Hip resurface or replacement

[v1car]

Hi, I've seen a few threads around hip replacement but I wondered if anyone had experience or views around the hip resurface technique as opposed to a full replacement.

Would appreciate any views as I need to have surgery in the near future and looking at the best option to ensure I can continue to ski post operation

[RichardDoane]

http://rediscoveryourgo.com/bhrbirminghamhipresurfacing.aspx

 

I'm in the same boat so to speak

[eleeski]

Birmingham hip rocks. It is a bigger operation than a total hip but gives better sporting results. Floyd Landis got the operation - legal cheating? I won MM tricks at Regionals and Nationals less than a year out. My trick scores are almost back to pre injury levels - despite my body falling apart as I age. I walk normally now.

 

I struggled to get up double booted on a slalom early in the summer. I switched into a rear hardshell kicker and can enjoy slalom now but my slalom buoy count is way down - but it has been for a few years since the injury.

 

Might be worth a read.

hip trip

My brother saw my results and just got his done. He's swimming long workouts already.

 

Surface-hippy.com is another good resource

 

Good luck,

Eric

 

 

[v1car]

Thanks Eric, really helpful. I enjoyed reading your hip trip. So great that you took the time to share this. I noticed you mentioned loss of muscle after a year and I have seen similar comments on some other forums. Have you noticed this has recovered now and good strength? Did you have any effect of the metal on metal? Squeaking, etc? I’m starting to go towards the Birmingham technique as i’m 43 and think it’s a better option for someone of my age.

[Deke]

Just to throw a little perspective on this...

 

The Birmingham and Total Hip are both good. With the Total Hip the "Approach" is most important. The claim that the Birmingham has fewer dislocations is not completely true compared to a Anterior Approach Total Hip so in that respect there is not advantage either way. There are a lot of other pluses and minuses to each that you really need to discuss with your potential surgeon. Find out what each surgeon doesn't like about the other technique. Some do both. If your surgeon says to quit sports, find another! From a sports perspective there is absolutely no reason not to go with either of these specifically for waterskiing. Running is another story. My main sport is ice hockey and my Anterior Approach Total Hips are fine after 4 years.

 

Early recovery time for the Anterior Approach is quick. I had no limitations immediately after surgery and I was skating in 5 weeks after each of my surgeries. Longer term they are all the same.

 

The biggest deciding factor for me choosing the Anterior Approach Total Hip (I have 2) is that the Birmingham is metal on metal. Some people may be sensitive to this over a long period and I feared I might be one of them.

 

@v1car you are very young at 43 to need a replacement! You are likely to need revision surgery at some point in the future so that is a concern to discuss with you doctor(s) now. As far as the muscle loss thing goes, it is just like any other recovery. When you "think" you are recovered and when you actually are recovered are two different things. You have to know where those gaps are and continue to work on them after you are actually healed enough. Patience!

[ktm300]

This site is informative regards the Birmingham hip. http://www.grossortho.com/

[eleeski]

At your age, absolutely go for the Birmingham. It's target patient is the younger athletic patient (you!). If you need a revision, you can get a total hip later.

 

I am a bit weaker. Probably due to laziness and age as much as anything surgical. Initially I dropped a bit of weight but that quickly reversed. Maybe I'm just feeling the stubborn extra few pounds. Probably lost muscle and replaced it with fat as well. But I'm still only a couple pounds up and I can do everything. I've had worse swings of muscle/weight - it's just harder when you're old.

 

No squeaking but sometimes there's a little slip/catch. It's worst when I'm tired - like standing still after a couple challenging days of early season snow skiing. But it doesn't affect my athletics or even walking. Just tottering, and I'm not so old that I want to be smooth at tottering.

 

My blood work at one year showed no issues with metal. No symptoms either. While I'm fairly active, I don't run. People do run a lot with this hip but that's where I'd worry about the metal on metal (engineer opinion, not medical). I am lucky enough to not have any metal allergies which are a rare issue they warned me about.

 

I've had a couple late releases toe tricking that gaaked me pretty good (might have dislocated a THR?). No problems - for the hip. Tweaked my shoulder in the energetic falls. The hip is still a little sore - but so is the other one. And it's my shoulder (or neck or back) that wakes me up at night. Aging sucks.

 

My experience is only one year. The procedure isn't terribly old either. My doctor hasn't seen many problems with the Birmingham - less than a THR. But the skill of the doctor is critical. Don't be your doctor's first one (or first one in a year). Shop for the right doctor. While good doctors aren't rare, they aren't common. Dr. Ball at UCSD did a good job on me.

