Re: the case against resurfacing

[Guest guest]

Hi Folks ..Just came to the site again after about 9 months..I found the post

interesting enough and still enjoy hearing all the success stories as I am

one month away from my One year mark... I found though that, I was not compelled

to write in on any issue until now.

I just know what I went through to come to a decision about having surgery at

all...let alone THR vs BHR...blah blah blah...lets face it..

Coming to terms with that was enormous. To have felt so alone and afraid and

then come to find out there was the option of resurf after being told

un-equivocably by three Los Angeles top Orho's that I need a THR. and that I

was

crazy to consider the BHR because blah blah blah......excuse me.....No I had to

educate myself! Thank God for this site Thank God I trusted my instincts...

Through some stroke of luck I was informed and began an incredible journey by

educating myself, It put me in the seat of commander rather than victim!!

So if some of you feel compelled to get on some soap box about one doctor or

another who disagrees with this innovative surgery than so be it..For me I

found that in life we need to take what we like and and leave the rest.

There is no right answer there are answers and there is no right opinions

there are opinions. We have been blessed with the power of choice so if you are

NEW read read read ....keep an open mind and choose what is you best option...

Sue in CA

Very successful RBHR

Dr. Koen Godlike De Smet

3/11/03. ..

[Guest guest]

Hi,

I could only wish that when statements were made like

" As regular readers of this group know, most of the orthopedic community is

not yet convinced of the value of resurfacing. Many participants to this

site tend to dismiss these doctors as uninformed or unwilling to accept new

technology or, occasionally, untrustworthy. If most surgeons were doing

resurfacings with a minority of holdouots, I might agree with this

assessment. But as I understand it, the large majority of the orthopedic

community has not yet embraced this procedure. For me, it is important to

know why. "

The words in the USA were inserted...........this isn't true in other

countries............ and it is more about how things operate in USA than

the resurfacing device itself.......... Very highly respected doctors in my

country will now tell one that you put in the device that fits the

situation.........In younger patients if possible a resurface is considered

first and work down from there........for obviously some femurs are not able

to take a resurface........ Whether they like it or not one hour US

surgeons will also operate like that too.............

Sorry to keep harping..............

Edith LBHR Dr. L Walter Syd Aust 8/02

[Guest guest]

I must tell you, that i just had another newpaper pick up my story, really,

our story, about resurfacing. In it, there is a photo of me teaching pilates,

hugging my knees, and grinning ear to ear. If i were to have had a double

total hip replacement, i still would have had the metal ion issue. I would

have very likely a pain down the front of my thigh from the metal implant put

into the femur after the marrow is reamed out of the femural canal. I would

have had to give up my kayaaking, yoga and teaching pilates. I would not be

able to sit on the floor and play with children at least the way i do now.

From this newspaper article, i have had several phone calls. One from a woman

here in Corpus Christi who had a total hip replacement surgery scheduled. She

weighed the facts. She is only forty two. She cancelled her sugery

intending to check out resurfacing. If worse come to worse, you may have to

get a

total hip replacement later. BUT....the big BUT....you buy yourself TIME.

Precious TIME, so that you can have range of motion and activity as you wish.

Now we know that for sure, these resurfacings can last for twelve years,

because they all ready have! I think it was more of a risk to have the total

hip

replacement than to have my double resurfacings with Dr. De Smet! I just

recieved an email from Dr. Tom Gross nurse, who, in Colombia, South Carolina,

assists Dr. Gross with resurfacing surgeries. She read the book i wrote about

hip resurfacing. She said that three people have called her recently

because of the news coverage. THe interest of people and how they weigh the

facts

SPEAKS FOR ITSELF!

Peggy

bilateral

Dr. Koen De Smet

9-11-02

[Guest guest]

I must tell you, that i just had another newpaper pick up my story, really,

our story, about resurfacing. In it, there is a photo of me teaching pilates,

hugging my knees, and grinning ear to ear. If i were to have had a double

total hip replacement, i still would have had the metal ion issue. I would

have very likely a pain down the front of my thigh from the metal implant put

into the femur after the marrow is reamed out of the femural canal. I would

have had to give up my kayaaking, yoga and teaching pilates. I would not be

able to sit on the floor and play with children at least the way i do now.

From this newspaper article, i have had several phone calls. One from a woman

here in Corpus Christi who had a total hip replacement surgery scheduled. She

weighed the facts. She is only forty two. She cancelled her sugery

intending to check out resurfacing. If worse come to worse, you may have to

get a

total hip replacement later. BUT....the big BUT....you buy yourself TIME.

Precious TIME, so that you can have range of motion and activity as you wish.

Now we know that for sure, these resurfacings can last for twelve years,

because they all ready have! I think it was more of a risk to have the total

hip

replacement than to have my double resurfacings with Dr. De Smet! I just

recieved an email from Dr. Tom Gross nurse, who, in Colombia, South Carolina,

assists Dr. Gross with resurfacing surgeries. She read the book i wrote about

hip resurfacing. She said that three people have called her recently

because of the news coverage. THe interest of people and how they weigh the

facts

SPEAKS FOR ITSELF!

Peggy

bilateral

Dr. Koen De Smet

9-11-02

[Guest guest]

Hi ,

You raise concerns that everyone should explore and form their own

conclusions. I opted for the C2K after reviewing data available on

the web and discussions with a few surgeons. In their opinion, I was

trying to be too conservative ... and that long term data is not

available ... but so far it(resurfacing / replacement)is showing

promise. Their concern was my long term results. I believe the most

important issue is the skill of the surgeon and your comfort level.

We will be living with the results of our choices. Many individuals

have excellent long term results with a THR. Many factors come into

play.

Best wishes.

Stan aka Wolf

[Guest guest]

I just got back from my 7 month check up for resurfacing (I was about a month

late). I was resurfaced by Dr. Gross last July. My surgeon here in Houston

was always HIGHLY supportive of my decision to have resurfacing and was

thrilled to see how well it went. He told me that once there was FDA approval,

he

and MANY other orthos would be doing resurfacing.

