Re: Less than ideal hip resfacing candidates

[Guest guest]

Hi

I have not have the BHR yet but I am not the ideal candidate either(scheduled

for January 6 with De Smet): being 61 year old and my bones are not in perfect

condition (slight osteoporosis). Dr De Smet told me that the risk for me was of

femoral neck fracture but was not a very big risk (did not quantify it though)

and that if I had a fracture I could have a THR.

I wonder if your doc told you what kind of failure could happen in these 22 %? I

think it would be helpful to know if it fails what are the solutions.

good luck

sunita

Less than ideal hip resfacing candidates

Hello Everyone,

Reading many wonderful postings about people being evaluated as good

candidates for hip resurfacing. Wish all of you great success! Wonder, if there

are any people who were evaluated as less than ideal candidates, but who had the

surgery anyway and have had positive outcomes. Of course, would want to know

about situations where outcomes were not positive (Hope, though, that everyone

succeeded)

I have been diagnosed with advanced Avascular Necrosis (Oct 16, 2003) of my

right hip. Surgeons here in NYC suggested a THR. I am 46 years old, and until

recently, was very physically active. I completed the NYC Marathon and

sky-dived. I very much want a resurfacing and would have it in a heartbeat if I

was reasonably confident that the procedure would hold and be long lasting.

Recently, I have flown to see Dr. Schmalzried in LA at the Joint

Replacement Institute. He said he would perform hip resurfacing if I wanted it.

However, he said I have " early femoral failure " and cyst present. He said

further, that normally the outcome is 95% successful, but for me it would be

88%. Wonder, whether, given the increased odds against me, I ought take the

risk.

It appears, I face a very difficult decision. Am I alone in this are there

others out there in similar situations and hopefully may have some useful advice

to pass my way? Any information is greatly appreciated.

(hopeful and determined to find the best treatment given my situation)

Warmly,

(New York City)

[Guest guest]

Hi and Sunita. I have been on this board for four years and feel I

have a Ph.D. in Hip Replacement. I don't but I have been resurfaced and

revisioned in that time and have a very realist opinion on both procedures. I

constantly read on this board disinformation about both Resurfacing and THR. I

just

read a post that said resurfacing will last 400 years. I understand that

most people who have had resurfacing are extremely happy with it and I am

absolutely convinced when it is good it is good. It may actually be great. It

was not

for me. I am therefore trying to reach out to those who are may not be good

candidates and who have read all the hype about resurfacing and tell them the

following. If you are not a good candidate then explore all of your options!

There are others that can make you just as happy.

Ask your OS the following: What caused my OA. How far advanced am I.

What is my alternative if I am in surgery and I am not a good candidate. Does

the

Component Company have a revision alternate? Will you do resurfacing no

matter what! Really stress this last question!!!! Will my leg length be affected

or

corrected? This will greatly affect you recovery and performance after

surgery. Don't ask about %'s. Press them into a better answer than 88%. Do I

have

Cysts? How will they affect my out come?

Listen to their answers. Don't be confused with THR as only being a

small fermur head with a plastic lining. Do you homework and be comfortable with

your decision. I have a great hip and so will you.

[Guest guest]

> Wonder, whether, given the increased odds against me, I ought take

>the risk.

Why do you consider it such a risk, if it does not work you still can

have a THR. I too, have AVN, and I am still recovering from my

surgery, but for me the choice between THR and resurfacing was

simple, with THR I would have multiple restrictions and have to do a

revision sooner rather than later, resurfacing no restrictions after

healing and therapy, and doing nothing was not an option for me.

The opportunity to have my life back was worth the risks for me.

Mueller

Beaule 10-3-03

[Guest guest]

:

Keep in mind that a Metal-on-Metal THR with a large femoral ball is

not a bad compromise if, for any reason, you can't get a resurfacing

job. It should give you the long wear, good range of motion and

reduced risk of dislocation characteristics that make a resurfacing

operation such a good option.

Some (maybe all) of the resurfacing system will accomodate a stemmed

femoral component if the resurfacing component should fail (I believe

the femoral component is where the problems most often happen) - I

know this is the case with the Conserve Plus. While nobody

looks forward to a second surgery, this is a pretty good long-term

plan - if the resurf fails, you still end up with a M-o-M THR with a

large femoral component and many of the advantages of the resurf.

And, if the resurf works - you are golden!

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as

good candidates for hip resurfacing. Wish all of you great success!

Wonder, if there are any people who were evaluated as less than ideal

candidates, but who had the surgery anyway and have had positive

outcomes. Of course, would want to know about situations where

outcomes were not positive (Hope, though, that everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16,

2003) of my right hip. Surgeons here in NYC suggested a THR. I am 46

years old, and until recently, was very physically active. I

completed the NYC Marathon and sky-dived. I very much want a

resurfacing and would have it in a heartbeat if I was reasonably

confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the

Joint Replacement Institute. He said he would perform hip resurfacing

if I wanted it. However, he said I have " early femoral failure " and

cyst present. He said further, that normally the outcome is 95%

successful, but for me it would be 88%. Wonder, whether, given the

increased odds against me, I ought take the risk.

