Hip Resurfacing News

Sports Activity After Total Hip Resurfacing Study 2010

Sports Activity After Total Hip Resurfacing Study 2010

Original Link http://www.ncbi.nlm.nih.gov/pubmed/20223940?dopt=Abstract

March 11, 2010

Banerjee M, Bouillon B, Banerjee C, Bäthis H, Lefering R, Nardini M, Schmidt J.
Dreifaltigkeits-Krankenhaus and Cologne Merheim Medical Center.

BACKGROUND: Little is known about sports activity after total hip resurfacing.

HYPOTHESIS: Patients undergoing total hip resurfacing can have a high level of sports activity. STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: The authors evaluated the level of sports activities with a standardized questionnaire in 138 consecutive patients (152 hips) 2 years after total hip resurfacing. Range of motion, Harris hip score, and Oxford score were assessed, and radiological analysis was performed.

RESULTS: Preoperatively, 98% of all patients participated in sports activities. Two years postoperatively, 98% of the patients participated in at least 1 sports activity. The level of sports activity decreased after surgery. The number of sports activities per patient decreased from 3.6 preoperatively to 3.2 postoperatively. Intermediate- and high-impact sports, especially tennis, soccer, jogging, squash, and volleyball, showed a significant decrease while the low-impact sports (stationary cycling, Nordic walking, and fitness/weight training) showed a significant increase. Physical activity level at the time of follow-up as measured by the Grimby scale was significantly higher than in the year before surgery. Duration of sports participation per week increased significantly after surgery. Men had a significantly higher sport level than women before and after surgery. Eighty-two percent felt no restriction while performing sports. One-third missed certain sports activities such as jogging, soccer, tennis, and downhill skiing. The Harris hip and Oxford scores showed a significant increase postoperatively.

CONCLUSION: The results of this short-term follow-up study show that sports activity after total hip resurfacing surgery is still possible. Physical activity level increased with a shift toward low-impact sports. Duration of sports participation increased. High-impact sports activities decreased. These findings can be important for the decision-making process for hip surgery and should be communicated to the patient.

Linda Ward LBHR April 30, 2008 Dr. Clarke

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

Darlene Chissom RBHR February 4, 2009 Dr. Clarke

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

Joseph P. Tierney Left Biomet Uncemented 11/11/09 Dr. Gross

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

Dr. Barry Tannen Bilateral HR Dr. Su 12/18/08

Dr. Barry Tannen (bilateral HR 12/18/08)

I am a 52 year old physician who had bilateral hip resurfacing with Dr. Su on December 18th 2008 at the Hospital for Special Surgery in New York. I had been diagnosed with moderate to severe osteoarthritis 3 years earlier and increasingly had to deal with the pain and limitations that this brought on. I am an avid tennis player who competes locally and in USTA tournaments and obviously my tennis game was greatly impacted, but so were ordinary activities of daily living such as tying shoelaces, etc.

My experience with Dr. Su, his staff, and the entire team at the Hospital for Special Surgery was nothing short of amazing. I left the hospital 6 days after surgery and was discharged to my 2 story home. My wife was terrified that I would be climbing stairs immediately, but it was no problem. I started outpatient physical therapy one week after being home, returned to work 4 weeks after surgery, and started playing doubles tennis in 8 weeks, singles in 12.

I feel better than I have in at least 8 years, maybe longer. I enthusiastically recommend HR, and especially Dr. Su who is an amazing surgeon in my opinion.

Emanuel captures tennis tourney

Temple Emanuel captured the recent Jewish Athletic Group (JAG) Tennis Tournament. Barry Tannen (left) and Mike Spivak hoisted their trophy. The duo overcame the father-son team of Richard and David Fischer of Cong. M’kor Shalom in the finals. Over 30 area players representing many area men’s clubs participated in this year’s event.

Paul Jacobson Bilateral Dr. Su Dec. 1, 2009

I'm 10 days out of bi lateral hip resurfacing with Dr. Su. Can't say enough good things about Dr. Su.

