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Hip Resurfacing: BEWARE!
Only in Research Stages with Known Failures and Unknown Long-Term Success
Hip resurfacing is a surgery getting a lot of press lately. If you do a Google search on the word hip resurfacing, the first sponsored advertisement is from a respected device manufacturer who proceeds to tell you all the "good" things about this operation.
They do not tell you the truth, though. They suspiciously compare the operation to hip replacement using older plastic techniques and cover over any of the serious complication that may loom. They tell you nothing of the range of research or potential negative aspects of the procedure.
This operation could be very dangerous for you. This operation could be very successful for you. Here is the problem: we really just don't know right now. The respected surgeons working on the implant should be applauded in that they are rigorously studying an alternative to hip replacement. The early advertising and "physician locator" features found on some advertisers' websites should be outright condemned.
Here are some of the projected problems associated with "hip resurfacing:"
This information is summarized from a superb review article in "Orthopaedic Clinics of North America." The article was written by a group from Melbourne, Australia. According to the data supplied by this respected journal, none of the authors were either investigators of the implant, reserved royalties for the development, or had any financial interest in the outcome of hip resurfacing.
That pretty much sums it up. When choosing hip replacement procedures, ask your surgeon real and serious questions.
In 2006 through 2007 the data supports a cementlesss titanium hip replacement of a ceramic head and modern cross-linked plastic cup, a ceramic head and a ceramic cup, or a metal head and a modern cross-linked plastic cup.
When hip resurfacing is compared for 10 years against all three of those models then it should be considered. It is not an operation for the general public now.
Dr. K.
Related Topics: WebMD Video: Joint Camp: Where Boomers Go , Is Less-Invasive Hip Replacement Best for You?
Technorati Tags: hip resurfacing, arthritis, hip replacement, Arthritis Center
Hip resurfacing is a surgery getting a lot of press lately. If you do a Google search on the word hip resurfacing, the first sponsored advertisement is from a respected device manufacturer who proceeds to tell you all the "good" things about this operation.
They do not tell you the truth, though. They suspiciously compare the operation to hip replacement using older plastic techniques and cover over any of the serious complication that may loom. They tell you nothing of the range of research or potential negative aspects of the procedure.
This operation could be very dangerous for you. This operation could be very successful for you. Here is the problem: we really just don't know right now. The respected surgeons working on the implant should be applauded in that they are rigorously studying an alternative to hip replacement. The early advertising and "physician locator" features found on some advertisers' websites should be outright condemned.
Here are some of the projected problems associated with "hip resurfacing:"
This information is summarized from a superb review article in "Orthopaedic Clinics of North America." The article was written by a group from Melbourne, Australia. According to the data supplied by this respected journal, none of the authors were either investigators of the implant, reserved royalties for the development, or had any financial interest in the outcome of hip resurfacing.
- There were serious problems with the older designs of hip resurfacing which has prompted this development of a new generation of hip resurfacing (the one in the above mentioned advertisement is an example of this new generation).
- There are NO LONG TERM results available on this new generation of hip resurfacing.
- The more of these hip resurfacing procedures that are being put in, especially by non-developers, the more the complications appear.
- Fracture of the femur (the top of the hip bone) is a real and serious complication.
- The fracture rate is 1-2 people every one hundred cases. That is high.
- The ideal candidate to receive a hip resurfacing at all is unknown by any real data and is conjecture at best.
- The metal-on-metal surface of hip resurfacing produces circulating metal in the bloodstream. These are cobalt and chromium levels. It is yet to be known what the negative effects of these circulating metals are. [My Note: given the choice of metal circulating through my liver, kidneys, lungs, and brain or not- I choose NOT]
- The problem with metal ions can be removed if ceramic surfaces were used [My Note: Like in successful ceramic bearing in total hip replacement!]
- There is a need for INDEPENDENT research to allow better guidance on this procedure.
That pretty much sums it up. When choosing hip replacement procedures, ask your surgeon real and serious questions.
In 2006 through 2007 the data supports a cementlesss titanium hip replacement of a ceramic head and modern cross-linked plastic cup, a ceramic head and a ceramic cup, or a metal head and a modern cross-linked plastic cup.
When hip resurfacing is compared for 10 years against all three of those models then it should be considered. It is not an operation for the general public now.
Dr. K.
Related Topics: WebMD Video: Joint Camp: Where Boomers Go , Is Less-Invasive Hip Replacement Best for You?
Technorati Tags: hip resurfacing, arthritis, hip replacement, Arthritis Center
49 Comments:
knee replacement is a very successful surgery to restore the knee movement and relieves the pain, it literally gives you your life back
i agree with that it did wonders for me i know worry that i am acting way to young with no pain is it bad or what
This blogger is not telling anything like the full truth. Check out http://health.groups.yahoo.com/group/surfacehippy/
and you will find blog containing one success story after another from patients about their success with resurfacing and the big difference with resurfacing is that there are NO restrictions on activities 6 months after the procedure. Compare that to THR which involves a drastic curtailemnt of physical activity for active people. Don't do THR without reviwing that site!
