Hemi-Resurfacings are not easily converted to a total hip resurfacing

[Pat Walter]

Hemi - resurfacings

Please note - they can NOT be easily revised to a total hip resurfacing by most surgeons.  In most cases, the old hemi resurfacings can't be converted.  The components to a total hip resurfacing must be properly matched together - then when they are installed it is criticial that they are installed at the proper angles for the hip to work correctly.

There are not many surgeons I know of that would even consider revising a hemi-resurfacing into a full hip resurfacing using the existing femur cap component.  If they can - it is very rare. Plus why would anyone want to go thru 2 surgeries if they did not have to? 

The only option normally available is a revision to a THR.

No one should ever consider a hemi-resurfacing according to the experienced hip resurfacing surgeons I know of.  Either you get a full resurfacing or a THR.  You don't want to be opened up twice for major surgery.  Get it done properly the first time.

Hemis are not normally converted to full hip resurfacings because few experienced hip resurfacing surgeons would use them. If less experienced surgeons use hemis - they have to be installed at the proper angle for conversion and also be sized so a acetabular component can be matched to them That is very important.  I would never consider letting a doctor give me a metal cap on my femur without a metal bearing component in the acetabulum of my hip.  They did not work well.  It was primarily used for AVN since only the damage was to the femur bone.  Overal, however, they did not work well.

Pat

[skysue34]

  Hi  Pat,

 I saw this post and I wanted to thank you.  It is more fuel for my fire.  I tried to find out some information on the hemi-resurfing myself and I could not. You are more computer savey than I.  I will keep you informed as to what I plan to do.  Thanks again, You are Great !!
 Sue

[Bionic]

Sue,

I hope you will keep your mind open to the possibility that your doctor did not screw this up.  Medicine is a complicated discipline, and, when it comes to surgery, one size does not fit all.  I think you'll get the best results from your doctor if you approach this matter with an open mind rather than by taking an accusatory stance.

Wait to have all the information before you accuse.  Also, realize that top professionals in this field have differences of opinion about which surgeries are best for any given condition.  We have strong opinions here (and we think we're right!).  But informed people can disagree.

Case in point: Here's one study recommending total hip arthroplasty over both total hip resurfacing and hemi resurfacing as a treatment for osteonecrosis.  One of the authors is Michael Mont, one of the most experienced resurfacing docs on the planet.  So go figure.

[Pat Walter]

Hi Bionic

I don't want this hemi-resurfacing thing to become a battle.

Each person can read the info and make a decision.

Dr. Mont and I are actually friends and talk via phone often.  I will ask him to explain this further when I get a chance and he is not busy.  He is very busy most of the time.

Personally, I don't care what pieces of info you find - on the whole hemi-resurfacings are not easily converted to a full hip resurfacing unless they have been done with that purpose in mind.  Full hip resurfacing is very, very complicated and all the angles for the caps and cups must be done right.  That is the problem now, too many doctors are not placing the acetabular cups properly and causing revisions and high metal ion problems from the wear resulting from the improper placement.

I have been to the conferences and talked with surgeons personally.  Again, I want to emphasize for new people - be very very careful before you accept a hemi-resurfacing.  I would encourage anyone who has been told this is their solution to contact the really top surgeons in the field and get a further consultation.

Perhaps a few of the more current hemis have been converted - but the older ones can't be.  A doctor would have to place the femur cup just as if he were doing the complete hip.  If you have watched the complete surgeries you will see the two components must match properly and be at the right angles.

I am not going to comment any more on the situation until I can get a statement of Dr. Mont. I would also appreciate eveyone else to put this on hold for now.  I don't want new people getting confused and go looking for a hemi resurfacing.

I don't want new people getting the idea that hemis are the way to go.  There are old fashioned surgeons and surgeons not very knowledgeable that will push them.  Perhaps there are a few cases where they think they are correct - but again - the reason full hip resurfacing was developed was because the hemis were failing. They do not have a good track record.

This website is for people to learn about the current modern version of hip resurfacing - not the old fashioned hemis or an occasional hemi that might still be done. 

The FDA has approved the Birminham Hip Resurfacing Device and the Cormet Hip Resurfacing Device for a reason - it is believed that they are a  better solution for hip replacement.  McMinn would not be spending his time developing the BHR if he thought hemis were a good solution.  All the medical companies would not be developing the BHR, CHR, Wright C+, ASR and Biomet if they thought hemi-resurfacing was a good solution.  Think about it!

