Hip Talk at Surface Hippy

So, about 9-10 months ago I was told I did  on have enough osteoarthritis for resurfacing. I sent my scans and was told for some unknown reason, people with my leve of OA don't fare well.  I have failed scopes because of the OA.   Now i gave my six month later Xrays to Desmet, and he asked about my symptoms, which are similar or a bit worse.  And replied with a nonchalant, "maybe have your right hip resurfaced" without mentioning his impressions from the Xray. Makes me feel a bit uneasy.  I did actually see him person last year.

Anyway, did anyone get operated that wasn't bone on bone on the Xray?  Of so, how are you doing?

A sensation: The femoral head where the femoral component is attached gets its necessary blood supply (to keep the bone alive and strong) through vessels both inside the bone as well as outside in soft tissue. As the hip develops osteoarthritis, it changes the way it supplies blood to the femoral head. The blood through soft tissue becomes less and the blood supply through the femoral neck inside the bone increases. Bone on bone arthritis is a benchmark that gives enough assurance that the blood supply will have changed enough to be sufficient after resurfacing.

Otherwise you run the risk of avascular necrosis where the bone dies underneath the device.
So while it is possible to have successful resurfacing without bone on bone arthritis, the risk for a bad outcome is elevated.

If you cannot live with the pain to wait for resurfacing you can just go with a total hip replacement. They replace the whole head and neck so blood supply is not an issue. But, of course, you then don't have a resurfaced hip and may have restrictions.

Chuckm

Thank Chuck,  that has been the best explanation I have been told.  Waiting game continues. Only 31, so I don't want to jump to the thr. 

I am in the same boat as you two failed arthroscopic surgeries mild arthritis still have good joint space. I visited Dr.Gross last year and he was hesitant as well. He did not mention what ChuckM stated.

I am now starting to have issues with my knees as well as the chronic hip pain in both hips 24/7. I actually reached out to Dr. Gross last week to see if I qaulify for his outpatient procedure.

That is concering what ChuckM mentioned.
Thanks,
Larry

LJ,

Let me know how the visit goes and what he says.
Thanks

A. S.

I wouldn't be concerned at all about the bone on bone issue unless you found a rogue surgeon who felt that resurfacing while you still had joint space would be okay.

The blood flow issue is not fully understood but it does seem surgeons don't want to alarm anyone by talking in detail about it. It's just an unknown. If you reach a bone on bone arthritic state but don't have AVN then you can probably support a resurfacing. Before bone on bone it becomes more unknown.

Chuckm

When I met with Dr.Gross and Dr.Ratterman neither mentioned this. I was under the assumption that Dr. Gross prefers the patients to utlize all options before HR.

We are in odd situations as hip arthroscopy did not work and we still have joint space. Hip replacement is not an option for me as i am 44. I will ask Lee at Dr.Gross office what he thinks about the bone on bone and blood flow. Living in chronic pain all day is not an option for me any longer, i have had these hip issues since 09. Two failed surgeries i want to be done with it once and for all

Thanks for bringing it up, its very interesting.

Thanks,
Larry

There are many reasons to wait for advanced arthritis before resurfacing. The blood flow issue is just one. 

As long as there is joint space (meaning you still have a layer of cartilage) it's not a sure thing that replacing that cartilage lining with a metal lining will alleviate the pain. When the space is gone and the bones are touching, it is a sure thing that resurfacing will stop the pain generated by that. 

It's a tough spot to be in. I'm in that spot with my other hip that is now becoming more and more painful.

Chuckm

Tough spot indeed. It stinks cause I have pain when I sit, so I am in pain all day at work. My OS that did the arthroscopy says its to risky to try a microfracture on the same spot. Dr ratterman also stated the same.


If the pain is coming from the arthritis in the joint even though it's limited, the hip resurfacing should resolve it, I would think.


I am stuck basically.

I was 43 when things got really bad. My surgeon said I had to tough it out until 50 to get to a THR.

Luckily, by time I found out about hip resurfacing, my bones were rubbing. But I endured about a year or two in that condition.

I'm pretty sure I would have had to wait if I had gone straight to the resurfacing surgeon.

I watched a good friend of mine wait until the joint space was gone. I think it was about two years before that surgeon finally said that it was time.

