Marianne C.s experience with two BMHR protheses
My problems started in the middle of the 1990’s with pains in the groin on the right and drawing to the thigh when I was active, for example after longer walks or much garden work. Since then I have had many consultations with doctors to find out more about the reason. Only much later in 2008 I found out that I had osteo-arthritis. Sadly enough there was no good dialog with the doctor that had given me the diagnosis, he said: “It is too early to put the knife in you”.
In 2012 new x-rays were taken and a new diagnosis of a Swedish orthopedic surgeon sounded: “It is too early for an operation”. I was given the recommendation to take more painkillers.
I realized that I needed to do some research to counter these arguments. When I started to search on the Internet I found information about Hip Resurfacing. After I contacted Ron I found with his help a number of foreign surgeons willing to judge my x-rays from 2012. They unanimously concluded that I should have been operated a few years earlier and then finally everything started to fall in place! The procedure that the Swedish orthopaedic surgeons prescribe means that the thighbone’s neck is chopped off and the combination of materials and sizes used does not allow high loads under a longer period. For that reason they want to postpone hip operations as much as possible. Hip resurfacing on the other hand means that the thighbone’s neck is spared to the highest possible degree and the combination of materials is more wear resistant. To save as much of the bone of the thighbone as possible the operation should be performed as early as possible. In my situation it was far too late to use BHR-prostheses, so it had to be the next best: BMHR-prostheses. The operation on the right hip was done March 2013 and the left hip September 2013 by Dr. Völker in the ATOS-clinic in München. With both occasions the operation went well and I was well cared for in the ATOS-clinic.
Now at the time of writing it is November 2013 and I have progressed well in my rehabilitation. Clearly the muscles must get the strength back that I have lost partly under the operation and the time with limited range of movement and activity before and directly after the operation. Towards spring I hope to do gardening work again and ride my bike to work.
Allt detta är möjligt med ytersättningsproteser!
James Roxburgh, or ”Jim” is a 51 year old man from Wilton in California, USA who has been practising martial arts since 32 back. In 1999 he received a 5 degree black belt in Moo Duk Kwan Tae Kwon Do. Sadly enough during a diagnosis in 2002 osteo-arthritis was found in both hips and serious enough to demand medical intervention with prostheses of some kind. The time thereafter Jim started searching for information about the different available procedures and prostheses, what he concluded best for him is called Hip Resurfacing. Everything that was written about the possibilities with Hip Resurfacing agreed with Jim’s lifestyle and activities.
You should know that to be classed a good candidate for Hip Resurfacing you should be within a certains age group, the skeleton should be of high enough quality and if possible you should be an active person. A specialized surgeon will even have checkpoints in his list for bone diseases, bone density, which can be evaluated with x-ray, MRI, CT-scan, DEXA-scan etc.
It took until 2004 before Jim met a doctor by the name of Jamali who concluded that he was a very good candidate for the för Hip Resurfacing procedure. Jims pains had by that time become unbearable, his sporting life had been destroyed and he became depressed. It was of course positive for Jim that doctor Jamali regarded him to be a very good candidate for Hip Resurfacing.
But even though Dr. Jamali correctly agreed that the only right procedure for Jim would be Hip Resurfacing and definitely not THA (Total Hip Arthroplasty) with a traditional hip prosthesis, Jims medical insurance only wanted to refund a THA.
Of course Jim could not accept this injust decision of the insurance and the whole story ended by Jim paying for the whole operation and of course he selected nothing less than Hip Resurfacing! However it was not Dr. Jamali who operated Jim, because he was told of another surgeon who was already more experienced with Hip Resurfacing, this was Dr. Thomas Schmalzried. And so it happened that Jim was finally operated the 22nd of November 2004 by Dr. Schmalzried.
As you might understand this was tougher for Jim than with other operations of this kind since Jim had both his hips done simultaneously, a bilateral operation in other words that is done much less frequent. Being a bilateral case even has an influence on the rehabilitation period, so this demands some determination from the side of a patient.
