Resurface or Metal on Metal THR

[Guest guest]

Hello Surface Hippies

I was considering a resurfacing for my badly degenerated hip. I am 48

years old and have been living with a hip that was operable when I

was 35. Ruined myself through overindulgence in sports. Anyway, I put

this off to wait for improvements in the technology. I really can't

put it off any longer for reasons that I am sure you are all well

aware of. Hip resurfacing appealed to my engineer's sensibilities.

Got the book by Peggy and I am most of the way through it. I

noticed in the back of the book that Dr. Alan Inglis was listed as

one of the Cormet 2000 surgeons and that he is in NYC which is close

to where I work. I gave Alan a call and left a message. He called me

back the next day talked to me for 15 minutes - he was very generous

with his time and advice. Dr. Inglis made the following points to me:

1)There is absolutely no way to get a resurfacing done NOW in the US.

The reason being that there are no studies under way presently and it

is actually illegal for any surgeon to perform a resurfacing unless

part of an approved study. I think he said that he might be doing

another study later this year.

2)Dr. Inglis completed his Cormet 2000 study a couple of years ago

and said that he had complete success with all 28 patients with no

complications to date. However, when I asked whether I should

consider waiting for another study (which would not be covered by any

type of insurance), wait for FDA approval (with means insurance

coverage) or go to Europe, I got a surprising answer. He said that

there was no point and that I would be better off with a THR using

the new metal on metal implants.

3)Dr. Inglis said that the main reason to go to a resurfacing type of

hip is for people who are concerned with maintianing very large range

of hip rotation. So, yogis, dancers and martial arts people would

need this but people only interested in conventional team sports or

sports like tennis would have no reason to consider resurfacing.

Dr.Inflis was of the opinion that a resurfaced hip would not be

likely to last any longer than a good THR for all types of

conventional activities.

4)Dr. Inglis also said that the THR was a better choice because the

operation is less brutal and the recovery times are shorter.

So, my thanks to Dr. Inglis for taking time to answer my questions so

frankly. I have to say that he definitely caused me to point back to

a THR even though I have been spending the last 13 years trying to

avoid one. There are a number of very good surgeons in the NYC area

that use the latest in metal on metal THRs and one is even in-network

for my insurance. I would like to hear opinions from this group that

would either support or challenge what I have just heard. This is

really a tough thing to decide. Thanks for your support.

Noah

[Guest guest]

>

> 1)There is absolutely no way to get a resurfacing done NOW in the US.

> The reason being that there are no studies under way presently and it

> is actually illegal for any surgeon to perform a resurfacing unless

> part of an approved study. I think he said that he might be doing

> another study later this year.

This is completely untrue. I'm scheduled for a bilateral resurfacing

(Conserve Plus) at JRI in 19 days. Ongoing studies using both the

Conserve Plus and Corin Cormet 2000 are still in progress.

The nearest resurfacing surgeon to you is Dr. Mont in Baltimore. I'd

strongly recommend that you contact him or one of the other surgeons

in the or Corin trials ASAP.

Steve

[Guest guest]

1) " There is absolutely no way to get a resurfacing done NOW in the US.

The reason being that there are no studies under way presently and it

is actually illegal for any surgeon to perform a resurfacing unless

part of an approved study. "

Response: Not really accurate. There are surgeons who have

compeleted their initial allocation of clinical trial devices for

both the Conserve+ and Cormet 2K who are continuing to do

resurfacings based on FDA approval for " continued access " . I know Dr

Mont from Sinai in Baltimore is one of the surgeons and I suspect all

the surgeons in the trials have or will request authority

for " continued access. "

2) " I got a surprising answer. He said that

there was no point and that I would be better off with a THR using

the new metal on metal implants. "

Response: By way of background: I was told by Dr Schmalzried from

JRI that I would be equally well-off with a m-o-m THR as the

resurfacing. At the time I doubted that. I went to Dr Mont for a

resurfacing but ended up with a m-o-m THR 20 months ago. I am now 7

weeks post-op with a Cormet 2K resurfacing on the other hip from Dr

Schmalzried. Since I am sitting here with both devices installed and

live 24/7 with them, I think I have some degree of experience few

others have on which to base my answer.

My answer, surprisingly, is AT THIS POINT, I would have to agree

with your doctor. My m-o-m has enabled me to ski, backpack and I

have totally forgotten that it is an artificial joint. It difficult

for me to think that a resurfacing could be any better than my THR,

BUT the ultimate answer is going to have to wait until 15-20 years

from now. My gut feel is that there are fewer failure modes with the

THR, less disruption to the femur and the natural " location " of the

bone and muscle and less chance for dislocation...that is why I opted

for the resurfacing on the second hip.