My hips feel strong enough to stand with no issues and no crutches 7 days out. Post surgery, he told me my hips were a mess, and I had pretty big cuts, around 14 inches per leg. I went on a strong natural product regiment right out of surgery, only taking pain killers for a few days, and trying to avoid everything else. I used natural wound healing products and probiotics so my GI system would be normal.

There's no sugar coating the first 7-10 days after surgery. It's hard work and a lot of discomfort, but it's not from pain per se. It's that it's hard to sleep, and you're confined to bed most of the time with both hips having been done. However, with PT, stretching etc, you can recover fast and feel a lot better.

Once you get past the first week, things improve daily. I got my staples out on the 10th day, which is a big improvement. Starting tomorrow I expect even bigger improvements daily, as I'll really begin focusing on regaining flexibility.

HSS is excellent and you can't find a better doctor than Su.

December 27, 2009

I’m 3.5 weeks out of bi lateral surgery with Dr. Su. I’ve been on a stationary bike for a week, no resistance, up to 20 minutes a day, and another 20 minutes walking on a treadmill. I started driving just short of 3 weeks out of surgery, although I get stiff when I’m in the car too long. I’ve had no pain, just discomfort around trying to regain flexibility. I still can’t put socks on (although I got lucky a couple of times), but I’m able to walk without crutches, including stairs. My physical therapist recommended I buy a cane that’s more for hiking, so I got one that collapses made by Leki called the Wanderfreund, and tossed the crutches. I’ve got 2 14 inch scars because my hips were so bad, and yet, I cannot believe how fast I’ve progressed since surgery. The absolute worst time for me was just the discomfort post surgery (not bad pain), and getting the pain meds out of my system (even after stopping all opiods 3 days after surgery), so I could pass the stairs test to leave HSS. Now, it just feels like I have to work hard on flexibility, so I can push the endurance part of rehab. Each day seems to get a little better, and I frankly, I’m surprised at how well things have gone. Still can’t say enough good things about Dr. Su, and for those considering doing both hips at the same time, I’d say the experience has been way better than I expected, and he’s got to be a doctor you consider. In the beginning, the improvement comes every 3-5 days, but as time progresses, I’ve found improvement daily. You wake up and suddenly you can do something you couldn’t do the day before. I fully expect to be back on all non impact sports soon.

Mr. Bloomfield responds to the The Times Article: "Is hip resurfacing the best solution for arthritis?"

Mr. Bloomfield responds to the The Times Article: "Is hip resurfacing the best solution for arthritis?"

Let's start at the beginning!

Fact No. 1 : Nothing is as good as nature's own. Nothing can ever replicate the perfection of your native, original hip - before it became diseased. One day, maybe we can grow you a new one, then this debate will be irrelevant. Everything else is a compromise. Some compromises are better than others, and it depends on the individual patient, their activity or age, as well as the experience of the surgeon and the quality of components used.

Fact No. 2: However you 'spin' it, Conventional total hip replacement or THR is effectively an amputation of the head & neck of the femur. No if's and's or but's. Once it is gone, that's it, no going back. So, even if hip resurfacing [I call it BHR as I only use the Birmingham device] has a SLIGHTLY higher failure rate than THR, it is still worth thinking about the preservation of your femoral head & neck. The younger or more active you are, the more important this thought becomes.

Fact No. 3: The article only looks at revision rates when comparing BHR to THR. It says nothing about other, more subtle problems with THR like dislocation. OK, dislocation maybe rare with THR and almost unknown with BHR, but it is still a great concern in the early recovery phase. The fear of dislocation with THR drives the rehabilitation in the first few weeks and greatly restricts the advice the surgeon can give patients. Patients have to be given guidance to avoid dislocation which is often more onerous than is strictly required so that everyone can 'cover their backsides' so to speak. With BHR, my team is now [or should be!] telling MOST patients there are no special or onerous restrictions. Patients can sleep on their sides. They do not need raised toilet seats at home. They do not need to worry about dislocation because it is almost impossible. It allows the patient to recover full range of motion earlier and more safely. Unless there are concerns about bone quality, patients can be told to get back to activities of daily living as fast as their body allows. The only thing we have to be a bit cautious about is high impact stuff like running or jogging, football, rugby, skiing and the like. These can be allowed after the 3 or 4 month x-ray and if surgeon is happy that the danger of neck of femur fracture has passed.