>

> It appears, I face a very difficult decision. Am I alone in this

are there others out there in similar situations and hopefully may

have some useful advice to pass my way? Any information is greatly

appreciated.

>

> (hopeful and determined to find the best treatment given my

situation)

>

> Warmly,

> (New York City)

[Guest guest]

Trever,

I am glad they've come up a rating scale to quantify the risk now, I was one

who had cysts on the femoral head and ended up having trouble with one of my

hips. I guess it is up to the patient to decide if the potential problem

and revision is worth the risk. Did he offer the option of the large

femoral head metal-on-metal THR? I am happy with that which was used for a

revision to the side that had the trouble, and it offers the same

dislocation reduction benefits of the natural sized head, and of course the

metal/metal hard bearing surface -- personally, that is the way I would go

if I were told those numbers.

Good luck.

-

Less than ideal hip resfacing candidates

Hello Everyone,

Reading many wonderful postings about people being evaluated as good

candidates for hip resurfacing. Wish all of you great success! Wonder, if

there are any people who were evaluated as less than ideal candidates, but

who had the surgery anyway and have had positive outcomes. Of course, would

want to know about situations where outcomes were not positive (Hope,

though, that everyone succeeded)

I have been diagnosed with advanced Avascular Necrosis (Oct 16, 2003) of my

right hip. Surgeons here in NYC suggested a THR. I am 46 years old, and

until recently, was very physically active. I completed the NYC Marathon and

sky-dived. I very much want a resurfacing and would have it in a heartbeat

if I was reasonably confident that the procedure would hold and be long

lasting.

Recently, I have flown to see Dr. Schmalzried in LA at the Joint

Replacement Institute. He said he would perform hip resurfacing if I wanted

it. However, he said I have " early femoral failure " and cyst present. He

said further, that normally the outcome is 95% successful, but for me it

would be 88%. Wonder, whether, given the increased odds against me, I ought

take the risk.

It appears, I face a very difficult decision. Am I alone in this are there

others out there in similar situations and hopefully may have some useful

advice to pass my way? Any information is greatly appreciated.

(hopeful and determined to find the best treatment given my situation)

Warmly,

(New York City)

[Guest guest]

Trever,

I am glad they've come up a rating scale to quantify the risk now, I was one

who had cysts on the femoral head and ended up having trouble with one of my

hips. I guess it is up to the patient to decide if the potential problem

and revision is worth the risk. Did he offer the option of the large

femoral head metal-on-metal THR? I am happy with that which was used for a

revision to the side that had the trouble, and it offers the same

dislocation reduction benefits of the natural sized head, and of course the

metal/metal hard bearing surface -- personally, that is the way I would go

if I were told those numbers.

Good luck.

-

Less than ideal hip resfacing candidates

Hello Everyone,

Reading many wonderful postings about people being evaluated as good

candidates for hip resurfacing. Wish all of you great success! Wonder, if

there are any people who were evaluated as less than ideal candidates, but

who had the surgery anyway and have had positive outcomes. Of course, would

want to know about situations where outcomes were not positive (Hope,

though, that everyone succeeded)

I have been diagnosed with advanced Avascular Necrosis (Oct 16, 2003) of my

right hip. Surgeons here in NYC suggested a THR. I am 46 years old, and

until recently, was very physically active. I completed the NYC Marathon and

sky-dived. I very much want a resurfacing and would have it in a heartbeat

if I was reasonably confident that the procedure would hold and be long

lasting.

Recently, I have flown to see Dr. Schmalzried in LA at the Joint

Replacement Institute. He said he would perform hip resurfacing if I wanted

it. However, he said I have " early femoral failure " and cyst present. He

said further, that normally the outcome is 95% successful, but for me it

would be 88%. Wonder, whether, given the increased odds against me, I ought

take the risk.

It appears, I face a very difficult decision. Am I alone in this are there

others out there in similar situations and hopefully may have some useful

advice to pass my way? Any information is greatly appreciated.

(hopeful and determined to find the best treatment given my situation)

Warmly,

(New York City)

[Guest guest]

Trever,

I am glad they've come up a rating scale to quantify the risk now, I was one

who had cysts on the femoral head and ended up having trouble with one of my

hips. I guess it is up to the patient to decide if the potential problem

and revision is worth the risk. Did he offer the option of the large

femoral head metal-on-metal THR? I am happy with that which was used for a

revision to the side that had the trouble, and it offers the same

dislocation reduction benefits of the natural sized head, and of course the

metal/metal hard bearing surface -- personally, that is the way I would go

if I were told those numbers.

Good luck.

