Re: What Surgery? Confused

[Guest guest]

Jujulabee, Celeste:

In trying to determine what particular surgical procedure I would choose, I do

my best to assess:

- The probability that I will die from the surgery

- The probability that I will develop serious complications as a result of the

surgery

- The difficulty of the recovery/ rehabilitation from the surgery

- The type of life I can have " post-surgery "

Will I die from this surgery?

Regarding death from hip surgery, the best data I was able to find came from the

2009 Australian Orthopaedic Association's Annual Report

(http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009)(P\

age 180, Table M3).

The %deaths from Total Resurfacing is 1.1% whereas it's 8.7% from conventional

Total hip replacement. One note - the average age of the THR surgical candidate

is almost 20 years older than the average age for a resurfacing candidate so

this obviously influences the rate of death. However, 1.1% versus 8.7%. Pretty

easy decision to make if you have a choice.

The risk road-map I'd drawn up for myself goes something

like......arthroscopy.......resurfacing........THR........THR revision. My goal

is to never get to a THR revision as that is a more complicated, hence higher

rate of death, surgery than the THR.

What is the likelihood that I will develop serious complications from this

surgery?

Perhaps the best resource referred to me (thanks Ian Christoph! ) to date has

been the Australian Orthopaedic Association web site

(http://www.dmac.adelaide.edu.au/aoanjrr/) and their extensive annual reports

and joint registry. Please refer to the attachment below for graphs which

depict the revision diagnosis for both Primary Total Hip Replacement and Primary

Total Resurfacing. While there are substantially more THR patients (147,422)

than resurfacing (12,093), the quantity of resurfacing patients is substantial

statistically and merits a comparison of revision diagnosis between THR and

Resurfacing:

Revision Diagnosis

THR

Resurfacing

Fracture

14.5%

39.4%

Loosening/ Lysis

29.1%

29.3%

Infection

16.6%

8.9%

Metal Sensitivity

0.8%

6.4%

Avascular necrosis

3.2%

No femoral head

Deep Vein Thrombosis & Pulmonary Embolism

Additionally, one of the most serious complications once can encounter after hip

surgery is deep vein thrombosis (blood clots) which could also become a

pulmonary embolism should a sizable clot make its way to your lungs. I found

the following excerpt in an article within the Journal of Bone & Joint Surgery,

" Seagroatt et al(21) reported a readmission rate for sympto- matic

thromboembolic complications of 0.73% within 28 days of discharge after THR.

Warwick et al16 reported a readmission rate of 1.39%. "

http://www.jbjs.org.uk/cgi/reprint/85-B/5/661.pdf

Difficulty of Recovery

I've had a chance to sit-in on two THR operations and what I saw looked more

like a heavy construction site than an operating suite. The THR is a

substantially more invasive surgery than resurfacing in that it cuts off the

femoral head and drills out the femur for insertion of the metal stem. It is my

opinion that this results in more days in the hospital as well as a longer

recovery for the patient. I, however, have not had this surgery myself and ask

that those who have -- please share your experiences w/ Celeste.

What type of activity/ life can I have post surgery

Activity restrictions have been less severe for resurfacing candidates.

However, I've been hearing rumors of less brittle ceramics and metal/ metal THRs

that provide for a more active lifestyle. Perhaps some in the group can share

their personal experiences in this regard.

If any of you have any other excellent resources for mortality and revision

statistics, please share. Take care and have a great week!

Don

===================================

On Feb 16, 2010, at 8:52 PM, jujulabee@... wrote:

> There are objective reasons why someone might opt for hip resurfacing

> but the two you mention are not among this

>

> The size of the incision is not necessarily smaller. And of course,

> the length of the incision has very little to do with anything since

> most of the real " work " is below the surface. The last thing most

> people should be concerned with is the size of the incision since one

> wants to have an OS have sufficient " room " to provide the best

> outcome. FWIW, all incisions are much shorter than they were a decade

> ago.

>

> Hip resurfacing doesn't prevent less " risk " -- I am not sure what

> criteria you are using as an indicia for " risk " . Both a replacement

> and a resurfacing are major surgeries and recovery from either one is

> about the same.

>

> The chief benefit appears to be that a " revision " is theoretically

> simpler in the event that one needs one for some reason in the future.

> However, weighed against that is the increased risk of complications

> -- particularly for post menopausal women.

>

> I am not anti-resurfacing -- want to make that clear as I think it is

> a good procedure. However, anyone making a decision should be deciding

> it based on objective criteria. For some reason, the name

> " resurfacing " seems to make people think it is less of an " operation " .

>

> I do second that one should consult with medical personnel who are

> objective. Obviously the best would be an OS who is experienced and

> equally capable in both resurfacing and replacement. If that is not

> possible, then meet with a resurfacing OS and a replacement OS and ask

> them questions about why you are or aren't a good candidate and what

> they perceive as the benefits and drawbacks of each procedure. Of

> course, one needs to go into an appointment as educated as possible so

> that one can ask intelligent questions and be able to evaluate

> responses and follow up if something does not comport with other data

> you have.

> On Feb 16, 2010, at 6:06 PM, Moseman, Jr. W. wrote:

>

> > Celeste:

> >

> > The hip resurfacing procedure is less invasive (smaller scar, retain

> > femoral head, etc.) than a THR and, in my opinion, presents less

> > risk. Just curious, does the surgeon you spoke with have the

> > ability to perform both THRs and resurfs? Would you mind sharing

> > the surgeon's name? Thanks.

> >

> > Don

> > Nothing Yet, Drs. P.Callendar, J. Dickinson, T. Sampson

> > On Feb 16, 2010, at 6:18 AM, celesteshearer@... wrote:

> >

> >> Hi,

> >> My 1st time on this site. I saw an orthopedist yesterday that was

> >> local with an excellent reputation. He sat down with me and my x-

> >> rays. He said I am in " end stage " hip arthritis or something like

> >> that...the words " end stage " are what stuck w/me. He said I am bone

> >> on bone in many places. He said each hip was equally as bad. My

> >> ball is no longer round but oblong as the spurs have reshaped them.

> >> Today I get my hips injected. The Dr. will see me again the end of

> >> March. I have looked into resurfacing. I saw one Dr. for

> >> resurfacing and he said I had hip dyplasia...this Dr. said there is

> >> no evidence of nip dysplasia. The Dr. I saw yesterday did not think

> >> resurfacing was the way to go. He also told me the THR now should

> >> last 25/30 yrs. I am confused. I am also an avid horse back rider,

> >> but now I cannot do that in my current state. The Dr. yesterday

> >> said there are far more complications w/resurfacing than THR and as

> >> a result not many Dr.'s are doing resurfacings . Now I am confused.

> >> I am

> > 49 yrs. old...active, (would like to get back in the saddle), &

> > obese...other than my weight I am in good health...well weight and

> > hips, LOL. Is a replacement very painful? How is the recovery

> > period? Does a replacement eventually feel normal? Any input is

> > appreciated. Trying to decide what to do.

> >> Thanks in advance,

> >> Celeste

> >>

> >>

> >

> >

> >

[Guest guest]

Don, what the Australian joint registry does not take into account is the

quality of surgeon you have, if you have an excellent surgeon and a hospital

with low infection rate, then those numbers decline significantly.

You don't say how old you are, many resurfacing docs think the bone condition

deteriorates after 65 although many that age have had resurfacing and are very

happy with it. Skiing again.

I had resurfacing on both hips from one of the two top docs in the US at that

time, flew cross country to go to him. Upon awakening from surgery I stood up

and was full weight bearing and never needed walkers or crutches. I believe

that's the kind of recovery one gets from going to the top docs. I was/am a

post menopausal woman and was bone on bone.

I believe the best questions to ask are how many of your same procedure have

they done, and their infection rate. There is some research that for

resurfacing the failure risk lessens if they've done over 200, but I always opt

for 1,000 or more.

If later in life I have to have a revision it won't be difficult.

Picking the best surgeon for each surgery is of utmost importance. Most, if not

all, hip resurfacing docs also do replacements.

Good luck,

Hollie

RL Hip Resurfs Dr. Gross 2006, 2007

RL TKRs Dr. Coon 2008, 2009

>

> Jujulabee, Celeste:

>

> In trying to determine what particular surgical procedure I would choose, I do

my best to assess:

>

> - The probability that I will die from the surgery

> - The probability that I will develop serious complications as a result of the

surgery

> - The difficulty of the recovery/ rehabilitation from the surgery

> - The type of life I can have " post-surgery "

>

> Will I die from this surgery?

> Regarding death from hip surgery, the best data I was able to find came from

the 2009 Australian Orthopaedic Association's Annual Report

(http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009)(P\

age 180, Table M3).

>

>

>

> The %deaths from Total Resurfacing is 1.1% whereas it's 8.7% from conventional

Total hip replacement. One note - the average age of the THR surgical candidate

is almost 20 years older than the average age for a resurfacing candidate so

this obviously influences the rate of death. However, 1.1% versus 8.7%. Pretty

easy decision to make if you have a choice.

>

> The risk road-map I'd drawn up for myself goes something

like......arthroscopy.......resurfacing........THR........THR revision. My goal

is to never get to a THR revision as that is a more complicated, hence higher

rate of death, surgery than the THR.

>

> What is the likelihood that I will develop serious complications from this

surgery?

> Perhaps the best resource referred to me (thanks Ian Christoph! ) to date

has been the Australian Orthopaedic Association web site

(http://www.dmac.adelaide.edu.au/aoanjrr/) and their extensive annual reports

and joint registry. Please refer to the attachment below for graphs which

depict the revision diagnosis for both Primary Total Hip Replacement and Primary

Total Resurfacing. While there are substantially more THR patients (147,422)

than resurfacing (12,093), the quantity of resurfacing patients is substantial

statistically and merits a comparison of revision diagnosis between THR and

Resurfacing:

>

> Revision Diagnosis

> THR

> Resurfacing

> Fracture

> 14.5%

> 39.4%

> Loosening/ Lysis

> 29.1%

> 29.3%

> Infection

> 16.6%

> 8.9%

> Metal Sensitivity

> 0.8%

> 6.4%

> Avascular necrosis

> 3.2%

> No femoral head

>

>

>

> Deep Vein Thrombosis & Pulmonary Embolism

> Additionally, one of the most serious complications once can encounter after

hip surgery is deep vein thrombosis (blood clots) which could also become a

pulmonary embolism should a sizable clot make its way to your lungs. I found

the following excerpt in an article within the Journal of Bone & Joint Surgery,

" Seagroatt et al(21) reported a readmission rate for sympto- matic

thromboembolic complications of 0.73% within 28 days of discharge after THR.

