THR instead of a resurfacing

[DC]

Barry,

I just had a THR done on Sept 15 by Dr. Mont in Baltimore.

I live in NC, but hooked up with Dr. Mont  through a resurfacing chat on this website (see his chats in the chat room).

I sent him my x-rays by e-mail, then he gave me a call and he told me I was a candidate for a resurfacing.

He also told me that a ceramic femoral head (36-40 mm) with a heavily cross linked polyethelyene  acetabular cup used in a THR would allow me to do everything I wanted to do.  The big selling point is that might last  30 years.

I am very active and used to race my road bike and ski steeps in the back-country out west.  Thus, I liked the selling points of a resurfacing.  Yet, I was concerned about the longevity of the glued femoral head and other issues related to the metal wear particles generated from the MOM device used in the resurfacing.

I talked with 3 local surgeons at UNC-Chapel Hill and Duke and then had an office visit with Dr Mont.  I got a wide range of opinions and views on resurfacing. The big edge for the resurfacing is bone preservation and a less complicated revision.  However the surgeons I talked to who had done revisions of resurfacing patients indicated that they were not real simple.  I also talked to folk who had had revisions of THR and they said that they were tolerable.
 
I liked Dr. Monts approach to total hip care and wanted to do the resurfacing.  Yet, in the end, I bucked the trend, and went conservatively with a THR.  Once I decided to do the THR, Dr Mont was pretty fired up and spoke positively about the procedure.  He told me that people with the type of THR that I got run marathons and have no range of motion limitations.

I found this decision to be very difficult and would yo-yo back and forth, so take the time to educate you self as well as possible, and then make your choice.

Good luck,

DC

[obxpelican]

DC,


Good luck on your new hip--- hope you get 30 years plus out of that new hip.


Chuck

Barry,

I just had a THR done on Sept 15 by Dr. Mont in Baltimore.

I live in NC, but hooked up with Dr. Mont  through a resurfacing chat on this website (see his chats in the chat room).

I sent him my x-rays by e-mail, then he gave me a call and he told me I was a candidate for a resurfacing.

He also told me that a ceramic femoral head (36-40 mm) with a heavily cross linked polyethelyene  acetabular cup used in a THR would allow me to do everything I wanted to do.  The big selling point is that might last  30 years.

I am very active and used to race my road bike and ski steeps in the back-country out west.  Thus, I liked the selling points of a resurfacing.  Yet, I was concerned about the longevity of the glued femoral head and other issues related to the metal wear particles generated from the MOM device used in the resurfacing.

I talked with 3 local surgeons at UNC-Chapel Hill and Duke and then had an office visit with Dr Mont.  I got a wide range of opinions and views on resurfacing. The big edge for the resurfacing is bone preservation and a less complicated revision.  However the surgeons I talked to who had done revisions of resurfacing patients indicated that they were not real simple.  I also talked to folk who had had revisions of THR and they said that they were tolerable.
 
I liked Dr. Monts approach to total hip care and wanted to do the resurfacing.  Yet, in the end, I bucked the trend, and went conservatively with a THR.  Once I decided to do the THR, Dr Mont was pretty fired up and spoke positively about the procedure.  He told me that people with the type of THR that I got run marathons and have no range of motion limitations.

I found this decision to be very difficult and would yo-yo back and forth, so take the time to educate you self as well as possible, and then make your choice.

Good luck,

DC

[Pat Walter]

Hi DC

I just returned from a hip resurfacing conference with over 200 hip resurfacing surgeons.  Trust me that there was a great deal of discussion about THRS vs Resurfacing.  Some doctors only do THRs, some do a mix and others try to do all resurfacings whenever possible. 

There was just as much disagreement over how difficult the revision of a hip resurfacing was vs the revision of a THR.  Some say revision of the resurf is very difficult while others say it is very easy.  Some say the revision of a THR is very easy while others say it is difficult.

So if the doctors can't agree, how can a patient hardly make a good decision.  You have to learn, read, listen to your doctors - then listen to your own feelings.  Choose what you think will be best for you.

Personally, I believe my hip resurfacing will last as long as any THR based on the information I have learned over the last 3 years.  Of course, there are many doctors that don't agree, while others feel like I do.

So you made your decision for a ceramic THR.  THat is not a bad decision since you will be out of pain and be able to live an active life.  Again, we each have to follow our hearts.  Most of us on this site believe our resurfs are the best for us and will last us a lifetime.  Only history will prove us right or wrong.

