When buying real estate the old saying about what is important is “Location, Location and Location.” In many people’s minds the most important factor in choosing a surgeon for hip resurfacing is “Experience, Experience and Experience.” I realize that every hip resurfacing surgeon has to start somewhere to do his first operation, but I feel, in layman’s terms, that hip resurfacing is as much of an art as it is a learned skill. The angle of the cup in the acetabulum is very important, the proper amount of inpact to place the stem is important, shaping the femur bone for the cap is important, how the surgeon approaches the hip itself is important. There are many, many factors involved in a successful hip resurfacing operation.
There have been studies done to determine the learning curve for Hip Resurfacing with the BHR. These studies and others indicate that a surgeon needs 50, 100 or more hip resurfacing operations to become experienced. I have personally been told by a very experienced doctor that a surgeon should do many hundreds of hip resurfacings before a patient decides to use them. There is a LARGE AMOUNT of debate over this number and subject. Many people feel that a surgeon is already experienced if he has been performing THR’s for many years. Hip Resurfacing, however, is a much more demanding and technical surgery than a THR.
I personally feel that experience can only be learned, it can not be taught. Many professional sportsmen have learned the technical skills to play the game – but you generally see the most experienced quarterbacks, pitchers, or goalies playing in the pros. The difference is the experience. These people learn almost instinctively what to do, they don’t take time to reason and figure out what to do. That is the kind of surgeon I want to do my hip resurfacing – a surgeon that has seen it all and done it all. Unfortunately a surgeon that has only done 10 or 50 hip resurfacings has not seen it all and done it all. My personal surgeon, Dr. De Smet, even told me that he still has very difficult surgeries and he has done over 3000 hip resurfacings.
I feel if a person has a more difficult hip problem such as advanced AVN, cysts, misaligned hips or an unusual physical problem – they need a very experienced surgeon. If you are an older female or even male, many surgeons will suggest a THR instead of a hip resurfacing. The more experienced doctors are willing to tackle more difficult problems since they have the experience.
I have personally read thousands of emails from hip resurfacing patients and my personal observation of post-op results show that the patients of the very experienced surgeons usually have a quicker and easier recovery. There are always exceptions due to the prior medical conditions of a patients hips, but the post op recoveries are often related to the surgeon’s experience in my opinion.
There are many possible problems for the failure of a hip resurfacing surgery. Using a more experienced doctor will often help alleviate these problems, but it is not a 100% guarantee. There have been many more slipped cups and femur neck fractures since the newer surgeons began doing hip resurfacing in the US in 2006.
To sum up the question of “How to Select a Surgeon”, choose a doctor that you feel comfortable with. Ask the doctor:
- How many hip resurfacings has he/she done
- How many femur neck fractures have they had
- How many infections have the had
- How many of the hip resurfacing operations have required a revision to a THR
- When they trained to do hip resurfacing
- Who did they train with
- What is the chance of them changing their mind during the hip resurfacing operation to do a THR instead