Warwick et al16 reported a readmission rate of 1.39%. "

http://www.jbjs.org.uk/cgi/reprint/85-B/5/661.pdf

>

> Difficulty of Recovery

> I've had a chance to sit-in on two THR operations and what I saw looked more

like a heavy construction site than an operating suite. The THR is a

substantially more invasive surgery than resurfacing in that it cuts off the

femoral head and drills out the femur for insertion of the metal stem. It is my

opinion that this results in more days in the hospital as well as a longer

recovery for the patient. I, however, have not had this surgery myself and ask

that those who have -- please share your experiences w/ Celeste.

>

> What type of activity/ life can I have post surgery

> Activity restrictions have been less severe for resurfacing candidates.

However, I've been hearing rumors of less brittle ceramics and metal/ metal THRs

that provide for a more active lifestyle. Perhaps some in the group can share

their personal experiences in this regard.

>

> If any of you have any other excellent resources for mortality and revision

statistics, please share. Take care and have a great week!

>

> Don

[Guest guest]

Any surgery and any anesthesia has risks. I updated things that were kind

of floating out there. This was for my own peace of mind and not so much

that I expected to die. I tend to agree that the risks when undergoing

total joint replacement are minimal when compared with the improvement of

one's quality of life.

No regrets on my end.

Reen

[Guest guest]

I don't know where you are getting those statistics but there is not

an 8.7% death rate for a hip replacement surgery. I don't think heart

by pass surgery has those kinds of death rates.

I mean this in the nicest way, but I think in your case your research

is leading you to a lot of meaningless statistics which you are then

taking out of context.

At any rate, risk of complications (let alone death) for a procedure

are meaningless since they vary significantly between surgeons and

hospitals.

On Feb 17, 2010, at 9:19 PM, Moseman, Jr. W. wrote:

> Jujulabee, Celeste:

>

> In trying to determine what particular surgical procedure I would

> choose, I do my best to assess:

>

> - The probability that I will die from the surgery

> - The probability that I will develop serious complications as a

> result of the surgery

> - The difficulty of the recovery/ rehabilitation from the surgery

> - The type of life I can have " post-surgery "

>

> Will I die from this surgery?

> Regarding death from hip surgery, the best data I was able to find

> came from the 2009 Australian Orthopaedic Association's Annual

> Report

(http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009)(P\

age

> 180, Table M3).

>

>

>

> The %deaths from Total Resurfacing is 1.1% whereas it's 8.7% from

> conventional Total hip replacement. One note - the average age of

> the THR surgical candidate is almost 20 years older than the average

> age for a resurfacing candidate so this obviously influences the

> rate of death. However, 1.1% versus 8.7%. Pretty easy decision to

> make if you have a choice.

>

> The risk road-map I'd drawn up for myself goes something

> like......arthroscopy.......resurfacing........THR........THR

> revision. My goal is to never get to a THR revision as that is a

> more complicated, hence higher rate of death, surgery than the THR.

>

> What is the likelihood that I will develop serious complications

> from this surgery?

> Perhaps the best resource referred to me (thanks Ian Christoph! )

> to date has been the Australian Orthopaedic Association web site

(http://www.dmac.adelaide.edu.au/aoanjrr/

> ) and their extensive annual reports and joint registry. Please

> refer to the attachment below for graphs which depict the revision

> diagnosis for both Primary Total Hip Replacement and Primary Total

> Resurfacing. While there are substantially more THR patients

> (147,422) than resurfacing (12,093), the quantity of resurfacing

> patients is substantial statistically and merits a comparison of

> revision diagnosis between THR and Resurfacing:

>

> Revision Diagnosis

> THR

> Resurfacing

> Fracture

> 14.5%

> 39.4%

> Loosening/ Lysis

> 29.1%

> 29.3%

> Infection

> 16.6%

> 8.9%

> Metal Sensitivity

> 0.8%

> 6.4%

> Avascular necrosis

> 3.2%

> No femoral head

>

>

>

> Deep Vein Thrombosis & Pulmonary Embolism

> Additionally, one of the most serious complications once can

> encounter after hip surgery is deep vein thrombosis (blood clots)

> which could also become a pulmonary embolism should a sizable clot

> make its way to your lungs. I found the following excerpt in an

> article within the Journal of Bone & Joint Surgery, " Seagroatt et

> al(21) reported a readmission rate for sympto- matic thromboembolic

> complications of 0.73% within 28 days of discharge after THR.

> Warwick et al16 reported a readmission rate of 1.39%. "

http://www.jbjs.org.uk/cgi/reprint/85-B/5/661.pdf

>

> Difficulty of Recovery

> I've had a chance to sit-in on two THR operations and what I saw

> looked more like a heavy construction site than an operating suite.

> The THR is a substantially more invasive surgery than resurfacing in

> that it cuts off the femoral head and drills out the femur for

> insertion of the metal stem. It is my opinion that this results in

> more days in the hospital as well as a longer recovery for the

> patient. I, however, have not had this surgery myself and ask that

> those who have -- please share your experiences w/ Celeste.

>

> What type of activity/ life can I have post surgery

> Activity restrictions have been less severe for resurfacing

> candidates. However, I've been hearing rumors of less brittle

> ceramics and metal/ metal THRs that provide for a more active

> lifestyle. Perhaps some in the group can share their personal

> experiences in this regard.

>

> If any of you have any other excellent resources for mortality and

> revision statistics, please share. Take care and have a great

> week!

>

> Don

> ===================================

> On Feb 16, 2010, at 8:52 PM, jujulabee@... wrote:

>

>> There are objective reasons why someone might opt for hip resurfacing

>> but the two you mention are not among this

>>

>> The size of the incision is not necessarily smaller. And of course,

>> the length of the incision has very little to do with anything since

>> most of the real " work " is below the surface. The last thing most

>> people should be concerned with is the size of the incision since one

>> wants to have an OS have sufficient " room " to provide the best

>> outcome. FWIW, all incisions are much shorter than they were a decade

>> ago.

>>

>> Hip resurfacing doesn't prevent less " risk " -- I am not sure what

>> criteria you are using as an indicia for " risk " . Both a replacement

>> and a resurfacing are major surgeries and recovery from either one is

>> about the same.

>>

>> The chief benefit appears to be that a " revision " is theoretically

>> simpler in the event that one needs one for some reason in the

>> future.

>> However, weighed against that is the increased risk of complications

>> -- particularly for post menopausal women.

>>

>> I am not anti-resurfacing -- want to make that clear as I think it is

>> a good procedure. However, anyone making a decision should be

>> deciding

>> it based on objective criteria. For some reason, the name

>> " resurfacing " seems to make people think it is less of an

>> " operation " .

>>

>> I do second that one should consult with medical personnel who are

>> objective. Obviously the best would be an OS who is experienced and

>> equally capable in both resurfacing and replacement. If that is not

>> possible, then meet with a resurfacing OS and a replacement OS and

>> ask

>> them questions about why you are or aren't a good candidate and what

>> they perceive as the benefits and drawbacks of each procedure. Of

>> course, one needs to go into an appointment as educated as possible

>> so

>> that one can ask intelligent questions and be able to evaluate

>> responses and follow up if something does not comport with other data

>> you have.

>> On Feb 16, 2010, at 6:06 PM, Moseman, Jr. W. wrote:

>>

>>> Celeste:

>>>

>>> The hip resurfacing procedure is less invasive (smaller scar, retain

>>> femoral head, etc.) than a THR and, in my opinion, presents less

>>> risk. Just curious, does the surgeon you spoke with have the

>>> ability to perform both THRs and resurfs? Would you mind sharing

>>> the surgeon's name? Thanks.

>>>

>>> Don

>>> Nothing Yet, Drs. P.Callendar, J. Dickinson, T. Sampson

>>> On Feb 16, 2010, at 6:18 AM, celesteshearer@... wrote:

>>>

>>>> Hi,

>>>> My 1st time on this site. I saw an orthopedist yesterday that was

>>>> local with an excellent reputation. He sat down with me and my x-

>>>> rays. He said I am in " end stage " hip arthritis or something like

>>>> that...the words " end stage " are what stuck w/me. He said I am bone

>>>> on bone in many places. He said each hip was equally as bad. My

>>>> ball is no longer round but oblong as the spurs have reshaped them.

>>>> Today I get my hips injected. The Dr. will see me again the end of

>>>> March. I have looked into resurfacing. I saw one Dr. for

>>>> resurfacing and he said I had hip dyplasia...this Dr. said there is

>>>> no evidence of nip dysplasia. The Dr. I saw yesterday did not think

>>>> resurfacing was the way to go. He also told me the THR now should

>>>> last 25/30 yrs. I am confused. I am also an avid horse back rider,

>>>> but now I cannot do that in my current state. The Dr. yesterday

>>>> said there are far more complications w/resurfacing than THR and as

>>>> a result not many Dr.'s are doing resurfacings . Now I am confused.

>>>> I am

>>> 49 yrs. old...active, (would like to get back in the saddle), &

>>> obese...other than my weight I am in good health...well weight and

>>> hips, LOL. Is a replacement very painful? How is the recovery

>>> period? Does a replacement eventually feel normal? Any input is

>>> appreciated. Trying to decide what to do.

>>>> Thanks in advance,

>>>> Celeste

>>>>

>>>>

>>>

>>>

>>>

[Guest guest]

jujulabee@... wrote:

> I don't know where you are getting those statistics but there is not

> an 8.7% death rate for a hip replacement surgery. I don't think heart

> by pass surgery has those kinds of death rates.

