Decisions before hip surgery- Help!

[Horseshoe]

@horserider , I had the same concerns and questions. Also wondered whether I could hold out for the next great invention. Both femoral heads were no longer round but jagged and bone pain was horrendous so it was two thrs for me. Very glad I did them. Could not have waited any longer, I could barely walk. I reconciled it in my mind that if I ever need revisions, I will take advantage of the latest and greatest like I did this time. Thrs today are much better then before, we are so incredibly fortunate that our pain can literally be cut away. Imo don't lose precious today on a hope for tomorrow.

The worse off your hips become, in general, the harder the recovery. Waiting is also hard on your body. You have one or two sick joints, your body tries to fix it and cannot; it gets exhausted, sleep is interrupted, you can't move and so gain weight and get cranky. Nothing good about waiting in my opinion.

Fwiw, I have large size ceramic heads for stability on polyethylene liners (wanted all ceramic but the slight chance of shattering/squeaking put OS off as I intend to resume working out. OS used fluoroscopic guidance and so far, so good. Got the op report and it was interesting to see the fluoroscopic photos yet rather odd too see my hip dislocated; graphic pics don't bother me though.

From day one, I could not feel the implants, no clunky weird feeling, they're in there tight and feel like my own but without OA pain..yeah!

When you find the right OS with whom you can place your trust, most of your concerns will be alleviated.

 

[DAP]

Hi There, this is my first time to this forum and look forward to learning from the group. I have recently succumbed to the idea that I will have a hip replacement in the next couple of months.

I had hip preservation surgery two years ago, but my issues did not resolve. One thing I was considering up until two weeks ago was a cartilage transplant procedure being done at Mizzou BioJoint - biojoint.com - in Columbia Missouri. I believe this is the only place in the US where this is being done, and have heard some good success about it. This might be something worth checking out if it holds any interest for you. The reason I am not pursuing this option is that I have dysplasia and a bone cyst on my femur so putting new cartilage in my existing hip joint will not fix my issues.

Hope this helps . . .

 

[horserider]

Does anyone have any input on the new mobile bearing implants that have two articulation points rather than one? Also, with ceramic on ceramic - which they say is the longest lasting least wearing joint type, does anyone know the percentage of these units that squeak post op? Thanks

 

[Ramp]

I have heard the number 5 percent being used for squeaking. They can also crack but I think it is rare but dangerous. I'm not sure if they are supposed to last that much longer than the new cross linked polyethylene ones or not.

 

[sammylou99]

I have got ceramic on ceramic as my surgeon likes it for "younger" (52 lol) patients. No squeak here although he told me it happens in 1% of cases. I took the risk as I trust his advice and want this hip to last as long as possible!!
Sam


Sent from my iPhone using BoneSmart Forum

 

[horserider]

Has anyone had a THR using Makoplasty or similar computer navigation other than simple X-rays during the operation- and if so what were the results as to pain, recovery and post op leg length.? Thank you.

 

[Josephine]

Does anyone have any input on the new mobile bearing implants that have two articulation points rather than one?

They're okay but have no benefit overall. Your surgeon will choose what he thinks is best for you. That;s why you are paying him the big bucks- for his knowledge and expertise.

Also, with ceramic on ceramic - which they say is the longest lasting least wearing joint type, does anyone know the percentage of these units that squeak post op?

None of them these days. it was a problem about 10 years ago but the scientists discovered what the problem was and fixed it.

Has anyone had a THR using Makoplasty

There are a few - go look in the Hip Recovery forum though you might have to go back a few pages! I've known a few surgeons who were all fired up to this, co-erced the hospital to buy the equipment and then after a while, got irritated by the limitations and went back to the 'old' methods. The expensive robot ended up in the corner of some store room outside the OR, hidden under a dust sheet!

and if so what were the results as to pain, recovery and post op leg length.?

They are all exactly the same as the traditional approaches. So no benefits whatsoever, despite the advertising claims.

 

[Hip Hip Hooray!]

Hi @horserider, Dr. Joel Matta did my bilateral surgery. I didn't ask all the details, but I believe I had most of what you mentioned, with excellent results. I was asleep the whole time, but I recently watched him perform the surgery on a video. I listened as he explained why he uses the anterior technique, the specialized table, and the robotic arm. I found it really interesting. He told me that my hip is ceramic, with a PE liner. I have a titanium stem.

