Written in 2008 by Vicky Marlow  - Update from August 28, 2011 post below this one

Doctors have a vast array of scientific studies that they can reference to their advantage even though they may not match their own personal outcomes. When I heard Mr. Treacy speak at a conference I attended, his opening statement was a joke about how the one thing he has learned from studies is that you can really make them turn out pretty much any way you want them to. The response was a thunderous laugh from the huge audience of orthopedic surgeons.

All we have as patients, ones that are here to actually and genuinely help other patients, are the thousands of posts we read from real life people and the countless phone calls and emails received and replied to OFFLINE, again, helping and working with REAL LIFE people. Many of the veterans including myself have taken our posts offline due to certain personalities that were allowed to constantly cause problems by attacking and starting fights on another support group (SH).  Those flamers seem to get a kick out of stirring things up and causing confrontations, so I started up the new group where that sort of bickering and arguing is NOT tolerated and not allowed.  But unfortunately we lost a lot of great posters that contributed SO much back in the day.  Hopefully we will build that up again in our Support group from now on.

I received an email from a friend and he worded it much better than I, so I am going to draw from some of what he said to me below.

What some people fail to consider is that there is a very large amount of offline activity. First and foremost, because SH is such a relentlessly upbeat forum, people with problems often feel like they can't post when their resurfacings have gone bad. It's a very small number that come back to tell about their pain or their revisions. But they are out there.
 
Both Alan (one of the veterans that left the other group) and I help a lot of people offline. We have access to a lot of stories that most people never hear about, and we remain ethical enough not to post details about other people's problems or about the doctors involved.
 
The world is not as black-and-white as some would like to believe it as. One doesn't need a statistically-backed study published in a peer-reviewed journal to know when something is wrong with a particular doctor or approach.

I keep track of a lot of data, not only posts, but private emails and phone calls as well. Currently I speak to at least one patient a day on the phone and sometimes up to 6 patients a day.

To give an example, I spoke to and worked with 4 patients and know of 2 others of one particular surgeon who will remain unnamed. The outcomes have been far from positive, several needing revision surgeries to THR’s and a couple ready to have theirs revised. You will never see me recommending this surgeon. Have these patients posted on SH? Yes, prior to their surgeries and prior to their problems. Does anyone on SH know about these problems? Certainly not, as evidenced by reading the board. Has this doctor had some positive outcomes? Sure, but considering this particular surgeon has not done that many resurfacings, this is NOT a surgeon I will ever recommend. Is that data published anywhere? Absolutely not. Will there be a patient that posts on SH about having a good outcome? Absolutely, but you tell me, if you were sitting in my shoes, would you look at 6 failures that you personally know of in less than 100 procedures and not do something to give this information to a future patient about this doctor?

On the other side of the coin, I have met many doctors in person and I can see and hear the difference between those that have passion in their voice about hip resurfacings and can tell that they genuinely care about the outcome of their patients and advancing their knowledge and skills to better serve their patients versus those that I can genuinely tell they only care about the outcome of their practices.

I gather a ton of data in many ways, from patients, reading stories from patients, from the doctors themselves, mingling with many of the surgeons at the functions I attend, participating in cadaver labs, (4 as of 8/11) observed one REAL live surgery in full scrubs, etc. Out of all of this gathered information over the past five plus years, I have come to my own conclusions. Those conclusions are constantly evolving with the more I learn. Are they right or wrong? No, they are just my own opinions based on education and experience, and some of it is based on gut instincts as well. I am a patient advocate. I try to stay as neutral as possible, but I always look out for the patient’s best interest first, not the doctor’s best interest or any manufacturers, but the patient’s best interests.

I recommend certain doctors because I see their outcomes and talk to their patients. I don’t recommend certain doctors because I see their outcomes and talk to their patients. Is this a scientific study? Absolutely not. But if you only believe in scientific studies and discard the real life experiences of people that have become your friends as fellow surface hippies, then what is the point? Which would you tend to believe? A fellow surface hippy calling in tears (happy or sad) or a scientific paper or study?

