Hip Resurfacing is a more conservative approach to hip surgery than the conventional Total Hip Replacement (THR). It gets rid of your hip pain but allows you to return to a full active lifestyle with no limitations. It accomplishes this by conserving your bone and using an implant that is more like a natural hip. Here is an explanation of why I chose Hip Resurfacing over a THR and my story that follows.
One of the differences between resurfacing and a THR is the amount of bone that is preserved or removed. With resurfacing your bone is preserved. Opposed to a THR, they remove approximately 30% - 45% of your proximal femur then place a stem down your thigh.
This is the part that stands out to me on a THR With a THR, the surgeon begins by making an incision on the side of the thigh to allow access to the hip joint. Once the hip joint is entered, the surgeon dislocates the femoral head from the acetabulum. Then the femoral head is removed by cutting through the femoral neck with a power saw. To begin replacing the femur, special tools are used to shape and hollow out the femur to the exact shape of the metal stem of the femoral component. Once the size and shape are satisfactory, the stem is inserted into the femoral canal.
To me, it is like the difference between pulling a tooth and getting a complete root canal (THR) or crowning a tooth (resurfacing). Resurfacing allows a full return to all activities, including running. Many patients have even finished an Ironman since their surgeries. Yoga, martial arts, skiing, surfing, the possibilities are endless. Just take a look at some of the featured athletes on the referenced website. Also look at the referenced YouTube link for a collection of real life patients post op. You will see some dancing at 2 and 3 weeks post op, one guy skiing at 4 weeks post op, another guy speeding down the road on a bicycle at only 3 weeks post op. You would never guess these people just had major hip surgery! Of course a top surgeon is crucial in obtaining the best results. I realize some newer THR devices also allow patients to return to MOST activities now, but there is really no long term data on the newer THR devices that claim "no limitations" to really know what the long term effects of that will be (see Wolfs Law below). This is because no matter what a THR is made of, it still has the long metal stem and the improper loading of the hip and stress shielding. Most doctors will tell THR patients to NEVER run again, no basketball or any heavy impact sports, whereas this is not the case with resurfacing and the right surgeon.
There is now over 11 years of history on the Birmingham Hip Resurfacing (BHR) device. As a matter of fact, the first protocol was implanted in a patient named Katie in 1991 and she is still doing well. Katie had two healthy children since her resurfacing surgery and they are around 9 and 14 years old now. The very first BHR that is the same design today was implanted in July 1997. The data presented in Miami in October 2007 showed Derek McMinn's survival rate at 8 years to be 99.8%. Mr. McMinn is the inventor of the BHR device. The two main reasons you want to try to get a resurface first before a THR if possible besides preserving your bone, is due to stress shielding, (Wolfs Law) see below, and also due to revision surgery. If you choose to remain active with a THR, you risk revision surgery which takes away more bone each time. Take a look at this animation video that shows you what they do to revise a THR.
http://ww2.arthritis.org/conditions/SurgeryCenter/surgerycenterflash/revhip.html
With a hip resurfacing, IF you ever need it revised, it is like starting out with your first THR. Here is an explanation of Wolf's Law, remember, no matter what material is used with a THR device, it still has the long stem.
"... Wolfe's Law of Bone, which is that bone is formed and retained along the lines of stress in that bone. Another way of putting it is: "Form follows function." Look at the trabecular pattern in a calcaneus or a proximal femur -- it's easy to see where the lines of stress are here, because that's where the trabeculae are. Another way to express this rule is: "Use it or lose it." ..." and " ...What does this have to do with patients with prosthetic joints? Well, in an ideal world, a prosthetic joint component would carry stress and distribute it to the underlying bone in a manner identical to the original bone. Alas, this does not happen in real life. Prosthetic components react to stresses a lot differently than the original bone that they replaced, and tend to distribute it to the remaining bone much differently. For example, in a hip prosthesis, much of the load applied to the femoral component tends to be transmitted to the bone near its distal tip. The bone near the proximal part of the component tends to have less force transmitted through to it. What happens to the native bone that is now no longer receiving its usual loading? Bone loss occurs here. This phenomenon is called "stress shielding". Since one can get quite a bit of stress shielding around a prosthesis, it's no mystery why one sees progressive bone loss around prosthetic components over the years on follow-up radiographs.... " The prosthesis referred to is the total hip replacement, not a resurfacing that loads the weight onto the femoral head, as the original issue joint does. stress shielding n. Osteopenia occurring in bone as the result of removal of normal stress from the bone by an implant. osteopenia /osoteoopeonia/ (oste-o-pe´ne-ah) 1. reduced bone mass due to a decrease in the rate of osteoid synthesis to a level insufficient to compensate for normal bone lysis. 2. any decrease in bone mass below the normal." With resurfacing the load on the hip is more like your natural hip. Again, it is similar to crowning a tooth instead of pulling it and doing a root canal. It is always better to try to preserve as much bone as possible. There is a lot of info available on the referenced website. I hope this information is of value, now my story of how I became a Patient advocate for hip resurfacing.