The other, very subtle and impossible to quantify downside of THR is that surgical invasion of the femoral medullary canal forces marrow contents into the bloodstream. The bone marrow of the long bones is where your body makes all your blood cells. Red ones, white ones and platelets. It is why dogs love the marrow of a bone so much - it is rich in fat and protein. Forcing this marrow fat, rich in immature blood cells and other proteins, triggers an inflammatory cascade in the leg around the whole length of the femur and in the lungs which filter the globules before they would enter the circulation to the brain or other major organs. When severe, this phenomenon is called fat embolism. BHR dramatically reduces this embolisation phenomenon and is why I feel quite happy doing bilateral BHR when the patient has bilateral disease, but I would be very, very careful or wary of bilateral THR on the same day. In fact I tried bilateral THR several times before BHR came along and had lots of trouble. Done over 30 cases of bilateral BHR now and never regretted it. A truly astonishing operation as patients take only one or 2 more days to go home as compared with a single side BHR. i.e the recovery time is not doubled.

Fact No. 4: Some of us have always instinctively realized this, but BHR is exquisitely sensitive to accurate component positioning, and the exact metallurgy/manufacture of the components. THR can be put in quite sloppily and still work. At least for more than the 3 years the Times article is looking at. The figures in the UK National Registry are for all surgeons, using all the currently available hip resurfacing prostheses in varying mix. One should look ONLY at high volume, experienced surgeons to get the true picture. I wish I had the time and energy to look in detail at my own series, but it is certainly less than 4% failure at 3 years! The other trouble is that McMinn has already published large, detailed series so does the world need yet another one? McMinn's own figures, particularly in the under 55's are so good, many thought he must have fabricated them. I think less than 1% 'failure' at 5 years, not 3 years. This is the problem with raw statistics: they are so easily used like a drunk man uses a lamppost - more for support than illumination.

So much of the 'failure' we are looking at is due to poor surgery, poor prostheses or a combination of both. Women are only more at risk because their hips tend to be smaller, therefore the precise positioning of components is more critical. Women also tend to naturally have slightly weaker or less dense bone than men, so their cups may not integrate as planned or they may fracture through the neck of the femur. Apart from that, I personally don't believe there is any great gender difference.

Fact No. 5 ALVAL or metal ion 'allergy' is very, very rare. Irritation from excessive metal wear from poorly positioned or poorly manufactured prostheses accounts for the vast majority of the so-called ALVAL being reported. It sounds to me like Andrea had excessive metal wear leading to predictable irritation, fluid accumulation around the hip, and pain. Andrea, I do not think you had true ALVAL. Indeed your surgeons tend to confirm this as they did not find the masses of inflammatory tissues and destruction that would have been present if you had true ALVAL. The Melissa test is useless for predicting who will get ALVAL. The Melissa test has been used to justify large scale extraction of dental fillings from people, particularly in Scandinavia, on the basis that allergy to the metal in the fillings was making these people ill. Mass hysteria on a quite fascinating scale, and remember for very tidy profit. ALVAL is not confined to BHR. It is a problem with any metal-on-metal bearing couple. If ALVAL is used as a reason to discredit BHR, then all metal on metal bearings would have to be suspect. Which would leave only metal or ceramic on polyethylene, or ceramic on ceramic.

So lets look at metal or ceramic on polyethylene. Polyethylene is basically like hardened wax. Soft and slippery. Under pressure and when heated, it deforms or flows, just like melting wax. You can make the wax a bit harder, but it is still wax. There are constantly new or improved polys on the market. We have been here before. Let's look at Hylamer, a trade name from De Puy:

Hylamer polyethylene was introduced in the 1990s as an alternative to conventional polyethylene. Its chemical and physical properties, and especially its high crystallinity, were claimed to improve resistance to wear. Initially Hylamer devices were sterilized by gamma radiation in air, then the technique was changed and gamma radiation was performed in the absence of oxygen. Clinical experience has shown the early loosening of some devices made from Hylamer.