-

Less than ideal hip resfacing candidates

Hello Everyone,

Reading many wonderful postings about people being evaluated as good

candidates for hip resurfacing. Wish all of you great success! Wonder, if

there are any people who were evaluated as less than ideal candidates, but

who had the surgery anyway and have had positive outcomes. Of course, would

want to know about situations where outcomes were not positive (Hope,

though, that everyone succeeded)

I have been diagnosed with advanced Avascular Necrosis (Oct 16, 2003) of my

right hip. Surgeons here in NYC suggested a THR. I am 46 years old, and

until recently, was very physically active. I completed the NYC Marathon and

sky-dived. I very much want a resurfacing and would have it in a heartbeat

if I was reasonably confident that the procedure would hold and be long

lasting.

Recently, I have flown to see Dr. Schmalzried in LA at the Joint

Replacement Institute. He said he would perform hip resurfacing if I wanted

it. However, he said I have " early femoral failure " and cyst present. He

said further, that normally the outcome is 95% successful, but for me it

would be 88%. Wonder, whether, given the increased odds against me, I ought

take the risk.

It appears, I face a very difficult decision. Am I alone in this are there

others out there in similar situations and hopefully may have some useful

advice to pass my way? Any information is greatly appreciated.

(hopeful and determined to find the best treatment given my situation)

Warmly,

(New York City)

[Guest guest]

I suggest you send your xrays to Dr. DeSmet (see contact info in

surfacehippy files - Ghent, Belgium). He is known for doing

difficult cases and will not charge you to look at your xrays. He

will give you a clear picture of your candidacy for resurfacing. All

the best.

R. Bures rbhr, DeSmet, 5/13/03

[Guest guest]

I suggest you send your xrays to Dr. DeSmet (see contact info in

surfacehippy files - Ghent, Belgium). He is known for doing

difficult cases and will not charge you to look at your xrays. He

will give you a clear picture of your candidacy for resurfacing. All

the best.

R. Bures rbhr, DeSmet, 5/13/03

[Guest guest]

I suggest you send your xrays to Dr. DeSmet (see contact info in

surfacehippy files - Ghent, Belgium). He is known for doing

difficult cases and will not charge you to look at your xrays. He

will give you a clear picture of your candidacy for resurfacing. All

the best.

R. Bures rbhr, DeSmet, 5/13/03

[Guest guest]

There is an option that hasn't been mentioned. Like you I had cyst

formation (in the femoral neck, at the sight of a fracture I'd been

walking round on,on crutches, for months) and the femoral neck wasn't

salvageable. That meant a THR stem, but the week before surgery my

surgeon (bless him) offered me the option of BHR components. Midland

Medical Technologies, the firm that makes the BHR, makes a complete

metal femoral head for cases where the person's own femoral head has

to be lost. I understand Corin also makes a full femoral head. I had

the BHR acetabular cup + complete metal head. The metal head slotted

nicely onto the standard THR stem - I know, as I watched and my

surgeon gave me a good look, on the TV monitor, at the back of the

metal head to show how it was done. Fascinating! Since he's done mine

(27/8/03) he has done several more, saving people who have to lose

the femoral neck from many of the disadvantages of the usual THR.

You may be pleased to know that I've been very flexible in the

hip from early on and now can hardly believe that I've had this major

surgery - except that I've got the scar to prove it! I hope this

helps in your negotiations wiht your surgeons.

Virginia (Brisbane, Queensland, Australia)

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as

good candidates for hip resurfacing. Wish all of you great success!

Wonder, if there are any people who were evaluated as less than ideal

candidates, but who had the surgery anyway and have had positive

outcomes. Of course, would want to know about situations where

outcomes were not positive (Hope, though, that everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16,

2003) of my right hip. Surgeons here in NYC suggested a THR. I am 46

years old, and until recently, was very physically active. I

completed the NYC Marathon and sky-dived. I very much want a

resurfacing and would have it in a heartbeat if I was reasonably

confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the

Joint Replacement Institute. He said he would perform hip resurfacing

if I wanted it. However, he said I have " early femoral failure " and

cyst present. He said further, that normally the outcome is 95%

successful, but for me it would be 88%. Wonder, whether, given the

increased odds against me, I ought take the risk.

>

> It appears, I face a very difficult decision. Am I alone in this

are there others out there in similar situations and hopefully may

have some useful advice to pass my way? Any information is greatly

appreciated.

>

> (hopeful and determined to find the best treatment given my

situation)

>

> Warmly,

> (New York City)

[Guest guest]

There is an option that hasn't been mentioned. Like you I had cyst

formation (in the femoral neck, at the sight of a fracture I'd been

walking round on,on crutches, for months) and the femoral neck wasn't

salvageable. That meant a THR stem, but the week before surgery my

surgeon (bless him) offered me the option of BHR components. Midland

Medical Technologies, the firm that makes the BHR, makes a complete

metal femoral head for cases where the person's own femoral head has

to be lost. I understand Corin also makes a full femoral head. I had

the BHR acetabular cup + complete metal head. The metal head slotted

nicely onto the standard THR stem - I know, as I watched and my

surgeon gave me a good look, on the TV monitor, at the back of the

metal head to show how it was done. Fascinating! Since he's done mine

(27/8/03) he has done several more, saving people who have to lose

the femoral neck from many of the disadvantages of the usual THR.