Vicky
LBHR Dr. Bose Dec 01 05

From: Vicky
To: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Sent: Sunday, August 28, 2011 9:30 AM
Subject: [Hipresurfacingsite] Cadaver Labs and Surgeon Training/ Selecting the Right Surgeon

I thought I would start a new thread for this topic in response to Don's post about surgeon training. Sorry, this will be long but I believe very important for all the newbies out there especially.

I don't know what each manufacturers protocols are for training. But even after practicing on a cadaver, the way some of those surgeons fumbled on the cadaver, I can't imagine they would remember even a fraction of what Dr. Gross was telling them they did wrong and how they should have done it this way or that way. Then I can imagine some of them constantly continuing to do the same things wrong on real live people. Because unless they trained UNDER a surgeon and were able to do it the RIGHT way under the guide of a trained and skilled surgeon, then they would only be doing the surgery from memory. Like Dr. Bose trained under Derek McMinn for a couple of years I believe. It is also great that some surgeons take the time to travel to some of the best surgeons and observe them doing the surgery to get even more training. Training is critical. If they just fly over and get trained one time, and don't practice also on cadavers and get more training under a skilled surgeon, I just don't see how they can get this procedure right.

Again, I have live surgeries here and I am not going to name any names but you can see one surgeon just do plain sloppy work and you can see others, some of the greats, do meticulous work. Again, another patient had found my website before joining any support groups and happened to watch the really bad live surgery first with his girlfriend/partner and they both thought yikes! What a SLOPPY surgeon! As a hint, it is one of the videos that you have to "click to watch video". At first they thought they were watching Dr. Bose then they found Dr. Bose surgery video and realized that the first one they watched was a different surgeon because you can see how much of a perfectionist Dr. Bose is in his surgeries and just how different each surgeon is in the way they do surgery.

http://www.hipresurfacingsite.com/Live-Surgery-Videos/Live-Surgery-Videos/menu-id-82.html

I also have a segment of my own live surgery from my last right hip that was done 8 months ago here, showing how Dr. Bose preserves the neck capsule and also showing my femoral head cyst that had just started to form and would have gotten larger had I waited another year or so to have my surgery.

http://www.hipresurfacingsite.com/VM-s-Live-Surgery-Video/VM-s-Live-Surgery-Video/menu-id-118.html

I can spot the few that are a natural at it and there was at least one surgeon that I recognized from prior cadaver labs that were at this one too. One in particular that I remember from the cadaver lab I attended in Belgium, Dr. Whatley, he is from Dubai but was originally from Canada and I remembered him because of a patient that went to him back then and Dr. Whatley had asked a lot of questions and made some excellent comments while we were in Belgium and we observed Andrew Shimmin for one cadaver and Dr. Bose, my doc for another cadaver. Again this time he did the same thing while watching Dr. Gross. He would make comments like, that's how I do it too or ask a pertinent question about a certain technique Dr. Gross was doing, when Dr. Gross would tell the other surgeon with the knife how to do something.

The last couple of cadaver labs I saw an expert doing the procedure and demonstrating to the other surgeons. The first cadaver lab and this one I saw a brand new surgeon operating on the cadaver while the faculty surgeon showed them what to do and pointed to things then would take over for a few minutes if the trainee was completely getting it wrong which happened with both cadavers several times with two different trainees.

I personally think any patient that decides to go to a surgeon that has only done 100 or less is really taking a HUGE risk. You might as well fly to Vegas and gamble if you like those odds, because to me, if you do decide to stay local with a less experienced surgeon, it is like rolling the dice whether or not you will end up with a good outcome or one of the really poor outcomes that will end up facing revision surgery. AND I believe it is INSANE (just my own personal opinion) to go with a manufacturers doctors list and think for even a second that just because a surgeons name is on that list that this surgeon is going to know what the heck they are doing. Because I can guarantee you, some of these SLOPPY surgeons I saw in the cadaver lab, WILL now indeed be ON those manufacturers lists. Some patients that recommend those lists just have NO clue when they send patients there to look for a surgeon. I mean what are they thinking? They just are NOT thinking or have no idea what those lists mean. I don't think they are doing purposely to mislead patients, but they really have NO clue what those lists consist of. A lot of those surgeons are bait and switch docs too, they went to one cadaver lab, saw how difficult it is, might try resurfacing on you if you insist, or talk you into a THR and badmouth resurfacing, but they want their name on that list.

