NEW MEMBER WHO NEEDS HIP REPLACEMENT IN BOSTON AREA

[RUSS H.]

CAN ANYONE OUT THERE HELP ME WITH MAKING A DECISION ON HIP RESURFACING IN THE BOSTON AREA?  I'VE TALKED TO 3 SURGEONS SO FAR.  DR SCHELLER FROM N.E. BAPTIST,  DR. READY FROM BRIGHAM WOMENS AND DR FREIBERG FROM MASS GENERAL.  I WILL BE SEEING DR WARD FROM N. E. BAPTIST NEXT TUESDAY.  AND MAYBE DR SNYDER FROM NEWTON WELLESLEY NEXT MONTH.  I'M GETTING A LITTLE CONFUSED,  BUT AM LEANING TOWARDS HIP RESURFACING, ESPECIALLY SINCE A GOOD FRIEND OF MINE HAD IT DONE WITH DR DE SMET IN BELGIUM 6 YEARS AGO.  HE REALLY RECOMENDS IT.  I AM 52 YRS OLD.   I WANT TO DO THIS BEFORE THE END OF THE YEAR.   THANKS SO MUCH.    RUSS

[Tarhoo2]

Russ,

I'm 48, live in Northern Virginia, and have had both hips resurfaced in the last 9 months (12/07 and 4/08).  I had been in significant pain for years, was told three years ago that something needed to be done, looked into my options and was convinced hip resurfacing was right for me.  I am very happy I made the decision to have this done and feel very fortunate to have my life back.  Not only am I walking without any pain (I won't be able to run -- which I haven't been able to do for about 5 years --until I'm 12 months post-procedure), but I'm playing golf with no stiffness or pain afterward.  I'd be happy to answer any questions you may have or discuss my experience further.

Jim

[Pat Walter]

Hi Russ

Welcome to Hip Talk.

You did not mention how old you are?  If you are under 70, I would always recommend hip resurfacing over THR since it is bone conserving.  I assume you understand the difference since you are looking into hip resurfacing.

I was 61 when I had my resurfacing and feel I was way to young for a THR.

So you are on the right tract to consider hip resurfacing.  Choosing a doctor is not always easy.  Normally, the more experience the surgeon has, the more likely you will have a good outcome.  There is a steep learning curve for hip resurfaicng and usually most the exprienced surgeons suggest using a doctor that has done 100 - 200 resurfacings.  THe newer doctors overal revisions rate has been about 4% in the US since the FDA approved hip resurfacing.  That means 4 out of 100 people could expeirence revisions or problems with the newer doctors.  Of course, not all their patients will have problems - 96 should be OK.  Normally these problems of femur neck fractures and loose acetabular cups occur during the learning curve with the first 100+ patients.

So the way you can make sure you won't have any problems is to use the experienced surgeons.  THe doctor you choose is up to you.  You need to like them and feel good after talking with them.  If you have nagging doubts or questions that were not answered, look for another doctor.  Many people have used the newer surgeons sucessfully, but there is always a small chance of a problem.

I have a lot of experienced surgeons on my list  http://www.surfacehippy.info/listofdoctors.php

I don't have them all because it is impossible for me to know them all.  Many are there because their happy patients write to me and tell me about the good experiences.

Pat

[TomBuell]

My personal experience with Birmingham Hip resurfacing (7/1/08) has been fantastic. I would recommend it to anyone.
I'm 52 and weigh 260.
- Tom

[stevel]

Also check out the posts in "looking for doctor recommendations in Boston, Massachusetts" under "Doctor Information" topic.  Somebody else from Boston inquired last month.

[nslocum]

I'm looking for a surgeon in the Boston area too.  I'm meeting with Dr. Daniel Snyder of Newton Wellesley and Dr. Dennis Burke of MGH.  I'd like to talk with one or two more. 

[Bionic]

I'm looking for a surgeon in the Boston area too.  I'm meeting with Dr. Daniel Snyder of Newton Wellesley and Dr. Dennis Burke of MGH.  I'd like to talk with one or two more. 