The text understates the problem. Hylamer was an unmitigated disaster and has long ago been withdrawn. So I don't trust poly in any shape or form FOR YOUNG ACTIVE PATIENTS. I still use it for the more elderly and sedentary. It still works perfectly well in this group.

What about ceramic-ceramic? This is the best alternative if you cannot have metal-metal for any reason. BUT some ceramic hips squeak. So loudly they can be heard across a room full of people. Ceramic is brittle and although ceramic fracture is now rare, it still happens and is under-reported. Ceramic ages or oxidises in the body and this can then lead to higher wear rates as the ceramic surfaces lose their shine or surface finish. Finally ceramic-ceramic is a very 'hard' bearing couple with no 'give' or shock absorption. BHR will, in most situations, have a thin film of fluid which can be displaced to absorb shocks at bearing interface.

So, in summary: Yes, BHR will likely ALWAYS have a very slightly higher revision rate than THR at 3 or 5 years, when comparing like for like in terms of young active patients. But the increased risk should be of the order of 1% or less, in the hands of an experienced surgeon. Not the 7 to 14 times quoted. It is the 30 or 40 year comparative results that will tell a different tale!

BHR revision, if ever unfortunately required, will always be easier than THR revision. Pity the poor patient whose THR fails early, or even later, particularly if the femoral side needs to be redone - their surgeon has a much tougher job on his/her hands. And abandoning BHR in favour of THR would mean abandoning all the more subtle advantages of an anatomical-sized component sitting on top of your own preserved femur.

We need to focus on precise surgery, good patient selection, the very best metallurgy and manufacture, not scare ourselves into abandoning the most revolutionary development in the field of hip arthroplasty in the last 50 years.

Mark

Jonna Ramey Right BHR 2009 Dr. Klug

Jonna Ramey

Right BHR 2009 Dr. Klug

I had surgery on November 10, 2009. I am 4+ weeks post-BHR surgery on my right hip. Dr. Raphael Klug of Kaiser Roseville CA was my surgeon.

I'm a 59-year old post-menopausal woman. Previous to my year of increasing hip pain and surgery, I was an active stone sculptor. Exercise for me consisted of water aerobics and walking. I had been experiencing unusual thigh pain. It was as if my muscles just gave out. I could barely walk. My general practitioner referred me to a sports doctor. The sports doc immediately steered me to an orthopedic surgeon in San Rafael who only did lateral total hip replacements. I got on his 3-month waiting list because I thought this was my only option. Then, I began to research.

I attended a lecture sponsored by Queen of the Valley Hospital in Napa at which two orthopedic surgeons talked about the benefits of anterior THR. At this lecture I learned that there was one surgeon at Kaiser Vallejo that performed anterior THR. I immediately got a referral from the San Rafael Kaiser surgeon, consulted with the surgeon in Vallejo, who said I was a good candidate for anterior THR and got on his 3-month surgery waiting list.

All of this research took months and my hip was getting worse by the day. The anti-inflammatory drugs I was taking were no longer controlling my pain. I hobbled with a very pronounced limp. It was so obvious that people stopped me on the street and asked me if I had a bad hip. Everyone was full of advice; much of it very helpful. All of it was pointing me toward an anterior total hip replacement. Then one night, at my neighborhood table tennis club, Jeff, a man with a deadly slam, told me that he had had a Birmingham Hip Resurfacing two years earlier. He had been an ardent soccer player before the BHR. Now he ran, exercised and had complete freedom of movement. He explained the difference between a BHR and a THR. His wife Linda told me about a great website called Surface Hippy and how it had really helped them. They whole-heartedly recommended their surgeon Dr. Gilbert in San Francisco. However, he wasn’t in the Kaiser system so I had to find a Kaiser surgeon that performed BHR surgery.

I went home and checked out Surface Hippy. Loved it! I went into the Kaiser member website and tried to find a surgeon in my area who performed the procedure. There was no information. I sent an email to the surgeon in Vallejo that I was scheduled with and asked if he did BHRs and was I a good candidate for one? He responded that he did not do them but would forward my x-rays to Dr. Baker in Oakland and Dr. Klug in Roseville. Both surgeons did BHRs.