 

Good luck,

Eric

[A_B]

My friend who is 66, had a hip replaced before last Christmas and was skiing close to where he was before surgery and pain, by the end of this season.

 

Another friend’s wife had one replaced and one injected with stem cells. Both hips doing fine. Jacksonville FL center. Not readily available all over and usually not covered by insurance.

[Jaypro]

ask @WaterSkier12

[liquid d]

Resurfacing this monday...will update in a few weeks!

[realestate2ski]

I had my hip resurfaced with a Birmingham on Oct 14, 2005. I was snow skiing on January 1st and water skiing in March of 2006. I have totally forgotten I have a resurfacing. As someone above mentioned, you can get a total replacement later if you need to but I doubt you will ever need to. I am a Canadian and because the wait time for surgery was 2 years in Canada I went to Dr. V. J. Bose in India to have it done. Dr. Bose did his orthopedic degree in Birmingham England when they were inventing the Birmingham resurfacing. He saw all the successes and the failures during the invention period. When he did my hip in 2005 he had done 450 hips at that time. It was an amazing trip. He is an amazingly kind and dedicated doctor. If anyone doesn't have medical insurance and is looking for a less expensive and better option Dr. Bose is the Doctor to see. He is a true surgeon and not a framing carpenter. The scare on my left butt cheek is pretty much gone now but it was only 4.5 inches long right after surgery. Surface-hippy.com is the web site I did all my research on. Some of the hip resurfacing done in Canada has been done with other hip resurfacing devices and they have failed at the 10 year mark. At the time I got my resurfacing there were several other medical companies starting to make hip resurfacing devices and promoting them as better than the Birmingham. I was fooled by the slick advertising at the time and wanted Dr. Bose to do one of the newer devises. However, when I got to India he sat me down and showed me how light weight the supposedly better devices were, then he pulled a Birmingham device out of his top drawer and dropped it on his desk. It landed with a big thud. I smiled back at him and said, you win, I want the Birmingham. The Birmingham resurfacing gave me 100% of my life back. Being as India is somewhat close to England Dr. Bose was doing a lot of double resurfacings on rugby players which gives you an idea of how tough and strong they are. I was 49 at the time. I am 61 now and never, ever even consider I have anything but my birth hip. The hip does not restrict me even the slightest in flexibility or strength. I hope this helps as I remember how worried I was at the time about making the wrong decision.

[ktm300]

Thanks @ realestate2ski for posting that. I will need a resurfacing sooner than later and, most definitely, am apprehensive. Your positive story helps.

[v1car]

Thanks @realestate2ski. Great to hear of your positive experience. Certainly helps provide peace of mind and understanding of what is possible

[bko]

4 years ago, at the age of 48, I got my hip replaced.

3 days later I left hospital (without crutches or stick - which was a little over-ambitious)

2 months later I snowskied & 4 months later I ripped the slalomcourse (35 off/36 mph) without any problems whatsoever.

For 7 or 8 months while jogging (which I never was really fond of) the hip was bothering me.

 

My resume: the prothesis works like a brandnew hip; my body only had to overcome the stress of the surgery.

 

Good luck!

 

[v1car]

Thanks @bko. Inspiring! Hope I get the same result!

[m_pags]

@liquid d hope everything went well.

 

Like @bko I had THR at the age of 48. The 1st one went so well 6 months later I had the other one done. I took a year off from skiing but part of that was due to winter. Now six years out I'm in my best physical shape since I played Junior Hockey. Absolutely no regrets.

 

@v1car Good Luck with your decision. Your surgeon and rehab are probably the biggest factors either way.

[v1car]

@m_pags awesome to hear! So far i’ve Seen 3 surgeons so definitely choosing carefully. Still deciding on resurface or replacement. Will depend on how my questions go with both surgeons who specialise in each. Being 43 I am worried about it wearing out whilst still relatively young

[Deke]

@v1car I'm sure you've heard this but on newer THR's the ball is replaceable. It would not be super invasive if that was all that was needed way out in the future.

[turbogoose]

Consider that; If resurfacing is performed and doesn't work well, full replacement is still a option. However, once full replacement is performed, you are stuck with it.

[6balls]

@turbogoose excellent point...options are always good.

[WaterSkier12]

Stay away from the modular head/neck components as deke recommends, excessive wear is a major problem

Birmingham is the way to go at your age, if u and ur surgeon agree. Mine was too far advanced to consider, have had both completely replaced and have done great. I did quit skiing, bad back too. I know lots who continue to rip it after TJA.

