Discussion on the merits of hip resurfacing

[dedicated]

Hello Daniel,

Sorry to hear about your problems, but luckily there is a good way to full return of your previous life and sport activities. But bluntly put, that is not reached by the placement of any prosthesis whereby the femoral head and neck are sawn off, as would be the case with the ceramic-on-ceramic prosthesis that you took up. Apart from the question of the material choice (metal-on-plastic, ceramic-on ceramic, metal-on-metal, metal-on-bone) there are some very important other considerations that will determine to field of use for the prosthesis and the expected life of the device. For instance, the diameters of the joints bearing surfaces determine if high impact can be sustained or not without permanent damage to the components and high wear. Also, the larger the diameter, the less chance there is that dislocations will occur.
Apart from this there is the question whether or not the placed prosthesis introduces the negative phenomenon "Stress-Shielding", which disturbs the leg's loading that was required to keep the bone stimulated and healthy. You should even look at which other important bloodvessels and tissue is cut and tossed out during the operation.
All the above negative points are attached with your choice, the ceramic-on ceramic prosthesis. I will list and explain for the ceramic-on-ceramic applies:
1-The femoral head and neck are sawn off and tossed out together with bloodvessels that earlier on nourished the top section of your leg. Future nourishment for health of that top section is lost.
2-The bone is emptied from some or all of it's marrow to allow some reaming and the placement of the shaft. Marrow has an important function? Why remove it then?
3-Placing the shaft inside the now empty canal will create forces that are facing outward, if you like compare it with a wedge...and we all know what a wedge can do!
4-You introduce a hard, sturdy and non-flexible shaft in bone that is not hard and that can flex to some degree. Hereby you create an incompatibility, because the two just don't match in the type of action that they are intended for. In time this will cause loosening or at least it will attempt to loosen itself and cause irritation in the mating surfaces.
5-You are needlessly exposing yourself to dislocations of the hip by choosing the smaller ball size, because they don't come higher in size than 38mm for the newest of the newest.
6-Sawing off the femoral head/neck and placing a shaft also suddenly opens up for other mistakes, your foot could after the operation be facing to the left or right, if the shaft was accidentally rotated in the operation.
7-Your leg's length could after the operation suddenly be more or less than you expected, leaving you wobbling for many years to come.
Now with a "hip resurfacing" none of the above can or will occur!
The femoral neck stays in place and thereby all of the above negative points can be forgotten, every single point of them (and some more points that I haven't even touched yet).
I welcome you to contact me in any way you'd like, but please visit my website and learn as much as you can so that you really see how hip resurfacing is the best for you and certainly not any prosthesis with a shaft that mutulates your leg needlessly and changes your future negatively. Hip resurfacing was in fact specifically designed for the younger and active patients!
This can mean that you get another impression about your surgeon, the main point is that you stay awake and open for logic, whatever new views that will give.
Ron van Mierlo
https://resurfacingscan.be (click on "English)

 

[Josephine]

Re: Jock training for a marathon

For instance, the diameters of the joints bearing surfaces determine if high impact can be sustained or not without permanent damage to the components and high wear. Also, the larger the diameter, the less chance there is that dislocations will occur.

Well that's true - as I said earlier.

Apart from this there is the question whether or not the placed prosthesis introduces the negative phenomenon "Stress-Shielding", which disturbs the leg's loading that was required to keep the bone stimulated and healthy. You should even look at which other important bloodvessels and tissue is cut and tossed out during the operation.
All the above negative points are attached with your choice, the ceramic-on ceramic prosthesis.

What scaremongering tactics are these? You clearly have little or no understanding of the circulation of bone. You really think surgeons would cut and toss out important blood vessels?

2-The bone is emptied from some or all of it's marrow to allow some reaming and the placement of the shaft. Marrow has an important function? Why remove it then?

The little that is removed is about 0.2% of the body's whole. The body misses that even less than the pint of blood that blood donors give.