He took down Dr. Gross' name and number to give him a call to tell him how

good everything looked, to discuss the device, and other chat.

Dr. G 7/03

[Guest guest]

Dear ,

Forgive us all because these comments by the OS who favors

THR bring back painful memories to many of us.

All of the points the OS made have been properly responded to

by BHR supporters. The data is there for this procedure to

be accepted but the medical community refuses still to accept it.

My favorite is no fear of dislocation and the fact that I don't

see or hear about the same number of horror stories and law suits

that are found with unsatisfied THR customers.

Jeff (C2K 1-3-03)

[Guest guest]

:

IMO - The reason orthopedic surgeons don't like hard bearing surfaces

and resurfacing is because it cuts out their continuing revenue

stream. The head nurse in the orthopedic wing at Fairfax Hospital in

Virginia told me about how their active patients had to come back

every few years to have new polyethylene inserts put in their hip and

knee replacements. That's a predictable revenue stream that ensures

the doc can continue to drive a new Mercedes. It's no surprise that

more durable technology scares them.

[Guest guest]

:

> 1. The metal ion issue. Human studies go back as much as 25 years

>and show no evidence of any problems. However, there are some animal

>studies that suggest there might be. No one can tell you with

>certainty whether the metal ions that will be shed from a metal on

>metal device will cause problems, such as cancer, in the long run.

>The data right now look good, but this does not mean there cannot be

>a problem in the future. (This argument applies with equal force to

>metal on metal THRs.)

The metal ion issue is not exclusively a problem with resurfacing, it

is a problem with any device with metal on metal bearing surfaces.

Strangely, many of those doctors who will not do a resurfacing will be

more than happy to give you a metal on metal THR. Does that make any

sense?

So, if you don't do metal on metal what do you do? If you are that

conservative you don't do ceramic on ceramic because that's even newer

and there's even less long term data on that. So, you do

polyethylene? Polyethylene is well proven . . . proven to cause

osteolysis (the leading cause of prothesis failure).

Don't even mention the irradiated (and other cross linked forms)

polyethylene - that has no long term track record and there are

several studies indicating the process may make the polyethylene

brittle.

> 2. Resurfacing has been tried in many different forms over the last

>25 years. Everything up until now has had very limited success.

>(Perhaps I should say has been a failure.) The current device

>appears to be a dramatic improvement over prior hip resurfacing

>procedures. But the long term results are not in.

One could make the same argument that THR's have a terrible track

record. 5 to 7 % dislocation rate, loosening due to osteolysis, not

to mention lousy quality of life.

> 3. This procedure requires more skill and more time than a total hip

>replacement. Competence of the surgeon is critical. Right now, there

>are not many surgeons in the US who have done a lot of them.

This is true and may explain why your doctor won't recommend the

procedure . . . because he can't do it. As long as it is being done

under the investigational device exemption, there will be a limited

number of surgeons able to do it (in the U.S.). Outside the U.S. it

is quickly becoming the standard procedure.

> 4.The technology on total hips has improved dramatically in the past

>few years. Components are now modular, meaning that in revision

>surgeries, the femoral component generally will not have to be

>replaced. (Dr. Dennis told me that in 18 years, he had not seen one

>of his patients have a loosening of the femoral component.) Instead,

>the ball of the femoral component or the liner of the acetabular

>component is replaced. (One of the principal arguments in favor of

>hip resurfacing is that it preserves bone stock in the femur in case

>a total hip is needed later. But if you never have to remove the

>femoral component of a THR, then this isn't an issue.) The design of

>the components has been very well refined, as has the surgical

>method. Materials have improved greatly. There is a a new kind of

>polyethylene that is much more durable that the old HDPE. DePuy is

>now conducting a trial with a new type of ceramic that appears to

>have greatly improved ceramic's resistance to shattering, and

> so ceramic on ceramic is now looking very good. (Not the ceramic

>that Jack advertises. Talk to your doctor if you want more

>info about ceramic. It is the most bio-inert material being used in

>hip replacements.)

How can you say the resurfacing is unproven and then say that there

are all kinds of new, unproven technologies that prove THR is superior

- there's a serious flaw in your logic. Also, if the good old THR is

so darn good, why are all these companies coming out with all these

new kinds of THRs? Because the good old THR isn't so good and they

are trying to make it better. They are making it better by using

ideas that are already part of all the resurfacing devices. Ideas

such as hard bearing surfaces, large femoral balls, and bone

conserving designs.

Your doctor is misleading you about the failure modes of THRs. They

don't even count it as a failure when the polyethylene wears out and

they have to replace it. Loosening (primarily due to osteolysis) is

the primary cause of THR failure. You need to do some research - your

doc is wrong!

> That, in essence, is the nature of the argument, as I understand it.

>Most hip surgeons who have been around a while are skeptical of new

>devices. They have seen too many prior devices that appeared to have

>great promise turn out to have unexpected problems, so they are risk

>adverse.

Exactly how many orthopedic surgeons did you interview before you came

to the conclusions about what " most " hip surgeons think? Is it a

statistically significant sample?

> To me, the decision rests in part on your risk tolerance. If you are

>the type of person who loves investing in NASDAQ stocks, who likes to

>rock climb, who enjoys whitewater kayaking, or who is a business

>entrepreneur, then hip resufacing is probably right for you. It may

>involve some extra risk, but the potential rewards are great. If you

>are the type of person who likes municipal bonds, golf, and a good

>book, then maybe hip resurfacing is not for you. I think of myself

>as somewhere in the middle (as probably are most of you), and so for

>me, this is a hard decision.

