| Hip Resurfacing is a more conservative approach to | | | | was in her early 60s. She has never been able to |
| hip surgery than the conventional Total Hip | | | | cross her legs or stoop down to get something out |
| Replacement (THR). It gets rid of your hip pain but | | | | of a low kitchen cabinet. She is unable to fully enjoy |
| allows you to return to a full active lifestyle with no | | | | her younger grandchildren, because she can not lift |
| limitations. It accomplishes this by conserving your | | | | them or get down on the ground to play with them. |
| bone and using an implant that is more like a natural | | | | She is now limping again, unable to walk up a flight of |
| hip. Here is an explanation of why I chose Hip | | | | stairs without holding onto a handrail and pulling |
| Resurfacing over a THR and my story that follows. | | | | herself up one step at a time. She will already be |
| One of the differences between resurfacing and a | | | | facing revision surgeries in the next couple of years. I |
| THR is the amount of bone that is preserved or | | | | was diagnosed with OA (osteoarthritis) about 5 |
| removed. With resurfacing your bone is preserved. | | | | years ago and knew that it was inevitable that I too |
| Opposed to a THR, they remove approximately 30% | | | | eventually would be facing hip surgery. What I did |
| - 45% of your proximal femur then place a stem | | | | not realize is that in the beginning of 2005 (in my |
| down your thigh. | | | | 40s), my OA would hit a point where it would all of a |
| This is the part that stands out to me on a THR | | | | sudden progress rapidly. I was then faced with the |
| With a THR, the surgeon begins by making an incision | | | | reality of getting my left hip replaced, I shuttered at |
| on the side of the thigh to allow access to the hip | | | | the thought that my life as I knew it would soon be |
| joint. Once the hip joint is entered, the surgeon | | | | over. Here I was, a single female in her 40s, I could |
| dislocates the femoral head from the acetabulum. | | | | not imagine living life as limited as my Moms had |
| Then the femoral head is removed by cutting | | | | become, even though she was no longer crippled like |
| through the femoral neck with a power saw. To | | | | prior to her surgeries, to me she was still disabled. |
| begin replacing the femur, special tools are used to | | | | The story of Paying it forward. |
| shape and hollow out the femur to the exact shape | | | | Luckily I found out about hip resurfacing quite by |
| of the metal stem of the femoral component. Once | | | | accident. I was searching on craigslist and happened |
| the size and shape are satisfactory, the stem is | | | | upon an ad from someone that was selling items you |
| inserted into the femoral canal. | | | | will need if you are having hip surgery. I emailed Jay |
| To me, it is like the difference between pulling a | | | | who posted the ad and I asked him if he had his hip |
| tooth and getting a complete root canal (THR) or | | | | replaced and if he had heard about this new MIS |
| crowning a tooth (resurfacing). Resurfacing allows a | | | | approach that I had read about. Jay responded with |
| full return to all activities, including running. Many | | | | the fact that he had found something much better, it |
| patients have even finished an Ironman since their | | | | was called hip resurfacing and he sent me links to the |
| surgeries. Yoga, martial arts, skiing, surfing, the | | | | Yahoo Surface Hippy Message board and to JRIs |
| possibilities are endless. Just take a look at some of | | | | website. When Jay responded that day, it forever |
| the featured athletes on the referenced website. | | | | changed my life. When I did my research and realized |
| Also look at the referenced youtube link for a | | | | the incredible differences between the two |
| collection of real life patients post op. You will see | | | | procedures, (see below) my mind was made up. But |
| some dancing at 2 and 3 weeks post op, one guy | | | | then, the struggles began. How would I get this |
| skiing at 4 weeks post op, another guy speeding | | | | accomplished when I could not find anyone that even |
| down the road on a bicycle at only 3 weeks post op. | | | | knew about the procedure? |
| You would never guess these people just had major | | | | I went to three orthopedic surgeons including one |
| hip surgery! Of course a top surgeon is crucial in | | | | top surgeon at Stanford that all told me that a THR |
| obtaining the best results. I realize some newer THR | | | | was my only option. The doc at Stanford went so |
