Doctors

Navy Chief Petty Officer Mike Carrol deployed to Iraq in 2007 and remains on active duty today, at 53, to train fellow reservists.

Mike Carroll couldn't touch his knees together. Couldn't play basketball with his children. Couldn't walk other than taking "a big limp," he said.

The former Navy SEAL wasn't going to let those limitations drown his dream of returning to the special-warfare compound in Coronado to help in the war effort.

At age 49 in 2006, Carroll wasn't the oldest SEAL to re-enlist after an absence. But he was certainly not the usual face in the recruiter's office.

Adding to the odds against him, he was packing two artificial hips.

Even with that weighing down his résumé, the Alpine resident deployed to Iraq in 2007 with his special-warfare team and remains on active duty today as a trainer of fellow reservists.

It was a long shot, Carroll is the first to acknowledge.

"If the dream's big enough, there's nothing that you can't overcome, especially with technology," said Carroll, now 53.

Being a SEAL, the Navy's elite sea-air-land combat force, is usually a young man's game.

The age ceiling for entry is 28. Highly sought-after candidates can get an age waiver up to 30. An enlisted SEAL looking to become an officer may receive a pass up to 33.

Carroll remembers seeing a Navy doctor a few weeks after the Sept. 11, 2001, attacks. Angered by the terrorist action, he wanted to get back on a SEAL team and use his 16 years of military experience.

Carroll, who ran a computer-based business after leaving the Navy, kept in shape over the years. He was roughly 6 feet and 183 pounds.

He told the physician that his joints felt fine. Then the doctor asked him to perform a few side lunges and knee bends.

"I couldn't do it," Carroll remembered. "The doctor said, ‘We can't take you Mike, you'd be a liability.' "

So Carroll basically gave up. Surgeons said he was too young for a hip replacement, which is usually reserved for older people because of the chance that the artificial parts will break down over time.

Carroll, a former senior chief petty officer, felt deflated. He had wanted to serve as an example of patriotism to his young sons. They knew he had been a SEAL but had never seen him go to work in combat boots.

Then one day a buddy called to point out an article about a new hip procedure. Carroll bought the magazine immediately.

By March 2004, he was on an operating table in Los Angeles. The treatment replaces only the outer part of the hip joint with metal. It can be a place holder for a future total hip replacement or, if it works, a permanent fix.

Carroll's surgeon, Dr. Thomas Schmalzried, said the former SEAL was basically the prototype for the procedure - someone still young and fit whose joints just gave out too early.

"Mike is a special person. I was proud that he was able to continue as a SEAL with two artificial hips," Schmalzried said.

After the surgery, Carroll managed to get age and medical waivers from the Navy, though he had to drop a rank.

His return took some convincing of re-enlistment officials, so he called on his former teammates. One of them was Cmdr. Roger Meek, who had become an officer at the special-warfare base in Coronado.

The higher-ups largely foresaw that Carroll's role would be training younger SEALs, which is what special-warfare veterans switch to as they finish their careers. But Meek said he wouldn't have recommended Carroll if he didn't believe it was safe to place another sailor's life in his hands, as SEALs do in the tight corners of combat.

"He's a very thorough and squared-away guy with a good reputation for getting things done," Meek said. "In our community, reputation is everything."

The surgery left Carroll with two hockey-stick-shaped scars on his hips, but no complications so far. He now leads daily fitness workouts for his unit.

Sure, the younger SEALs call him "grandpa." In Iraq, the second-oldest SEAL in Carroll's unit was only 36. Another sailor teases him that this story will appear on the cover of AARP magazine.

Carroll said he is living the dream, with a year to go until retirement.

"I think there's a little bit of respect there from the younger guys," he said. "When they ask me how old I am, they can't really believe I'm that old - at least that's what they say. Maybe they are just being nice."

He adds, grinning, "I feel like a 25-year-old man."


 

Here is my story about my hip resurfacing. It starts in October of 2006 when I went to a local doctor in southwest Michigan and had my right hip X-rayed. I wanted to make sure it was arthritis and not something else. He said it was indeed arthritis in my hip and I would have to have it replaced in three to five years. I laughed and said fat chance. After my visit I started taking glucosamine/chondroitin regularly and ibuprofen if I had pain. I am quite active and started to ballroom dance which put more stress on my right hip. The activity that hurt the most was driving. I could not drive for more that 30 minutes without pain going right down to my knee. The same pain was involved when I rode horses. During the week, while I was at work the pain was not too bad but on the weekend when I would walk extensively at the farm or do more manual labor my hip would hurt. As my hip continued to deteriorate I could not ride my horse and dance in the same day. When my leg started giving out while I was dancing I knew something had to be done.

I went to the Cleveland Clinic in August of 2009 and asked the surgeon if there was anything else I could do besides replacement. He was a replacement surgeon and strongly recommended replacement. He mentioned resurfacing but told me there were a lot of issues with it. I scheduled replacement surgery for April 29th. I had a lot of time before the surgery, so I started doing some research. I was disturbed about the restrictions that are involved with hip replacement. I read more about resurfacing and decided I needed to see Dr. Brooks at the Cleveland Clinic about this procedure. My appointment was February 24, 2010 and he said I was a candidate for resurfacing and it was scheduled for May 5, 2010, Cinco de Mayo.

Because I am from out of town Phil, Dr. Brooks' Physician's Assistant scheduled my preop examination on Tuesday May 4 to save me an extra trip to Cleveland. I traveled to Cleveland with my wife and we got a hotel room for the week. My daughter is a nurse at the Cleveland Clinic so she was with me as well. I was getting rather apprehensive and thought about going back to Michigan but decided that was a foolish thought and continued. My surgery was scheduled for 8:30 AM on Wednesday morning so I had to check in the hospital at 6:00 AM. I was taken to the pre-surgery suite at about 7:15 AM and wheeled in the operating room at 8:23 AM. I was back in my room before Noon just in time for lunch. I felt great. I of course had no pain with the spinal and was in a very positive and upbeat mood. Dr. Brooks came to see me in the afternoon and saw how well I was able to move my right leg with my "dog leash" and said as soon as the spinal wore off I could get out of bed and walk.

