Pat's Corner -Thoughts from Patricia Walter 

How To Select a Surgeon?

How To Select a Surgeon for Hip Resurfacing

Selection of a surgeon is a personal choice. It is a choice that makes you feel confident that your surgery will go well, that your surgeon has a good bedside manner and you can ask questions anytime you need answers.

When buying real estate the old saying about what is important is "Location, Location and Location." In many people's minds the most important factor in choosing a surgeon for hip resurfacing is "Experience, Experience and Experience." I realize that every hip resurfacing surgeon has to start somewhere to do his first operation, but I feel, in layman's terms, that hip resurfacing is as much of an art as it is a learned skill. The angle of the cap on the femur bone is very important, the proper amount of pounding to place the stem is important, shaping the femur bone for the cap is important, how the surgeon approaches the hip itself is important.  There are many, many factors involved in a successful hip resurfacing operation.

There have been studies done to determine the learning curve for Hip Resurfacing with the BHR and for Hip Resurfacing with the ASR. These studies and others indicate that a surgeon needs 50, 100 or more hip resurfacing operations to become experienced. I have personally been told by a very experienced doctor that a surgeon should do at least 100 hip resurfacings before a patient decides to use them. There is a LARGE AMOUNT of debate over this number and subject.  Many people feel that a surgeon is already experienced if he has been performing THR's for many years. Hip Resurfacing, however, is a much more demanding and technical surgery than a THR.

I personally feel that experience can only be learned, it can not be taught. Many professional sportsmen have learned the technical skills to play the game - but you generally see the most experienced quarterbacks, pitchers, or goalies playing in the pros.  The difference is the experience. These people learn almost instinctively what to do, they don't take time to reason and figure out what to do.  That is the kind of surgeon I want to do my hip resurfacing - a surgeon that has seen it all and done it all.  Unfortunately a surgeon that has only done 10 or 50 hip resurfacings has not seen it all and done it all.  My personal surgeon, Dr. De Smet, even told me that he still has very difficult surgeries and he has done over 2500 hip resurfacings.

I feel if a person has a more difficult hip problem such as advanced AVN, cysts, misaligned hips or an unusual physical problem they were born with - they need a very experienced surgeon. If you are an older female or even male, many surgeons will suggest a THR instead of a BHR.  The more experienced doctors are more willing to tackle more difficult problems since they have the experience.

I have personally read thousands of emails from hip resurfacing patients on the Yahoo Surface Hippy Discussion Group. My personal observation of post-op results show that the patients of the much more experienced surgeons usually have a quicker and easier recovery. There are always exceptions often due to the prior medical condition of a patients hip or muscles, but anyone can take time and read thru the thousands of emails on the discussion group and see how patients recover after their surgeries.

There are many possible problems for the failure of a hip resurfacing surgery. Using a more experienced doctor will often help alleviate these problems, but it is not a 100% guarantee. Here is an informal list of some of the problems encountered by Yahoo Surface Hippy patients :

To sum up the question of "How to Select a Surgeon", choose a doctor that you feel comfortable with. Ask the doctor:

Some of the newer doctors are not as comfortable with hip resurfacing and will revert back to a THR if they encounter problems.  A THR is an easier operation than a Hip Resurfacing.  Make sure your doctor is a true advocate of hip resurfacing. Some of the new doctors have told me that they only use hip resurfacing in special situations and still prefer doing a THR in most cases. The very experienced hip resurfacing doctors will always give a person a hip resurfacing if possible - some have even changed their mind during a THR and ended up giving a patient a hip resurfacing.

Ask questions and opinions from other people, then trust your own instincts and make up your own mind. It is your hip and your life.