Jim received as said his operation in November 2004 and is has gone well. All the photos on this page are taken since and say much more than words can! Don’t attempt to do everything that is shown here with a traditional hip prosthesis! Many of us with a Hip Resurfacing wouldn’t even match this! Jim’s two Hip resurfacings (see the photo) are Conserve® Plus prostheses from Wright Medical.
The two rows with staples that Jim had initially show up clearly on the x-ray.If anyone would like to come in contact with James Roxburgh he will be glad to share his experiences, you can do this either through the Yahoo group ”Surfacehippy” where he has participated, see:
http://health.groups.yahoo.com/group/surfacehippy or Click here for direct contact by e-mail with Jim Finally, two images from Jim doing a spagat….don’t do this with a traditional hip prosthesis!
My name is Andrea and I am 48. Thinking back I remember that I had my hips x-rayed after my second child, in other words 18 years ago. Then already I could feel that something was not quite right with my right hip. Pain came and subsided again, but since they didn’t discover anything strange with my hips I learned to live with the pain, that as said would disappear every now and then. In autumn 2010 the pain came more often and more intensive, I saw different physiotherapists and a naprapat, but nothing fully helped. Spring 2011 I finally finished up at the county’s orthopedic department here in Kalmar where it was discovered that I had osteo-arthritis. I was recommended to follow a hip-school and training since I was still comparatively young but even received the information that little by little an operation would become necessary to give me a new hip. This was a shock to me then, it felt so bad having to undergo this kind of operation at my age and to be honest I associated hip-diagnoses with older people only. Then I already started to Google and landed on Rons information page. I started to get more and more pain, the daily walks with the dog really started to torment me just like following my youngest girl to school only 300 meters from home. I woke up often and even had pain during the nights and felt more and more frustrated as a result of the pain. Again I contacted the reception of the orthopaedic department where I was offered and operation with a traditional THR prosthesis.
I should mention that in conversations with my orthopedic surgeon I had named that I was interested in the Hip Resurfacing method and he was not completely negative about the idea since they had done some of them here. But this didn’t lead anywhere since I was a woman with a far too small femoral neck. I even sent email to orthopaedic surgeons in other counties, answering that I had the wrong gender! Ron helped me to send my x-rays to different orthopedic surgeons in Europé. My choice fell on Dr. Faensen in Berlin, from a gut feeling together with appealing information on different prostheses that he gave. Once I had made up my mind things went so fast, the booking for the date of operation and the flight tickets. I was going to be operated in a clinic in Potsdam and if I am not mistaken the operation would come to about 180,000kr, which was and still is a lot of money.
I had a good impression about Dr. Faensen and the clinic. The operation went well, I was post-op free of pain and after a while I went home again, this was after a week. Touch wood I have today no problems whatsoever and don’t even think about the fact that I have a prosthesis. I am modestly active, have been sitting too much due to studies and as a result I have some pains in the loins, but now I have taken up regular training again. I have even registered myself for crossfit.
If I were to sum up things I am today very grateful for all the help and support that I received from Ron in the first place but even the other participants in the hip group Nordenshippies. Today I do not for a second regret this.
Thanks. / Andrea Karabová Bäckström
Mary Ellis från Austin, Texas, USA
June 2006 meant a change in the life of Mary Ellis when she dared to take up her problem in the Yahoo discussion group ”Surfacehippy”. Mary wrote the group about her osteo-arthritis that by then had reached a serious stage, she also reported on the doctors that she had seen, the x-rays, MRI and bone density-tests that had been done.