This is some kind of "I'm really good at THR and I don't want to learn a new technique AND I don't want other surgeons beating my time with something more effective and less restricting than THR" jive, in my opinion. Just because something hasn't been done or tested in the US doesn't mean it hasn't been done and tested in other ADVANCED and DEVELOPED countries. When I was diagnosed with OA, I went to see an orthopedic surgeon who said, "You need a total hip replacement." I said, "Will I be able to hike afterward?" He kind of laughed and said, "Well, we wouldn't advise that, but you'll be able to walk." I don't think twenty years down the road, when that doctor is my age (54) he would be any happier to hear that than I was. I walked out of there and searched for an alternative. I was given an alternative by a doctor friend of mine in Europe. I will be going to Europe to have hip resurfacing in two months. The doctor performing the surgery has been performing the procedure for more than 10 years and has resurfaced the hips of nearly 2000 patients with a failure rate of virtually nil. There is no reason I can see that doctors in the US don't get out there, embrace this WELL TESTED and EXCELLENT alternative to THR for younger active patients. The average age for total hip replacement, by the way, is 74. I have even had doctors tell me to "wait" because the THR lasts 10 to 15 years. Since I can barely walk NOW what would I wait FOR? To be completely non-ambulatory before I get surgery so I can walk again?
Go to activejoints.com if you have questions about this.
The first of the hip resurfacing devices - the Birmingham Hip Resurfacing device - was recently approved by the FDA. The clinical trials for the Wright Conserve + have been completed and submitted to the FDA and approval is expected in the short term. No logitudinal studies are available for any "new" device, but what research is out there reults in complication rates comparable to THR complication rates, but without the restrictions associated with THR. Yes, beware of resurfacing, but beware of THR. Note that no life expectancy data is provided for any of the newer THR configurations noted in the original post.
This is an incredibly biased report by some-one with no resurfacing expertise. The metal alloys in the resurfacing devices are the same as those use for years in THR, and other devices. The BHR was approved by the FDA because of the more than 10 years of success in the UK and elsewhere. This procedure will become the standard for active individuals. It is more stable and won't wear out. I am an MD, and had my successful hip resurfacing 3/03, in Durham NC. See the www.activejoints.com
website for full, non-commercial information and other links.
Dr K - It would have been better for you to have disclosed your consultation relationship with the ceramic hip manufacturer. My OA wants to do a MoM THR because of my size and age, and although I believe ceramic may indeed prove to be superior - what track record can you demonstrate with it? And since when is bone conservation not a worthy first choice option? If it fails, THR. Back to square one but at least in a sensible progression for a younger candidate. Resurf > THR Revision (2nd Revision unlikely) vice an almost guaranteed more radical revision for younger THR patients.
I am the happy recipient (post-op one year) of an "overseas" hip resurfacing done by a very experienced surgeon.
Unfortunately, you are one of the one-trick-pony U.S. surgeons who refuse to investigate this valid, bone-saving technique. Instead, you publish this drek and cram the THR down our throats as if that is the only answer. Wake up and smell the metal!
You point out Fracture of the femur (the top of the hip bone) is a real and serious complication.
The fracture rate is 1-2 people every one hundred cases. That is high. So getting a THR completely deminishes that problem doesn't it. Why don't you mention how the wonderful THR doesn't give you that problem??? Because you amputate it with a THR, that's why. No risk of fracture there, the bone is now gone! Chopped off! Oh, fracture would be horrible, so instead let's just amputate the bone so there's no more chance of fracturing it. Great solution doc. Hate to say it, but I sure hope one day you end up with OA, then let's see what option you would choose.
I would have thought your background and training encouraged you to publish the facts and not embelished rhetoric or BS where I come from. Yes there have been some femoral head fractures at the rate you state, but not all surgeons have reported that high an incident. In fact globally the rate is much lower. I think it is sad that you seem to have missed seeing what any active person would want... another chance to live a reasonably active lifestyle. I have worked hard all my life so that when I retire travel, golf, scuba diving, para sailing and enjoying the sun will be possible. You must admit that a THR provides no chance for me to do most of my chosen activities and hobbies. Where a Resurface actually gives me that chance. If it turns out that in 5 years my resurface fails for some reason then it will mean I had the chance to do these things for that 5 years. It will also mean that only having to go through one THR prior to my death is a distinct possibility. For those who do not know what is involved when a THR fails and needs to be replaced please look up Hip THR revision on your search engine. It is not pretty and recovery takes a long time. On the surfacehippy.com site there are a number of surgeons who did not perform the procedure prior to FDA approval and yet they fully supported their patients decision to seek resurfacing out of country. Come on Dr. because Interestingly enough I see a lot of passion from the details of your post but I would like to know where is your compassion?
A contently Resurfaced man.
Another one trick pony doc. THR basically enables you to walk. BHR or other resurfacing enables one to do what you want to do. It's that simple. I shiver thinking I originally was scheduled for the regular ole' THR.
Dear reader,
Please do your homework. I studied everything I could find on this subject before getting my hip resurfaced last year in South Carolina. I am absolutely delighted with the results so far and I am doing better every day. Remember, if you get a THR there is no goin back. If you get a resurfacing and you later want a THR, you still have the bone stock to do that. I could find no data that poined to danger from metal ions. The original post does not consider what you have after your recovery; your quality of life! I love my resurfacing.
I would luv to read about anyone with AVN who has done resurfacing...
Yes, some people with AVN have had resurfacings. Go to http://health.groups.yahoo.com/group/surfacehippy/ and search for AVN and you will find success stories.
