Total Hip Replacement or Hip Resurfacing

Dec 15, 14 10:25

Post #1 of 17 (6628 views)

The purpose of my post is to hopefully get some feedback from others who have or are going through my specific situation between choosing a

Total Hip Replacement (Anterior Birmingham) or Hip Resurfacing. Also, all others with knowledge or first hand experience please chime in as well.

Specifically, what were your driving factors and what were you told about restrictions and longevity. how long did you have to wait before your Dr. could actually perform procedure.

Lastly, thanks for your consideration and please feel free to chime in with any other considerations you think are pertinent that I'm over looking or need to address consider further as well ( i.e.. mfg.). My gut instinct is more towards THR but I think I need to be a bit more logical rather than how I feel when making this decision.

Diagnosis:

Osteoarthritis, FAI (CAM)

Prognosis:

Total Hip Replacement (THR) or Hip Resurfacing

Patient:

45 year old male, 6'1", 225lbs, active, healthy and good bone density.

Additional info:

I have spoken with two hip surgeons and one of the two never brought up resurfacing so I guess he's not a fan. After realizing I would be a candidate for this type of procedure the second Dr. said that I don�t want resurfacing. He sited recalls, metal on metal and that the socket is all one piece, compared to a traditional THR that has a modular socket. Modular allows the liner to be just replaced in the event it wears down. He said in resurfacing that not only does the entire socket have to be replaced, but the ball as well for alignment purposes.

Both surgeons have done about 3000 THR's. One doctor's schedule was about four and half months out and the other about 2 and half months out. One is a "Top Dr." from a longstanding community publication and are chosen by their peers.

One doctor claims that there are NO restrictions and that it should last 25 years. The other said very light running and it could last 25 to 35 years. These figures seem to be all over the board and I've had PT's in the past tell me 10-15 years. I do realize a lot probably depend on lifestyle/activities, etc.

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Dec 15, 14 12:37

Post #2 of 17 (6586 views)

Questions.
1.) where are you located?
2.) are you not a candidate for FAI arthroscopic surgery?
3.) did these docs suggest Full replacement because you are not a candidate for a resurfacing or because your joint is too far gone?
Comments
1.) see more docs and educate yourself. You need to figure out what is the best solution for you.
2.) find the best doc for the surgery that you decide on. This is not something you want to find a "good deal" on.
3.) be willing to travel if needed.
I have had FAI arthroscopy- it worked great for me. I know others who have had resurfacing, still others who have had a full hip replacement.
Success for each of them hinged on the correct procedure for each athlete and also the right doctor for each type of surgery.

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Dec 15, 14 14:04

Post #3 of 17 (6566 views)

''I would be a can''didate for this type of procedure the second Dr. said that I don�t want resurfacing''

First thing you should do is go to SurfaceHipp.com and ask your questions

Now, why did you decide against hip resurfacing. On 11/15/2011 I had bilateral HR's at NYU Joint Disease Hospital with Dr Scott Marwin. A properly placed BHR by a very experienced HR surgeon is your best bet if you plan to return to running. The key words there are ''properly placed'' and very experienced surgeon''. This is a very difficult surgery for the surgeon. It's a steel ball bearing and it has to line up perfectly. If not it will cause problems. HR had two problems is the past; Johnson & Johnson rushed out a bad product that had to be recalled and a lot of hip surgeons rushed into HR without doing what was necessary to learn the procedure. My first hip doc was one of those. He was the one who told me about HR, but two years later he was against it telling me that it caused problems. His patients had problems. When I was doing my rehab, I learned that his THR patients had a tough time also.

I'm three years out from my bilateral hip surgeries. I'm running better than I have in ten years. My metal levels were tested very low last year and I really can't tell that I have them. I'm running four days a week and plan to for a long time to come.

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Dec 15, 14 21:42

Post #4 of 17 (6516 views)

Does your hip hurt every day in a way that interferes with your daily activities? Would you be willing to trade that for months of rehab, more pain, etc etc? Do you have the correct diagnosis?

