Appropriate patient for Resurfacing?

[coloradopatrick]

I have found this web site to be extremely helpful and informative.  So thanks to Pat and all contributors.

I wanted to see if anyone has insight that may help me as an "atypical" patient.  I have had 2 failed FAI hip labral reconstructions on the right (2016, 2018) and one failed on the left in 2017 (the surgeon replaced my labrum with a cadaver labrum due to FAI for all 3).  I still have a lot of problems with my hips, but my x-rays look ok - i.e., no significant space narrowing.  I had an MRI and it showed "moderate" OA in both hips. A 9mm cyst on the left that was not there prior to the surgery and some edema on the right that was not there prior to the surgery. The surgeon who did the original failed labral reconstructions doesn't understand why I still have hip problems.  He has said that he doesn't see any evidence of significant problems in my hips, but I have symptoms...pain in the left and lack of functionality of the right while walking/cycling/standing/sitting.  My right hip is mildly painful but very dysfunctional - I can't really stand on it solidly. I get a lot of pain in the left that I think is coming from not being able to stand normally on the right.  I can feel that my hips are just way off.  I have seen 3 surgeons and 1 suggested THR for both hips while the other 2 suggested injections and waiting.
 I am very athletic and want to be able to get back to competing athletically.  Any thoughts on the appropriateness of HR in this situation?
I have seen some posts that say that if you have adequate cartilage, you may not get good blood flow to the bone and are not a good HR candidate?
Thank you!

[Pat Walter]

coloradopatrick
I am sorry to hear your have hip problems.
The best way to know if you are a candidate for hip resurfacing is to ask several of the surgeons that do free email consultations.  Most answer quite quickly and some like Dr. Gross will actually call you.  Just send some emails off with a copy of your x-rays in a digital format and tell them your story. Can't beat that - it's free and you can get several opinons.
https://surfacehippy.info/doctors-with-1000-hip-resurfacings/
That will be the only way you will know other than visiting one of the experienced hip resurfacing doctors.  We are not medically trained or doctors, so it is always best to rely on the experts.  There are many that have FAI and had hip resurfacings. Dr. Gross does a lot of men with FAI.
I hope that helps and you can find a doctor to get you out of pain and back to being active again.
Pat

[ahausheer]

Sorry in advance for the wall of text but you and I have lots of overlap so I wanted to go into detail.

I am a lot like you, active, young 30's, (I'm male), bilateral cam impingement with labral tears causing hip pain, and what would later be discovered after surgery, 15 years of low back and surprisingly enough, 15-20 years of unexplained shallow medial knee pain. X rays showed very slightly''reduced'' hip cartilage spacing (not significant) and very minor and insignificant dysplasia that I was not even told about.  No obvious or even suggestive cause of pain seen on any post surgical x ray. I could not walk more than a few minutes without later needing 50-100 mg tramadol just to take the edge of pain off.  Nsaids/tylenol would not touch the pain, it was disabling.

I had failed bilateral open surgery to correct the FAI/labral tears, and then failed arthroscopic surgery to again attempt to repair the re-torn labrum, and continued cam impingement. So that's 4 failed surgeries (2 per side) and all imaging ''looking good''.  To be more specific I had pain relief for a a few months post op each time, but the pain then fully returned.

At 35 with 4 failed surgeries and losing my ability to walk I was told by 2 surgeons I needed a THR but they wanted to wait due to my age. Another surgeon wanted to perform a periacetabular osteotomy - dumbest idea ever, if you hear that phrase, get second and third opinions because that surgery is about as questionable as they get.  I wanted to be able to keep surfing and literally found this website just in time.

So I started looking for a surgeon:

One of the best BHR surgeons turned me down due to ''too much cartilage spacing''. He used a posterior type surgical approach, as do most, which I have read can disrupt blood supply to the femoral head and neck. If you have osteoarthritis and reduced cartilage spacing the disease will cause blood flow to begin to alter itself so disrupting that blood supply is not so critical.  If you don't have arthritis and have preserved cartilage spacing, I have read (I could be wrong), you need to be careful to preserve that blood supply.  In theory, an anterior or anterolateral (aka trans-gluteal) approach will better preserve that blood supply.  Since I didn't have arthritis, and thus my femoral neck/head blood supply had not begun to alter, it made sense to choose a surgical approach that is a little more gentle on that blood supply.

Another surgeon, who has done over 3,000 BHR surgeries, uses an anterolateral approach, and has a track record as good as anyone, said I was a good candidate and later performed the surgeries. So if you go this route and get turned down, don't give up.

I could write another wall of text about which implant/hardware to use but I will sum up my opinion by saying stick with a BHR made by Smith and Nephew.  In the hands of the best surgeons their total implant survivorship at nearly 20 years is in the upper 90 percentile. Other newer implants/materials just don't yet have the long term track record, and why experiment with near perfection anyway unless you have a metal sensitivity.

So jump forward and now I am bilateral BHR. My hip pain is gone and at 7 months on my right, and 8 weeks on my left I can walk, hike, do yoga, work on my car etc.  Still recovering and it has not been near as easy or as fast as most people post on here but I am continuing to get better/stronger/looser even at 7 months.  I could probably surf lightly now (the second hip is healing 2-3x faster than the first) but will wait a few more months as I am probably at 50% and still have some surgical/recovery related pain on both hips.

I won't post my surgeons name here as I am not a doctor, have no medical background, don't want to diagnose you in place of a doctor, and don't want to accidentally spread information that I might be wrong about.

However,feel free to private message me and I will pass his info along to you.

Good luck.

[karlos.bell]

Hi Patrick.
Yes been there done that with FAI.
Hip resurfacing works. Lots of options. Metal on Metal, COC now Dr De Smet, Metal on Poly Dr Pritchett USA Metal on Poly McMinn depends if you want the metal or not. THR is Zimmer and Biolox COC combination is good (not sure if you want to compete on it) 40mm largest size.
I don't know if the COC new hip resurfacing has had any issues yet.
Many options.
If the hip has had altered labrums and have had  them resected the acetabular from my experience it will not work. If they only altered the ball in and not your socket it would work.
Good luck cheers K