*I* thought that figure was a bit (lot?) high. That's almost 1 in 10 -

people die from hip surgery? I don't think so! That figure is enough

to frighten anybody off!!! Or, maybe, the statistician should inform

us as to which surgeon it relates, and we'll all stay a million miles

away from him! LOL

Mick.

--

*****************************************************

'Be not forgetful to entertain strangers; for thereby

some have entertained angels unawares!'

*****************************************************

[Guest guest]

Dear group mates:

Sorry for the messy data in the previous e-mail. It looked a lot better when I

sent it. Here goes again w/ a different format:

Revision Diagnosis

THR

Fracture - 14.5%

Loosening/ Lysis - 29.1%

Infection - 16.6%

Metal Sensitivity - 0.8%

Avascular Necrosis - No femoral head

Resurfacing

Fracture - 39.4%

Loosening/ Lysis - 29.3%

Infection - 8.9%

Metal Sensitivity - 6.4%

Avascular Necrosis - 3.2%

What I see in the data above is as follows:

Fractures - younger (20 years younger on average) patients overextending

themselves, resulting in almost three times the rate of fracture as the primary

revision diagnosis

Infection - THR, the more open and invasive surgical procedure (as compared to

resurfacing via arthroscopy), has roughly double the rate of infection.

Metal Sensitivity - Substantial difference in metal sensitivity. Not sure what

to speculate about this. Thankful that it's only 6.4%.

I'm interested to see what other's take may be on these. Take care and have a

fun week!

Don

On Feb 17, 2010, at 9:19 PM, Moseman, Jr. W. wrote:

> Jujulabee, Celeste:

>

> In trying to determine what particular surgical procedure I would choose, I do

my best to assess:

>

> - The probability that I will die from the surgery

> - The probability that I will develop serious complications as a result of the

surgery

> - The difficulty of the recovery/ rehabilitation from the surgery

> - The type of life I can have " post-surgery "

>

> Will I die from this surgery?

> Regarding death from hip surgery, the best data I was able to find came from

the 2009 Australian Orthopaedic Association's Annual Report

(http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009)(P\

age 180, Table M3).

>

>

>

> The %deaths from Total Resurfacing is 1.1% whereas it's 8.7% from conventional

Total hip replacement. One note - the average age of the THR surgical candidate

is almost 20 years older than the average age for a resurfacing candidate so

this obviously influences the rate of death. However, 1.1% versus 8.7%. Pretty

easy decision to make if you have a choice.

>

> The risk road-map I'd drawn up for myself goes something

like......arthroscopy.......resurfacing........THR........THR revision. My goal

is to never get to a THR revision as that is a more complicated, hence higher

rate of death, surgery than the THR.

>

> What is the likelihood that I will develop serious complications from this

surgery?

> Perhaps the best resource referred to me (thanks Ian Christoph! ) to date

has been the Australian Orthopaedic Association web site

(http://www.dmac.adelaide.edu.au/aoanjrr/) and their extensive annual reports

and joint registry. Please refer to the attachment below for graphs which

depict the revision diagnosis for both Primary Total Hip Replacement and Primary

Total Resurfacing. While there are substantially more THR patients (147,422)

than resurfacing (12,093), the quantity of resurfacing patients is substantial

statistically and merits a comparison of revision diagnosis between THR and

Resurfacing:

>

> Revision Diagnosis

> THR

> Resurfacing

> Fracture

> 14.5%

> 39.4%

> Loosening/ Lysis

> 29.1%

> 29.3%

> Infection

> 16.6%

> 8.9%

> Metal Sensitivity

> 0.8%

> 6.4%

> Avascular necrosis

> 3.2%

> No femoral head

>

>

>

> Deep Vein Thrombosis & Pulmonary Embolism

> Additionally, one of the most serious complications once can encounter after

hip surgery is deep vein thrombosis (blood clots) which could also become a

pulmonary embolism should a sizable clot make its way to your lungs. I found

the following excerpt in an article within the Journal of Bone & Joint Surgery,

" Seagroatt et al(21) reported a readmission rate for sympto- matic

thromboembolic complications of 0.73% within 28 days of discharge after THR.

Warwick et al16 reported a readmission rate of 1.39%. "

http://www.jbjs.org.uk/cgi/reprint/85-B/5/661.pdf

>

> Difficulty of Recovery

> I've had a chance to sit-in on two THR operations and what I saw looked more

like a heavy construction site than an operating suite. The THR is a

substantially more invasive surgery than resurfacing in that it cuts off the

femoral head and drills out the femur for insertion of the metal stem. It is my

opinion that this results in more days in the hospital as well as a longer

recovery for the patient. I, however, have not had this surgery myself and ask

that those who have -- please share your experiences w/ Celeste.

>

> What type of activity/ life can I have post surgery

> Activity restrictions have been less severe for resurfacing candidates.

However, I've been hearing rumors of less brittle ceramics and metal/ metal THRs

that provide for a more active lifestyle. Perhaps some in the group can share

their personal experiences in this regard.

>

> If any of you have any other excellent resources for mortality and revision

statistics, please share. Take care and have a great week!

>

> Don

> ===================================

> On Feb 16, 2010, at 8:52 PM, jujulabee@... wrote:

>

>> There are objective reasons why someone might opt for hip resurfacing

>> but the two you mention are not among this

>>

>> The size of the incision is not necessarily smaller. And of course,

>> the length of the incision has very little to do with anything since

>> most of the real " work " is below the surface. The last thing most

>> people should be concerned with is the size of the incision since one

>> wants to have an OS have sufficient " room " to provide the best

>> outcome. FWIW, all incisions are much shorter than they were a decade

>> ago.

>>

>> Hip resurfacing doesn't prevent less " risk " -- I am not sure what

>> criteria you are using as an indicia for " risk " . Both a replacement

>> and a resurfacing are major surgeries and recovery from either one is

>> about the same.

>>

>> The chief benefit appears to be that a " revision " is theoretically

>> simpler in the event that one needs one for some reason in the future.

>> However, weighed against that is the increased risk of complications

>> -- particularly for post menopausal women.

>>

>> I am not anti-resurfacing -- want to make that clear as I think it is

>> a good procedure. However, anyone making a decision should be deciding

>> it based on objective criteria. For some reason, the name

>> " resurfacing " seems to make people think it is less of an " operation " .

>>

>> I do second that one should consult with medical personnel who are

>> objective. Obviously the best would be an OS who is experienced and

>> equally capable in both resurfacing and replacement. If that is not

>> possible, then meet with a resurfacing OS and a replacement OS and ask

>> them questions about why you are or aren't a good candidate and what

>> they perceive as the benefits and drawbacks of each procedure. Of

>> course, one needs to go into an appointment as educated as possible so

>> that one can ask intelligent questions and be able to evaluate

>> responses and follow up if something does not comport with other data

>> you have.

>> On Feb 16, 2010, at 6:06 PM, Moseman, Jr. W. wrote:

>>

>>> Celeste:

>>>

>>> The hip resurfacing procedure is less invasive (smaller scar, retain

>>> femoral head, etc.) than a THR and, in my opinion, presents less

>>> risk. Just curious, does the surgeon you spoke with have the

>>> ability to perform both THRs and resurfs? Would you mind sharing

>>> the surgeon's name? Thanks.

>>>

>>> Don

>>> Nothing Yet, Drs. P.Callendar, J. Dickinson, T. Sampson

>>> On Feb 16, 2010, at 6:18 AM, celesteshearer@... wrote:

>>>

>>>> Hi,

>>>> My 1st time on this site. I saw an orthopedist yesterday that was

>>>> local with an excellent reputation. He sat down with me and my x-

>>>> rays. He said I am in " end stage " hip arthritis or something like

>>>> that...the words " end stage " are what stuck w/me. He said I am bone

>>>> on bone in many places. He said each hip was equally as bad. My

>>>> ball is no longer round but oblong as the spurs have reshaped them.

>>>> Today I get my hips injected. The Dr. will see me again the end of

>>>> March. I have looked into resurfacing. I saw one Dr. for

>>>> resurfacing and he said I had hip dyplasia...this Dr. said there is

>>>> no evidence of nip dysplasia. The Dr. I saw yesterday did not think

>>>> resurfacing was the way to go. He also told me the THR now should

>>>> last 25/30 yrs. I am confused. I am also an avid horse back rider,

>>>> but now I cannot do that in my current state. The Dr. yesterday

>>>> said there are far more complications w/resurfacing than THR and as

>>>> a result not many Dr.'s are doing resurfacings . Now I am confused.

>>>> I am

>>> 49 yrs. old...active, (would like to get back in the saddle), &

>>> obese...other than my weight I am in good health...well weight and

>>> hips, LOL. Is a replacement very painful? How is the recovery

>>> period? Does a replacement eventually feel normal? Any input is

>>> appreciated. Trying to decide what to do.

>>>> Thanks in advance,

>>>> Celeste

>>>>

>>>>

>>>

>>>

>>>

[Guest guest]

Again these are meaningless statistics since they lack any context and

indicate the reason for a revision in each set of operations and not

what the total rate of revisions for each procedure broken down by

type of operation; type of prothesis; patient age (and other variables).

For example, metal sensitivity -- all resurfacings are MOM whereas a

smaller percentage of THR use MOM -- so is the sensitivity for all THR

or just those with MOM?

The statistics aren't adjusted for population or demographics in any

way. For starters, patient outcome in resurfacing is linked to a great

extent to bone density which is why many OS don't recommend for

smaller post menopausal women.

Loosening or whatever - within what time period. Loosening after a

year is one thing -- loosening after 20 years completely different.

What materials were used as outcome seems different based on newer

materials such as MOM or ceramic.

And of course infection corresponds to hospital infection rates to a

great extent -- some hospitals have higher infection rates for all

operations and doctors will have significantly different outcomes

which is why OS choice and hospital in which surgery is performed are

among the most critical factors to consider.

