When is the Right Time to Have Surgery?

You need to consider many factors in whether this is the right time for you to have surgery. Such factors include: your present quality of life and level of pain; the extent of damage to your hip joint and the rest of your body; finding a qualified surgeon; and what you can afford financially.

Quality of Life and Level of Pain
Is your hip interfering with your ability to work? Does it prevent you from enjoying the activities you like?
Are you making excuses and avoiding your friends and loved ones? Are you living on pain medication? Prior to surgery I alienated myself from my family and friends—it was completely unlike me. I’m normally a very social and outgoing person. I was in survival mode. Each time someone would call and ask if I wanted to go to an art and wine festival I would say no. Concert, no. Not even a movie.

I equated every event with the amount of pain it would cost me to attend. I became more and more withdrawn. My quality of life deteriorated with each passing month. It got to the point where even a walk from my car to the front door of a place was too painful to face. I lost years of my life to a degenerating hip. And life is too short as it is.

Do you have children or grandchildren? Does your hip prevent you from fully participating in their lives? You can never reverse the clock and get that time back. What are you waiting for?

Extent of Damage to Your Hip and Body
Keep in mind there is only a certain window of opportunity for resurfacing. This is completely different than the Total Hip Replacement where the doctor tells you to wait until you can't stand it any longer. Your bone quality must be good enough to be considered a candidate. If you wait too long you might damage your hip beyond what can be resurfaced. Then your only option would be to have a Total Hip Replacement. Here is a perfect example of someone that waited too long, click here to read Richard's story.

Here are some questions you should consider.  How is your bone quality? Do you have osteopenia or osteoporosis? Do you have cysts in your bone? What level is your osteoarthritis (OA) or avascular necrosis (AVN)? Are you bone on bone? Are other parts of your body suffering, such as your spine, knees, due to compensation? What level is the damage? How long can you afford to wait before you might miss your opportunity for resurfacing?

Keep in mind that the rate of degeneration in your hip is unpredictable -it can become a lot worse fast. Age is also a factor. How old are you? Some doctors in the US will not take patients after they are over a certain age—55 for some, 65 for others. Some will not even take women on any longer (which is absolutely ridiculous to me).  Only a handful of surgeons worldwide will accept older patients or are qualified to handle the most difficult cases. If a doctor tells you that you are a candidate for hip resurfacing and your pain limits your day to day living, then it is time. If you are not in that much pain and a skilled hip resurfacing surgeon tells you that you can wait, then maybe you can wait. But you must get the opinion from an experienced and highly skilled hip resurfacing surgeon.

The Right Surgeon for You
The surgeon you choose is the single most important factor in the success of your surgery. How experienced and skilled is your surgeon? How many hip resurfacings has he done? What are his surgery statistics? What is his rate of complications? Is yours an easy or difficult case? Do you require one of the top international surgeons?

If your case is straightforward, then you have more leeway in your choice of surgeon. You might do well staying close to home as long as your surgeon has done a minimum of at least a few hundred hip resurfacings and has a decent track record in those surgeries and does them on a regular basis. IMO, it should be at least 500, but, that's just me.  However, if you have a difficult case, you should consider traveling to go to one of the top surgeons in the world that are equipped to handle difficult cases or cases that do not fit into the pefect mold of an "ideal" candidate.  I am probably the poster child of what NOT to resurface.  Female, entering or about to enter menopause, very small bones, dysplasia, extremely allergic to metal earrings, but I do have bones as strong as an ox.  The average orthopedic surgeon out there today would only give me a Total Hip Replacement if I were not a well known patient advocate.  But here I am with two perfectly functioning well placed BHR's (Birmingham Hip Resurfacing) placed by a world class surgeon.

Now some have asked how will the surgeons ever get the experience they need if everyone wants a doctor that has done at least several hundred hip resurfacings? My response is this— there are enough people out there that show up at a doctor’s office, are told they need surgery and just book it, no questions asked. They do not know the device they will be getting or the procedure, it just amazes me.  I know of people like that, some don't even remember their surgeon's name!

You have taken the time out to find this website, now you deserve to know what will give you the best odds for a positive outcome and a long-lasting hip. Do not allow yourself to be a guinea pig.

There is quite a range of experience and skill among surgeons. Unfortunately, failures and complications do sometimes happen—that’s why you need to be really careful in choosing a surgeon. I have heard stories of surgeons blaming failed surgeries on patients’ post-op activities or their anatomy,or metallosis, instead of calling it what it really was—surgeon error.

Well, why did the surgeon give the patient a resurfacing in the first place if he thought the anatomy was wrong for it?  In a couple of cases, we found out later that the surgeon placed the device incorrectly or made a mistake in notching the femoral neck. By the way, I highly suggest to everyone following surgery to get copies of your surgical report and x-rays, so you have them for future reference.

Please read the following articles for more information:

Selecting the Right Surgeon for You

Staying Close to Home Might be a Mistake

Why I Recommend the Surgeons that I Do

When Second Opinions Are Needed
If you go to an orthopaedic surgeon (OS) that has not done any hip resurfacings, 90% of the time he will advise you against it—not because you aren’t a good candidate, but because he just doesn’t do that kind of surgery. He won’t want to lose your business and will try to sell you on a Total Hip Replacement.  So it is important to go to an OS who does both Total Hip Replacement and hip resurfacing, not just Total Hip Replacement and has done a lot of BOTH. Click this link to find a list of experienced hip resurfacing surgeons in your area.

