hip resurfacing ?

[Kraftwerk]

Does anyone know anyone who has had a hip resurfacing?
I know a few people who have had hip replacements and frankly they don't seem to be any better off. I am a good canidate for a re-surfacing (aparently)

I am just asking here because I know some of you are very astute with mechanical knowledge and a hip resurfacing is rather mechanical. The website "Surface Hippy" ( I cringe at the name) and also suspect that it may be corporate cover, a kind of free-wheeling-positive-info-fest sponsored by the Corporation who makes them. How am I to know if these things work?

There are a lot of money in these medical trinkets...
For me its not a case of engine rebuild or hip replacement? The 3.0 is running better than ever, my left hip: not so much..

Thanks for info's

[Seahawk]

JT,

A hip replacement is in my future. Long story short, I was hit by a car riding to baseball practice in college. Left tib and fib compound fracture(s), left foot broken almost in half. I lost a 1/4 inch plus in length on my left leg.

Docs were great but said I'd walk with a bit of a limp. I am way too stubborn...after rehab I kept playing sports, spent 26 years in the Navy running and playing, flying.

Now, lots of problems with my left hip due to the imbalance. I am 53 and looking at options.

I've spent a lot of time researching alternatives. Every Doc I have worked with recommend delaying any procedure as long as possible. I do a lot of soft workouts, manage the pain through very minimal drugs...I have a naturally high pain threshold and an aversion to drugs of any kind. I really monitor what I take, how much and why.

All that said, the link below directs to a site that details a procedure that holds promise. I have talked with three people who have had the procedure done and all have glowing recommendations concerning the results.

Orthopedics - Orthopedics & Joint Replacement - Hip Replacement Surgery: Anterior Approach - Mercy

Best of luck.

[island911]

My research may be dated, (circ 2005) but here goes;

Thin-film bearings; the cobalt chrome (metal/metal) makes for the best bearing surface. Decades ago, precision was tough to have reliable repeatable results with metal. Now, they seem to have it dialed in. The ceramics can have some catastrophic failures - it's just simply not as tough as 'steel.'

if you can get by with just a resurfacing thats great. Paul, you should be looking at THR, which will square you up. Lot's of modular components exist for custom sizing to meet your needs.

They either cut a lot of muscle, going in, or do the minimal approach which has poor visibility. --I expect that the resurfacing can be done with the minimally invasive approach, ...the THR not so much.

You are not supposed to run after any of these, due to worries of impact to the joint. From what I saw of the metal/metal testing, high loading of the bearing was not an issue. But, the metal joint is not as soft/damping as the OE, so, like solid engine mounts, it will feel different, because it is.

Oh, and from what I recall, the hip Sx is one the most satisfying Sx people have done. --life changing for many.

Also, because it's a pivot-only joint, long-term success is higher than knee-replacements (where the joint has to both slide, and pivot)

[Tobra]

Paul, you needed to put a lift in your L shoe about 30 years ago, you still can, and it will still help.

Idea with delaying total joint replacement is to wait until the patient will die before the joint wears out and you have to do a revision.

[island911]

I'm crossing my fingers that the newer metal/metal joints FAR outlast those plastic POS. My engineering POV says, yes, absolutely..

[Seahawk]

Originally Posted by Tobra

Paul, you needed to put a lift in your L shoe about 30 years ago, you still can, and it will still help.

Idea with delaying total joint replacement is to wait until the patient will die before the joint wears out and you have to do a revision.

I've had a lift in for years...the problem is I didn't until it began to hurt.

Stupid doesn't even begin to describe...

Kraftwerk, how does one "qualify" for resurfacing?

