Re: ?!$*!#...WHEN (a bit long-winded:)

January 9, 2008

Hi~ HIPSRUS... here's my two cents, after quickly reading over the

responses... Mostly, it's " What Deb said " but I really want to

stress that when you see an OS, make sure you see one that does BOTH

resurfacing and hip replacements, and LIKES the option of

resurfacing. If an OS hasn't spent the time and money for the

additional training required (which they are unlikely to do, unless

they are excited about resurfacing as an option) then he/she may try

and steer you away from it as an option. I myself, and many other

resurfacing patients also, have had multiple OSs either dismiss

resurfacing, or not mention it until it was brought up. In my case I

saw two, and neither had factual information. One surgeon didn't

even know about large-head MOM devices.

If your doctor says no, it might be a good idea (just to see) to

email digital Xrays to a few other doctors and get their opinion..

there are three in particular who are very experienced, and do well

with difficult cases. Not sure if yours is necessarily difficult,

but since you've been throu a lot of surguries to " save' your hip,

I'm thinking maybe.

I can testify that a resurfacing is a wonderful choice. For me, I

spent almost five years progressively getting worse, without

insurance to find out the cause of my pain. An early Xray revealed

nothing, and perhaps an MRI would have shown a soft tissue tear, from

a fall I took, and arthroscopy might have staved off further

deterioration. Maybe. Anyway, untreated, it turned into trauma-

induced OA, and by the time I got the news I needed a THR, my

cartilage was nearly bone on bone. I heard about Resurfacing from

another source the same day, and knew that's what I wanted. I'm

older than you, (47) but still too young to want to go straight to a

THR.

I didn't have money, no one in my state did/does Resurfacing, and I

watched myself become a cripple: took a huge downward turn during the

fifth year, and began using a cane, stopped sleeping, was haggard,

cranky, depressed and ready to cave to a THR. Then my new MIL came

to the rescue and lent us the money to go to Belgium and get

resurfacing from Dr. Smet. I was a difficult case, and even with my

husband's good insurance, I was too far gone with a bone cyst for

most newly trained American doctors to want to try my case.

Anyway, I'm a little over five months out.. the limp is gone, my life

is back, I sleep through the night, I can outwalk my family, and I'm

so happy. The hip pain was gone immediately, although of course it

took the muscles and soft tissue a while. There is still healing to

go, as well as more flexibilty/ROM to be gained. But for normal,

daily-wear, it's fantastic. If the hip ever messes up, then I can go

to a primary THR later.. probably much later. The expectancy for

both THRs and Resurfacing is equally long, (they talk 15 years to a

lifetime now) and there is no data longer than 10 to 15 years

(approx) on either appliance to do more than make a projection. At

your age, say the resurf lasted 25 years, then you'd have had that

many great years, and have a first THR around 60. Sounds like a plan

to me!

The newer THR devices are modular, which does lessen the possibility

of the very complicated revision that requires removal of the stem

that goes in the thigh. But stem loosening does happen, and wanted to

stack all the cards in my favor, should I live a long time. Also,

body weight loads differently on a THR, and consequently causes

changes in the bone called stress-shielding. (I can find the details

if you haven't read about this before)

If I needed to have a THR though, I definately wanted the large head

MOM, for the same reasons other cited: less risk of dislocation, and

greater range of motion. Also, if a BHR resurfacing needs to be

revised to a THR, there is a compatible device that will work with

the same acetabular cup.

My surgeon said that he is seeing a lot of THR revisions due to the

MIS approach, because, he feels, the surgeon doesn't have enough room

to place the device accurately... the debate rages on about this

subject, and I know of two very good resurfacing surgeons who make a

small incision. For myself, I don't mind that I have a sizable scar,

because I know that he had enough room to do what was neccessary. I

had a lot of osteophytes and a mal-formed femur, that latter which

didn't show in the Xray.

The jury is out on risks associated with metal ions, but the first

couple years are when the levels are higher, so if you don't take

more chromium (get vitamins that don't have any extra, at GNC)and

keep the water intake going, I think we'll be fine! I've read about

ladies who have had children after surgery, and no unusual levels of

ions reported in either mother, or children. I've said before, if

there is a risk, I think eating bacon will probably kill me first.

Anyway, these *astards get worse, not better, and if I had it to do

over, with the ability to do anything I wanted, I'd get the

resurfacing BEFORE most of my forties were gone. Before I gave myself

arthritis in the knees from walking funny. I wish you the best of

luck.. you can email me off-site if you like... there's a handful of

us resurfers on here that can help you with addresses to send JPG

Xrays (free BTW) and help, if you feel you want to pursue that route.