My Journey
About ten years ago my Mom had her first hip replaced, a year later she had her second. The THRs (Total Hip Replacements) that her doctor implanted in her were the old metal on poly small head devices. She was told they would last her between 8 -12 years before she would need revision surgery. She was in her early 60s. She has never been able to cross her legs or stoop down to get something out of a low kitchen cabinet. She is unable to fully enjoy her younger grandchildren, because she can not lift them or get down on the ground to play with them. She is now limping again, unable to walk up a flight of stairs without holding onto a handrail and pulling herself up one step at a time. She will already be facing revision surgeries in the next couple of years. I was diagnosed with OA (osteoarthritis) about 5 years ago and knew that it was inevitable that I too eventually would be facing hip surgery. What I did not realize is that in the beginning of 2005 (in my 40s), my OA would hit a point where it would all of a sudden progress rapidly. I was then faced with the reality of getting my left hip replaced, I shuttered at the thought that my life as I knew it would soon be over. Here I was, a single female in her 40s, I could not imagine living life as limited as my Moms had become, even though she was no longer crippled like prior to her surgeries, to me she was still disabled.
The story of Paying it forward.
Luckily I found out about hip resurfacing quite by accident. I was searching on craigslist and happened upon an ad from someone that was selling items you will need if you are having hip surgery. I emailed Jay who posted the ad and I asked him if he had his hip replaced and if he had heard about this new MIS approach that I had read about. Jay responded with the fact that he had found something much better, it was called hip resurfacing and he sent me links to the Yahoo Surface Hippy Message board and to JRIs website. When Jay responded that day, it forever changed my life. When I did my research and realized the incredible differences between the two procedures, (see below) my mind was made up. But then, the struggles began. How would I get this accomplished when I could not find anyone that even knew about the procedure?
I went to three orthopedic surgeons including one top surgeon at Stanford that all told me that a THR was my only option. The doc at Stanford went so far as to tell me that I did not qualify for hip resurfacing due to having dysplasia (shallow sockets) and also told me that they removed more bone which I later found out was not true. I was crushed and scheduled surgery with him for a THR. On a side note, this still happens today, so please do NOT take a no to resurfacing as a final answer. Seek out other opinions like I did.
Luckily I joined the yahoo surface hippy group and found out that I needed to get more opinions. I scheduled an appointment with Dr. Harlan Amstutz and flew to Los Angeles for a consult He gave me the good news that I was indeed an excellent candidate for hip resurfacing.
Then the struggles began with my insurance company. I had various problems with out of network doctors, then experimental procedure, non approved devices, etc. Basically the insurance company used any angle they could to deny coverage for the procedure I wanted. By this time, my pain was increasing every single day and I ended up having to purchase a cane to walk.
Then two things happened, I submitted another request to my insurance company, and again they denied me, and when I called to change my surgery date from Dr. Amstutz to Dr. Schmalzried, JRI then informed me that they ran out of hip resurfacing devices and that they could not schedule a surgery date for me. They had no idea when a device would be available and that I would just have to call back at a later date. I basically sat down and cried. I could no longer function at work due to my pain and I was self-employed. I had to have surgery.
I was faced with the decision of allowing my health insurance to dictate the type of procedure (THR covered 100%) I would get, or possibly be stuck paying out of pocket to get the procedure I wanted and have to wait for it. Hip resurfacing in the U.S. was about $23k out of pocket for Dr. Amstutz. Looking at my Mom and her limitations, I could not and would not allow that to happen to me. I realize now that some of the newer THR devices do not have the limitations that my Mom has, but the doc at Stanford clearly told me that I WOULD indeed have limitations for the rest of my life with the THR he was planning to implant in me.
Taking charge of my own Health against all odds
I was told to not give up and fight my insurance company, so with a fellow hip resurfacing patients's help I put together another appeal letter to get surgery approved for hip resurfacing down in Los Angeles.
I then emailed my x-rays to Dr. Koen De Smet in Belgium and to Dr. Vijay Bose in India. When I received a response in half an hour from Dr. Bose and within three hours from Dr. De Smet, at first my thoughts were, wait a minute, something is really wrong with this picture? Doctors in the U. S. never responded to emails personally that I knew of and here were two of the world's top doctors personally emailing me back!
I put together a detailed cost spreadsheet and decided that I no longer could deal with the stress of my insurance company and that I would pay the less than $12k out of pocket and go to India. I emailed Dr. Bose on September 22, 2005 and booked my surgery for December 1, 2005 in India. It was like a ton of bricks had just lifted off my shoulders just to know that there was finally a light at the end of the tunnel. By the time I left for my surgery, I could no longer walk without a cane and was in terrible pain. My surgery was 3 years ago and I don't even think about my hip anymore. It is just like a normal hip. Unfortunately today even with two devices being approved by the FDA, many doctors still do not even tell patients this surgery exists. Why? Because it is an extremely complex surgery and takes a lot more skill and practice to get it right. As a result of my struggles and all of the help I received from fellow patients, I have now become a patient advocate for hip resurfacing and continue to pay it forward. Please do your research before you allow any doctor to amputate the head of your femur. If you are an active person under the age of 65, you should definitely look into the option of hip resurfacing. I hope this information is of value.
No comments:
Post a Comment