Re: When to replace? and hip resurfacing --- old news!

[Guest guest]

Wow, the changes in modern medicine, when you get to weigh having a

baby against having a THR!!!! I agree with the other posters, you

don't have wait until you are crawling to have the THR, quality of

life is everything and as soon as your pain keeps you up at night and

interferes with your daily functioning, it's time to do it. I waited

like that on my shoulder joint replacement and I wished I hadn't, I

am so glad I did it. But that's another story.

As (one of) your list PT's, I want to caution all of you -- the hip

resurfacing procedure is NOT new, it has been around for more than 20

years but just two years ago was approved to be done in the U.S. My

brother in law is dean of BioMed department at Clemson University and

he says there is plenty of research out there saying the procedure is

not all that great, there are only a few people where it is REALLY

appropriate but most who have it go on fairly soon to the full THR. I

have talked to five different OS, including the one who did my TKR

last March, and all have stopped doing the resurfacing.

And by the way, my TKR was quad-sparing and my OS is in Greenville,

South Carolina.

Annie Pal, PT

R TKR 2000

L TKR 2008

R TSR 2008

>

> >

> > And during that period of time one has one's life back --- as I

had

> > posted originally (and others agreed with), one often doesn't

> realize

> > how compromised one's life has become prior to surgery until

> > AFTERWARDS when one realizes the gradual accommodations one made

> > because of the increasing pain and lack of mobility. You are a

young

> > woman with children and you are willing to hobble around with a

cane

> > when you are likely enough to have a " disease " that can be

> completely

> > cured -- one that will give you a " normal " life. At 38 years old

> (heck

> > at 56 years when I had my surgery), I wouldn't have chosen that.

> > ====================

> >

> > Bingo with a big fat capital B!

> >

> > I was 35 when my hip started acting funny and my lower back

> started

> > to hurt. Nothing to major, but enough to notice. As time went

on,

> > it got worse.

> >

> > When I was 40, I went to my GP for Xrays and she said I had minor

> OA

> > and spinal spurs, but 'nothing major'. Funny, the pain and lack

of

> > mobility didn't seem minor to me.

> >

> > Go another year, it gets worse. Everyday activities pretty much

> > cease. I gained alot of weight b/c of my inability to do

> activity.

> > Even carrying laundry from my bedroom to the washer killed my

> back.

> > Getting up from a seated position felt like I was 80 YO. I got

> > little to no sleep b/c it was impossible to get comfortable. I

was

> > popping more ibuprofin all the time.

> >

> > I went to my GP who referred me to apparently the best

> rhumatologist

> > in the city who quickly dismissed my issues, told me to lose

weight

> > (I gained weight b/c it was too painful to do anything) and

> > prescribed naproxen. He further stated an orthopod wouldn't look

> at

> > me until I was AT LEAST 50. In the meantime, my back would be

> > thrashed because of the brunt it took from my hip that had ZERO

> > rotation and mobility.

> >

> > I moved to another city for my dh's job. AFter getting settled,

I

> > searched out an orthopod and he wanted to try cortisone shots and

> > fluid injections in teh joint first. I didn't mind trying them

if

> > they worked and avoided hip replacement surgery. the cortisone

> shot

> > worked for a couple weeks, but boy , did I feel like a million

> > bucks. Next was the joint injection, that lasted for 6 months,

but

> > did nothing for my back pain.. in fact, it got worse.

> >

> > I finally went to the OS and told him I was done. I wanted the

> > surgery. I had it done on Oct. 16 and as soon as I woke up, I

was

> > PAIN FREE, well, except for surgical pain. But I immediately

felt

> a

> > difference.

> >

> > I have been completely pain free since. My back is still very

weak

> > from prior to the surgery, but physio is working on that. My

> > physiotherapist tells me I'm teh greatest compensator on the face

> of

> > the planet. I found many ways to subsitute for the pain and use

my

> > body in strange ways to get around, avoid the pain and to avoid

> using

> > my bad hip. Now I have to learn to walk properly and not use the

> old

> > habits I had for 8 years.

