Selecting The Right Surgeon For You

Updated March 12, 2012

The first step in finding out if Hip Resurfacing is right for you or whether or not you qualify for resurfacing, is selecting the right surgeon.

Selecting the right surgeon is crucial to getting long term positive results.  It is a personal decision but one that must be taken very seriously.  Basically, if you choose the wrong surgeon and the surgery does not go as planned, you cannot get a “do over” without risking a revision surgery to a Total Hip Replacement, which in turn means another major surgery.

The most important factor in choosing a surgeon is his/her experience and skill level. There are many questions you should ask your doctor. Also remember that if the first doctor you see tells you that you are not a candidate for resurfacing and that a Total Hip Replacement is your only option, do not take their word as the end all, be all. There are many top surgeons that can take on difficult cases that other newer doctors will not touch. I am not saying to “shop around” for a doctor by just going to any doctor, I am saying that if one tells you that you are not a candidate, do not stop there. Get your x-rays into a digital format or jpeg and email them ONLY to some of the world’s top resurfacing surgeons to find out if they believe you are a candidate. (Feel free to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it and I can do that for you since I have access to over 40 of the world's top hip resurfacing surgeons for this, depending on where you live worldwide).  And this does not mean just any doctor that claims he does resurfacing, but the surgeons I access for opinions, that have done a minimal of 500 hip resurfacings (IMO) if you want to get a true unbiased opinion. I am not saying you have to pick one of these surgeons, but once you get several different opinions, then at least you know where you stand.  The number or procedures the surgeon has done does not neccessarily equate to skill level or how great of a surgeon they are.  I know some surgeons that are at around 100 or less procedures that are exceptional and outstanding surgeons and I know of some that have done thousands that I would not send my worst enemy to.   (Did you know that most Top Hip Resurfacing surgeons have done more Total Hip Replacement's than Resurfacings, since Total Hip Replacement's have been around longer, so they are really the ones that truly have the experience to speak to you from an unbiased perspective)  I know many patients, (myself included) that were told we were not candidates for resurfacing by other orthopedic surgeons only to end up getting successful resurfacings with the right doctor.

Hip resurfacing surgery is a very technically demanding and difficult procedure, very different than a THR. Just because a surgeon has done a lot of THR’s means absolutely nothing when it comes to his ability to perform a resurfacing. In my 6+ years of research on the subject and having had the opportunity to attend orthopedic conferences, cadaver labs and even scrub in to observe a live surgery, I have learned a great deal on the subject. Some of the world’s top resurfacing surgeons that have done over 1000 hip resurfacing procedures all say that they are still learning. You can read my overviews of these conferences here. Ortho conference overviews.

The overwhelming theme at these conferences was the fact that the majority of failures in resurfacings that required revisions to THR’s were due to surgeon error. Not all, but many of them were especially in the early days when the learning curve was much higher until the surgeons learned to perfect things so there are now lower risks of femoral neck fractures, etc.  So, again, experience and skill plays a major role in all of this. This is an incredible procedure and has very positive results IF the device is placed correctly in the hands of a skilled and experienced “resurfacing” surgeon AND you pick a PROVEN device..

So how important is it to select the right surgeon? Do you want to risk impingement problems for the rest of your life or an early failure? You tell me!  Many doctors will vary in their opinions on the number of procedures needed to get past the learning curve. And yes, there is a proven learning curve

Article: Learning curve may be longer than thought for placing hip resurfacing components

Article: 2007 Annual Meeting Podium Presentations; Adult Reconstruction Hip 2: New Technology, Resurfacing THA; Navigation, Minimally Invasive Approaches; Establishing a Learning Curve for hip resurfacing

Article: Low morbidity, few dislocations make hip resurfacing an option for young patients

With resurfacing, actually with any surgery but with one as technical as resurfacing, there is definitely a learning curve.  Some say 50, some 100, some 150 and now many are saying 200, even 500 now.  You will have to decide for yourself what that number should be, AND the number should not be the only determining factor.  How often does the surgeon do these procedures?  If he did 100 five years ago and now has taken the next 5 years to do the next 100, then I would say that is not enough experience, in my opinion.  How many failures has he/she had?  How about misplaced devices that cause long term groin pain?  What about slipped cups?  AND remember, again,  that numbers alone do NOT tell the whole story.  If a surgeon learns or remembers how to do the surgery WRONG, then he will just keep doing it wrong no matter how many he/she has done.

Piano Analogy
I use a piano analogy when describing the experience and skill of a surgeon for hip resurfacing.

With the piano, you will get one or two people that will sit down and be instant Mozart’s, but those are extremely rare.

You will get a group that will be incredibly good even when they first start out and their excellent skills and talent just keep improving with time.

