in on general recovery trends per these two surgeons? My friends from Dr DeSmet were without pain meds after a very short time, and up and walking miles pretty quickly. Maybe it's apples and oranges in that cementless reaming of the ball causes more pain?

I have friends who had very successful outcomes 12 years ago with Dr. DeSmet, when Dr. Su was still actually calling back potential patients and Dr. Gross had not done so many. I am considering between Drs. DeSmet and Gross. I am small and likely cannot get a BHR. It would be the Biomet with Gross or the Adept with DeSmet.

I don't mean to start a flame war "DeSmet is better! No, Gross is!" but would appreciate any input. My apologies in advance for lurking silently on the site for awhile and then suddenly writing this novella post.

Thanks!

Sboon


MattJersey

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Re: Choices choices... flipping a coin is NOT an option
« Reply #1 on: April 27, 2019, 06:15:04 AM »
I had BHR done by McMinn, and I chose him due to his experience, reputation, published articles, the fact he invented (? Or pioneered) this, so I figured he would be best. He calls out all the issues and explains clearly what and why, very confidently. I could have gone with a local surgeon too but felt I wanted the best.

By the time my left hip comes up for renewal, I fear McMinn will have retired. I would not hesitate to go to De Smet, for similar reasons. If De Smet was no option, I'd go to Gross. That is driven by proximity and their experience and what I detect as respect within the community of truly expert resurfacing surgeons. If I lived in US I would go to Gross first.

Personally I wouldn't get hung up on all the data, statistics are useful but individual outcomes will vary, and trying to measure recovery time is an exercise in futility I feel: once done I would expect 2 months of progress, slow at first and tough, but think about looking back after 6 or 9 months of working hard on exercises and recovery you should be basking in delight.

I understand your position because it will be new for you. I was fearful, wasn't sure I could believe the content on this site and the testimonials, feeling it is too good to be true. But my GP had bilateral with McMinn and a great outcome and that sealed it.

If you decide to proceed with either surgeon you propose I feel you are making an excellent choice. I would go closest to home. And in 6 months ... I would expect you to also be an advocate or evangelist.

I think the reason so many of us continue to post for years on here is simply because we are all (bar one or two exceptions) still amazed at the Renaissance the resurfacing has given us.

Tomorrow is my 4th anniversary. Weddings would be marked with fruit or flowers I believe. But for me it's cobalt and chrome all day tomorrow :)
28 April 2015, RBHR Mr McMinn

Pat Walter

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Re: Choices choices... flipping a coin is NOT an option
« Reply #2 on: April 27, 2019, 12:16:55 PM »
Hi Sboon

What you are feeling is very similar to what most people feel before having surgery.  Lots of doubt.  I won't quote statistics to you since it is almost impossible to know about every patient all the top surgeons had.  Many do post stats about their outcomes and their revisions or failures are very, very few. You can see much of Dr. Gross's info here:  https://surfacehippy.info/dr-gross-interview-about-hip-resurfacing-and-cementless-techniques/

Dr. De Smet talks about his statistics in his new video about the ReCerf  https://surfacehippy.info/dr-de-smet-offers-new-recerf-ceramic-on-ceramic-hip-resurfacing-in-south-africa/

You have to know that not every human body is the same or perfect. So the best surgeon in the world using the best device in the world could possibly, very small possibly, have a problem.  We are not automobile motors all put together with the same parts in the same factory.  And yet, even the cars have problems. The best device in the world is manufactured by humans and placed by humans.  So it is with the human body, even God's work sometimes is not perfect in joints.  They wear out and are sometimes not formed quite properly.

So we still know the best top surgeons have the very best outcomes.  We also know that the very best THR in the world can and do have problems.  There is no perfect answer with a 100% guarantee. So you think about the best surgeons and choose what one feels right for you. There is that little voice inside that knows what is right. You finally just have to be quiet enough to hear it.
Getting hip surgery is like flying on a big jet plane. We all get on them and once we decided on our flight, we are in the hands of the pilot. Our lives are at stake, but we believe and assume the pilot is well trained and very experienced.  Once the plane takes off, it is out of our hands and mind. We made a choice.

Many of the top surgeons do use several different devices or have used different devices.  All the current devices will do well when placed by an excellent surgeon. The placement is really more important than the device and of course a top surgeon would not chose a bad device.  The reason they stick with certain ones is because they feel their outcomes are the best with that device. Dr. De Smet use to use the BHR and Wright C+.  It depended on the size of the person and need of the person as to what he chose. He often used the Wright C+ for small people and when special sizes were needed.He also designed tooling for the device to make it easier to place. The tools were not available in the US because they were not FDA approved. The Wright C+ was FDA approved at one time.  Dr. Gross has developed the Biomet cementless device and works with that.  In the past he used the Cormet.   He has good outcomes with them all using both cementless and cemented. The best athletes often use different brands of equipment, yet still have great outcomes.

