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Dual mobility acetabular cup vs traditional implant #2

@Josephine

Yes, its the traditional lateral approach I'm referring to. https://www.orthobullets.com/approaches/12021/hip-anterolateral-approach-watson-jones

I've had this recommended to me by three different surgeons, and when I say no thanks, they then offer the mini-posterior. Its an odd dance that dissolves trust, in my view. If they are going to recommend the best solution for you, then why not do it the first time, why wait till the patient gets home and researches it.

.....................

I'm giving up on my surgeon, he derated me for having researched my condition. Then when I asked his secretary for a small piece of information about the implant, I was told to google it. And now my surgery has been postponed and no new date have been given.

So, no, I dont have an trust in these people at all, its chaos
 
Perhaps the ones who suggested it second time around aren't too adept at doing it!
Like on the lines of "well if I have to, suppose I'll give it a go"!
I'd steer clear of them, me.
 
@Andy P
When I read your posts it feels like if they were written by me.
I tend to overthinking and scrutinize all the factors before making a decision.

Curious sly and aware of this tendency, I decided to commit with the most respected surgeon in town.
I didn't ask him about the approach nor the type of implant.

In the end he used a lateral approach, and a metal/poly uncemented piece.

I couldn't have asked for a better outcome. Ultra short time at the OR, a very easy recovery, and the rehab seems to be doing excellent.

When there are so many variables and so many estudies and 'educated' opinions that sometimes come against each other, I believe it's best to put your trust in who you think is more qualified and let him make the decision.

Good luck on your journey friend.
 
@Josephine yes, and I'm aware of attempting to push a surgeon in the wrong direction

Thing is, with UCLH, the first offer was a lateral approach (anterolateral-approach-watson-jones) then when I spoke to the lead surgeon he told me the standard practice of UCLH is mini-posterior. The later comes up time and again for being the best all round approach> risk/recover/outcomes

So, I just dont get it at all. Personally, I think their first offer is always the cheaper, speed 'em through. Then is someone is slightly aware of whats going on, they offer a minimally invasive approach.
 
To be honest none of these approaches are minimally invasive. This is major surgery - carpentry. I had mini posterior on the left and lateral on the right and in my experience lateral was a much easier recovery. No restrictions, no sitting on the incision and in my case less swelling. Much of this is about the skill of your surgeon. The surgeon who did my right THR does over 200 THRs per year. Practice makes perfect!
 
Mine was lateral too and It has been a smooth ride up till now.
 
@Jaycey I'm sorry, but thats just patronising, yes, it is still surgery. But as NICE recommends MI THR then thats what i'd go for. The lateral has a history of issues around limping and continued pain around the entry point.

@Josephine I'm afraid what Im seeing here is a mimicking of the NHS, many of your responses have been to shout be down for asking questions. I dont accept 'nothing is known' or 'everyone is different', especially when its sort a common surgery. I believe the surgeons do know, but they are largely untrained in presentation, other than a very basic description. Younger surgeon registrars often do better in this respect.

The underlying issue is that they do not what to give you any idea of what they are intending to do as they are afraid it will come back on them. But this does not allow for an informed consent, so this is all very thin ice. Mention the words 'informed consent' and they will drop you as a patient.

I came on this site to ask if anyone knew of the difference in use between DM and traditional cups, but have witnessed the same bully I see in the NHS overal. Is a worthwhile question, and the answer will be know by the surgeons. So why do we not know it?
 
Andy P said:
Mention the words 'informed consent' and they will drop you as a patient.
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This opinion is based upon what evidence? In my experience, very few - and I do mean very few - surgeons are impartial to informed consent. It's common practice for one thins but primarily, it's the law!
Andy P said:
So why do we not know it?
Click to expand...
Interesting that you seem to think it's de riguer for everyone to know everything about everything! Are we not all fallible human beings?
 