> >

> > OP - have the surgery. You will not regret it. You will wonder

> why

> > you didn't do it before. I used to be so depressed from the

pain,

> > lack of mobility and reduced quality of life. I'm so much

happier

> > because I have hope. Honestly, you do not have to wait until you

> are

> > crawling to have this done. you deserve to have a decent quality

> of

> > life.

> >

> > My surgeon also advised against resurfacing. HE said that it was

> > done too much, too soon and now studies are showing it's not all

> that

> > it was cracked up to be. Just not enough studies and period of

> > history to recco it.

> >

> > Please do not allow yourself to remain in pain. I got used to

> being

> > in pain all the time, that I even denied myself appropriate meds

in

> > the hospital and at home post op thinking i should have some

level

> of

> > pain.

> >

>

[Guest guest]

Regarding your comments you made about the viability of hip

resurfacing I feel I must challenge your facts. I researched this

procedure for 12 months prior to my surgery and found the positives

simply overwhelm the negatives however; this is based perhaps for

the younger more dynamic person. I found that the restrictions post

op for someone like me unrealistic – no carrying heavy weights, no

bending over 90deg, no crossing legs, no sleeping on your stomach…..

too much.

I have no restrictions and up until my recent knee replacement I was

a competitive cyclist kicking 30 year old butts (well not that hard

actually!!!)

Regards,

Bill

> > >

> > > And during that period of time one has one's life back --- as

I

> had

> > > posted originally (and others agreed with), one often doesn't

> > realize

> > > how compromised one's life has become prior to surgery until

> > > AFTERWARDS when one realizes the gradual accommodations one

made

> > > because of the increasing pain and lack of mobility. You are a

> young

> > > woman with children and you are willing to hobble around with

a

> cane

> > > when you are likely enough to have a " disease " that can be

> > completely

> > > cured -- one that will give you a " normal " life. At 38 years

old

> > (heck

> > > at 56 years when I had my surgery), I wouldn't have chosen

that.

> > > ====================

> > >

> > > Bingo with a big fat capital B!

> > >

> > > I was 35 when my hip started acting funny and my lower back

> > started

> > > to hurt. Nothing to major, but enough to notice. As time

went

> on,

> > > it got worse.

> > >

> > > When I was 40, I went to my GP for Xrays and she said I had

minor

> > OA

> > > and spinal spurs, but 'nothing major'. Funny, the pain and

lack

> of

> > > mobility didn't seem minor to me.

> > >

> > > Go another year, it gets worse. Everyday activities pretty

much

> > > cease. I gained alot of weight b/c of my inability to do

> > activity.

> > > Even carrying laundry from my bedroom to the washer killed my

> > back.

> > > Getting up from a seated position felt like I was 80 YO. I

got

> > > little to no sleep b/c it was impossible to get comfortable.

I

> was

> > > popping more ibuprofin all the time.

> > >

> > > I went to my GP who referred me to apparently the best

> > rhumatologist

> > > in the city who quickly dismissed my issues, told me to lose

> weight

> > > (I gained weight b/c it was too painful to do anything) and

> > > prescribed naproxen. He further stated an orthopod wouldn't

look

> > at

> > > me until I was AT LEAST 50. In the meantime, my back would be

> > > thrashed because of the brunt it took from my hip that had

ZERO

> > > rotation and mobility.

> > >

> > > I moved to another city for my dh's job. AFter getting

settled,

> I

> > > searched out an orthopod and he wanted to try cortisone shots

and

> > > fluid injections in teh joint first. I didn't mind trying

them

> if

> > > they worked and avoided hip replacement surgery. the

cortisone

> > shot

> > > worked for a couple weeks, but boy , did I feel like a million

> > > bucks. Next was the joint injection, that lasted for 6

months,

> but

> > > did nothing for my back pain.. in fact, it got worse.

> > >

> > > I finally went to the OS and told him I was done. I wanted

the

> > > surgery. I had it done on Oct. 16 and as soon as I woke up, I

> was

> > > PAIN FREE, well, except for surgical pain. But I immediately

> felt

> > a

> > > difference.

