Hip resurfacing anyone?

[CSTRider]

It appears my 60 year old stoker/bride has suddenly developed severe arthritic pain in her hip due to femoral/acetabular impingement ... a THR is in her future, but the question is when. She's very active with hiking, skiing, and cycling - and we have two overseas tandem tours planned over the next 18 months. Another factor is that she has longevity on her side with a very active/healthy 97 year old mother, and grandparents on both sides who lived to 100.

We have researched the benefits of hip resurfacing (bone sparing; larger/natural joint; no activity restrictions; long life if no complications; easy revision to THR later if needed; etc.). But resurfacing seems to have recently fallen out of favor with long term metallosis complications from the popular Birmingham metal on metal device, and especially with women. So my question is: how many Paceliners have had a hip resurface, and what has been your experience?

Many thanks in advance for any insights!

[CiclistiCliff]

I, myself, have not had one but I've had multiple customers who have had THR.

62 YO male - Double THR. Back on the bike in 4 or so months and doing big rides. Triathlete and competing shortly after.

45 YO male- THR due to accident. Back on the bike within 2 months. He's one of those 'superman types' and recovers extremely quickly from any injury, so keep that in mind.

54 YO male - competitive ballroom dancer and cyclist. Has not been able to fully return to ball room dancing after two years, but cycling has been a non issue. He thinks they botched something.

I know, it doesn't help much, but to see these guys walking with a normal stride, logging big rides and continuing to compete in multisport events is a positive sign.

From what we've spoken about, they say recovery is generally smooth and muscular atrophy is minimal compared to ACL/ligament related injuries. They say the hip is sore for a while because the surgeons move everything aroun during the procedure, but swelling/range of motion wasn't an issue for them.

[einreb]

So my question is: how many Paceliners have had a hip resurface, and what has been your experience?

I had my hip resurfaced seven years ago at 40 years old. The results have been fantastic.

Being a bit younger, I was very focused on bone preservation and future options. However, I have every reason to believe that this will last my lifetime. I was very much data driven in my decision process. The current survivorship data for my surgeon and selected device is 99% at 9 years and the trend graph looks very promising. He is still performing resurfacing on women and has very good results.

http://www.grossortho.com/patient-education/latest-results

My surgeon and device selection was a combination of wanting latest good technology, but a history of good results.

This link is a few years old, but addresses some of the differences with resurfacing in women. The age and sex may certainly play a role in the decision process.

http://www.grossortho.com/phocadownload/userupload/current-topics/HRA-in-women.pdf

But resurfacing seems to have recently fallen out of favor with long term metallosis complications from the popular Birmingham metal on metal device, and especially with women.

This aspect of resurfacing is complicated. Inexperienced surgeons, poorly designed devices and a particularly litigious environment have been a headwind to resurfacing.

The surgery itself is more difficult than THR and the recovery is potentially a little tougher. Find a very experienced surgeon. Consider the slightly longer recovery an investment in the future hip.

-Bernie

[Tommasini53]

by THR I assume you mean total hip replacement??

I was treated for an impingement (FAI) and labral tear. They chiseled and reshaped the head of the femur to be a better fit and sewed the tear. No replacement just resurfacing/reshaping. It went well, exactly as the surgeon described for recovery; 5 months then back to full activity. I really don't know how much that recovery protocol varies from patient to patient; a PT might provide some insight. The injury was painful and turned this lifelong athlete into a couch-potato for several months prior to repair.

I would encourage your wife to speak with both the surgeon AND a PT that has experience rehabing patients with this injury and get their thoughts on timing. I ended up with a university med center an hour from home; ortho surgeons in my town did not have experience. good luck.

[batman1425]

I second the point above. For big ortho surgery on heavily used joints (hips and knees) - I wouldn't be afraid to travel to get the best care you can, insurance/cost permitting of course.

Once you go into a joint surgically, the clock starts for when you will have to go in again, and there can be a stark difference in outcomes for providers that are the best in the business vs. the rest. A really well done hip intervention will heal faster w/ less pain, last longer, and give your wife much less trouble in the long run.

Don't be afraid to ask tough questions to the docs. What are their complication rates, what complications are most common, what's the average longevity of their repairs, average down time, etc. Make sure they are giving you their data, not national averages. Any good doc will readily provide this info. Also be sure to make it clear what her current activity level is and what her expectations about returning to that level of activity are.

