| The first step in finding out if Hip Resurfacing is right | | | | Many doctors will vary in their opinions on the number |
| for you or whether or not you qualify for hip | | | | of procedures needed to get past the learning curve. |
| resurfacing, is selecting the right surgeon. Selecting | | | | And yes, there is a proven learning curve, check the |
| the right surgeon is crucial to getting long term | | | | referenced website under Articles, Learning Curve. |
| positive results. It is a personal decision but one that | | | | With resurfacing, actually with any surgery but with |
| must be taken very seriously. First you MUST see a | | | | one as technical as resurfacing, there is definitely a |
| surgeon that does both hip resurfacing and THR | | | | learning curve. Some say 50, some 100, some 150 |
| (Total Hip Replacement). Make sure the surgeon has | | | | and now many are saying 200, even 500 now. I |
| done at least 100 hip resurfacing surgeries or they | | | | agree with at least the 200 number AND the number |
| might be a bait and switch doctor. Unfortunately | | | | should not be the only determining factor. How often |
| there are many of those out there since only a small | | | | does the surgeon do these procedures? If he did 100 |
| percentage of really skilled surgeons do hip | | | | five years ago and now has taken the next 5 years |
| resurfacing. This is due to the fact that hip | | | | to do the next 100, then I would say that is not |
| resurfacing is a very technically demanding procedure, | | | | enough experience, in my opinion. How many failures |
| a lot more difficult for the doctor to do than a THR. | | | | has he/she had? How about misplaced devices that |
| These bait and switch doctors will advertise that | | | | cause long term groin pain? What about slipped cups? |
| they do hip resurfacing, only to talk their patients into | | | | I use a piano analogy when describing the experience |
| a THR. I went to a highly respected surgeon at | | | | and skill of a surgeon for hip resurfacing. With the |
| Stanford that told me I did not qualify for hip | | | | piano, you will get one or two people that will sit |
| resurfacing due to having dysplasia. There are many | | | | down and be instant Mozarts, but those are |
| patients with dysplasia that have been successfully | | | | extremely rare. You will get a group that will be |
| resurfaced by doctors that are skilled in hip | | | | incredibly good even when they first start out and |
| resurfacing. I found out later that he did not do full | | | | their excellent skills and talent just keep improving |
| hip resurfacing, he only did hemi resurfacing. He was | | | | with time. You will get a group that with a LOT of |
| a bait and switch doctor who will basically try to talk | | | | practice, they will be pretty good but never |
| every patient that asks for hip resurfacing into a | | | | outstanding at it. Then you will get a group that no |
| THR and still does to this day. | | | | matter how often they practice or how long they |
| Think of it this way, why would someone want to | | | | have played the piano, they are just NOT going to |
| send business away, if the doctor does not do the | | | | EVER play the piano well. They might even be good |
| procedure he is probably not going to know if you | | | | at teaching the piano but they themselves will never |
| are a candidate for it or not. If one surgeon tells you | | | | be very good at playing it. |
| that you are not a candidate, seek out more than | | | | There are so many factors involved in a successful |
| one opinion. I saw three doctors that all told me to | | | | resurfacing. The more experience a surgeon has, the |
| get a THR, none of them did hip resurfacing. I then | | | | more complicated cases he/she will be able to tackle. |
| sought out three more opinions from top hip | | | | Many patients that go to the more experienced |
| resurfacing surgeons via email, they all told me I was | | | | surgeons will also enjoy quicker recoveries |
| an ideal candidate for hip resurfacing. My hip was | | | | A top surgeon when asked how many it takes to be |
| successfully resurfaced on December 1, 2005, more | | | | proficient responded with the fact that Surgeon |
| than three years ago and I am doing fantastic. | | | | talent varies tremendously, probably more so than |
| I can not emphasize this point enough. Please keep | | | | athletic talent. The problem is that it is extremely |
| this in mind when first looking for a surgeon, do NOT | | | | hard for a non surgeon to evaluate who is best. |
| waste your time seeing surgeons that do not do hip | | | | Some have done large numbers and still are not |
| resurfacing or have just started out, if you do, get | | | | particularly skilled. Some are good at writing research |