Once I had the names of Kaiser surgeons who performed BHRs, I got back on the internet and did more research. I found an extremely informative video of Dr. Klug discussing the procedure at length. Subsequently, I received an email from my Vallejo surgeon. Dr. Klug had looked at my x-rays and was confident he could help me. I contacted his medical assistant and got on Dr. Klug’s 3-month waiting list for the initial consultation. Fortunately, there was a cancellation and I was able to see Dr. Klug in two weeks.

The initial meeting with Dr. Klug was informative. I appreciated his candor and experience. He has performed hundreds of BHRs. He was very clear, however, that while his goal for me was an anterior BHR, it was possible that I’d need a total hip replacement and he couldn’t make that call until he actually touched my bone. I agreed. For me this was an important consideration. I wanted a surgeon to have all the tools at his disposal for my benefit. Yes, my preference was the BHR but I wanted long-term success above all.

Did I mention, there was a three-month wait for the surgery? Since it was close to the Thanksgiving holiday, I stressed my strong desire to take any surgery cancellation that might occur. Even though his office is 2 hours from my home, I would drop everything, at a moment’s notice, to get the surgery done. Luck was with me. His scheduler called back in a couple weeks; someone had cancelled and I was having surgery four days later.

As it turned out, I did get a BHR. I was in the hospital 2 nights. Dr. Klug’s surgery team is hard working and bright. The staff at Kaiser Roseville was sharp, attentive, friendly and motivated. I really appreciated that. The physical therapist started me with a walker that I used for about 10 days. With the approval of my in-home physical therapist, I transitioned to a cane. Recovery is going great. Every day I walk further and longer and my stamina increases. I'm looking forward to weaning myself off the cane, getting back in the pool and on an exercise bike. I’m about two weeks away from being able to drive but I’m trying to be patient. And, I’m waiting for the rains to stop so I can begin sculpting stone again in my outdoor studio. Thanks Dr. Klug.

I read that there is a perception out there that some surgeons are generally reluctant to perform BHRs on post-menopausal women. I think it has more to do with each patient’s situation and the skill and expertise of the surgeon. Any responsible surgeon would refuse to perform a procedure if it wasn’t in the best interest of the patient. I'm proof that there are surgeons out there (like Dr. Klug) who are capable and comfortable working on us middle-aged and older broads.

Maggie Bilateral Dr. Mont January 2010

One month ago, I lay in Sinai Hospital in Baltimore recovering from bilateral hip resurfacing a la Dr. Michael Mont. I'm a 49 year old active married professional woman 2 kids from Philadelphia with severe osteoarthritis. Your website helped lead me to Dr Mont after failing to find a surgeon I trusted in the Philly area, notwithstanding all our fine orthopedic hospitals/doctors. The three prior surgeons I interviewed were all anxious to replace my young 49 year old hips and recommended against resurfacing, citing amorphous risks of metal ion contamination and osteoporosis fracture risks. I sensed they just didn't want to do the surgery and wondered aloud what I would do if I needed a revision in 20 years? The women in my family live well into their nineties, so this is a legitimate concern for me. I had suffered from the arthritis for about three years and acted only when it became unbearable because I don't like to be out of the game. But when I couldn't ride my horse or my bike, coach soccer, walk my dogs, garden or go skiing with my family, it was time to get radical.

My initial appointment with Dr Mont was in July 2009, and he didn't rush me at all, spent all the time I needed with me and seemed to actually care about me. I questioned if he was actually a surgeon since he also had a personality. He laughed. I scheduled surgery for January 2010, the soonest I could do it, and was essentially handicapped on a cane with 6 vicoden a day for pain before I headed in for surgery. I had each hip done, one week apart, and spent three days in the hospital each time. Immediately after the hospital, I went to Genesis at Brightwood, a skilled nursing center in the Baltimore county area, for rehab for a week before heading home.

