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  • 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

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    Old 05-08-2006, 05:04 AM   #1
    GooseCA
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    27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    Hello,

    Well let me say that it's been very interesting doing all this research on my upcoming surgery. I have pretty much run the gauntlet and even saw a few surgeons out of pocket to get there opinion. Have had JRA since I was the age of 2, always very active even though I have had joint damage and limited movement. Approx a little over a year ago I noticed that my range was even worse when going up stairs. After a X-Ray was taken it was noticeable that my hip socket was basically pushed into my pelvis, which prevented me from even the range I had just a few years ago. It was very clear that I needed a hip replacement and in fact both hips were pretty close to each other.

    First thing that I have to consider is the bearing choice. Since I am so young at the age of 27 all the soft bearings were eliminated. Left was a metal on metal or a ceramic on ceramic. Understand that a lot of the surgeons choose metal on metal but I believe this is just because of the past breakage issue.
    Most surgeons operate on older patients so even some experienced surgeons dont have much experience with metal on metal let alone the new ceramics. One of the major factors that made me choose ceramic is the biomechanically composition which dosn't spread the metal ions throughout your blood and urine. Since I am looking at both hips now and both knees in the future the slight risk of breakage I believe is well worth the risk. Current statistics show that your chance of breakage is anywhere from 1 in 10,000+. Some studies show even a higher number. Rather take a breakage chance than having a very high metal ion level which is really unknown what this may cause. Plus there hasn't been many studies showing the ion level for someone with 2 artificial joints or even higher. And the wear data for ceramic is incredible even over metal.

    Then of course popped up all the literature regarding MIS (Minimally Invasive) surgery. It seems that there is some confusion out there regarding MIS. MIS is supposed to be a less invasive surgery meaning preventing damage to muscle and tissue. The size of the incision isn't as much important as the technique to do as little damage as possible. None of the surgeons I saw perform the old 10inch incision. And the funny thing is the smallest 2-incision technique that was first used turned out to do more damage to the muscle than even a standard approach. So from what I can gather one of the most important things is to make sure your surgeon uses a technique that he has done a ton of.

    Then comes the issue of using cement or not. Since I am going for a ceramic component in which the goal is to last me a very long time think only uncemented makes sense. Cement as I understand it can break off and revisions are common 15 years down the road. Not to mention if you need to change your implant no surgeon likes to remove a cemented hip. Was told much easier to remove a naturally grown in hip.

    Lastly came the issue of doing a bilateral or a staged replacement. There is a lot of information out there showing that a bilateral in one visit is just as safe as a staged. I am sure that if you have health problems that a staged will make more sense. But honestly I want to begin my rehab tommorow and since I have no other health condition besides my arthritis feel it will be a great outcome. Anyone here had a bi-lateral and would you do it again?

    So I have a CT scan scheduled for the 23rd of May, hopefully my bones are in good health and I will be able to put some weight on my hips after replacement. Looks like I will go in for surgery sometime end of July or early August. So right now I am looking at a bilateral using the posterior approach and a ceramic bearing made by Dupey Orthopedics. Surgeon I have chosen dosn't have a ton of ceramic experience like some of the doctors I have heard of. But I am hoping he can do a good implant regardless of the bearing choice. Guess ultimately you have to put trust in somoene ;-). I live here in Northern California and have Kaiser insurance. Have gone through 4-5 referalls before I found what I believe is a great surgeon. Video imaging would be nice to compliment the ceramic bearing but finding a surgeon with a lot of video imaging experience is like looking for a needle in a hay stack.

    Want to get a epideral during the surgery and not have any general anesthesia anyone here decided to do that?

    Well if anyone can add anything to my journey or just general comments are much appreciated. Since I am pretty excited to get my surgery this is a way to calm my excitement ;-). Will also answer any questions to my best knowledge and provide links in which I have researched.

    Thanks!