[Kraftwerk]

All good info. Glad I posted this because I think about my hip daily, things that hurt are hard to ignore. I bicycle everywhere instead of walking and try not to take any med's, just an occasional ibuprofen, 4x week. Dr. gave me a script for Celebrex but frankly that stuff frightens me a bit, the chemical route seems wrong somehow. I too want to delay as long as possible, though Doctor says I am immediately ready: Qualify...I know that is a weird word, I suppose it is his experience,he has done 700+ hip operations his website says only two went awry, I am young and healthy enough to take the surgery well. Apparently there is a concern of cysts developing where bone meets bone and since walking all day is no longer possible, I am starting to consider. ( Did I mention that I hate operations? )
My left hip has zero cartilage, thanks to a motorcycle crash in 1992, oh my wild youthful days, I am 45 now. Walking with a bit of a limp. like "50 cent", sort of.




(Health insurance only covers a percentage & that is a real issue, but off-topic -- ha ha)

[Tobra]

It is a big surgery and should not be entered into lightly. It is making you miserable now and clearly has had an adverse impact on your day to day life. Basically, when the cartilage is gone, the lube in the joint seeps into the bone and collects to form a cyst. Bone with cysts in it is weaker, and in a weight bearing bone you can see pathologic fractures. That happens and you are done waiting for surgery.

Paul, had a Commander in the Medical Corps tell me about Naval Aviators. Don't feel bad, apparently almost all of them would handle it just like you.

[9dreizig]

What they refer to as "resurfacing" is in fact a mini replacement. I'm assuming you're looking at the Smith and Nephew unit ? It looks very good IMHO. I had my hip done 13 years ago. Skied 7 weeks after it was done.. Saved my lifestyle. I'm heading back for a "revision" in July.
Do yourself a favor, talk to the the sales guys from some of the devices. It's all about getting the right doc to install it (think mechanic).
Hip replacements are probably one of the most remarkable achievments in modern medicine.
I"ve also had a knee replacement. I still ski 40 days a year, hunt, lift weights,, everything but play basketball basically. I'd suggest getting it done!

[Halm]

I was the Total Knee Replacement manager at one of the major Ortho companies many moons ago. Hip resurfacing was in its infancy but researched like the Holy Grail. In those days, when it worked it was the best of best results. It should be pretty well ready for prime time now.

Since you are in the NYC area, make sure you get one of the HSS doc's to do the procedure for you. Lenox Hill was right up there too.

[Kraftwerk]

I would love to be able to ski & snowboard again...

Not far enough along the process to have chosen a particular product but Smith and Nephew are on the list.

HSS is were I would go. I like Dr. Su who is there, though at HSS my insurance only covers 50%, not going to cheap out on this,
but I might change my insurance..


I wish I had a way to post my x-ray, one hip has a nice fat piece of cartilage the other - zip.

[A930Rocket]

My dad had a hip replacement 21 years ago. It's still working, but at 83, he's not all that active now.

[svandamme]

i hear Adamantium is the way to go. Terribly expensive, hurts like a mother when they do it... But durable like nothing else.

[einreb]

I had my hip resurfaced 4 months ago. Researched devices and surgeons for years, put it off as long as possible since I'm only 40.

Dr su has an excellent rep. I had mine done by dr Tom gross in sc.

I'm on vac, and on the iPhone... Will post more info when I get back.

[einreb]

A quick overview of my years of 'research':

Surgeon:
Pick the best, most experienced surgeon that you can find and afford. The operation is more difficult than a total hip due to the required alignment of the cap to make sure that it doesn't notch the bone and the placement of the acetabular cup. In a THR (total hip replacement), the top fo the femur is cut off giving a clear shot to the acetabular work. In resurfacing, the bone has to be tucked out of the way.

Dr Su in NY, Dr Gross in South Carolina, DeSmet in Belgium, Vijay Bose in India, McMinn in England are all big names. I mention the guy in India for those that may have insurance issues. Don't let the location scare you, he is the real deal.

Surgery technique:
Most do posterior approach. Minimal invasive is something that I was not concerned about. Cut it open wide enough to see whats going on. That being said, my doc (Gross) does 'minimal' and I have a 4" scar. The anterior approach seems to be preferred by those with more total hip experience. It may make for a shorter recovery, but there is a thought that it has a higher chance of nerve damage resulting in permanent leg drop. It also has fewer post op recovery movement restrictions that are more of an issue with small ball total hips.