Meanwhile, we will all remain friends - and live active, pain free lives.

Good Luck with your new hip and stay in touch.  We like to hear about everyones stories here.

Pat

[Rob]

One thing that I am noticing about the hip resurfacing chats and marketing information is that there is always a comparison between MOM resurfacing and the old style smaller (plastic) ball THR's. When making this comparison it is obvious that re-surfacing is the way to go. I'd like to hear someone's expert opinion on THR MOM versus resurfacing MOM. I turned down the THR when it was proposed 8 months ago in favour of finding more about resurfacing and now am thinking there may be strong benefits with the THR.

I recently met with a very good orthopaedic surgeon and he gave me the following reasons why with today's technology you may have made a good choice for yourself in choosing a THR.

1. THR's cup and socket match perfectly and there is less bone removed in the hip cavity (bone preserving) than in resurfacing. The size is same as your natural hip and slightly smaller than the resurfacing hip. A larger resurfacing socket means more hip bone has to be removed.
2. Range of motion on the THR was explained to me to be full - no restriction.
3. No glue is used in THR and the bone has a larger stem to adhere to than in resurfacing making it more stable and not prone to loosening over time. (Glue may eventually break down over time.)
4. MOM THR's claim lifetime longevity.

I haven't yet chosen which way to go, so now I am confused. I'd like to hear a doctor's response to MOM THR versus MOM resurfacing.

Undecided.

Rob

[John C]

I would suggest that you be sure to get on the live chat with Dr Gross on Nov. 11
1. Though he is a leader in resurfacing, he is also a strong supporter of MOM THRs as s second choice.
2 His cement-less approach addresses your concerns about the glue.
3. I am not positive, but I believe he may have an interesting answer about the argument that resurfacings require a larger cup, and therefore affects pelvic bone stock.
I will look forward to seeing your questions get answered.

John

[Pat Walter]

Hi Rob

I just returned from 2 1/2 days with 200 hip resurfacing doctors.  I sat thru tons of presentations about hip resurfacing to teach new doctors about the technique.  I am not a doctor and don't even play one on TV, but I can tell you that your doctor has not passed on complete and accurate information to you.

Normally we compare a hip resurfacing to a Metal on Metal MOM THR.  That is because they are the same sized femur cap and same sized acetabular cup.  If you have a resurfacing and for some reason needed a revision to a THR, you would not normally have both the cup and cap removed.  They would just continue to use the acetabular cup that was originally placed and then use the same sized cap for the femur except it will have a long stem. 

They are one in the same except for the way the cap is placed on the femur bone.  With a resurfacing, the bone is conserved and only shaped to accept the femur cap.  You can go to Dr. Gross and receive an uncemented femur cap if you choose to go cementless.  All of the acetabular cups are normally uncemented unless they need to use a special displasia cup which has screws.

So the doctor is misleading you to tell you that they remove more bone for a resurfacing than a MOM THR.  I have a number of articles here by experienced hip resurfacing surgeons who also do THRs that explains this misconception. http://www.surfacehippy.info/faqacetabularboneloss.php

Also if your doctor is telling you that there is more history for MOM THRs than resurfacing in the current generation of hip devices - he is incorrect since the MOMs are the same age as resurfacings in their current form.  So that is not a correct statement.  There is a great deal of history for the old fashioned small ball plastic/metal THRs - but you are not dealing with statistics for the current models of MOM THRs.

The reason resurfacings and MOM THRs work so well is because they are matched to be the same size as the ball of your femur.  That is why both have little dislocation because they more match the size of your natural body.  A resurfacing is considered better by many surgeons because the loading is more like your natural hip.  That can be debated - but technically, as an engineer, it makes sense to me as you watch how they design the angles and placement of the hip devices. 

The ROM of a resurfacing is as good if not better than a THR.  That is because it more closely matches the design of your actual hip. THere are no restrictions with a resurfacing either.  The doctors are very careful in planing the placement of the resurfacing device and take in consideration what activities and sports you do. 

A surgeon that does not perform hip resurfacing will often not give you good information about hip resurfacing.  On the other hand, a surgeon that does both will give you good information about both resurfacing and THRs.  Many doctors still believe resurfacing is hem-resurfacing.  Many doctors simply are not talented enough to learn to perform the difficult resurfacing surgery.  Many doctors don't take time to learn about resurfacings.   

I sat with a number of surgeons that do not and don't plan to learn resurfacing, yet attending the conference to learn so they can give their patients reliable information.  These doctors are to be applauded for their efforts to keep up to date and educate their patients with current information.