It gets so bad that you start thinking that you will take the higher risk just to get it done - if the surgeon would say yes. And so what, if it fails you will have it revised to a THR which is the only option right now.
Unfortunately good surgeons are not willing to take those same risks.

Chuckm

Part of the joint is exposed 2 cm x 2 cm they saw and did microfracturing during the scope.  That is the part that is rubbing.  On the Xray, it appears to have space because other parts of the femoral head are grade 3 or grade 4 and likewise with the acetabular.  Too bad the stem cells aren't there yet to fill in that gap.

 ;) Hi Sensation ...... Yep Dr DeSmet will not say to much why would you at 12,000 plus hips and I don't know how many resurfaced. Why would a world class surgeon say to much ? Yep been there and done all that FAI stuff scopes ETC..... Found the issues never stop... Find out from Desmet if you have Deep hip sockets or normal. Was 8 years in the making 6 on crutches and still no good. Yep look do-able on paper or film but not do=able was my body saying. Now the longer you muck around the harder it is to train the muscles back into what should happen the longer the rehab. Try 1 at a time I did 2 and it is hard man. Do not do too much exercise before probably better massages... He told me I was hard to do due my muscle tone was so strong. Well you would be after 6 years of walking hobbling like I was and told all the rehab stuff by the FAI surgeon which was never going to work. Hell the FAI bloke even said we will get about 10 -15 years out of those hips. De Smet said I may get the rest of my life on prosthetic s.   So I opted to give my body a change. I am going through some rough time at the moment with the tissue rebuild but its a process and once you get your head around it and do it, get a result it encourages you to keep going. Be honest if De Smet says thats the issue why would a world class surgeon risk their reputation?
If I had my time again I would ask him earlier on and get it down asap as the suffering you go through with crook hips is long, long process.
More find out if your hips are congenital issue, injury, or poor wear and tear.
He knows about all this as he has seen it before so maybe he is just going to get to the point. No body should be stuck in this position. if they can get a bit of coin. It is cruel and painful as it may never be your fault. The cost is very reasonable. I would look at it "seriously" email me if you wish. Look up Pats stories.  8)

Thanks for chiming in Karlos.  The thing that has me apprehensive at the moment,  is how he disregarded what he told me in person less than a year ago. So, I am concerned about the joint space issue.   I wrote back, see what he says.  He mentioned some mild dysplasia on less problematic side.  No mention of deep sockets.

So, we're you operated by him?  How far out are you?  Good luck with the recovery

 :) Hey sensation. Yep only about 4 months out. One of the things this web site  says the longer the problem the longer the rehab. Not sure on your stuff but I had FAI pincer quite bad. So I had gaps in my sockets but quite a bit of cartilage. The cartilage was never going to get worse so the joint and surrounding tissue gets a hammering with inflammation from the joint.

Never ending story. If you can get around it do it but me I would use my legs and be in chronic pain not so much in the joint but from the joint. So if you don't have that and really can walk on it sweet. I don't think any condition what ever it is in the joint is the same. Recovery is slow due I had this well over 7 - 8 years of fighting myself it would get better. It never did. But now I can walk on them no hobble. But still a long way to go for the surgical inflammation to recede. Good keep  luck what ever you find out. I see some amazing stories on here at times .. back doing dancing after 8 weeks.... biking 40km after 12 weeks. Not me but I do not hobble. Those must be exception people. Good luck cheers K :)

Hey karlos, how long did the fai surgery last you? Did you get any relief? Something that is noted on my recent MRIs is bone re growth from earlier MRIs.


So the surgeon shapes the bone and then it can grow back. This is something not mentioned by many scope surgeons. I know no surgery is guranteed but some of these scopes are just a waste of people's time, seems there should be a better screening of patients.