More importantly, it's a decision about what kind of quality of life

you want for the rest of your life. If you are happy to sit in front

of the TV in a recliner for the rest of your life - get a good old

faashioned, conservative, proven, Charnley style THR. If you want to

be able to climb rocks, or do some martial arts, or dance, or ice

skate, or play tennis, . . . . then you might want to consider

resurfacing.

> Total hip replacement is " the gold standard. " against which all

>other procedures, including hip resurfacing, are measured. Maybe hip

>resurfacing will become the new gold standard. We don't know that

>yet, but we need new hips now. For me, I think the gold standard

>might be the best way to go.

THR is the OLD standard, not the GOLD standard. But as long as you

are making an informed decision - it is your decision to make. As you

stated, you are very risk averse - for you maybe it's the right thing.

I could not recommend it to anyone.

[Guest guest]

in response..........let me just explain a little about my situation

I am 32 and had a resurfacing last july.....I work alongside my

orthopaedic surgeon every day in the operating theatre as a theatre

nurse. He retires this year and has been doing THR for years and was

taught a few years ago by MR Mcminn concerning the

resurfacing...there are also other surgeons in the hospital who do

resurfacings..........now during the time i have worked there and as

far back as anyone can remember no resurface has returned for

revision..........however many THR do come back.......now i know that

the THR has been around earlier but in response to the comment that a

THR femeoral component is never replaced........well it is!! I know

because i sit through hours of revision surgery and the femeorel

component of a THR is a BUGGER to get out andf it takes ages.

I understand that many people are wary of something so knew but,

since july i have been pain free , able to keep fit.....I am able to

play football with my son and dance etc etc. If in the future I have

to have a THR then so be it but if this avoids that even for a while

then I am happy...........

Lets face it I saw my surgeon do a hell of a lot of surgery before he

did mine and i would recommend the resurface to anyone....

sarah-lou (7/7/03) Mr , Midlesbrough, RBHR

[Guest guest]

> :

>

> > 1. The metal ion issue. Human studies go back as much as 25 years

> >and show no evidence of any problems. However, there are some

animal

> >studies that suggest there might be. No one can tell you with

> >certainty whether the metal ions that will be shed from a metal on

> >metal device will cause problems, such as cancer, in the long run.

> >The data right now look good, but this does not mean there cannot

be

> >a problem in the future. (This argument applies with equal force to

> >metal on metal THRs.)

>

> The metal ion issue is not exclusively a problem with resurfacing,

it

> is a problem with any device with metal on metal bearing surfaces.

> Strangely, many of those doctors who will not do a resurfacing will

be

> more than happy to give you a metal on metal THR. Does that make

any

> sense?

>

> So, if you don't do metal on metal what do you do? If you are that

> conservative you don't do ceramic on ceramic because that's even

newer

> and there's even less long term data on that. So, you do

> polyethylene? Polyethylene is well proven . . . proven to cause

> osteolysis (the leading cause of prothesis failure).

>

> Don't even mention the irradiated (and other cross linked forms)

> polyethylene - that has no long term track record and there are

> several studies indicating the process may make the polyethylene

> brittle.

>

>

> > 2. Resurfacing has been tried in many different forms over the

last

> >25 years. Everything up until now has had very limited success.

> >(Perhaps I should say has been a failure.) The current device

> >appears to be a dramatic improvement over prior hip resurfacing

> >procedures. But the long term results are not in.

>

>

> One could make the same argument that THR's have a terrible track

> record. 5 to 7 % dislocation rate, loosening due to osteolysis, not

> to mention lousy quality of life.

>

>

> > 3. This procedure requires more skill and more time than a total

hip

> >replacement. Competence of the surgeon is critical. Right now,

there

> >are not many surgeons in the US who have done a lot of them.

>

>

> This is true and may explain why your doctor won't recommend the

> procedure . . . because he can't do it. As long as it is being done

> under the investigational device exemption, there will be a limited

> number of surgeons able to do it (in the U.S.). Outside the U.S. it

> is quickly becoming the standard procedure.

>

>

> > 4.The technology on total hips has improved dramatically in the

past

> >few years. Components are now modular, meaning that in revision

> >surgeries, the femoral component generally will not have to be

> >replaced. (Dr. Dennis told me that in 18 years, he had not seen

one

> >of his patients have a loosening of the femoral component.)

Instead,

> >the ball of the femoral component or the liner of the acetabular

> >component is replaced. (One of the principal arguments in favor of

> >hip resurfacing is that it preserves bone stock in the femur in

case

> >a total hip is needed later. But if you never have to remove the

> >femoral component of a THR, then this isn't an issue.) The design

of

> >the components has been very well refined, as has the surgical

> >method. Materials have improved greatly. There is a a new kind of

> >polyethylene that is much more durable that the old HDPE. DePuy is

> >now conducting a trial with a new type of ceramic that appears to

> >have greatly improved ceramic's resistance to shattering, and

> > so ceramic on ceramic is now looking very good. (Not the ceramic

> >that Jack advertises. Talk to your doctor if you want

more

> >info about ceramic. It is the most bio-inert material being used in

> >hip replacements.)

>

>

> How can you say the resurfacing is unproven and then say that there

> are all kinds of new, unproven technologies that prove THR is

superior

> - there's a serious flaw in your logic. Also, if the good old THR

is

> so darn good, why are all these companies coming out with all these

> new kinds of THRs? Because the good old THR isn't so good and they

> are trying to make it better. They are making it better by using

> ideas that are already part of all the resurfacing devices. Ideas

> such as hard bearing surfaces, large femoral balls, and bone

> conserving designs.

>

>

> Your doctor is misleading you about the failure modes of THRs. They

> don't even count it as a failure when the polyethylene wears out and

> they have to replace it. Loosening (primarily due to osteolysis) is

> the primary cause of THR failure. You need to do some research -

your

> doc is wrong!

>

>

> > That, in essence, is the nature of the argument, as I understand

it.