I couldn't be happier with my results. I feel very fortunate that he was my surgeon. I have a friend in CT who had her hip replaced by a surgeon who trained under Dr. Matta. She is pain free and very happy with her hip, as well. I'm sorry I don't know his name, but you could check the reviews on line.

I have no leg length discrepancy. My gait is now excellent, and people tell me that you can't even tell that I had my hips done. It's amazing.

 

[Ramp]

This is a pretty interesting article to read about metal on plastic vers ceramic on ceramic.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324779/

To me it sounds like ceramic on ceramic is longer lasting if you can get past the risks of a possible fracture or squeak. Perhaps it's an implant for life.

The cross linked polyethylene is supposed to be low wear but the study seems to say there are some risks to contamination in the surrounding area with it.

 

[horserider]

Thanks for the reply about Dr. Matta. The only CT OS I could find that trained under him is a Dr. Baumgaertner from New Haven CT. Perhaps you can tell me if that is the same OS who did your friend's hip. Thanks so much.

 

[horserider]

BEST PROSTHESIS FOR HIP THA ? - This is a tough question because I'm sure there is no correct answer - just opinion. Prosthesis companies are many, including Stryker, Zimmer, DePuy and Smith and Nephew etc. They ALL at some point have either had recalls of hip components or voluntarily pulled some components. The latest reports seem to suggest that COC (ceramic on ceramic) and COP (ceramic on plastic HCLPE) may be the latest and greatest - maybe even made better with the infusion of Vitamin E. BEFORE, I used to think that it's best to let the OS decide which implant is best based on his prior experience and expertise BUT I don't believe that to be completely true anymore. Many OS Doctors and hospitals have business arrangements with the prosthesis companies - often undisclosed to the patient. For example, in my area, a well respected OS told me that in a local city where there are two hospitals, he uses a Zimmer prosthesis at one hospital and Stryker prosthesis at the other. The hospitals dictate the prosthesis to be used - clearly based on some prior arrangement between the hospital and manufacturer. NOW, that's like driving and preferring Fords in the north side of town but driving and preferring Chevy's on the southside. On the other hand, one OS reportedly left a well respected hospital (one of the best in the nation) because he didn't want to use the prosthesis that they required. I conclude that of course the OS's input is still important but I would like to know if anyone can contribute and share some input, especially post op input, good or bad, on the BEST choice of prosthesis. Thanks in advance.

 

[Hip Hip Hooray!]

Thanks for the reply about Dr. Matta. The only CT OS I could find that trained under him is a Dr. Baumgaertner from New Haven CT. Perhaps you can tell me if that is the same OS who did your friend's hip. Thanks so much.

I'm no longer in touch with her, but I remember that the surgeon got five star reviews. It said in his bio that he trained with Dr. Matta, and does the anterior technique. She was very happy with her surgery, and she had no pain, just stiffness. She only took tylenol, because the meds made her sick.

 

[Jamie]

Horserider, all surgeons and hospitals have relationships with manufacturers. There is nothing sinister with this. In fact, in many hospitals the implant manufacturer has a rep present in the surgery to assist the surgeon. Surgeons work with various manufacturers to help develop and test new products and procedures.

It would not make sense for a hospital to have individual surgeons deciding what tools and equipment would be used for their specific surgeries. Talk about driving up the costs!! The people making the decisions on a manufacturer choice are not "the hospital." They are the surgeons in the orthopedic department who usually, as a group, make choices based on their experience and comfort with a particular system.

The point is that from a patient's perspective, it really doesn't matter all that much which implant is used. What does matter is the skill of the surgeon with that particular implant. Surgeons don't usually go through years of medical training and then come out and decide what implants they are going to use. They generally stick with what they learned in school and during their hospital residency and fellowships. One doesn't just switch to a new implant overnight. It takes a lot of time to learn the new process (while the implants don't differ much, many of the manufacturer tools used do). I have talked with excellent surgeons who did decide to make a switch (to the anterior method) and they report that it was at least two years before they were comfortable with the new tools and procedures. Surgeons usually opt to stick with the familiar and just get on with helping patients get back to their lives. Each manufacturer is constantly making improvements, so there are "latest and greatest" all over the place.

As for the surgeon you mention who left a hospital because he didn't want to use the implant they required, my guess is that had a lot more to do with the idea of not wanting to relearn new instruments and techniques than the quality of the implant itself.

