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New guy needs both hips replaced with questions

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TBONE

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Feb 5, 2009
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United States--Washington D. C. area
Hi folks-thank you for your input. I am a 51 y.o. male 6' 2" 215lbs. I ignored this problem for many years but now know that I need both hips replaced. I am bone on bone in both hips, with lots of extra bone growth. I used to be very active, but not so in the last 5-7 years.
I am considering 2 doctors and both doctors and hospitals are well regarded. I like and trust both. Both recommend pre-op local radiation to deter bone growth (heratopic bone formation). Doctor A recommends a cementless metal on metal joint. Doctor B recommend a cementless metal on plastic joint, each having done many using their preferred procedures and joints. Dr. B also advised that because of my relative good health and youth, I would be a candidate for doing both hips with a 5 day stagger, if I chose to for my own ease and convenience. Doctor B has no or a very low incidence of dislocation, due, in part to his placement method which, as I understand it, is from the side/front. Doctor A does a posterior procedure and has a higher incidence of dislocation which, he advises, has been remedied by using a larger hip ball (metal on metal joint). I am torn between metal on metal and metal on plastic and, I suppose I have a bias for metal on metal because of doctor friends' advice. However, I am worried about dislocation and I am intrigued by the possibility of doing both hips in one hospital visit. Any words of advice or comfort?
Surgery is scheduled for April 2009
 
Welcome Tbone! I'm from the knee side and cannot offer an opinion on your situation. But our forum nurse, Josephine, will check in and hopefully provide you with information to help in your decision. Good luck to you. You will find lots of help and support here at BoneSmart from folks who have been through it before you.
 
Hi TBone,
I hope this forum helps you as much as it is helping me.
I am scheduled for a Left THR on Feb. 18th. My OS chose ceramic for me, I am not sure why, but I believe it is for younger more active patients. Josephine probably knows more about why. My OS was trained by Zimmer to do minimally invasive in only 40 minutes, and does 1,000 hips and knees a year.....nothing else.
My family doctor told me that I chose the best OS too, so I feel confident knowing that. Experience rules!
 
Welcome T-Bone

I am 51 and had my right hip replaced on June 6th ceramic ball/ new poly cup. My doc preferred the posterior approach, I preferred him so I went with it. He is awesome, my new hip is awesome. I do remember at the time when lying in my hospital bed wondering how peple who have both replaced at the same time are aBLE TO move. My leg temporarily weighed at least 1,000pounds and I needed help getting it to the edge of the bed and out. So how do you do it with both?
Hopefully some folks who have done the bi lateral will chime in although it is such a successful surgery, that people tend to recover and leave the forum.

There were some aches along the way, at the time I thought it was taking forever, but at 3 months all restrictions were lifted and I was back on my hiking trails having a great time. I even had a cracked femur during the surgery. I had a great fantastic surgeon, listened to him regarding when to do what and life is good.

Judy
 
Thank you Hop and Sewell--Ceramics seem to be real popular for younger patients. I'm going to take it all in for a while, read up on it some more and then decide. I am very encouraged to hear about all of the successes and I am even interested in the problems, because problems can occur. I even started to watch a video of the op but I turned it off. I'll probably watch it in a few days. It does sound like, all other things being equal, pick the doctor you trust over the joint material.
 
My regular members know what I am going to say - I've said it so many times before! That choosing a prosthesis is nowhere near as important as choosing a surgeon. Once you have found a surgeon who fits certain criteria, then accept whatever prosthesis he recommends/uses. Choosing a hip implant is a job for people who know this stuff which is not the patients!

Consider this - you choose a particular implant. Please tell me how you are going to know if it was better or worse than another implant? And if you feel you made a poor choice, what are you going to do about it? Take it back for an exchange?

The vast majority of dislocations occur because of incorrect placement or other errors and little or nothing to do with the prosthesis.

I take it you've read the post How to choose a surgeon and a prosthesis and made a note of the points I've made there. You can choose the brightest humdinger of a prosthesis you like but it will succed or fail because of the surgeon's skill.

Another point I have laboured is - where do you get most of your information about various products from? The manufacturer's websites! And the object other their literature is to promote their stuff. Naturally they are going to offer statistics to prove that their products dislocate less than someone else's, etc., etc.

I hope you don't think I am questioning anyone's ability to make their own choices but I am concerned that people sometimes focus too much on the wrong issues. I am shortly going to have a TKR. As it happens, I know which implant I will have because I worked for the surgeon for several years. But if he has changed it in the meantime (unlikely!) I still am not going to fuss about the prosthesis because I know his skills are by far the most important thing.
 
At first I thought I was going to have to decide on an implant type too, but then the OS didn't even ask me. In fact I had to ask his coordinators which type he chose for me. All I know is Zimmer & ceramic. I don't know if it is the large or small ball joint.
But that's fine.....one less thing to worry about, I am stressed out enough as the day have counted down to only 12 days away! Each day the butterflies in the stomach increase.........today it feels like bats.

I just got a call from the hospital, they want me to go there for pre-op bloodwork for blood type & antibodies on the 13th. I also have to go to the cardiolodist on Monday because of the slow heartbeat. I'm sure the beat will pick up on its own as we get closer to show time though.
 
Nothing too exotic, Judy! Codeine phosphate is all. But they work on me half way to a general anaesthetic! Antihistimines do as well.
 