Best regards, Kellen in NM

>

January 9, 2008

Kellen (and all)~

What you and everyone else is saying is alot to digest, I must admit,

but after being down the road I've been I think it was all for a

reason, if none other than to prepare me for what is to come next.

You have provided me with a great deal of information that I truly

appreciate...and gives me alot to consider. The surgeries I have had

have not been for nil, as I did receive some successful months after

each and the time has been pushed back a bit. But it is hard to know

so soon after the last that things are what they are...and it is

exhausting to even think that another surgery may be in store for me,

which I think makes me want to consider a THR over a BHR just to be

done with surgeries for awhile...does that make any sense?

I'm ready to " take the bull by the horns " , as is my personality

anyway (what can I say...a former Marine!). I just want to make sure

I am taking the RIGHT bull by the horns, and want to make sure I know

as much as possible and ensure I ask plenty about that bull before I

get in the ring with it! =)

I want to be able to quit going to the DR all the time, get back to

work, enjoy my kids (while they still want me around!), look forward

to not having to rely on my hubby for SO much extra help, and just

have something else as my " major " focus other than pain and grinding

in my hip(s). I want my life back!

Thanks again!!!

>

> Hi~ HIPSRUS... here's my two cents, after quickly reading over the

> responses... Mostly, it's " What Deb said " but I really want to

> stress that when you see an OS, make sure you see one that does

BOTH

> resurfacing and hip replacements, and LIKES the option of

> resurfacing. If an OS hasn't spent the time and money for the

> additional training required (which they are unlikely to do, unless

> they are excited about resurfacing as an option) then he/she may

try

> and steer you away from it as an option. I myself, and many other

> resurfacing patients also, have had multiple OSs either dismiss

> resurfacing, or not mention it until it was brought up. In my case

I

> saw two, and neither had factual information. One surgeon didn't

> even know about large-head MOM devices.

>

> If your doctor says no, it might be a good idea (just to see) to

> email digital Xrays to a few other doctors and get their opinion..

> there are three in particular who are very experienced, and do well

> with difficult cases. Not sure if yours is necessarily difficult,

> but since you've been throu a lot of surguries to " save' your hip,

> I'm thinking maybe.

>

> I can testify that a resurfacing is a wonderful choice. For me, I

> spent almost five years progressively getting worse, without

> insurance to find out the cause of my pain. An early Xray revealed

> nothing, and perhaps an MRI would have shown a soft tissue tear,

from

> a fall I took, and arthroscopy might have staved off further

> deterioration. Maybe. Anyway, untreated, it turned into trauma-

> induced OA, and by the time I got the news I needed a THR, my

> cartilage was nearly bone on bone. I heard about Resurfacing from

> another source the same day, and knew that's what I wanted. I'm

> older than you, (47) but still too young to want to go straight to

a

> THR.

>

> I didn't have money, no one in my state did/does Resurfacing, and I

> watched myself become a cripple: took a huge downward turn during

the

> fifth year, and began using a cane, stopped sleeping, was haggard,

> cranky, depressed and ready to cave to a THR. Then my new MIL came

> to the rescue and lent us the money to go to Belgium and get

> resurfacing from Dr. Smet. I was a difficult case, and even with my

> husband's good insurance, I was too far gone with a bone cyst for

> most newly trained American doctors to want to try my case.

>

> Anyway, I'm a little over five months out.. the limp is gone, my

life

> is back, I sleep through the night, I can outwalk my family, and

I'm

> so happy. The hip pain was gone immediately, although of course it

> took the muscles and soft tissue a while. There is still healing to

> go, as well as more flexibilty/ROM to be gained. But for normal,

> daily-wear, it's fantastic. If the hip ever messes up, then I can

go

> to a primary THR later.. probably much later. The expectancy for

> both THRs and Resurfacing is equally long, (they talk 15 years to a

> lifetime now) and there is no data longer than 10 to 15 years

> (approx) on either appliance to do more than make a projection. At

> your age, say the resurf lasted 25 years, then you'd have had that

> many great years, and have a first THR around 60. Sounds like a

plan

> to me!

>

> The newer THR devices are modular, which does lessen the

possibility

> of the very complicated revision that requires removal of the stem

> that goes in the thigh. But stem loosening does happen, and wanted

to

> stack all the cards in my favor, should I live a long time. Also,

> body weight loads differently on a THR, and consequently causes

> changes in the bone called stress-shielding. (I can find the

details

> if you haven't read about this before)

>

> If I needed to have a THR though, I definately wanted the large

head

> MOM, for the same reasons other cited: less risk of dislocation,

and

> greater range of motion. Also, if a BHR resurfacing needs to be

> revised to a THR, there is a compatible device that will work with

> the same acetabular cup.