Four weeks out now, I am on a cane, twice a week outpatient PT (pain and torture) having graduated from a walker. My arthritic pain is totally gone, no medication needed and my incisions are healing well. The only issue I am having now is that the muscles down the front of my thighs are so tight from stooping over during the arthritis period, it seems to be taking forever to stretch back out so I can stand up straight. So I continue to work on my gait, and I go back to work in two weeks. I have a 5 week follow up appointment with Dr Mont in ten days so I'm hoping for a green light to my prior active life. No regrets about anything and I am so blessed by your website resource. I will continue updates as I progress.

Maggie

Bill Thom BHR Mr. Treacy November 2, 2009

My name is Bill Thom, aged 67 and a Scot living in London.   My hip operation was a Birmingham Hip Resurfacing procedure and was done on November 2nd 2009.   I had been consulting my surgeon Mr. Ronan Treacy for about 7 years as my hip was gradually deteriorating which made it difficult for me to enjoy an active life.    I am an accomplished ski-er and I also play tennis every week.   It was becoming increasingly clear that the BHR solution was pretty ideal for me and eventually, the hip joint showed signs of serious wear and Mr. Treacy advised that it was now up to me to decide whether to have the surgery.

I was fortunate as I had private medical cover that would cover most of the costs and so I quickly decided around October 2009 to get the thing sorted.   I attended the Priory Hospital in Birmingham where Mr. Treacy does his hip surgery for the pre-operative tests and then was admitted for the surgery on November 2nd.    I met Mr. Treacy who drew where the incision would be made on my hip and I was sure that I was in good hands with him and his team as he has done between 5000-6000 of these operations which is his specialty.    My anaesthetist talked to me about his role, and the next day I was put to sleep. The surgery was conducted in well under an hour and everything went very well.

When I revived and I woke up I was given self administered pain control using morphine and could top up any time I felt discomfort using a button on a small handheld machine.   I was fine.   The only awkward after effect was I had to have a catheter inserted as I could not seem to urinate. The following morning after the surgery I was able to stand and took a few tentative steps with support.   The following day I was able to walk with a type of Zimmer frame up and down the corridor, and the day after that I was walking with two sticks without pain.   The procedure was a complete success and the care and treatment I received from Ronan Treacy and his team was superb as was the care and support given by nursing staff and physiotherapists at the Priory.

I left hospital on the fifth day and when my wife Betsy arrived to pick me up to take me home to London she was amazed how well I was walking with sticks, and standing she thought about two inches taller and with a good posture.   The wound was neat and clean and I had no sign of infection. The dressings used were easily changed and I was given some to take home along with some pain killers.    I did get constipated for a while, probably caused by the morphine and the painkillers, but this was easily dealt with using suppositories for a few days.

Six weeks after the surgery in mid December I returned to Birmingham to see Mr. Treacy and he was very pleased with the progress. I exercised each day with simple techniques given to me by the physiotherapists at the hospital.   I also started walking about a mile each day, and within 3 weeks of the surgery I was down to one stick, then in a few days I was walking very well without any support.   The leg swelled up after exercise but I used high pillows to raise it while resting and was able to manage the pain reasonably enough.   I had no infection and was careful to follow the procedure of not raising the leg too high and sitting correctly.   I soon began to get full movement and was able with a little help get my socks on and dress myself without assistance.

I was also able to return to playing some gentle tennis doubles and this was just before the end of the year just eight weeks or so after the operation. To my great surprise Ronan Treacy also said that I would also be able to ski this season, and in the first week of March 2010 just four months after the BHR was done I was zooming down the blue and red runs in Courchevel with a friend. It was superb exercise for my hip and I only fell once during my six full days of ski-ing. The one time I took a dive, I landed with a crunch on a rather hard packed piste on the new hip side, but there was no problem.

I would advise any one with a progressive hip problem, especially if you want to be active in your old age, to consider the BHR hip option and get yourself along to see Ronan Treacy. He has basically given me back full movement, and I am free from pain. Should you wish to contact me then I would happily relate the details of my hip resurfacing experience and have no hesitation in recommending the Birmingham team who put me back on the tennis court and the Alpine pistes in under four months.

Bill Thom