Larry

Hey LJpviper. Ok I am no surgeon.
But My FAI surgery failed from the day I had surgery on them. For this. I should have left the FAI alone. Ok here is why.
I have just been to Sydney to see a specialist there and he forwarded me onto a rehab bloke in NZ that used to work with FAI people in Victoria - Tasmania. Hip rehabilitation is his specialty. He was involved with outcomes and research into the surgeries of FAI Bruckner and Kahn sports peoples who write the sports bibles.
Ok basically if you have pincer dominant they do not do this operation any more in Australia as it destabilizes the hip joint even more (this is what I had).
They only remove the cam and fix up the labral tears or separation of the tears now (Australia).
Bone  grow back I am not so sure? but you can have a bone on bone some people do and get away with it. If your FAI surgery works cool, wait. But I had too much so called cartilage but all in the wrong areas. My joints were flogged from being impinged yep and I suffered for about 8 years until I plucked the courage to have them resurfaced.
No relief. No did not last, bad deep sockets I had pincer type.
Good luck keep doing your research.
Cheers K

Hi there, I have the same issue; Ive had 6 scopes - 3 on each side which have all failed due to bad surgeons and then scar tissue formation.  I also have hip dysplasia and an old piriformis release surgery which adds to my instability.  I'm only 36 but had the last 3 years in a lot of pain an not able to do simple things like walk.

Anyway, my scans show good joint space on one side and then mild arthritis on the other.   Dr De Smet said he would do one side and Im waiting to hear back from Dr Gross. 

I have a local surgeon in South Africa who has performed about 1000 of them, he himself has had his hip resurfaced, he seems to think it is ok to resurface both; i think he his much more sympathetic to my situation as he has been through it.

I think its worth the risk of resurface, living in pain really sucks and not to mention the de-conditioning of the body which puts everything else out of whack.   

Im just trying to decide whether i push for it with the aforementioned surgeons or go with the local guy which would be much easier.  Another complication I have is I want to get pregnant asap but couldn't imagine going through it with my current hip function and not being able to have cortisone to keep the pain at bay.

Hi westro.
Please scroll down to one of the previous posts in this thread by chuckm. He gives a very good explanation of some of the risks of doing a resurfacing when there is not sufficient arthritis present for the body to start re-routing the blood supply. It might be a topic worth discussing with any surgeons that you talk to.
Also, you mentioned wanting to get pregnant. Some people have concerns about a pregnancy with metal on metal joints like resurfacing, because many believe that the metal wear debris might cross to the baby. It is possible that some doctors might advise you to have your baby before getting a resurfacing. Something else you might ask the surgeons about.

hi John C


Thanks for the pointers,  the surgeon seems to think the risk is relatively small but i am consulting with a few doctors so will have different opinions. Dr Bose was against it for the same reason.


Re pregnancy, Dr De Smet has good data comparing metal ion wear rates of the  conserve plus vs the BHR, so if I opt pre-children will need to use a surgeon who does not use the BHR as it has higher levels for the first 2 years after placement. I cant really bare to think of 4 more years of my current status.


thanks!

 :) Hey Westro.
Sounds like you been through a lot or heaps. 6 scopes now that is starting to ring alarm bells already. Common logic for me would be after 2 scopes and see what it is like then start looking at what the real issue is. Dysplasia is the opposite of what I had, so one way it is not normal  . I met a woman on my way home from Belgium in the plane same thing she could almost dislocate her hip from a standing position she was only young.

Maybe  give one a shot or the bilateral. But be aware it is a grueling operation Bilateral but if you think you can handle it do it. I meet a polish woman when in Belgium who had 1 BHR 11 years ago, she plays tennis rides a bike and was most active and normal. The prosthesis was like the  day it was inserted. So some good things happen. Unfortunate you have dysplasia but good to know someone in the world can help. Good luck sounds like you are on the right track. Cheers K

cheers Karlos.


I would have stopped at 2 scopes on both hips but I was getting married and in significant pain leading up to it, so decided the more prudent path was to give it one last shot (before going down the resurfacing/replacement route). Turns out they didn't work so should have bitten the bullet then. 


I think the dysplasia/piriformis release surgery is what is causing the problems, they say scopes in dysplastic patients are less successful; as once they've operated on the capsule it can create instability.  Ive been unlucky that on my right I keep getting scar tissue which is causing the cartilage to keep retearing, its in bad shape.  My left has been hampered by my piriformis release surgery i had 6 years ago  (worst mistake ever) which has made me even more unstable, even with physio.