>

> My surgeon said that he is seeing a lot of THR revisions due to the

> MIS approach, because, he feels, the surgeon doesn't have enough

room

> to place the device accurately... the debate rages on about this

> subject, and I know of two very good resurfacing surgeons who make

a

> small incision. For myself, I don't mind that I have a sizable

scar,

> because I know that he had enough room to do what was neccessary.

I

> had a lot of osteophytes and a mal-formed femur, that latter which

> didn't show in the Xray.

>

> The jury is out on risks associated with metal ions, but the first

> couple years are when the levels are higher, so if you don't take

> more chromium (get vitamins that don't have any extra, at GNC)and

> keep the water intake going, I think we'll be fine! I've read about

> ladies who have had children after surgery, and no unusual levels

of

> ions reported in either mother, or children. I've said before, if

> there is a risk, I think eating bacon will probably kill me first.

>

> Anyway, these *astards get worse, not better, and if I had it to do

> over, with the ability to do anything I wanted, I'd get the

> resurfacing BEFORE most of my forties were gone. Before I gave

myself

> arthritis in the knees from walking funny. I wish you the best of

> luck.. you can email me off-site if you like... there's a handful

of

> us resurfers on here that can help you with addresses to send JPG

> Xrays (free BTW) and help, if you feel you want to pursue that

route.

>

> Best regards, Kellen in NM

>

> >

>

January 10, 2008

No, no, no! I really appreciate knowing ALL sides of ALL

possibilities! And what you say (type!) makes much sense. And it

sounds like you also understand my predicament, trying to truly know

whatever decision that is made is THE right one. I hear what you say

about the reserve also, and that's actually also been my

thinking...if I do choose to go straight to a replacement vs. a

resurfacing, then what about all of the " what if's " I may

experience...and what if the revision is alot sooner than 20

years...gosh, combine that with trying to figure out would it be

wiser to do now or sometime after we move and everything that comes

with that.

I don't know what to expect right now. I left a message for my OS 2

full days ago about what's going on, called to make sure he got the

message yesterday, and I was expecting a call at the end of his day

yesterday from what I was told from the person who took my message

and spoke with him. No call. No call yet today either, and it's 4pm

here already. Supposed to call my PT tomorrow morning and talk to him

about how things are and if we will do anything, but nothing has

changed.

Question...I didn't realize there is much difference in the movement

issues post-op depending on which procedure is done...do you have a

link for that? Is it external and internal rotation you have to be

careful with or what type of movement? That really could be a

deciding factor, since I still want as much freedom as

possible...that is, depending on what my OS says and who is available

for what procedure where I live.

Thanks! =)

>

> ACK! I didn't mean to overload or overwhelm... or be the posting

that made you just fry and be weary of the whole thing. I can't even

imagine having gone through five surgeries. It is a huge process,

and takes a lot out of us. You must be very tired of thinking about

it. I was tired of thinking hip hip hip, all day every day, in

everything I do. I still think about it, but think about how cool

things are these days, and respond to a post ever so often, on a few

of the 'body-parts' sites:)

>

> If you choose either THR or Resurf you will be done for a while..

quite a while I imagine. Doctors on either side may say that one will

last longer than another, but they don't know. What IS in your

favor, with a resurf, is simply having a whole femur to use IF you

need another one down the road. Kind of like a reserve tank of gas

(bad analogy, I know) But I do understand that feeling of overwhelm,

of hearing advocates of either procedure (whether Dr.s or patients)

giving equally good supporting and convincing information. It gets

confusing and too much at times.

>

> One absolutely has to feel right about the decision one makes.

For me, if I'd gone with the THR, once I knew I was a resurf

candidate after all, I would have always regretted not going with the

resurf. From the beginning, the idea of keeping as much of " me " as

possible felt emotionally right. A immediate gut feeling. On the

other side of it all, I can also see, that either procedure would

have been a miracle for me.. being out of the hip pain is good. While

it was also important to me to be able to move as naturally and

freely as possible, I'm sure I would have learned to accomodate any

positional and movement considerations that I may have had with a THR.

>

> Best Wishes!

>

> Kellen in NM

January 11, 2008

Dear hipsrus, the range of movement post-op with a metal on metal

resurfacing and a large ball metal on metal THR is the same. The

reason is that they are both anatomically the correct size. The

recovery from THR done in the traditional way and a resurfacing is

the same unless you recieve a THR through MIS(minimally invasive

surgery)which allows for rapid recovery. Normal recovery not being

so bad at all though. The only difference between the two surgerys

(THR and BHR)is that the BHR(or another equal device)conserves bone

for " possible " use later on in the game. This you already knew.

