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Decisions before hip surgery- Help!

Discussion in 'Hip Replacement Pre-Op Area' started by horserider, Mar 8, 2017.

  1. horserider

    horserider New Member
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    I am in need for a THA as my hip is bone on bone. I have led a very active sports filled life and I know that THA will change that. This is my first post and I have done over a hundred hours of research on THA.

    So FIRST: Type of implant. Almost all of the major manufacturers have had recalls or simply removed a prosthesis from the market - most issues and suits involve metal on metal implants so it seems that ceramic on highly cross linked PE is the way to go - possibly improved with the use of Vitamin E. I don't know which of Stryker, Zimmer, DePuy or Smith & Nephew is best.

    SECOND: It appears that assuming you are a candidate for minimally invasive surgery (not overly obese or muscular) the muscle sparing anterior or mini posterior approach is the way to go. But there is one more issue to consider.

    THIRD: intra-operative navigation: Many prosthesis companies have their own computer guided or robotic systems that enable a skilled surgeon to more precisely place the stem and cup components. (Examples include Makoplasty, Intellijoint and the like) A few studies including one Harvard study have suggested that when hip replacements are done without intra-operative NAVIGATION the preoperative goal for offset, angles of inversion and ante-version and leg length etc. are only achieved in 50 to 60% of replacements. To me, that percentage is not acceptable as it may have a huge effect on postoperative comfort, gait, leg length and perhaps longevity due to a more uniform stress/force on the new joint.

    And FOURTH: I understand that proper operating table, such as HANA or ARCH, is needed for optimal outcomes when using the anterior approach. Of course, the experience and knowledge of the surgeon is always paramount. I cannot find any Orthopedic group in Connecticut who complies with all four of these concerns and who takes my insurance. I would appreciate any input of this matter. Thanks
     
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  2. Itzdor

    Itzdor Member

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    I am having a right hip replacement done here in CT on 3/20 by Makoplasty.
    My left hip was done by the same surgeon at the same hospital, but not Makoplasty.
     
  3. horserider

    horserider New Member
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    I would love to know where you are having the makoplasty and who is the doctor.
     
  4. Ramp

    Ramp Junior Member

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    My doctor said the two best he uses are the ceramic ball with PE vitamin E and ceramic on ceramic. The latter should last longer. Possibly forever but he said there is a small chance of cracking which is very bad. He offered to let me pick either. I think I am leaning towards the first one. As for anterior I have heard it's best to have a table that lets them manipulate the limbs. I'm sure there are a few different ones out there. Depending on age I know some active people have been getting hip resurfacing but it may not be for everyone because it is metal. You should talk to a few doctors and see what they recommend for you. I would trust a skilled surgeon without a computer.


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  5. Josephine

    Josephine NURSE DIRECTOR, BONESMART Staff Member Administrator

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    I've always thought that the choice of implant is the surgeon's job - that being why you are paying him the big bucks! But basically, there really isn't a lot to choose between all these implants. They all have a good history and track record. The crucial factor is that the surgeon you choose works with whatever he has trained on, has most success with and confidence in.

    Besides which, the metal on metal hips are no longer used so you can cross that off your list!
    This is a very old premise which is not generally shared by exponents of the anterior approach.
    There are indeed a number of robotic systems out there but in my experience, not so many surgeons who are really committed to their use. There are issues with them such as when the surgeon can see a bone spur which needs attending to but is outside the target area of the computer and won't let him go there. His only option then is to switch the device off! It's a largely held opinion amongst hip surgeons that they are more trouble than they are worth and certainly don't guarantee a perfect placement.

    Additionally, considering the hundreds of thousands of hip replacements that are done world wide, very, very few of them are done using robotics and yet very few of them have such ghastly results as you have quoted.
    Not at all! There are hundreds of surgeons who do the anterior approach on a standard flat table. The Hanna is good but not essential and it can cause problems post-op with pain from strained hip and/or knee joints.

    Choosing a surgeon and a prosthesis
     
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  6. Itzdor

    Itzdor Member

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    Danbury Hospital. Dr. Robert Devaney, Danbury Orthopaedic Group.
     
  7. Jaycey

    Jaycey Moderator Staff Member

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    @horserider Looks like Josephine has given you some good information. Best to let your surgeon chose the implant and approach that is right for you and fits your lifestyle. The key is finding a surgeon that you trust and who has extensive experience doing THR (200+/year). My RTHR surgeon fit this criteria. I had lateral approach and recovery was a matter of weeks.
     
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  8. horserider

    horserider New Member
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    I understand that the latest gadgets and technology are not always the best BUT I had a well established and experienced OS tell me that before using intraoperative guidance (which for him includes a CT scan and pre-op 3D model which is then compared to the post-op result) his practice achieved their pre-op objectives post operatively only 65 -70% of the time (although the relative patient outcome was considered good which of course improved the patient's overall quality of life) and that WITH the intraoperative navigation the pre-op objective is achieved about 98% of the time. To me this is a huge difference especially if you ended up in the 30 - 35% that didn't get precise placement without the navigation aid. Such better, more precise placement MAY translate into a replacement which more closely resembles a natural hip and perhaps added longevity. And added longevity would seem to be a big plus especially for anyone in their 50's or 60's who may want to get every possible step and ounce of wear of out of the new replacement so as to avoid possible revision (from normal wear-out) down the road. As I see it its the difference between a new pair of shoes that you can wear and a new pair of shoes that really fit. A new front tire on a misaligned car will still run for about 20,000 miles. Align that car to exact factory specs and the same tire will last for 40,000 miles. Just my two cents.
     