3-Placing the shaft inside the now empty canal will create forces that are facing outward, if you like compare it with a wedge...and we all know what a wedge can do!

What nonsense! Years of research have gone into the design of the taper-fit stem and thousands upon thousands of patients are walking around happily on them and have done so for years!

4-You introduce a hard, sturdy and non-flexible shaft in bone that is not hard and that can flex to some degree. Hereby you create an incompatibility, because the two just don't match in the type of action that they are intended for. In time this will cause loosening or at least it will attempt to loosen itself and cause irritation in the mating surfaces.

Another totally unsubstantiated opinion! Statistics for loosening are extremely low. And I never heard the term "mating surfaces" before, nor that 'irritation' occurs. That would almost be funny if it wasn't so misleading to those anxiously awaiting surgery.

5-You are needlessly exposing yourself to dislocations of the hip by choosing the smaller ball size, because they don't come higher in size than 38mm for the newest of the newest.

You're making it sound like dislocations are an inevitability and they're not at all. Incidence of dislocations, while less that in the larger head styles, are still extremely low.

6-Sawing off the femoral head/neck and placing a shaft also suddenly opens up for other mistakes, your foot could after the operation be facing to the left or right, if the shaft was accidentally rotated in the operation.

Excuse me? "Accidentally" rotated? You obviously have no idea of the procedure of hip replacement.

7-Your leg's length could after the operation suddenly be more or less than you expected, leaving you wobbling for many years to come.

For many years? That's a new one!

Now with a "hip resurfacing" none of the above can or will occur!

Really? Never ever? All surgical procedures have their problems.

The femoral neck stays in place and thereby all of the above negative points can be forgotten, every single point of them (and some more points that I haven't even touched yet).

You're not from SurfaceHippy by any chance, are you?

 

[shugaplum]

Re: Jock training for a marathon

Thank you for that Jo...I just get a little peeved when people get pushy. I too looked at resurfacing as an option and it was not a possibility. My surgeon who is a very well known successful surgeon did not have much to say about it either in terms of it being WAY better than the replacement.

I understand that we all want to feel as though our choice was the right one and we are also trying to get others to make a good decision but I feel that sometimes the persuasion is made at the cost of belittling another's decision. I am perfectly happy with my THR and so are so many others on this board. And others are very happy with their HR. To each his own and thats the beauty of this surgery...there are so many options out there and most of them are good options. You could have the best option in the world and still have complications in surgery. You could have less than ideal...I cannot have metal on metal...but my choice was still a great one and my surgery was beyond textbook. Just because I have a THR does not mean that I will not be active, jump, dance, and live my life. I have been given the go ahead by my doctor to go back to my normal 26 year old life. So let's all just agree to disagree and stop putting down other people's choices. :D

Also-as much as we all feel like a family we do not know the ins and outs of everyone's personal lives. Daniel was very upfront that there was a financial situation regarding the surgery. It sounds like he has done a fantastic job to secure a great surgeon who is willing to work with him...why push him away from that?

Also-my apologies to Daniel that his thread has been hijacked!!

 

[Josephine]

Re: Jock training for a marathon

Quite so, shuga! I hate diving into these rants but sometimes it has to be done.

Regular scheduling may now continue!

 

[dedicated]

Re: Jock training for a marathon

Well that's true - as I said earlier.



What scaremongering tactics are these? You clearly have little or no understanding of the circulation of bone. You really think surgeons would cut and toss out important blood vessels?
Yes, if you are the person with the experience that you say you have you must have had your eyes closed for all that time. Together with the sawn off femoral head the big circumflex vein is lost.



The little that is removed is about 0.2% of the body's whole. The body misses that even less than the pint of blood that blood donors give.
Whatever the perecentage, it is a loss that can needlessly be created and can't be a positive move. If I came past and asked you just to clip the nail of one finger you wouldn't allow me but you will allow an orthopaedic surgeon who very well can have made the wrong choice to sawn off your femoral head, now that is twisted logic!