You may be pleased to know that I've been very flexible in the

hip from early on and now can hardly believe that I've had this major

surgery - except that I've got the scar to prove it! I hope this

helps in your negotiations wiht your surgeons.

Virginia (Brisbane, Queensland, Australia)

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as

good candidates for hip resurfacing. Wish all of you great success!

Wonder, if there are any people who were evaluated as less than ideal

candidates, but who had the surgery anyway and have had positive

outcomes. Of course, would want to know about situations where

outcomes were not positive (Hope, though, that everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16,

2003) of my right hip. Surgeons here in NYC suggested a THR. I am 46

years old, and until recently, was very physically active. I

completed the NYC Marathon and sky-dived. I very much want a

resurfacing and would have it in a heartbeat if I was reasonably

confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the

Joint Replacement Institute. He said he would perform hip resurfacing

if I wanted it. However, he said I have " early femoral failure " and

cyst present. He said further, that normally the outcome is 95%

successful, but for me it would be 88%. Wonder, whether, given the

increased odds against me, I ought take the risk.

>

> It appears, I face a very difficult decision. Am I alone in this

are there others out there in similar situations and hopefully may

have some useful advice to pass my way? Any information is greatly

appreciated.

>

> (hopeful and determined to find the best treatment given my

situation)

>

> Warmly,

> (New York City)

[Guest guest]

Sunita,

I'm your age and I have osteoporosis, too. I also already had a

fracture of the femoral neck - which was the reason for the surgery

on a non-arthritic hip. As I had to lose the femoral neck anyway (it

wsn't salvageable as no blood supply and cyst formation), there

wasn't any risk becasue of teh osteoporosis. I had a BHR acetabular

cup and full metal " head " component, that slotted onto the standard

THR " stem " . This has worked out well for me and I've bounced back

and recovered well. (See my previous post.) This may be an option

you want to discuss with your surgeon.

Virginia (27/8/03, Brisbane, Australia)

> Hi

> I have not have the BHR yet but I am not the ideal candidate either

(scheduled for January 6 with De Smet): being 61 year old and my

bones are not in perfect condition (slight osteoporosis). Dr De Smet

told me that the risk for me was of femoral neck fracture but was not

a very big risk (did not quantify it though) and that if I had a

fracture I could have a THR.

> I wonder if your doc told you what kind of failure could happen in

these 22 %? I think it would be helpful to know if it fails what are

the solutions.

> good luck

> sunita

> Less than ideal hip resfacing candidates

>

>

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as

good candidates for hip resurfacing. Wish all of you great success!

Wonder, if there are any people who were evaluated as less than ideal

candidates, but who had the surgery anyway and have had positive

outcomes. Of course, would want to know about situations where

outcomes were not positive (Hope, though, that everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16,

2003) of my right hip. Surgeons here in NYC suggested a THR. I am 46

years old, and until recently, was very physically active. I

completed the NYC Marathon and sky-dived. I very much want a

resurfacing and would have it in a heartbeat if I was reasonably

confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the

Joint Replacement Institute. He said he would perform hip resurfacing

if I wanted it. However, he said I have " early femoral failure " and

cyst present. He said further, that normally the outcome is 95%

successful, but for me it would be 88%. Wonder, whether, given the

increased odds against me, I ought take the risk.

>

> It appears, I face a very difficult decision. Am I alone in this

are there others out there in similar situations and hopefully may

have some useful advice to pass my way? Any information is greatly

appreciated.

>

> (hopeful and determined to find the best treatment given my

situation)

>

> Warmly,

> (New York City)

>

>

[Guest guest]

Sunita,

I'm your age and I have osteoporosis, too. I also already had a

fracture of the femoral neck - which was the reason for the surgery

on a non-arthritic hip. As I had to lose the femoral neck anyway (it

wsn't salvageable as no blood supply and cyst formation), there

wasn't any risk becasue of teh osteoporosis. I had a BHR acetabular

cup and full metal " head " component, that slotted onto the standard

THR " stem " . This has worked out well for me and I've bounced back

and recovered well. (See my previous post.) This may be an option

you want to discuss with your surgeon.

Virginia (27/8/03, Brisbane, Australia)

> Hi

> I have not have the BHR yet but I am not the ideal candidate either

(scheduled for January 6 with De Smet): being 61 year old and my

bones are not in perfect condition (slight osteoporosis). Dr De Smet

told me that the risk for me was of femoral neck fracture but was not

a very big risk (did not quantify it though) and that if I had a

fracture I could have a THR.

> I wonder if your doc told you what kind of failure could happen in

these 22 %? I think it would be helpful to know if it fails what are

the solutions.

> good luck

> sunita

> Less than ideal hip resfacing candidates

>

>

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as

good candidates for hip resurfacing. Wish all of you great success!