  9. Jaycey

    Jaycey Moderator Staff Member

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    You had one OS quote what they found within their own practice. The numbers they are quoting for "post operative objectives" are not a standard or the norm for everyone. I

    t's great that you are researching but I think you might want to focus on surgeon profiles. Look at their expertise and years of experience. More and more surgeons are specialising on younger, more active patients. Find the right surgeon and all this will fall into place.
     
  10. horserider

    horserider New Member
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    You have a good point. There is NO substitute for experience, knowlegde and professionalism. But I can tell you that several non OS doctors have told me that Navigation is the only way they would go if they needed such an operation. Also, there are many doctors on You Tube (I know -consider the source) that say that these intraoperative checks have made them better surgeons. One in particular says that he has done over 7,000 hips and knees and while he was skeptical of the computer/robotic arm at first it has clearly made him a better more consistent surgeon. I would bet that if we could look into the future - say 5 to 10 years - almost no OS will perform these operations without navigational guidance. I surmise that some OS ego's and the substantial cost (sometimes 250K or more) have slowed the acceptance and use of these newer navigational tools. Only time will tell.
     
  11. horserider

    horserider New Member
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    QUESTION Does anyone know if there are any new procedures or treatments for a bone on bone hip that are currently being tested and or developed at research centers either in the USA or abroad. My biggest fear is that I will have a THR and then a year or two down the road someone will come up with a procedure to inject some type of cartilage into the hip socket - much the same as the newer and somewhat successful knee treatments. Perhaps there is something used in overseas that is not approved here yet. Once that femoral head is cut- its lost. Thanks
     
  12. confused newb

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    Unfortunately I don't think there's any 'magic bullet' treatments on the horizon for us. Beyond the traditional THR, there aren't a lot of options out there. Hip resurfacing is another similar, yet different, treatment that's available in some instances. You could look into that and see if it's an option for you. There are not as many surgeons out there that perform the resurfacing, and there has been some bad press (deservedly) on the procedure over the years.
     
  13. opie

    opie Member

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    @horserider. My first THR was done 8 years ago in the traditional, lateral manner. My surgeon moved. 6 weeks ago a surgeon at the same hospital did a Stryker/Robotic arm /ceramic. Quite a difference in recovery. My first I had significantly more and longer pain with more swelling and bruising, however, I have been extremely happy with it. I really cannot tell I have a THR. This time, my surgeon, my old surgeon's colleague, was trained and highly recommended in the field. I had much less pain, very little swelling and bruising. He also does a lateral approach. The entire process was so much less invasive and gentle.
    I very much agree that you find the best surgeon possible and he/she will educate you on their procedure. Hope this helps.


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  14. opie

    opie Member

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    Also, with resurfacing, in my case, 3 surgeons told me a THR would more than likely be in my future.


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    Last edited by a moderator: Mar 10, 2017
  15. confused newb

    confused newb Member

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    I don't know that that's necessarily true. I've read a lot on them over the past few months and there's nothing concrete on life expectancy. I would think that a properly selected device implanted by a highly experienced surgeon should have a similar life to a standard thr.
    If there are studies to the contrary, I haven't seen them.

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  16. opie

    opie Member

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    I'm reporting on my first THR. I went to 3 surgeons asking for hip resurfacing and, in my situation, all three said I would eventually need a THR. So, only using my data.
     
  17. Celle

    Celle Forum Advisor Staff Member Forum Advisor

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    "Somewhat successful" is the correct description for knees. The new treatments seem to be successful when cartilage loss is at a very early stage, often when the patient has no symptoms. When the patient already has symptoms and pain, the treatments are far less successful.
    There really is no magic bullet yet, for knees or hips.
     
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  18. Nivea

    Nivea Member

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    I did not doctor for my hip as I just dealt with it, until I could no longer walk. I should have but didn't. At any rate, by the time I saw the doctor, my hip was bone on bone. I was told I needed a THR, which I had 2/15/17. I was told by my OS that by the time it's bone on bone, injections are not possible as there is no place to put anything anyway. The pain I had was excrutiating and the OS wished he could have given me an injection to tide me over until I had surgery. However, it was not possible as there was no place to put it. Now, I would think that would be the scenario for any type of substance that would be able to be injected.

    I am very happy that I went through with surgery. 3.5 weeks and am pain free and can walk! Of course, I still have the limp but things are getting better each day. I am using a cane but have taken a couple of steps without it as I have "forgotten" it.
     
  19. Itzdor

    Itzdor Member

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    The Danbury Orthopaedic Group has been doing this since 2014. I volunteer at the hospital so have had the opportunity to talk about it with a lot of the nurses involved in the surgical area and the ortho floor. They have given me the encouragement I need. Devaney did other hip in 2010. I understand Hartford Hospital just got a new machine, but that is all I know. My sister was a nurse and she always advised me to ask a nurse...they know what goes on behind the scenes and who is the best. I've followed her advice always.

    http://www.prweb.com/releases/2014/10/prweb12224106.htm
     
  20. Jaycey

    Jaycey Moderator Staff Member

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    In most cases there is no joint left to inject and the femoral head is deformed due to deterioration.

    I attend several meetings a year where surgeons are discussing the latest techniques. The technology innovations for THR have moved on with better, longer lasting implants - many now targeted for younger more active patients. Surgeons are also addressing better recovery times and shorter hospitals stays. Can't say I am a fan of shortening hospital stays unless the patient is both physically and mentally ready to go it alone.

    MAKOplasty isn't really new. It's been around for awhile. We have several members on this forum who have had PKR using this technique with mixed results. It's still joint replacement.
     

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