In my opinion, there will be a time to stop making up stats or studying stats, and listen to your inner voice.  We all know stats can be used to prove anything. Each of the top surgeons literally have thousands of successful hip resurfacings. There are thousands of stories on this website and discussion group. Talk with each surgeon and make a decision. In my opinion, you could not go wrong with any of the most experienced surgeons. That is why they are still doing hip resurfacing - they have done thousands and thousands of successful surgeries. 

As far as recovery, we are all different. There is no guarantee you will be running at 6 weeks post op. In fact, most surgeons don't want you running for a full year. It really takes a full year for your body to recover. Whether you use a walking aid for 2 weeks or 2 months makes no difference.  It is the end game of returning to being active and out of pain that is important. Over a lifetime, a few weeks or months really has no affect. Everything good in life takes time and patience.  Roll with the punches and you will be a winner.
I wish you the very best.
Pat

« Last Edit: April 27, 2019, 12:20:01 PM by Pat Walter »
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

Rn2md

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Re: Choices choices... flipping a coin is NOT an option
« Reply #3 on: April 27, 2019, 12:37:52 PM »
Hello,
I am now past the denial phase where I thought it was just a pulled abductor and thought the xray showing no cartilage was just a bad exposure...and am almost ready to commit. But I need some help deciding... It is a choice between Dr Gross and Dr DeSmet.

Here are my questions followed by backstory. I would REALLY welcome any and all comments:
1) the published data by all doctors always seems to be a selected subset of the numbers claimed done - and much lower. How do you know what the validated real numbers are for total, done with a particular implant, % revisions for each year post op for each device, etc? And how can you interpret the data when it includes implants done by less skilled sugeons or more compromised patients?

2) has anyone seen validated data on ALL (not just a little selective sampling) the cemented vs uncemented outcomes by any surgeon (I would love to see a published paper including all the patients Dr Gross did but cannot find). Gross has been doing it since 2007 but how many, how many needed revisions? Were they the early 'learning' ones and if so will the later ones be better? I saw one paper with a few hundred but he indicates thousands done I think.

3) with all the ownership changes (Adept was made by Finsbury who had made the BHR but now is sold to DePuy - THAT DePuy of the bad implant - but they PROBABLY have better quality control now - the Conserve + would have fit but now is Chinese owned and lost its CE certification), and 'advancements', how can you be sure that implant data is valid year to year and what can you trust?

4) what are your thoughts on a very skilled Dr like DeSmet working with multiple different devices (some fairly new) vs Dr Gross (also very skilled) working with just the device he has developed? I could envision less familiarity if you are always switching from one device to the next or not accepting issues that come up with 'your' device. I seem to dwell on the scariest possibilities...

5) I cannot get a sense of a post-op recovery compilation of all the patients of the two (I have tried putting one together) - that is how long each group took to get to the various stages (one crutch, no crutch, walking a mile, running, etc), and the pain levels at each. I have to think that one measure of surgical 'quality' is recovery timelines. Can anyone out there weigh in on general recovery trends per these two surgeons? My friends from Dr DeSmet were without pain meds after a very short time, and up and walking miles pretty quickly. Maybe it's apples and oranges in that cementless reaming of the ball causes more pain?

I have friends who had very successful outcomes 12 years ago with Dr. DeSmet, when Dr. Su was still actually calling back potential patients and Dr. Gross had not done so many. I am considering between Drs. DeSmet and Gross. I am small and likely cannot get a BHR. It would be the Biomet with Gross or the Adept with DeSmet.

I don't mean to start a flame war "DeSmet is better! No, Gross is!" but would appreciate any input. My apologies in advance for lurking silently on the site for awhile and then suddenly writing this novella post.

Thanks!

