Recommended Surgeons in Colorado

[BillyH]

Greetings!  So here's my story (bear with me!): 43 year old very active male with an arthritic left hip.  Got a cortisone injection a little over two years ago (Nov 2018).  It has surprisingly provided enough relief for me to get along.  I do a lot of road cycling and some weight training.  Was saddened to have to hang up the running shoes as per two ortho's I saw back in 2018.  Used to be a competitive triathlete (mostly half ironman distance, but did do 3 full IM's).  I walk a mile or two with my dog each day.  I've gotten a little "gimpier" over the past two years but I've been able to manage. 

So last week I decided to go back for another cortisone shot but to also discuss other options.  In particular, PRP and stem cell.  Neither of those two sounded very promising based on my condition.  We did an x-ray and the arthritis has worsened since 2018 as expected.  I've known that some kind of surgery was inevitable but I only knew of THR.  The doctor described hip resurfacing and I was immediately drawn in.  Came back the next day to see their actual hip resurfacing specialist (Dr Michael Dayton @ UCHealth here in Denver).  He reviewed my x-ray and told me I'd be a good candidate for HR.  Wasn't the best appointment though.  It was mid afternoon and he seemed rushed so I didn't get a ton of detail.

So I did more research.  I was very encouraged to hear about some of the pro athletes who've had a BHR: Floyd Landis, Isaiah Thomas, Andy Murray (watched his documentary over the weekend).  Also came across this website which is great!

Since my last cortisone shot worked so well and given that I'm not in too much discomfort, I'm going to get another one next Wednesday.  My goal is still to put off surgery as long as I can.  I'd really like to eventually expand the activities that I'm able to do.  I played tennis growing up and would love to get back into that one day.  Wouldn't mind being able to run short distances again too.  I know things like those won't be possible with another shot so I'm going to have to step back and evaluate what I'm able and not able to do and decide when surgery makes sense (side note: I am aware that I'd need to wait 3 months after the shot to be ready for BHR).

So in the meantime, I'm trying to do plenty of research.  My wife is helping me there too.  She has concerns on the potential effects from the metal on metal that this article details: https://aoj.amegroups.com/article/view/5437/html   Any disputes to that study?  I have no kidney issues.

I'm pretty convinced that the BHR is the route I'll go.  I obviously want to find a great surgeon.  I see plenty of mentions of Dr Gross so I will definitely reach out to him.  One downside is that it would require travel but not a deal breaker.  I see Dr James Rector out of Boulder on the doctor recommendations page here so I'll reach out to him.  Does anyone have any great surgeons in Colorado that they'd recommend checking out? 

Thanks!

Billy

[Boomer]

Dr. Rector did both of my hips, and my life has been excellent ever since. I highly recommend him. Contact me directly if you want additional information.

Boomer

[LDub]

Hi Billy

I am in a similar position to yourself. I was diagnosed with OA this summer and have been ruminating over my plan of action. I'm definitely getting resurfacing but covid has thrown a bit of a wrench into my plans. Vaccinations are set to begin in April however (BC Canada)(60-79 yr) unless even more vaccines are approved (which seems likely). So I hope to go soon.

I do have some experience with hip resurfacing already as my wife and I went to India twice (11 and 10 yrs ago) to see Dr. Bose. He and his group were great and my wife is back doing everything she did before her hips were an issue (Cycling, ice hockey, hiking, badminton, pickle ball, etc.). She is super active and has no issues with her hips (MoM) whatsoever. We are both 60 now. It now appears it's my turn

You mention some concerns about MoM resurfacing. Like yourself I did a lot of reading 10 years ago and repeated it again over the last few months. Things haven't changed that much actually. I'm pretty confident MoM would work fine for me (or you) based on what I read. In the hands of a good surgeon it works very well.

But there is also a recent option for ceramic on ceramic hip resurfacing you might consider. Drs. De Smet (Belgium), Paul Beaule (Ottawa) and Bill Walter (Australia) are using the recerf CoC prosthetic. You can find more information here on the site or with a simply google search.

See also Annals of Joint (AOJ) Vol 5 (April 2020) (there are numerous papers in that volume but "Ceramic resurfacing: the future and challenges" describes the Recerf device).

There is the H1 ceramic also but I haven't researched it much. Of course these are early days for CoC resurfacing. It (Recerf) has been in use only since late 2018 so the long term data is still unavailable. You can make a case for it based on the history of ceramics in total hip replacement, but ultimately it is up to you.

I know that Dr. De Smet is performing surgeries again in Belgium and I also know two fellow Canadians who are there now for hip resurfacing. Dr. De Smet will look at your hip x-rays and determine if you are a candidate free of charge. Something to consider.

Cheers,
LDub.

[LDub]

I thought I might as well point you to some videos I found on youtube regarding ceramic on ceramic (and to some extent MoM) resurfacing. I thought the one by Mike Tuke provided some particularly interesting information about both the history and development of resurfacing prosthetics. Some of the videos are rather long, but eventually yield some pertinent information. Luckily we're all supposed to stay indoors these days. So pour yourself a beverage and enjoy! 