I am really not sure what you are attempting to accomplish with this.

On Feb 18, 2010, at 5:51 AM, Moseman, Jr. W. wrote:

> Dear group mates:

>

> Sorry for the messy data in the previous e-mail. It looked a lot

> better when I sent it. Here goes again w/ a different format:

>

> Revision Diagnosis

>

> THR

> Fracture - 14.5%

> Loosening/ Lysis - 29.1%

> Infection - 16.6%

> Metal Sensitivity - 0.8%

> Avascular Necrosis - No femoral head

>

> Resurfacing

> Fracture - 39.4%

> Loosening/ Lysis - 29.3%

> Infection - 8.9%

> Metal Sensitivity - 6.4%

> Avascular Necrosis - 3.2%

>

> What I see in the data above is as follows:

>

> Fractures - younger (20 years younger on average) patients

> overextending themselves, resulting in almost three times the rate

> of fracture as the primary revision diagnosis

> Infection - THR, the more open and invasive surgical procedure (as

> compared to resurfacing via arthroscopy), has roughly double the

> rate of infection.

> Metal Sensitivity - Substantial difference in metal sensitivity. Not

> sure what to speculate about this. Thankful that it's only 6.4%.

>

> I'm interested to see what other's take may be on these. Take care

> and have a fun week!

>

> Don

> On Feb 17, 2010, at 9:19 PM, Moseman, Jr. W. wrote:

>

> > Jujulabee, Celeste:

> >

> > In trying to determine what particular surgical procedure I would

> choose, I do my best to assess:

> >

> > - The probability that I will die from the surgery

> > - The probability that I will develop serious complications as a

> result of the surgery

> > - The difficulty of the recovery/ rehabilitation from the surgery

> > - The type of life I can have " post-surgery "

> >

> > Will I die from this surgery?

> > Regarding death from hip surgery, the best data I was able to find

> came from the 2009 Australian Orthopaedic Association's Annual

> Report

(http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009)(P\

age

> 180, Table M3).

> >

> >

> >

> > The %deaths from Total Resurfacing is 1.1% whereas it's 8.7% from

> conventional Total hip replacement. One note - the average age of

> the THR surgical candidate is almost 20 years older than the average

> age for a resurfacing candidate so this obviously influences the

> rate of death. However, 1.1% versus 8.7%. Pretty easy decision to

> make if you have a choice.

> >

> > The risk road-map I'd drawn up for myself goes something

> like......arthroscopy.......resurfacing........THR........THR

> revision. My goal is to never get to a THR revision as that is a

> more complicated, hence higher rate of death, surgery than the THR.

> >

> > What is the likelihood that I will develop serious complications

> from this surgery?

> > Perhaps the best resource referred to me (thanks Ian

> Christoph! ) to date has been the Australian Orthopaedic

> Association web site (http://www.dmac.adelaide.edu.au/aoanjrr/) and

> their extensive annual reports and joint registry. Please refer to

> the attachment below for graphs which depict the revision diagnosis

> for both Primary Total Hip Replacement and Primary Total

> Resurfacing. While there are substantially more THR patients

> (147,422) than resurfacing (12,093), the quantity of resurfacing

> patients is substantial statistically and merits a comparison of

> revision diagnosis between THR and Resurfacing:

> >

> > Revision Diagnosis

> > THR

> > Resurfacing

> > Fracture

> > 14.5%

> > 39.4%

> > Loosening/ Lysis

> > 29.1%

> > 29.3%

> > Infection

> > 16.6%

> > 8.9%

> > Metal Sensitivity

> > 0.8%

> > 6.4%

> > Avascular necrosis

> > 3.2%

> > No femoral head

> >

> >

> >

> > Deep Vein Thrombosis & Pulmonary Embolism

> > Additionally, one of the most serious complications once can

> encounter after hip surgery is deep vein thrombosis (blood clots)

> which could also become a pulmonary embolism should a sizable clot

> make its way to your lungs. I found the following excerpt in an

> article within the Journal of Bone & Joint Surgery, " Seagroatt et

> al(21) reported a readmission rate for sympto- matic thromboembolic

> complications of 0.73% within 28 days of discharge after THR.

> Warwick et al16 reported a readmission rate of 1.39%. "

http://www.jbjs.org.uk/cgi/reprint/85-B/5/661.pdf

> >

> > Difficulty of Recovery

> > I've had a chance to sit-in on two THR operations and what I saw

> looked more like a heavy construction site than an operating suite.

> The THR is a substantially more invasive surgery than resurfacing in

> that it cuts off the femoral head and drills out the femur for

> insertion of the metal stem. It is my opinion that this results in

> more days in the hospital as well as a longer recovery for the

> patient. I, however, have not had this surgery myself and ask that

> those who have -- please share your experiences w/ Celeste.

> >

> > What type of activity/ life can I have post surgery

> > Activity restrictions have been less severe for resurfacing

> candidates. However, I've been hearing rumors of less brittle

> ceramics and metal/ metal THRs that provide for a more active

> lifestyle. Perhaps some in the group can share their personal

> experiences in this regard.

> >

> > If any of you have any other excellent resources for mortality and

> revision statistics, please share. Take care and have a great week!

> >

> > Don

> > ===================================

> > On Feb 16, 2010, at 8:52 PM, jujulabee@... wrote:

> >

> >> There are objective reasons why someone might opt for hip

> resurfacing

> >> but the two you mention are not among this

> >>

> >> The size of the incision is not necessarily smaller. And of course,

> >> the length of the incision has very little to do with anything

> since

> >> most of the real " work " is below the surface. The last thing most

> >> people should be concerned with is the size of the incision since

> one

> >> wants to have an OS have sufficient " room " to provide the best

> >> outcome. FWIW, all incisions are much shorter than they were a

> decade

> >> ago.

> >>

> >> Hip resurfacing doesn't prevent less " risk " -- I am not sure what

> >> criteria you are using as an indicia for " risk " . Both a replacement

> >> and a resurfacing are major surgeries and recovery from either

> one is

> >> about the same.

> >>

> >> The chief benefit appears to be that a " revision " is theoretically

> >> simpler in the event that one needs one for some reason in the

> future.

> >> However, weighed against that is the increased risk of

> complications

> >> -- particularly for post menopausal women.

> >>

> >> I am not anti-resurfacing -- want to make that clear as I think

> it is

> >> a good procedure. However, anyone making a decision should be

> deciding

> >> it based on objective criteria. For some reason, the name

> >> " resurfacing " seems to make people think it is less of an

> " operation " .

> >>

> >> I do second that one should consult with medical personnel who are

> >> objective. Obviously the best would be an OS who is experienced and

> >> equally capable in both resurfacing and replacement. If that is not

> >> possible, then meet with a resurfacing OS and a replacement OS

> and ask

> >> them questions about why you are or aren't a good candidate and

> what

> >> they perceive as the benefits and drawbacks of each procedure. Of

> >> course, one needs to go into an appointment as educated as

> possible so

> >> that one can ask intelligent questions and be able to evaluate

> >> responses and follow up if something does not comport with other

> data

> >> you have.

> >> On Feb 16, 2010, at 6:06 PM, Moseman, Jr. W. wrote:

> >>

> >>> Celeste:

> >>>

> >>> The hip resurfacing procedure is less invasive (smaller scar,

> retain

> >>> femoral head, etc.) than a THR and, in my opinion, presents less

> >>> risk. Just curious, does the surgeon you spoke with have the

> >>> ability to perform both THRs and resurfs? Would you mind sharing

> >>> the surgeon's name? Thanks.

> >>>

> >>> Don

> >>> Nothing Yet, Drs. P.Callendar, J. Dickinson, T. Sampson

> >>> On Feb 16, 2010, at 6:18 AM, celesteshearer@... wrote:

> >>>

> >>>> Hi,

> >>>> My 1st time on this site. I saw an orthopedist yesterday that was

> >>>> local with an excellent reputation. He sat down with me and my x-

> >>>> rays. He said I am in " end stage " hip arthritis or something like

> >>>> that...the words " end stage " are what stuck w/me. He said I am

> bone

> >>>> on bone in many places. He said each hip was equally as bad. My

> >>>> ball is no longer round but oblong as the spurs have reshaped

> them.

> >>>> Today I get my hips injected. The Dr. will see me again the end

> of

> >>>> March. I have looked into resurfacing. I saw one Dr. for

> >>>> resurfacing and he said I had hip dyplasia...this Dr. said

> there is

> >>>> no evidence of nip dysplasia. The Dr. I saw yesterday did not

> think

> >>>> resurfacing was the way to go. He also told me the THR now should

> >>>> last 25/30 yrs. I am confused. I am also an avid horse back

> rider,

> >>>> but now I cannot do that in my current state. The Dr. yesterday

> >>>> said there are far more complications w/resurfacing than THR

> and as

> >>>> a result not many Dr.'s are doing resurfacings . Now I am

> confused.

> >>>> I am

> >>> 49 yrs. old...active, (would like to get back in the saddle), &

> >>> obese...other than my weight I am in good health...well weight and

> >>> hips, LOL. Is a replacement very painful? How is the recovery

> >>> period? Does a replacement eventually feel normal? Any input is

> >>> appreciated. Trying to decide what to do.

> >>>> Thanks in advance,

> >>>> Celeste

> >>>>

> >>>>

> >>>

> >>>

> >>>

[Guest guest]

Don,

 

Are you going to die?  Yes...eventually...for some reason...but when and where

cannot be determined by us.  Running statistics is fine, but no matter

what...we're all going to die.  I am not making fun of you.  I had a surgery

years ago that had me convinced I would die...whatever was going on in my head

at the time, I don't recall.  But I had the surgery, it went well, alleviated a

lot of problems and I'm here today to tell the story.

 

The report you found on DVTs was written back in 2002.  If you read the report

completely, you'll notice the last paragraph: 

 

" Our study has some limitations. First, the number of

patients is small. Secondly, the incidence and natural history

of venous thrombosis and pulmonary embolism would seem

to be different in Korean patients when compared with

Western patients. "

 

200 patients is a very small study to base a decision upon.  I have had two DVTs

and went through surgery (several besides THR) without complications.  I might

just note this study, but not use it as a basis for a decision.

