A new member of the Hip Talk Discussion Group is considering hip resurfacing, but very concerned about the negative press and the medical communities not supporting hip resurfacing.
Patricia Walter, owner of the Surface Hippy Website, responded to his concerns about hip resurfacing in the following article:
Hip Resurfacing is a very special method of replacing a hip. Ever since I began this website in 2005, hip resurfacing has never been widely accepted by the medical community. There might be several reasons for that. One is that hemi-resurfacing which only replaced the femoral portion of the device had very poor success. When full hip resurfacing began, the situation was now metal on metal bearings, not metal on bone bearing surface. So once a procedure received poor outcomes and bad press – it never goes away, even when it isn’t the same as the similarly named option.
So many surgeons remember hemi-resurfacing and remember how poorly it worked.
Also hip resurfacing requires more training than a THR and many surgeons chose not to learn it or find it difficult to perform. That is another reason why hip resurfacing received a bad rap – too many non experienced surgeons jumped in and performed a large amount of poor surgeries with very poor outcomes. One big study that indicated hip resurfacing had bad outcomes was from a group of 20 interns that were taught hip resurfacing and performed them – poorly. That was in the UK and that study continues to plague hip resurfacing with a really bad name. Really, how can inexperienced surgeons expect to have the outcomes of experienced surgeons who have done thousands. Once the news media reports poor outcomes for a procedure, they never seem to forget and continue to bad mouth it since negative news is always more sensational than positive news.
Hip resurfacing is almost an art as much as a skill. Just like an athlete, if the pitcher doesn’t practice every day – he becomes rusty. So with difficult surgery. A surgeon that has excellent results must perform hip resurfacing every day, every week and every month. They must be specialized in hip resurfacing to have excellent outcomes. The surgeons on this list are very experienced: http://surfacehippy.info/doctors-with-1000-hip-resurfacings/
Also if you want to know about the great outcomes of hip resurfacing, you need to talk to and read about the results of the top surgeons. You can’t rely on the negative press that attacks hip resurfacing over and over again. Here are excellent articles from the top surgeons: http://surfacehippy.info/category/hip-resurfacing-positive-results-and-information/
When you want something special, you must find a specialist. You don’t go to Wal-Mart to buy a Smith & Nephew BHR. You go to a specialist in hip resurfacing to receive a BHR. You don’t go to the local flea market to buy a sophisticated piece of equipment. You need to decide where to acquire professional, high end equipment or hip resurfacing surgeries.
There are over 1420 personal hip resurfacing stories posted here by the members:
Also thousands of posts from hip resurfacing patients on this discussion group of 5000 folks.
If you want to find out about hip resurfacing, you need to talk with the top experienced surgeons and the patients that have had a hip resurfacing. Yes, there are occasional problems, but there are very few. There are always a small amount of problems with any surgery, or any vehicle or product you buy – but you can’t do nothing or buy nothing thinking you will have problems. That is life, we choose what we think is the best for us and know we have done our homework. Sometimes there are problems, but not normally. Sometimes the jet plane you are riding on will crash – but not very often. Sometimes the car you are riding in will crash – but not very often. Sometimes your house will burn down – but not very often.
We always need to do our homework and learn as much as possible, then make an educated decision. Hip resurfacing has been chosen by hundreds of thousands of people who had excellent outcomes.
Additional Comments from John C posted on the Hip Talk Discussion Group
1, In any profession or skill, there will be a large number of people who are competent at basic tasks, and just a few who are expert at very difficult specialized tasks. If you look at the results of the average practitioner attempting the very specialized tasks, you will come away with the conclusion that the specialized task has a low success rate. This information is only relevant if you intend to have the average practitioner perform the specialized task. Only by isolating your study to the performance of the few experts in the field will you come up with a realistic view of the potential of the task.
2. Resurfacing is a challenging surgery that has a learning curve, meaning that even a very talented surgeon may have a poorer success rate for his first few hundred surgeries. This presents a tough barrier for any surgeon to decide if going through that learning curve for himself and his patients is worth it in the long run. It would only make sense for those in a position to be able to plan on doing a high volume of resurfacings in the long run. I have talked this over with orthopedic surgeons who are friends as well as with other surgeons who I respect, and most of them do not do resurfacings for this reason; they never expect to do enough of them to justify the learning curve and to be able to keep their skills honed. Some surgeons will blame the procedure as being flawed, rather than acknowledging that it is too specialized to fit into their practice. In an ideal world, these surgeons would refer potential resurfacing cases to a specialist, but in reality that seldom happens.
3. I applaud your homework in contacting some of the top hospitals with your questions. My view is that the answers you will get will be determined by whether each hospital has a resurfacing specialist on staff, and there are not many of those to go around. If their staff does not include a resurfacing specialist, you will get a negative review from the staff members who do not do them. As far as Mass General’s statement about “high rates of early revisions”, this statement can only be based on mass studies from the early days of resurfacing when things like femoral neck notching, cup angles, and poor prosthetic designs had not yet been worked out. It is also a certainty that any statistics they quote will be from studies including large numbers of non-specialized surgeons, which as mentioned above are not relevant if you are planning on using a resurfacing specialist, in which case only results from those surgeons are relevant to your study.
I admire you for doing your homework, it is a process that most resurfacing patients have gone through. I think that you have found a great surgeon in Dr Su. If you want to do further research on resurfacing, I would not worry about top overall orthopedic hospitals since that covers a huge field of questionable relevance, but focus your research on top resurfacing surgeons and read through their published results. Then if you want a comparison, compare that to the statistics for those top overall hospitals, but be very certain to match the age and activity levels in the studies you are looking at to your own situation. If you are an athletic 42 year old, most studies involving THRs will not be relevant to your case unless you break the study down to fit your age and activity level, which will likely change the results of the study dramatically. In the end it is a very personal decision that balances trade-offs, since there is still no perfect risk free solution that can bring us back to a perfect biological hip. Find the option that best suits the balance of risks and rewards for your needs and the demands that you expect to place on it.