Karen
THR on one hip, but going BHR this time.
I'm having THR in two weeks. I've been to the doctor that specializes in hip resurfacing and he said he'd only give me a 50/50 chance that it would work. I'm a young 51 year-old that skis, does aerobics and is generally very active but he said the problem is that he has seen a higher rate of fracture in women and he is reticent about performing hip resurfacing on me. Not good news and I'm really upset about having my femur cut off.
I have to agree with those who excoriate Dr. Kirschenbaum for his "none so blind as those who will not see" stance. The operation has 10 years of history.
As a very athletic 45-year-old I found the stiffness that had been growing worse was arthritis, and had to quit running and ultimate. With previous technology my future would have been limp around for 10 years waiting for the pain to get worse (and developing joint problems in my back, knees, neck...), and then get a hip replacement.
Instead, at 5 months post-op I am running 12 miles and sprinting on the ultimate field - with doctor approval, which I never could do with hip replacement. If there is a problem and I need replacement after 10 years it will have been 10 good years, not 10 years of limping and aspirin.
With this reasoning there would be no transplants, and, for that matter, no hip replacement. Have all questions been 100% answered? No. But, Dr. Kirschenbaum, you might want to broaden your knowledge a little. Buggy whip factories sneered at the new-fangled automobile technology - their technology was good enough, and cars were untested.
This statement is the medical estabolishment fighting a new (and financially threatening option) to THR. I almost had a THR, asked my doc if there were any new procedures or develpments on the horizon (Dec. 2005) and he repeatedly said no.
I'm 32 years old, very active and healthy. I had bad hips (cartilage issues), now I have two resurfaced hips and couldn't be happier. I am over 6' tall and have large bones, so femur fracture - not really a concern. Metal ions in the blood -IF and WHEN they determine that is a health issue, I'll deal with it.
I met a women who had her first hip replaced at 33, she was approx 50 at the time when she was having her 6th hip surgery (1 replacement and 2 revisions each side) she could barely walk - each time they go back in there is less bone to work with (osteolisis). Choice between 1 surgery per hip or multiple, I'll go with one.
One thing I do know is that the failure rate for THR is very high for younger patients - higher activity level.
Reurfacing surgery itself seems to be a little tougher (cutting out less bone means more pushing and pulling for resurfacing).
THR works, no doubt, but if given the choice I recommend resurfacing.
I had the BHR in Oct '06 after being diagnosed with AVN due to a break 10 yrs earlier. I am a smaller women, 5"6", 116 lbs, 49 yrs and I developed a "squeek" in that hip about a month ago. My ortho and Smith-Nephew seem stumped by this development and, of course, I am concerned.
To all the anonymous who feel so free to anonymously rant:
Reread my post. I did. I stand by it all the way. Hip resurfacing may or may not be the future- we just don't know. The fact that we do not know yet is important for the public to know. Any claims about its success are hearsay for now until long-term studies by non-developers are done.
I am neither condemning nor recommending the procedure. I am pointing out the facts as we know them now.
Remember that hip resurfacing needs to be cemented in and cement has a finite life expectancy. Additionally, important data about metal wear debris is coming out which includes possible kidney effects and chromosomal changes. Individuals testimonials on web sites do not replace facts about surgery. The science data is generally not reported on testimonial web sites. These sites are superb but reasearch also helps.
Hip resrfacing may be a method of the future but a hip replacement with large femoral heads may have the same results as hip resurfacing.
An important fact- hip resurfacing is not minimally invasive. The designers of the operation actual report on larger incisions and more exposure.
Either way- time will tell whether this current hip resurfacing is successful or not.
Doctor K.
One last point- you can agree of disagree but personal comments will be removed from this blog.
It is amazing what some simple research can find (one of the articles is by the developer of one of the hip resurfacing models). This was only one page of a simple literature search on Medline:
Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty. Witzleb WC, Ziegler J, Krummenauer F, Neumeister V, Guenther KP. Acta Orthop. Department of Orthopaedic Surgery, Universty Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. Wolf-Christoph.Witzleb@uniklinikum-dresden.de2006 Oct;77(5):697-705. INTERPRETATION: During the first 2 years after surgery, the Birmingham hip resurfacing arthroplasty leads to a significantly greater increase in serum chromium and cobalt levels than the 28-mm metal-on-metal MTHR. Observation of patients over a longer period will be necessary in order to evaluate any chronic adverse effects to the system due to elevated chromium and cobalt serum concentrations.
Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty: four-year results of a prospective longitudinal study. Daniel J, Ziaee H, Pradhan C, Pynsent PB, McMinn DJ. The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham B15 3DP, UK. josephdaniel@mcminncentre.co.ukJ Bone Joint Surg Br. Feb;89(2):169-73. There was a significant early increase in urinary metal output, reaching a peak at six months for cobalt and one year for chromium post-operatively. There was thereafter a steady decrease in the median urinary output of cobalt over the following three years, although the differences are not statistically significant. The mean whole blood levels of cobalt and chromium also showed a significant increase between the pre-operative and one-year post-operative periods. The blood levels then decreased to a lower level at four years, compared with the one-year levels.