I am also a hip resurfacing candidate in the Boston area.  I visited Dr. Dennis Burke at MGH in 2005 with high hopes that he would give me a bright thumbs-up on hip resurfacing.  He did not.

His position at the time was that hip resurfacing offered absolutely nothing over THR.  He said that he had personally witnessed the consequences of hip resurfacing the first time it was popular, and personally cleaned up the messes that the procedure left behind.  He talked about removing tissue that was dark with metal contamination.  He warned by about broken femoral necks and other risks.

I suggested to him that resurfacing might be a better option for young people like myself (now a 47 year old healthy and active male), since it is bone conserving and might eliminate a lot of trauma and complexity if a revision were ever required.  He scoffed at that.

His position was that I would do much better with ceramic on highly cross-linked polyethelene.  He told me I should not pick an operation that I read about on the Internet and then find a surgeon who will do it.  He said that was backwards, and that I should first find a surgeon that I trust and let him pick the operation that is best for me.

I left his office feeling incredulous and not knowing whether it was he or I who was uninformed.

I must say, Dr. Burke is a highly respected orthopedic surgeon around these parts; other doctors and patients rave about him.  His opinion is not to be lightly discounted.

That said, I have to wonder whether his earlier experience with "cleaning up after" first generation resurfacings (metal on teflon, I think) may have permanently turned him off from resurfacing, even though the procedure now appears to be much better.

If you're going to see Dr. Burke, please be as prepared as possible and have your questions and arguments lined up before your appointment.  He is a very strong and persuasive guy.  Go to the appointment armed for bear.  Bring studies, testimonials, anything you can think of.

Also, please report back on your experience with Dr. Burke.  I am very curious to see whether he has changed his opinion on resurfacings.

[Pat Walter]

Hi Bionic

Glad you made it to Hip Talk.  Sorry about the bump in the road.

Many surgeons just don't support hip resurfacing either because they do not know about full hip resurfacing, only remember hemi resurfacing, or are not capable or don't want to learn the difficult surgery.  Resurfacing is definitely a much more difficult surgery than a THR.  So don't let the surgeons that don't do hip resurfacing completely influence your decision.

There are many experienced hip resurfacing surgeons in the US and you have the most experienced BHR surgeon near you - Dr. Su in NY.  There are other greats that are a few states away - Dr. Mont in MD, Dr. Gross in SC, etc.  Look at my list.  Many of us were not able to stay in our home town to get a resurfacing.  It is like any professional in any sport or activity - they are not in everyone's home town.  You often have to travel to use them.

Many of us have traveled great distances to have our hips resurfaced, especially before the FDAapproval in the US.  I went to Belgium to Dr. De Smet as have probably hundreds of others.  A large number have gone to Dr. Bose in India.  So please consider using a really experienced surgeon and travel a bit if you need to.

The best input will be from a surgeon that does both a THR and resurfacing.  Most resurfaicng surgeons will always try to give a patient a resurfacing if possible.

So the best advice I can give is - don't listen to the local doctors, try to get some input from the really experienced hip resurfacing surgeons.  I paid 4 local yokels $200 a piece to hear them tell me that an old fashioned small ball/plastic/metal THR would be perfect!  I did not think so!

Stay in touch.

Pat

[Bionic]

Hi Pat,

Thanks so much for your reply and for this wonderful site.  I've heard a lot about Dr. De Smet and Dr. Bose and have been thinking about taking a nice family trip culminating in surgery.  That would be a vacation to remember!

But I might have a hard time justifying that if Dr. Su and Dr. Mont are so close.  I plan to do some reading about those and other local docs.  Thanks for the list.

My right hip is the real nasty one.  The left hip is still nasty-in-training.  Physical therapy and ibuprofen have made the last several years bearable, but only because I work from home and don't demand much from my hips.

Lately, the left hip has started giving me more trouble, and that's the signal it's getting time for surgery.  If the left hip gets half as bad as the right one is now, I'll be very disabled, and that's not where I want to be as a youngish active father of two young kids who doesn't want to live life from a rocking chair.