Wonder, if there are any people who were evaluated as less than ideal

candidates, but who had the surgery anyway and have had positive

outcomes. Of course, would want to know about situations where

outcomes were not positive (Hope, though, that everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16,

2003) of my right hip. Surgeons here in NYC suggested a THR. I am 46

years old, and until recently, was very physically active. I

completed the NYC Marathon and sky-dived. I very much want a

resurfacing and would have it in a heartbeat if I was reasonably

confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the

Joint Replacement Institute. He said he would perform hip resurfacing

if I wanted it. However, he said I have " early femoral failure " and

cyst present. He said further, that normally the outcome is 95%

successful, but for me it would be 88%. Wonder, whether, given the

increased odds against me, I ought take the risk.

>

> It appears, I face a very difficult decision. Am I alone in this

are there others out there in similar situations and hopefully may

have some useful advice to pass my way? Any information is greatly

appreciated.

>

> (hopeful and determined to find the best treatment given my

situation)

>

> Warmly,

> (New York City)

>

>

[Guest guest]

Hi,

I totally agree with many of the comments made hereunder........ there is a

lot in just who you land as a surgeon if you are a marginal case and how

they read the %'s............. I have seen people get told they have a high

% chance of needing a THR when opened up, and another surgeon giving them a

low % ..........and the person getting the Resurface.........

This then being the case you have far more to think about with your

decision......... I didn't have any - it was a Resurface really or

nothing.......... as I was dealing with a fused hip of 35 years and a

history of osteomylitis....... Placing a metal shaft down my femur really is

a risky business for me........... and I only had a doctor having kittens

about me doing this on Sunday......... just to keep reminding me of the

odds.

I just found the best surgeon possible and threw the dice.......... little

more I could do if I wanted any form of life...........

However others get along fairly happily with THR's......... I have a truck

driver friend who has been running his business hauling gravel, fertlizer

etc for years with 2 THR's......... they are only the common garden variety

and I think he ended up with one leg shorter than the other to make matters

even more interesting for him...... So often these things are the luck of

the draw....... and a lot of other life issues come into play............and

I know it may sound silly, but how charmed your life has been to date plays

a role here..........

Having said all that there are a few things I see as significant with the

Resurface......... some of us simply don't like the idea of a shaft down

bone marrow and it obviously increases risks of infection etc given it was

always considered out of the question for me............. the bone loading

or stress factors are better with the Resurface...... i.e. the femor bone

has a better opportunity to remain stronger.......... and mine has actually

gained bone density since the operation.......... Against that you have the

possibility of having 2 operations in short space if for some reason your

Resurface ends up being one of those tiny number who fail........... but of

course if you have that kind of luck, there is no saying you may not fall

into the small % of people who find themselves having early hassles with a

THR and needing another operation anyway..........

Edith LBHR Dr. L Walter Syd Aust 8/02

> Hi and Sunita. I have been on this board for four years and

feel I

> have a Ph.D. in Hip Replacement. I don't but I have been resurfaced and

> revisioned in that time and have a very realist opinion on both

procedures. I

> constantly read on this board disinformation about both Resurfacing and

THR. I just

> read a post that said resurfacing will last 400 years. I understand that

> most people who have had resurfacing are extremely happy with it and I am

> absolutely convinced when it is good it is good. It may actually be great.

It was not

> for me. I am therefore trying to reach out to those who are may not be

good

> candidates and who have read all the hype about resurfacing and tell them

the

> following. If you are not a good candidate then explore all of your

options!

> There are others that can make you just as happy.

> Ask your OS the following: What caused my OA. How far advanced am I.

> What is my alternative if I am in surgery and I am not a good candidate.

Does the

> Component Company have a revision alternate? Will you do resurfacing no

> matter what! Really stress this last question!!!! Will my leg length be

affected or

> corrected? This will greatly affect you recovery and performance after

> surgery. Don't ask about %'s. Press them into a better answer than 88%. Do

I have

> Cysts? How will they affect my out come?

> Listen to their answers. Don't be confused with THR as only being a

> small fermur head with a plastic lining. Do you homework and be

comfortable with

> your decision. I have a great hip and so will you.

[Guest guest]

Hi,

I totally agree with many of the comments made hereunder........ there is a

lot in just who you land as a surgeon if you are a marginal case and how

they read the %'s............. I have seen people get told they have a high

% chance of needing a THR when opened up, and another surgeon giving them a

low % ..........and the person getting the Resurface.........

This then being the case you have far more to think about with your

decision......... I didn't have any - it was a Resurface really or

nothing.......... as I was dealing with a fused hip of 35 years and a

history of osteomylitis....... Placing a metal shaft down my femur really is

a risky business for me........... and I only had a doctor having kittens

about me doing this on Sunday......... just to keep reminding me of the

odds.

I just found the best surgeon possible and threw the dice.......... little

more I could do if I wanted any form of life...........

However others get along fairly happily with THR's......... I have a truck

driver friend who has been running his business hauling gravel, fertlizer

etc for years with 2 THR's......... they are only the common garden variety

and I think he ended up with one leg shorter than the other to make matters

even more interesting for him...... So often these things are the luck of

the draw....... and a lot of other life issues come into play............and

I know it may sound silly, but how charmed your life has been to date plays

a role here..........