Development and problems of metal-on-metal hip arthroplasty. Shetty VD, Villar RN. Cambridge Hip and Knee Unit, Cambridge Lea Hospital, 30 New Road, Impington, Cambridge CB4 9EL, UK. Proc Inst Mech Eng [H]. 2006 Feb;220(2):371-7. For over 40 years, the metal-on-polyethylene bearing has dominated the field of total hip replacement. Problems of wear, osteolysis (dissolution of bone), and ultimately failure of prostheses have led to the development of alternative bearing surfaces. Metal-on-metal hip resurfacing has taken current orthopaedic surgery almost by storm. However, metal ion release following metal-on-metal hip resurfacing remains a major cause for concern.
Differences in ion release after ceramic-on-ceramic and metal-on-metal total hip replacement. Medium-term follow-up. Savarino L, Greco M, Cenni E, Cavasinni L, Rotini R, Baldini N, Giunti A. The Rizzoli Orthopaedic Institute, Bologna, Italy. lucia.savarino@ior.itModern metal-on-metal bearings produce less wear debris and osteolysis, but have the potential adverse effect of release of ions. Improved ceramic-on-ceramic bearings have the lowest wear of all, but the corrosion process has not been analysed. Our aim was to measure the serum ion release (ng/ml) in 23 patients having stable hip prostheses with a ceramic-on-ceramic coupling (group A) and to compare it with the release in 42 patients with a metal-on-metal bearing (group B) in the medium term. Reference values were obtained from a population of 47 healthy subjects (group C). The concentrations of chromium, cobalt, aluminium and titanium were measured. There was a significant increase of cobalt, chromium and aluminium levels (p < 0.05) in group B compared with groups A and C. Group A did not differ significantly from the control group. Despite the apparent advantage of a metal-on-metal coupling, especially in younger patients with a long life expectancy, a major concern arises regarding the extent and duration of ion exposure. For this reason, the low corrosion level in a ceramic-on-ceramic coupling could be advantageous.
I "completed" LHR less then a week ago and my MD was curious to as my reaction to the blog observations post op and my thoughts.Please understand that 4 and 1/2 years ago I had my left knee repalced after years of excruciating everything.You know the story.
But how would one...the knee...affect the other. We'll see.
Enter left hip.S day had come. Last Monday.But prior to that x-rays had revealed a painfull source of almost no activity and loosing the to ability to sit or drive to enjoy anything whether it be Big 10 football or my daughter's school events or even a movie.
Result other than invasive surgey and minimizing lower back pain was the reality that something had been done to alleviate or resolve just horrible pain. Three weeks. Four weeks. Let's move on.
We wait and hope and move ahead with optimism. See you on my bike in the spring !!!!!
I had my BHR 7 weeks ago. I am a 49 year old 6'1" 260 lb male. My progress has been nothing short of fantastic. I am back at work in a very active job. I started hitting golf balls at an indoor range just recently, and short of a lack of flexability in my operated hip it has exceeded my expectations. I was walking without a cane in less than 5 weeks and swimming and stationary bike riding in therapy 3 weeks after surgery! I am glad my surgeon recommended this procedure. I was a competitive amatuer golfer and this has given me hope I can get back to being able to walk on the course and become competitive in golf again. I look forward to seeing the progress of other patients who have had the BHR.
I am having my first flare of arthritis in my left hip. I am 60. I had an x-ray and there is bone on bone, the MRI confirms good bone stock and I was told I am going to need a Hip Replacement and that I would be a candidate for the Birmingham hip. I still have pain and am considering a steroid hip injection. Anyone had this? Also, how long do you have to wait to have the hip replacement after injection, because of the risk of infection?
Thanks for any info
Bravo, Dr. Kirschenbaum.
I am 51 and had a bi-lateral hip (both hips) resurfacing done in Sept. 07. One month after the resurfacing I started feeling strange. I am losing hair, losing weight and generally do not feel well. I have been feeling this way for three months. I decided to do something about it. I went to my surgeon and I said that I was not feeling well and that I wanted a script to have the level of my cobalt and chromium checked in my blood. He declined my request. I then went to my primary doctor and asked him for a script. He agreed and on Dec. 19,2007 I had my blood drawn. Today I received my results.
Cobalt levels in your blood should be between 0-1. Mine was 9 !
Chromium levels should be between
0-1. Mine was 15 !! I have 9x and 15x the amount of metals in my blood. That is the equivilent of the doctor coming to you one day and telling you your cholesterol is 3000. I know I can't prove that my hip resurfacing has caused my symptoms, I also can't prove where the Universe begins and where it ends.
Chromium Man, you wrote that you had metal ions in your blood. Guess what, if you had a THR with a MoM you would still have it in your blood because it's the same cap and cup. It's not the procedure, it's the material. And Dr. K should be ashamed of himself for not explaining that.
In response to Anonymous who posted after me. That's true. It is not the procedure that has caused the high levels of metal in my blood it is the content of the material used. However, you do not have to have a Metal on Metal THR. There are combinations that you can have that are not so toxic, in fact there are studies that show that other combinations of materials produce 1/2 the levels of metal in your blood.
And another thing. There is no mention in any main stream literature that actually tells the patient that their metal levels after the operation can be 1500 % higher than what is considered normal.
We have been conditioned to think of the words "higher" in regards to our blood (whether it be cholesterol or glucose etc.)to mean 15, 20, 25 % higher. Not 1500%
higher. If I knew that metals in my blood could rise this high I never would have had this operation.