After I ate dinner I got out of bed, got rid of the hospital gown, and started walking with my walker. It felt great. My wife and daughter did not want me to walk too far so I spent the rest of the evening in my chair before I went back to bed. On Thursday morning I got up, got dressed and walked with my walker as much as I could. On Friday they taught me how to use crutches, made sure I could go up and down stairs and released me from the hospital at about 2:00 PM. That night we all went out to dinner at a nice restaurant in Cleveland. My wife and I spent the night in the hotel and drove back to Michigan on Saturday morning. It was a four hour drive and I really had very little pain in my leg. Saturday May, 8th happened to be my birthday and I dearly wanted to be home on my birthday so that worked out well. Oh, I should probably mention that on May 8, 2010 I turned 63.

I can't say enough about the care I received at the hospital. Cleveland Clinic took over the Euclid Hospital several years ago. The whole staff was excellent and took very good care of me. I owe a lot of my speedy recovery to Dr. Brooks who is a magician when it comes to this surgery. He did an excellent job. Unfortunately I will have to have my left hip resurfaced soon and you better believe I will be right back at Euclid Hospital with Dr. Brooks doing the resurfacing.


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July 2010

James Laveglia - Hip Resurfacing Part II

I forgot to mention that the picture is of me and my daughter 10 hours after surgery. After my stroll down the hall with my walker after dinner on Wednesday, May 5th I came back to the room and took this picture with my daughter.

I went back to work on Tuesday, May 11 for half a day. I have a desk job so that was a fairly easy task. I did half days for the rest of the week. I have to admit I was tired after being at work for just half days that week. I was not prepared for the swelling that occurred in my thigh, lower leg and foot. By the end of the day it was fairly painful and I would go home and raise my foot up. I had to wear a sneaker on my right foot for several days. The swelling lasted less than a week and although there may be a very slight amount of swelling in my ankle and foot today (8 weeks post surgery) for all practical purposes it was pretty much gone at three weeks post surgery.

I travel quite a bit and I had a trip scheduled for Japan on June 14th (5 weeks and 5 days after surgery). My 6 week check up was scheduled for June 16th so I contacted Phil and asked if I could come in for my check up on June 10th (5 weeks and 1 day after surgery). He said that was fine. They took X-rays and Phil had me walk without my crutches and told me I could go to Japan but to continue taking my aspirin until I got back. It is a 13 hour flight from Detroit to Tokyo and this was a preventative measure. Phil noticed I had a slight limp when I walked and he gave me an additional exercise to do. He told me to lay on my left side and raise my right leg as high as I could and to do this exercise 90 times a day. This was difficult in the beginning but it has really strengthened my muscles and my limp is gone.

I have been inspired by the post surgery video’s on Surface Hippy especially the video of the young lady dancing 4 weeks after surgery. I dearly wanted to make a dancing video 4 weeks after my surgery but I just could not dance very well. I continued to work on it and I did make a video of me waltzing 5 weeks after my resurfacing surgery. I will send that video to Surface Hippy. At that time I could actually dance better than I could walk. I went for my check up in Cleveland the next day and with the exercise that Phil gave me it has really improved my dancing and walking.

It has been 8 weeks since my resurfacing surgery and I can honestly say I am very happy I did this procedure and I have been very pleased with my recovery. Dancing has become a big part of my life and before my hip resurfacing I was unable to perform the Viennese Waltz as my hip would not hold up to all the movement and pressure that is required to perform this dance. I am learning that dance now and with my new resurfaced hip I am able to do the dance with no pain and my hip does not give out. We are putting together a Viennese Waltz routine for our dance competition in September and once we have the routine down I will take a video and submit it to Surface Hippy. I recommend this procedure to anybody that is thinking about hip surgery. It is truly a phenomenal procedure.

I am a 49 year old state highway heavy equipment operator. I have arthritis all through my body. Over the years my hip gave me some trouble but it would come and go until 2 1/2 years ago when it came and stayed. The pain got worse and worse until I was no longer able to hunt, fish, and on some days, I was unable to even do my job. The deciding factor was when my wife and I could no longer enjoy our 2008 Yamaha venture motorcycle. The pain was so bad I had to stop every 30 minutes and fall off (there was no graceful way for me to get off and on the cycle anymore and my rides were becoming few and far between.

Where we live no doctor will touch anyone for hip replacement younger than 60 years old, no matter how much pain you are in. I was lucky to know that my neighbor, also a young 47 had her hip resurfaced by Dr. Mont the previous year and she was doing great. We have great insurance that did not require referrals so my wife called on April 26, 2010 and I was shocked that I got an appointment on May 20, 2010.

I took my x-rays but they did new ones as soon as I got there. I figured I would see a phy. assit. and would have to come back to speak to the surgeon. NOPE. Dr. Mont came in and said I was perfect for surgery and that he had an opening on June 16, 2010. NO MRI. NO HIMHAWING AROUND. JUST EASY TO UNDERSTAND STRAIGHT TALK. So we took it.

I have never had any medical procedures of any kind done over the past 48 years, so all this was new to me. Dr. Mont assured me that he and his staff would make this as pleasant an experience as possible. The next few weeks before surgery went quickly.

I had pre-surgery testing. A physical (full exam) an ekg, a chest x-ray and lots of blood work. Except for some minor hbp all went well. Mt. Sinai does have a hotel/guest house on campus but it fills up quickly so if you are coming from out of town you need to call asap. We had to stay at a motel about a mile away.

We arrived early on the day of surgery (about 6:45am) and surgery was for10:15 am. The only thing we didn't like was that they take the patient in first. Put in the iv and get them in bed before a family member could come in. Being it was my first time I would have liked my wife there from the beginning. Then you get the 1000 questions. Ted stockings. You speak to the anesthesiologist and decide on general or spinal. I took spinal and I am glad I did. You won't remember anything.