> > >

> > > I have been completely pain free since. My back is still very

> weak

> > > from prior to the surgery, but physio is working on that. My

> > > physiotherapist tells me I'm teh greatest compensator on the

face

> > of

> > > the planet. I found many ways to subsitute for the pain and

use

> my

> > > body in strange ways to get around, avoid the pain and to

avoid

> > using

> > > my bad hip. Now I have to learn to walk properly and not use

the

> > old

> > > habits I had for 8 years.

> > >

> > > OP - have the surgery. You will not regret it. You will

wonder

> > why

> > > you didn't do it before. I used to be so depressed from the

> pain,

> > > lack of mobility and reduced quality of life. I'm so much

> happier

> > > because I have hope. Honestly, you do not have to wait until

you

> > are

> > > crawling to have this done. you deserve to have a decent

quality

> > of

> > > life.

> > >

> > > My surgeon also advised against resurfacing. HE said that it

was

> > > done too much, too soon and now studies are showing it's not

all

> > that

> > > it was cracked up to be. Just not enough studies and period

of

> > > history to recco it.

> > >

> > > Please do not allow yourself to remain in pain. I got used to

> > being

> > > in pain all the time, that I even denied myself appropriate

meds

> in

> > > the hospital and at home post op thinking i should have some

> level

> > of

> > > pain.

> > >

> >

>

[Guest guest]

I agree with Bill, hip resurfacing is wonderful and so much better

than hip replacement. I am able to relax in my normal position

of " cobbler pose " with both feet soles together and knees flopping

to the floor while laying down. My knee doc said " you wouldn't be

able to do that if you'd had a hip replacement " .

I also researched resurfacing ad nauseum and the biggest mistake the

people you mention make is going to surgeons without much

experience. I don't know why people think they have to have surgery

in their own towns!!! Go to the expert surgeons and these problems

don't exist.

I flew across country to go to Dr. Gross who at the time had done

more resurfs than anybody in the US excepting Amstutz. It's a small

group, the docs that have done over 1,000 resurfs and I'd bet none

of the surgeons you talked to, Ann, were one of those. Hip

resurfacing isn't as easy as replacement and so many surgeons who

think they can segue into resurfs from replacements just can't do

it, either because of the additonal learning or they just aren't

good enough.

Now if Dr. Su, Dr. Gross, Koen DeSmet, Dr. McMinn or Dr. Amstutz was

in your group of doctors, I'd be interested but I'm sure they aren't

since they are still getting fabulous results from their resurfs. I

bet you only have some local docs that took a stab at resurfs,

couldn't get patients since they did so few, and the ones they did

were guess work and probably botched. This is more difficult

surgery than replacement.

I'm surprised you didn't check out Dr. Gross who did both my hip

resurfs since he is in Columbia, South Carolina. Great OS.

Nice to know you found a " quad sparing " TKR doc in South Carolina,

what is his name? I've only found my " quad sparing " OS, Dr. Coon

here in California and looking for others. I'm 10 weeks out now and

I'm fully recovered. Didn't even have to do PT. Now that my

husband's heart surgery recovery is progressing, I finally have time

to go to PT, but my excellent PT/certified Pilates

instructor/certified yoga instructor told me I didn't need to see

her for PT, I was already recovered. She couldn't believe my TKR

recovery, quad sparing vs. regular.

At two weeks I was 120 degrees flexion, full extension....now I know

I'm over 145 flexion and my opped knee has more flexion than my non-

opped. Is this the same as your quad sparing surgery? Really fast

recovery, 24 hours or less in hospital? Never a need for walkig

aids?

Please tell me the name of your doctor...I'm thinking of a knee

doctor list for a website.

Thanks,

Hollie

> Regarding your comments you made about the viability of hip

> resurfacing I feel I must challenge your facts. I researched this

> procedure for 12 months prior to my surgery and found the

positives

> simply overwhelm the negatives however; this is based perhaps for

> the younger more dynamic person. I found that the restrictions

post

> op for someone like me unrealistic – no carrying heavy weights, no

> bending over 90deg, no crossing legs, no sleeping on your

stomach…..