The Skill of The Surgeon.
Always.
What they do best they can do best.
I had Swiss Medacta implants via AMIS..phrased for Anterior Minimally Invasive Surgery
Didn't feel minimally invasive at the time:heehee:
Have had great recovery...no nerve damage, no limp and am now 15 months post op and an working a very active job with lots of activity on the weekends.
Great results for this Bilateral...and he had two chances to screw one of mine up:giggle:

My surgeon teaches this method but he apparently it's very good at it.
I didn't research or pick the approach or implant, but did pick my surgeon!
Hope you will be confident with yours!:yes:
 
Regarding informed consent. I asked the surgeon whether the DM has any drawbacks in comparison with traditional CoC implants, I've needed to ask his secretary as he doesn't respond to emails

Responses are:
1. this is your best option (no other comments)
2. Google it (and I am not kidding about this)
3. If you want to see another surgeon then go ahead

When I mentioned 'informed consent' I had a call from admissions two days later to say my op was cancelled and they are not wanting to book me in again. Each time I call it gets pushed back another month.

Regarding 'knowing' the difference, well, it would be absurd if they didn't know basic bio-dynamics. This surgeon is the lead surgeon at the hospital. It is well known that larger bearings are better, being closer to the natural size. My question is only to ask where DM's fit within this. If its not known, then this would be an acceptable answer. Being told to go away is confirmation that they do not have my interests in mind

So, not being given me the informed choice between Traditional and DM implants does breach my rights. Ive needed to CC my GP on each email, as Im so concerned about this bullying approach to consent

Basically, this has felt me with what feels like a death sentence, i dont want to live anymore if i cant have control over what happens to my body and I dont want to live not knowing whether ive done the right thing or not
 
Well this is a very bad thing, that you perceive this as being bullying, which I wouldn't in the least disagree with. I am similarly shocked that your hospital should almost black list you because that too, is against the law. And this is a legal issue, as I am sure you know.

This is Guy's, is it not? Never been too impressed with the Guy's crowd. Too impressed with themselves, if you know what I mean!

I suggest you get yourself referred to a different surgeon. I can look out 2-3 alternative surgeons if you like.
 
This might be news to you, Sall1014, but it's not to many. Which is why the quote was removed from your post which violates copyright law.
 
Josephine said:
This might be news to you, Sall1014, but it's not to many. Which is why the quote was removed from your post which violates copyright law.
Click to expand...

Hmmm.... you're removing my google article because you think everyone alrerady knows this except me? I"ve posted several other articles I found on google to provide help to others without having them removed. And you just posted a response to Andy P on another question above he asked with the following: "Interesting that you seem to think it's de riguer for everyone to know everything about everything! Are we not all fallible human beings?" But you removed my response because you think everyone should aleady know it? Your response to me is very condescending. I thought this was a site for sharing information and helping people?
 
Small1014 said:
Hmmm.... you're removing my google article because you think everyone alrerady knows this except me?
Click to expand...

I think she removed it because pasting in that much of the text here can be seen as infringement of copyright. The link is still there.
 
The link pulls up a blank page- not the article I had posted.
 
Thx DLP- I see it now! Must have had a connectivity issue when I first clicked the link.
 
Small1014 said:
Hmmm.... you're removing my google article because you think everyone alrerady knows this except me?
Click to expand...
Don't worry, I'm trying to find the actual article as yours was an abstract so I can post it in our Library.
Small1014 said:
The link pulls up a blank page- not the article I had posted.
Click to expand...
Works fine for me! You must have an Adblocker on
 
Andy P said:
So, then is it a compromise, I know that 'large head' bearing (40mm +) are better for biomecanics, but there are wear issues over 36mm. So then DM comes somewhere in the middle of small and large. Its strange that its not discussed though
Click to expand...
This is a major concern for me -- the head/bearing size. I want to resume a high level of physical activity while not worrying so much about possible stability or dislocation issues, and from everything that I have read, a larger head seems to promote hip stability.

I have two surgeons that I am seriously considering using but they differ on which size ball they prefer to use. One surgeon said he would likely use a 36mm ceramic head and a mini-posterior approach; the other surgeon said he would likely use a 32mm ceramic head and an anterior approach.

Naturally, in this case, I assume that bigger here is better, but maybe not? I realize that the larger the head, the greater the potential for bearing wear - so maybe it's not an easy decision to make.

But at the end of the day, I simply want my hip to feel and function as normally as possible. I worry about having to restrict certain activities or movements because of instability or dislocation issues over the long-term.
 
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