I would suggest that you get an appointment with an expereinced hip resurfracing surgeon and ask them the questions you stated.  They will give you accurate and truthful answers. They will also not suggest a resurfacing if they feel a THR is a better option for you.

http://www.surfacehippy.info/listofdoctors.php

I would also suggest you join some of our upcoming chats where you can talk with some of the very experienced surgeons.  I am setting up video chats with several of the worlds best.  Will place ads shortly.

Please try to do some more studying and get some more input from an experienced resurfacing surgeon before you make up your mind.  Once you have good information, then go with you own gut feeling as to what is best.  Obviously you are not yet convienced a THR is the best solution yet or you would not be posting here. 

Many of us on this board have traveled long distances to get our resurfacings because either surgeons in the US would not do us or we could not afford surgery in the US.  I knew that I would not probably get any US doctor to do me since I was a 61 year old female.  Yet overseas, doctors often do older people.

Good Luck and stay in touch.

Pat

[counsel934]

hi everyone

I have surgery scheduled with dr clarke in syrcuse on 12/3/08, he has recommended bhr resurfacing

i guess im scared because i dont know if this is right decision vs thr, i heard people who have both done have had excellent results
im fairly active , i used to jog three times a week prior to my diagnosis in 2004, it appears with bhr you have more options
the longevity scares me ,however dr clarke told me with the thr it could also only last 10 years
whats everybodies thought

[obxpelican]

Counsel,

You have to look at it this way, a hip resurfacing is bone conserving, what you don't have cutoff will be cut off if your hip resurfacing needs to be revised.  To have a THR revised can be a difficult operation, having a hip resurfaced allows you options.

I had a hip resurfacing Aug 6th, 8 weeks later I golfed 18 holes and I was walking at 4 weeks without crutches.

The hardware for a THR and a BHR are both metal, the hip resurfacing allows for a more natural geometry in your hip as your surgeon will not remove much bone.

Go with what will give you options in the future.


JMHO.


Chuck

[John C]

Just a quick add to Chuck's post. While metal on metal THR's are becoming more common, I think that it is safe to say that most THR's today are not metal on metal, but will likely involve either poly or ceramic on one side. I do think that is true that most surgeons that specialize in resurfacings use MOM if they do a THR, but I am not sure that this is true of the general population of surgeons.

[stevel]

A skier complained of feeling thigh pain with his THR (metal socket, polyethylene liner, metal ball and shaft).  When the metal shaft flexs, it carries the stress to the thigh bone.  A BHR is a more natural installation since the existing ball and neck is preserved and the hip/thigh bone is loaded, naturally.

[peteuk]

hi, i think all this talk of thr versus resufacement is good but none of it addresses the real issues,

1, if you are able to have a resurface take that option because it is bone preserving but more importantly it preserves your unique femural neck angles,

2, the chance of leg length discrepancies is less with a resurfacement,

3, if a resurfacement is/nt possible medically a mid head  resection is the next option

4 a mom thr is the next option after that ,

5 there should be no reason that any doctor should be fitting  small bearings and polythene cups that i can see when there is a better range of mom devices  with bearing sizes more of a natural  anatomical size,

6,generally information is/nt given on a like for like basis .meaning its more like old thr/s versus  modern resurfacements,

i have a mom thr which the ball head can be replaced if it wears without disturbing the spike in the femur, which is a good point but it may never wear out at all , i would have rather had a resurfacement because of the above points, my leg is 1/2 inch longer because its harder to achieve leg length equality with a thr,

you have to do your own research to find out what you think would be best for you and then find a doctor who thinks the same , its a bit more difficult here in the uk because we just have to go to the nearest hospital and almost accept what they do, but taken everthing into account if there is no medical reason not to  a resurfacement is the best option, pete       mom thr right

[montanahippy]

My decision to go with a BHR was made after a thorough review of the THR options, including the latest large ball and ceramic options. However, when I asked my local THR surgeon what type of joint he would use, his reply was basicly whatever he thought was best and that was the end of it. He never inquired into my life style.

Speaking as an engineer, the real selling point for BHR is the structural integrity. The average pelvic bone has ample stock to accommodate the acetabular cup, which is tightly hammered into place. The ball is likewise driven down on the exactly reamed outer surface of the femur placing the bone in compression. Virtually all THR's hollow out the femur, putting the bone in both axial and radial tension and leaving a potentially weak stress point at the end of the shaft. The angles are all the natural angles, providing the work is done by a highly experienced surgeon (at least 100 and preferably more than 200 procedures). The bearing surface is large and wear-resistant. The incision is small.