What nonsense! Years of research have gone into the design of the taper-fit stem and thousands upon thousands of patients are walking around happily on them and have done so for years!
Despite the years of reasearch they now have the much better hip resurfacing and listen: other much more bone-sparing options than the one Jock has so far been offered from what I read. Your "Taper-fit" says it already, even if Jock hasn't seen it yet he will realize that the taper under his weight is eventually making it's way down in the bone, nroaml natural results that you can expect, the time for that to happen will depend much on Jock's weight and his activities.


Another totally unsubstantiated opinion! Statistics for loosening are extremely low. And I never heard the term "mating surfaces" before, nor that 'irritation' occurs. That would almost be funny if it wasn't so misleading to those anxiously awaiting surgery.
Look, I am not from an English speaking country but the words "mating surfaces" are apart from normal English exactly that what is involved anywhere where two components meet(mate). If this basic point is not understood then you may be missing understanding of all the other ortho-technical terminology involved with hips.
That you lack this technical insight can nobody hold against you but only as long as you hold yourself out of discussions that go deeper in the mechanics of the hip.

You're making it sound like dislocations are an inevitability and they're not at all. Incidence of dislocations, while less that in the larger head styles, are still extremely low.
Sorry but you made a few mistakes here you, I presume that you intended to write: "while more than in the larger head styles, are still extremely low."



Excuse me? "Accidentally" rotated? You obviously have no idea of the procedure of hip replacement.
Whatever the procedure is, with the completely sawn off femoral head it is mechanically unavoidable not to introduce a fault in rotation and leg length. Normally I might hope, that these two faults are kept to a minimum and each surgeon has his/her own ways to approach this as closely as possible but it is fact. Occasionally you see (I at least though my support groups) people that were operated with a traditional hip prosthesis and a foot set wron or with real leg length differences.



For many years? That's a new one!
Yes, exactly for that period of time that the shaft is holding in the leg or the time it takes before the bearing materials in the joint have worn out or the time before the bearer is getting fed-up and demands a revision for correction of the length discrepancy



Really? Never ever? All surgical procedures have their problems.
Yes really. Surgical procedures all have their problems but the points made above are as the are, re-read them if you like.



You're not from SurfaceHippy by any chance, are you?

I am from Nordenshippies and Heupen-Ned groups, but have participated also in many other hip forums.

 

[Josephine]

staff notice

These posts were moved into this forum
for hip resurfacing and because
they were derailing another member's thread
​

 

[Josephine]

the big circumflex vein is lost.

I take it you are actually referring to the circumflex artery rather than vein?

The only blood vessels are are crucial are the aorta, the vena cava and associated divisions such as the femoral artery and nerve. The circumflex artery supplies the upper end of the femur and it isn't the only blood supply to that structure. There are interstitial nutrient arteries within the cortical bone and the bone marrow itself provides quite a degree of nutrition as well (by nutrition I mean oxygen).

And if you did mean the vein, then there is a great deal of redundancy in the venous system so one vein can easily be lost without compromising anything. That's how come we can remove varicosed veins without a problem.

Whatever the perecentage, it is a loss that can needlessly be created and can't be a positive move.

Well that's not entirely inaccurate either since bone and blood cells are constantly being remade and replaced. The average life of either is about 2-3 months. Our entire skeleton is a manufacturing plant for blood and bone cells and marrow is just fat which is around in plenty. The loss of a few grammes of it is neither here nor there and will place no strain on the body whatsoever.

the taper under weight is eventually making it's way down in the bone,

All evidence to the contrary, my friend! The taper fit has performed extremely well under trials and many people are walking around very happily 15-20-25 years and more after having them implanted.

Look, I am not from an English speaking country but the words "mating surfaces" are apart from normal English exactly that what is involved anywhere where two components meet(mate). If this basic point is not understood then you may be missing understanding of all the other ortho-technical terminology involved with hips.
That you lack this technical insight can nobody hold against you but only as long as you hold yourself out of discussions that go deeper in the mechanics of the hip.