> >Most hip surgeons who have been around a while are skeptical of new

> >devices. They have seen too many prior devices that appeared to

have

> >great promise turn out to have unexpected problems, so they are

risk

> >adverse.

>

>

> Exactly how many orthopedic surgeons did you interview before you

came

> to the conclusions about what " most " hip surgeons think? Is it a

> statistically significant sample?

>

>

> > To me, the decision rests in part on your risk tolerance. If you

are

> >the type of person who loves investing in NASDAQ stocks, who likes

to

> >rock climb, who enjoys whitewater kayaking, or who is a business

> >entrepreneur, then hip resufacing is probably right for you. It

may

> >involve some extra risk, but the potential rewards are great. If

you

> >are the type of person who likes municipal bonds, golf, and a good

> >book, then maybe hip resurfacing is not for you. I think of myself

> >as somewhere in the middle (as probably are most of you), and so

for

> >me, this is a hard decision.

>

>

> More importantly, it's a decision about what kind of quality of life

> you want for the rest of your life. If you are happy to sit in

front

> of the TV in a recliner for the rest of your life - get a good old

> faashioned, conservative, proven, Charnley style THR. If you want

to

> be able to climb rocks, or do some martial arts, or dance, or ice

> skate, or play tennis, . . . . then you might want to consider

> resurfacing.

>

>

> > Total hip replacement is " the gold standard. " against which all

> >other procedures, including hip resurfacing, are measured. Maybe

hip

> >resurfacing will become the new gold standard. We don't know that

> >yet, but we need new hips now. For me, I think the gold standard

> >might be the best way to go.

>

>

> THR is the OLD standard, not the GOLD standard. But as long as you

> are making an informed decision - it is your decision to make. As

you

> stated, you are very risk averse - for you maybe it's the right

thing.

> I could not recommend it to anyone.

>

>

>

Obviously, you don't know what you're talking about.You are so mis-

informed it's scary.I have a m/p RTHR and I hike, dance, ice skate,

ski, and I play tennis, as well as a lot of other things. You

shouldn't comment on something you know nothing about. At 20 yrs, 80%

of THR's are still going strong. Regarding m/m vs m/p. I think I'd

rather get osteolysis than possibly end up with cancer or other organ

problems.

dawkins

[Guest guest]

Dawkins

I think you got into some bad mushrooms! It's more likely that at 20

yrs 80% of THR's have already been revised at least once or their

owners have passed on. Glad to hear that yours is still hanging tough

though.

Regards,

Dr Steve Vince

Bilat BHR De Smet jan 6, 2004

> > :

> >

> > > 1. The metal ion issue. Human studies go back as much as 25 years

> > >and show no evidence of any problems. However, there are some

> animal

> > >studies that suggest there might be. No one can tell you with

> > >certainty whether the metal ions that will be shed from a metal on

> > >metal device will cause problems, such as cancer, in the long run.

> > >The data right now look good, but this does not mean there cannot

> be

> > >a problem in the future. (This argument applies with equal force to

> > >metal on metal THRs.)

> >

> > The metal ion issue is not exclusively a problem with resurfacing,

> it

> > is a problem with any device with metal on metal bearing surfaces.

> > Strangely, many of those doctors who will not do a resurfacing will

> be

> > more than happy to give you a metal on metal THR. Does that make

> any

> > sense?

> >

> > So, if you don't do metal on metal what do you do? If you are that

> > conservative you don't do ceramic on ceramic because that's even

> newer

> > and there's even less long term data on that. So, you do

> > polyethylene? Polyethylene is well proven . . . proven to cause

> > osteolysis (the leading cause of prothesis failure).

> >

> > Don't even mention the irradiated (and other cross linked forms)

> > polyethylene - that has no long term track record and there are

> > several studies indicating the process may make the polyethylene

> > brittle.

> >

> >

> > > 2. Resurfacing has been tried in many different forms over the

> last

> > >25 years. Everything up until now has had very limited success.

> > >(Perhaps I should say has been a failure.) The current device

> > >appears to be a dramatic improvement over prior hip resurfacing

> > >procedures. But the long term results are not in.

> >

> >

> > One could make the same argument that THR's have a terrible track

> > record. 5 to 7 % dislocation rate, loosening due to osteolysis, not

> > to mention lousy quality of life.

> >

> >

> > > 3. This procedure requires more skill and more time than a total

> hip

> > >replacement. Competence of the surgeon is critical. Right now,

> there

> > >are not many surgeons in the US who have done a lot of them.

> >

> >

> > This is true and may explain why your doctor won't recommend the

> > procedure . . . because he can't do it. As long as it is being done

> > under the investigational device exemption, there will be a limited

> > number of surgeons able to do it (in the U.S.). Outside the U.S. it

> > is quickly becoming the standard procedure.

> >

> >

> > > 4.The technology on total hips has improved dramatically in the

> past

> > >few years. Components are now modular, meaning that in revision

> > >surgeries, the femoral component generally will not have to be

> > >replaced. (Dr. Dennis told me that in 18 years, he had not seen

> one

> > >of his patients have a loosening of the femoral component.)

> Instead,

> > >the ball of the femoral component or the liner of the acetabular

> > >component is replaced. (One of the principal arguments in favor of

> > >hip resurfacing is that it preserves bone stock in the femur in

> case

> > >a total hip is needed later. But if you never have to remove the

> > >femoral component of a THR, then this isn't an issue.) The design

> of

> > >the components has been very well refined, as has the surgical

> > >method. Materials have improved greatly. There is a a new kind of

> > >polyethylene that is much more durable that the old HDPE. DePuy is

> > >now conducting a trial with a new type of ceramic that appears to

> > >have greatly improved ceramic's resistance to shattering, and

> > > so ceramic on ceramic is now looking very good. (Not the ceramic

> > >that Jack advertises. Talk to your doctor if you want

> more

> > >info about ceramic. It is the most bio-inert material being used in

> > >hip replacements.)