That's a combination that is hard to beat, even with the latest THR technology.

One month post-op and I can't tell one leg from the other. No limitations. I realized a couple of days ago that I had worked all day and never given my hip a thought.

[Rob]

Thanks PeteUK for your information.

It appears to me that the strongest points in favour of resurfacing seem to be the preserved angle and leg length. As far as the bone preservation is concerned, I think the real issue is stability and longevity of design - no use in having more bone if it is more prone to bone fracture or cap movement. To me it physically looks like a THR would be more stable distributing the weight over the full length of the shaft as opposed to the natural stem (preserved in resurfacing) that has been reemed to fit the metal ball.

I do like the testimonials I hear (Montanahippy) regarding recovery time and activity level with resurfacing. The difficulty in Canada is similar to the UK; however, we do have the option to shop for the right doctor if we have the patience to wait. I have waited almost 6 months to just speak with a good resurfacing surgeon - never mind scheduling surgery.

From everything I've heard, if you do not have the best resurfacing surgeon you're almost better off with a good THR surgeon. Right now I'm inclined to wait to get an appointment with a good Canadian doctor (and we do have some) but it is a painstakingly long process here in Canada. Once accomplished, it is free, though.

Thanks for your input.

Rob

[stevel]

I know two seventy year old active, avid skiers that had a conventional THR installed many years ago.  One skier needed a revision THR because the polyethlene liner wore out after 14 years due to osteolysis.  The other skier periodically dislocates his THR (once a year I heard).  I believe this is due to the small diameter of the conventional THR (femoral head).  Sometimes he dislocates it at home rather than during skiing.  My local OS said he does not install full size metal THRs.  He installs a modern version THR with a polyethlene liner, oxinium head (surface turns into a ceramic) and metal socket.  The femoral head is still a smaller diameter and I was concerned about dislocations.  Nobody in Alaska does BHRs.  My insurance would pay for a BHR and travel to the nearest facility that does BHRs which is Seattle.  BHMRs are not installed in the US and my insurance would not pay for one.  I searched for an experienced hip resurfacing surgeon and a top notch hospital and went to Dr. Su at the Hospital for Special Surgery in New York, NY.  My insurance pays for travel as far as Seattle.  I made up the difference to NY.  I actually used frequent flier miles and a roundtrip to Seattle costs the same as a rountrip to NY (80000 miles, first class).  Dr. Su said a full sized metal THR is "almost" as good as a BHR.  He estimated a 90 to 95 percent probability of installing a BHR.  If not, he would install a THR.  Happily, I received a BHR on 9/29/08.  I am an engineer and I felt more comfortable with BHR than a full size metal THR.  Its like installing a crown for your tooth.  The dentist grinds down the original tooth and cements a cap on the remaining tooth.  Rather than pulling the tooth and installing a bridge.  A BHR is cemented and subjected to compressive loads compared to a crown which is cemented and subject to shear loads (up and down).  I have had crowns come loose after flossing.  I wasn't worried about a BHR coming loose because Dr. McMinn's patients under 55 years old have a 99 % success rate after 10 years plus.  I couldn't imagine cement failing under compression even if it is subject to load cycles.  One reason doctors use a cementless femoral shaft for THR's is because cemented shafts are so successful it is difficult to get the old shaft out during a revision THR (when the conventional THR wears out).

[Rob]

Stevel,

I'd agree with most of what you said except the theory of loading. With a BHR it seems to me that the loading is not exactly up/down since the femoral head meets the  top of the leg at an angle. This would put more pressure on the edge of the cup and the stem as far as I understand and this seems to be an area of concern (over the life of the hardware) with doctors who are advocates of replacement over resurfacing. Having said this, I think with a good surgeon, it appears that the geometry of the hip would be closer to a normal hip with BHR as opposed to THR. I can't pretend to understand all of this, but it is good to have as much info as possible before making a decision. I think what we all hope for is an outcome that allows a return to activity without pain. I'm glad for the testemonials from people on this site that have had positive outcomes.

Rob

[cindy26]

I have to have a THR instead of resurfacing.  The kind of hip condition I have can't be fixed with resurfacing.  My doctor wants to use cermanic too.  He said we me being 26 yrs old it would probably last me 20-30 yrs.  Which is great for me.  It seems that I have been having surgery half of my life.   20-30yrs is like a miracle.  Of course in time the other hip will have to be done.  How did you do from the hip replacement?  I went on the hip talk for THR and nobody talks on there. 