Sboon


Hey Sboon,
Below is a link to 2017 article by Dr. Gross, where he studied implant survivorship and other factors in those patients of his <50 years old vs >50. I think it may give you some or all of the type of data youíre looking for. By the way, Dr. Gross has been doing the procedure from 1999 to present with well over 5000 resurfacing procedures, giving him a large experience and volume advantage over almost any other surgeon for resurfacing. De Smet, Pritchett, and McMinn are the only other ones I know of that have that large an experience.
The study population comprises 3269 patients and spans the 2001-2013 timeframe, as defined in the paper. It is implied that he would have also done patients from 1999-2001 and from 2013 to present, which would not be included in that number, since he has been doing this procedure over that period. The study had a large representation of his uncemented implant, but also contains a significant proportion of the cemented Corin, and the cemented Biomet implant, which he used prior developing the uncemented Biomet. Separate survivorship curves were generated for each, so youíll get a good appreciation of the incremental improvements in results with each new development.
Notice that Biomet implants in his study had a 99% survivorship at 11 years, which is essentially identical to McMinns BHR data over that time frame, who is the designer surgeon on the BHR.

https://www.ncbi.nlm.nih.gov/pubmed/28578684

Of course, the BHR has the advantage of longer term data being available and more surgeons using it.

The uncemented implant does have a theoretical advantage longer term, in that there is no potential for eventual cement breakdown. But that remains a theory at this point, since we probably wonít know for sure for at least another 10 years in my estimation.

Iím sorry I donít know much about Dr. De Smet, other than what Iíve seen in Pat Walterís interview series and selected papers of his that Iíve read. I know he has an excellent reputation and is another one of the worlds best, as you probably already know. Many on this site have used him though, and can probably tell you more.

I had mine done by Gross on 3/20, and my early healing and recovery has gone very well I think. The full details of my story can be found here under the Dr. Gross patient stories tab, if interested.

I would recommend looking at as many patient stories under each surgeon as possible, to get a sense of what recovery is like for each. The stories span many procedures over many years. So itís probably representative.

I hope this was helpful. Keep posting on what you decide.






catfriend

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Re: Choices choices... flipping a coin is NOT an option
« Reply #4 on: April 27, 2019, 09:53:29 PM »
I don't know where you live, and I expect that may be part of the equation. If you are too small to have the BHR the other possibility I will throw out there for consideration (or confusion) is Dr. Pritchett in Seattle. He uses a different device made of ceramicized titanium with a highly cross linked polyethylene cup. That's the device I have, and it feels like a completely natural hip that was never diseased. He has a lot of info and links on his website.

Regarding recovery time vis a vis different surgeons: Your recovery will be your own. How somebody else recovered is irrelevant. Your body will heal in its own way, with its own quirks. Some people heal faster, some slower, but everybody heals. What constitutes a "normal" recovery varies.

tommyhip

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Re: Choices choices... flipping a coin is NOT an option
« Reply #5 on: April 28, 2019, 12:16:48 PM »
As you already know, both DeSmet and Gross are among the most experienced and competent surgeons.  The more important decision might be the choice of bearing surface - metal on metal (MOM) or the new re-cerf ceramic on ceramic (COC). (I would rule out HCLP - do the research on potential wear effects) Dr. Gross believes that metal wear ion issues are substantially reduced with proper placement of the implanted device and the post op data (2 years out) seems to support this. I chose MOM with Dr. Gross and the result has been quite good. I am coming up on my first metal ion test in about seven months and of course hoping for the best. Ceramic issues in the past have mostly involved breakage and squeaks but ceramics have come a long way and may likely be the future of HRA and THA. I would have been interested in COC if it had been offered 18 months ago - but only time and other post-op data will tell. For now, at least for that decision, you may have to get the coin out.

jimbone

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Re: Choices choices... flipping a coin is NOT an option
« Reply #6 on: April 28, 2019, 04:58:56 PM »
Tommyhip-

I am not aware of any data on negative highly crossed linked poly inset wear issues.  Can you provide any links or reference any studies to consider?  Thank you in advance.

Sboon

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Re: Choices choices... flipping a coin is NOT an option
« Reply #7 on: May 02, 2019, 05:19:19 AM »
Thanks all for the replies.

I guess it is time to bite the bullet.... ha, finally used that phrase in the exactly right etymological context!

FYI - the same reason I don't trust the limited uncemented data etc is the reason I would hesitate on the COC; I don't want to be the guinea pig. It SOUNDS good and right...but in my body I want the data.

karlos.bell

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Re: Choices choices... flipping a coin is NOT an option
« Reply #8 on: May 10, 2019, 10:33:46 PM »
 :) Hi Sboon
Yes its a bit hard sometimes to make the decision.
De Smet does small size resurfacing and face to face he says it is difficult but very doable.
But so was someone like me a male with reasonable size.
He uses the conserve plus for various reasons.
In Europe the sizes increment 2mm, in the USA they are 4mm I think.
That can make it difficult to start with.
So there are alot of different factors to consider.
Good luck with your choice.

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

 

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