 

Limitations after surgery?  How about limitations before surgery?  Will I get

better?  I'm sure most of us here will report that if we did not have hip/knee

surgery, our lives would keep spiralling down into pain and more pain, drugs and

therapies that provide only temporary relief.  Life in a wheelchair has

challenges and statistics that I wouldn't care to investigate, at this point, if

there was a more viable solution.

 

And the limitations post-op are for our good...I'm sure as time moves forward,

our limitations decrease and we keep moving forward and live our lives in a much

better, healthier way.  And if we push too hard, disregard cautions while

recovering, well, that's a choice the individual takes, as well as the risk.

 

I'm sure the operating room looked like a construction site.  Getting the leg

over the head to pop the femur out of place to make it easier for the surgeon. 

I asked my surgeon to have someone take a pic, for it's the one and only time my

leg would be over my head and I had to see that!  Sadly, he would not oblige. 

And forgive me for making fun of myself...it's irresistable.

 

I think any surgery has a risk attached to it.  But, from my own worries and

fears, and from the surgeries I've had, I would rather determine the quality of

my life before...do I want pain, limping, declining invitations to the most

simple of functions...well, I guess you can say do I loose my life to my

handicap or do I choose to be brave and try to start to improve it with a good,

qualified doctor who I trust and then belly up to the bar and do the thing, get

through post-op surgical pain (which is nothing compared to what it was before

surgery, trust me) and get my life back on track.  I said yes, personally, it

was a hard decision but a very good one I don't regret. 

 

Good luck to you!

 

Lynn

THR, 26 Oct 2009

Dr. Rabbitt 

What other people think of me is none of my business!  Terry Cole Whittaker

Here's my art blog:  http://www.adreamseyeview.blogspot.com/

> >

> >> Hi,

> >> My 1st time on this site. I saw an orthopedist yesterday that was

> >> local with an excellent reputation. He sat down with me and my x-

> >> rays. He said I am in " end stage " hip arthritis or something like

> >> that...the words " end stage " are what stuck w/me. He said I am bone

> >> on bone in many places. He said each hip was equally as bad. My

> >> ball is no longer round but oblong as the spurs have reshaped them.

> >> Today I get my hips injected. The Dr. will see me again the end of

> >> March. I have looked into resurfacing. I saw one Dr. for

> >> resurfacing and he said I had hip dyplasia...this Dr. said there is

> >> no evidence of nip dysplasia. The Dr. I saw yesterday did not think

> >> resurfacing was the way to go. He also told me the THR now should

> >> last 25/30 yrs. I am confused. I am also an avid horse back rider,

> >> but now I cannot do that in my current state. The Dr. yesterday

> >> said there are far more complications w/resurfacing than THR and as

> >> a result not many Dr.'s are doing resurfacings . Now I am confused.

> >> I am

> > 49 yrs. old...active, (would like to get back in the saddle), &

> > obese...other than my weight I am in good health...well weight and

> > hips, LOL. Is a replacement very painful? How is the recovery

> > period? Does a replacement eventually feel normal? Any input is

> > appreciated. Trying to decide what to do.

> >> Thanks in advance,

> >> Celeste

> >>

> >>

> >

> >

> >

[Guest guest]

Don:

Mark Twain once said, " There are three kinds of lies: Lies, damned lies and

statistics. "

In a way, he was right. The statistics you give are " free floating " , that

is, there's no relevant context at all. This is like a survey saying that

90% of housewives love XXX detergent, when we don't know that half of those

surveyed don't even use it.

I shudder to think that anyone could believe there's an overall 8.7%

mortality rate among THRs. You DO realise that's one out of every 11 to12

patients, don't you? When I saw that, my first thought was that the

hospitals in that country are not for me.

My surgery was done in the Haim Sheba Medical Center by Prof. Chechik

just outside of Tel-Aviv, where they do about 20 THRs and 15 TKRs per week.

The last fatality they had was a 78-year-old man with so many other medical

problems that he shouldn't even have been a candidate for the TKR he

underwent--it was the catalyst for the breakdown of other body systems that

were fragile to begin with, at best (kidneys, heart, ulcers, high blood

pressure and I don't know what else). He was in the bed next to mine in

2003. I don't know when they last had a THR-related death.

This is what " surgeon.com " has to say:

" Morbidity/Mortality

" Information about mortality and complication rates following THR is limited

because the procedure is considered elective. In addition, different states

and countries use different sets of measurements in evaluating THR outcomes.

One Norwegian study found that patients who had THR between 1987 and 1999

had a lower long-term mortality rate than the age- and gender-matched

Norwegian population. A Canadian study found a 1.6% mortality rate within 30

days of <http://www.surgery.com/> surgery for THR patients between 1981 and

1999. A 2002 report from the Mayo Clinic found that the overall frequency of

serious complications (heart attack, pulmonary embolism, deep vein

thrombosis, or death) within 30 days of THR was 2.2%, the risk being higher

in patients over 70. The most important factor affecting morbidity and

mortality rates in the United States, according to a 2002 Harvard study, is

the volume of THRs performed at a given hospital or by a specific surgeon;

the higher the volume, the better the outcomes. "

After reading this, I thought, " Maybe Don's 8.7% figure refers to over-70s? "

There IS such a thing as " too much knowledge " , especially when one isn't

trained to understand some of it. I would bet that few of us here are

medical statisticians who could understand the methodology, terminology and

criteria used in any serious study. As an industrial engineer with 25 years

in the medical device industry, I can barely understand some of the

" statistical magic " and certainly can't perform it.

Note that in the quote above, all fatalities are from secondary causes

related to almost any invasive procedure. Would this stop you from having

an appendectomy if you needed one? Of course not. The benefit exceeds the

risk. You won't die if you don't have a hip replacement but your quality of

life may make you wish you had. I was bone-on-bone in my right hip before

surgery (age 53) and was not willing to spend the next 20-30 years in that

kind of pain and limitation. By the time I did the left a year later, it

was almost bone-on-bone.

While it's good to be an informed patient, there's no use in overloading

yourself with so much information you don't understand that you scare

yourself. For confirmation of what I've written here, just Google " total

joint replacement " +mortality.

My only advice is that if you live in Australia and the data you quote is

true, get your surgery done somewhere else.

D. RTHR: 2003; LTHR:2004

No trees were injured in the making of this e-mail, but a considerable

number of electrons were seriously inconvenienced.

_____

From: Joint Replacement

[mailto:Joint Replacement ] On Behalf Of Moseman, Jr.

W.

Sent: ä 18 ôáøåàø 2010 15:51

Joint Replacement

Subject: Re: What Surgery? Confused

Dear group mates:

Sorry for the messy data in the previous e-mail. It looked a lot better when

I sent it. Here goes again w/ a different format:

Revision Diagnosis

THR

Fracture - 14.5%

Loosening/ Lysis - 29.1%

Infection - 16.6%

Metal Sensitivity - 0.8%

Avascular Necrosis - No femoral head

Resurfacing

Fracture - 39.4%

Loosening/ Lysis - 29.3%

Infection - 8.9%

Metal Sensitivity - 6.4%

Avascular Necrosis - 3.2%

What I see in the data above is as follows:

Fractures - younger (20 years younger on average) patients overextending

themselves, resulting in almost three times the rate of fracture as the

primary revision diagnosis

Infection - THR, the more open and invasive surgical procedure (as compared

to resurfacing via arthroscopy), has roughly double the rate of infection.

Metal Sensitivity - Substantial difference in metal sensitivity. Not sure

what to speculate about this. Thankful that it's only 6.4%.

I'm interested to see what other's take may be on these. Take care and have

a fun week!

Don

[Guest guest]

jujulabee@... wrote:

> I don't know where you are getting those statistics but there is not

> an 8.7% death rate for a hip replacement surgery. I don't think heart

> by pass surgery has those kinds of death rates.

*I* thought that figure was a bit (lot?) high. That's almost 1 in 10 -

people die from hip surgery? I don't think so! That figure is enough

to frighten anybody off!!! Or, maybe, the statistician should inform

us as to which surgeon it relates, and we'll all stay a million miles

away from him! LOL

Mick.

--

*****************************************************

'Be not forgetful to entertain strangers; for thereby

some have entertained angels unawares!'

*****************************************************

[Guest guest]

True that LOL. I assume any hospital or surgeon with those kinds of

death rates would have been shut down -- or effectively put out of

business by malpractice awards LOL.

FWIW, hip replacement surgery is not a super risky surgery in terms of

death -- especially in terms of modern techniques. Most people have it

performed under some form of local -- this significantly cuts down the

risks of any operation.

Chief risks then remaining are DVT -- generally well controlled in

" normal " patients through blood thinners as well as getting them to

walk around as much as possible and as soon as possible. My hospital

had me on some kind of electrical squeeze machine for the first 24

hours when I was basically lying in bed for most of the time.

As for infection -- hospitals have a startling range of infection

rates and people might want to check those rates out. There are fairly

basic routines that can be put into place which can lower infection

rates drastically -- simple hand washing is probably the most

important. My hospital had fairly low infection rates -- every room

had a hand sanitizer in place and all personnel used it before

touching me.

On Feb 18, 2010, at 8:04 AM, Mick Armitage wrote:

> jujulabee@... wrote:

> > I don't know where you are getting those statistics but there is not

> > an 8.7% death rate for a hip replacement surgery. I don't think

> heart

> > by pass surgery has those kinds of death rates.

>

> *I* thought that figure was a bit (lot?) high. That's almost 1 in 10 -

> people die from hip surgery? I don't think so! That figure is enough

> to frighten anybody off!!! Or, maybe, the statistician should inform

> us as to which surgeon it relates, and we'll all stay a million miles

> away from him! LOL

>

> Mick.

>

> --

> *****************************************************

> 'Be not forgetful to entertain strangers; for thereby

> some have entertained angels unawares!'