I meant I'd never heard them used in professional orthopaedic circles. And I can promise you I do go deeper into such discussions. I was at a major hip symposium in Edinburgh only recently and never heard these terms used by the surgeons there or anywhere else. No doubt they are part of general engineering parlance, however.

What there was much discussion about was the disparity of results between HR and THR and it was generally accepted that HR did not come off too well overall, that it is not a "one size fits all" option where the generality of THR choices was much more favourable. I still have my notes on that particular seminar.

Sorry but you made a few mistakes here you, I presume that you intended to write: "while more than in the larger head styles, are still extremely low."

LOL - you got me there - typo! Actually it should have read "while less in the larger head styles"

Occasionally you see (I at least though my support groups) people that were operated with a traditional hip prosthesis and a foot set wron or with real leg length differences.

I would suggest that most of those had some kind of pre-op rotational deformity which only showed up or got accentuated when the hip was corrected. You make it sound like casual carpentry!

Leg length differential can be due to that correction also and often as not, is due to a tilted pelvis acquired when the patient was walking abnormally pre-op. True, some are real LLDs but the numbers are extremely low.

Your leg's length could after the operation suddenly be more or less than you expected, leaving you wobbling for many years to come.

For many years? That's a new one!

Yes, exactly for that period of time that the shaft is holding in the leg or the time it takes before the bearing materials in the joint have worn out or the time before the bearer is getting fed-up and demands a revision for correction of the length discrepancy

The point is, you make it sound like an inevitability and it's not. Sure it happens to a few people here and there but then so do the numerous problems arising from HR.

Now with a "hip resurfacing" none of the above can or will occur!

Really? Never ever? All surgical procedures have their problems.

Yes really. Surgical procedures all have their problems but the points made above are as the are, re-read them if you like.

My friend, your ardent advocacy on behalf of HR does you credit but you forget the essential principle about internet forums which I posted here A word of caution about forums . But to save you the trouble of hitting the link, what I said was:

A word of caution:
Forums like this get a disproportionate number of people with problems registering as those whose recoveries go smoothly have no need to seek information and support. They might post pre-op to ask questions and get help/reassurance in the lead up but if things go as they should afterwards, then they're off and getting on with their lives which is exactly as it should be.

Therefore, please don't be discouraged by the number of problems that seem to be represented here.

Your forum may be successful in terms of activity and numbers but - as with this forum and any other - no way can it be taken as representative of hip surgery as a whole.

I also cited these figures from legitimate government sources

Statistics:
US: 225,900 primary hip replacements and 431,485 primary knee replacements were carried out in 2004 according to data from the Nationwide Inpatient Sample
UK: 27,814 primary hip replacements and 75,629 primary knee replacements were recorded in the broken link removed: https://www.njrcentre.org.uk/njrcentre/Healthcareproviders/Accessingthedata/StatsOnline/NJRStatsOnline/tabid/179/Default.aspx in 2008

This forum currently has 2,839 registered members. calculating from the sum of the number of hip surgeries in the stats above, that means this membership is 0.0111% of that total. It's a very rough calculation, to be sure, but illuminating, don't you think? Especially if I ever bothered to figure out what % of my members had problems such as you describe.

Fact is, we're talking about very, very, very small numbers of problem outcomes though it in no way diminishes the distress of the individuals. It's just really not as common as you would care to make out.

I hope our spirited debate has not made you feel unwelcome. I am pleased to engage with people from other forums. If you have information to share then please do. I just ask that you don't make it such a campaigning manner.

By the way, I hit on your website some time ago and have it bookmarked, I think it's an excellent and informative site. Look forward to hearing from you again sometime!

:flwr:

 

[UTdave]

Thank you Jo for taking the time to correct this gentleman's broad-reaching and largely inaccurate claims. I have never seen this degree misinformation be posted in this forum and defended by the poster as much - without any sources mind you.

