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Hip Resurfacing Bilateral BHR, Need advice

Jamie

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That's an interesting study. It would have been more meaningful to me if the comparison had been between cemented THRs and the hip resurfacing. Cemented hips are more commonly done and they have a smaller revision rate than uncemented hips.

Good luck with your resurfacing and it will be great to read about your recovery.
 
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Bioguy501

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Jamie... I could be mistaken, but I believe it is more common to have cementless THR in this day and age. The cement was always thought to be one of the weak links in total hip replacements... for obvious reasons... cement cracks over time. That is why they transitioned over to implants that are porous to allow bone to actively grow right into the implant, on both the cup (acetabulum of the pelvis) and the femoral (medullary) cavity.

That being said, the revision rate is only slightly higher in cemented implants. See this meta-analysis:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662257/ ...so it is sort of a non-issue either way.

The thing that I keep coming back to is the fact that if something goes wrong with the BHR resurfacing many years down the line, it is easier to transition to a total hip by simply cutting the neck of the femur and sliding in a new femoral component.

And keep in mind, for me, a relatively young male (56 years old) 6'4" tall, 52 mm femoral cap implant, the BHR has a LOWER revision rate than the THR...assuming a high volume experienced surgeon, which I have. Plus, absolutely no restrictions on activity of any type.

After a lot of research, I am finally at ease with my decision. I am going to get BHR hip resurfacing for each hip. First surgery (for right hip) scheduled for September 22nd. Wish me luck. I will post my progress so others can read my story.
 

Jamie

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I don't know where you got the idea that bone cement cracks over time. The cement, when properly applied is compressed into the bone structure and hardens quickly, giving a very stable joint. It is especially effective for the acetabular cup fixation and preferred by many surgeons. There is also a "hybrid" hip that seems to work well where the cup is cemented and the stem is not. Hips done today are projected to last 30 years or more. So it's still an excellent procedure to resolve arthritis issues and be done with it.

It really doesn't matter. You have made your choice based on your personal situation and that's good. Be sure and chronicle your recovery here so others can benefit from your experience.
 

BigDon

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@Bioguy501

Howdy. I'm 34 and 8 weeks post Anterior hip replacement. 33 at the date of surgery. I am an avid golfer HC-1` and when researching / deciding which direction to go in had similar thoughts / concerns as yourself.
I had titanium implants with ceramic ball and socket. I entertained resurfacing and metal on metal replacement was also in discussion. I am lucky to have one of the best hip surgeons in the world and his advice i trusted. our conversations around the above lead me to go with the traditional ceramic option.
resurfacing / metal on metal replacement puts you at risk of metal ion poisoning as the metal on metal can sheer due to the friction. This can also result in rapid deterioration of the joint. Ceramic is the tried and tested option. Due to my age and activity level this was my best option. Below a link to my approach / material used


I'm 8 weeks post op and yet to get back to golf in any capacity. However after 12 weeks i am able to get back to it. I feel well enough to go back now, however the healing between bone and implant needs more time before applying rotational force. After discussion with my surgeon about returning to golf, there is no issue with weight shift, loading in rotation and release in the golf swing once cleared to return to it. I have couple of time tried a backswing ( without club ) and i can rotate better with a great increase in ROM. When i get back to the course i will play better golf 100%
Not each person / hip replacement is the same and the periods of recovery alike.
I was on crutches for 4 weeks post surgery, most people are not
most return to golf between 8 - 12 weeks, I'm back after 12.

Your choice in surgeon will be simple, go with what your gut. If you choose a surgeon and then upon reflection do not feel comfortable then that is an indicator to review.
 

BigDon

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@dapplega Here is the latest from the Aussie Joint Registry:
Revision rate.JPG

As you can see from the above data taken directly from the 2020 report, as of 2019... 15.2% of all people that got hip resurfacing at 19 years had a revision. For the THR, it is 12.2% at 19 years. To most people, it would seem from this data that resurfacing is worse compared to THR. But here is where you have to analyze the data carefully, because the above information is not factoring in a lot of variables. Over the last 19 years, there were many types of hip resurfacing implants... and virtually all of them were recalled within the last 10 years...except the BHR. So there is 10 years of data from bad devices in the early years negatively affecting the revision rate of hip resurfacing. (Yes... this would be the case to some degree with total hip implants... but the affect would not be as dramatic). Another key variable is that people with hip resurfacing are younger and more active. That is why they get hip resurfacing. A better comparison would be to separate the data so that the same age range is compared. (I used to have that data somewhere). When you compare apples to apples, hip resurfacing has a lower revision rate. Perhaps the biggest variable in the data is that 19 years ago, many hip surgeons were just learning how to do hip resurfacing. Whereas the THR is definitely taught in med school for all hip surgeons, but not putting in a BHR. And finally, the most important variable is surgeon experience. If you look at the data from Dr. Su, Gross, Pritchett, Brooks, (obviously McMinn) and other high volume hip resurfacing surgeons, their revision rates are exceeding low and much better than the THR revision rate... where EVERY THR surgeon is pretty much a high volume surgeon.