| second third and even fourth opinions, I sought out 6 | | | | papers but are not so skilled at cutting. Unless you |
| doctors. There is a list of experienced doctors on the | | | | are a surgeon who knows the literature in this field |
| referenced website which is an excellent starting | | | | and can watch several surgeons before they make a |
| point, some will give you free email consults, that | | | | decision; I advise you to talk to a few patients who |
| way you don't have to even travel or waste the | | | | have had a particular surgeon work on them and |
| time making so many appointments to find out if you | | | | base most of your decision on this word of mouth |
| qualify for resurfacing. Some of the top hip | | | | reputation. Most reasonably talented Joint |
| resurfacing surgeons in the world offer free email | | | | Replacement Fellowship trained orthopedic surgeons |
| consults because they realize how difficult it is to find | | | | will probably be adequate after 100 Resurfacing; over |
| a good experienced hip resurfacing surgeon. Plus | | | | 500 to be considered experienced. |
| many patients have had to travel to get the best | | | | The most important decision you will make is |
| care, so it is easier to get a remote consult than | | | | selecting the right surgeon. It is strictly a personal |
| traveling for each one, especially when you are in | | | | decision and no one can make that decision for you. |
| pain while you are doing your research. | | | | Bottom line, your chance of a successful outcome is |
| Once you find out you are a candidate for hip | | | | greatly improved when choosing a surgeon with |
| resurfacing, the next most important factor in | | | | more skill and experience. Do your research, make |
| choosing a surgeon is his/her experience and skill level. | | | | sure your surgeon has done at least 100 hip |
| When faced with having to have surgery myself, I | | | | resurfacing procedures, has been properly trained and |
| chose to go to one of the best surgeons in the | | | | has an excellent track record. Trust your gut |
| world and pay out of pocket for it. My insurance | | | | instincts, but ask the right questions until you hear |
| company would only cover a Total Hip Replacement | | | | the right answers for you. Also post on the Yahoo |
| surgery for me here in the U.S. If I would have | | | | Surface Hippy message board (link below), many |
| chosen that option, the surgery would have cost me | | | | patients are happy to help answer your questions |
| nothing. But when I look at the limitations my Mom | | | | regarding different doctors. |
| has with her two THR's, (she can not even cross her | | | | Selecting the Right Surgeon is the single most |
| legs) I just could not allow myself in my 40's to be | | | | important decision you will make in regards to your |
| limited for the rest of my life. I thought about the | | | | surgery, recovery and livelihood moving forward. |
| amount of money I paid for the car I drive for | | | | Hope this helps you get started on your journey. |
| maybe an hour a day, I have my hip with me 24/7 | | | | Questions to ask your doctor if you want to get |
| for the rest of my life, what was that worth to me? | | | | your hip resurfaced. |
| We as patients really need to look at this in the | | | | How many full Hip resurfacing have you done (not |
| proper perspective, how much are YOU worth? | | | | observed or assisted with and NOT including |
| Please keep in mind that if you choose the wrong | | | | hemi-resurfacing)? |
| surgeon and the surgery does not go as planned, | | | | How many hip resurfacing do you do a month? |
| you can not get a do over without risking a revision | | | | When and where did you train and who did you train |
| surgery to a THR, which in turn means another | | | | under, have you continued your training? If so, what |
| major surgery. | | | | continuation of training have you done? |
| There are many questions you should ask your | | | | How many complications have you had? |
| doctor, I attached the list below. Again, remember | | | | How many resurfacing failures with revision to THR |
| that if the first doctor you see tells you that you are | | | | have you had? |
| not a candidate for resurfacing, do not take their | | | | How many loose acetabular cups have you had? Did |
| word as the end all, be all. There are many top | | | | they require a second surgery to repair or a revision |
| surgeons that can take on difficult cases that other | | | | to a THR? |
| newer doctors will not touch. I am not saying to | | | | How many times during surgery have you had to |
| 'shop around' for a doctor by just going to any | | | | change to a THR instead of a resurfacing and why |
| doctor, I am saying that if one tells you that you are | | | | was the change made? |
| not a candidate, do not stop there. Get your x-rays | | | | For what reasons would you switch from resurfacing |