| devices also allow patients to return to MOST | | | | far as to tell me that I did not qualify for hip |
| activities now, but there is really no long term data | | | | resurfacing due to having dysplasia (shallow sockets) |
| on the newer THR devices that claim "no limitations" | | | | and also told me that they removed more bone |
| to really know what the long term effects of that | | | | which I later found out was not true. I was crushed |
| will be (see Wolfs Law below). This is because no | | | | and scheduled surgery with him for a THR. On a side |
| matter what a THR is made of, it still has the long | | | | note, this still happens today, so please do NOT take |
| metal stem and the improper loading of the hip and | | | | a no to resurfacing as a final answer. Seek out other |
| stress shielding. Most doctors will tell THR patients to | | | | opinions like I did. |
| NEVER run again, no basketball or any heavy impact | | | | Luckily I joined the yahoo surface hippy group and |
| sports, whereas this is not the case with resurfacing | | | | found out that I needed to get more opinions. I |
| and the right surgeon. | | | | scheduled an appointment with Dr. Harlan Amstutz |
| There is now over 11 years of history on the | | | | and flew to Los Angeles for a consult He gave me |
| Birmingham Hip Resurfacing (BHR) device. As a | | | | the good news that I was indeed an excellent |
| matter of fact, the first protocol was implanted in a | | | | candidate for hip resurfacing. |
| patient named Katie in 1991 and she is still doing well. | | | | Then the struggles began with my insurance |
| Katie had two healthy children since her resurfacing | | | | company. I had various problems with out of |
| surgery and they are around 9 and 14 years old now. | | | | network doctors, then experimental procedure, non |
| The very first BHR that is the same design today | | | | approved devices, etc. Basically the insurance |
| was implanted in July 1997. The data presented in | | | | company used any angle they could to deny |
| Miami in October 2007 showed Derek McMinn's | | | | coverage for the procedure I wanted. By this time, |
| survival rate at 8 years to be 99.8%. Mr. McMinn is | | | | my pain was increasing every single day and I ended |
| the inventor of the BHR device. The two main | | | | up having to purchase a cane to walk. |
| reasons you want to try to get a resurface first | | | | Then two things happened, I submitted another |
| before a THR if possible besides preserving your | | | | request to my insurance company, and again they |
| bone, is due to stress shielding, (Wolfs Law) see | | | | denied me, and when I called to change my surgery |
| below, and also due to revision surgery. If you | | | | date from Dr. Amstutz to Dr. Schmalzried, JRI then |
| choose to remain active with a THR, you risk revision | | | | informed me that they ran out of hip resurfacing |
| surgery which takes away more bone each time. | | | | devices and that they could not schedule a surgery |
| Take a look at this animation video that shows you | | | | date for me. They had no idea when a device would |
| what they do to revise a THR. | | | | be available and that I would just have to call back at |
| With a hip resurfacing, IF you ever need it revised, it | | | | a later date. I basically sat down and cried. I could no |
| is like starting out with your first THR. Here is an | | | | longer function at work due to my pain and I was |
| explanation of Wolf's Law, remember, no matter | | | | self-employed. I had to have surgery. |
| what material is used with a THR device, it still has | | | | I was faced with the decision of allowing my health |
| the long stem. | | | | insurance to dictate the type of procedure (THR |
| "... Wolfe's Law of Bone, which is that bone is formed | | | | covered 100%) I would get, or possibly be stuck |
| and retained along the lines of stress in that bone. | | | | paying out of pocket to get the procedure I wanted |
| Another way of putting it is: "Form follows function." | | | | and have to wait for it. Hip resurfacing in the U.S. |
| Look at the trabecular pattern in a calcaneus or a | | | | was about $23k out of pocket for Dr. Amstutz. |
| proximal femur -- it's easy to see where the lines of | | | | Looking at my Mom and her limitations, I could not |
| stress are here, because that's where the trabeculae | | | | and would not allow that to happen to me. I realize |
| are. Another way to express this rule is: "Use it or | | | | now that some of the newer THR devices do not |
| lose it." ..." and " ...What does this have to do with | | | | have the limitations that my Mom has, but the doc at |
| patients with prosthetic joints? Well, in an ideal world, | | | | Stanford clearly told me that I WOULD indeed have |