> too much.

> I have no restrictions and up until my recent knee replacement I

was

> a competitive cyclist kicking 30 year old butts (well not that

hard

> actually!!!)

> Regards,

> Bill

>

>

> > As (one of) your list PT's, I want to caution all of you -- the

> hip

> > resurfacing procedure is NOT new, it has been around for more

than

> 20

> > years but just two years ago was approved to be done in the

U.S.

> My

> > brother in law is dean of BioMed department at Clemson

University

> and

> > he says there is plenty of research out there saying the

procedure

> is

> > not all that great, there are only a few people where it is

REALLY

> > appropriate but most who have it go on fairly soon to the full

> THR. I

> > have talked to five different OS, including the one who did my

TKR

> > last March, and all have stopped doing the resurfacing.

> >

> > And by the way, my TKR was quad-sparing and my OS is in

> Greenville,

> > South Carolina.

> >

> > Annie Pal, PT

> > R TKR 2000

> > L TKR 2008

> > R TSR 2008

[Guest guest]

I had a hip replacement and no restrictions -- so this isn't accurate

-- at least with respect to large head devices. I also had an anterior

approach -- no muscles cut -- no risk of dislocation and no

restrictions.

On Dec 21, 2008, at 11:43 PM, Hollie wrote:

> I agree with Bill, hip resurfacing is wonderful and so much better

> than hip replacement. I am able to relax in my normal position

> of " cobbler pose " with both feet soles together and knees flopping

> to the floor while laying down. My knee doc said " you wouldn't be

> able to do that if you'd had a hip replacement " .

[Guest guest]

>

> Nice to know you found a " quad sparing " TKR doc in South Carolina,

> what is his name?

That would be Tom Pace. He did both of my TKR's. In Greenville, SC.

Annie

> I've only found my " quad sparing " OS, Dr. Coon

> here in California and looking for others. I'm 10 weeks out now and

> I'm fully recovered. Didn't even have to do PT. Now that my

> husband's heart surgery recovery is progressing, I finally have time

> to go to PT, but my excellent PT/certified Pilates

> instructor/certified yoga instructor told me I didn't need to see

> her for PT, I was already recovered. She couldn't believe my TKR

> recovery, quad sparing vs. regular.

>

> At two weeks I was 120 degrees flexion, full extension....now I know

> I'm over 145 flexion and my opped knee has more flexion than my non-

> opped. Is this the same as your quad sparing surgery? Really fast

> recovery, 24 hours or less in hospital? Never a need for walkig

> aids?

Not quite. 48 hours in hospital and home health PT, but I had so much soft

tissue damage from the sudden collapse (read implosion) of this knee, also

" blew " both of my shoulders which is why I had a TSR six months later.

Still need to do the other one. My ROM though was like yours. I was on a

cane by 7 days and no aids by 14 days.

The reason we caution use of walking aids in the first two weeks is that is

the INFLAMMATORY stage of healing so there is naturally more fluid, more

tendency for blood clots, more pain. That's also why we don't load the knee

too much (here I'm talking compression and weight bearing). It's too hard

on the subpatellar area.

Your recovery was indeed awesome.

In the long run, we're sooo glad we did it, right?

Oh, as compared to my first TKR in 2000 with Dr. Pace also, he preserved the

posterior cruciate ligament. Then he asked me if I could tell a

difference. The answer is yes, there is much more stability going down

steps and down hills. With the older one that was still an issuie at 6

months post op.

Your list idea is great.

Thanks for writing!

>

> > Regarding your comments you made about the viability of hip

> > resurfacing I feel I must challenge your facts.

Well, I'm just quoting those orthopedic surgeons who have all given up doing

the procedure, and the biomed engineers who say it's just not that big a

deal, and it's certainly not new.

Be well and happy holidays!

Annie Pal

[Guest guest]

From what Ive read the overall revision rates after 7 years for

resurfacing compared to THR is only 1.2% higher. Pretty good odds if

retaining more of your own bone is important to you. But it depends

on the individual - gender, age, bone size, reason for replacement

etc. In my case the odds increase ten-fold given my situation, so a

resurfacing is not worth the risk for me.

