THR VS Resurfacing Option

[jam5387]

I have finally given my OS the "green light" to put me on his list for a THR. I have been attempting to research and follow Hip Resurfacing Surgery both in India and Belgium and most recently in the US. One of my major reasons is that my OS has told me no running after the THR. (I haven't been able to run for years and was hoping to get back into it after the surgery.) When the Resurfacing procedure in India was featured on 20/20 last year the Dr said many of his patients were back to running, football (soccer I'd guess), etc. When I questioned my OS about the new procedure, he said that the complications rate in the US is much higher for this procedure than THP surgery. He reccomended that I stick with the tried and true THR.
Anyone have any thoughts?
Thanks,
John

 

[shantijodi]

I am alos getting my hip resurfacing or THR depending on the results when I get there, but I have opted for India with a facilitator here in the states that will arrange all the details from the flight to the recuperation in Goa, all included. There are several people doing this type of arrangements. I personally have been to India several times over the past 5 years and the hospitals were top of the line, but the best was the care of the staff and nurses, they treat you like a human, not like here in the states where they make you feel like they are doing you a favor when they finally do decide to do something for you. I will be leaving in May for a TKR and possibly THR at the same time.
Hope this helps

 

[Josephine]

I am flabbergasted! I have known innumerable people who have run ½ marathons with a THR!! And to be honest, that's the point of the resurfacing, that patients could get back to the physical stuff with greater confidence.

My recommendation is that if this surgeon has so little confidence in his own work, find a different, better one!! There are plenty to choose from.

You don't say how old you are but the resurfacing option is always a better bet for the younger persons.

 

[jam5387]

I am 50 which isn't quite as old as I used to think it was... I am not aware of any doctors in the area that are resurfacing. I believe it was just approved in the US April 07. My OS has done many THR's and has a very good reputation for them. Being that the resurfacing option is new in the US he and the research I have done indicates that there is and will be a learning curve for the US. I am also hearing that some folks are running on THRs. Do some OS support running after the THR?

 

[Josephine]

They certainly do! Read around the threads. There was one only a couple of days ago ...

 

[Bob A.]

I am 50 which isn't quite as old as I used to think it was... I am not aware of any doctors in the area that are resurfacing. I believe it was just approved in the US April 07. My OS has done many THR's and has a very good reputation for them. Being that the resurfacing option is new in the US he and the research I have done indicates that there is and will be a learning curve for the US. I am also hearing that some folks are running on THRs. Do some OS support running after the THR?

Take this for what it is worth, but medicine as practiced in the US is pretty conservative vs. everywhere else. That has good and bad points for sure. They (FDA, AMA, other agencies) want to keep us safe and avoid problems with less than well documented procedures. But in that effort, they are somewhat slow to adapt to new techniques that seem to gain foothold in other countries much faster. For years, THR has been the standard because they have worked out most of the bugs with the devices and the procedure to install them. Open you up, cut the femur, drill the pelvis, drill the femur, put the hardware in and close you up. Chance of success, pretty good. Resurfacing from what I can tell takes more time, needs more skills to be learned and doesn't have the track record here that makes most US surgeons happy. (keeping in mind that this country is malpractice lawsuit crazy).

My biggest concern on resurfacing vs. THR is the potential for revision in 15-20 years. If I have a resurfacing, and I need to have it fixed down the road, it wont be as problematic as if I have a THR since there is alot more bone left to work with. I think resurfacing will gain a foothold here in the US but it may take quite a bit more time. I know I don't have that much time that I want to wait.

Going overseas to have the surgery done is an option, but it comes with risks for sure. It would not be my decision for a number of reasons. But, if you are looking at paying for the surgery yourself (no insurance), then maybe it is your best option.

Running afterwards may be something that you can do either way, but it is probably not without a certain amount of risk as well. A car that is raced everyday isn't going to last as long as one only driven to church on Sunday. Simple physics say you will wear out parts quicker. Maybe some other form of low impact exercise and recreation would be a good alternative. I am looking forward to getting back on a bicycle. Most folks getting hips fixed are not spring chickens so we need to keep sight of maintaining and preserving our health now so that we will have it when we are all collecting social security and Medicare. It's your call John, do what you feel is right.