> *****************************************************

>

>

>

[Guest guest]

Something is wrong with those statistics from Australia. I googled " total hip

replacement statistics " and got a much better reported outcomes. Here are a few

of the interesting sites I found, but you can search for your self as well.

http://www.totaljoints.info/TOTALHIPREPLACEM1.htm

Not statistics, but a wealth of information:

http://www.nlm.nih.gov/medlineplus/hipreplacement.html (note, the tutorial or

the hour long THR video are graphic.)

Short summary opinion:

http://stanford.wellsphere.com/back-neck-pain-article/who-or-what-to-blame-when-\

hip-replacements-fail/658920?query=Hip+Replacement+Complications

http://www.answers.com/topic/hip-replacement-surgical-term

http://www.jbjs.org.uk/cgi/reprint/79-B/6/896.pdf

http://www.springerlink.com/content/c350323783145421/

http://informahealthcare.com/doi/ref/10.1080/00016470052943838 Interestingly

claims increased survivaly than normal population after 10 years.

My advice. Stop worrying and choose an experienced doctor practicing at a major

hospital.

R THR 3/20/2007

L THR 12/22/2009

Dr. Leo Whiteside

Mo. Bone & Joint Center

Des Peres Hospital(St. Louis, MO suburb)

> > > I don't know where you are getting those statistics but there is not

> > > an 8.7% death rate for a hip replacement surgery. I don't think

> > heart

> > > by pass surgery has those kinds of death rates.

> >

> > *I* thought that figure was a bit (lot?) high. That's almost 1 in 10 -

> > people die from hip surgery? I don't think so! That figure is enough

> > to frighten anybody off!!! Or, maybe, the statistician should inform

> > us as to which surgeon it relates, and we'll all stay a million miles

> > away from him! LOL

> >

> > Mick.

> >

> > --

> > *****************************************************

> > 'Be not forgetful to entertain strangers; for thereby

> > some have entertained angels unawares!'

> > *****************************************************

> >

> >

> >

>

>

>

>

[Guest guest]

Curtis:

You're a wealth of information. Very interesting and informative resources.

Thanks for sharing. I checked out the Totalhipreplacem1.ntm link and looked up

the referenced study from Parvizi J et al: Clin Orthop 1999; 369:39-48

http://www.ejbjs.org/cgi/content/abstract/83/10/1524

As you mentioned, the statistics are a lot more encouraging. The Australian

Orthopaedic Association's (AOA) annual report has their mortality rate at 8.7%

(8 year post op) compared to the 0.29% (30 Day post THR).

Curtis - After looking over the AOA annual report (see link below, Figure M-2

graph on page 180, Conventional Total (purple line), I owe the group an apology.

I should have looked harder to determine the time basis for the AOA's 8.7%

mortality rate. When one considers that the average age of their THR recipients

was mid-seventies, it's not surprising that 8.7% of these folks are dead after 8

years. Looks like the Norwegians had a similar result.

http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009

I extracted the following from the www.answers.com link you provided below.

Very informative.

" Morbidity and Mortality Rates

Information about mortality and complication rates following THR is limited

because the procedure is considered elective. In addition, different states and

countries use different sets of measurements in evaluating THR outcomes. One

Norwegian study found that patients who had THR between 1987 and 1999 had a

lower long-term mortality rate than the age- and gender-matched Norwegian

population. A Canadian study found a 1.6% mortality rate within 30 days of

surgery for THR patients between 1981 and 1999. A 2002 report from the Mayo

Clinic found that the overall frequency of serious complications (heart attack,

pulmonary embolism, deep vein thrombosis, or death) within 30 days of THR was

2.2%, the risk being higher in patients over 70. The most important factor

affecting morbidity and mortality rates in the United States, according to a

2002 Harvard study, is the volume of THRs performed at a given hospital or by a

specific surgeon; the higher the volume, the better the outcomes. "

Take care and have a great week!

Don

On Feb 18, 2010, at 12:18 PM, Curtis wrote:

> Something is wrong with those statistics from Australia. I googled " total hip

replacement statistics " and got a much better reported outcomes. Here are a few

of the interesting sites I found, but you can search for your self as well.

>

> http://www.totaljoints.info/TOTALHIPREPLACEM1.htm

>

> Not statistics, but a wealth of information:

http://www.nlm.nih.gov/medlineplus/hipreplacement.html (note, the tutorial or

the hour long THR video are graphic.)

>

> Short summary opinion:

http://stanford.wellsphere.com/back-neck-pain-article/who-or-what-to-blame-when-\

hip-replacements-fail/658920?query=Hip+Replacement+Complications

>

> http://www.answers.com/topic/hip-replacement-surgical-term

>

> http://www.jbjs.org.uk/cgi/reprint/79-B/6/896.pdf

>

> http://www.springerlink.com/content/c350323783145421/

>

> http://informahealthcare.com/doi/ref/10.1080/00016470052943838 Interestingly

claims increased survivaly than normal population after 10 years.

>

> My advice. Stop worrying and choose an experienced doctor practicing at a

major hospital.

>

> R THR 3/20/2007

> L THR 12/22/2009

> Dr. Leo Whiteside

> Mo. Bone & Joint Center

> Des Peres Hospital(St. Louis, MO suburb)

>

>

> > > > I don't know where you are getting those statistics but there is not

> > > > an 8.7% death rate for a hip replacement surgery. I don't think

> > > heart

> > > > by pass surgery has those kinds of death rates.

> > >

> > > *I* thought that figure was a bit (lot?) high. That's almost 1 in 10 -

> > > people die from hip surgery? I don't think so! That figure is enough

> > > to frighten anybody off!!! Or, maybe, the statistician should inform

> > > us as to which surgeon it relates, and we'll all stay a million miles

> > > away from him! LOL

> > >

> > > Mick.

> > >

> > > --

> > > *****************************************************

> > > 'Be not forgetful to entertain strangers; for thereby

> > > some have entertained angels unawares!'

> > > *****************************************************

> > >

> > >

> > >

> >

> >

> >

> >

[Guest guest]

Mick:

My mistake. Turns out, the statistic is correct, but I should have indicated

that it's 8 years post op for patients whose average age is mid-seventies. Not

a surprise here. Curtis had more valuable information in his previous

post...the 30 and 90 day mortalities are more reasonable and in the fractional

percentages. Sorry. Take care.

Don

On Feb 18, 2010, at 5:45 AM, Mick Armitage wrote:

> jujulabee@... wrote:

> > I don't know where you are getting those statistics but there is not

> > an 8.7% death rate for a hip replacement surgery. I don't think heart

> > by pass surgery has those kinds of death rates.

>

> *I* thought that figure was a bit (lot?) high. That's almost 1 in 10 -

> people die from hip surgery? I don't think so! That figure is enough

> to frighten anybody off!!! Or, maybe, the statistician should inform

> us as to which surgeon it relates, and we'll all stay a million miles

> away from him! LOL

>

> Mick.

>

> --

> *****************************************************

> 'Be not forgetful to entertain strangers; for thereby

> some have entertained angels unawares!'

> *****************************************************

>

[Guest guest]

:

My apologies. It was definitely way out of context. Turns out, it's the

mortality rate 8 years post THR. When once considers that the average age of

THR recipients in the AOA annual report was mid-seventies, no surprise here.

Curtis provided a much better and accurate assessment with the articles he

posted (i.e., 30 day mortality rates being significantly lower than the 8.7% AOA

figure based on 8 year post-op). Below, is an excerpt of some of this

information.

Sorry. I really should have looked at the graph (AOA FY09 annual report, page

180, Figure M-2) and put a time basis to the statistic before presenting it.

I extracted the following from the www.answers.com link you provided below.

Very informative.

" Morbidity and Mortality Rates "

" Information about mortality and complication rates following THR is limited

because the procedure is considered elective. In addition, different states and

countries use different sets of measurements in evaluating THR outcomes. One

Norwegian study found that patients who had THR between 1987 and 1999 had a

lower long-term mortality rate than the age- and gender-matched Norwegian

population. A Canadian study found a 1.6% mortality rate within 30 days of

surgery for THR patients between 1981 and 1999. A 2002 report from the Mayo

Clinic found that the overall frequency of serious complications (heart attack,

pulmonary embolism, deep vein thrombosis, or death) within 30 days of THR was

2.2%, the risk being higher in patients over 70. The most important factor

affecting morbidity and mortality rates in the United States, according to a

2002 Harvard study, is the volume of THRs performed at a given hospital or by a

specific surgeon; the higher the volume, the better the outcomes. "

Take care and have a great week!

Don

On Feb 18, 2010, at 8:04 AM, on wrote:

> Don:

>

> Mark Twain once said, " There are three kinds of lies: Lies, damned lies and

> statistics. "

>

> In a way, he was right. The statistics you give are " free floating " , that

> is, there's no relevant context at all. This is like a survey saying that

> 90% of housewives love XXX detergent, when we don't know that half of those

> surveyed don't even use it.

>

> I shudder to think that anyone could believe there's an overall 8.7%

> mortality rate among THRs. You DO realise that's one out of every 11 to12

> patients, don't you? When I saw that, my first thought was that the

> hospitals in that country are not for me.

>

> My surgery was done in the Haim Sheba Medical Center by Prof. Chechik

> just outside of Tel-Aviv, where they do about 20 THRs and 15 TKRs per week.

> The last fatality they had was a 78-year-old man with so many other medical

> problems that he shouldn't even have been a candidate for the TKR he

> underwent--it was the catalyst for the breakdown of other body systems that

> were fragile to begin with, at best (kidneys, heart, ulcers, high blood

> pressure and I don't know what else). He was in the bed next to mine in

> 2003. I don't know when they last had a THR-related death.

>

> This is what " surgeon.com " has to say:

>

> " Morbidity/Mortality

>

>

> " Information about mortality and complication rates following THR is limited

> because the procedure is considered elective. In addition, different states

> and countries use different sets of measurements in evaluating THR outcomes.