Good news though, Dr De Smet is happy to do both hips.  I think i should be ok to do bilateral as I am pretty strong (even though very unconditioned) and just want to get on with my life rather than dragging this out for more years.


Thanks again

 :) :D Hey Westro awesome news about De Smet if he will do both. Now check it out with him as he releases the piriformis tendon to get back in there properly. He may even put your hips to as normal as he can get them for someone like you which will be different. Mine were real deep so its different now they work totally loose as I would say. Good ROM compared to my old deep hips.
But check out to see what he can do try and make the piriformus as normal as possible when doing the operation. He is fast so he don't muck around.  great hospital, great people as well, nice hotel to stay in after.. Good luck if you go...

thAnks Karlos, thats good to know re piriformis as a good reminder to ask him - if he can fix what the other surgeon messed up that would be fantastic.


Glad to know you got good results with him - when you organise from abroad you feel a bit more like a ticket number rather than a patient..

 Well I tried PRP shots in both hips in November did nothing except waste 800 dollars.

I spoke to Dr.Gross again last night about my current situation. He reviewed some current xrays and saw the joint space the same as last year. He is still a little hesitant to go forward because of that. I am still in pain daily especially sitting and any activity it will flare up, also knees and back have been taking a beating lately. At this point I don’t think it’s worth waiting for a miracle, I am 44.

He mentioned to try another scope with Dr.White in Colorado might help. I don’t think it’s worse the risk and time to try another scope. Dr. Ratterman who I saw in May stated that another scope is like opening a hornets nest in your hip.

Dr.Gross is so passionate about his work thus he wants to make sure I am happy with the outcome, that’s his concern. Most of his patients are bone on bone, unfortunately I fall in the grey area of hip resurfacing patients.

Thanks,

Larry

Larry, isn't your condition bone on bone when you are in a seated position?

Chuckm

Yes, the two bad spots are where the microfracture failed. They are deep in the socket, thus aggrivated by sitting or bending at 90 degrees. The rest of the joint is fine, thus is why Dr. Gross is a little hesitant. I understand he does not want failures and told me i would live with the resufaced hip even if I didn't like it, in very stern words.

Have you taken your case to Dr White or another doc who would do a scope? Would he do it? Or would he reject you for that spot of OA?


You are in a tough situation. Reading patient stories, people with less OA are less satisfied with their HR. The new, bionic joint isn't as good as the one God gave you. Whatever you decide, go into it with your eyes open.

I'm still surprised by Dr Gross' comments here too Larry. My pre-op x-rays weren't bone-on-bone through the entire joint and still showed some remaining space (although similarly, I was bone-on-bone in one big area where microfracture had failed). I'm also younger. Despite that, Dr Gross had no hesitation in saying he thought I was a good candidate for resurfacing. He didn't seem worried about implant longevity in my case and stressed that he thought the waiting for full bone-on-bone was a myth.

Is his concern that he thinks your pain *isn't* from the joint?

JD,Not sure why, I guess he hates to sacrifice a good looking joint for one bad spot. I beleive that is his concern all the pain is not coming from the joint. He sees cases like mine and yours infrequently, but it appears he is searching for the correct care if not with him with another scope surgeon. Like i said we are gray area patients

Blinky, he mentioned Dr. White, I just think another scope is not worth the risk of it failing again. JD knows, its a very difficult recovery. Dr. Ratterman who I saw in May-15 does not like to do repeat scopes, and he does both scopes and HR. He was a little more gun ho about the resurfacing and said i should do it.

Thanks,
Larry

That's got to be frustrating Larry!

My understanding was that repeat microfracture really didn't work very well (much lower success than primary microfracture), but I may be wrong in more recent data.

Did Dr Gross say he wouldn't do it? Or just that he thought you had better options first?

What are you going to do next?

I am going forward with the hip resurfacing, he says he will do it. As stated, my knees and back are taking a beating. I dont want to try a scope again, to much risk it will fail again.
Larry

Alright, good to hear! Perhaps he was just making sure that you were clear that there was a chance most of your pain wasn't from directly in the joint.

I know you've been headed down this path for awhile so, while it's frustrating to get get a ringing "yes" from Dr Gross, I bet you're relieved to just be moving forward.

When is it going to happen?

