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Knee & Hip Problems Message Board


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Hi,

My name is Marty and I'm a 49 year old male in need of a total hip replacement. I'm a Fire Captain and I was injured in 1999 when a building collapsed and broke my pelvis shattering my acetabulum. I now have post traumatic arthritis to such a degree that a hip replacement is necessary.

My question is what type of hip should I go with? I'm still fairly young and very active. My physician advised a metal on metal but I don't like what I'm reading about cobalt ions in the blood. I am now leaning towards a ceramic on ceramic. The new ones are supposedly very good and not prone to breakage in addition to being very smooth and long lasting with a much better wear rate than metal on metal or metal on plastic. Help! My surgeon also said this could be my decision and to learn as much as I can.
Also does anyone have any advice on the 'Jimmy Connor Hip' also known as the CONSERVE with a BHF system?
Thanks in advance for any advice,
Marty
Marty

At your age you should be a prime candidate for resurfacing. The procedure was developed for younger more active persons who would likely wear out a traditional hip replacement. It has been very successful. The recently released 2006 Annual Report of the Australian Joint Replacement Registry shows the results so far of over 7000 hip resurfacings carried out in Australia since the Register commenced. Of interest to you would be the rate of "failures" for males under 55. In this group there has so far been less than 1% revised.

Now bear in mind that activity levels after resurfacing are better than after hip replacement (makes sense because the bone isn't amputated), and that if a resurfaced hip does eventually need to be revised, then the revision operation is to a primary THR. If a THR needs to be revised, then the revision operation is much more difficult and the revised hip is not as good as it was with the primary THR.

Floyd Landis had his bad hip resurfaced 3 weeks ago, and the reports are that he intends to aim to win the Tour de France again (drug bans permitting).

Find a resurfacing surgeon who has done over 100 of the operations. Unfortunately I don't think that I can post names on this site. Many from the US travel to Belgium or even India for resurfacing, as there are excellent surgeons there and the cost is much less than in the US (for those who find that their insurance refuses to pay for resurfacing).

Levels of metals in the blood have not been found to cause problems, so do not let this put you off resurfacing. Cobalt and chrome are part of almost all joints, other than ceramic or titanium ones - for THR as well as resurfacing. Have been for decades and hundreds of thousands of joints. If problems were going to show up they would have by now. Metal on metal will not wear out because of wear on the metal. If failure did occur then it would be because of failure of the cement, or weakening of the bone leading to loosening of the implant.

Overall, resurfacing would be your best option, and if and only if an experienced resurfacing surgeon says that you are not a candidate, then the next best option would be a large ball metal on metal THR. A large ball THR largely overcomes a major problem of THRs - that they dislocate easily. Ordinary size THRs have a dislocation rate about 5% in the first year. It is a real problem and that is why there are so many movement restrictions with a THR. A large ball THR almost brings the dislocation rate down to the dislocation rate of resurfacing (about 0.05%). After the hip capsule heals, there are no repeat no activity restrictions with a resurfaced hip. Personally I think that those with a resurfaced hip who do a triathalon within the first three months are mad. But thats a debate that has been had in other forums.

You could also look at the problem in THRs of "stress shielding", leading to significant, and sometimes continuing, thigh pain. Also, the rate at which THRs lead to differences in leg length (the top of the femur is amputated, and a great spike driven down the middle of the remaining bone. Getting the length exactly the same as the other leg is sometimes hit and miss......). Not a problem with resurfacing, as it is just the head of the femoral ball that is shaved and shaped).

Last December I had both my hips resurfaced in one operation (I posted reports on the operation in the 6 Months after thread, and the Hip Resurfecing (sic) thread). I have never regretted that decision for an instant. The research that I have done and the feedback I've seen from other surfacehippies has strengthened my belief that resurfacing should be the first choice for males under 65 and females under 60. Only if resurfacing is not possible should a bone amputating THR be done.

Once the bone has been amputated, it is too late. Think about this very carefully and do the research. Bear in mind that surgeons who do not do resurfacing tend to poo poo the operation. Be polite, but do not believe them.

Regards

Ross





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