When I woke up, Jill said I was a rough one and that they almost went to a thr, but Dr. Mont did get the resurfacing done. The normal incision size is 4-5 1/2 inches. Mine was 8 1/2 inches. No staples either. Dissolvable stitches. THE FIRST 30 HOURS ARE HELL. SO BE PREPARED. The pain pump does control pain but made me sick to my stomach, not nauseated. Just could not keep anything down and believe me, you will love the catheter for that first night. I also loved the compression machine on my legs. It was like getting a massage on your legs.

Day 2 catheter gone. Pain pump gone.. Pt got me up. SHOCKINGLY PAINFUL. Had to find something to control my pain so I could sleep. They did and I slept great all night.

What a difference day 3 made. Got me up and walked down the hall. I was ready to go home. We arrived home after a 3 hour ride and it has been awesome ever since, I am 1 week out and I am on a cane. I am driving (it was my left hip) . I take no percocet except 1 before bed.

I WANT EVERYONE TO KNOW HOW GREAT DR. MONT'S TEAM IS. JILL WAS AN ANGEL TO MY WIFE AND WE APPRECIATED HER SO MUCH. BUT EVERYONE WAS GREAT. THE NURSES IN SURGERY (ONE EVEN HELD MY HAND BEFORE SURGERY STARTED) IN RECOVERY AND ON THE FLOOR WERE AWESOME. A SPECIAL THANK YOU TO TERESA, KRISSI AND DAVID (THEY WERE MY NURSES ON THE 3RD FLOOR) WITHOUT THEM I WOULD NOT HAVE HAD THE GREAT EXPERIENCE I HAD. MY advice. DON'T WAIT AND STAY IN PAIN. GET YOUR LIFE BACK. CALL THE MIRACLE WORKERS AT DR. MONT'S OFFICE. I WOULD DO IT AGAIN IN A HEART BEAT. FROM THE BOTTOM OF MY HEART. THANK YOU.

WAYNE AND CINDY
 

In January of 2010, at age 38, I had the difficult decision of what to do about an ailing right hip that had been diagnosed as moving toward advanced osteoarthritis. I first experienced pain in the joint at the age of 26 when my regular doctor told that I should restrict my physical activity (i.e., stop running) and that I would likely need a hip replacement within 6-8 years. That just didn’t really seem like an option for me at that early age. I had been very athletic and active my whole life – starting with basketball, football and track through college and then playing competitive ultimate Frisbee since then, up to 3-4 days a week. Besides, I was still fairly mobile—the rest of my body worked fine—and I was still able to play all the sports I loved. So, despite my family doctor’s advice, I continued my regular activities for the next 12 years, just cutting back when I felt soreness or the stiffness became too painful. Over time, I realized I had to cut basketball out of my activities because it would leave me sore throughout the next day. Then running even a few miles would leave me sore as well. I noticed myself slowly having to cut back on activities I loved because of the pain and stiffness in the hip joint.

I visited a newer family doctor in late 2009 to inquire about what was possible. He told me I "have the hip of a 70 year old," and that I was probably a good candidate for hip replacement. He respected the fact that I was still very active, playing competitive ultimate Frisbee (now at the coed level) and wanted to see that I could continue that. He told me about new developments in hip replacement—namely, hip resurfacing—and referred me to an orthopedic surgeon who he said "wasn’t a surgery nut" and would give me a fairly objective opinion on my options. After I saw him and expressed an interest in hip resurfacing, he referred me to Dr. James Rector in Boulder, CO. I talked with Dr. Rector and he thought I’d be a very good candidate for hip resurfacing. So, after doing a couple weeks of research on the procedure (including quite a bit on the Surface Hippy site, which was a great resource), I decided to go ahead with it, and I scheduled an appointment for late January 2010.

My early post-op recovery was, by all measures, excellent. I was off of all pain meds within 5 days after surgery, I was walking with one crutch at about 9 days, I was walking without crutches by two weeks, and I was driving by 16 days after surgery! In weeks 2 & 3, I would sometimes use a crutch when going on longer walks, because I really wanted to work on maintaining a normal gait, since I didn’t want to normalize any kind of limp which I would still fall into doing sometimes without a crutch. The limp was not so much out of pain as because of the relative stiffness in the joint that was operated on.

I was very committed to making a strong and quick (as possible) recovery. For the first 3 weeks of PT (2 weeks at-home, 1 week outpatient), I worked on the standard exercises they typically give you for post-op strengthening and increasing range of motion. They were great, and I did them religiously every day. When I got to about 3 ½ weeks, I’d pretty much exhausted what they could offer in terms of PT and I got the go-ahead to get onto a stationary bike, and by 5 weeks I was even on the elliptical machine doing 15-20 minute workouts. By about 6 weeks, I decided to get a pool membership and begin working on some water aerobics, which were nice because they allowed me to work on my range of motion without much impact on the joint.

At about 2 months, I felt relatively mobile – I could go on long walks and I was in the gym doing light weights. I’d bike 2 miles to work every day, and I’d go to the pool when I could. It was about that time that I began doing plyometric exercises – the kind that runners and other athletes do to stretch and strengthen muscles—focusing on the ones that did not require any high impact. It was these exercises that made the biggest difference, I think, in speeding my recovery (I would be happy to share those that I did). I focused on ones that strengthened and helped stretch the hip-flexor and quad area muscles, as those seemed to remain the weakest muscles for me (particularly when lifting the knee and extending the leg forward). I continued to do these, along with weights and low impact cardio work, until about 12 weeks post op, when I added beginners’ yoga classes. I didn’t push myself to do everything in the class; just what I could without pain or without breaking the restrictions explained by my surgeon. Between these classes and the plyos, I was able to figure out what muscles seemed to be coming back strong and which remained weaker and needed more attention. Since I still had one fairly strong hip, I was able to use it as a barometer for what "normal" should feel like in terms of strength and flexibility. I made it to the gym 4-5 days a week, for about 1 – 1 ½ hours each time, working on plyos, stretching to increase range of motion, and weights (increasing to moderate by month 3).