3) " Dr.Inflis was of the opinion that a resurfaced hip would not be

likely to last any longer than a good THR for all types of

conventional activities. "

RESPONSE: Until the data comes in 20 years from now, that is all

we are dealing with...opinions. He is probably correct, especially

if you are talking of " conventional activities " . If you consider

skiing, backpacking, rock climbing, running and other such " impact "

sports, I think the general consensus is that the resurfacing has a

far better chance of outlasting the THR. That does not mean it is

risk free and guaranteed not to fail under these type impacts...it

does put more stress on the components and as a result increase the

chances for ultimate failure...so you have to consider what amount of

risk you are willing to take and how important these activites are to

you personally. (not your surgeon)

4) " Dr. Inglis also said that the THR was a better choice because the

operation is less brutal and the recovery times are shorter. "

RESPONSE: This is the only item I would take issue with the

opinions offered by your surgeon. How can it be " less brutal " when

the acetabular side is identical (for large femoral balls), there is

no six-inch prothesis driven into the middle of the femoral canal and

the femoral head is not " cut off " ?

As far as recovery times, I can tell you what my experience is and

you can judge for yourself. I was doing things at three weeks post-

op with the resufacing that I could not do at six weeks post-op with

the THR. At six weeks post-op with the resurf, I was walking with no

crutch, no cane and no limp. With the THR at six weeks, I needed a

cane and limped badly. Dr Schmalzried cautioned me when I made this

comparison, that there are MANY factors which influence recovery

times--type of incision, skill of surgical team, condition of the

surrounding muscle/tissue, etc--and that to attribute differences in

recovery times to just one factor might not be accurate. It depends,

but based on my personal experience and the experiences of others I

have corresponded with, I would say the resurf recovery has a better

chance of a quicker recovery and return to normal activities.

Overall, I think you have to do the research, listen to qualified

opinions, decide what is important to YOU and how much risk YOU are

willing to assume...then make your decision. Its a decision you will

have to live with a long, long time...hopefully!! Good luck!

p.s You can see pictures of my THR and my resurfacing experience at

this website: http://groups.msn.com/hipuniversesupportgroup

Click on " Pictures " and look for " Denny's New Hip " and the " Denny's

Resufacing " albums.

DENNY M

[Guest guest]

Noah,

I'm sure Dr. Inglis has good credentials, but there's more to

the picture. Continue your research - get a 2nd opinion, and a 3rd,

or 4th until you get a more complete understanding of your options.

Taking responsibility for your health care is super important,

especially when there are differing opinions.

I was one of the first 50 to have my hip resurfaced with the C+ over

6 years ago. I had my second hip resurfaced 2/12/2004 in LA so that

shoots down Dr. Inglis's first point that you can't get it

done here in the US. Resurfacings are performed nearly every day in

the US. True, they have to be part of a clinical study of an implant

manufacture, but there are being performed.

Regarding #2, there are many surgeons with far more than 28

resurfacings under their belt and many of these are in the US. You

need to talk to one or more of these to see if they have the same

conclusions as Dr. Inglis. And some won't. Check the surgeon

locator on the Medical Technology web site for your area for

other surgeons. You'll find some surfacehippys will also

disagree, but in the end, it may because you more easily get

insurance coverage that leads you a M2M THR. My surgeon, Dr.

Amstutz, performs both M2M THR and resurfacing and feels resurfacing

is superior, although his colleague, Dr. Schmalzried, favors M2M

THR. Dr. Amsutz has more experience with resurfacing and I'm

told it requires more surgical skill, so you have to wonder how much

that influences their respective decisions.

Regarding #3, This is interesting and may be true now, but it

hasn't always been the case. Remember Bo ? He had THR

and needed a couple of revisions within three years. In early 1998,

when I had my first resurfacing, the M2M large head implant offered

the best hope of resumption of full athletic activity and the

possibility that it might last a lifetime. Technical improvements in

THR, specifically the large M2M head used in the resurfacing implant,

have given hope that its results will match those of M2M

resurfacing. Some surgeons obviously feel it will, but the final

verdict won't be in for many years. Regardless, resurfacing will

always have one advantage - no amputation of the femur, meaning no

limit on future options if new technologies emerge. I looked into

M2M THR when my insurance carrier denied my second resurfacing. I

found it had a slightly different loading than the more anatomically

correct resurfacing, but this may only be important if you're an

elite athlete. My gut also wondered why you would want to cut out

several inches of perfectly good bone.

Regarding #4. I heard this is true if THR is performed anterior,

meaning from the front of the leg. A few years ago, Jack Nicklaus

had THR metal-to-poly and was in the hospital one night. To my

knowledge, resurfacing is most always performed posterior (through

the buttocks) and requires a 3 – 4 night hospital stay. So that

part about different recovery time is true. However, you need to

look at the long term. Would you take a longer recovery for a better

end result? I'd certainly listen to any surgeon you find that

performs large head M2M THR with a one night hospital stay.

It's a sad think that insurance coverage or the lack of it may

dictate your choice, but that may be the deciding factor. You

have much more information available with more good options then when

I faced surgery over 6 years ago. Keep sorting it out and

selectively screen all the free advice. Give more weight to the

opinions of those with similar conditions to your own, and give more

credence to hard evidence over soft. Best of luck.

Dave