 

[v1car]

@turbogoose thanks for that and definitely a key factor in my leaning towards the resurface. I like the fact it gives me a plan B.

[chopper]

@v1carl, same result as @bko? Just to warn you that there isn't any type of hip replacement that will take you from 0 off/46 kph to 35 off/36 mph! ;-)

 

Good luck with your decision

[v1car]

@chopper classic. If that was the case i’d Get both done!

[gcam4]

@v1car are you bone on bone? I was having a ton of pain and found out I tore my labrum and had an impingement and decided to have arthroscopic surgery. I was 32 at the time and my Dr. said that 10-15 years ago I likely would have had a total hip replacement. It's not a common surgery and you may not be a candidate based on what is wrong. Recovery is about 4-6 months but I cannot tell I had anything done except for 2 tiny scars now and I wish I would have had it done years before I did!

[Barry]

@v1car , I had a THR in January 2017 at the age of 54, I asked my surgeon about re surfacing as opposed to THR, as a skiing friend of mine had a resurface that appears very successful and also after reading Eric's hip trip. He advised against it as he had experienced replacing worn resurfacing that had caused complications, also my private health care insurance would not cover metal to metal resurfacing.

I had a hybrid ceramic Exeter x3 joint fitted and now after 11 months my hip is better than it has been for years.

I skied after 5 months, took it easy to start with but by the end of the season was not far off of my normal score just getting into 13m @ 55kph. I worked hard in the gym & cycled a lot to build up strength in my leg.

My advise would be to find a surgeon you can trust, make sure he knows what you are expecting to do after surgery, discuss all the options & take his advise on which surgery to have, as what is good for me possibly would not suit you.

 

Good luck

[liquid d]

Nowadays, they know if you have any labrum left to fix from xray/images.

Many Docs don't do resurfacing for a variety of reasons...as it's a bit more complicated operation to make the alignment right (so you don't have excessive metal wear/ions), they don't get paid any more money than a THR, some of their malpractice ins won't allow it,the femoral head needs to be in good shape, and they don't do it on women (smaller femoral heads don't work as well), etc-I'm sure there is more reasons.

 

My advice is to seek out a surgeon who has done a bunch of hip resurfacings to see if you're a candidate. A surgeon who doesn't do them, will always tell you that you shouldn't have one, and give you several reasons. Any surgeon who does resurfacings, does THR's as well. That type of surgeon can guide you the right way, and advise you one way or the other.

Conservation of the bone may come in handy in 15-20 years.

 

I did a resurface on Monday (after a few years of scoping, fixing what was left of labrum,etc). Eventually, there will be no restrictions on what I'm allowed to do. Most Drs won't say that for a THR. I'm just walking with a crutch a couple days later. I'm a couple weeks away from the start of real rehab. Will update ya in a few months.

[v1car]

@liquid d good luck with your rehab. Thanks for sharing your journey to date. Great insight

[v1car]

@Barry sounds like your replacement has worked really well. Great insight. Yes I am bone on bone. I’m looking to see The surgeon in Nz who has done the most resurfaces so be interesting to hear what he has to say.

[liquid d]

I'm still less than 2 weeks out (12/11 surgery), was on crutches for about 3 days, 1 crutch for several more days if walking any distance. I'm now 11 days out, Christmas shopping at the mall with nothing. I'm walking nice an slow, but there is no noticeable dif in my walk. The leg is calming down every day. It has felt like you had worked out for a day, after not having worked out in years. Every muscle in the upper leg was super tight, a tiny bit swollen, and sore as hell. The last 3 days it's just all started calming down.

 

At this point, I can tell that the joint pain that started all this is gone, not diminished..gone. I'm pumped. I know that I'll be a gym rat for the next 3-4 months, and start skiing slowly. Can't wait to pitch to my kids baseball team again! I'm bringing the heat!

[eleeski]

@liquid d You are healing faster than I did! Way to go. Don't get discouraged when the rate of improvement slows down. Keep up the PT and you'll continue to improve. Might take a bit longer than 4 months - like forever.

 

At a little over 1 year, I was demonstrating how I couldn't kiss my knee - but I could. Easily! I bet I could get up in double boots again. My hip still annoys me - about as much as the good one. Even though I'm totally over the operation, I'm still doing the PT (on my own) and still getting better. My strength is fine - but still less than I want.