> >

> >

> > How can you say the resurfacing is unproven and then say that there

> > are all kinds of new, unproven technologies that prove THR is

> superior

> > - there's a serious flaw in your logic. Also, if the good old THR

> is

> > so darn good, why are all these companies coming out with all these

> > new kinds of THRs? Because the good old THR isn't so good and they

> > are trying to make it better. They are making it better by using

> > ideas that are already part of all the resurfacing devices. Ideas

> > such as hard bearing surfaces, large femoral balls, and bone

> > conserving designs.

> >

> >

> > Your doctor is misleading you about the failure modes of THRs. They

> > don't even count it as a failure when the polyethylene wears out and

> > they have to replace it. Loosening (primarily due to osteolysis) is

> > the primary cause of THR failure. You need to do some research -

> your

> > doc is wrong!

> >

> >

> > > That, in essence, is the nature of the argument, as I understand

> it.

> > >Most hip surgeons who have been around a while are skeptical of new

> > >devices. They have seen too many prior devices that appeared to

> have

> > >great promise turn out to have unexpected problems, so they are

> risk

> > >adverse.

> >

> >

> > Exactly how many orthopedic surgeons did you interview before you

> came

> > to the conclusions about what " most " hip surgeons think? Is it a

> > statistically significant sample?

> >

> >

> > > To me, the decision rests in part on your risk tolerance. If you

> are

> > >the type of person who loves investing in NASDAQ stocks, who likes

> to

> > >rock climb, who enjoys whitewater kayaking, or who is a business

> > >entrepreneur, then hip resufacing is probably right for you. It

> may

> > >involve some extra risk, but the potential rewards are great. If

> you

> > >are the type of person who likes municipal bonds, golf, and a good

> > >book, then maybe hip resurfacing is not for you. I think of myself

> > >as somewhere in the middle (as probably are most of you), and so

> for

> > >me, this is a hard decision.

> >

> >

> > More importantly, it's a decision about what kind of quality of life

> > you want for the rest of your life. If you are happy to sit in

> front

> > of the TV in a recliner for the rest of your life - get a good old

> > faashioned, conservative, proven, Charnley style THR. If you want

> to

> > be able to climb rocks, or do some martial arts, or dance, or ice

> > skate, or play tennis, . . . . then you might want to consider

> > resurfacing.

> >

> >

> > > Total hip replacement is " the gold standard. " against which all

> > >other procedures, including hip resurfacing, are measured. Maybe

> hip

> > >resurfacing will become the new gold standard. We don't know that

> > >yet, but we need new hips now. For me, I think the gold standard

> > >might be the best way to go.

> >

> >

> > THR is the OLD standard, not the GOLD standard. But as long as you

> > are making an informed decision - it is your decision to make. As

> you

> > stated, you are very risk averse - for you maybe it's the right

> thing.

> > I could not recommend it to anyone.

> >

> >

> >

>

>

>

> Obviously, you don't know what you're talking about.You are so mis-

> informed it's scary.I have a m/p RTHR and I hike, dance, ice skate,

> ski, and I play tennis, as well as a lot of other things. You

> shouldn't comment on something you know nothing about. At 20 yrs, 80%

> of THR's are still going strong. Regarding m/m vs m/p. I think I'd

> rather get osteolysis than possibly end up with cancer or other organ

> problems.

>

> dawkins

[Guest guest]

> > > :

> > >

> > > > 1. The metal ion issue. Human studies go back as much as 25

years

> > > >and show no evidence of any problems. However, there are some

> > animal

> > > >studies that suggest there might be. No one can tell you with

> > > >certainty whether the metal ions that will be shed from a

metal on

> > > >metal device will cause problems, such as cancer, in the long

run.

> > > >The data right now look good, but this does not mean there

cannot

> > be

> > > >a problem in the future. (This argument applies with equal

force to

> > > >metal on metal THRs.)

> > >

> > > The metal ion issue is not exclusively a problem with

resurfacing,

> > it

> > > is a problem with any device with metal on metal bearing

surfaces.

> > > Strangely, many of those doctors who will not do a resurfacing

will

> > be

> > > more than happy to give you a metal on metal THR. Does that

make

> > any

> > > sense?

> > >

> > > So, if you don't do metal on metal what do you do? If you are

that

> > > conservative you don't do ceramic on ceramic because that's

even

> > newer

> > > and there's even less long term data on that. So, you do

> > > polyethylene? Polyethylene is well proven . . . proven to cause

> > > osteolysis (the leading cause of prothesis failure).

> > >

> > > Don't even mention the irradiated (and other cross linked forms)

> > > polyethylene - that has no long term track record and there are

> > > several studies indicating the process may make the polyethylene

> > > brittle.

> > >

> > >

> > > > 2. Resurfacing has been tried in many different forms over

the

> > last

> > > >25 years. Everything up until now has had very limited success.

> > > >(Perhaps I should say has been a failure.) The current device

> > > >appears to be a dramatic improvement over prior hip resurfacing

> > > >procedures. But the long term results are not in.

> > >

> > >

> > > One could make the same argument that THR's have a terrible

track

> > > record. 5 to 7 % dislocation rate, loosening due to

osteolysis, not

> > > to mention lousy quality of life.

> > >

> > >

> > > > 3. This procedure requires more skill and more time than a

total

> > hip

> > > >replacement. Competence of the surgeon is critical. Right

now,

> > there

> > > >are not many surgeons in the US who have done a lot of them.

> > >

> > >

> > > This is true and may explain why your doctor won't recommend the

> > > procedure . . . because he can't do it. As long as it is being

done

> > > under the investigational device exemption, there will be a

limited

> > > number of surgeons able to do it (in the U.S.). Outside the

U.S. it

> > > is quickly becoming the standard procedure.