> One Norwegian study found that patients who had THR between 1987 and 1999

> had a lower long-term mortality rate than the age- and gender-matched

> Norwegian population. A Canadian study found a 1.6% mortality rate within 30

> days of <http://www.surgery.com/> surgery for THR patients between 1981 and

> 1999. A 2002 report from the Mayo Clinic found that the overall frequency of

> serious complications (heart attack, pulmonary embolism, deep vein

> thrombosis, or death) within 30 days of THR was 2.2%, the risk being higher

> in patients over 70. The most important factor affecting morbidity and

> mortality rates in the United States, according to a 2002 Harvard study, is

> the volume of THRs performed at a given hospital or by a specific surgeon;

> the higher the volume, the better the outcomes. "

>

> After reading this, I thought, " Maybe Don's 8.7% figure refers to over-70s? "

> There IS such a thing as " too much knowledge " , especially when one isn't

> trained to understand some of it. I would bet that few of us here are

> medical statisticians who could understand the methodology, terminology and

> criteria used in any serious study. As an industrial engineer with 25 years

> in the medical device industry, I can barely understand some of the

> " statistical magic " and certainly can't perform it.

>

> Note that in the quote above, all fatalities are from secondary causes

> related to almost any invasive procedure. Would this stop you from having

> an appendectomy if you needed one? Of course not. The benefit exceeds the

> risk. You won't die if you don't have a hip replacement but your quality of

> life may make you wish you had. I was bone-on-bone in my right hip before

> surgery (age 53) and was not willing to spend the next 20-30 years in that

> kind of pain and limitation. By the time I did the left a year later, it

> was almost bone-on-bone.

>

> While it's good to be an informed patient, there's no use in overloading

> yourself with so much information you don't understand that you scare

> yourself. For confirmation of what I've written here, just Google " total

> joint replacement " +mortality.

>

> My only advice is that if you live in Australia and the data you quote is

> true, get your surgery done somewhere else.

>

> D. RTHR: 2003; LTHR:2004

>

> No trees were injured in the making of this e-mail, but a considerable

> number of electrons were seriously inconvenienced.

>

>

> _____

>

> From: Joint Replacement

> [mailto:Joint Replacement ] On Behalf Of Moseman, Jr.

> W.

> Sent: ä 18 ôáøåàø 2010 15:51

> Joint Replacement

> Subject: Re: What Surgery? Confused

>

>

>

>

> Dear group mates:

>

> Sorry for the messy data in the previous e-mail. It looked a lot better when

> I sent it. Here goes again w/ a different format:

>

> Revision Diagnosis

>

> THR

> Fracture - 14.5%

> Loosening/ Lysis - 29.1%

> Infection - 16.6%

> Metal Sensitivity - 0.8%

> Avascular Necrosis - No femoral head

>

> Resurfacing

> Fracture - 39.4%

> Loosening/ Lysis - 29.3%

> Infection - 8.9%

> Metal Sensitivity - 6.4%

> Avascular Necrosis - 3.2%

>

> What I see in the data above is as follows:

>

> Fractures - younger (20 years younger on average) patients overextending

> themselves, resulting in almost three times the rate of fracture as the

> primary revision diagnosis

> Infection - THR, the more open and invasive surgical procedure (as compared

> to resurfacing via arthroscopy), has roughly double the rate of infection.

> Metal Sensitivity - Substantial difference in metal sensitivity. Not sure

> what to speculate about this. Thankful that it's only 6.4%.

>

> I'm interested to see what other's take may be on these. Take care and have

> a fun week!

>

> Don

>

>

>

>

[Guest guest]

Lynn:

No offense taken at all. I appreciate you sharing and providing another

perspective and some clarification of DVT report. I'm very happy the surgery

worked out well for you. Take care and have a good weekend.

Don

On Feb 18, 2010, at 7:56 AM, Lynn wrote:

>

> Don,

>

> Are you going to die? Yes...eventually...for some reason...but when and where

cannot be determined by us. Running statistics is fine, but no matter

what...we're all going to die. I am not making fun of you. I had a surgery

years ago that had me convinced I would die...whatever was going on in my head

at the time, I don't recall. But I had the surgery, it went well, alleviated a

lot of problems and I'm here today to tell the story.

>

> The report you found on DVTs was written back in 2002. If you read the report

completely, you'll notice the last paragraph:

>

> " Our study has some limitations. First, the number of

> patients is small. Secondly, the incidence and natural history

> of venous thrombosis and pulmonary embolism would seem

> to be different in Korean patients when compared with

> Western patients. "

>

> 200 patients is a very small study to base a decision upon. I have had two

DVTs and went through surgery (several besides THR) without complications. I

might just note this study, but not use it as a basis for a decision.

>

> Limitations after surgery? How about limitations before surgery? Will I get

better? I'm sure most of us here will report that if we did not have hip/knee

surgery, our lives would keep spiralling down into pain and more pain, drugs and

therapies that provide only temporary relief. Life in a wheelchair has

challenges and statistics that I wouldn't care to investigate, at this point, if

there was a more viable solution.

>

> And the limitations post-op are for our good...I'm sure as time moves forward,

our limitations decrease and we keep moving forward and live our lives in a much

better, healthier way. And if we push too hard, disregard cautions while

recovering, well, that's a choice the individual takes, as well as the risk.

>

> I'm sure the operating room looked like a construction site. Getting the leg

over the head to pop the femur out of place to make it easier for the surgeon.

I asked my surgeon to have someone take a pic, for it's the one and only time my

leg would be over my head and I had to see that! Sadly, he would not oblige.

And forgive me for making fun of myself...it's irresistable.

>

> I think any surgery has a risk attached to it. But, from my own worries and

fears, and from the surgeries I've had, I would rather determine the quality of

my life before...do I want pain, limping, declining invitations to the most

simple of functions...well, I guess you can say do I loose my life to my

handicap or do I choose to be brave and try to start to improve it with a good,

qualified doctor who I trust and then belly up to the bar and do the thing, get

through post-op surgical pain (which is nothing compared to what it was before

surgery, trust me) and get my life back on track. I said yes, personally, it

was a hard decision but a very good one I don't regret.

>

> Good luck to you!

>

> Lynn

> THR, 26 Oct 2009

> Dr. Rabbitt

>

> What other people think of me is none of my business! Terry Cole Whittaker

> Here's my art blog: http://www.adreamseyeview.blogspot.com/

>

>

> > >

> > >> Hi,

> > >> My 1st time on this site. I saw an orthopedist yesterday that was

> > >> local with an excellent reputation. He sat down with me and my x-

> > >> rays. He said I am in " end stage " hip arthritis or something like

> > >> that...the words " end stage " are what stuck w/me. He said I am bone

> > >> on bone in many places. He said each hip was equally as bad. My

> > >> ball is no longer round but oblong as the spurs have reshaped them.

> > >> Today I get my hips injected. The Dr. will see me again the end of

> > >> March. I have looked into resurfacing. I saw one Dr. for

> > >> resurfacing and he said I had hip dyplasia...this Dr. said there is

> > >> no evidence of nip dysplasia. The Dr. I saw yesterday did not think

> > >> resurfacing was the way to go. He also told me the THR now should

> > >> last 25/30 yrs. I am confused. I am also an avid horse back rider,

> > >> but now I cannot do that in my current state. The Dr. yesterday

> > >> said there are far more complications w/resurfacing than THR and as

> > >> a result not many Dr.'s are doing resurfacings . Now I am confused.

> > >> I am

> > > 49 yrs. old...active, (would like to get back in the saddle), &

> > > obese...other than my weight I am in good health...well weight and

> > > hips, LOL. Is a replacement very painful? How is the recovery

> > > period? Does a replacement eventually feel normal? Any input is

> > > appreciated. Trying to decide what to do.

> > >> Thanks in advance,

> > >> Celeste

> > >>

> > >>

> > >

> > >

> > >

[Guest guest]

Jujulabee:

The revision diagnosis percentages presented by the AOA report are quite clear

and indicate the respective orthopaedic surgeon's perception as to the revision

diagnosis (i.e., the primary reason he/she is seeing this patient for a revision

and whether they are coming off of a resurf or THR). The percentages below are

for exactly what they state (THR aka conventional total; and resurfacing). If

you're looking for lots of statistics broken down by each type of surgery (i.e.,

partial, total, etc, etc.) take a read thru the AOA annual report:

Australian Orthopaedic Association's Annual Reports

http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009

It's a bit overwhelming, but if you wade through it, you'll find there's lots if

very interesting and useful data.

Regarding some of the concerns you raise below, there will always be limitations

to the collection and presentation of the data (i.e. limitations of time, money,

people involved in gathering/ analyzing the data, etc.). Are you aware of a

more complete or informative joint registry? If so, please share with the

group.

Regarding my motivations -- they're simple -- provide the original e-mailer

(Celeste) with resources she can read/ reference (i.e., AOA annual report, joint

registry, etc.) in order to make a sound decision regarding resurfacing and THR.

Whether it's me or anyone else in this group who helps get her comfortably and

confidently to that decision is no matter to me. Curtis went a long way towards

that with some of the references he provided previously.

Don

On Feb 18, 2010, at 6:40 AM, jujulabee@... wrote:

> Again these are meaningless statistics since they lack any context and

> indicate the reason for a revision in each set of operations and not

> what the total rate of revisions for each procedure broken down by

> type of operation; type of prothesis; patient age (and other variables).

>

> For example, metal sensitivity -- all resurfacings are MOM whereas a

> smaller percentage of THR use MOM -- so is the sensitivity for all THR

> or just those with MOM?

>

> The statistics aren't adjusted for population or demographics in any

> way. For starters, patient outcome in resurfacing is linked to a great

> extent to bone density which is why many OS don't recommend for

> smaller post menopausal women.

>

> Loosening or whatever - within what time period. Loosening after a

> year is one thing -- loosening after 20 years completely different.

> What materials were used as outcome seems different based on newer

> materials such as MOM or ceramic.

>

> And of course infection corresponds to hospital infection rates to a

> great extent -- some hospitals have higher infection rates for all

> operations and doctors will have significantly different outcomes

> which is why OS choice and hospital in which surgery is performed are

> among the most critical factors to consider.