I also want to comment on the revision video where Dr. De Smet did convert a hemi resurfacing to a normal hip resurfacing.  If you watch the video you will realize how very lucky the patient was that Dr. De Smet was able to remove the femur cap.  Once he could do that and reshape the femur bone for the new cap - he was able to convert it.  If he could not have removed the femur cap easily and the bone was destroyed under the cap - he could not have done a resurfacing.  You will also note that he was not able to do a resurfacing using the cap that was in place.  This patient was very lucky and Dr. De Smet is one of the greatest surgeons in the world.  I would never accept a hemi - making the assumtion that it could easily be converted.  Not all surgeons are created equal and De Smet is one of the best in the world but he needs good bone stock to do his magic.  Many of the hemis resulted in degenerated bone under the cap.

Let's put the hemi-resurfacing converstaion aside and get on with sharing information about the current modern wonderful Hip Resurfacing Solution that most of us have chosen.

Pat

[obxpelican]

Bionic,

Keep in mind that statement on that web page that you're quoting is saying only in extreme circumstances, lupus, sickle cell etc and the hemi-surfacing is just one of a number of options that was listed in those extreme circumstances, Dr. Mont does not use hemis except in those extreme cases.  Hemi-Resurfacings have pretty much gone the way of dinosaurs. 

If Mont does more than one hemi a year I would be really surprised. 

Sue, you should not dwell on what happened, the decisions that were made were made yesterday, your future is tomorrow.  You will come out of this ok, and I am secure in the knowledge that with a very good surgeon you'll be walking in straight lines soon.  Nobody really knows for sure, you might end up stabilizing soon with the hardware that is in place.


Chuck

Sue,

I hope you will keep your mind open to the possibility that your doctor did not screw this up.  Medicine is a complicated discipline, and, when it comes to surgery, one size does not fit all.  I think you'll get the best results from your doctor if you approach this matter with an open mind rather than by taking an accusatory stance.

Wait to have all the information before you accuse.  Also, realize that top professionals in this field have differences of opinion about which surgeries are best for any given condition.  We have strong opinions here (and we think we're right!).  But informed people can disagree.

Case in point: Here's one study recommending total hip arthroplasty over both total hip resurfacing and hemi resurfacing as a treatment for osteonecrosis.  One of the authors is Michael Mont, one of the most experienced resurfacing docs on the planet.  So go figure.

[Bionic]

Actually, Chuck, Dr. Mont said he preferred THR over hemi's even for those patients.

I am new to all this and I have a tendency simply to report things as I learn them from web searches, etc.  I tend to speak in complete sentences and am good at following a line of logic, but that doesn't mean I actually know what I'm talking about.  My posts about hemis were more along the lines of asking a question, rather than giving an answer.  I was also frankly motivated by a desire to be supportive of SkySue, who I can imagine is somewhat grief-stricken by the direction of this thread.

So please don't think I'm out there swinging for hemi's.  NOT AT ALL!  I'm just trying to figure this out as I go along.

Now back to our regularly scheduled programming?

[Pat Walter]

Link  http://www.springerlink.com/content/308r282u2q11w8r5/

Etienne L. Belzile1, Ole A. Raustol2, Varatharaj Mounasamy2  and Thomas E. Brown2

(1)  Dept. of Orthopedics, 11 Cote Du Palais, Hotel Dieu, G1R2J6  Quebec, QC, Canada
(2)  Orthopaedic Surgery Department, University of Virginia, 400 Ray C. Hunt drive, Suite 330, Box 800159 HSC, Charlottesville, VA 22908, USA

Received: 23 December 2005  Accepted: 5 July 2006  Published online: 11 August 2006

Abstract  We reviewed the clinical and radiological results of 32-cemented femoral head resurfacing arthroplasty, performed by a single surgeon in 25 patients with femoral head osteonecrosis at a mean age of 36.2 years. All patients received a cemented conserve (Wright Medical Technology Inc., Arlington, TN, USA) femoral hemiresurfacing arthroplasty. Data were complete on 16 patients with 21 hips at a mean follow-up period of 50.8 months. Five patients had bilateral procedures. The Harris hip score, and the Merle d’Aubigné score improved significantly from 54.7 to 72.3 (P = 0.0001), and from 12.1 to 13.9 (P = 0.01), respectively.

Seven hips had undergone revision to total hip arthroplasty at the time of follow-up while one hip is scheduled for revision surgery, representing a 38% failure rate. When clinical failure is defined as a Harris Hip Score of less than 70 at follow-up, clinical failure was 81% at 4.25 years.

[obxpelican]

Thanks Pat.

That published report pretty much tells it like it is.

Hemi-resurfacing is a horrendous way to hold off getting a THR because the rates of failure are MUCH higher than that of a HRS. 

I think we're all on the same page now.

Keep posting the doctors responses, I think the hippie community needs to understand what doctors like Bose are saying.  Don't get a half when you can have a whole resurfacing. 


Chuck