You should see more surgeons. Surgery is irreversible. You must be certain its the correct diagnosis, the correct surgeon, the correct procedure. You will have to live with it for the rest of your life.

Two wheels good. Four wheels bad.

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Dec 16, 14 0:21

Post #5 of 17 (6492 views)

Re-emphasising the advice below, I undertook a review of knee replacements for a large implant manufacturer looking at procedures on 5 continents involving 70 surgeons in 30+ facilities.

Lessons:

Find the best clinician for your particular procedure - volume and outcome data
Get the right diagnosis
In so far as its possible, ensure that the person who's meant to be operating, completes the procedure - not that you're on a Surgeons list but a senior training surgeon does it - (thats how they get their experience - operating under supervision)

I visited three of the highest volume ortho centres in the world and aside from the surgical volumes, these centres offered exceptional PT, early mobilisation, short lengths of stay, excellent post surgical follow up and pre-surgical assessment and diagnosis

As a total aside, I'd hold off as long as possible, a colleague of mine, the medical director of a large Academic Health System had a total joint replacement a number of years ago, he's currently part of a class action and has had the joint removed and the joint fused because of metal on metal abrasion

Anyway, long story short, he'd had the original joint replaced due to wear and tear from a athletics career so he could spend his retirement years walking etc with his wife, he now can't run, ride or walk, as a significant leg length discrepancy.

The lesson is - you need to ensure that the procedure you pick is correct, necessary, has the appropriate post surgical care and is undertaken by the right clinician. I think you also need to get crystal clear guidance on the post surgical life of the implant and what activities would degrade it and the implications for requiring further surgical intervention down-stream i.e. if they say don't run, you do and cause accelerated wear - can you get a further replacement or will it have a significant detrimental impact on your quality of life.

I think people can continue to ski and run post knee's, but I'm not sure what the long term effects of these are and what the options are if they need a revision.

Re: Total Hip Replacement or Hip Resurfacing [bootsie_cat] [ In reply to ]

Dec 16, 14 9:22

Post #6 of 17 (6409 views)

Great questions and comments. Thanks so much for the response. I'm sure I'm just looking for some validation here, but I do feel very confident with the three referrals (different practices) that I received from Dr. Chris Larson (see below). I also believe that I understand the many hip surgery options and the specific ones that are applicable for my situation, but it still doesn't make it easier. Again though, I appreciate everyone's feedback. Kind Regards.

Located:

Minneapolis/St. Paul

Consulted Dr. Chris Larson. From what I understand, he's a leading, if not the top surgeon for this type of procedure. Great Dr., but unfortunately as he put it, I could make your femur head symmetrical and smooth, but you still don't have enough cartilage. Hold out as long as you can, but I see you getting one in the five years or sooner" So, I guess that's the joint that's too far gone.

Personally, I would like to know what others think about MRI/X-ray. Personally, the right hip in question doesn't; look that bad, but I do know that it's been bothering me for a good 10 months and now effects my sleep. I haven't run in over a year and would not even attempt to. Thankfully I can do the elliptical, swim, and most importantly, ride my bike. Thank god! :). The pain is manageable and I take Mobic and tramadol; which both work nicely, but like everything else, I would imagine they too will run there course.

Re: Total Hip Replacement or Hip Resurfacing [Sweeney] [ In reply to ]

Dec 16, 14 9:36

Post #7 of 17 (6404 views)

Thanks for sharing your feedback. I haven't ruled out BHR. Sorry for any confusion that my grammar may have caused. I'm a candidate for either THR or BHR. The one doctor that steered me away from BHR also supposedly does perform them as well; but maybe he's not as confident or only performs them on better candidates that he feels will be successful for both patient and doctor? of us. I never did clarify that point, so that's a good follow-up question.

Thanks for the specific info regarding BHR and I'm very happy to hear about the success people are having.