>

> I am really not sure what you are attempting to accomplish with this.

>

> On Feb 18, 2010, at 5:51 AM, Moseman, Jr. W. wrote:

>

>> Dear group mates:

>>

>> Sorry for the messy data in the previous e-mail. It looked a lot

>> better when I sent it. Here goes again w/ a different format:

>>

>> Revision Diagnosis

>>

>> THR

>> Fracture - 14.5%

>> Loosening/ Lysis - 29.1%

>> Infection - 16.6%

>> Metal Sensitivity - 0.8%

>> Avascular Necrosis - No femoral head

>>

>> Resurfacing

>> Fracture - 39.4%

>> Loosening/ Lysis - 29.3%

>> Infection - 8.9%

>> Metal Sensitivity - 6.4%

>> Avascular Necrosis - 3.2%

>>

>> What I see in the data above is as follows:

>>

>> Fractures - younger (20 years younger on average) patients

>> overextending themselves, resulting in almost three times the rate

>> of fracture as the primary revision diagnosis

>> Infection - THR, the more open and invasive surgical procedure (as

>> compared to resurfacing via arthroscopy), has roughly double the

>> rate of infection.

>> Metal Sensitivity - Substantial difference in metal sensitivity. Not

>> sure what to speculate about this. Thankful that it's only 6.4%.

>>

>> I'm interested to see what other's take may be on these. Take care

>> and have a fun week!

>>

>> Don

>> On Feb 17, 2010, at 9:19 PM, Moseman, Jr. W. wrote:

>>

>>> Jujulabee, Celeste:

>>>

>>> In trying to determine what particular surgical procedure I would

>> choose, I do my best to assess:

>>>

>>> - The probability that I will die from the surgery

>>> - The probability that I will develop serious complications as a

>> result of the surgery

>>> - The difficulty of the recovery/ rehabilitation from the surgery

>>> - The type of life I can have " post-surgery "

>>>

>>> Will I die from this surgery?

>>> Regarding death from hip surgery, the best data I was able to find

>> came from the 2009 Australian Orthopaedic Association's Annual

>> Report

(http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2009)(P\

age

>> 180, Table M3).

>>>

>>>

>>>

>>> The %deaths from Total Resurfacing is 1.1% whereas it's 8.7% from

>> conventional Total hip replacement. One note - the average age of

>> the THR surgical candidate is almost 20 years older than the average

>> age for a resurfacing candidate so this obviously influences the

>> rate of death. However, 1.1% versus 8.7%. Pretty easy decision to

>> make if you have a choice.

>>>

>>> The risk road-map I'd drawn up for myself goes something

>> like......arthroscopy.......resurfacing........THR........THR

>> revision. My goal is to never get to a THR revision as that is a

>> more complicated, hence higher rate of death, surgery than the THR.

>>>

>>> What is the likelihood that I will develop serious complications

>> from this surgery?

>>> Perhaps the best resource referred to me (thanks Ian

>> Christoph! ) to date has been the Australian Orthopaedic

>> Association web site (http://www.dmac.adelaide.edu.au/aoanjrr/) and

>> their extensive annual reports and joint registry. Please refer to

>> the attachment below for graphs which depict the revision diagnosis

>> for both Primary Total Hip Replacement and Primary Total

>> Resurfacing. While there are substantially more THR patients

>> (147,422) than resurfacing (12,093), the quantity of resurfacing

>> patients is substantial statistically and merits a comparison of

>> revision diagnosis between THR and Resurfacing:

>>>

>>> Revision Diagnosis

>>> THR

>>> Resurfacing

>>> Fracture

>>> 14.5%

>>> 39.4%

>>> Loosening/ Lysis

>>> 29.1%

>>> 29.3%

>>> Infection

>>> 16.6%

>>> 8.9%

>>> Metal Sensitivity

>>> 0.8%

>>> 6.4%

>>> Avascular necrosis

>>> 3.2%

>>> No femoral head

>>>

>>>

>>>

>>> Deep Vein Thrombosis & Pulmonary Embolism

>>> Additionally, one of the most serious complications once can

>> encounter after hip surgery is deep vein thrombosis (blood clots)

>> which could also become a pulmonary embolism should a sizable clot

>> make its way to your lungs. I found the following excerpt in an

>> article within the Journal of Bone & Joint Surgery, " Seagroatt et

>> al(21) reported a readmission rate for sympto- matic thromboembolic

>> complications of 0.73% within 28 days of discharge after THR.

>> Warwick et al16 reported a readmission rate of 1.39%. "

http://www.jbjs.org.uk/cgi/reprint/85-B/5/661.pdf

>>>

>>> Difficulty of Recovery

>>> I've had a chance to sit-in on two THR operations and what I saw

>> looked more like a heavy construction site than an operating suite.

>> The THR is a substantially more invasive surgery than resurfacing in

>> that it cuts off the femoral head and drills out the femur for

>> insertion of the metal stem. It is my opinion that this results in

>> more days in the hospital as well as a longer recovery for the

>> patient. I, however, have not had this surgery myself and ask that

>> those who have -- please share your experiences w/ Celeste.

>>>

>>> What type of activity/ life can I have post surgery

>>> Activity restrictions have been less severe for resurfacing

>> candidates. However, I've been hearing rumors of less brittle

>> ceramics and metal/ metal THRs that provide for a more active

>> lifestyle. Perhaps some in the group can share their personal

>> experiences in this regard.

>>>

>>> If any of you have any other excellent resources for mortality and

>> revision statistics, please share. Take care and have a great week!

>>>

>>> Don

>>> ===================================

>>> On Feb 16, 2010, at 8:52 PM, jujulabee@... wrote:

>>>

>>>> There are objective reasons why someone might opt for hip

>> resurfacing

>>>> but the two you mention are not among this

>>>>

>>>> The size of the incision is not necessarily smaller. And of course,

>>>> the length of the incision has very little to do with anything

>> since

>>>> most of the real " work " is below the surface. The last thing most

>>>> people should be concerned with is the size of the incision since

>> one

>>>> wants to have an OS have sufficient " room " to provide the best

>>>> outcome. FWIW, all incisions are much shorter than they were a

>> decade

>>>> ago.

>>>>

>>>> Hip resurfacing doesn't prevent less " risk " -- I am not sure what

>>>> criteria you are using as an indicia for " risk " . Both a replacement

>>>> and a resurfacing are major surgeries and recovery from either

>> one is

>>>> about the same.

>>>>

>>>> The chief benefit appears to be that a " revision " is theoretically

>>>> simpler in the event that one needs one for some reason in the

>> future.

>>>> However, weighed against that is the increased risk of

>> complications

>>>> -- particularly for post menopausal women.

>>>>

>>>> I am not anti-resurfacing -- want to make that clear as I think

>> it is

>>>> a good procedure. However, anyone making a decision should be

>> deciding

>>>> it based on objective criteria. For some reason, the name

>>>> " resurfacing " seems to make people think it is less of an

>> " operation " .

>>>>

>>>> I do second that one should consult with medical personnel who are

>>>> objective. Obviously the best would be an OS who is experienced and

>>>> equally capable in both resurfacing and replacement. If that is not

>>>> possible, then meet with a resurfacing OS and a replacement OS

>> and ask

>>>> them questions about why you are or aren't a good candidate and

>> what

>>>> they perceive as the benefits and drawbacks of each procedure. Of

>>>> course, one needs to go into an appointment as educated as

>> possible so

>>>> that one can ask intelligent questions and be able to evaluate

>>>> responses and follow up if something does not comport with other

>> data

>>>> you have.

>>>> On Feb 16, 2010, at 6:06 PM, Moseman, Jr. W. wrote:

>>>>

>>>>> Celeste:

>>>>>

>>>>> The hip resurfacing procedure is less invasive (smaller scar,

>> retain

>>>>> femoral head, etc.) than a THR and, in my opinion, presents less

>>>>> risk. Just curious, does the surgeon you spoke with have the

>>>>> ability to perform both THRs and resurfs? Would you mind sharing

>>>>> the surgeon's name? Thanks.

>>>>>

>>>>> Don

>>>>> Nothing Yet, Drs. P.Callendar, J. Dickinson, T. Sampson

>>>>> On Feb 16, 2010, at 6:18 AM, celesteshearer@... wrote:

>>>>>

>>>>>> Hi,

>>>>>> My 1st time on this site. I saw an orthopedist yesterday that was

>>>>>> local with an excellent reputation. He sat down with me and my x-

>>>>>> rays. He said I am in " end stage " hip arthritis or something like

>>>>>> that...the words " end stage " are what stuck w/me. He said I am

>> bone

>>>>>> on bone in many places. He said each hip was equally as bad. My

>>>>>> ball is no longer round but oblong as the spurs have reshaped

>> them.

>>>>>> Today I get my hips injected. The Dr. will see me again the end

>> of

>>>>>> March. I have looked into resurfacing. I saw one Dr. for

>>>>>> resurfacing and he said I had hip dyplasia...this Dr. said

>> there is

>>>>>> no evidence of nip dysplasia. The Dr. I saw yesterday did not

>> think

>>>>>> resurfacing was the way to go. He also told me the THR now should

>>>>>> last 25/30 yrs. I am confused. I am also an avid horse back

>> rider,

>>>>>> but now I cannot do that in my current state. The Dr. yesterday

>>>>>> said there are far more complications w/resurfacing than THR

>> and as

>>>>>> a result not many Dr.'s are doing resurfacings . Now I am

>> confused.

>>>>>> I am

>>>>> 49 yrs. old...active, (would like to get back in the saddle), &

>>>>> obese...other than my weight I am in good health...well weight and

>>>>> hips, LOL. Is a replacement very painful? How is the recovery

>>>>> period? Does a replacement eventually feel normal? Any input is

>>>>> appreciated. Trying to decide what to do.

>>>>>> Thanks in advance,

>>>>>> Celeste

>>>>>>

>>>>>>

>>>>>

>>>>>

>>>>>