Journal paper written by my doc...

Minimally Invasive Posterior Approach for Hip Resurfacing Ar... : Techniques in Orthopaedics

Device:
Big discussion here. the Smith and Nephew (BHR) claims the longest history. Early 90's with the current version being about 14 years old. Good track record when installed by good surgeons.

The Wright C+ also has a long track record with good results. The Wright is heat treated and claimed to be harder with better wear properties than the BHR.

Read this for a comparison... http://www.surfacehippy.info/pdf/bhvsrconserv.pdf

(FYI, the surfachippy site is not tied to a manufacture that I know of and i've been following this stuff for years. The person that started the site got a resurfacing years ago and has been preaching about it to 'get the word out' and sell ad space.)

Heat treating is an interesting issue. It makes the metal harder for better wear, but then it is harder to machine to tolerance. That may have been one of the issues with the ASR device that was recently recalled due to higher failure rates.

Biomet:
I have the Biomet un-cemented device. Note, this is not yet FDA approved (perfectly OK to use in an 'off label' application), but has a solid track record in the hands of a good surgeon. I researched and felt that cement may be a long term weak link.

What is the Best Bone Fixation Type? by Dr. Gross

Prior devices (BHR, C+) cement the cap on the hip. Historically, cement has been a longer term failure point for total hips, but that cement is in shear. The porous surface was difficult to apply on the inside of the cap. Biomet has had one out for 4 years with great success.

Disclaimer: Dr Gross is the developing surgeon for the Biomet device. This initially freaked me out due to the potential conflict of interest, but talking with him and his team at great length and following his work and papers for years put my mind at ease. He has done thousands of installs (1300+ of the cementless resurface). I talked to several ortho doctors that had the procedure and Dr Gross was the guy they went to... for me it was the right fit.

Note: Apparently, the C+ device now also has a cement-less version that I've heard DeSmet is using. Not sure if its available in the US. My guess is that other manufacturers will go to the cement-less version, but that the BHR will stay cemented so they can provide a device with a long track record.

Activity with the resurfacing:
Most docs will not limit your activity after 6 months to 1 year. You can run, jump, etc. Google 'cory foulk resurface'... he's done several ironmen and ultra length tri's with his resurfaced hip. I suspect that more running and would increase the wear rate, butI dont know how much. Would it cut the life from 30 to 20 years? 100 to 80? Metal on metal was a viable choice for me. An article arguing the point...

http://www.grossortho.com/forms/Metal-metal%20Rationale-2-16-2011.pdf

Lots to digest and I only touched the surface. #1 priority is to get a great surgeon.

Also, the pain prior to surgery is such a freaking drain on life. It sucks. Its amazing for me to be able to sit in a car without pain, go for a walk, etc. I played 18 holes of golf on Saturday 4 months post op. No pain. I can easily put 40 miles on the bike now. No pain. The weight that's been lifted is amazing. I hope it lasts a long time. I think it will, but there are no guarantees in life.

Good luck, ask questions if you have them.

-bernie

[Kraftwerk]

Some questions today in the nytimes http://www.nytimes.com/2011/08/23/business/complaints-soar-on-hip-implants-as-dangers-are-studied.html?_r=1&partner=rss&emc=rss

I believe the article refers to hip replacement, not hip resurfacing, yet of the same problems might exist. Perhaps some patients are allergic to the metals? Maybe they should use 24 k gold, might double the price!

Anyway, read the comments attached to the article they are useful as well.

[m110]

1. Hip resurfacing is a bigger surgical exposure than a total hip replacement
2. It necessitates a metal-on-metal bearing (search the internet about this and ALVAL)
3. It only conserves some bone on the femur, the idea being a revision is easier, but never been proven to date
4. More challenging than a regular total hip replacement, more room for error