I had 3 PHR in JR High and now I have had a THR at the age of 31. I have been smelling metal on my skin and blood. I am not sure why yet.
Dr. Kirschenbaum,
Thanks you for cautioning us - highly appropriate.
Can you please advise on the correctness of my logic as I am contemplating either a Ceramic-Ceramic THR or the BHR.
1. The revision rate for my potential surgeons (1,000+ operations each) is 2% for THR and 1% for BHR.
2. Although I intend to limit my activity after the operation (swimming instead of running, tennis doubles instead of competitive squash) my profession requires a high level of intense activity (squash coach), which I believe favors the BHR (fewer dislocations, greater range of motion).
3. I have none of the conditions which should preclude a BHR (poor bone stock, leg length discrepency, etc.).
4. I believe (with the recent Australian review of BHR) there is now an adequate 10-year history for the BHR (adequate enough for careful, studied implementation with appropriate patients).
5. If in the next 10 years or so it turns out that the metal ions are in fact dangerous, I could at that point (at the age of 60-65, past my "intense activity" period) have a THR ceramic-ceramic revision which hopefully might see me into my grave (85??).
So to me I am trading off "possible" negative effects of ions against a more difficult but inevitable second revision (if I had a THR now), and a significantly (10-25%) more "active" sporting life with the BHR.
What do you think of this rational?
Appreciate your time.
Tim
As a left hip BHR patient of Dr. John S. Rogerson, Meriter Heights Hospital, Madison, WI, I can tell you from personal experience that as in any surgical and/or orthopedic procedure, there are risks. HOWEVER, as a patient, you need to do research and understand what your options and risks are. For me, resurfacing was the best option. I just turned 44 years old this month (Jan) and I lived in chronic pain for 7 years. It kept getting worse and in Oct of 2003 I found out I had to have major back surgery. My presenting complaint? Left hip pain, loss of movement in my left leg and sciatica. After the lumbar fusion S1-L5 (with screws and pins) I still had hip pain and I still limped. That is when I found out I had OA in my left hip. I was told by a very good hip replacement surgeon that I just needed to realize I would be very young when I had my hip replaced...(this was the summer of 06) which meant a revision in the not to distant future. After this diagnosis I decided to do some research on my own and that is how I found out about resurfacing.
Just because the FDA only approved the Birmgingham hip May of 06 does not mean there have not been surgeons in other countries performing this procedure. IN point of fact, they are and have been, and they do have follow up. Dr. Rogerson was one of the first US Surgeons trained in the BHR which was a big deciding factor for me.
I had my surgery August 9th of 2007.I am almost at my six month anniversary. All I know is that I woke up on the recovery room with NO HIP PAIN!!! For the first time in years I was free of hip pain. Of course there was discomfort from the surgery, but I have had no hip pain since surgery. I can walk miles now where I could not even make it around the grocery store before!!! I gave up using my handicap parking permit because I do not need it! I was off crutches in 8 days, no limping, although I had to keep my mind on walking, re-training those muscular-neuropatterns, like learning to walk over again. Now I walk like crazy!! If I did not have my back fusion I could run...all I know is that I feel great! This summer, for the first time in years I will be able to go hiking and camping and next winter...cross crounty skiing!
Dr. Rogerson and his team are amazing, I would recommend anyone who has bad OA to research resurfacing and THR and then make the best decision for your health, after all, it is your body and your life. You are in charge, don't let anyone push you into surgery without researching. If you do decide that you want to find out if resurfacing is for you contact Dr. Rogerson or one of the other re-surfacing surgeons. There are many people who still fly out of country for this procedure because the surgeons there do have so many more years of experience then our surgeons here in the US.
Michelle in Oregon
I had the Birmingham Hip Resurfacing procedure done on my right hip 10 months ago. Althgough I understand it is relatively new in the US, it has been performed in Europe for a number of years.
I feel great and am thankful I had it done (vice a total hip replacement). I had it done at the Anderson Othopaedic Clinic in Alexandria, VA by Dr. C. Enghe. He did a fantastic job!
I have been scheduled for an MRI on Thurs. for the AVN. I am not real familiar with it. My doctor says that the artery feeding my femoral head may be blocked, causing the femoral head to die.
Any information for me?
"If you do a Google search on the word hip resurfacing, the first sponsored advertisement is from a respected device manufacturer who proceeds to tell you all the "good" things about this operation."
Well your add comes in third, jealous?
But, you do bring up counterpoints that all need to consider, as I will. This is not the type of proceedure to jump into based only on testimonials. Has any of the research in the past year and a half changed your thoughts on the matter? I am 49 and will need a new hip sooner rather than latter depending on how hard I will be pushing my failing one.