 

[Josephine]

For years, THR has been the standard because they have worked out most of the bugs with the devices and the procedure to install them. Open you up, cut the femur, drill the pelvis, drill the femur, put the hardware in and close you up. Chance of success, pretty good.

Oh my, how you reduce our skill and expertise to carpentering!!

Actually, THR has been the standard because surgeons worked with great commitment and drive to get it right. I was working with Ken McKee back in the 50s when he was the pioneer of hip replacements and he was a driven man. He and his then registrar (later his successor as chief of the Hip Department) John Watson Farrer, were forever adjusting and tweeking the design - as a result of which we only ever had about 3 hips in stock as each was hand crafted.

Resurfacing from what I can tell takes more time, needs more skills to be learned and doesn't have the track record here that makes most US surgeons happy. (keeping in mind that this country is malpractice lawsuit crazy).

Resurfacing was the precursor of hip replacements and was developed by broken link removed: https://www.jbjs.org.uk/cgi/reprint/35-B/3/482.pdf as long ago as 1930 and was, for its age, very successful (though probably not by modern standards). But resurfacing was supplanted by THRs as they reached their peak of popularity. In those days, no-one under 60 would have been considered for any kind of remedial hip surgery except an arthrodesis or fixed hip. It was the plight of people like this that spurred McKee into developing the original THR. However, since surgery on the younger patients are being brought into the realms of possibility, Smith Peterson's procedures have been given another airing but with the benefit of modern technology.

My biggest concern on resurfacing vs. THR is the potential for revision in 15-20 years. If I have a resurfacing, and I need to have it fixed down the road, it wont be as problematic as if I have a THR since there is a lot more bone left to work with.

I think your misgivings are somewhat misplaced here, Bob, as the amount of bone removed in a revision is, in my experience, minimal. Besides which, these THRs are lasting an awful lot longer than the 10-15 years people are often told. I think this misinformation is often prompted by the fear of litigation that is becoming prevalent all over.

Going overseas to have the surgery done is an option, but it comes with risks for sure. It would not be my decision for a number of reasons. But, if you are looking at paying for the surgery yourself (no insurance), then maybe it is your best option.

I always had misgivings about overseas surgery. It's okay so long as it's okay, if you get what I mean. Problem comes when there are problems. BBCtv put out a documentary quite recently detailing the plight of several people who had traveled to Europe for their hip/knee replacements. Their tales made disheartening reporting as it seemed that nobody in their locality would take responsibility for them or offer them help. Sad, sad.

 

[Bob A.]

Josephine
My biggest concern as you can gather is the longevity question. I asked my wife, she flat out told me 15 years. I asked my surgeon, he was a bit more indirect but would not flatly say it would last over 20 years. He did say that he would be monitoring me every year and if they detected something going awry, that he could go in and fix it "like you would fix a flat tire".

At this stage, I don't know which way I will go. I like to gather as much information as I can, both hard facts and opinions (sometimes difficult to tell apart) and then with enough time, make my decision and hope for the best. Most likely I will go with what my ortho recommends, but I will express my thoughts as best I can and hope he listens.

As far as the carpentering goes, woodworking is my hobby. My wife is the one that pointed out to me that most of the orthos she knows are wanna be carpenters as well. I will stand by my comment that from a "carpentry" point of view, the THR is more straightforward in that there is no carving of the top of the femur to fit the new ball. No its not carpentry, but they are using saws and drills aren't they?

I do appreciate your responses whether you agree with my viewpoint or not. I am open to persuasion. I know what I don't know, and right now that is the greater part of my knowledge. My wife can tell me alot of what she knows from working with her patients all day, but she cant tell me what its like to have the surgery done, how it feels during the recuperation and what the improvements do for your quality of life. Until you go through it, you just don't know.