You will get a group that with a LOT of practice, they will be pretty good but never outstanding at it.

Then you will get a group that no matter how often they practice or how long they have played the piano, they are just NOT going to EVER play the piano well. They might even be good at teaching the piano but they themselves will never be very good at playing it.

To add one more to the mix, my friend Paul (a talented pianist) told me, there is also the group that has the talent, but they are just plain sloppy/lazy at it.

There are so many factors involved in a successful resurfacing. Dr. Su explains the learning curve really well in his video interview in the last three minutes of it here. Link to video interview.  Also Dr. Gross explains it well in his written interview question #17 about how many Hip Resurfacing surgeries it takes before a surgeon is proficient at it.  Link to written interview.  One more thing is you can check out the Survey/polls on the HipResurfacingSite Survey Group to see what a lot of fellow surface hippies believe to be a good number of Hip Resurfacing surgeries before a surgeon is proficient at doing this procedure.  Click here to join that group to see or participate in the survey. When you click on that link it will take you to the message board, look to the left side menu and find Polls and click on that to participate and see others answers, please join the group first as membership is required to access these features or read the posts.

The more experience a surgeon has, the more complicated cases he/she will be able to tackle.

Many patients that go to the more experienced surgeons will also enjoy quicker recoveries, but recoveries vary greatly from patient to patient and there is no way to know how long your recovery will take.  I am a perfect example since I went to the same surgeon for both of my hips done 5 years apart, my first recovery was very slow and took a very long time, I was still on one crutch at 2 1/2 months post op.  My newer right hip done in December 2010, I was down to one crutch at 6 days post op, no walking aids by 3 weeks, practically running up and down my stairs by 4 weeks and could touch my nose to my knee by 3 months post op.  Same surgeon, same device, day and night recoveries.  And that is the case for either procedure, whether it is hip resurfacing or a Total Hip Replacement (THR), recoveries vary greatly.   I have kept an ongoing list of failures and complications that have posted before, but now I keep that strictly confidential except for the percentages which you will see below.  This is interesting data, all anecdotal, but interesting nonetheless.

Using a more experienced surgeon will greatly reduce the risk of any of these complications happening to you.

Information gathered by Vicky Marlow Updated 9/7/09

12% Loose Femoral Component  
38% Slipped or problem Cups  
18% Fracture  
9% AVN  
6% Nerve Damage  
6% Infection  
3% Unknown  
8% Metal Allergy ?  

*Out of the 12 fractures, 7 were women and 5 were men.
*Look here for the possible reasons for a slipped cup (Link to Doctors on Slipped Cups)

This chart is strictly anecdotal and only represents problems posted from members of several online Discussion Groups as well as patients that have contacted me personally.  This does not include all hip resurfacing patients in the US or worldwide. This is in no way a scientific study, just a sampling of failures of patients gathered informally.

Copyright Surface Hippy Info/ Hip Resurfacing Site (Vicky Marlow)

And to quote Dr. Thomas Gross when asked “What do you consider an adequate number of surgeries before a doctor is proficient at resurfacing?

Dr. Thomas Gross: “Surgeon talent varies tremendously, probably more so than athletic talent. The problem is that it is extremely hard for a non surgeon to evaluate who is best. Some have done large numbers and still are not particularly skilled. Some are good at writing research papers but are not so skilled at cutting. Unless you are a surgeon who knows the literature in this field and can watch several surgeons before they make a decision; I advise you to talk to a few patients who have had a particular surgeon work on them and base most of your decision on this “word of mouth” reputation.  Most reasonably talented Joint Replacement Fellowship trained orthopedic surgeons will probably be adequate after 100 Resurfacings; over 500 to be considered experienced.”

The most important decision you will make is selecting the right surgeon.  It is strictly a personal decision and no one can make that decision for you.  Bottom line, your chance of a successful outcome is greatly improved when choosing a surgeon with more skill and experience.

Read the doctors written interviews, watch the video interviews, trust your gut instincts, but ask the right questions until you hear the right answers for you. Also post on the Surface Hippy/HipResurfacingSite message board, many patients are happy to help answer your questions regarding different surgeons.

As a patient advocate, I am here to help guide you in making that decision.  Many patients have asked me what they should do, which doctor should they pick?  I can not and will not tell them an answer to that. Only YOU can make that decision.  I can help to guide you to your own research which will assist you in making your own decision that is right for you.

Click here to print the Surface Hippy/ Hip Resurfacing Site List of Questions to Ask Your Surgeon.

I hope this article has been helpful to you.

Vicky Marlow

Some additional questions provided by John Karpowicz if your doctor tries to talk you into a THR.

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