Questions created by Patricia Dukes and Vicky Marlow

How many full Hip resurfacings have you done (not observed or assisted with and NOT including hemi-resurfacings)?

How many hip resurfacings do you do a month?

When and where did you train and who did you train under, have you continued your training?  If so, what continuation of training have you done?

How many complications have you had?

How many resurfacing failures with revision to THR have you had?

How many loose acetabular cups have you had? Did they require a second surgery to repair or a revision to a THR?

How many times during surgery have you had to change to a THR instead of a resurfacing and why was the change made?

For what reasons would you switch from resurfacing to a THR after starting the surgery? If you switch, what device would you be using for a THR?

What hip resurfacing device (prosthesis) do you use, how long have you been using it and why do you prefer it?  Do you have any financial stake in that device company?

Do you use cemented or uncemented? Why?

Do you cement the stem?

Will you be preserving the neck capsule?

Do you re-attach the gluteus maximus tendon?

What type of anesthesia do you use?

How long does the surgery normally take?

What surgical approach do you use? Anteriolateral, Direct Anterior or Posterior?

What is the incision length?

What is your post-op pain control plan?

What hospital do you use?

What is their infection rate?

Have any of your patients had infections that required IV antibiotics following resurfacing?

What drugs/methods do you use for anti-coagulation after surgery?

How long will I be in hospital?

How successful have you been obtaining insurance approvals for resurfacing?
 
What is the rehab protocol?
 
When will I be 100% weight bearing?
 
What assistive devices will I use for walking after surgery? Will you provide them or do I need to purchase my own?

How long on 2 crutches, 1 crutch, cane?

What if any restrictions do you place on your patients after surgery and how long do they last?

Will I be given any at home nurse or PT care?

How does my other hip look at this time?

If both hips are bad, how do you handle bilateral resurfacing?

Is there anything unusual about my hip that might present problems?

Do you have other hip resurfacing patients that I could talk to about their experience?

What is your opinion of my returning to whatever work or activities I have done in the past?

Have you done resurfacing for anyone who has returned to these activities?

Provided by John K.
Re: THR versus resurfacing

My suggestion is to ask this OS the following questions:

1. What data does he have to support a claim that a MoM THR will not require revision in the future? Or is he really just "crystal-balling"? And is he claiming that MoM-THR's will have a 100% success rate?
2. What does appropriate behavior mean? Does it imply restrictions that are not required with a resurfacing? This statement sounds like a blanket disclaimer to me....or an "exit strategy".
3. Which device yields bone-loading which better replicates that of a natural, healthy hip?
4. Is he aware of studies which have demonstrated ~ 10% degradation in bone-density with THR (regardless of type) but a 10% - 15% bone density improvement with a resurf?
5. If it were his hip and he had to consider a possible failure at some point in the future, would he prefer to get revised from a Resurf to a Primary THR...or revised from a Primary THR to a THR-revision?

It's quite natural to want to believe that surgeons have the power to grant guarantees for our future success. Unfortunately since they are human, this is a power they can never have. It may comfort us to hear such words but we have to remember that it is only us who will have to live with the results; and therefore, the final responsibility for doing the research (ie going deeper than simply accepting things at face value) lies with us and us alone. If his claim is solid, he'll have data to back it up with (I've searched and never found such data. Also, since MoM THR's have less history than Resurfs, I doubt such data even exists. Finally, the underlying science - i.e. Wolfe's Law - supports Resurfacing as being superior to THR).

I hope you get the chance to ask these questions and to post back the replies you get. My guess is that rather than getting any solid data or references to specific studies on MoM-THR longevity, you'll get vague explanations intended to placate your desire to dig deeper.

John(46)
Gross R-Biomet 12Jul06