When I saw my surgeon for a 3 month appointment, I was doing pretty well. My range of motion – bringing my knee toward my chest—still had a way to go and was limited and somewhat painful if I tried to stretch it too far. Otherwise, the joint strength felt good. He said things looked good, and told me I should keep up with the biking, weights, stretches, and that I could hike as long as I wanted. He told me I should not be doing any running until a full year after the surgery (beyond running to cross the street or something like that). I told him I was doing low impact plyos, and he seemed fine with that. Strangely, he also told me that he thought I could return to playing ultimate Frisbee by about 5-6 months post-op, which made me think: I don’t think he know what ultimate Frisbee is. For those who aren’t familiar, it’s a lot like soccer in terms of sprinting, cutting, jumping, changing direction, etc. So it didn’t make much sense to me, especially when he told me not to run for a year! I tried to explain to him what the sport was, but I’m not sure he ever got the idea of Frisbee golf out of his head – which is a whole different game! He said the fact that it was on a soft surface (grass) – rather than long-distance repetitive motion on something like concrete—made it less taxing on the new joint. He told me ever after the year of no running, I should refrain from playing much basketball. I’ve resigned to doing that for the long term health of the hip joint.

Even though I expected to be in rehab, I committed to be the conditioning coach for the local competitive co-ed ultimate Frisbee team. At about 3 months and one week post-op, I started hosting twice a week, early season track workouts. These included a lot of sprinting exercises, like short recovery sets of 6 x70 yard sprints (1:1 run/rest ratio), with 2 minute recoveries in between, 3 sets total in each workout. Since it was spring, the track infield was very soft, lush grass, so I decided to participate in the workouts on the track infield while they ran on the surfaced track. While I didn’t have full range of motion, my strength was good, and I had enough motion to run relatively normally at the 70-75% speed range. I felt as if the plyometric exercises I‘d been doing prepared my muscles for these types of movements, and I only pushed myself to the point where I felt no real pain at all doing it. I did the "sprints" relatively painlessly, although I was sucking wind because it was the first real cardio work I had done beyond the elliptical machine, which I rarely did at sprinters’ pace because I hated sweating all over the equipment! I was a little sore after the first couple of workouts, mostly in the muscles in the front of my hip, rather than in the joint itself. I’d still be able to bike home, and I was fine by the end of the next day. I never took any pain meds or anti-inflammatory drugs during my early recovery process because I figured if I needed them, I was probably trying to do too much. I kept up the 2 a week (soft) track workouts – largely sprinting, with minimal jogging (less than ½ mile to warm up before stretching) for the next 3 weeks. The reason I did as little jogging as possible was because I was more worried about what the repetitive motion of longer distance jogging would do to my joint than with the sprinting, which was bursts of about 10-15 seconds of running on a soft surface. I’m not saying my logic is medically confirmed, it was just the feeling I had. I also continued to do stretching to increase my range of motion on the days I wasn’t sprinting, as well as some low-impact plyometric stretching and strengthening. If I felt any kind of prolonged pain that could cause me to limp, for example, I would take a day or two off, because while I wanted to come back as fast as I could, I didn’t want to do it too fast. I let pain be my guide.

At about 4 months, I began to add a host of higher impact plyometric exercises to my routine – e.g., high knees, hoping, jumping, bounding, although I had been mixing them in, to some degree, for the previous couple of weeks. I also added some change or direction or "cutting" running drills into the sprinting track workouts – like ladder sprints, where you run 10 yrs and back, then 20 and back, and then 30 and back. I continued these on the soft grass and I changed into cleats so that I wouldn’t slip at all on the turns. I eased into these because I wasn’t sure how my body would respond, but it responded well. The worst part is that the operated hip was still stiffer than the good hip, and I didn’t want to create an imbalance in my stride or muscles by sprinting/cutting too hard one way and not the other. So I only did them at the speed that was within my comfortable flexibility range on both legs, which at that time was about 75% of what I would consider maximum. As it turned out, changing direction did not feel hard on the joint, but changing speed (slow to fast) was a bit difficult because it requires different muscles to slow down and speed up quickly, and I realized I needed some time to get those back.

At 4 ½ months post-op, our team had our first 2-day tournament. I didn’t expect to play, as I really hadn’t done any live-action running and cutting other than very controlled drills. However, I convinced our captain, who called the field lines on our team, to put me in for a few points at a position where I was less likely to have to run or chase people all over the field but would still have to make relatively quick cuts and changes of direction (at the "handler" position, for those who know the sport). I wasn’t super fast or quick, but I was okay! The second day, I took a lot more points, and even played some of the tough, final points in a competitive semi-final game. In that game, I found that having to chase around a quicker opponent was stressing the inside groin muscle on the operated leg, so I wisely benched myself for the final game, not wanting to put my progress back.

My groin was sore for a day or two after the weekend tournament, but I continued to stretch it, and found that all the running I had done had really begun to loosen up the joint and extend the range of motion – still not back to normal but closer to 80-85% - I was finally able to bring my knee to my nose while having one leg on the ground and the operated leg bent on the seat of a chair (that had been my goal for about 2 months. To get this flexibility, I found it helpful to do 5 minute deep stretches, which my PT had recommended. This meant that without pushing too hard at once, I could work on elongating the muscles in the joint over time rather than trying to do anything to force them quickly. It seemed to me to be a safer way to increase range of motion. After 5 minutes of the stretch, my leg would sort of get "stuck" in this position, but after I’d slowly ease my leg back down with my arms and set it straight, it would take just several seconds to return to its regular state. I certainly have a new found respect for the resiliency of human musculature!

At about 5 months post-op, which was the Fourth of July weekend 2010, I attended a 3 day ultimate Frisbee tournament in Seattle Washington. It had been my goal from the day I scheduled the surgery to be able to play in this tournament. It’s much more of a "fun" than competitive tournament, so I wasn’t worried about having to impress or play 100% all of the time. We played 3 - 1 ½ hour games each day, over three days, and I played in each game. I started fairly cautiously on day 1, and I did a lot of standard and plyometric stretching exercises before and after the games. I didn’t entirely feel like my old self – I’m usually the person who doesn’t get tired running and jumping around, but I was definitely tired, both in terms of muscles and lung capacity, but that is typical enough given where I was in my rehab. After day 1 and 2, I was sore, but it was the typical sore – hamstring muscles, a little in the hip flexors on both sides, but nothing that different than before the surgery. If anything, my non-operated hip was a bit sorer than the operated one, and this has generally been the case since I started doing more of the "cutting" types of sprinting activities. My assumption about why this is true is because the operated hip does not have full 100% flexibility—and sometimes I do run at 100%--as a result, the other leg has to compensate a bit. That is why I continue to make it a top priority to get as full a range of motion back in the operated hip as I can, and for me it has taken on-going commitment and work. Anyway, by the end of day 3, I was pretty much feeling like my old self – I was sprinting well, cutting well, and jumping well. I was very pleased to hear my teammate say "welcome back" after the final game, when I played as well as anyone on the field, and played a key role in turning at 6-1 deficit into a 9-6 win for our team!