 

Speedy recovery and good luck,

 

Eric

 

[liquid d]

7 weeks out and went to the golf range this past week, just hitting wedges through 7 iron...amazing different ball flight; much higher trajectory with easy draw. I had not noticed over the past few years my trajectory was getting lower due to less turn. No pain at all. Doc says after 8 weeks, i can turn on the driver. Not going to ski at all for a couple more months. Strength coming back , and feel like i could walk for miles with no problems. All about the gym and rehab for a while.

[liquid d]

Have had 5 sets back, and there is no pain...except for spray leg! Dr has cleared me to run just 28's/32's. Spray leg is now almost gone after 5 sets. Leg is weaker than the other one. In june, Dr is supposed to turn me loose to do anything again. Hopefully strength will continue to come back with rehab and skiing....but it took over a year for a shoulder to come back to full strength.

Another positive note....i can draw the golf ball again! Looking forward to the Hall of Fame Golf Tourney this Friday!

[v1car]

@liquid d awesome to hear how well your recovery is going. I’m a week and a half away from surgery. Feeling a bit nervous! What was your rehab plan? How long before you were back skiing? Any pain/issues when/post skiing? Notice anything with deep water starts?

[liquid d]

For me, it was 4 months to skiing--no supershortline yet. I'm just working on strength until June. It's my back leg, so starts are not affected. Going beyond 90 degrees is not allowed for the first 2-3 months. Good luck!

[v1car]

Seeing I've been the annoying guy asking heaps of questions I thought it was time to share my experience. Hopefully it will help others make informed decisions.

I'm now 1 day after having the Birmingham resurface procedure. That is after 3 years of trying to find the best outcome for me. I have seen 4 surgeons and a heap of medical practioners. What I found is in NZ, the resurface isn't promoted. It is hard to find out any info or who does it. So if you are in NZ and need your hip done then you need to see Hugh Blackley.

Day one down from surgery and I'm already in less pain than I was pre op. I'm up and walking with crutches and excited about the rehab journey.

I'll provide a regular update of my rehab and when I am back out there skiing. Hopefully it will provide useful insight.

To those who have given me advice above, thank you. Without it I probably would have given up and ended up with a total hip replacement. I'm very pleased I perserved and wrapped with the outcome.

[v1car]

One month down. Walking without crutches but I wouldn’t describe it as a normal walk yet! Bit of a limp so still building strength in that leg to take the weight and walk normally. Been off all pain medication for a couple of weeks now. Able to sleep on that side for the first time in years. Able to cycle at the gym and doing 30 min sessions. So definitely progressing. Frustrating at times when don’t feel like making progress and little things are frustrating like not being able to tie up my shoe lace yet as can’t get to it! Got to remember progress day by day and reflect back on milestones achieved and progress made. Working on rehab plan with physio to be back skiing in summer. Hoping for November. Stoked with the result so far and feel made the right decision.

[liquid d]

Keep up the rehab, and don't go past 90 degrees! I go to final Dr appointment tomorrow, and hopefully will be released to get after it. Been skiing since mid April, and finally shortened to run 38's in the last week. Letting go unless it's really smooth, taking no hits. The leg strength is finally coming back, but it's still 75%. It took a year for my shoulder to come back from surgery a few years ago...this growing old stuff is not for pansies!

 

Resurfacing cuts the muscle, so it takes a while for it to grow back. I'm more and more convinced this is the way to go for those that qualify for this type of surgery. Take your time, slow and steady progress. ...and my golf game is EN FUEGO!

[eleeski]

I hurt my (other) knee. Had to get up two footed in slalom. Last year I struggled with two foot starts. This year there's no issue.

 

The strength comes back slowly. Be patient. It does come back.

 

The other crap (shoulders, knees, back, work) will become the limiting factors.

 

Great to hear the good recoveries. PT never ends though...

 

Eric

[eleeski]

@scotchipman Most of my issues were age and arthritis. But the trigger was a too aggressive pull out for the gates (crushed the top of my femur but at least I didn't fall). One factor was that I had my rear boot canted the wrong way - I do not recommend that!

 

Still, waterskiing allows high performance until late in life. It might be the best sport for longevity. Don't worry about hip issues. If they happen, the fixes work.

 

Eric

Birmingham hip 2016

MM trick champion 2017

[thager]

Hip displasia is caused by to much inbreeding in dogs. Hmmmm?

[liquid d]

My dad would slap you silly thager! He's 92 and wouldn't hesitate a bit!

 

But to answer Scotchipman...yes, slalom wears the rear leg/hip out quite a bit- a lot of grinding. I suggest switching which foot forward you ski with in slalom.