But this is what is wonderful about modern medicine - we have the

CHOICE. The main thing is that we do our own research and are happy

with our decision.

> > > >

> > > > And during that period of time one has one's life back --- as

> I

> > had

> > > > posted originally (and others agreed with), one often doesn't

> > > realize

> > > > how compromised one's life has become prior to surgery until

> > > > AFTERWARDS when one realizes the gradual accommodations one

> made

> > > > because of the increasing pain and lack of mobility. You are

a

> > young

> > > > woman with children and you are willing to hobble around with

> a

> > cane

> > > > when you are likely enough to have a " disease " that can be

> > > completely

> > > > cured -- one that will give you a " normal " life. At 38 years

> old

> > > (heck

> > > > at 56 years when I had my surgery), I wouldn't have chosen

> that.

> > > > ====================

> > > >

> > > > Bingo with a big fat capital B!

> > > >

> > > > I was 35 when my hip started acting funny and my lower back

> > > started

> > > > to hurt. Nothing to major, but enough to notice. As time

> went

> > on,

> > > > it got worse.

> > > >

> > > > When I was 40, I went to my GP for Xrays and she said I had

> minor

> > > OA

> > > > and spinal spurs, but 'nothing major'. Funny, the pain and

> lack

> > of

> > > > mobility didn't seem minor to me.

> > > >

> > > > Go another year, it gets worse. Everyday activities pretty

> much

> > > > cease. I gained alot of weight b/c of my inability to do

> > > activity.

> > > > Even carrying laundry from my bedroom to the washer killed my

> > > back.

> > > > Getting up from a seated position felt like I was 80 YO. I

> got

> > > > little to no sleep b/c it was impossible to get comfortable.

> I

> > was

> > > > popping more ibuprofin all the time.

> > > >

> > > > I went to my GP who referred me to apparently the best

> > > rhumatologist

> > > > in the city who quickly dismissed my issues, told me to lose

> > weight

> > > > (I gained weight b/c it was too painful to do anything) and

> > > > prescribed naproxen. He further stated an orthopod wouldn't

> look

> > > at

> > > > me until I was AT LEAST 50. In the meantime, my back would

be

> > > > thrashed because of the brunt it took from my hip that had

> ZERO

> > > > rotation and mobility.

> > > >

> > > > I moved to another city for my dh's job. AFter getting

> settled,

> > I

> > > > searched out an orthopod and he wanted to try cortisone shots

> and

> > > > fluid injections in teh joint first. I didn't mind trying

> them

> > if

> > > > they worked and avoided hip replacement surgery. the

> cortisone

> > > shot

> > > > worked for a couple weeks, but boy , did I feel like a

million

> > > > bucks. Next was the joint injection, that lasted for 6

> months,

> > but

> > > > did nothing for my back pain.. in fact, it got worse.

> > > >

> > > > I finally went to the OS and told him I was done. I wanted

> the

> > > > surgery. I had it done on Oct. 16 and as soon as I woke up,

I

> > was

> > > > PAIN FREE, well, except for surgical pain. But I immediately

> > felt

> > > a

> > > > difference.

> > > >

> > > > I have been completely pain free since. My back is still

very

> > weak

> > > > from prior to the surgery, but physio is working on that. My

> > > > physiotherapist tells me I'm teh greatest compensator on the

> face

> > > of

> > > > the planet. I found many ways to subsitute for the pain and

> use

> > my

> > > > body in strange ways to get around, avoid the pain and to

> avoid

> > > using

> > > > my bad hip. Now I have to learn to walk properly and not use

> the

> > > old

> > > > habits I had for 8 years.

> > > >

> > > > OP - have the surgery. You will not regret it. You will

> wonder

> > > why

> > > > you didn't do it before. I used to be so depressed from the

> > pain,

> > > > lack of mobility and reduced quality of life. I'm so much

> > happier

> > > > because I have hope. Honestly, you do not have to wait until

> you

> > > are

> > > > crawling to have this done. you deserve to have a decent

> quality

> > > of

> > > > life.