Physical therapy has been a great help for me, but only sometimes.  These moist autumn days are a bear!  Still, the PT has gotten me in good enough shape that I remember what it was like to be really fit and active--and I want more of it!

Resurfacing is my best hope, I think, followed by large ball ceramic.

One concern I have about having hip surgery in the US is that I'll go in for a resurfacing and wake up with a THR.  If I have to get a THR, I want it to be ceramic on ceramic with a large ball.  Can a US surgeon guarantee me that?  Or is it off the Belgium?

Many thanks again.

[obxpelican]

One concern I have about having hip surgery in the US is that I'll go in for a resurfacing and wake up with a THR.  If I have to get a THR, I want it to be ceramic on ceramic with a large ball.  Can a US surgeon guarantee me that?  Or is it off the Belgium?

Many thanks again.

Hey... not to butt in on your conversation, most doctors have a very good percentage of surgeries that do end up as planned.  I think Dr Gross told me that his was like 1 or 2 in the 1600+ he's done.  You have an impressive list of doctors but that is a great question to ask, you might also want to tell them that if by some chance the worst happens you want C on C large ball.

You're going to find that things get better really quickly once you get the surgery, my joint pain ended when I awoke from surgery and I've never looked back.


BTW--- welcome to the forum.

Chuck

[Bionic]

Thank you Chuck.  I just made an appointment with my primary care physician to get some updated x-rays.  I'm very curious to see how my left hip has degenerated since my last films in 2005.  From the new x-rays, I should be able to get opinions from some resurfacing docs about my chances of success with resurfacing, or whether it looks like I'm headed for THR.

[Pat Walter]

Hi Bionic

You are correct that the only large ball ceramic on ceramic is only available overseas.  The ceramic on ceramics in the US are smaller diameters. 

Dr. De Smet uses the large ball version. 

Most of the really exprienced surgeons don't normally change their minds during surgery very often.  That is a question to ask of your doctor - what is my chance of not getting a resurfacing and ending up with a THR.  They should give you a pretty accurate answer.  You can also be more sure of getting the resurfacing with the really expreinced surgeons rather than the newer surgeons.  They often opt for a THR if the resurfacing looks difficult because they don't want a revision and don't want to cause their patient a second revision surgery.

So since you have really bad hips, you are correct in heading only for the really experinced surgeons.

I choose De Smet since I thought Beligum was closer than India.  It was an 8 1/2 hour flight for me, plus I loved the Belgium experience.  It was wonderful.  A great vacation along with a great new hip.

Keep asking questions and talking to the doctors.  Most of the really exprienced surgeons will give you a email consultation or phone call for free.

Don't leave Dr. Gross off your list.  I just did a video interveiw with him and will have it posted on the website in a day or so.  It is a very informative video about cementless resurfacing. Dr. Gross is very talented along with the other greats.  You can't beat experience when you have difficult hip problems.

Good Luck.

Pat

[Bionic]

I will certainly allow only an experienced doc anywhere near my hips!  No need to sell me on that one!

I personally love the idea of traveling to Belgium or India for my operation, but I have to weigh that against my concerns about being so disabled so far from home.  There's also a cost advantage to having the surgery in the US, I think, since US insurers are now covering the operation.

My preference for large ball ceramic-on-ceramic as a backup plan comes from things I've read that indicate ceramic has a much lower wear rate than anything else, including metal, and entirely avoids the whole metal ion issue, to the extent that it is an issue.

I think that large ball MOM THR's are done in the US, however.  Maybe they're not such a bad back-up plan.  Ceramic will wear better, theoretically, but is also more likely to fracture than MOM.  And who knows if the theoretical predictions about ceramic hip longevity will hold up in practice.

Is there a concensus on this site about the comparative advantages of MOM versus large ball ceramic THR's?

[Bionic]

As a follow-up, I recently received a note from Dr. Dennis Burke of MGH.  As it turns out, Dr. Burke and his associate, Henrik Malchau, are now performing hip resurfacing in Boston at MGH.  Both of them spent a week in England training with Treacy and McMinn.

I have no idea how many procedures Burke has performed, although his note indicated that he now does them "on a fairly regular basis."