My husband had resurfacing done at 42 years old, with Dr. Thomas Gross in Columbia South Carolina. In June it will be 7 years. His implant was a Corin product. The surgeons in Europe that had used this hip had 9 years with great results prior to him having his done. We therefore feel we have 16 years of evidence and success. Dr. Gross was the only surgeon in US working with that manufacturer of resurfacing implant. My husband was one of the patients in the FDA clinical trial with this implant. He was # 6 to have it done after trial opened. And first to fly into SC for surgery. We live in Upstate New York, and had a three year old so the trip to South Carolina was a difficult decision, but after talking to his wonderful nurse/assistant Lee, the decision was easy. He traveled alone,not wanting to leave our 3 year old with our babysitter. (NO FAMILY CLOSE)He had no direct support,but found more support then I could ever have given him. His every need was more then taken care of with not just typical Southern Hospitality. Care that was above and beyond any expectation. One Nurse that took home his limited supply of clothes to be washed and returned, 20 lb dumbells given him by the male head nurse, who also had his wife and 2 chidren visit several times because he had no visitors, the young male PT that got chicken barbaque and had dinner with him several times and also took him to the airport upon discharge. BV was fearful of getting into taxi. AND, AND, AND.
He too had horrible pain that went from hip, back and groin, to his ankle. A very athetic man, with tons "competative manly" traits, he was down to using a cane, all the time, strong pain meds every day all day, while waiting and investigating options. We were told at 39 he had the hip of a 64 year old man. Believe me, he searched every option, he was in so much pain he couldn't do much else. Major reluctance to having whole top of femur removed at that age or continue to live that quality of life, as lots of resurfaced patients have stated. We visited Drs. in several places before deciding on North Carolina. Dr. in NY City, he had designed the hip he proposed. Next was Dr. from University of Penn.He used ceramic on ceramic cemented as I remember and the last Dr. was the surgeon that performed The golfer,Jack Nicholson's hip surgery in Boston Mass. He proposed ceramic on ceramic cementless/ bone intigrated implant. These were all THR recommondations. First we consulted a few docs in our immediate area.
Ok, back to his experience. The wonderful care and CARING he received in the hands of Dr.Gross and Lee Webb was unbelievable!! He is today and immediately after surgery PAIN FREE. He also had concerns about the metal ions. Research at the time, was inconclusive but the pain was not. The pain won over the concern. He has not had any effcts from that either. He would never wait as long if he needed the other side done, pain--to surgery would be minimal.He could not have had a better experience and outcome. His research took him to sites and summeries of National Ortopedic seminars and courses. He would have the summary before the Docs could get home. I don't even know where and how he thought of the places and information he found. The internet is a wonderful resource when checked out very throughly. The Surface Hippies site and Active Joints.com (or) .org was also a huge place for support and valuable trading and checking of information. To be able to "talk" to others in the same pain and same decisions to be made or had been made was ultimately what helped him through these painful difficult times. Although not MD's, the wealth of info from actual patients sometimes is a different kind of positive information gathering resource. This interaction always sent him to research each piece of info shared. One Doctor we visited , started his consult with WHERE I WOULD Be waiting for him return from surgery. Then BV asked his first very technical question!! He put his hands behind his head and said "OH You are well read." Then proceeded to have an in depth discussion about Which, What, How, and Why. Although not having any of these docs do surgery, he continued to gather information with each consultation we attended.Ultimately making his final decision of resurfacing.
For a young, healthy, active person resurfacing has been the BEST decision he was able to make and gratefully found a wonderful Dr, and staff to give him his life back and ability to PLAY with his now 11 year old boy.
Grateful Wife of Happy,Pain free Resurfaced Dad.
I was 27 years old when I receieved a conceve resurfacing hip replacement. Yes my femr fractacted. I do not think it is a good thing to receve. I'm young and very actice. This option did not work for me.
Dr. K,
I recently had hip resurfacing surgery by Dr. Gross in South Carolina. I wanted to clear up 2 things that you stated earlier. My surgery was cementless metal on metal (you said that it had to be cemented in) and minimally invasive. My scar is 4 inches long. I agree that there is a lot of research that needs to be done but you might want to have a little more of an open mind about it.
After reading all of the comments, I am absolutely, totally frightened. I am a "young" 78
with an active life stlye: swimming walking. I also work as "working/walking Chaplain. I am now so afraid I will need to leave my VOCATION.
The pain is forcing me to make some kind of decision however.
I need more information. Anybody got any more links?
My husband also had hip resurfacing done by Thomas Gross in SC, to spectacular results. He could barely walk at age 52 just prior to having this surgery. We now refer to the resurfaced hip as the "good" hip. He waited so long to do it, now the other one is starting to go, and we are likely going to be headed back to SC in the next year or so.
American doctors seem to like to like to practice something they refer to as "conservative medicine" and there is nothing wrong with caution. Having said that, hip resurfacing had been done almost a decade in Europe before it was introduced here - so sometimes conservative doesn't mean good medicine so much as it means "I won't take a chance on something new, even if it's better."
Is it better? I haven't had either hip replacement or resurfacing, and I'm not a doctor, but here's what I do know:
There is much less chance that the resurfaced hip will dislocate due to the increased diameter of the femeral head on the resurface prosthesis, as compared to traditional hip replacement surgery.
Hip resurfacing is a much less invasive procedure than hip replacement in the sense that there is no metal spike down your leg bone with resurfacing.
There is reduced need for physical theropy. My husband had none and recovered perfectly.
There is more flexibilty with regard to movement after resurfacing. My husband is able to do everything (cross his legs, play squash, work out) with his hip that he could before it needed surgery. My mother in law had traditional hip surgery years back and is now not even allowed to cross her legs.