> > >

> > >

> > > > 4.The technology on total hips has improved dramatically in

the

> > past

> > > >few years. Components are now modular, meaning that in

revision

> > > >surgeries, the femoral component generally will not have to be

> > > >replaced. (Dr. Dennis told me that in 18 years, he had not

seen

> > one

> > > >of his patients have a loosening of the femoral component.)

> > Instead,

> > > >the ball of the femoral component or the liner of the

acetabular

> > > >component is replaced. (One of the principal arguments in

favor of

> > > >hip resurfacing is that it preserves bone stock in the femur

in

> > case

> > > >a total hip is needed later. But if you never have to remove

the

> > > >femoral component of a THR, then this isn't an issue.) The

design

> > of

> > > >the components has been very well refined, as has the surgical

> > > >method. Materials have improved greatly. There is a a new

kind of

> > > >polyethylene that is much more durable that the old HDPE.

DePuy is

> > > >now conducting a trial with a new type of ceramic that appears

to

> > > >have greatly improved ceramic's resistance to shattering, and

> > > > so ceramic on ceramic is now looking very good. (Not the

ceramic

> > > >that Jack advertises. Talk to your doctor if you

want

> > more

> > > >info about ceramic. It is the most bio-inert material being

used in

> > > >hip replacements.)

> > >

> > >

> > > How can you say the resurfacing is unproven and then say that

there

> > > are all kinds of new, unproven technologies that prove THR is

> > superior

> > > - there's a serious flaw in your logic. Also, if the good old

THR

> > is

> > > so darn good, why are all these companies coming out with all

these

> > > new kinds of THRs? Because the good old THR isn't so good and

they

> > > are trying to make it better. They are making it better by

using

> > > ideas that are already part of all the resurfacing devices.

Ideas

> > > such as hard bearing surfaces, large femoral balls, and bone

> > > conserving designs.

> > >

> > >

> > > Your doctor is misleading you about the failure modes of THRs.

They

> > > don't even count it as a failure when the polyethylene wears

out and

> > > they have to replace it. Loosening (primarily due to

osteolysis) is

> > > the primary cause of THR failure. You need to do some

research -

> > your

> > > doc is wrong!

> > >

> > >

> > > > That, in essence, is the nature of the argument, as I

understand

> > it.

> > > >Most hip surgeons who have been around a while are skeptical

of new

> > > >devices. They have seen too many prior devices that appeared

to

> > have

> > > >great promise turn out to have unexpected problems, so they

are

> > risk

> > > >adverse.

> > >

> > >

> > > Exactly how many orthopedic surgeons did you interview before

you

> > came

> > > to the conclusions about what " most " hip surgeons think? Is it

a

> > > statistically significant sample?

> > >

> > >

> > > > To me, the decision rests in part on your risk tolerance. If

you

> > are

> > > >the type of person who loves investing in NASDAQ stocks, who

likes

> > to

> > > >rock climb, who enjoys whitewater kayaking, or who is a

business

> > > >entrepreneur, then hip resufacing is probably right for you.

It

> > may

> > > >involve some extra risk, but the potential rewards are great.

If

> > you

> > > >are the type of person who likes municipal bonds, golf, and a

good

> > > >book, then maybe hip resurfacing is not for you. I think of

myself

> > > >as somewhere in the middle (as probably are most of you), and

so

> > for

> > > >me, this is a hard decision.

> > >

> > >

> > > More importantly, it's a decision about what kind of quality of

life

> > > you want for the rest of your life. If you are happy to sit in

> > front

> > > of the TV in a recliner for the rest of your life - get a good

old

> > > faashioned, conservative, proven, Charnley style THR. If you

want

> > to

> > > be able to climb rocks, or do some martial arts, or dance, or

ice

> > > skate, or play tennis, . . . . then you might want to consider

> > > resurfacing.

> > >

> > >

> > > > Total hip replacement is " the gold standard. " against which

all

> > > >other procedures, including hip resurfacing, are measured.

Maybe

> > hip

> > > >resurfacing will become the new gold standard. We don't know

that

> > > >yet, but we need new hips now. For me, I think the gold

standard

> > > >might be the best way to go.

> > >

> > >

> > > THR is the OLD standard, not the GOLD standard. But as long as

you

> > > are making an informed decision - it is your decision to make.

As

> > you

> > > stated, you are very risk averse - for you maybe it's the right

> > thing.

> > > I could not recommend it to anyone.

> > >

> > >

> > >

> >

> >

> >

> > Obviously, you don't know what you're talking about.You are so

mis-

> > informed it's scary.I have a m/p RTHR and I hike, dance, ice

skate,

> > ski, and I play tennis, as well as a lot of other things. You

> > shouldn't comment on something you know nothing about. At 20 yrs,

80%

> > of THR's are still going strong. Regarding m/m vs m/p. I think

I'd

> > rather get osteolysis than possibly end up with cancer or other

organ

> > problems.

> >

> > dawkins

[Guest guest]

Just an attempt to lighten the mood, dawkins! I've seen a fair number

of bad hips and THR's in the past 20 years and your 80% at 20 figure

is high across a broad collection of devices based on that experience.

THA devices are constantly improving but until your revelation none

that I'm aware of has come with the kind of activity recommendation or

longevity claim that you're describing. Perhaps you would share your

experience a bit more specifically? What kind of THR device do you

have? Why did you get it? How old were you when you got it? How old

are you now? Anything that might be of benefit to the group at large

as we collectively deal with hip failure and it's remedies.

Regards.

Dr Steve Vince

Bilat BHR De Smet Jan 6, 2004

> > > > :

> > > >

> > > > > 1. The metal ion issue. Human studies go back as much as 25

> years

> > > > >and show no evidence of any problems. However, there are some

> > > animal

> > > > >studies that suggest there might be. No one can tell you with

> > > > >certainty whether the metal ions that will be shed from a

> metal on

> > > > >metal device will cause problems, such as cancer, in the long

> run.