Josephine and others: Thank you all. I had read many of Josephine's and other posts and I agree with all of the comments. It is difficult, however, to sort through all the data. I've read a bunch in a short amount of time about wear rates and the pros and cons of each devise. And the question as posed assumed that both doctors are top notch. I also was aware of https://bonesmart.org/forum/showthread.php?t=714 and found it very helpful.
As for the source of my information gathering, I have not utilized any information from manufacturers. I have been fortunate in my area to have some contacts and friends in physical therapy, hospital administration, and two in particular, who are orthopaedic surgeons. Interestingly, both friends, who also do hip replacement but not as frequently, recommended the doctors I am considering because of my particular situation, both hips, bone growth, age. But both also liked metal on metal for me.
My thinking and theris, I think, was as follows, based upon the date I have seen: plastic wear rates are about .1 mm/year; the newer ones are about .05 mm/year; metal wear rates are about .01 mm/year; ceramics are much lower, or about .001, no doubt the reason that many younger patients are being steered to them. So If metal on plastic lasts 20 years of so, and metal on metal longer, there is a higher chance that I will need another hip or hip cup replacement in my lifetime if I choose plastic. Generally speaking, I would prefer to avoid another surgery on each hip, hence the question and concern, all other things being equal. But I do agree that choosing the surgeon is more important than choosing the prosthesis.
And if "Choosing a hip implant is a job for people who know this stuff which is not the patients!" why do knowledgeable people differ so? Why is there not a concensus? Why do 2 or more doctors confronted with the same facts, recommend different devices? My concern is that doctors choose the prosthesis because they are comfortable with it, or because they make money using them, or a host of other reasons that do not equate to "this is the best prosthesis out there for you." I feel certain that this concern is at least true in part. And while that is not a reason to eliminate a particular doctor, it is a valid consideration. "Trust me...I'm a doctor" only takes us so far. I dare say, that is one of the major reasons we are all here on this wonderful, fact filled website.
 
TBone,

Maybe you should ask the doctors to explain the reason of their choice of implant. Your situation is different, having bone growth, I wonder if that affected any decisions of choices. Do they know the reason for the bone growth? Is that like bone spurs?
 
Tbone,

I am up for my second hip Monday. For my first hip, about 4 months ago, I did quite a bit of research and felt like I ran in circles (even combing this website the very night before surgery trying to decide on resurfacing vs total hip). My surgeon told me he would like to do a metal/metal large diameter total hip based upon my problem. He also told me he would do a resurfacing if I wanted. He told me he would do posterior approach no matter what because my problem would require better exposure. I came to realize several things: 1. Your surgeon thinks about a lot more things than he/she tells you before making a decision - they just don't feel the need to bore you with the details. 2. Not all hips are the same and the solutions for them are not necessarily uniform. 3. If your surgeon uses a particular method and feels good about it, try not to get them to do something else - you want your procedure to be very routine. 4. Beware of products that are touted as "brand new" and, therefore, "better" as "brand new", by definition, hasn't stood the test of time to be judged "better". 5. This is a pretty damn good and a VERY well studied surgery, which in capable hands will serve you quite well no matter what prosthesis/technique is used.

That all being said, if I was 50-ish, had "run of the mill" arthritis and lived where I do, I'd have anterior approach metal/metal total hip replacement with one of our two surgeons in my hospital who do them all day every day. I'd do them in separate operations rather than at once. That's my two cents!

. . . I'll probably die of metal ion poisoning. . .
 
Dave, You made me chuckle. I have RTHR and metal on metal biomet. At almost 6 months, I am doing great. My only small worry is the metal ions..something that my dr didn't mention beforehand. Though can't do anything about, will mention to him when I go in for my check up in a couple weeks. He does tons of these surgeries, and obviously prefers the m on m. Curious, did your doc discuss the metal ion issue with you?

Laurie
 
Hi T bone,
I had two done at the same time in Sept. PLEASE choose your surgeon carefully even if you have to drive a good distance to get to a center of excellence. Not only does it make a difference with your outcome but it also may mean you can have both done at once. My surgical time was similar to those that just had one done because of the skill of my surgeon and his team. It also translates to less hospital time and less recovery time.
Like you I didn't have a good hip so I saw no reason to do only one at a time. It was the best decision I have ever made. I was out of that horrible gnawing pain the DAY OF SURGERY.
You can do a search on my posts so I don't bore everybody retelling the same old story. I have composite rods, ceramic ball and the crosslinked poly liners. I love my new parts they are so much more stable than the original equipment.

Best wishes,
Donna
 
Laurie,
My family doctor does IV chelation therapy right in her office to rid the body of heavy metals, if you test high in a blood or urine test. She has recliners in front of a big TV, and people just hang out on an IV washing the metals and toxins out. She said the 6-hour at home urine test works better than the blood test to know your metal levels.
I used an at-home test and was high in both mercury & cadmium. I might try this chelation down the road. (and get my metal dental work replaced too) People that have had it claim it made them feel so much better.
Even with ceramic, isn't the post and cup metal though?
 
Hopalong, Thanks for the info. I know nothing about this. I have heard about the mercury problems and have not had silver fillings done in years though have some left over that are slowly being replaced by crowns anyway.

I will definitely ask about that test to check my levels--probably need a referral through my primary dr? Wonder if covered by insurance..
Thanks,

BTW, how are you doing? Counting down the days? What hospital are you going to have your surgery in?

Laurie
 
Hackensack Medical Center, 11 days-----eeeeewwww!!!!
As long as I get clearance from the cardiologists on Monday.
I am half scared, and half excited to be able to walk again.....I can't wait to be a post-op like you!!
I will have to ask about insurance coverage for chelation.
 
I will keep my fingers crossed that all systems are go on Monday. Post op is great--my pain and disability are becoming a distant memory. I am so looking forward to hiking this spring. Now waiting for my husband to heal from his foot (bone spur, growth) surgery. May have to get out there w/o him--hear temps are supposed to go to 50's tomorow.

In meantime am off to gym as soon as I can get motivated to get off this wonderful new bed mattress cover (yes, we got the 3 in. memory foam cover and it is so comfy!!!)

Laurie
 
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