I’m a 48-year old male, pretty active/fit, but far from a competitive athlete. I started to feel some hip pain Memorial Day 2013 when I did a 12-mile hike with what was probably a 60+ pound pack. I thought it was just poor adjustment of the pack and/or lower back pain but rest and ice didn’t improve the situation. I remained pretty active (e.g., playing singles tennis, working out including 180# squats) because I believe that the moment inactivity sets in, everything gets considerably worse. In October 2013 I realized it was time to see a doctor and since I live in SF and had a very successful ACL reconstruction at UCSF, I inquired with my knee doc and was referred to an orthopedist there who specialized in hips, who couldn’t see me until January 2014.
That doctor confirmed a diagnosis of osteoarthritis via x-ray and recommended a THR and that given the limited life span of the prosthetic, he suggested I put off surgery as long as possible. This (waiting plus total hip) seemed a little nuts to me so I started doing some research online and, amongst other site, found surfacehippy.info (thank you Patricia!). I came to the initial conclusion that hip resurfacing made much more sense for my age and activity level. To supplement my extensive research, I consulted with another SF orthopedist, one who does neither procedure, and he concurred that replacement was a more appropriate choice over a total hip. Then, I returned to the UCSF ortho to discuss why he was recommending a total hip and he said, "The bulk of the literature suggests that MOM Resurfacing is a riskier operation, and your best chance of achieving improved function and reduced pain over the long-term is with metal-on-polyethylene hip replacement." He also referred me to a April 2014 article from the University of Calgary entitled "Hip Resurfacing versus Total Hip Arthroplasty: A Systematic Review Comparing Standardized Outcomes."
My own research on revision rates and the potential risks of metal-on-metal led me to a different conclusion. Regarding revision rates, I found two data points that suggest that for my age and gender, revision rates were comparable if not better with resurfacing than a total hip. First, there was the 2008 Australian Orthopaedic Association National Joint Registry Annual Report showing lower revision rates for males <55 yrs with resurfacing versus THR. Second, there was “Failure rates of metal-on-metal hip resurfacings: analysis of data from the National Joint Registry for England and Wales”, by Professor AW Blom, published on October 2, 2012 which indicates lower revisions rates for larger males like myself with resurfacing than THR, 10x lower dislocation rates, and less hip pain. Finally, the study U of Calgary article he sent me says in the first sentence of the conclusion, "Revisions and reoperations are more frequent and occur earlier with metal-on-metal hip resurfacing, except when discontinued devices are removed from the analyses." Since I was, of course, not going to get a discontinued device, this assertion seemed specious.
As for the metal loss/toxicity issue, surgical experience may be the contributing factor in achieving proper alignment which goes a long way to reducing friction and resulting metal loss. A Feb 2012 article on Orthopedics Today by Harlan Amstutz notes "Recent long-term data show that certain currently available hip resurfacing devices can reach up to 99.7% survivorship at 10 years in patients with good bone quality and implanted with large component sizes" and that "Often misunderstood, the hypersensitivity or allergic reactions to metal are a very rare occurrence. In nearly every case, ALTR are associated with increased wear from poorly positioned or poorly designed components or both." Another study seems to confirm Amstutz’ assertions. "Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement" from the University Hospital Brussels notes significantly higher serum metal ion levels with inclinations of the acetabular component of greater than 55 degrees, probably due to edge-loading, and no correlation between level of activity and concentration of metal ions.
From January to about June the pain got progressively worse to the point where walking my dog even a block or two resulted in about an hour-long "recovery" where I’d have to lie down for the pain to subside. Using crutches helped, but it was clear that something needed to be done. I got Dr. Su’s name from a friend from high school who had hip resurfacing in early 2014 and contacted his office in June 2014 and after not having any openings to schedule surgery until November, a 7/31 date opened at Hospital for Special Surgery in NYC and I gleefully took it.
Dr. Su’s office was excellent in scheduling all the pre-op testing and exams and my procedure was completed in about 90 minutes, as expected. Once the spinal block wore off, I was in a considerable but manageable amount of pain but the bone-on-bone pain I had been experiencing was gone (because the bone was no longer there). The first night in the hospital was pretty rough (increasing pain, neighbor snoring, hallway conversations, plus I’m a light sleeper) and by sunrise, having slept little if at all, I figured I would be there for at least another night. But by 9AM when the physical therapist came around to get me up and walking, I figured it was worth a try and I managed to complete a lap around the nurses’ station and get myself back into bed. The physical therapist said, "After that performance, I could clear you to leave." Inspired by the idea of sleeping at my parents’ apartment rather than another night at the hospital, I told the nurse I wanted to go and after a flurry of paperwork, I was out the door by 3PM. Wheelchair to the curb, crutches to get from the wheelchair to the cab, and moving very gingerly at this point.
Upon arrival at my parents’ apartment building, I successfully navigating 2 steps up to the lobby level and 2 steps up to the elevator level, all on crutches, and inspired by Dr. Su’s mantra, "Let pain be your guide," I decided to try walking without crutches from the elevator to my parents’ apartment door, probably 150′. It wasn’t fast, but I was able to cover the distance without crutches and haven’t used them since. The rest of Day 1-post was ice packs, a steady diet of Vicodin, and an Ambien before bed for a solid 8 hours sleep. I woke up feeling pretty good and sitting was no problem so I went with my folks from Manhattan to Southampton where they have a condo. We stopped at Costco on the way and just to keep moving I went into Costco (no crutches) and did a lap around the store with my folks while they shopped. The remainder of the day was more sitting, ice packs, and Vicodin and I got another decent night’s sleep that night. Day 3, I decided I was done with the Vicodin (I’d make a bad junkie — I don’t enjoy narcotics), and since my folks wanted to go to their gym, and because Dr Su said I had no restrictions , I decided to suit up and go along and see what I could do. It took a little bit of effort, but I was able to put on my own socks and shoes, and I wound up walking a mile on the treadmill and, feeling pretty good, did an additional 15 minutes on the stationary bike.
That much activity combined with stopping Vicodin made for an uncomfortable evening but the next day, with a Celebrex in my system, I was up and about with relative ease. The next few days were pretty low-key, including trips to the store, in and out of the car, and some walking around. Day 6 was my follow-up with Dr. Su and he said I was doing better than 99.9% of his patients, that I needed to be careful not to push it too hard and give myself a case of tendonitis, but that I was cleared to fly, so I flew home to SF that evening. I started PT at two weeks, and today is 8 weeks post and I’m going to try to play some tennis this weekend. I still have a few more weeks of rehab to do and need to regain lost strength and stamina for what was 3-4 months of inactivity, but all in all it’s been a remarkable recovery.
My advice to folks considering resurfacing is three-fold. First, do your own research. I don’t know I could have learned as much about this without the Internet and SurfaceHippy.info. Had I simply taken my first doc’s recommendation, I’d have a THR and in all likelihood, need a revision in 10-15 years and then another 10-15 years after that. With my Birmingham hip, I stand a decent chance of being "one and done." Second, pick a doc that has lots of experience – preferably hundreds or thousands of procedures under his/her belt. Third, don’t hold off on your surgery if you can do it sooner. The "hold off until you can’t stand the pain" philosophy seems to only be applicable to THRs and the more tine you spend limping and inactive, the harder the recovery will be. Finally, I’ll share what I believe to be has been the key to my unusual recovery and progress — you’ll never know till you try and you’ll never do it until you try, so try. Cautiously, carefully, but try. Try to get out of bed. Try to walk with a walker. Try to walk without the crutches. Like the saying goes, "If at first you don’t succeed, try, try again.