| into a digital format or jpeg and email them to some | | | | to a THR after starting the surgery? If you switch, |
| of the worlds top resurfacing surgeons to find out if | | | | what device would you be using for a THR? |
| they believe you are a candidate. I know many | | | | What hip resurfacing device (prosthesis) do you use, |
| patients, (again, myself included) that were told we | | | | how long have you been using it and why do you |
| were not candidates for resurfacing by other | | | | prefer it? Do you have any financial stake in that |
| orthopedic surgeons only to end up getting | | | | device company? |
| successful resurfacing with the right doctor. | | | | Do you use cemented or uncemented? Why? |
| As I mentioned before, hip resurfacing surgery is a | | | | Do you cement the stem? |
| very technically demanding and difficult procedure, | | | | Will you be preserving the neck capsule? |
| very different than a THR, (Total Hip Replacement). | | | | Do you re-attach the gluteus maximus tendon? |
| Just because a surgeon has done a lot of THRs | | | | What type of anesthesia do you use? |
| means absolutely nothing when it comes to his ability | | | | How long does the surgery normally take? |
| to perform a hip resurfacing. From the several | | | | What surgical approach do you use? Anteriolateral, |
| orthopedic surgeon conferences I have attended and | | | | Direct Anterior or Posterior? |
| the many surgeons I have spoken with, I have | | | | What is the incision length? |
| learned a great deal. Some of the worlds top | | | | What is your post-op pain control plan? |
| resurfacing surgeons that have done over 1000 hip | | | | What hospital do you use? |
| resurfacing procedures all say that they are still | | | | What is their infection rate? |
| learning. | | | | Have any of your patients had infections that |
| The overwhelming theme at these conferences was | | | | required IV antibiotics following resurfacing? |
| the fact that the majority of failures in hip | | | | What drugs/methods do you use for anti-coagulation |
| resurfacing that required revisions to THRs were due | | | | after surgery? |
| to surgeon error. So, again, experience and skill plays | | | | How long will I be in hospital? |
| a major role in all of this. This is an incredible | | | | How successful have you been obtaining insurance |
| procedure and has very positive results IF the device | | | | approvals for resurfacing? |
| is placed correctly in the hands of a skilled and | | | | What is the rehab protocol? |
| experienced RESURFACING surgeon. The difference | | | | When will I be 100% weight bearing? |
| is being able to fully return to all activities including | | | | What assisted devices will I use for walking after |
| running and basketball with hip resurfacing, or being | | | | surgery? Will you provide them or do I need to |
| limited the rest of your life with a THR. I realize with | | | | purchase my own? |
| a THR if that is done correctly, you can also return | | | | How long on 2 crutches, 1 crutch, cane? |
| to a lot of activities you love, but you will never be | | | | What if any restrictions do you place on your |
| able to do any real high impact sports like you can | | | | patients after surgery and how long do they last? |
| with hip resurfacing. | | | | Will I be given any at home nurse or PT care? |
| So how important is it to select the right surgeon? | | | | How does my other hip look at this time? |
| Do you want to risk impingement problems for the | | | | If both hips are bad, how do you handle bilateral |
| rest of your life or an early failure? You tell me! Keep | | | | resurfacing? |
| in mind that with a THR there are also many | | | | Is there anything unusual about my hip that might |
| complications that can occur, so it is not just with hip | | | | present problems? |
| resurfacing. At least with hip resurfacing you have | | | | Do you have other hip resurfacing patients that I |
| preserved the majority of your bone and IF you | | | | could talk to about their experience? |
| ever need a revision down the road, it is like getting | | | | What is your opinion of my returning to whatever |
| your first THR where with a THR revision, you have | | | | work or activities I have done in the past? |
| already removed a large portion of your proximal | | | | Have you done resurfacing for anyone who has |
| femur only to have to remove a lot more with each | | | | returned to these activities? |
| revision surgery. Take a look at the short video clip in | | | | Remember again, the single most important decision |
| the referenced website under "Why Resurfacing" | | | | you will make is in selecting the right surgeon. . Good |
| that shows the difference in the amount of bone | | | | luck! |
| removed for each procedure. | | | | |