ot...hip replacement.

[shinomaster]

My poor boss need to get his hip replaced. He is a pretty active 59 year old wind surfer, and the occasional cyclist. He can't decide which type of hip replacement to get. There is the older tried and true method of replacing the whole end of the femur, and the new resurfacing, which Floyd had done recently.
The new technique is somewhat unproven and he will be more of a test subject. Why did Floyd Landis choose the new type of surgery? Does anyone know?

[BarryG]

Younger patients are more likely to opt for hip resurfacing - more bone is left in place and it leaves open more options for future interventional techniques. The younger the patient, the more likely the surface will wear out down the road and I suspect the resurfaced hip will be easier to service than the replaced hip.

Also, there's less chance of dislocation following resurfacing compared to replacement.

(all disclaimers - I ain't no orthopedist, although I've been to 6 of them in the past 18 months trying to get my own hip fixed and will go under the knife again in 5 days)

[stevep]

shino,
i have had 2 good friends who travelled to belgium and had the resurfacing before the idiots in the fda approved the operation in the usa. they paid out of pocket rather than the then approved us operation.
this operation has been widely used in europe for years and is in no way experimental.
both these guys are very active and both are cyclists. one is back racing after practically being unable to walk. the other does not race but rides actively. they are both extremely happy with the outcome.
if your boss wants to email either of these guys i bet they will be willing to share experience.

[DRZRM]

A buddy of mine has had the "resurfacing," and apparently will have to do it again soon (didn't take off enough, docs said that if he were treated now, they would have been much more aggressive). My understanding is that the younger you are the less they want to replace the hip, I guess there is a limited shelf life on those things.

[ald]

i suggest he consult a surgeon familiar with anterior hip replacement before deciding on which proceedure:

http://www.newhipnews.com/patient/index.html


pm me if you want more info

david

[chuckred]

MY poor boss need to get his hip replaced. He is a pretty active 59 year old wind surfer, and the occasional cyclist. He can't decide which type of hip replacement to get. There is the older tried and true method of replacing the whole end of the femur, and the new resurfacing, which Floyd had done recently.
The new technique is unproven and he will be a test subject. Why did Floyd choose the new type of surgery? Does anyone know?

My father was an active cyclist up to going in to get his first knee replacement a little over a year ago - 77 at the time. He thought it was going to be "no big deal"...

Ended up having a "minor" stroke during the procedure, although that was the least of his worries. More significantly, he got a drug resistant infection that almost killed him. Just as he got home and was regaining strength, the infection caught him - back into intensive care, kidney failure, convinced he was on his way out, etc.

Not to add to his worries, as at the relatively young age of 59 there's alot of good active years to look forward to. But, tell him to be sure he researchs the hospitals non-socomial infection rate, that he discusses it carefully with his surgeon, and that someone in his family stand guard and chase anyone out of the room who tries to come near him without carefully washing their hands first!

Needless to say, while my dad has regained enough strength to get around without a cane, his kidney function has returned and he's as mentally sharp as can be expected at almost 80, he hasn't had his second knee done, and his bike is collecting dust. (Of course if I'm riding that far into my 70's I'll be pretty happy!).

[Needs Help]

Bigger concern - infection!
Don't discount that. It's the ugly under belly of modern medical treatment. Infections contracted in hospitals are the fourth largest killer in the U.S, causing as many deaths as AIDS, breast cancer, and auto accidents combined. One out of every twenty hospital patients gets an infection.

Infections add an average of $15K to hospital bills. That makes one wonder what incentive hospitals have to reduce infection rates. The more infections their patients contract, the more money hospitals make. And, since hospitals continue to fight all attempts by legislatures to make them disclose their infection rates, there is no accountability.

Your boss needs to do the research and know what pointed questions to ask his/her doctors, and what simple precautions he demand that his/her doctors take. There is one case where a hospital adopted procedures that reduced their serious infection rate to 0! Something like 50% of doctors don't even wash their hands between patients, and that rate is significantly worse at some hospitals. Next time you visit a doctor, think twice about extending your hand in greeting.

I would love to hear the view from the other side from some of the docs on this forum.

[Otis50]

I just had my right hip replaced using conventional THR, not re-surfacing. I'm 51, was a very active cyclist, raced for 15 years. But I got arthritis in my right hip 3 years ago, was mis-diagnosed by about 5 different docs until the much needed hip replacement. I went to a surgeon locally, using minimally invasive technique and am very happy so far. It has been 8 wks post op and I'm back onthe bike riding it on the trainer for 20-25 minutes, no resistance. I race with a guy down in DC, who had his hip replaced 5 years ago and he is back at the elite level (cat I) and things are going great (says he even has crashed at speed on the replaced hip with no problems). One thing to discuss with the surgeon is, tell them what you want to do post op and how physically acitve you are, and ask for the biggest ball they can use for surgery, this will help with range of motion. I don't know what to tell your boss, but I think hip resurfacing is for much younger patients and you have to have the right hip condition/problem for them to consider this type surgery. The surgeon said I can basically do anything I want now, except running. I feel like a new man! Tell him to contact me if he has any questions, I'd be glad to discuss.