[Pat Walter]

Hi Gang

I just returned from the 2nd Annual Hip Resurfacing Course in LA which teaches surgeons how to do hip resurfacing.  THere were a number of presentations where I learned a lot.

I understood that a resurfacing does load the hip more naturally than a THR.  That was also confirmed at the course in LA.  It is very important that the surgeon places both the acetabular cup and femur cap just right.  If all the angles, etc are not done properly, the load in not as your natural hip would be.  It takes a great deal of experienced to place the components properly. That's why I always suggest using the very experienced hip resurfacing surgeons.

Pat

[Pat Walter]

Hi Cindy

You are welcome here.  I am sorry there is not more support on the THR Total Hip Talk Group.  It just seems those that get the THRs are not as much into talking via the internet.  I do hope the group will grow some day.

Maybe I should have a special section for people that can't have resurfacings or don't want them.  I will think about that.

Ceramic on Ceramic is a good option.  I am not sure most surgeons would tell you it will last 30 years.  A lot depends on your own bone condition and how well your bones age. 

We will all hope you do get 30 years for your THR.  I am hoping my BHR will last that long - or may that I will live that long since I am already 64!!!!

Good Luck.

Pat

[bothdone]

Hi

I've had both BHR in both hips.   I live in the UK.    I had the left one done privately in 2004 when I was 50.  I had to have it done privately as my local National Health Service (NHS) hospital did not do BHR.  I've absolutely no regrets spending the money.

I had the right one done in March this year, on the NHS - same surgeon!

The big arguments for me were:

It preserves more bone.   If it needs revision you go into the THR route.

It is more suited to the younger, more active, patient.    I hope to get back into light jogging and running. 

I've got my surgeon review in a couple of weeks.  I'll keep you posted after that as to my progress.

Ed

[decooney]

Hi,

I just found this thread and was glad to read for the first time that my situation, and what I ended up with recently, is not so unique or "on the edge" so to speak if it's currently being discussed and/or debated at hip resurfacing conferences like I read in this thread.  Whew. 

I'm Post-Op, as of October 21st, 2008.  2.5 weeks into recovery.  Today I'm starting to feel a bit less pain in the joint. 

My surgeon installed what I guess is a mix-match hybrid of THR and Hip resurfacing components.   

• My acetabular cup is a Stryker/Cormet X3 Technology 56mm cup with polyethelne liner; normally used in THR I guess.
  
  
• My femoral head/cap is a hip resurfacing stainless steel cap/ball; normally used in hip resurfacing.     
  
  
  
  I'm 43yrs old, use to be active, and my true hope is this:  I just want to be able to go on my mountain bicycle on very light trails once in a while, and be able to walk and climb up steeper grades and steps when doing mild trail hiking around maybe once or twice a month.  My absolute and worst fear now is dislocation. My first and new hip replacement dislocated just 30 minutes into recovery on my frist surgery.  My resurfacing cup slipped as I was shaking so violently coming out of anestisia.  The x-ray'd me and found my cup slipped upward and forward about 30 degrees.  They also discovered it disloated too.  So, my surgeon when right back in, same day, and removed the slipped cup, and reinstalled a larger 56mm unit with two screws this time around, changing to the new X3 THR cup.  He kept the femor ball in place and reused it from the first surgery, mating the two together.  I understand the Stryker rep was there in the room at surgery time. I still wonder what they must have been thinking at the time to come up with this revised approach.  Now I have a hybrid mix of the two.  I spoke with my surgeon afterwards, but he was very busy and frankly didn't seem too thrilled about answering my questions about "what happened"; he just said "I moved...", and that what I have installed now with screws and all "is not going to come out now". 
  
  I hope this lasts and works.  Wow, reading above, maybe even lasting 20-30 years. Now that would something if it worked out like this, even 20 years wouild be incredible.  I've read about the 97% increase in wear rate reduction with this new technology. Obviously, I lost some confidence by having to do my surgery twice (11hrs., a do-over on the same day), but I am becoming more positive each day as I find threads like this one on this website.  I'm also keeping my fingers crossed this was a blessing in disguise, him having to go back in there and replace the cup with the heavy duty screw-in THR X3 cup setup.  I have no clue at this point... ?  Thanks, Duane
  
  Feedback apreciated about any other examples like mine.