Please do not think that you must make a decision to hastily.

Another month or so researching and thinking will bring you to the

right choice for you personally. Relax.

Deb

> >

> > ACK! I didn't mean to overload or overwhelm... or be the posting

> that made you just fry and be weary of the whole thing. I can't

even

> imagine having gone through five surgeries. It is a huge process,

> and takes a lot out of us. You must be very tired of thinking

about

> it. I was tired of thinking hip hip hip, all day every day, in

> everything I do. I still think about it, but think about how cool

> things are these days, and respond to a post ever so often, on a

few

> of the 'body-parts' sites:)

> >

> > If you choose either THR or Resurf you will be done for a

while..

> quite a while I imagine. Doctors on either side may say that one

will

> last longer than another, but they don't know. What IS in your

> favor, with a resurf, is simply having a whole femur to use IF you

> need another one down the road. Kind of like a reserve tank of

gas

> (bad analogy, I know) But I do understand that feeling of

overwhelm,

> of hearing advocates of either procedure (whether Dr.s or

patients)

> giving equally good supporting and convincing information. It

gets

> confusing and too much at times.

> >

> > One absolutely has to feel right about the decision one makes.

> For me, if I'd gone with the THR, once I knew I was a resurf

> candidate after all, I would have always regretted not going with

the

> resurf. From the beginning, the idea of keeping as much of " me "

as

> possible felt emotionally right. A immediate gut feeling. On the

> other side of it all, I can also see, that either procedure would

> have been a miracle for me.. being out of the hip pain is good.

While

> it was also important to me to be able to move as naturally and

> freely as possible, I'm sure I would have learned to accomodate

any

> positional and movement considerations that I may have had with a

THR.

> >

> > Best Wishes!

> >

> > Kellen in NM

>

January 11, 2008

Hi Deb... I read somewhere that there a slightly better ROM with

resurface, not enough for the average person to notice. The thing I

found, is that a lot of OSs don't DO large heads, and if one sits there

and take whatever Joe/Jane OS says, you may start nodding your head and

find oneself with a small head device. I almost did. The one I saw here

in New Mexico, argued with me that there IS no large heard device..

that there has to be a liner in the acetabular cup, and the size of the

head is dictated by your skeletal frame, and the size cup you need. I

could not convince her that I myself had been looking at the product

and the cup does not have a liner, so it can accomodate this large

femoral head.(I believe Kathy Lee Gifford has one) She was pissed to

deal with one of those difficult patients. I still wonder if she ever

found out that I was right! Also here in NM, I could only find one guy

in the state who used Large Head MOM THR devices, and I couldn't get

him to return a phone call or an email.

Kellen in NM

>

> Dear hipsrus, the range of movement post-op with a metal on metal

> resurfacing and a large ball metal on metal THR is the same. The

> reason is that they are both anatomically the correct size. The

> recovery from THR done in the traditional way and a resurfacing is

> the same unless you recieve a THR through MIS(minimally invasive

> surgery)which allows for rapid recovery. Normal recovery not being

> so bad at all though. The only difference between the two surgerys

> (THR and BHR)is that the BHR(or another equal device)conserves bone

> for " possible " use later on in the game. This you already knew.

> Please do not think that you must make a decision to hastily.

> Another month or so researching and thinking will bring you to the

> right choice for you personally. Relax.

>

> Deb

January 11, 2008

Deb~

Thanks for the clarification...I thought there was a difference between

a THR and BHR with recovery time, movement precautions, and post-op

activity (from what I had read).

I am not thinking I have to make a quick decision, but I am admittedly

frustrated with my hip and hurting...and after so much time spent in

pain and in subsequent recovery from all the previous surgeries, I

truly want and need to move forward to get back to being active as

possible, without the wincing and grumbling from the pain. And I refuse

to get drugged up where I can not mentally function.

Like I said, having a move ahead and starting from scratch with

everything/everyone doesn't thrilll me either, and quite honestly the

thought makes me very nervous with the continued problems, so if one of

these procedures is a viable option sooner rather than later then at

least I have a history where I am, DRs who know me and what's gone on,

and my hubby around now to help.

Maybe if I were older and had lived a long, happy, *active* life then I

wouldn't be sounding " in a rush " ...but after so many years of

misdiagnosed pain, finally getting to the point of not being able to

really function or move much at all, moving beyond that surgery after

surgery for a taste of " normalcy " but only to have it all go downhill

again time after time...well, at almost 36 I'd like to finally live a

life without pain for awhile and have a focus other than medical

problems for awhile as well.

Thanks for listening!