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 you’re 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 you’ll 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/28578684Of 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 won’t know for sure for at least another 10 years in my estimation.
I’m sorry I don’t know much about Dr. De Smet, other than what I’ve seen in Pat Walter’s interview series and selected papers of his that I’ve 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 it’s probably representative.
I hope this was helpful. Keep posting on what you decide.