Once you have found a resurfacing surgeon, you still have to be very careful because there are some bait and switch doctors out there. I know this from personal experience and have heard the same from many patients—the OS is trained in hip resurfacing, advertises that he does them , and then he tries to talk all his patients into Total Hip Replacement's, perhaps because Total Hip Replacements are technically easier. These doctors will come up with all sorts of reasons why you should not get resurfaced, and some of these surgeons can be very convincing. I was booked and scheduled for a Total Hip Replacement after my appointment at Stanford—thank goodness for the surface hippies!

The reality of the situation is that these doctors are correct in one point—you definitely should not be resurfaced by them! A doctor might have an excellent reputation as an OS and still not be the right surgeon to resurface your hip. If you are told a list of reasons why hip resurfacing is bad, write down everything and come back to the Yahoo Hip Resurfacing Site message board and post about it. Let the many surface hippies point you to studies that prove otherwise.

It also does not matter how many Total Hip Replacements the doctor has done—Total Hip Replacement is very different than resurfacing. Hip Resurfacing is a lot more technically demanding than a Total Hip Replacement. Through my research and contact with prominent international surgeons, I have found that resurfacing involves a huge learning curve, especially in the first 100, and that most failures in hip resurfacing are primarily due to surgeon error. The surgeon you choose is the single most important factor in the success of your surgery.  Seek out a second opinion from a surgeon who believes in resurfacing and won't botch your surgery.

You're Not a Candidate for Resurfacing?
I was told by at least three US orthopaedic surgeons that I should get a Total Hip Replacement, and one of them told me I was definitely not a candidate for resurfacing. I’m sorry, but it has been almost seven years since my left hip was resurfaced and almost two years since my right. I’m doing just fine, better than fine, my hips feel like normal hips to me. In other words, do not take no as your final answer—even including from an OS who does resurfacing. Just because the OS tells you that you are not a candidate, does not always mean you are not a candidate.

A no from the OS could mean that you are not the ideal candidate for their skills—the OS may not yet have enough experience to handle a difficult case.  Several surface hippies have even been told they couldn’t have resurfacing in the US due to lack of availability of devices at the time. To me that is not professional or acceptable behavior. If your case is a difficult one, then seek out a top surgeon who has done at least 500 resurfacings. Make sure you get second opinions from doctors who do full Hip Resurfacing (not just hemi-resurfacing), before closing the door on hip resurfacing.

Some conditions that may not allow resurfacing are: osteoporosis; severe AVN; too much wear on your bones; cysts that are too large or are too near to the head-neck junction; not enough joint space narrowing; and a number of other factors that only an experienced hip resurfacing surgeon can know and tell you for sure. So your next step is to book an appointment with the most experienced resurfacing surgeon you can find in your area and if there isn’t one, then go to the closest one even if you have to travel out of state.

If you are faced with traveling, then you should consider emailing your x-rays first for a consultation and I can help you with that, just contact me. Here are some U.S. and international doctors who seem to be the most open to risk cases: Mr. Derek McMinn - UK, Dr. Gross - South Carolina, USA; Dr. Su - New York, USA; Dr. De Smet - Ghent, Belgium; and Dr. Bose - Chennai, India (especially for AVN). Please do not email any of these doctors unless you are sincerely considering going to one of them. I can help as well if you want to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to contact several docs for you for their opinions.  If they say you are a candidate, then it would be a safe bet that you are. Once you have found out that you are indeed a candidate then you can weigh all of your options.

Financial Considerations and Traveling Abroad for Surgery
What can you afford? How are you going to pay for it? Do you have insurance? Can you afford the procedure without insurance covering it?

If you have insurance and your hip is an easy case, you may do well staying close to home—if you can book surgery with a properly experienced and skilled resurfacing surgeon. But what happens if you do not have insurance? Medical costs are high in the US, and most doctors cannot give you a definite price, only a ball park figure. When you ask for that figure—their lowest negotiated insurance price or the lowest price they can give if you if you pay out of pocket—I do not believe it will be any lower than at least $25k. That is one of the reasons why so many surface hippies have gone abroad for surgery.  Because you can get the entire medical portion done in India for around $7,500 (depending on the current exchange rates) and that includes about 8 days in the hospital, device, surgery, tests, everything.  Then you add hotel and airfare as well as incidentals on top of that.  Heck many of us have paid a lot more for the cars we drive, what are you and your future liveilihood worth to you?

Another factor is that sometimes a patient’s case is too difficult for the local surgeons. The patient is then faced with one of three decisions: to risk a bad hip resurfacing locally; to have a Total Hip Replacement; or to pay out of pocket for a top surgeon in a different state or county to resurface their hip.

There are also top athletes and other such people, who have high performance expectations and will pay out of pocket to go to the very best, regardless of what their insurance company says. If you can pay out of pocket, you can take this matter into your own hands.  I have put together a detailed cost comparison forthe UK and India to help you, should you need to travel abroad for your surgery.  You can also read under Ask Vicky tips on Preparing for Overseas Travel .

A resurfacing may last you the rest of your life, if done correctly. Bottom line, if you have a resurfacing done, you can always revisit a Total Hip Replacementin the future - if you even have to.  But if you start out with a Total Hip Replacement, each time your Total Hip Replacement wears out (typically every 10-20 years), you get into more and more complicated Total Hip Replacement revisions and more and more bone if removed. We can’t know for sure, but having a resurfacing now (with the chance that it may last the rest of your life) may save you a lot of money and hassle in the long-run.

If you are open to taking this matter into your own hands (and that is what I ultimately decided to do), and are considering an overseas option but are scared at the prospect of traveling abroad for surgery, then post on the Yahoo Surface Hippy Hip Resurfacing Site message board. You’ll be in contact with an unbelievable group of caring, intelligent, and empathetic individuals who have either already taken the journey or are also in the process. Good luck!