I just got back from the Seattle tournament last night, and I decided to take time to write this long story. I know that in my own process of deciding on the BHR surgery and undertaking rehab, I depended on, and found strength in, the stories of others who have posted on this site. The stories gave me the confidence to go ahead with the surgery and made me believe a strong recovery was possible.

Even though I was very methodological about my recovery process, I would not suggest that others go against their surgeons orders on how to best assure a successful recovery. Medical doctors know much more about stuff than I do. I only know my body, and I listened to it as best I could, and although I pushed it at times, I always pulled back when pain or discomfort told me I should. And I was very good about heeding the post-op restrictions for the first few months of recovery. In the end, I’m very pleased with my recovery to date. My old real worry is about how long the joint may last, because of course no one knows for sure. But being where I am, 5 months post-op, I couldn’t be happier, and I wanted to share my story.

 

Smith & Nephew Press Conference about the Safety and Effectiveness of Hip Resurfacing with the BHR -
Birmingham Hip Resurfacing Device

Review by Patricia Walter

May 6, 2010

Introduction: Joseph M. DeVivo, President of Smith & Nephew Orthopaedics

Joseph M. DeVivo, President of Smith & Nephew Orthopaedics (NYSE: SNN, LSE: SN), the maker of the BHR Hip introduced the press conference and discussed the safety and effectiveness of the BHR.  He explained that over 125,000 patients worldwide have received a BHR since 1998. The BHR and the issue of metal sensitivity in patients with MOM (metal on metal) implants will be discussed. The purpose of this event is to deliver specific facts about the BHR and its unrivaled track record of success for active patients around the world.

Mr. DeVivo explained that information about hip resurfacing presented at the 2010 American Academy of Orthopedic Surgeons will be discussed.  Recently, there has been negative information in the press about metal on metal devices which includes hip resurfacing devices like the BHR.  The press has taken the failures of a few to cast doubts about all hip resurfacing.   It has omitted the successes of hip resurfacing and that 7 out of 10 surgeons performing hip resurfacing choose the BHR.  Smith & Nephew feel the BHR is a safe and effective device providing successful hip resurfacing for patients worldwide.

Derek McMinn, MD, British surgeon and inventor of the BHR

Derek McMinn, MD, pioneering British surgeon and inventor of the BHR hip explained that the BHR has been proven successful by peer review data and his own clinical data. There are four main pieces of evidence that show the success of the BHR:

1.   The Australian Orthopaedic Association's National Joint Replacement Registry - tracked every hip resurfacing since 1998.  Less than 1/3 of 1 percent of hip resurfacing failures are caused by an adverse tissue reaction.

2. In a 9 center Canadian study presented at the recent 2010 AAOS, 3 resurfacing patients out of 3400, less than 1/10 of 1 percent, experienced a tissue reaction.

3. Long Term data, from the Owestry outcome center, tracked 5000 BHR patients and now 518 BHR patients at 10 years of follow up. The study was carried out by 18 surgeons in 16 different countries. There was a 95% success rate at 10 years.

4.  Mr. McMinn’s own clinical data started in 1997.  He performed 3095 BHRs until end of 2009.  At 12 years follow up, he has a 96% survivorship.

Therefore, according to McMinn, those 4 pieces of data from a large number of surgeons and his own clinical experience shows the BHR works.  There have been adverse reactions reported in all of the studies, but these numbers are incredibly small. However, since MOM resurfacing has been going on in UK since 1991, when he did his first resurfacings, there have been a number of adverse reactions reported. One study from Oxford has over 30 presentations or publications of pseudotumors.  In 2008, one percent of their patients were affected by this condition. Mr. McMinn explained that we need to examine what has happened in Oxford. They presented and published 610 BHRs in 2008. Those patients were operated on by 7 consultants and 30 trainees resulting in a large input from inexperienced surgeons. We know, explained McMinn, from a presentation from the last academy meeting that they have reported on poor surgery. The inclination angle of the cup should be 40 degrees; however, the Oxford pseudotumor group reported angles from 10.1 to 80.6 degrees.  I need to stress, the high inclination angles up to 80.6 angles are completely unacceptable. Every BHR, Metal on Metal, Ceramic on Ceramic and metal on poly device will fail with that type of poor surgery.  

McMinn explains that the adverse reactions for hip resurfacing are reported from 2 categories:

1. Poor results from well established BHRs put in badly causing edge loading, high metal wear and an adverse tissue reaction to lots of debris.

2. Poor results from implants that don’t work. The  4^th generation devices such as the Durom and ASR devices have both been associated with much higher failure rates than the BHR both on individual surgeon reports and Australian national registries. The adverse tissue reactions to the ASR are particularly prevalent. The UK reports around 7% revision rate for ASR resurfacing.  ASR THR mom failures are also double than other devices.  So the UK regulatory bodies are faced with reports of devices that are poor and adverse tissue reactions by well established devices put in badly.