Having said all that there are a few things I see as significant with the

Resurface......... some of us simply don't like the idea of a shaft down

bone marrow and it obviously increases risks of infection etc given it was

always considered out of the question for me............. the bone loading

or stress factors are better with the Resurface...... i.e. the femor bone

has a better opportunity to remain stronger.......... and mine has actually

gained bone density since the operation.......... Against that you have the

possibility of having 2 operations in short space if for some reason your

Resurface ends up being one of those tiny number who fail........... but of

course if you have that kind of luck, there is no saying you may not fall

into the small % of people who find themselves having early hassles with a

THR and needing another operation anyway..........

Edith LBHR Dr. L Walter Syd Aust 8/02

> Hi and Sunita. I have been on this board for four years and

feel I

> have a Ph.D. in Hip Replacement. I don't but I have been resurfaced and

> revisioned in that time and have a very realist opinion on both

procedures. I

> constantly read on this board disinformation about both Resurfacing and

THR. I just

> read a post that said resurfacing will last 400 years. I understand that

> most people who have had resurfacing are extremely happy with it and I am

> absolutely convinced when it is good it is good. It may actually be great.

It was not

> for me. I am therefore trying to reach out to those who are may not be

good

> candidates and who have read all the hype about resurfacing and tell them

the

> following. If you are not a good candidate then explore all of your

options!

> There are others that can make you just as happy.

> Ask your OS the following: What caused my OA. How far advanced am I.

> What is my alternative if I am in surgery and I am not a good candidate.

Does the

> Component Company have a revision alternate? Will you do resurfacing no

> matter what! Really stress this last question!!!! Will my leg length be

affected or

> corrected? This will greatly affect you recovery and performance after

> surgery. Don't ask about %'s. Press them into a better answer than 88%. Do

I have

> Cysts? How will they affect my out come?

> Listen to their answers. Don't be confused with THR as only being a

> small fermur head with a plastic lining. Do you homework and be

comfortable with

> your decision. I have a great hip and so will you.

[Guest guest]

Hi,

I totally agree with many of the comments made hereunder........ there is a

lot in just who you land as a surgeon if you are a marginal case and how

they read the %'s............. I have seen people get told they have a high

% chance of needing a THR when opened up, and another surgeon giving them a

low % ..........and the person getting the Resurface.........

This then being the case you have far more to think about with your

decision......... I didn't have any - it was a Resurface really or

nothing.......... as I was dealing with a fused hip of 35 years and a

history of osteomylitis....... Placing a metal shaft down my femur really is

a risky business for me........... and I only had a doctor having kittens

about me doing this on Sunday......... just to keep reminding me of the

odds.

I just found the best surgeon possible and threw the dice.......... little

more I could do if I wanted any form of life...........

However others get along fairly happily with THR's......... I have a truck

driver friend who has been running his business hauling gravel, fertlizer

etc for years with 2 THR's......... they are only the common garden variety

and I think he ended up with one leg shorter than the other to make matters

even more interesting for him...... So often these things are the luck of

the draw....... and a lot of other life issues come into play............and

I know it may sound silly, but how charmed your life has been to date plays

a role here..........

Having said all that there are a few things I see as significant with the

Resurface......... some of us simply don't like the idea of a shaft down

bone marrow and it obviously increases risks of infection etc given it was

always considered out of the question for me............. the bone loading

or stress factors are better with the Resurface...... i.e. the femor bone

has a better opportunity to remain stronger.......... and mine has actually

gained bone density since the operation.......... Against that you have the

possibility of having 2 operations in short space if for some reason your

Resurface ends up being one of those tiny number who fail........... but of

course if you have that kind of luck, there is no saying you may not fall

into the small % of people who find themselves having early hassles with a

THR and needing another operation anyway..........

Edith LBHR Dr. L Walter Syd Aust 8/02

> Hi and Sunita. I have been on this board for four years and

feel I

> have a Ph.D. in Hip Replacement. I don't but I have been resurfaced and

> revisioned in that time and have a very realist opinion on both

procedures. I

> constantly read on this board disinformation about both Resurfacing and

THR. I just

> read a post that said resurfacing will last 400 years. I understand that

> most people who have had resurfacing are extremely happy with it and I am

> absolutely convinced when it is good it is good. It may actually be great.

It was not

> for me. I am therefore trying to reach out to those who are may not be

good

> candidates and who have read all the hype about resurfacing and tell them

the

> following. If you are not a good candidate then explore all of your

options!

> There are others that can make you just as happy.

> Ask your OS the following: What caused my OA. How far advanced am I.

> What is my alternative if I am in surgery and I am not a good candidate.

Does the

> Component Company have a revision alternate? Will you do resurfacing no

> matter what! Really stress this last question!!!! Will my leg length be

affected or

> corrected? This will greatly affect you recovery and performance after

> surgery. Don't ask about %'s. Press them into a better answer than 88%. Do

I have

> Cysts? How will they affect my out come?