> > > > >The data right now look good, but this does not mean there

> cannot

> > > be

> > > > >a problem in the future. (This argument applies with equal

> force to

> > > > >metal on metal THRs.)

> > > >

> > > > The metal ion issue is not exclusively a problem with

> resurfacing,

> > > it

> > > > is a problem with any device with metal on metal bearing

> surfaces.

> > > > Strangely, many of those doctors who will not do a resurfacing

> will

> > > be

> > > > more than happy to give you a metal on metal THR. Does that

> make

> > > any

> > > > sense?

> > > >

> > > > So, if you don't do metal on metal what do you do? If you are

> that

> > > > conservative you don't do ceramic on ceramic because that's

> even

> > > newer

> > > > and there's even less long term data on that. So, you do

> > > > polyethylene? Polyethylene is well proven . . . proven to cause

> > > > osteolysis (the leading cause of prothesis failure).

> > > >

> > > > Don't even mention the irradiated (and other cross linked forms)

> > > > polyethylene - that has no long term track record and there are

> > > > several studies indicating the process may make the polyethylene

> > > > brittle.

> > > >

> > > >

> > > > > 2. Resurfacing has been tried in many different forms over

> the

> > > last

> > > > >25 years. Everything up until now has had very limited success.

> > > > >(Perhaps I should say has been a failure.) The current device

> > > > >appears to be a dramatic improvement over prior hip resurfacing

> > > > >procedures. But the long term results are not in.

> > > >

> > > >

> > > > One could make the same argument that THR's have a terrible

> track

> > > > record. 5 to 7 % dislocation rate, loosening due to

> osteolysis, not

> > > > to mention lousy quality of life.

> > > >

> > > >

> > > > > 3. This procedure requires more skill and more time than a

> total

> > > hip

> > > > >replacement. Competence of the surgeon is critical. Right

> now,

> > > there

> > > > >are not many surgeons in the US who have done a lot of them.

> > > >

> > > >

> > > > This is true and may explain why your doctor won't recommend the

> > > > procedure . . . because he can't do it. As long as it is being

> done

> > > > under the investigational device exemption, there will be a

> limited

> > > > number of surgeons able to do it (in the U.S.). Outside the

> U.S. it

> > > > is quickly becoming the standard procedure.

> > > >

> > > >

> > > > > 4.The technology on total hips has improved dramatically in

> the

> > > past

> > > > >few years. Components are now modular, meaning that in

> revision

> > > > >surgeries, the femoral component generally will not have to be

> > > > >replaced. (Dr. Dennis told me that in 18 years, he had not

> seen

> > > one

> > > > >of his patients have a loosening of the femoral component.)

> > > Instead,

> > > > >the ball of the femoral component or the liner of the

> acetabular

> > > > >component is replaced. (One of the principal arguments in

> favor of

> > > > >hip resurfacing is that it preserves bone stock in the femur

> in

> > > case

> > > > >a total hip is needed later. But if you never have to remove

> the

> > > > >femoral component of a THR, then this isn't an issue.) The

> design

> > > of

> > > > >the components has been very well refined, as has the surgical

> > > > >method. Materials have improved greatly. There is a a new

> kind of

> > > > >polyethylene that is much more durable that the old HDPE.

> DePuy is

> > > > >now conducting a trial with a new type of ceramic that appears

> to

> > > > >have greatly improved ceramic's resistance to shattering, and

> > > > > so ceramic on ceramic is now looking very good. (Not the

> ceramic

> > > > >that Jack advertises. Talk to your doctor if you

> want

> > > more

> > > > >info about ceramic. It is the most bio-inert material being

> used in

> > > > >hip replacements.)

> > > >

> > > >

> > > > How can you say the resurfacing is unproven and then say that

> there

> > > > are all kinds of new, unproven technologies that prove THR is

> > > superior

> > > > - there's a serious flaw in your logic. Also, if the good old

> THR

> > > is

> > > > so darn good, why are all these companies coming out with all

> these

> > > > new kinds of THRs? Because the good old THR isn't so good and

> they

> > > > are trying to make it better. They are making it better by

> using

> > > > ideas that are already part of all the resurfacing devices.

> Ideas

> > > > such as hard bearing surfaces, large femoral balls, and bone

> > > > conserving designs.

> > > >

> > > >

> > > > Your doctor is misleading you about the failure modes of THRs.

> They

> > > > don't even count it as a failure when the polyethylene wears

> out and

> > > > they have to replace it. Loosening (primarily due to

> osteolysis) is

> > > > the primary cause of THR failure. You need to do some

> research -

> > > your

> > > > doc is wrong!

> > > >

> > > >

> > > > > That, in essence, is the nature of the argument, as I

> understand

> > > it.

> > > > >Most hip surgeons who have been around a while are skeptical

> of new

> > > > >devices. They have seen too many prior devices that appeared

> to

> > > have

> > > > >great promise turn out to have unexpected problems, so they

> are

> > > risk

> > > > >adverse.

> > > >

> > > >

> > > > Exactly how many orthopedic surgeons did you interview before

> you

> > > came

> > > > to the conclusions about what " most " hip surgeons think? Is it

> a

> > > > statistically significant sample?

> > > >

> > > >

> > > > > To me, the decision rests in part on your risk tolerance. If

> you

> > > are

> > > > >the type of person who loves investing in NASDAQ stocks, who

> likes

> > > to

> > > > >rock climb, who enjoys whitewater kayaking, or who is a

> business

> > > > >entrepreneur, then hip resufacing is probably right for you.

> It

> > > may

> > > > >involve some extra risk, but the potential rewards are great.

> If

> > > you

> > > > >are the type of person who likes municipal bonds, golf, and a

> good

> > > > >book, then maybe hip resurfacing is not for you. I think of

> myself

> > > > >as somewhere in the middle (as probably are most of you), and

> so

> > > for

> > > > >me, this is a hard decision.