Edwin Su, MD, of the Hospital for Special Surgery

Edwin Su, MD, of the Hospital for Special Surgery, agreed about the importance of hip resurfacing in the lives of patients.    After training with Mr. McMinn and Dr. Amstutz, he has completed over 1300 hip resurfacings with majority being BHRs.  I can say with authority that this procedure can be a life restoring event for the patients. Metal on Metal hip resurfacing done with precise technique and a well designed implant can work.  In appropriate patients, hip resurfacing can achieve nothing short of miraculous life changing results.  Hip resurfacing allows patients to return to active pain free lives. Certain patient types do better with resurfacing than others.  Good solid bone stock means you will do well.  Poor bone stock means there is an elevated risk of a femoral neck fracture. This is common knowledge    Patients under age 65 have best bone stock.  92.7% of all resurfacings are in patients under 65.  Patient selection is very important.  The data shows men do better than women.  Women require smaller components and are more difficult to align during surgery.  Also women’s bones are less dense, so some women are not ideal candidates for hip resurfacing. Australian shows 80% resurfacings are in men.  Resurfacing works better in men than women. Women of child bearing years are not recommend to have hip resurfacing.

Dr. Su explained about the issue of Implant alignment.  If the components are misaligned, there will be an increased risk of metal wear because the surfaces will not be properly lubricated during regular physical activity. There is a resulting risk of adverse tissue reactions and possible revision surgery.  Although this is true for most hip replacement surgery, it is especially true for resurfacing since the implants are less forgiving due to their precise manufacturing.  This rate of adverse tissue reactions is extremely rare in resurfacing and less than ½ of 1 percent.

The literature, explained Dr. Su, shows experienced surgeons who have undergone appropriate training, can place a hip resurfacing device correctly.  A surgeon not doing them on a regular basis has a greater chance of not achieving optimal results. It’s that simple explained Dr. Su.   This is true in any surgery in any specialty. While some implants perform better than others, good outcomes with hip resurfacing most often are achieved by experienced surgeons who have received excellent training and are careful in patient selection.  Dr. Su has offered hip resurfacing since 2006 and has seen spectacular results since then.

Scott Marwin, MD, an orthopedic surgeon with New York University's Hospital for Joint Diseases

Dr.  Marwin explained that the use of the BHR, after 12 years use worldwide and 4 years use in the states, remains an exciting option for some patients.  It has never been suggested for all hip replacement surgery.  Fewer than 10% of all patients are candidates.  Fundamentally, it is a bone conserving procedure and saves a significant amount of healthy bone.  Preservation of the basic structure of femur retains the natural size and angles of the joint and reduces any possibility of leg length discrepancy after surgery.  Also patients’ soft tissue doesn’t have to adjust to a different set of shapes and kinematics that comes with a THR. Many patients forget which side has the BHR implant.  Hip resurfacing also retains the patient’s anatomy which decreases the possibility of a dislocation. In a THR, the long metal neck can act like a lever on the edge of the metal cup and dislocate the ball out of the socket.   The natural femoral neck retained during hip resurfacing means incidence of dislocation is extremely rare.  If a resurfacing patient needs a revision, they can receive a matching THR component to match the existing cup.  Hip resurfacing reduces wear and leads to a longer life for the implant as compared to a THR.  Dr. Marwin has implanted more than 750 hip resurfacing devices and can see what they can do for the active patient.

 

Summary by Joseph M. DeVivo

 The BHR is different than other MOM devices on the market that are not performing up to standard. The BHR outperforms the gold standard for THRs in the core patient age group. Hip resurfacing gives patients their active life style back.  BHR preserves so much healthy bone that it feels like a normal hip. More information can be found a www.hipsresurfacing.com

Question and Answers from Audience

Question:  Terry Stanton, AAOS.  Concerning the medical device alert in Britain - is it warranted and correctly crafted?

Answer: Dr. Su - It casts a general concern over MOM usage, but does not speak specifically to the BHR.  BHR has its own clinical data and has not produced the type of concern other MOM device have.  It stands on its own according to worldwide sources.

Q: Surgeon inexperience and poor technique – more globally in the US, what factor will it play?

A:  Dr. Su - Where the BHR is concerned, as part of the FDA approval, it has mandated a very high level of training.  Every surgeon is trained to same protocol.

Q: Canadian Study presented in New Orleans – follow up was 3 years. Comment on how solid the evidence is since the follow up is shorter.

A.  Mr. McMinn - Important to look at what happens in first 3 years in hands of a new group of surgeons to hip resurfacing.  The Oxford Group is reporting adverse reactions to metal debris in the early years. It is highly significant how a new group of trained surgeons get on.  The fact that there are an incredibly low number of incidents of adverse reactions in a 9 center study with over 3000 patients speaks volumes for the devices and training of the surgeons.  The longer term results are more important. The Australian registry has over 8000 people with an incredible low incidence of adverse reactions with survivorship at  95% for BHR at 8 years.  The Oswestry registry with 518 patients at 10 years, shows a  95.4% implant survivorship.  Phenomenally good results.  In my own group, adverse reactions have occurred in 0.3% of my whole group.  Out of 3095 BHR patients thru 2009, there were 10 adverse reactions.  Unlike the Oxford Group, all the revisions have been fine. None were associated with soft tissue destruction.  These were in the main, fluid collections requiring a bearing change to solve the problem. The patient made a totally uncomplicated recovery.  I saw adverse reactions much later.  Oxford was showing them 2 or 3 years after surgery. 

Q. Metal sensivity and pseudotumros are always curious problems.  In terms of devices, is there is less metal release in different devices?

A. Mr. McMinn - It is very clear who gets the pseudotumors. The retrievals from the Oxford Group show pseudotumors were associated with aged wear of the acetabular cup.  With normal lubrication and normal wear, there are no pseudotumors.  Clearly,  if you want a MOM device to fail,  implant it badly or design it badly so you get age loading and age wear which results in a high metal volume of debris early on.

A Modified Posterior Approach Preserves Femoral Head Oxgenation During Hip Resurfacing 2010

Steffen RT, De Smet KA, Murray DW, Gill HS  2010 Mar 22

Original Link  http://www.ncbi.nlm.nih.gov/pubmed/20334994?dopt=AbstractPlus

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.