You are not going to get helpful input from people here on the forum about the "best" implant. Our members don't have any experience except with their own hips. If the process went well, then they will tell you their implant is great. If not, you may get the opposite opinion. But all of those comments are really not worth anything to you in trying to make a decision on which implant is "best." Your situation is unique and that's why you seek an excellent surgeon to help you make the right decision for you. Focus on the surgeon and go with whomever you are most comfortable.

 

[Jaycey]

@horserider The best implant is the one your surgeon choses for you! This is based on (as Jamie says) their experience with the implant and your own medical situation.

Approach and implant are just part of the equation. Find a surgeon you trust. Then let the expert do their job. They have years of training in all of this and perform THR many times per day!

 

[Clipper]

@horserider - Trying to choose the better implant from reading articles on the net, versus the advice of an experienced orthopedic surgeon with years of medical school and hundreds of operations, doesn't sound like a great idea. My advice would be to choose a surgeon you trust and go with his advice. Years from now, if you need a revision, who knows what better materials and methods will be available.

 

[sfbaylover]

Regarding the Vitamin E infused highly cross-linked polyethylene liner -- is this type of polyethylene the standard nowadays? If not, would it be worthwhile to ask for/request its use in a hip replacement? I am just about ready to schedule a right hip joint replacement, and my surgeon will use a 36mm Delta ceramic head on highly cross-linked polyethylene. My surgeon is in New York City (Hospital for Special Surgery) and I am in Southern California. At the time of my consultation with him, I was unaware of the Vitamin E infused polyethylene, so I didn't ask him about it.

Is there a clinical difference between the two types of Poly -- the highly cross-linked and the vitamin e infused? I'm only 42, so I would like to maximize the longevity of my eventual hip replacement.

 

[Horseshoe]

@sfbaylover depends upon the manufacturer your OS uses. I have the highly crosslinked poly liner with a ceramic head and am active too. Didn't see any mention of it being vit E infused though.

Your OS will likely stick with the brand that he's most familiar with. I researched implants a lot and at the end of the day, it's a highly competitive industry and would guess that parts are similar. As he's a top OS in a top hospital, I'd have faith in his choices.

As an aside, I hope the long journey works out well for you. As you're probably aware, there are many excellent OS in LA (Matta, etc).

 

[Buster]

Can't comment on THR but I love to run and want to continue so I opted for BHR (resurfacing). Had my left hip done last month - delighted. Right hip next month. My doc is James Pritchett in Seattle who is also an innovator in resurfacing for small women who can have issues with regular BHR. Could be worth a call.



cheers - buster

 

[sfbaylover]

@Horseshoe

Thank you for the response. Yes, I have read many positive reviews about Dr. Matta. He is obviously a very talented, experienced surgeon. My surgeon in New York also mentioned Larry Dorr at USC as a very experienced guy, but he did say Larry is slowly winding his practice down (I think he is in his late 70s, so he's probably inching towards retirement). For me, since HSS is so highly ranked and has some of the lowest infection and complication rates (along with being a very high volume orthopedic hospital), I think making the trek there for surgery is a small price to pay for peace of mind.
I'm currently house-sitting in San Francisco, and almost daily I have been walking the 'Streets of San Francisco' in order to both maintain my cardio fitness and explore the city. And with all this hill walking my right hip has been very angry, reminding me in not-so-subtle ways that is doesn't care for all this walking (especially the downhill walking; surprisingly, walking uphill is virtually pain free). So, I know I need to move ahead with scheduling surgery, as my hip is not going to improve. But like many others here, I am hesitant about scheduling the date because I want to insure that I am making the right choice at the right time (and also I worry about the type of prosthetic used; like others, I want to ensure I receive the best possible implant -- although I know that is hard to define, as there really is no consensus as to which type of implant or approach is best).

 

[sfbaylover]

@Buster

I originally thought that when the time came for me to have surgery that I would opt for a hip resurfacing, as many specialists believe it to afford better function and stability than a traditional total hip replacement. And since I am a younger guy (42 now, but have had 'hip problems' since age 13), I would like to lead as highly active a life as possible with the least amount of physical restrictions. So, naturally, I wanted a hip resurfacing. Unfortunately, because of the childhood hip problem that I had (Slipped Capital Femoral Epiphysis), my hip joint (more specifically the femoral head) is too deformed and misshapen to qualify for a surface replacement. Bummer! But I am hopeful that I can get close to normal function with a traditional hip replacement. I have my fingers crossed!