really confused now

[frosty1235]

I was just at my 3rd ortho surgeon here in Illinois to see about a hip resurfacing and he has me confused now. He said I was not a good candidate for HR because my femoral neck was too wide, that it might be notched during the surgery. I was just reading about someone here on Surface Hippy who had a surgeon tell them that their femoral neck was too thin and that made her a bad candidate. Which is it? The first 2 surgeons, who I did not feel comfortable with for other reasons never said a word about my femoral neck and said I was a fine candidate for HR. I dont know if doctor #3 is more careful and complete or just doesn't want to do HR compared to THR. I am a large healthy male, 51, with a seemingly haelthy femoral head, who I thought was the ideal candidate for HR. I thought femoral neck fracture was a minor problem that is mostly found in older smaller woman? Can anyone help with clarity on this issue?
Thanks Much
Frosty

[Pat Walter]

Hi Frosty

I am not sure what surgeons you are talking with.  I can tell you that if you have your heart set on hip resurfacing and have a difficult hip problem, only the most experienced hip resurfacing surgeons will give you a hip resurfacing.

You may need to consider traveling beyond your own state to get what you want.  You are still young at 51 and certainly should be considering a resurfacing if possible.

Look at my list and look for the really experineced surgeons.  Many of them will give you free email consulatations - some will even call you on the phone.  I would be looking at surgoens like Dr. Rogerson since he is close to you, Dr. Gross, Dr. Mont, Dr. Su and some of the overseas surgeons like Dr. De Smet and Dr. Bose.  Remember - they will all give you a free consultation.  If you find they don't feel you are a good candidate - then you start considering a MOM THR.  Until you know for sure from the best in the world, don't be confused - invest some time in trying to get input that will give you the solution you want.

Here is my list of surgeons with all of their info

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

There are also other surgeons on the West Coast that will consider giving difficult patients resurfacing too like Dr. Ure or Dr. Schmalzried, Dr. Amstutz, etc.

Make sure the best tell you that you are not a candidate - not the inexperienced newer surgeons.  They don't want to take any chance of having a failure which is in your best interest.  So go to the top docs and see if you are a candidate.

Pat

[frosty1235]

Thanks Pat, I have seen your list, and have appreciated all the info on surface hippy. I would love to go see Rogerson in WI but insurance/budget issues intrude. Thanks for the good work. I would still like to know if anyone else has been disqualified for having to thick a femoral neck, or if that sounds like a ruse?

[stevel]

Hi Frosty,

According to Dr. Amstutz's website a risk factor for total hip resurfacing is a head:neck ratio < 1.2 (diameter?) and a neck length < 2 cm.  For large boned males with good bone density of your age, femoral neck fracture is usually not a problem if the reaming of the head is stopped short of the neck.  However the geometry of the hip must allow installation of the femoral cap and bad geometry may preclude the device.

I recommend sending your x-rays to the top hip resurfacing surgeons that do free x-ray consultation, e.g. Dr. Mont, Dr. Bose, Dr. DeSmet and Dr. Su.  Dr. Amstutz charges $300 for prescreening.

[Pat Walter]

Hi

It is very difficult for patients to understand the various indications for or against hip resurfacing.  Often, they don't have the experience to really understand what is being said.  If a neck is too thick - how much is too thick?  See - only an experienced hip resurfacing surgeon can decide what an x-ray shows.

I have sat and listened to a panel of hip resurfacing surgeons - not even be able to agree about what they would do for certian patients.  Hip resurfacing is almost as much an art as a skill.  Each surgeon has their own opinon of what can and can't be done.  Some have the magic touch and experience to almost pull off a resurfacing - no matter what. I don't mean that people can always have a resurfacing, but if there is a chance - sometimes you need the best in the world to have the resurfacing succeed.

[sroberts]

Hey Frosty,

Dr Rogerson trained with Dr Stachnew in Galesburg, IL. You may want to see if he's available for a consult. 

take care and don't give up!

spencer

[Bionic]

Hey Frosty,

I thought I might have the same problem as you.  You can check out my x-rays here.

You can see that my right hip (appearing on the left) has an unusually thickened femoral neck.  Some of it is probably inborn deformity and some are changes due to arthritis, I think.

Yet, based on these x-rays Dr. Gross told me I was an "excellent" candidate for resurfacing.

Neck notching is a problem because it creates a region of high stress concentration (Pat is a mechanical engineer and can probably confirm this).  Under load the notch can give rise to cracks that lead to a break.

As far as I've been able to tell, neck notching is a surgical error that occurs when the femoral reamer overshoots its mark and scores the femoral neck.  It seems to me that a careful surgical approach should almost always avoid this, but that's just my opinion.