Surface replacement or THR?

[Guest guest]

I'm a 47 year old man who likes to hike in the mountains and play with

my 3 boys. I've had AVN in both hips for about 8 years since I had

neurosurgery which required that I be on streroids for an extended

period. I'm pretty tired of the pain in my hips and need to do

something about them soon. I've talked with Dr. Schmalzried of the

Joint Replacement Institute in Los Angeles and surface replacement is an

option. On the other hand there are a lot of new total hip devices out

there now, too. I'm looking for advice... Is surface replacement the

way to go, or is it riskier than the more conventional THR's. Of

course there are insurance issues, too -- has anyone had experience with

United Health Care?

Randy in NM

[Guest guest]

Hi Randy,

I've had more experience dealing with United Healthcare than I ever wanted!

Until a couple of weeks ago JRI was coding their hip resurfacings as

" unlisted procedure " because they wanted to increase the chances that after

FDA approval, hip resurfacing would have a separate insurance code with a

higher reimbursement for surgeons than the THR code. A couple of weeks ago

I got a call from Chuck to let me know that the JRI surgeons had

checked with the other surgeons in the Conserve + study and had decided,

effective immediately, to start using the THR code, as virtually all the

others have been doing all along. This policy change came too late for me.

Because of this policy, I've spent the past 9 months battling UHC writing

letters, calling, filing appeals for coverage of an investigational

procedure,during which time I've been in pain 24/7, and my hip damage has

progressed to the point that my window of opportunity to still have a

resurfacing done is now very small. I have no doubts the JRI surgeons are

excellent, but their coding policy has cost me dearly! I will be paying for

the proceure out of pocket, filing the claim after the fact, and hoping for

partial reimbursement! Several people on this site have been

Make sure that they are in fact using the THR code when they submit your

request for coverage! If they do, you will probably get UHC approval fairly

quickly, esp. since you haven't raised any red flags for them with a

previous " unlisted procedure " request. There have been a lot of postings in

recent weeks about the merits of resurfacing over THR, but the bottom line

is that resurfacing just conserves so much more bone than a THR, provides

normal range of motion, and loads the weight normally, on the head and neck

of the femur, instead of down the shaft of the femur. Stress shielding of

bone above the " stake " in a THR can cause osteolysis and loosening of the

femoral component over time. If you should need a hip revision years down

the road, revising a resurfacing is like a primary THR because you haven't

already chopped off the head & neck of the femur!

Research this thoroughly, and I think it will become clear to you that

resurfacing is the way to go for someone young who wants to remain active

for many tears to come.

Fortunately, when I sent my recent x-rays to Dr. De Smet in Belgium, he

3-mailed me back within 3 days, saying that I had so much damage to my hip

that I would need a dysplasia cup with screws (which neither of the devices

being studied in the US have), and very soon at that. He had an opening for

March 3rd, and I grabbed it!

Surface replacement or THR?

> I'm a 47 year old man who likes to hike in the mountains and play with

> my 3 boys. I've had AVN in both hips for about 8 years since I had

> neurosurgery which required that I be on streroids for an extended

> period. I'm pretty tired of the pain in my hips and need to do

> something about them soon. I've talked with Dr. Schmalzried of the

> Joint Replacement Institute in Los Angeles and surface replacement is an

> option. On the other hand there are a lot of new total hip devices out

> there now, too. I'm looking for advice... Is surface replacement the

> way to go, or is it riskier than the more conventional THR's. Of

> course there are insurance issues, too -- has anyone had experience with

> United Health Care?

>

> Randy in NM

>

>

>

>

>

>

>

[Guest guest]

Oops, I accidentally sent this before I fixed the typos and signed it!

Surface replacement or THR?

>

>

> > I'm a 47 year old man who likes to hike in the mountains and play with

> > my 3 boys. I've had AVN in both hips for about 8 years since I had

> > neurosurgery which required that I be on streroids for an extended

> > period. I'm pretty tired of the pain in my hips and need to do

> > something about them soon. I've talked with Dr. Schmalzried of the

> > Joint Replacement Institute in Los Angeles and surface replacement is an

> > option. On the other hand there are a lot of new total hip devices out

> > there now, too. I'm looking for advice... Is surface replacement the

> > way to go, or is it riskier than the more conventional THR's. Of

> > course there are insurance issues, too -- has anyone had experience with

> > United Health Care?

> >

> > Randy in NM

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Randy

Where in NM are you? A Surfaciehippie participant named Maya lives in Santa

Fe and went to Dr Amstutz @ JRI. She would be excellent for you to talk with

esp if you are located near each other.

I had my surgery in FL with DR Kennedy and my coverage was provided by United

Health Care. No problems there.

Yes there are many new developements in the THR. Look into the surguries -

THR and Surface replacement. As you gather information you may find your

comfort level. I am 48 and just could not be comfortable with the loss of bone

and

the metal shaft that goes down the femoral canal with a THR. Added to the

fact that revision surgery is something to highly think about.

Good Luck

Alyce

5/23/03 LC2K Wm Kennedy

[Guest guest]

Randy

Where in NM are you? A Surfaciehippie participant named Maya lives in Santa

Fe and went to Dr Amstutz @ JRI. She would be excellent for you to talk with

esp if you are located near each other.

I had my surgery in FL with DR Kennedy and my coverage was provided by United

Health Care. No problems there.

Yes there are many new developements in the THR. Look into the surguries -

THR and Surface replacement. As you gather information you may find your

comfort level. I am 48 and just could not be comfortable with the loss of bone

and

the metal shaft that goes down the femoral canal with a THR. Added to the

fact that revision surgery is something to highly think about.

Good Luck

Alyce

5/23/03 LC2K Wm Kennedy