     
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    Old 05-08-2006, 08:46 PM   #2
    legallyblondied
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    GooseCA.......I have some questions for you.....You said you have kaiser insurance and live in northern Ca. When you mentioned you had gone to a number of referrals before you decided on this specific OS, were the referrals outside of the Kaiser Permanente plan? Also if you have time research, the option of hip resurfacing instead of a THR...you are so young to contemplate a THR and there are many advantages of the hip resurfacing procedure. May i ask who the surgeon is that you have chosen? Thanks Karen

     
    Old 05-08-2006, 11:36 PM   #3
    GooseCA
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    Hi legallyblondied yes I actually have seen 4 OS at Kaiser and 4 outside of Kaiser. A couple were at John Muir, I wanted to see if I could get a Anterior approach done using the special table. Have heard a lot of great things and the recovery apparently is great. But the OS said that since I have some deformity and shallow hips the risk of breaking the femur was too great to do it Anterior using the table. Saw Dr. **** at UCSF, who I heard is a great surgeon but he wouldn't even spend 5 minutes with me. The first Kaiser surgeon wanted to do a poly hip which is out of the question. So it's been really a hit and miss. Seems some surgeons want to do what they feel like and not what is best for me.

    No surgeon has mentioned hip resufacing and I believe this is due to the deformity caused by the arthritis. In fact the prosthetic that everyone has chosen in a SROM by Deput Orthopedics. This seems to be a system that allows a lot of flexibility to the surgeon.

    [url]http://www.jnjgateway.com/home.jhtml?page=viewContent&contentId=fc 0de00100000309&loc=USENG[/url]

    I wanted to see the outside referalls because I have Kaiser through the California Major Medical Insurance which allows me to choose Kaiser or Blue Cross. So if I saw a surgeon that really impressed me then ultimately I could switch to Blue Cross which most OS accept. Problem is the enrollment period is end of the year and the outside referalls just never impressed me.

    Have chosen Dr. Burri at Kaiser San Francisco, if there is anything I should know please let me know ;-).

     
    Old 05-09-2006, 07:40 AM   #4
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    Hi Goose,
    Sorry to hear that you need new hips at such a young age, but you seem to be in a good frame of mind.

    I did have simultaneous bilateral THR, MIS, posterior approach on May 23, 05. I have Stryker crosslink poly/metal, uncemented. My surgeon is very experienced in all three materials, doing over 360/year. He chose poly/metal for me only because I want to run again and he was a little concerned with the ceramic being too brittle. Otherwise he would have used ceramic/ceramic for me since I am considered young for THR (not young like you tho!!).

    My surgery was extremely successful. I was home from the hospital in 2 days, walking without crutches in 4 days and back to all my athletic endevors within a few months. But, I was in excellent physical shape before surgery too.

    Not all surgeons will do simultaneous bilaterals and the ones that do have some strong criteria. I had to be motivated, lean, strong, good bone, good home support. But for me it was the best way to go. I suggest if you are thinking of going for simultaneous, start doing some core and upper body strength training now.

    My incisions were 3" and 3 1/2 ". No muscles were cut, just seperated. But as I said, my OS is very skilled and experienced. I am in total awe of him, and love the new hips he has given me. I had an epidural and was awake thru most the surgery. It was very interesting, sounding more like an auto body shop! There was some risk that the surgery would last longer than the epidural then I would have had to be given a general, but I made it thru with no trouble even tho the surgery was longer than 4 hrs.

    It sounds to me like you have done some good reseach. I totally agree with you that having the most experienced/skilled surgeon is the key. Next is get yourself in the best physical condition you can. Having a good home support system helped me greatly too. When are you planning your surgery? I sure hope you have as good luck as I did. I am totally thrilled with the quality of my life now.

     
    Old 05-10-2006, 12:46 AM   #5
    legallyblondied
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    Yo Goose......Most surgeons are trained in the posterior or lateral posterior approach like Ripcano had. The anterior approach has less docs doing. I think there is less muscle
    damage or stretching but I do not think one procedure is a great deal better than another. Dr. Joel Matta in LA uses the anterior approach and developed the table for surgery you are talking about called the PROfix table. Google his name and his site will come up that expains and show his approach and prosthetics he has developed and the operating table. I maybe mistaken but all Kaiser docs in the Kaiser system follow a certain protocol of what devises they can use.. Kaiser uses metal on a cross linked poly liner and does not do any other metal on metal THRs. The
    Srom Depuy hip replacement is just that.....metal on cross linked poly.....for younger patients they use cementless. You were not told about hip resurfacing because no one does this at Kaiser...They have one doc in Oakland Kaiser that they sent out for training...Just explore your options.
    Your are very young and you need to find the best OS that you have trust in .....look for one who has his fellowship in total joints hips only........Love Karen

     
    Old 05-10-2006, 07:38 AM   #6
    GooseCA
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    Hi Ripcanco,

    yeah it's a bummber but it's something that must be done. Everything I enjoy doing including fishing / hunting is just becoming a chore instead of fun. Always been active so I simply wore out my joints.