> > > >

> > > > My surgeon also advised against resurfacing. HE said that it

> was

> > > > done too much, too soon and now studies are showing it's not

> all

> > > that

> > > > it was cracked up to be. Just not enough studies and period

> of

> > > > history to recco it.

> > > >

> > > > Please do not allow yourself to remain in pain. I got used

to

> > > being

> > > > in pain all the time, that I even denied myself appropriate

> meds

> > in

> > > > the hospital and at home post op thinking i should have some

> > level

> > > of

> > > > pain.

> > > >

> > >

> >

>

[Guest guest]

I know the big ball heads do give much more flexibility, my hip OS

can't figure out why people still get the small ball heads which

dislocate so much easier.

At my age the resurf was the thing to do since no bone was cut and

later I can have the replacement if needed.

Hollie

> I had a hip replacement and no restrictions -- so this isn't accurate

> -- at least with respect to large head devices. I also had an anterior

> approach -- no muscles cut -- no risk of dislocation and no

> restrictions.

>

> On Dec 21, 2008, at 11:43 PM, Hollie wrote:

>

> > I agree with Bill, hip resurfacing is wonderful and so much better

> > than hip replacement. I am able to relax in my normal position

> > of " cobbler pose " with both feet soles together and knees flopping

> > to the floor while laying down. My knee doc said " you wouldn't be

> > able to do that if you'd had a hip replacement " .

>

>

>

>

[Guest guest]

Thank Annie, so many people from the East Coast ask me where they can

get a " quad sparing " TKR done.

Hollie

> >

> > Nice to know you found a " quad sparing " TKR doc in South Carolina,

> > what is his name?

>

>

> That would be Tom Pace. He did both of my TKR's. In Greenville, SC.

>

> Annie

>

>

> > I've only found my " quad sparing " OS, Dr. Coon

> > here in California and looking for others. I'm 10 weeks out now and

> > I'm fully recovered. Didn't even have to do PT. Now that my

> > husband's heart surgery recovery is progressing, I finally have time

> > to go to PT, but my excellent PT/certified Pilates

> > instructor/certified yoga instructor told me I didn't need to see

> > her for PT, I was already recovered. She couldn't believe my TKR

> > recovery, quad sparing vs. regular.

> >

> > At two weeks I was 120 degrees flexion, full extension....now I know

> > I'm over 145 flexion and my opped knee has more flexion than my non-

> > opped. Is this the same as your quad sparing surgery? Really fast

> > recovery, 24 hours or less in hospital? Never a need for walkig

> > aids?

>

>

> Not quite. 48 hours in hospital and home health PT, but I had so

much soft

> tissue damage from the sudden collapse (read implosion) of this

knee, also

> " blew " both of my shoulders which is why I had a TSR six months later.

> Still need to do the other one. My ROM though was like yours. I

was on a

> cane by 7 days and no aids by 14 days.

>

> The reason we caution use of walking aids in the first two weeks is

that is

> the INFLAMMATORY stage of healing so there is naturally more fluid, more

> tendency for blood clots, more pain. That's also why we don't load

the knee

> too much (here I'm talking compression and weight bearing). It's

too hard

> on the subpatellar area.

>

> Your recovery was indeed awesome.

>

> In the long run, we're sooo glad we did it, right?

>

> Oh, as compared to my first TKR in 2000 with Dr. Pace also, he

preserved the

> posterior cruciate ligament. Then he asked me if I could tell a

> difference. The answer is yes, there is much more stability going down

> steps and down hills. With the older one that was still an issuie at 6

> months post op.

>

> Your list idea is great.

>

> Thanks for writing!

>

>

> >

> > > Regarding your comments you made about the viability of hip

> > > resurfacing I feel I must challenge your facts.

>

>

> Well, I'm just quoting those orthopedic surgeons who have all given

up doing

> the procedure, and the biomed engineers who say it's just not that big a

> deal, and it's certainly not new.

>

> Be well and happy holidays!

>

> Annie Pal

>

>

>