Rest assured readers, your taperfit generally does not slowly work it's way down your femur shaft, your stress shielding does not always doom you to failure, the blood supply to your femur will be more than adequate, the (often perceived) leg length discrepancy will often go unnoticed a few weeks post-op and the 1/2 degree of rotation that may or may not even occur when the shaft is implanted will not be noted at all in a few weeks, if ever.

If you want to see sources, please search this forum for my posts with regards to resurfacing and many articles will be quoted or referenced.

There is no panacea, no perfect surgery, no perfect device and no "one size fits all." Most of us are forced into this surgery due to severe pain or functional limitations and this type of post preys on our hopes to return to getting "normal" joints back which just isn't possible. There's only what's best for you, your surgeon and your specific problem at the time. Fortunately, good results are the norm.

Back to lurking, until somebody pulls another stunt like this. . .

 

[Troweltalk]

From a purely "consumer" perspective:

After a great deal of research I am now the proud owner of a Birmingham Hip Resurfacing implant. My reason for choosing resurfacing over a traditional THR is simple - Odds.

I was 52 at the time of my hip surgery, and even the very best educated guess for the life of a new hip (of any kind) didn't exceed 20 years. The range given for most was between 7 - 15. so the "odds" favor that at some point in my life, when I am much more frail than I am now, I will probably need to have a revision done on my hip.

Once this became apparent I began to research what was entailed in such a revision. The "odds" suggest that by the time I've put 15 - 18 years of wear and tear on the implant that I might need to have the whole thing replaced. With a complete revision of a THR this means removing the spike and reaming out more bone to insert an even longer device. I learned that alot of the time they injure the femar when removing the old stem and use some method to secure the bone for healing, using screws or other fastening devices.

I then looked at what was necessary to revise a Hip Resurfacing implant. Replacing (if necessary) the cup side is identical to a THR, so that was a wash. But replacing the femar head and attachments (stem for a THR) was very different. Replacing a HR is almost exactly like doing a THR the first time. They wack off what's left of the femar neck and head, insert a normal size stem and you are good to go; maybe for another 15 or 20 years.

Not everyone is a good candidate for Resurfacing. You have to have excellent bone density, you can't have any metal allergies, and the medical issue to be resolved has to be fairly straightforward. Having injured my hip in my 20s in an accident that initiated arthritis, and having otherwise strong and healthy bone structure, I was an excellent candidate for the process.

Now you can analyize all the clinical jargon you want to, I left that part up to my doctors to advise me towards something that was safe, reliable and proven. I'm a construction professional and looked at the concept from more of an engineering perspective. By choosing to have the Resurfacing process over a total replacement, I believe I helped myself prepare for an easier time when the odds finally run out and I need to have it redone in my so-called "golden years" which we all know sometimes aren't so golden.

This guy has one of each, a THR and a RH, so you can easily see the difference in the mechanisms. When/if I need a revision I will basically trade the right side for the left. In the lower image, you see how much futher a replacement stem for a THR has to go:

 

[Josephine]

I learned that alot of the time they injure the femar when removing the old stem

Actually only sometimes, not a lot. Most of the revisions I've been associated with (and they were many as I worked with one of the early revision specialists) could get the stem out by back punching with a specially designed instrument. It had a yoke one end that fitted under the head. The surgeon then used a metal mallet on the other end that was outside the wound and angled some inches away from the body. Most implants came out without too much of a struggle.

Failing that he would make a small window in the femoral shaft about an inch below the end of the stem. Another specially designed rod could be inserted until it was sitting on the tip of the implant and a few whacks applied to the punch produced the desired effect! Mostly the revision implant was longer than the original so would go across the hole, taking up the strain whilst healing occurred. No weight bearing restrictions were applied and patients usually did pretty well after. Mind you, he was a master craftsman in the art of revision!