It is easier to revise a resurfaced hip than a traditionally replaced hip. The revision for a resurfaced hip is traditional hip surgery. That would seem also to speak of a longer normal life - hip revisions in traditional replacement surgery are something of a mixed bag at best to my understanding.
There are circumstances when hip resurfacing is not the right alternative - these mostly have to do with bone density issues. It will not work properly if bones are brittle - density should be checked.
I am not an MD, and you should check with others you feel you can trust before moving forward with this or any surgery. I would recommend the Surface Hippys website on yahoo for much more information.
But, I am really put off by the FEAR MONGERING of this doctor. While this surgery may not be for everyone who needs hip surgery, it is hardly brand new, and it has done a great deal of good. .
I also strongly recommend Thomas Gross. He is a brilliant surgeon, a great communicator and a kind and humble man. His assistant Lee Webb is incredibly dedicated - I have gotten return calls from her at 6 PM on Sunday evening. I wish I could find all doctors as dedicated at Dr Gross and his team. I wish all of the doctors I had to depend on could be as capable and approachable as he is.
I would like to tell you my story.I was a healthy,active, (rock-climbing/dancing/scrambling and horse-back-riding) kinda gal, but then, due to a prior trauma injury many years previously,had a hip that gave up the ghost! Soooo, I had a chromium/cobalt/manganese alloy Birmingham hip resurfacing in April, 2006. I did not progress as predicted, and that was felt to be due to a 70% muscle loss due to the long wait for surgery after my hip failed. I also lately discovered that as a result of the resurfacing, I have a 1 1/2 cm leg length discrepancy..which has caused an altered gait, with a constant "rub" in the resurfaced hip, thereby increasing the metal ions being released into my blood; and therefore tissues. Over time, I felt increasingly unwell, with perplexing symptoms, and eventually was tested (at my repeated request)for cobalt, chromium and manganese in my blood. My first test came back toxic for cobalt at 98 (normal levels are 0.51-3.69mmol/L). None of the medical people were concerned, however, as "we just don't know enough about this to know the adverse effects..and we don't know what to do about it anyway.. no research..no chelators.. no antidote..we'll just monitor you")...my latest level is 114.. I'm experiencing vision problems, nerve conduction issues; skin, joint problems, thyroid, kidney/fluid retention, cardiac..mobility issues because of the leg-length discrepancy..AND now have a palpable mass in my abdomen.. Of course..the surgeon and other medical practitioners are unsure that this is related to the cobalt...
So the promise of freedom from pain and a long and healthy active life that was the "gift" of this surgery for me has become something of a nightmare.
The information posted here by this doctor is far away from truth. He is very unrealistic. Don't hurry in taking your decisions
I had a successful THR 10 months ago and was told I could go back to my normal routine which was active. At 6 months, I noticed a clicking sound. One month later, the noise was louder and more frequent. After contacting my surgeon, it was suggested that the noise was from scar tissue or a bursal sac and was advised to wait and see. The noise was now generated everytime I moved. It was determined to remove the tissue. That was not the cause, but while operating the surgeon noticed metal staining on the surrounding tissue. After extensive allergy testing, ct scan and blood samples, it was determined the ion content was 90 to 100% higher than recommended. It has been determined to remove the current metal on metal THR and replace with metal/plastic. Suggestions??? Are high metal levels dangerous?
http://www.webmd.com/ira-kirschenbaum
"He serves as an orthopaedic consultant to Stryker Corporation."
Last time I looked, Stryker didn't have a resurfacing product. Coincidence? Think about it.
I don't want to create even more fear than Dr. Kirschenbaum already has - but he has only told part of the story - the part that supports his practice and the manufacturer he works with.
ALL of the hip replacement and resurfacing systems in use today are unproven! None of them have a long track record! All of the systems have been substantially changed over time - new materials, new manufacturing techniques, new surgical techniques, new designs, new cements (or lack of cements) . . .
There were massive and tragic failures with some of the early ceramic devices - some of them shattered. There were failures of devices with polyethylene due to plasstic debris causing loosening (osteolysis). Early metal-on-metal devices created large amounts of metal debris and metal ions. Small ball (femoral head) devices had extremely high dislocation rates. It's hard to find any kind of device that hasn't had some kind of problems.
The point is, all the surgeons and all the manufacturers are working to improve them. They are getting better every month. The device your friend received last year is likely not the device you will receive this year - even if it comes from the same manufacturer.
But, the downside to this continual improvement is that none of these new, improved devices have a long track record. Everyone is doing their hardest to make sure they are better but every now and then there's an "oops" - somebody missed something in the research or a manufacturing glitch, etc.
My point is this - we wouldn't want an implant that was obsolete technology - we know they ALL have problems. To some extent we are all living, breathing experiments.
There are grains of truth in many of Dr. Kirschenbaum's statements but he neglects to tell the whole story. That leads me to believe that he uses this forum to promote his own practice and the company he works with - I can not respect a man that does that. It would be nice if WebMD would get an expert in this field who could provide us with truly ubiased information.
I have just recently undergone BHR Surgery, and have been progressing well according to the physical therapists working with me.
I have noticed that the affected leg seems to be an inch longer than the "good" leg, and confirmed this with my physical therapist.
I mentioned this to my doctor who indicated not to worry, and that it would eventually "settle in".