> > > >

> > > >

> > > > More importantly, it's a decision about what kind of quality of

> life

> > > > you want for the rest of your life. If you are happy to sit in

> > > front

> > > > of the TV in a recliner for the rest of your life - get a good

> old

> > > > faashioned, conservative, proven, Charnley style THR. If you

> want

> > > to

> > > > be able to climb rocks, or do some martial arts, or dance, or

> ice

> > > > skate, or play tennis, . . . . then you might want to consider

> > > > resurfacing.

> > > >

> > > >

> > > > > Total hip replacement is " the gold standard. " against which

> all

> > > > >other procedures, including hip resurfacing, are measured.

> Maybe

> > > hip

> > > > >resurfacing will become the new gold standard. We don't know

> that

> > > > >yet, but we need new hips now. For me, I think the gold

> standard

> > > > >might be the best way to go.

> > > >

> > > >

> > > > THR is the OLD standard, not the GOLD standard. But as long as

> you

> > > > are making an informed decision - it is your decision to make.

> As

> > > you

> > > > stated, you are very risk averse - for you maybe it's the right

> > > thing.

> > > > I could not recommend it to anyone.

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > Obviously, you don't know what you're talking about.You are so

> mis-

> > > informed it's scary.I have a m/p RTHR and I hike, dance, ice

> skate,

> > > ski, and I play tennis, as well as a lot of other things. You

> > > shouldn't comment on something you know nothing about. At 20 yrs,

> 80%

> > > of THR's are still going strong. Regarding m/m vs m/p. I think

> I'd

> > > rather get osteolysis than possibly end up with cancer or other

> organ

> > > problems.

> > >

> > > dawkins

[Guest guest]

Dawkins:

I apologize to you and the group for exagerating. My point, which I

concede to you I overstated, was that conventional THR's come with

permanent lifestyle restrictions which are far more restrictive than

those typically advised to Resurfacing patients or patients receiving

large femoral head, metal-on-metal THRs. For example, the OS I first

saw explained to me that one of the permanent lifestyle restrictions

was that I could never (not just during recovery, but never) cross my

legs. That makes quite a number of activities quite difficult. I was

told I would have to give up downhill skiing because it was too risky.

The typical, smaller femoral head, THR (which is typically metal on

polyethylene) yields dramatically reduced range of motion compared to

a resurface or large head THR. This means there are lots of things

that you can't do (or you do them at risk of dislocation). I

repeatedly hear 5% to 7% dislocation rates (again, this was quoted to

me by the first OS I saw) for conventional THRs. So far, Resurfacing

and large head THRs are seeing rates less than 1%. Again, this has a

large impact on the activities you can do after receiving the device.

How does your orthopedic surgeon feel about you playing tennis and

skiing (and I am assuming you play singles and downhill ski, correct)?

Does he/she recommend this level of activity? Did he/she suggest

any warnings or restrictions?

Revision surgery represents 17% of all hip replacements but the number

of revisions is increasing. The consensus opinion now is this is

because younger and younger patients are receiving THR's and due to

their activity levels, they are failing sooner. I refer you to the

AAOS publication " Implant Wear in Total Joint Replacement " page 3.

For the same reasons (younger patients and more active patients) the

incidence of osteolysis is thought to be on the increase. Page 43,

same publication.

Based on what I have researched, I don't think the 20% failure rate

you have quoted is off base. I have not been able to confirm the 20

years - I think you are being optimistic there - most of the studies I

have seen are only quoting over 10 years. I would be interested in

your research sources on that. In any event, I consider a one in five

failure rate to be pretty bad - especially if I might be the one!

I am aware of no studies indicating metal debris causes cancer. If

you know of one, do the group a favor and post the title or a link if

it's available on the web. There are studies that indicate

polyethylene wear causes osteolysis. I refer you to page 98 of the

publication cited above.

This publication " Implant Wear " is not a bible but it does summarize

hundreds of peer reviewed clinical studies and is very informative.

It is available from AAOS.

>

> Obviously, you don't know what you're talking about.You are so mis-

> informed it's scary.I have a m/p RTHR and I hike, dance, ice skate,

> ski, and I play tennis, as well as a lot of other things. You

> shouldn't comment on something you know nothing about. At 20 yrs, 80%

> of THR's are still going strong. Regarding m/m vs m/p. I think I'd

> rather get osteolysis than possibly end up with cancer or other organ

> problems.

>

> dawkins

[Guest guest]

To all:

I have been absent for quite a while. For nothing but good reasons. Since

the resurfacing of my right hip in October 2002 (Dr. s, Baltimore, Good

Samaritan Hospital, Corin trial), I have gotten my life back and have become

joyously very unfocused on my hip.

I had told my sad tale of physical and emotional degeneration quite a few

times for the benefit of skeptics who luckily continue to find surfacehippy.com

-- and of my search for a solution, which took me to top OSs in Manhattan, each

of whom had his own favorite material, device, method, etc. And each of whom

pooh-poohed resurfacing, while demonstrating little real knowledge of the

procedure, the devices or the non-U.S. results.

In any event, many of you have responded to in detail so I won't

attempt to add anything to what's already said. Except that, from my purely

personal perspective, I thank whatever higher power there is that I chose to be

resurfacedly hip. And I take this opportunity for a long overdue " thank you, "

as

well, to all the surface hippies who came before me, inspired me and helped me

resist the naysayers, including family and close friends, who just wanted me

to " fix it fast " and stop the pain. I took the time to meet with THR-only

doctors and a surgeon in each of the trials, interview patients of both, read

everything I could find, kept my mind open and took my time.

Clearly I made the right decision for me -- and always recommend fully

exploring this option to anyone I've come in contact with for the past 18

months.

If ever my left hip goes, I'll be a reresurfacer in a nanosecond.

Thank you all.

Maureen in Manhattan