| a prosthetic joint component would carry stress and | | | | limitations for the rest of my life with the THR he |
| distribute it to the underlying bone in a manner | | | | was planning to implant in me. |
| identical to the original bone. Alas, this does not | | | | Taking charge of my own Health against all odds |
| happen in real life. Prosthetic components react to | | | | I was told to not give up and fight my insurance |
| stresses a lot differently than the original bone that | | | | company, so with a fellow hip resurfacing patients's |
| they replaced, and tend to distribute it to the | | | | help I put together another appeal letter to get |
| remaining bone much differently. For example, in a hip | | | | surgery approved for hip resurfacing down in Los |
| prosthesis, much of the load applied to the femoral | | | | Angeles. |
| component tends to be transmitted to the bone near | | | | I then emailed my x-rays to Dr. Koen De Smet in |
| its distal tip. The bone near the proximal part of the | | | | Belgium and to Dr. Vijay Bose in India. When I |
| component tends to have less force transmitted | | | | received a response in half an hour from Dr. Bose |
| through to it. What happens to the native bone that | | | | and within three hours from Dr. De Smet, at first my |
| is now no longer receiving its usual loading? Bone loss | | | | thoughts were, wait a minute, something is really |
| occurs here. This phenomenon is called "stress | | | | wrong with this picture? Doctors in the U. S. never |
| shielding". Since one can get quite a bit of stress | | | | responded to emails personally that I knew of and |
| shielding around a prosthesis, it's no mystery why | | | | here were two of the world's top doctors personally |
| one sees progressive bone loss around prosthetic | | | | emailing me back! |
| components over the years on follow-up | | | | I put together a detailed cost spreadsheet and |
| radiographs.... " The prosthesis referred to is the total | | | | decided that I no longer could deal with the stress of |
| hip replacement, not a resurfacing that loads the | | | | my insurance company and that I would pay the less |
| weight onto the femoral head, as the original issue | | | | than $12k out of pocket and go to India. I emailed |
| joint does. stress shielding n. Osteopenia occurring in | | | | Dr. Bose on September 22, 2005 and booked my |
| bone as the result of removal of normal stress from | | | | surgery for December 1, 2005 in India. It was like a |
| the bone by an implant. osteopenia /osoteoopeonia/ | | | | ton of bricks had just lifted off my shoulders just to |
| (oste-o-pe´ne-ah) 1. reduced bone mass due | | | | know that there was finally a light at the end of the |
| to a decrease in the rate of osteoid synthesis to a | | | | tunnel. By the time I left for my surgery, I could no |
| level insufficient to compensate for normal bone lysis. | | | | longer walk without a cane and was in terrible pain. |
| 2. any decrease in bone mass below the normal." | | | | My surgery was 3 years ago and I don't even think |
| With resurfacing the load on the hip is more like your | | | | about my hip anymore. It is just like a normal hip. |
| natural hip. Again, it is similar to crowning a tooth | | | | Unfortunately today even with two devices being |
| instead of pulling it and doing a root canal. It is always | | | | approved by the FDA, many doctors still do not even |
| better to try to preserve as much bone as possible. | | | | tell patients this surgery exists. Why? Because it is an |
| There is a lot of info available on the referenced | | | | extremely complex surgery and takes a lot more skill |
| website. I hope this information is of value, now my | | | | and practice to get it right. As a result of my |
| story of how I became a Patient advocate for hip | | | | struggles and all of the help I received from fellow |
| resurfacing. | | | | patients, I have now become a patient advocate for |
| My Journey | | | | hip resurfacing and continue to pay it forward. Please |
| About ten years ago my Mom had her first hip | | | | do your research before you allow any doctor to |
| replaced, a year later she had her second. The THRs | | | | amputate the head of your femur. If you are an |
| (Total Hip Replacements) that her doctor implanted in | | | | active person under the age of 65, you should |
| her were the old metal on poly small head devices. | | | | definitely look into the option of hip resurfacing. I |
| She was told they would last her between 8 -12 | | | | hope this information is of value. |
| years before she would need revision surgery. She | | | | |