Re: Total Hip Replacement or Hip Resurfacing [Andrewmc] [ In reply to ]

Dec 16, 14 10:13

Post #8 of 17 (6397 views)

Great Feedback! Thanks for taking the time to post. Really.

I believe the metal on metal has been corrected, but the class action suits we are all hearing about lately are for specific hardware that's no longer being used. So, I think the hardware is giving the resurfacing BHR procedure a bad wrap.

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Dec 16, 14 11:38

Post #9 of 17 (6366 views)

In Reply To:

Dr. David Palmer BHR trained Dr. MacKenzie Calgary August 2006
1500 Hip Resurfacings to date***
1991 Northwestern Avenue South
Stillwater, MN 55082
Phone 651-439-8807
Fax 651-439-0232 http://www.stcroixortho.com

I just found Dr Palmer on SurfaceHippy. He might be good for you to go talk to. I can't say enough good things about my HR's. If not for them I'd probably be in a wheelchair by now. With them I just had a great season of short course triathlon; getting age group awards at every race and got 1st, 2nd, 1st, age group in the trail race series around here. Right now you can ride the road bike but soon you won't be able to keep up high cadence without pain. By the time I had my surgery, my joints were in constant pain and my glutes were on fire. Right now, if it wasn't for the hassle at airports, I wouldn't know I had anything done.

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

Last edited by: Sweeney: Dec 16, 14 12:27

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Dec 16, 14 12:07

Post #10 of 17 (6352 views)

I think there was an issue with the implants - however, far more important is who does it and how well they do it and the quality of their support team, imaging, PT, pre-op etc

I'd not want to be the last person on an all day list - no matter who does it, and for other reasons, I'd want it done earlier in the week and thats once I know I have the right person doing it

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Dec 16, 14 18:14

Post #11 of 17 (6290 views)

HIPPT - you've gotten lots of good advice from the posters above. As an orthopedic surgeon, if you were in my office, I would be asking you what could you do or not do today to put you in the best position 30 years from now? We really don't know. Most of the problems with resurfacing in this country were prosthesis related. Some of the older designs still work well in the hands of experienced surgeons. But none of them last forever. None of them are equivalent to "original equipment" so to speak. Although my MD wife and I have sent a # of patients to Tom Gross, MD in Columbia, SC, arguably the most experienced resurfacing doc in North America, who gets great results, even he can't give you 20 year follow up. These patients do well, especially if they're thin, female runners 55-60. I would ask you, if you were in my office, if you could forego tri emphasizing swimming, rowing, cycling, etc.?

If I were in that spot, which I'm not, I think I'd become an ex-runner, aquathon-athlete to ensure I could get the most out of my hip. I wouldn't have resurfacing or a THR until I absolutely couldn't stand it and then make the best decision I could at that time.

Best of luck.

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Re: Total Hip Replacement or Hip Resurfacing [johnpostmd] [ In reply to ]

Dec 16, 14 23:59

Post #12 of 17 (6248 views)

out of curiosity,a general question:

what are the potential outcomes of a double knee or double hip who have them done at 50 and choose to carry on running?

whats the consequence of implant misalignment or people with bio-mechanical issues such as leg length discrepancy and wear and tear on implants?

Re: Total Hip Replacement or Hip Resurfacing [Andrewmc] [ In reply to ]

Dec 17, 14 5:43

Post #13 of 17 (6218 views)

Andrew - those, as you'd suspect, are some pretty broad reaching questions so I'll try to be concise. Bilateral knee replacement at 50, while not your everyday operation, is done. You'd want to discuss it carefully with your doc as some do them simultaneous, some a couple days apart but during the same hospitalization, etc. and each has positives and negatives. Contemporary polyethylene used in joint replacement is constantly under scrutiny to make it last longer and recent anti-oxident additions have brought claims of 30 year longevity. That's lab based so far since it's only been out a few years. You'd of course factor in you expected life span to see what makes sense for you. As for running, were it me, I might run a little. I know a few patients who have and several have said it's not the same, it doesn't feel "quite right." I'd bet, depending on the brand of components used, someone in their company has tested the prosthesis for the increased load and could give you a specific answer. The other thing to consider is that, as you age, you just may not feel like running as much. (More time at the senior center playing bridge!)