Mary, who at the time was 56 years old had until then been unlucky with orthopedic surgeons that only wanted to recommend a traditional total hip prosthesis (THR), and they advised her to book this operation right there and then. Mary on the other hand had the gut feeling that things were going just a little too fast. When the surgeon that she had had up till then even replied negatively on her questions about the hip resurfacing option she turned away from him. She wanted to have a prosthesis that would spare as much bone as possible, just as a Hip Resurfacing could. With the help of another woman from the ”Surfacehippy group” she then turned to a surgeon that is known for his accomplishments in Hip resurfacing, Dr. T. Gross from Midlands Orthopaedics in Columbia, USA.
Before the operation:
Dr. Thomas P. Gross, Mary and Lee Webb.Lee holds a Biomet ReCap prosthsis of the same type that Mary would get implanted in the hip.
Date: September 2006
The right hip (marked R) is still in good condition.The left hip (marked L) is in an obvious bad state. The left femoral head has worn through the cartilage, shows bone on bone contact and cystic changes in the load area.
The incision is here 16 days old. In Marys case it measures 5 inches. This size will differ from patient to patient and surgeon to surgeon.
East or West, home is best! This is certainly true if a patient like Mary has received a resurfacing and able to continue life without any limitations! It is worth mentioning that this photo was taken in the hotel during the post-op days where even her cat was present!
Mary has two e-mail addresses for anyone with questions:
Amy Petersen received the diagnosis osteo-arthritis already at the age of 25. In her case it was a bilateral problem, in other words both hip joints were affected. With osteo-arthritis, OA or degenerative arthritis as it is also called, the decrease in cartilage occurs much faster than normal. As a result the bony parts of the pelvis socket and femoral head can meet and grind on each other, leading to inflammation, pain and cyst formation in the femoral head and pelvis socket (acetabulum).
Amy who was 35 years old in 2007 had up till then had an active sports life, she ran a lot (half-marathon), took part in ’Western Boxing’, full contact karate, Muay Thai kickboxing and she trained in Brazilian jiu-jitsu. Just prior to the operation she could only do so bike riding and lighter forms of Yoga.In April 2007 Amy was successfully operated in India by the orthopaedic surgeon Vijay C. Bose.
An x-ray image with Amy’s pelvis from before the operation is shown below.
Helen Triggs from England
Helen Triggs gave me some interesting photos, taken in a hospital in London. In her left hip she received a Birmingham Hip Resurfacing (BHR) from doctor Koen De Smet in Belgium, February 2006. In her right hip she received the same typ prosthesis but from doctor Justin P. Cobb, August 2006 in the UK. The photos below are all from this last occasion.
The photos were generated with help of Helen’s own x-rays that were imported in a special medical computer program called ”acrobot”. By the way, the program name ”acrobot” has nothing to do with the program “Acrobat Reader”!
Not all the surgeons will use programs like ”acrobot”, this is among other things determined by the prosthesis manufacturer but also the specific wishes of the surgeon or hospitals.
Acrobot can help the surgeon to determine the size of the prosthesis and the instruments that he will need and calculate the positioning and angles involved before the operation is started.
As the photos above and below show does the surgeon have a number of device sizes in the list that the can select (depending on the make) that he can place on the patients x-ray to compare for size and positioning. Like always, any damages that did not show up on the x-ray but are only found during the actual operation may call for a slight change in size or positioning from that what was earlier determined with the program
Above the top of Helen’s femur is projected together with the selected prosthesis of 44mm. This photo shows the excess of bone in some placed and loss of bone in other places when compared to the prefect round shape of the femoral cap. Reamers and other instruments used in the operation can give the femoral head the required shape. Ideally the surgeon only removes as little bone as possible, while he still creates the perfect fit for the cap that will be used. But it is not uncommon that cysts in the femoral head exist that need to be removed. The judgement whether or not hip resurfacing really can be used requires a surgeon who is experienced and specialized on just Hip Resurfacing, don’t settle for less!
Placement of the acetabular cup in the pelvis is shown on the photos above and below. Above you can observe the two “inclination” (upward) and “anteversion” (forward) angles that the cup must have. With the correct angles of the cup the wear will be kept under control and the hip will also have the lowest luxation (=dislocation) tendency and lowest chance on causing impingement
This last photo gives more information about the pelvis side; the instructions that can be given to the program are listed on the right.