In 11 patients, the oxygenation was measured in the superolateral quadrant of the femoral head during resurfacing with a modified posterior approach, designed to preserve the blood supply, using a gas-sensitive electrode. These were compared with measures from 10 patients in whom the standard posterior approach was used. The modified approach patients maintained a significantly (P < .005) higher amount of relative oxygenation after the approach, 78% (standard deviation [SD], 45%) vs 38% (SD, 26%), and acetabular component implantation, 74% (SD, 56%) vs 20% (SD, 28%). The modified posterior approach, unlike the standard extended approach, does not significantly compromise the blood supply to the head; and we recommend this approach be considered for hip resurfacing.

I had my left hip resurfaced by Dr. Clarke on April 30, 2008 using the Birmingham hip. Prior to that I had been in physical and aqua therapy for nearly a year, attempting to retain range of motion and strength. My recovery after surgery was very quick. I walked without a cane in less than 3 weeks, and mowed my lawn with a self-propelled walking mower at 3 weeks. All the time I was diligent about my exercise program from my PT. The progress was amazing with noticeable improvement from one day to the next. In a month I was able to walk around my neighborhood (a little over a mile), something I had not been able to do in a couple of years.

In fact I was so pleased with the success of my left hip that I had my right hip done on July 23, 2008. Since it was not as debilitated or weak that side bounced back even faster! The surgery itself was very quick, about an hour, and because of my fitness on that side I noticed ability to move right away that was not present on the previous hip.

For both operations I stayed in Community General Hospital, where the care was outstanding. On the orthopedic floor they have many private rooms, and I was fortunate to be assigned to a private both times. The follow up care through Dr. Clarke was also top notch. My questions were always answered, and everyone was easy to talk to.

I am a teacher, and plan to return to my classroom ready to roll in September. Can't wait to do my job without pain.

Long story short, if you are considering this procedure, don't wait until things are terrible in your joints. Also try to prepare your body with exercise prior to surgery.

You will find it helps you to recover faster and with less pain. I feel blessed to have Dr. Clarke with this groundbreaking procedure, in the area, although I would definitely travel to obtain this care.

Linda Ward

After years of thinking I had a bad back, in the Sept. of 08, I found out I had a bad hip instead. With moderate degeneration I knew I had to have surgery. So I researched Hip Replacements on the internet. The Birmingham Hip Resurfacing popped up and I knew this was just what I needed.

I am a professional photographer and very active. I am also only 51 years old. I don't run marathons or play tennis, but I work really hard and I need to move unrestricted to do my job right. So I met with Dr Clarke. We had to have a few extra things checked first, (I only have 1 kidney) there was concern about the ions and my kidney's ability to excrete them.

My nephrologist did his research on the BHR and the ions and gave me the green light to have the surgery. I had my right hip resurfaced by Dr Clarke On Feb 4th 2009.

I am now almost 6 wks postop and I can walk around the house without my cane. I am progressing very rapidly. I work really hard at PT and do exactly what they say. Today I walked 3/4 of a mile. It felt great!

I know that eventually I will have to have the left done, but now I know what to expect, it will be less intimidating. But it sure beats having a THR especially at my age. Dr. Clarke is the greatest, and Community General is the best hospital I have ever been in. Never have I been treated as nice as they treated me. I am extremely satisfied.

Darlene N Chissom

30 years old. 11/11/2009 Left hip Biomet uncemented by Dr. Thomas Gross.

It has been exactly 7 days to the minute since I had my left hip resurfaced and I just walked my first mile so this seems like a good time to write this note. My story is similar to many of the stories on the Surface Hippy website. I could never thank Patricia Walter and all the other contributing Surface Hippies enough for this invaluable resource - it was the #1 resource I used while educating myself about my situation and available options. What an awesome example of how technology can empower the patient community!

At the age of 29 I was diagnosed with severe OA in my left hip, likely due to a slight malformation of my femoral head which caused uneven pressure and eventual breakdown of cartilage. The news was very unexpected and I was absolutely crushed. The tears started coming once I got back to my car. It wasn't that I was thinking "why me" or anything like that but that I felt a huge sense of loss. Everything about my life was active - a normal week might consist of 50 miles of single track mountain biking, soccer, softball, yoga, and the gym. Being active was how I relaxed - it was my only real hobby besides reading. My journey to the diagnosis was a long one and started with groin pain as a college soccer player - trainers and myself would assume the pain was due to a strain or pull and I would rest. Several weeks and I would always be fine. A blown knee and approaching graduation took the focus off soccer and on to academics. Once I stopped competing at a high level I paid little attention to a progressive loss of speed and agility. I was athletic enough to compete just fine in recreational sports and the years passed while I immersed myself in my professional life. I naturally transitioned to sports that better fit my changing abilities - yoga and mountain biking. I though I had just been slacking and yoga would bring back my flexibility. It didn't. I continued to loose flexibility, was unable to run at speed, and groin pain had become a constant part of my life. Eventually I realized I could not remember not using my hand on my knee to pull my left leg into my car or picking something up without lifting my left leg in the air behind me. Putting on socks and shoes was one of the hardest aspects of my day. "Are you limping?" questions came from all directions. It hurt to exist - awake, asleep, sitting, standing - chronic hip pain now defined who I was.

Before I found the Hippy Surface website two themes defined the messaging I received from medical professionals. The first was that I was too young for this to be happening and that my situation was weird (fascinating insight). The second was that this was a big shame, none of my options were ideal and I should wait as long as possible to consider surgery because of my age. I have enough experience in healthcare to know doctors are constantly wrong, information disseminates at a snails pace in medicine, and there were other people like me and I needed to find them ASAP. Finding the Surface Hippy website was one of the best days of my life.

At my age I never considered traditional THR - if you're reading this neither should you! There are situations when THR is the only option but they are rare. It is important to note that THR is a massive industry - there are billions of dollars and lifetimes invested in this procedure. If you think most physicians who have built their entire practice, professional career, and sent kids to college by performing THR's are going to be impartial regarding resurfacing you're nuts. I asked a physician at Washington University why anyone in their right mind would ever consider THR if resurfacing was an option. He seemed almost offended, stated it was a perfectly good procedure (for him maybe) and I should consider it as a very viable option. Doctors are people - its your hip, you're the expert and must take on the responsibility of the role. Ask questions and know the answers you're looking for.