Mike Tuke - The Evolution of Contemporary Hip Resurfacing:
https://www.youtube.com/watch?v=RZKNtthJcn8&t=16s

Metal Free Hip Replacement Dr. Pritchett:
https://www.youtube.com/watch?v=mrx9Pd8wVLo

Hip replacement and hip resurfacing with de Smet:
https://www.youtube.com/watch?v=tWJ6wd5AlFI&t=301s

Hip Resurfacing or Replacement Pritchett:
https://www.youtube.com/watch?v=CPg74VK2pq8

Just to be clear. I'm not advocating CoC over MoM. MoM is excellent when done by a skilled surgeon (in my opinion). And a lot of this information is available in the literature. But the information is sometimes easier to consume when presented in video format.

Cheers.

[BillyH]

Hi Billy

I am in a similar position to yourself. I was diagnosed with OA this summer and have been ruminating over my plan of action. I'm definitely getting resurfacing but covid has thrown a bit of a wrench into my plans. Vaccinations are set to begin in April however (BC Canada)(60-79 yr) unless even more vaccines are approved (which seems likely). So I hope to go soon.

LDub - thanks so much for the reply.  The vast amount of activities your wife has been able to maintain is quite encouraging.  I hadn't heard of the ceramic option which goes to show how green I am with everything.  I watched that first video with Mike Tuke which was very informative.  Sounds like ceramic resurfacing is very new like you mentioned.  That would be one area of concern but I'm still going to give it plenty of research. 

Have you decided which route you'll go (ie MoM vs CoC) or are you waiting until you can travel to visit some surgeons in person for an eval?

[BillyH]

Dr. Rector did both of my hips, and my life has been excellent ever since. I highly recommend him. Contact me directly if you want additional information.

Boomer

Boomer - thanks for the response.  So what made you choose Dr Rector?  Do you know others who have had successful HR performed by him? 

[jimbone]

A primary consideration for choosing an HR surgeon is finding one with a long history of previous success and does a lot of that surgery every year.  As you know it is more specialized than THR.  Dr. Pritchett in Seattle does the BHR and the synoval as well which uses a cross poly cup bearing surface so ions are not a concern.  His website is comprehensive and worth looking into.  Many patients travel to Seattle for his expertise.  I'm starting my 3rd year after bilateral and couldn't be more pleased with the results.  Surgical volume and exceptional results are key in surgical choice.  Best of luck and keep us informed.

[LDub]

Hey Billy

It is still early days from me so I haven't made a choice just yet. I sent out emails to three surgeons (Bose, de Smet and Beaule) and had replies from all three asking for my x-rays. I have since had a reply from de Smet who told me I was a good candidate for CoC.

CoC is more of an unknown, but I am leaning towards it largely for its pedigree. It seems more a new iteration rather than a revolutionary design (which I prefer).

I like the fact it has been developed by the group that made the original BHR and later developed the Adept system (as both are very successful). Surgical experience with Adept will hopefully translate into success with ReCerf.

Looking through the literature ceramic seems to have a good track record with THR (wear pattern, longevity, biocompatibility, less aseptic loosening potentially via less biofilm formation).

CoC side steps metal ion production. But as many here have said, the metal ion issue is not a problem with a good surgeon.

From the surgeon side Koen de Smet has 11000 hip surgeries under his belt. 6000+ are resurfacings and he used Adept for his MoM patients. He's only done a few hundred CoC resurfacings in the last few years, but is happy with the results.

I did find a paper (2005) with a CoC prosthetic that failed within 3 years (The Journal of Arthroplasty 30 (2015) 416-418). This is not the ReCerf CoC prosthetic. It was designed by a different group, but put in by McMinn, a very experienced surgeon. All patients had symptoms by 3 years. Just making the point there are examples of CoC not working. You can see the early failure as a good sign (ReCerf hasn't failed yet and its 2.5 yr in) or a bad one (CoC failed early). Your choice 

All that said I still haven't heard from the other surgeons and with covid I am not sure how soon I will. And I don't feel comfortable traveling internationally without a covid vaccination. Luckily I can still do all my activities (although some are cancelled now with the pandemic anyway). So I just keep reading and ruminating. But I find it interesting so it's all good.

Cheers.

[Pat Walter]

Thanks for sharing the links for these very interesting videos.  I particularly like The Evolution of Contemporary Hip Resurfacing by Mike Tuke.  I added it to the main website    https://surfacehippy.info/the-evolution-of-contemporary-hip-resurfacing-by-mike-tuke/
Thanks again for taking time to research and share information.
Pat

[LDub]

You are very welcome Pat. And thanks a million for your tireless efforts on this website. It is an incredible source of information (and inspiration) for everyone. 

Cheers.