Lori is a 46-year old woman from Orlando, USA who has had a milder form of dysplasia, which means that the acetabular cup did not develop correctly; possibly leading to outward pointing feet and one can be regarded short in stature. Her dysplasia and osteoarthritis that developed has not been in the way for application of a Birmingham Hip Resurfacing (BHR) prosthesis, that doctor Vijay C.Bose in India gave her.
Lori has written a lot about her trip from the USA to India and back to the participants in the Yahoo group ”Surfacehippy”, see ”Yahoo Discussion groups” under “Forum”.
On Loris x-ray from before the operation the hip joints can be compared. It is clear that the right hip (left on the photo) must have given her all the problems, where there is obviously much less cartilage than in the other hip.
On the 18th of September 2006 Lori received a Hip Resurfacing prosthesis of the same type that the surgeon McMinn helped to develop earlier on. The BHR prosthesis (white on the photo) clearly shows on the computer display in the hospital. With my untrained eye I would remark that the acetabular cup is positioned very deep in the pelvis, a result of her specific problem.
Lori works as licensed nurse on a heart surgery department in an American hospital.
This photo shows Lori at the Ideal Beach Resort in southern India, 7 days after her operation.
Just 4 days after the operation the incision looks fine.
After 3 weeks Lori drove her car again and went back to work. Anyone wanting to contact Lori can use the following adress:: firstname.lastname@example.org
Vicky is an American woman who had problems with her left hip, she was successfully operated by doctor Vijay C. Bose. This operation was performed 12-01-2005 in the Apollo Speciality Hospital in Chennai, India (see the list under Orthopedic surgeons for more information on this surgeon and others).
Here is an x-ray showing Vickys left hip just before the operation 12-01-2005
Together with Vicky there are many Americans and even Europeans that have their operations for Hip Resurfacing performed abroad from their home countries. The reasons for this stream of patients are diverse:
- In some situations the patients in the USA have not enough insurance cover or no insurance at all, whereby the operation in the USA itself would have become too expensive. On the other in hand some of the countries abroad, like Belgium and India, where many of these operations are performed the costs are much lower; a quarter or half less than in the home country is no exception
- There are many examples of surgeons in the home countries that refuse to consider the patients wishes for Hip Resurfacing and in stead stick to traditional hip prosthesis. The reasons for not accepting Hip Resurfacing as a better alternative differ but include the higher costs, the requirements for extra courses and willingness to specialize to gain the needed high experience.
- With the unacceptably long waiting periods for hip operations in the home country, even more so with the Hip Resurfacing procedure, the patients understandably select alternatives whereby they are helped quicker.
- Foreign surgeons are much freer in contact and more open to direct contact with their patients. It is possible to send MRI, MRA, Cat-scan and x-ray images to a foreign surgeon for free of charge consultation within minutes; while in the home country patients may have to wait up to 10 months to get a consultation with a specialist.
The points 2, 3 and 4 do in general also apply to the situation in Sweden.
On the photo a happy Vicky Marlow and the surgeon Dr. Vijay C. Bose 7 days post-operative, date: 12-08-2005
Vicky wanted that as many people as possible should hear how well it went for her and how natural her new Hip Resurfacing actually feels and behaves. She has taken up yoga again and promised to send pictures as proof that there really aren’t any limitations with a Hip Resurfacing prosthesis. She has been very active in the American forum for hip patients “Surfacehippy”.
The x-ray of Vicky’s pelvis shows what a Hip Resurfacing (or ytersättningsprotes in Swedish) can look like.
In case someone wonders what is possible with a BHR prosthesis the photo on the left will give a good impression.
At this stage Vicky was 11 months post-operative, date: 11-22-2006
Vicky Marlow USA