I should point out that another key consideration is that the re-revision rate (which means getting a 2nd revision - or 3rd overall hip implant) is much lower for BHR patients who get a first THR. If you have to revise a BHR, a THR performed at the time of the 1st revision has the lowest cumulative percent 2nd revision of 15.5% at 10 years... whereas the 2nd revision rate for the THR (thus... THR original to THR 1st revision to THR 2nd revision) is 27%... nearly 12 percent higher. Gary

Perusing more comments from this thread. Highlighted above, I must disagree. As I mentioned in a previous comment on your thread each individual / hip / outcome are different. The feedback you get will be different from surgeon to surgeon as there opinion is based on there outcomes. I believe you are mid 50's so i assume you are not playing contact sports. If I am correct then why would you entertain having the resurfacing and absorbing potential further complications down the track, than the method of THR that offers less?

You can search through continuous statistical threads for resolution, however majority of those cases would not reflect variables in there individual makeup and situation which would not be accounted for.

If you have settled and are at peace with resurfacing then that is the best outcome for you and your situation. Analysing the two through statistical evidence in search of a commonality in cases is a never ending process.
 
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dapplega

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I was doing some more research as my operation is getting closer. I like to use PubMed to look at articles. I came across this one which claims it was the largest study to compare the BHR hip resurfacing implant to cementless THR... in 55 year old people and younger. It is pretty eye-opening. Here is the link if you want to read everything, and check the context of the content: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224684/

Here is a key table in the article that summarizes the content in the article:
BHR vs THR.JPG

So for you young guys like me, this evidence is hard to ignore. Keep in mind this data is from experienced surgeons in hip resurfacing. Peter Brooks, out of Ohio, is one these doctors... and is involved in this study.
This is an interesting study and seems contrary to some of the joint registry information. I believe Australia does break out ages both for THR and BHR. It seems strange that the main component loosening for THR was the cup which is the common component between the two procedures. 5 - 7 years is not enough time for me to draw conclusions (but that is just me). Also worth noting that Dr. Brooks not only was involved in the study but receives yearly payments from on average of 20K from Smith and Nephew.
 

Jockette

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Also worth noting that Dr. Brooks not only was involved in the study but receives yearly payments from on average of 20K from Smith and Nephew.
Please provide a link to this information.
 

dapplega

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Also worth noting that Dr. Brooks not only was involved in the study but receives yearly payments from on average of 20K from Smith and Nephew.
Please provide a link to this information.
There are many statements given as fact yet without links throughout this site and this thread yet this is the one you want to see proof? I have always been very careful with what I post here. Every patient should research their doctor to understand what other payments they are receiving and from who. You would be surprised at some of the amounts.
 

Jamie

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@dapplega .... thank you so much for the link. I was the one who asked the staff to have you provide it because I was hoping you'd have just what you posted - an excellent resource for this type of information. It was a source I was not aware of and now we'll have it. We ask for links when we can, not so much for validation of what's said, but to have the entire reference for our benefit as much as the members reading the post. I appreciate that you helped us out in this way.

In this case, I'll be including this source in our update of material in the BoneSmart Library. It's important for patients who are doing research on surgeons to be aware of any funds they accept that are outside their practice. Granted, speaking fees, research projects and the like are very common, but it still helps to know the companies and amounts that are involved.

If you run across any other great links like this, don't hesitate to send them to me in a PM. We depend on members to assist us in this way since the staff is so busy helping people they don't have as much time as they'd like to cruise the internet for good resources.
 

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@Bioguy501

I am almost in the same exact situation as you were.

Yun for THR or Callander for BHR?

I'm 63 6' 170# and, like you very physically active -- 45 years and counting of rowing, cycling and weight-training. (No more running. Stopped about 15 years ago.)

Have appointment with Yun. And have contacted Callander.

My understanding (correct me if your pubmed research indicates otherwise) is that Yun can basically get the same results in terms of the mobility and ROM needed for vigorous exercise as BHR with lower odds of fracture or revision.

Anyway, any additional thoughts on Yun, Callander or THR vs. BHR would be greatly appreciated.

Good luck with your surgery.

You can DM me anytime.

pmv
 

Mojo333

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All the best for your resurfacing procedure tomorrow @Bioguy501

Look forward to seeing you on The Healing Side:ok:
 

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