> Listen to their answers. Don't be confused with THR as only being a

> small fermur head with a plastic lining. Do you homework and be

comfortable with

> your decision. I have a great hip and so will you.

[Guest guest]

Thanks Virginia

I think that what you are talking about (the THR full metal head on the standard

stem) must be what Dr De Smet was talking about for a solution if I got a

fracture of the neck of the femur at post operation stage. The problem I

understand with that is to make sure I can find the " right " size of prothesis if

I needed a THR after a BHR because of fracture. He mentionned that a woman left

Belgium with the " right " prothesis in her luggage just in case... I wonder if I

should buy it too when I am there (it is quite expensive!).

Does that make sense?

sunita

Less than ideal hip resfacing candidates

>

>

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as

good candidates for hip resurfacing. Wish all of you great success!

Wonder, if there are any people who were evaluated as less than ideal

candidates, but who had the surgery anyway and have had positive

outcomes. Of course, would want to know about situations where

outcomes were not positive (Hope, though, that everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16,

2003) of my right hip. Surgeons here in NYC suggested a THR. I am 46

years old, and until recently, was very physically active. I

completed the NYC Marathon and sky-dived. I very much want a

resurfacing and would have it in a heartbeat if I was reasonably

confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the

Joint Replacement Institute. He said he would perform hip resurfacing

if I wanted it. However, he said I have " early femoral failure " and

cyst present. He said further, that normally the outcome is 95%

successful, but for me it would be 88%. Wonder, whether, given the

increased odds against me, I ought take the risk.

>

> It appears, I face a very difficult decision. Am I alone in this

are there others out there in similar situations and hopefully may

have some useful advice to pass my way? Any information is greatly

appreciated.

>

> (hopeful and determined to find the best treatment given my

situation)

>

> Warmly,

> (New York City)

>

>

[Guest guest]

Hi ,

When I was in Belgium Dr. De Smet mistakingly looked at the wrong xrays and

told me the day before surgery that I had avascular necrosis and that a

third of the head of my femur was dead. I was very upset about this, of

course, but he told me that resurfacing would not be a problem. When I was

about to go into surgery I asked him to show me on my xrays what avascular

necrosis looks like. He looked at my xrays and then said " you have none. "

I lost sleep over nothing. But anyway, even with a third of the head of the

femur dead he would have resurfaced me anyway without blinking an eye.

June

> Date: Wed, 12 Nov 2003 14:22:03 -0500

> From: treverfox@...

> Subject: Less than ideal hip resfacing candidates

>

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as good

> candidates for hip resurfacing. Wish all of you great success! Wonder, if

> there are any people who were evaluated as less than ideal candidates, but who

> had the surgery anyway and have had positive outcomes. Of course, would want

> to know about situations where outcomes were not positive (Hope, though, that

> everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16, 2003) of my

> right hip. Surgeons here in NYC suggested a THR. I am 46 years old, and until

> recently, was very physically active. I completed the NYC Marathon and

> sky-dived. I very much want a resurfacing and would have it in a heartbeat if

> I was reasonably confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the Joint

> Replacement Institute. He said he would perform hip resurfacing if I wanted

> it. However, he said I have " early femoral failure " and cyst present. He said

> further, that normally the outcome is 95% successful, but for me it would be

> 88%. Wonder, whether, given the increased odds against me, I ought take the

> risk.

>

> It appears, I face a very difficult decision. Am I alone in this are there

> others out there in similar situations and hopefully may have some useful

> advice to pass my way? Any information is greatly appreciated.

>

> (hopeful and determined to find the best treatment given my situation)

>

> Warmly,

> (New York City)

[Guest guest]

Hi ,

When I was in Belgium Dr. De Smet mistakingly looked at the wrong xrays and

told me the day before surgery that I had avascular necrosis and that a

third of the head of my femur was dead. I was very upset about this, of

course, but he told me that resurfacing would not be a problem. When I was

about to go into surgery I asked him to show me on my xrays what avascular

necrosis looks like. He looked at my xrays and then said " you have none. "

I lost sleep over nothing. But anyway, even with a third of the head of the

femur dead he would have resurfaced me anyway without blinking an eye.

June

> Date: Wed, 12 Nov 2003 14:22:03 -0500

> From: treverfox@...

> Subject: Less than ideal hip resfacing candidates

>

> Hello Everyone,

>

> Reading many wonderful postings about people being evaluated as good

> candidates for hip resurfacing. Wish all of you great success! Wonder, if

> there are any people who were evaluated as less than ideal candidates, but who

> had the surgery anyway and have had positive outcomes. Of course, would want

> to know about situations where outcomes were not positive (Hope, though, that

> everyone succeeded)

>

> I have been diagnosed with advanced Avascular Necrosis (Oct 16, 2003) of my

> right hip. Surgeons here in NYC suggested a THR. I am 46 years old, and until

> recently, was very physically active. I completed the NYC Marathon and

> sky-dived. I very much want a resurfacing and would have it in a heartbeat if

> I was reasonably confident that the procedure would hold and be long lasting.

