Subject: Can you help me decide if I should choose a hip resurfacing or a THR
and what doctor to use
You've found the right group to help you in your search. Most of us here have
had resurfacing and we believe in it so much that we spend copious amounts of
time trying to educate others.
In all likelihood, you can return to whatever sports or activities you
want to. We've got people here doing every kind of imaginable activities, including hockey, handball, skiing, biking, horses, surfing, triathletes and runners.
I hope you are already looking through the
Surface Hippy Website that you were
referred to. It is full of much of the "basic" information that you need to understand resurfacing versus THR and to learn why most of us
here think that the day will come when resurfacing will be the first option offered to everyone that qualifies.
THRs were developed for elderly, sedentary people. In the late 70s,
younger people began appearing in doctor's offices with bad hips. The wisdom then, and for many of the older doctors now, was to advise patients to wait as long as possible until they could no longer stand
the pain and then have a THR. That was because the doctors didn't
want to limit their activities and because the doctor's were reluctant
to start cutting off leg bones in people that they knew wanted to be
active. As they began using THRs for younger, active people it became
apparent that the surgery which had turned out to be a Godsend for
many elderly, was failing at an unacceptable rate in younger, active
Resurfacing was developed as a bone conserving surgery for younger) active people who are not only likely to outlive a primary THR, but
will probably outlive a secondary THR. It was developed to lower dislocation rate that was unacceptably high in active patients and to eliminate the thigh pain which is a significant lifelong issue with some THR patients.
Yes, resurfacing is a newer technology and some of the docs want to wait until it has a 50 year track record (it is now looking good at 15 years)
before they begin offering it. Where does that leave you? With a prosthesis designed for elderly, sedentary people. Not good, do you think?
Now, hang with me here, there are some better THRs now on the market with large femoral ball which do lower the dislocation risk. New generation metal on metal has done away with the wear problem of poly/metal (which meant doing a surgery every time the poly cup began to wear out), and ceramic has to some extent improved to fix the shattering problem the earlier materials had.
BUT, and this is the very big point you must understand fully: If you have a THR and it fails or needs "revision" they must cut off even more of your leg bone to put in the new one. That second THR (THR revision) has a much higher likelihood of failure AND if you have to have one your activity level is going to have to diminish immediately and significantly. And, there isn't always enough bone left to do a third surgery.
If you have resurfacing, you keep your entire femur in tact. Only the surfaces of your femoral head and acetabular cup are "remodeled", smoothed and then covered with metal. Instead of a long spike extending down into your femur and changing the way your leg bone handles stress, you've got a little "stem" in the femur head. Your entire leg bone stays intact, and if at some later time you need a revision, you can have a primary THR in a surgery no more difficult than a primary THR would be in the first place. Resurfacing gives you a second chance at keeping your leg bone intact.
THR is the most extreme way (cut off the bone) to handle a surface problem. Resurfacing, keeps the leg bone it its natural state, while fixing the problem by replacing the SURFACE. I like the idea of only fixing what is wrong, not using the absolute most drastic fix for a problem that can be solved with a much less invasive solution.
One final thought. You must do away with the concept that the best doctor for you is a local doctor. With resurfacing, the best doctor for you is an experienced doctor, with a track record of good results and happy patients. He may be local, or possibly regional, or maybe across the country. Many people must travel to find a doctor that suits them. Up until the last couple of years, most people had to travel to find the doctor they wanted to do this difficult and challenging surgery. You want a doc with over 100 successful surgeries who is doing several resurfacing each and every week. You don't want a doc with 20 or 30 resurfs or one who is doing one resurf every few weeks in between THRs and other ortho surgeries.
You want a doctor who is convinced that resurfacing is an excellent choice for you and who WANTS you to have resurfacing. You want a doctor who says "I've done MANY cases like yours with excellent success". If a doctor says "I may be able to do it, or a THR is just as good" run, walk, limp, hobble, crawl out of that office - he's not the right doc for you.
We've got docs in the US who are very experienced and who will do an email or telephone consult for FREE. Also some of the best docs in the world will do email consults for FREE.
You've asked for a world expert, and I'm happy to put in a plug for my doctor - Dr Thomas Gross in Columbia, SC. He is considered by many to be one of the top in the world. People come from all over the country to have surgery with Dr Gross. He's approaching 1500 resurfs, he does cases many others won't, his office routinely handles out of town folks, he does 10 or more resurfs every week and he loves seeing young, active people hobble in the door with pain, worry and fatigue on their faces and 3 days later they are walking up and down the hospital hallway on crutches with a grin from ear to ear.
If you'd like to take a look here's his website. Look at Columbia HSR protocol. He does free telephone consults and he's a wonderful, kind, warm, caring man with a fabulous staff that really care. www.grossortho.com
Resurfacing is a bone conserving surgery and we are the lucky people it was developed for - offering a second chance at the lives we want to have. I couldn't walk, stand, sleep, sit or breath without pain. I'm
pain free and restriction free and at 57 that seems pretty darn good to me! Resurfacing - it is what you are looking for.
Pat(ricia)Dukes, Columbia, SC Dr Gross rBiomet 19June2006