In choosing my surgeon I met with teams at Washington University in St. Louis, Dr. Su at the Hospital for Special Surgery in New York, and Dr. Gross at Midlands Orthopaedics in South Carolina. The surgeon at Wash U was primarily a THR surgeon who basically does resurfacing on the side. He had completed about 60 cases in 3 years. I wanted someone with more experience. I met with Dr.Su in New York. I left the meeting feeling very confident he would do a great job and enjoyed our meeting. However I passed on Dr.Su for several reasons. I wanted to go with an uncemented femoral component and Dr. Su only does cemented. The Hospital for Special Surgery is an extremely difficult facility to navigate (one appt. had me visiting 3 completely different buildings) as is Manhattan (awesome town, unless you can't walk) - this seemed like a nightmare scenario after surgery. Some of the staff at the Hospital for Special Surgery were also extremely unprofessional - staff members making fun of and arguing with patients definitely had an impact on my perception of the facility.

I choose to have my surgery with Dr. Thomas Gross in South Carolina for several key reasons. Key factors included: surgeon's experience specifically with resurfacing; uncemented femoral component option; an incredibly friendly staff throughout the facility; and easy access to facilities.

THR and resurfacing are two completely different surgeries - skill at one DOES NOT necessitate skill at the other NO MATTER what any doctor might say - the entire process, tool set, prosthetic components, etc. is completely different. Resurfacing is going to continue to gain in popularity which means more and more inexperienced surgeons are going to start doing the procedure - I personally wouldn't want to be someone's practice. Ask your surgeon how many times they have performed the specific procedure with the specific components. The experience and skill of your surgeon is the single most important factor in your success. It is only day 7 and the only pain medication I took today was two Tylenol 7 hours ago and I'm sitting on my couch with ZERO pain. I have almost ZERO bruising. I walked one mile today without crutches or a cane and didn't have any pain - I could have walked another one, the last step didn't feel any different than the first. I have not heard any popping, clicking or other unnatural noises coming from the joint. The OA pain is GONE! I know my joint and recovery still have a very, very long way to go and I'm far from out of the woods - anything could still happen - but I could not be happier with how things have gone thus far. These results are all due to the skill of Dr. Gross. 

While the contemporary uncemented femoral component option is so new data is not yet available on outcomes it was an easy choice for me. I believe it will become the standard. While a 20 year lifespan for a cemented component is a great outcome it would still have me moving to a THR relatively early. I need both components to become parts of my body - I need the connection between the components and my body to be alive - I need the connection to be bone. I personally saw cement as one more point of failure which added variables to the overall system. Cement is not alive and cannot regenerate itself.

Everyone at Midlands Orthopaedics was extremely professional - from the front office, to x-ray, Nurse Nancy Smith, Nurse Practitioner Lee Webb, and Dr. Gross himself. After having visited Wash U and the Hospital for Special Surgery this professionalism was a giant relief. I finally knew I found the team I wanted to work with. Dr. Gross was the first surgeon who seemed genuinely excited about the components he used for the surgery. I asked other surgeons, "What components do you use and why?" The general answer before Dr. Gross was "I use 'x' mostly and it seems to work OK" - I absolutely hated that answer! These guys should be experts on the options and choose their tools of the trade with passion! I wanted to hear extremely specific reasons why, of all the options, this doctor thought I should have a particular piece of hardware in my body, potentially for the rest of my life. No doubt they're getting paid by the component vendors but I wanted to figure out what other specifics they used to pick their horse.

I'll share some of my advice for anyone facing the difficult situation of needing a new hip(s).

• Find ways to get into or stay in shape. Your body is a system - the stronger the overall system the better you will be able to cope physically and mentally with the challenges before and after your surgery and recovery. Find exercises you can do - swim without kicking, use adjustable elliptical machines to find a bearable setting, do upper body exercises, walk as much as possible. Rehabbing a hip is a difficult task - you don't want to have to rehab a quad, hamstring, calf, etc. all at the same time too. My left leg was still very strong at the time of my surgery - I can already tell this is an excellent help in my recovery. You also want to get into the habit of a daily exercise routine before surgery so you will have one less change you have to make after - you'll already feel comfortable with the daily routine of rehab.
  

• You are the foremost expert on this planet regarding your hip. Nobody else. Embrace this role and become an expert on every aspect of your situation. Don't let doctors intimidate you or pressure you into any procedure or timeline. Ask specific questions and demand specific answers, "how many hip resurfacings have you done?" - I had a doc answer this question by lumping THR's and resurfacings together 3 times and would not tell me the specific number eventually stating the surgeries are basically the same which we all know is nonsense. If you've studied the Surface Hippy site carefully, you have expert knowledge and know more than a vast majority of doctors.
  

• Take your time in choosing your surgical team. I remember just wanting to get the decision over with and move on with my life. If not for my very supportive family challenging me to make sure I felt comfortable with my surgeon I probably would have gone with the easiest option which upon further reflection would have been the wrong choice.

• Remember THR is a multibillion dollar institution - there are vested interests and a great deal of economic momentum working to keep THR procedures as the standard. Just because your local doctor isn't up to date on modern resurfacing doesn't mean it's not the better option in many cases. Personally I do not see any reason why someone who has the option of resurfacing would ever choose THR.
  

• Keep a positive attitude. Life is difficult. Always has been, always will be. I'm in a good place right now with my outcome but a fall on ice, an infection, or some random car accident and the game changes. Before I had my surgery I had reserved myself to accept the worst possible outcome (well death is the worst but that would be easy on me) which I saw as a long fight with infection, zero weight bearing, and ending up with a THR . This situation would suck but I'd need all my mental strength at hand to fight to get my health back. I entered the hospital ready to battle. My right hip isn't too far behind my left so I'll be on this journey for a while. 
  

If you've found this site consider yourself lucky. Take your time, get prepared, and take your life back from pain. I am so very thankful for my supportive family and my beautiful girlfriend Meghan who traveled with me to South Carolina. I am eternally grateful for and humbled by all the love and support I received from Meghan, my family, and our friends.

Best wishes on your journey!

Sincerely,

Joseph P. Tierney
Surface Hippy Newbie