 :) Hi Viper  8) Exactly that. Your back, That is also your whole spine... knees, even your feet will take a beating. Same if you have a crook shoulder the pain radiates down the arm even into the hand... Worse in a hip due it is weight bearing so the muscles change to accommodate the worn joint. 15 of them I think...
I am doing well, yes I had scopes but realized they are just if you have little issues. I also found out once that joint starts having issues and showing a small amount of wear it is never going to stop (the issues) . They always find more issues out when they do the total operation Like Dr De Smet. I asked if it was possible to have un - cemented femur  components. After the op he said no my femur  blood supply and bone was not up to it so he had to cement it, yet I am young and healthy (so far touch wood). Was the issues I had for years due I could not have un - cemented.
It is a hard road and yes he is exactly right you may be left with what he gives you there is no turning back...... Also the joint on paper looks good so why should he do it???  but it is not standing up to the pace. Same as me. The issues started and as cartilage cannot replace only repair you are left in no mans land... Stay the same... Floppy joint.. worn joint.... It is a hard decision for a surgeon but all you ask him is to help you and do the same job as every one else. Normally the same result will apply. So with that be confident and your rehab may even be longer than the others due your issues have been there for a longer time.
Been 8 months now up and down but still have issues but I was able to do a 3/4 hour walk and no issues the next morning so things are looking up.... Its a long rehab I feel the longer your issues are. Not sure how it goes for example I was on and off crutches for seven years to aid me walking yet on paper my joints were fantastic in the eyes of Radiologists in  NZ but to De Smet it was No.
Yes  my knees have taken a beating especially the left knee and may never recover and I will have to live with it.
Be confident in your self that you are making the right decision that then gives confidence sometimes to the surgeon.
If he is willing to do it for you under it all he must want to help you so why take the risk??
Good luck and hope it all goes well.
Cheers K

Thanks for the words Karlos, my OS just emailed me that did the scopes he does not think trying another scope is a good idea cause of the articular cartildge damage.

JD, now that you have had you hip resurfaced a few months do you feel it any different in movement compared to your natural hip. Like the joint itself, is it just as smooth? I wonder why Dr.Gross stated i might not like it compared to my natural hip, but it sures beats an arthritic hip.

Thanks,
Larry

The joint itself feels 100% normal as far as I'm concerned.

I have tweaks at extremes of ROM (which are still less than my non-op leg) but I think that that will continue to improve (and many people claim better ROM long-term).

There've been a few discussions on this idea that it'll be worse than a natural hip but I think the consensus here is that most people think their hips are at least as good as they remember a natural hip being. I suspect that if there's much difference, we've all long forgotten what that was like!

Thanks JD, just the answer i wanted to hear.

Of course the counter-argument is still that if you have fundamental major problems with soft-tissue, the surgery probably won't solve that, leaving you with residual pain and issues. As long as you know there's some chance that that's the case but you feel comfortable enough in thinking it's the joint and Dr Gross is willing to do the surgery, I think you're all good?

 8) Hi Viper again, and others reading this post..
Rom of these Resurfacing joints are amazing to say the least to a natural hip. but it depends on the natural hip depth and ROM  of the native hip. I know now what a normal hip should do. I was watching a You tube video one day of a couple of USA PT's. The bloke real tall just sat down and put one hip at right angles to the other (he was about 50 +) and I went "man alive" that is amazing. So it depends on the depth. I now almost can do that due the tissue is freeing up in the joint so they are to me amazing ROM. I have no impingement issues in any hip...
They do clunk around a bit due to they do not have the depth or a Labrum but they have stability, ROM,  the muscles around the joint once they get stronger and more available to work this seems to stop due then the joint cannot flop around or slightly clunk.
That is if you have had this muscle weakness along time.
Cannot see into the future but I am really hoping it's real good.... Cheers K

Got my surgery date April 13th, doing the right first, i am excited to be pain free!!!!

Congrats on the scheduling the surgery. I'll see you there, I'm scheduled for bilat with Dr Gross April 11 and 13. April can't get here soon enough...

good luck

Good luck to both of you!

Get strong in the mean time, it'll make recovery easier (gluteus medius in particular for me).

Yeah JD, i have been working glutes and core alot lately. I will keep working up to surgery date.