[Frankwurst]

I was diagnosed with osteoarthritis in both hips after getting to the point of barely being able to walk due to the pain in my right hip. After trying PT and weighing my options I told my doctor I wanted it replaced. Period. that was going to be the end result any how. He said that was a big decision but he had never replaced one that the person was not happy they had it done. I had mine done in November and I wish I would have had it done the day I was diagnosed. When the left one gets so bad I can't walk it too will be titanium and plastic. I always wanted a Ti bike but settled for a Ti hip instead. Recovery to me was a can of corn compared to rotator cuff surgery. Today I'm going snow shoeing and waiting for this white crap to be gone so I can go ride a bike. I don't know what the recovery is like on resurfacing. I do know this, after extensive research, that anterior vs posterior replacement recovery anterior is faster with less restrictions on movement after the surgery. I'll do it again without hesitation when the time comes. Bad news is they don't give you a replacement guarantee but my doctor said it would last a minimum of 20 years. I said "hell I'll probably be out of daylight by then Doc" Good luck to your wife no matter what her choice might be. Hip pain sucks.:beer:

[quattro]

I know you were asking about resurfacing, but here is my experience with a THR, ceramic ball and socket, Ti post, performed by Dr. Steven Murphy at Baptist Hospital in Boston, it's now 6 years post surgery, all is well, I was riding a stationary bike 10 days after surgery, and ride regularly with no issues, I turn 60 in 2 weeks. About 7-8 years ago I met with a surgeon that performed resurfacing, but after further research decided to go for the THR.Things may have changed since I did my research.

Here are a few information links to check out:
https://news.wgbh.org/post/inside-operating-room-total-hip-replacement

This is a bout a device he invented for getting the socket installed in the correct place:
https://www.prnewswire.com/news-releases/hipsextant-navigation-system-receives-its-first-commercial-use-132048778.html
This is a great video showing the surgery using animation, not the real thing, like building a ship in a bottle!

Just thought I'd share, feel free to PM me if you have any questions.

quattro

[quattro]

Deleted double post

[John H.]

Since you are in Colorado I suggest that you consult with Dr. Philippon.
https://www.thesteadmanclinic.com/our-doctors/marc-j-philippon
He is supposed to be one of the best.

Whatever you do- Use the best surgeon for stuff like this. Not the cheapest or easiest.

He might be able to achieve what she needs with FAI surgery- Recovery will be easier than a re-surface.

At the very least he will provide good choices.

[2metalhips]

I had bilateral BHR's in 2009, fantastic results, road, mtb and gravel rider, many thousands of miles, I'm 65 now, male, no restrictions. As others have mentioned, resurfacing isn't as popular as it was when I had mine. But it is still the best option for active athletes and the right surgical candidate with the right surgeon. Unfortunately just as all mechanics are not created equal such is the case with surgeons. Resurfacing is a more difficult procedure than THR so most surgeons won't learn or attempt it. And those that do aren't all highly qualified. As others have mentioned Smith and Nephew has withdrawn the BHR from the US market for females and small boned men. Many small women have returned to sports with excellent results withe correct surgeon. As mentioned Dr Gross in SC is well known for resurfacing with a different metal device with great results. I also believe Dr Su at the HSS in NYC is resurfacing women. Dr Pritchett in Colorado is resurfacing with a non metal device but long term results are unknown at this point. The BHR has a 20 year track record.

Pat Walters surfacehippy website is a great resource for these questions.

http://surfacehippy.info/hiptalk/index.php

[Ralph]

Can't speak to the resurfacing, but a good friend of mine recently moved from Central Florida to Tucson, AZ, is now 76, has had two THR's, is still riding over 100 miles per week, is also an avid hiker and spends his summers camping in Colorado (mostly) and is still climbing 14's. So if resurfacing doesn't happen, sounds to me like folks have had good results with THR. Hopefully someone will answer the question you have asked.

[harlond]

I had resurfacing 8 or 9 years ago. My surgeon was VERY experienced, but my prosthetic device turned out to be one of those that did not age well. I think there was only one brand that did. It's failing now, but I can still ride as much as I want and walk (though not more than a mile at a time). Eventually it will have to be replaced, and as far as I know, THR will be the only option.

Sure, I wish it would have lasted a lifetime. But I was just past 50 when I got it, and likely to need a second replacement at some point, so I figured the more bone I saved, the better. No regrets, but if I were doing it for the first time now that I'm past 60, I'd probably go THR.

[SPOKE]

In 09' I had a THR using the DePuy ASR all metal joint. 6 months after surgery I get the dreaded recall notification. Monitored cobalt and chromium in my blood every 6 months. In November 2014 we started seeing the levels starting to turn significantly upward so in March of 2015 I had a revision. The revision involved using the stem that was installed in 09' since it is Ti. The ball and cup were removed and a ceramic ball and HMC polyethylene lined cup was installed. No movement limitations with either the old all metal joint or the new replacement parts. Since your wife is very active I doubt that recovery will be difficult for her no matter What procedure you choose. About the only restrictions for the THR is running.