I understand when finances are a consideration and some patients just don't have a choice. But do NOT go with just a manufacturers list of doctors, at least try to pick the best out of the selection that you have. Or pull from your retirement or take a home equity loan and fly to India like I did and pay only $10k to $12k for your entire trip and have one of the best surgeons in the world do your surgery, Dr. Bose. Some have used credit cards to pay for it. We spend a ton of money on flatscreen TV's, cars we drive, cable, luxury items, what is your hip worth to you? I know I believe I am worth $12k, are you? For those of you that have no insurance and no finances or family members you can borrow from, check out DAST International, but ONLY if you have NO medical insurance and meet the other qualifications.

This all is just from MY experience with ALL the (must be thousands by now) patients I have worked with in the past, the conferences I have attended and continue to attend, the surgeons I have met and talked to..... Even any patient website list, take caution, on my OWN list, I have disclaimers ALL over it on top, every patient should read carefully what I write above my doctors list

http://www.hipresurfacingsite.com/List-of-Doctors/List-of-Doctors/menu-id-81.html

It STILL is in NO way a list of docs that I would personally recommend each and every one of them that are on the list on my website. If you want to know my opinion, it constantly changes and you would need to contact me offline and I will only discuss it in detail over the phone. What do I base my opinions on? A combination of a TON of things, number one being, patient RESULTS and OUTCOMES over the years. But this somewhat covers it

http://www.hipresurfacingsite.com/My-Point-of-View/2008102627/My-Point-of-View/Scientific-Studies-vs.-Real-Life-Experiences-Why-I-Recommend-The-Doctors-I-Do/menu-id-59.html

If you read the above article you will see that I have a ton of things to pull from, unlike other people. Surgeon recommendations, well, some of those could be just friends of surgeons, recommendations from ONE patient, well maybe the doc just lucked out on that one patient, or that patient is too early on to know what the long term results will be. I take ALL of my vast experience into consideration in order to come to my thoughts and opinions and again, they change all the time. Surgeons I used to recommend, I now no longer recommend them due to all the failures popping up lately, surgeons I did not recommend before, now I do recommend, due to more patients having excellent long term results.

Unless a new patient happens to find someone that is a natural at it, but even then, it is SO different then doing a THR because they have to preserve the neck or soft tissue capsule around most of the neck. It appeared to me like the number one thing these surgeons in the cadaver labs would mess up on is mistaking cutting off the neck capsule where they shouldn't, out of habit of doing so with a THR. Or almost tearing some of the soft tissue while trying to get through certain areas, this makes it difficult to sew things back up. Some might not even repair everything that they take down, because it IS a lot of work. Preserving the neck or soft tissue around the femoral neck, takes a lot more work to do and is critical for several reasons, one for preserving the blood supply to the femoral neck to prevent AVN, the other is to prevent dislocation.

I was happy to see quite a big turn out at the cadaver labs yesterday, even with the weather warnings. The attendees were very international which was nice to see. I am happy to see more surgeons interested in learning about resurfacing. But I can very easily see how many of them would try one of these cadaver labs and get frustrated and think to themselves, why should I learn this extremely complicated procedure when I can just stick to doing a THR and not worry about it. Then fall back on the metal on metal warnings out there as an excuse instead of the REAL reason, too technical for their own personal skills. That is the real bottom line IMO in most cases, either that or some surgeons have just formed too huge of an ego to even think they need to bother to learn something else.

To me, coming from a patients perspective, it is SO different, to a surgeon, many of them are looking for the easier way to do things, to me, do I care what is EASIER for the doc? Heck no!! I want what will give ME the patient the absolute BEST results possible, I don't care that it will be more work for my surgeon, like doing the posterior approach is harder then using the antero lateral approach from my understanding. Do I care? I want the approach that has less risk of HO (Heterotopic Ossification) and better long term gait results. NOT the approach that is easier for the doc!

The labs were packed and I heard the day before they were packed even more so since they had most of the faculty still there to help with training and yesterday it was pretty much only Dr. Mont and his fellows and Dr. Gross and a couple of other surgeons. This article is also excellent to read for newbies.

http://www.hipresurfacingsite.com/Selecting-The-Right-Surgeon-For-You

Vicky