Bob

[physasst]

There is a LOT of misinformation on the internet, please be careful. I am a PA working at Mayo Clinic for one of the top 2-3 hip/knee surgeons in the world, so I think I know a little about this topic. Floyd chose the resurfacing because of his hope to return to high level athletics. FWIW.Total hip resurfacing is NOT new, it's been around in one iteration or another for about 25 years...the earlier implants did not fare as well as Total Hip Replacements. For someone in their 20's or 30's, or even 40's who expect high performance, OR for people with certain specific conditions, such as avascular necrosis of the hip, it is a good procedure, with the understanding that it is probably NOT the last procedure they will have, and this will buy time and preserve bone until a total hip arthroplasty is required. ALSO, beware of the two incision MIS technique that was all over the news several years ago, the complication rate was much higher than with conventional THA. We are doing shorter incisions on almost everyone nowadays, and in younger active patients such as someone in their fifties who is an avid cyclist. We would be more prone to use a metal on metal articulation with a larger diameter ball which makes the hip more stable and more resistant to wear. If you have any specific questions please feel free to PM or ask on here......I live eat and breathe hip and knee replacement surgery....

Michael

[gasman]

Don't discount that. It's the ugly under belly of modern medical treatment. Infections contracted in hospitals are the fourth largest killer in the U.S, causing as many deaths as AIDS, breast cancer, and auto accidents combined. One out of every twenty hospital patients gets an infection.

Infections add an average of $15K to hospital bills. That makes one wonder what incentive hospitals have to reduce infection rates. The more infections their patients contract, the more money hospitals make. And, since hospitals continue to fight all attempts by legislatures to make them disclose their infection rates, there is no accountability.

Your boss needs to do the research and know what pointed questions to ask his/her doctors, and what simple precautions he demand that his/her doctors take. There is one case where a hospital adopted procedures that reduced their serious infection rate to 0! Something like 50% of doctors don't even wash their hands between patients, and that rate is significantly worse at some hospitals.

I would love to hear the view from the other side from some of the docs on this forum.


Shino- Your Dad would do fine with either operation. He does need to find someone with a lot of experience for either operation. Hip resurfacing has been around for a long time but has not been utilized much in this country for many years because the results were worse than the more traditional method. I know several active men that had hip resurfacing -2 went to England and one went to S. Africa where there were some very experienced surgeons. I also know several other guys who got traditional hip replacement including one who is a medical school buddy. They are all very happy and active.

Need Help- I think you need to look at the literature a little more closely.
This link to the Center for Disease Control

http://www.cdc.gov/nchs/datawh/statab/unpubd/mortabs/lcwk9_10.htm

does not even list hospital aquired infections in the top 10. Septicemia (#10) can be from hospital infections but a lot of septic patients come into the hospital already seriously ill. I've seen hundreds.

Now this isn't to say hospital aquired infections aren't serious. They can be, most aren't.
There is a nationwide push in almost every hospital to decrease infection rates from surgery or hospitaliztion. Hospitals usually lose money when someone has a prolonged complicated, hospital course from an infection.
We all wash our hands a gazilloion times a day or use alcohol gels. We use careful sterile technique whenever needed. We use special prep solutions with chlorhexadine and on and on and on. This problem is being addressed at so many levels it's hard to list. The expense is enormous but patients deserve the best care possible.
Now if you could get our population to stop smoking, eat right , exercise, lose weight, take there medications as prescribed and generally be accountable for their health I suspect our health care costs in this country would be cut in half.

[vaxn8r]

.... Infections contracted in hospitals are the fourth largest killer in the U.S, causing as many deaths as AIDS, breast cancer, and auto accidents combined...
Care to offer a source on that statement? I'll give you a hint, you're not even close. Cardiovascular disease is #1 and Malignancy is #2. Both of those are 36 times more common than #10 septicemia, most of which do not originate in the hospital.

...The more infections their patients contract, the more money hospitals make...
Not true. Hospital fees are typically prearranged or contracted and based soley on diagnosis. If you are an outlier and have a longer stay the hospital eats it.

[Skrawny]

Hospital fees are typically prearranged or contracted and based soley on diagnosis. If you are an outlier and have a longer stay the hospital eats it.

Diagnosis Related Groups:
Hospitals are paid a specified amount by insurance companies based on the admitting diagnosis (one amount for a knee replacement). If all goes well the hospital makes more money; if there is an infection, or other complication it all comes out of that bottom line and hospitals make LESS money. No conspiracy here.

-s