As far as mal alignment, the surgeon does his/her best to avoid that.

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Re: Total Hip Replacement or Hip Resurfacing [Sweeney] [ In reply to ]

Feb 24, 15 11:04

Post #14 of 17 (5884 views)

Yes, if I want to ever run again I would have to get hip replacement. I can trot now and I do the elliptical often. Scheduled for April 9 but second guessing myself. The symptoms seem manageable, but they also mess with you too. 45 seems so young that maybe I should and could endure a couple more years. Maybe at least postpone procedure until road biking is over in November. Spring and summer are too valuable in MN.

Oh, You are not worried about having to have a revision surgery?

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Feb 24, 15 12:34

Post #15 of 17 (5861 views)

I'm with you on delaying surgery until fall if you can. I had both of mine done on November 15, 2011, after having a small surgery to repair a tear in my shoulder on Sept 13 and after retiring from the rebuilding of the World Trade Center on Sept 10, 2010. I had been off the bicycle since May, when it seemed like both hips just gave out in a mountain bike race. I set my goal to make it until the tenth anniversary of 911 and it was tough. Somedays I could hardly walk out of there after work. Six months after my surgeries, I was back running and ran my first 5k race about one year after surgery (2nd age group). I've been doing great ever since!

Two questions, who is your doc and which implant does he plan to use?

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Feb 24, 15 16:46

Post #16 of 17 (5814 views)

The answer any orthopedic surgeon, well, any orthopedic surgeon I'd let work on me or my family, would give you at this age is to put off surgery until you can't stand it. Get another hobby and leave the running to others. I know it sucks but rather than dwelling on the "I can't" in life, your limiters in tri speak, turn it around and emphasize the "I cans." Best of luck!

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Re: Total Hip Replacement or Hip Resurfacing [hippt] [ In reply to ]

Feb 25, 15 6:10

Post #17 of 17 (5723 views)

I have a THR on my right side. It was done nearly 5 years ago when I was 38. I broke my hip when I was 14, completely snapped the neck. It was repaired with screws which were later removed in my early 20s. The cartilage eventually was completely gone. The pain was unbearable. It got to the point where I had to use my arms to lift my leg when getting into a car.

I was a runner, didn't bike or swim at all, and wanted to continue running. I researched as you are doing. Had discussions with my surgeon about wanting to stay active. He said I was a good candidate for the resurfacing because I had good bone structure but because original break was at a young age I had leg length discrepancy, so he recommended a full replacement instead since he could fix that. Now my legs are the same length and I have fewer back problems.

My OS recommended metal on metal with a larger head. I know of all the bad press about metal on metal but I haven't seen any negatives yet. If I do have problems later I'll cross that bridge then. I've done one full IM and four HIMs and a number of OLYs, sprints and half marathons and shorter running races. I doubt I'll ever get to be a high mileage runner and that's fine. I think I averaged around 35 mpw when training for the full IM. I won't say it's been pain free but for the most part I haven't had much trouble. When pain does flare up I just back off until it goes away.

I also road bike raced for a couple years but frankly it was way more dangerous than running. I wasn't involved in any crashes but it was only a matter of time so I stopped doing them. Recently, I've gotten more into mountain biking and really love it. I did have a pretty bad spill where my repaired leg slammed pretty hard on a large rock. Scared the hell out of me. Luckily the pain only lasted a week and wasn't serious. There are risks in any activity you choose to do. Only you can decide if it's worth it to you.

Good luck with whatever you choose to do.

------------------------
Loud pawls save lives

Last edited by: BionicMan: Feb 25, 15 6:11

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