    Congratulation on having your surgery work out so well it's very encouraging to hear that. Sounds like you had the Posterior Lateral approach what did the surgeon say about protecting the muscle? Did you have to take it easy or were you able to get your walk back without a problem?

    I am also very fit but of course not as active as I want to be. Have great support at home so the rehab is the last thing that would scare me. Upcoming on the 23rd I have a CT Scan and there I should find out my surgery date. We were estimating sometime end of July early August.

    Hi Legallyblondied yeah it turns out there really aren't that many approaches to doing the replacement. And I did get a consulation from a doctor who uses the profx table 95% of the time and he said for me he wouldn't do it. The SROM from what I can tell is just a modular system and has to do with the part that goes into the femur. The acetabular cup and ball is another system. The ceramic for ceramic using Depuy Orthopedics is called the Duraloc. Here is a link if anyone wants to look at it:

    [url]http://www.jnjgateway.com/public/USENG/Duraloc_Option_Design_Rationale.pdf[/url]

    Will go ahead and do some reading regarding the hip resurfacing. Would you happen to know if the Oakland doctor is Dr. Trauner? I really liked this OS the only problem is he was booked over a year in advance and has to take care of Oakland patients first. But I found him to be real nice and genuine.

    Ciao!

    Last edited by GooseCA; 05-10-2006 at 07:42 AM.

     
    Old 05-11-2006, 01:55 AM   #7
    legallyblondied
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    Goose.....The Oakland doc that has been trained in hip resurfacing is Dr. Thomas Barber. Also you said you have chosen ceramic on ceramic for your THR. I did not think that any OS in the Kaiser system did any other type of hip replacement other than metal on plastic. If I were you, and did not want to have the surgery again I would go for metal on metal hip resurfacing or metal on metal hip replacement
    with a large femoral ball so the chance of natural loading is optimal and dislocation and wear and tear from the plastic debris is a non issue. If your kidneys are in good shape the metal ions do not present a problem. Yesterday the FDA gave
    the Birmingham hip resurface prosthesis the ok for the US.
    Looks like for younger more active people this will soon far
    surpase the THR with many restrictions tied to it......Karen

     
    Old 05-11-2006, 03:02 AM   #8
    GooseCA
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    I dropped a e-mail asking the OS I saw at Oakland regarding hip resurfacing, maybe he can have Dr. Barber take a quick look. Kaiser OS do many types of bearing options the problem is that there are surgeons out there that have done a vast majority more ceramics. Just read a 5 year follow up which showed outstanding result with ceramic on ceramic with no sign of osteoysis or fractures except for 1 which was in a car accident. Another journal showed very early osteolysis with metal on metal. There dosn't seem a perfect solution and having 2 hips using metal on metal scares me. And then you add 2 knees and what does that elevate the metal ions in your body to. If I have damage to my kidneys or some other organ that could lead to something very bad. And I will always have to take anti-inflammatory drugs the rest of my life.

    So as you can see it's a real dilema choosing the correct bearing. There are patients that ceramic has been great and the same goes for metal. Activity precautions exist for both yet some people still do high activity sports. Everything that comes to hip replacement is in such a grey area. You can read journal after journal stating that bilateral is just as safe, then you have a OS say it's 4x as dangerous. Then you have a OS say that there is a higher chance of a fat embolism, then you read a study which shows there is no difference between a fat embolism in a staged or non-staged procedure.

    The list just goes on and on when it comes to contradiction between studies and what a OS says. When a OS says that a poly bearing is great and that ceramic data is not long enough. Then you look up when poly bearing came out and you realize that there is very little data for poly and ceramic has been used in europe for over 20 years. Poly wasn't introduced until 1998. So one can literally just go crazy when you actually sit down and read some journals and study this stuff.

    There are just so many questions and depending on who you talk to you will get a different answer. I am excited about my surgery and know I will work hard at getting back to all the things I love to do. My gut says to get a Ceramic and it has worked out great for so many people.

    Argggg ;-)

     
    Old 05-11-2006, 05:01 AM   #9
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    Re: 27-Year Old Rheumatoid Arthritis - BiLateral - Ceramic Bearing Surgery Planning

    It would be great to speak to a surgical assistant from a doctor that has done a lot of ceramic / metal. Think that way marketing and biased opinion would be removed.

     
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