 

[mikey]

I'm in Atlanta and the OS's here don't seem to discuss resurfaceing much. At least not with a 59 year old. In this area, all roads seem to lead to Dr. Kress. His office says he does approximately 10 hips per week. He only does hip and knee replacements. I hate the system. My first visit I saw his PA, very experienced, but still not the doctor. He looks at the xrays and makes the diagnosis. Next I get scheduled for surgery at the end of June and I actually visit the doctor in May prior to surgery! I could spend hours asking him questions. I'm scared.

I would like to know why resurfacing is not an option for a healthy, active 59 yr old. He usually uses a Zimmer with a poly liner, but I my reseach leads me to belive I should have metal / metal or metal / ceramic. The larger femoral head appeals to me. I would rather "over spec" this surgery than cut corners. I asked one of his people about a Wright Prothesis and she made light of the fact that they had a professional tennis player (Jimmy Connner) as a spokesman.

Your thoughts?

 

[Bob A.]

Mikey
Resurfacing is just not done very much in this country yet. Maybe in the next ten years it will be, but not right now. As for the other points you raised, I think I would be looking for another surgeon. I can't imagine that in Atlanta all roads lead to this one guy. That and no way do I want to talk to a PA when it comes to somebody opening me up and using saws and drills to put me back in shape.

Find a surgeon that will talk to you directly and take your wishes into account. From what I can tell, even conventional THR is using a larger ball along the lines of the size used by resurfacing. My surgeon favors metal on metal which makes sense to me. You don't sound like you are comfortable with this doctor, in your situation I would listen to that little voice and find someone else.

 

[Josephine]

Amen, Bob! Well said.



Mikey, I would not let a surgeon doing only 10 hips a week within a mile of me. Works out at around 400 a year. Little more than a hobby! No, not no way! 500 absolute minimum, the more the better.

As for the choice of surgery, the sad fact is that it is not a thing to do with the patient - it's ALL to do with what the surgeon prefers and feels like spending his time doing. Some just don't care to do certain procedures and thus they will not be made available to the patients he sees. After all, it is his choice and would be fairly unreasonable to expect a man to be doing all sorts of everything. Like that old saying "Jack of all trades, master of none"!

Check out the post at the top of this forum How to choose a surgeon and a prosthesis and you will see some tips and questions I have put together. Hope this helps.





And Bob - no-one is going to tell you anything different. 15 years is the best figure people will state because anything more might open them to litigation if it proves to be wrong. I still say that most knees are proving to have a MUCH longer life span than that as witness by the relatively low incidence of revisions. And they ARE low. If they were not, we would hardly have any theatre time left available to do primary TKRs, believe me!

Truth is also, that no-one will predict it as anything else might occur. There are a whole variety of reasons why a TKR might fail but most are pretty rare. So asking how long a prosthesis will last is a bit like asking "how long is a piece of string?"! In the end, you must just go for it and see what happens. It's all anybody can do.

Also - no worries about the carpentering crack - I was only teasing you! You know, I got my skills at DIY from working in the orthopaedic theatre!

 

[mikey]

My understanding is that 10 hip replacements per week is considered substantial, but I'm open to all opinions. This surgeon is considered the best in Atlanta. He does THR in the morning and TKR in the afternoon. I've asked for recomendations from the "sales dudes" from the prothesis manufacturers and his name is always mentioned first without any coaching. My Internest recommended him and evn my wife's gynocologist. I guess I have to keep in mind that in a city of this size we have a lot of docs doing this surgery. At any rate, although I am scared senseless, I'm tired of hurting, not sleeping, and walking like a penquin. I just want this prothesis "over speced".

 

[Josephine]

10 hips a week "substantial"? Don't think so! Just about average actually. It works out at around 500 per year which is the absolute minimum I would want for any surgeon who was going to do any work on me!

 

[Eeyore346]

I just received the Vigor Magazine put out by Cleveland Clinic (Ohio) On the back it says Euclid Hospital (A Cleveland Clinic Hospital) is one of the first hospitals in the country to offer hip resurfacing.

Sandy