I note one posting here indicated a similar problem, that eventually got much worse due to this leg length discrepancy causing greater wear on the metal parts.
Does anyone else have experience with greater leg length following BHR surgery? Does it ever "settle in".
I think people should beware of all medical procedures. Traditional, small ball THRs involve a risk of dislocation and early failure in young, active patients. Small ball ceramic implants (the only kind currently available in the US) and highly crosslinked polyethylene liners involve a risk of dislocation and fracture.
Metal-on-metal implants are the only type that can avoid these mechanical risks. But they carry a potential risk of high metal ions.
The question is, how can one receive the mechanical advantages of metal-on-metal without taking on excessive risk from the ions? The answer, in my opinion, is by selecting a highly skilled surgeon.
Studies have shown that metal ion concentration after surgery is directly related to the angle of placement of the acetabular implant. If the angle is too steep, the edge of the acetabular component can rub harshly against the femoral component, leading to a large release of particles. This may be the cause of the high ion count reported by some of the posters above.
See http://www.jbjs.org.uk/cgi/content/short/90-B/10/1291
Hip resurfacing is not an easy operation, even for a skilled orthopedic surgeon. Component placement is especially difficult. This is why, if you're going to have a resurfacing, you want to pick a surgeon with a lot of experience doing these operations successfully.
Problems like rubbing components and mismatched leg lengths are virtually unheard of in the patients of experienced resurfacing docs.
The problem seems to be that many docs are now jumping on the bandwagon and doing these surgeries. This leads to a plethora of inexperienced resurfacing docs.
To the people reporting high ion levels, please get a post-op x-ray and have your component placement checked. Properly positioned and seated components should glide over each other with minimal contact. In fact, synovial fluid lubricates the bearing so they often don't even directly touch.
Also, please have your kidney function checked. Chromium and cobolt are normally excreted by the kidneys. If your serum levels are so high, there's a possibility of kidney trouble.
I am not a doctor, just a prospective patient who has been doing a lot of homework.
For a good, organized source of resurfacing information, visit www.surfacehippy.info.
Here is a great source of information on the metal ion issue:
http://www.surfacehippy.info/metalioninformation.php
Dr. K,
In your post above you wrote:
"Additionally, important data about metal wear debris is coming out which includes possible kidney effects and chromosomal changes."
and this:
"Hip resrfacing may be a method of the future but a hip replacement with large femoral heads may have the same results as hip resurfacing."
Currently, the only "hip replacement with large femoral heads" is metal on metal, which carries exactly the same risks from metal ions as metal on metal resurfacing. Are you saying that metal inside ones body from a hip replacement is safe whereas the same metal from a hip resurfacing is not? They should be identical.
You also imply that large ball THR is better than small ball, when you say that large ball THRs "may have the same results as hip resurfacing."
While they may have similar results temporarily, it's a whole different story when it comes time for a revision. Revising a resurfaced hip to a THR is a snap, whereas revising a THR to a new THR is a majorly traumatic surgery.
I also question whether the results from a large ball, metal on metal THR are as good as those from a resurfacing during the lifetime of the implant. A resurfaced joint is loaded in a natural way--from the head of the femur on down. A THR hip is loaded quite differently, with a lot of lateral stress and bending moment transmitted through the stem. I would rather have the more normally functioning joint.
You also wrote, "Remember that hip resurfacing needs to be cemented in and cement has a finite life expectancy."
Perhaps this has developed since your post, but Dr. Thomas Gross in Columbia, SC performs a completely cementless hip resurfacing here in the US. Cementless procedures are also performed in Europe.
You further wrote, "An important fact- hip resurfacing is not minimally invasive. The designers of the operation actual report on larger incisions and more exposure."
Dr. Thomas Gross performs a minimally invasive (uncemented) hip resurfacing with a typically 4inch incision.
Maybe some of your concerns were valid at the time you raised them, but resurfacing is continuing to evolve, and the number of young, active patients who are thrilled with their resurfaced hips is continuing to grow.
This article is almost 3 years old and should be removed by the website administration. Hip resurfacing is growing in popularity among not only patients who wish to conserve bone, regain greater range of motion and activity levels; but also among surgeons at some of the top orthopedic departments and hospitals in the country.
For younger patients with OA so severe that it restricts their life choices and causes relentless pain, resurfacing offers a valuable option to THR.
No one solution will fit every situation; some patients are not candidates for resurfacing due to poor bone quality, but to dismiss the benefits of resurfacing is narrow minded and not in the best interests of your patients.
I am now 2 weeks post-op from my uncemented right hip resurfacing made through a 4" incision.
I am feeling great and walking about a mile or more each day, with the aid of only a cane.
My arthritis pain is gone, and I feel perfectly healthy.
Thank you for stepping up for the real truth.There is a higher complication rate in resurfacing.
Always ask the doctor about if they had complications with this surgery.Hope they tell the truth to you.I am a person that has got PERMANENT NERVE DAMAGE AND PARALIZED FROM THE KNEE DOWN.
Anonymous
After researching every angle of THR, I went with THR and not resurfacing, as every OS I consulted said the risks for a woman with THR outweighed the benefits. I have a blog about my experience from initial pain to present day (seven weeks post op) ---illustrated with watercolor drawings--- at http://abluetruedreamofsky.blogspot.com/
Thanks.
sva
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