>

> Recently, I have flown to see Dr. Schmalzried in LA at the Joint

> Replacement Institute. He said he would perform hip resurfacing if I wanted

> it. However, he said I have " early femoral failure " and cyst present. He said

> further, that normally the outcome is 95% successful, but for me it would be

> 88%. Wonder, whether, given the increased odds against me, I ought take the

> risk.

>

> It appears, I face a very difficult decision. Am I alone in this are there

> others out there in similar situations and hopefully may have some useful

> advice to pass my way? Any information is greatly appreciated.

>

> (hopeful and determined to find the best treatment given my situation)

>

> Warmly,

> (New York City)

[Guest guest]

At 09:28 PM 11/12/2003 -0800, you wrote:

> He mentionned that a woman left Belgium with the " right " prothesis in

> her luggage just in case... I wonder if I should buy it too when I am

> there (it is quite expensive!).

It would make an interesting (albeit expensive) paperweight, but no surgeon

in his right mind would implant it. He would likely lose his hospital

privileges, and the implant will have not gone through the proper

purchasing channels--at least in the states. What the rules are in other

countries...who knows?

Cindy

C+ 5/25/01 and 6/28/01

[Guest guest]

that is a good point Cindy; she was from Texas he told me; maybe she had made an

agreement with her surgeon in Texas beforehand? I am from Canada and don't know

the rules but what you say sounds logical. and yes it would be an expensive but

original paperweight!

sunita

Re: Re: Less than ideal hip resfacing candidates

At 09:28 PM 11/12/2003 -0800, you wrote:

> He mentionned that a woman left Belgium with the " right " prothesis in

> her luggage just in case... I wonder if I should buy it too when I am

> there (it is quite expensive!).

It would make an interesting (albeit expensive) paperweight, but no surgeon

in his right mind would implant it. He would likely lose his hospital

privileges, and the implant will have not gone through the proper

purchasing channels--at least in the states. What the rules are in other

countries...who knows?

Cindy

C+ 5/25/01 and 6/28/01

[Guest guest]

that is a good point Cindy; she was from Texas he told me; maybe she had made an

agreement with her surgeon in Texas beforehand? I am from Canada and don't know

the rules but what you say sounds logical. and yes it would be an expensive but

original paperweight!

sunita

Re: Re: Less than ideal hip resfacing candidates

At 09:28 PM 11/12/2003 -0800, you wrote:

> He mentionned that a woman left Belgium with the " right " prothesis in

> her luggage just in case... I wonder if I should buy it too when I am

> there (it is quite expensive!).

It would make an interesting (albeit expensive) paperweight, but no surgeon

in his right mind would implant it. He would likely lose his hospital

privileges, and the implant will have not gone through the proper

purchasing channels--at least in the states. What the rules are in other

countries...who knows?

Cindy

C+ 5/25/01 and 6/28/01

[Guest guest]

that is a good point Cindy; she was from Texas he told me; maybe she had made an

agreement with her surgeon in Texas beforehand? I am from Canada and don't know

the rules but what you say sounds logical. and yes it would be an expensive but

original paperweight!

sunita

Re: Re: Less than ideal hip resfacing candidates

At 09:28 PM 11/12/2003 -0800, you wrote:

> He mentionned that a woman left Belgium with the " right " prothesis in

> her luggage just in case... I wonder if I should buy it too when I am

> there (it is quite expensive!).

It would make an interesting (albeit expensive) paperweight, but no surgeon

in his right mind would implant it. He would likely lose his hospital

privileges, and the implant will have not gone through the proper

purchasing channels--at least in the states. What the rules are in other

countries...who knows?

Cindy

C+ 5/25/01 and 6/28/01

[Guest guest]

At 02:22 PM 11/12/2003 -0500, you wrote:

> I very much want a resurfacing and would have it in a heartbeat if I was

> reasonably confident that the procedure would hold and be long lasting.

>

>Recently, I have flown to see Dr. Schmalzried in LA at the Joint

>Replacement Institute. He said he would perform hip resurfacing if I

>wanted it. However, he said I have " early femoral failure " and cyst

>present. He said further, that normally the outcome is 95% successful, but

>for me it would be 88%. Wonder, whether, given the increased odds against

>me, I ought take the risk.

,

I was not an ideal candidate, but I was an even worse candidate for THR's

(the interior of my femurs are shaped funny and a regular stem would likely

have fractured them). I wonder if longer time on crutches might make some

of the borderline cases less so--the crutches giving the body time to

strengthen and heal without the stress of full weight-bearing and

activity. I was on crutches for seven months, then a cane for another few

months after that. So many say " I could never do that! " If you could

never do that, then get a large head THR. If you could, I wonder if that

would increase your chances of success? I had no trouble with the time on

crutches, as I was FAR more mobile with them than I had been pre-op, so

life on crutches was a HUGE improvement over what I had pre-op.

Thinking out loud again,

Cindy

C+ 5/25/01 and 6/28/01