Surgeons and Hip Resurfacing

Well, I was going to make my next post about the importance of surgeon experience for this particular surgery, and now I have even more to say about it. With this post, I think I'm moving into present tense with this process, as opposed to the "hey, just so you know, I've been doing this hip thing" tense of my previous posts.

As I've mentioned, there is a very active online hip resurfacing community. These are patients who have had or are looking into this procedure, including some who have become patient advocates who run websites, discussion groups, attend conferences, and communicate directly with some of the most experienced and well-regarded surgeons. This community is made up of people who take a very active role in their own health care, educating themselves about not only the procedure but also the specific prostheses (which manufacturer's device?), surgical approaches (where and what will be cut?), etc.

Frankly I was pleased that there was a surgeon close to where I live that had done enough surgeries for me to feel comfortable that he was well past the learning curve. He said I was a candidate for resurfacing, and I was happy.

Then last Friday I got a call about the final tests I would need before my pre-op appointment. I'm having an EKG and some blood work done at my Physician Assistant's office this week, and I had a DEXA (bone density) scan done about six weeks ago. The surgeon's office had received the DEXA report, but it isn't in the format they typically see. They want me to re-do the DEXA scan at their office when I come up for the pre-op appointment in a couple of weeks, because if the T-score in the report is comparable to the T-score they typically see (and why wouldn't it be? it's a freakin' T-score), Dr. Boyd will likely not be able to perform a hip resurfacing.

In the format they typically receive, they see a T-score and a note. My T-score is -1.2, which, in their format, would usually be accompanied by the note "moderate to high risk of fracture". My report has no note. A quick Google search, gives me the following information:

A T-score compares your bone density to the optimal peak bone density for your gender. It is reported as number of standard deviations below the average. A T-score of greater than minus-1 is considered normal. A T-score of minus-1 to minus-2.5 is considered osteopenia, and a risk for developing osteoporosis. A T-score of less than minus-2.5 is diagnostic of osteoporosis. (http://orthopedics.about.com/cs/osteoporosis/a/bonedensitytest.htm)

So maybe my -1.2 isn't really that bad? Just a leeetle bit osteopenic? I mean, come on, "moderate to high risk of fracture?"

The irony here is that the reason my femur's bone density is in question is because the hip socket isn't deep enough (hip dysplasia) and the socket doesn't fully cover the ball of the femur. In a correctly formed hip joint, the weight-bearing of your hip causes the femur to strengthen itself by becoming more dense. (This is why weight-lifting is recommended as you age, so that your bones remain strong.) But since my joint is not quite right, the bone density is not being encouraged by the joint.

This is all my own description, and not necessarily medically accurate - I should probably mention that, huh? I'm doing my best, but please remember I have no medical degree or training.

Here's what I'm thinking - if Dr. Boyd will not do a resurfacing with the -1.2 T-score, then he's pretty conservative about choosing his resurfacing patients, which he has every right to be.... I think my next move will be to contact a surgeon in Vancouver WA and see if he would consider me. The Vancouver doctor has more resurfacing procedures under his belt, and is more highly regarded in the online resurfacing community. From what I can tell, the more a surgeon participates in ongoing conferences, etc. in the resurfacing doctors' world, the better. Boyd is not that participatory, which I sort of attributed to him being late in his career. But there are stories I've heard (some people call them 'bait and switch') of doctors saying they do resurfacing, but unless you're a super-easy case, they'll talk you into a Total Hip. Which is really just a more pessimistic view of a doctor being conservative about choosing his resurfacing patients.

One option, should Dr. Boyd not be willing to do the resurfacing, is for him to do a Total Hip Replacement using the "Stryker Rejuvenate Stem." Again from a quick Google search, this system better replicates the anatomy of a hip joint (bigger ball than old-school hip-replacements, more comparable to the size of your femur) which provides better stability, less chance of leg length discrepancy, blah blee bloo blah blah. I can't find much about this, other than press releases or info from the Stryker Orthopaedics website. Which, frankly, I put as much faith in as any commercial for any other product.

Of course, yet another option is to take $12,000 out of my 401k and fly to Chennai, India for two weeks to have one of the top surgeons in the world take on my case. I'm not kidding. I think the surgeon in Vancouver would be covered under my insurance (he's listed as a provider) but any other US surgeon that I would go to is not, and resurfacing would therefore cost in the ballpark of $40,000 for surgery and hospitalization. Surgery, hospitalization for 5 days, another 9 days at a resort in Chennai, and airfare would be only $12,000. And infection rates at Apollo Specialty Hospital are apparently better than your average US hospital. So says the well-informed hip resurfacing community, many of whom have chosen this option.

And now we arrive at the point where I whine, "I HAD EVERYTHING PLANNED! WHY ARE MY PLANS BEING DISRUPTED LESS THAN A MONTH BEFORE MY SURGERY!?" Seriously, I don't like this. Up until now it seemed like everything fell into place rather effortlessly, and frankly, I took it as a sign from the universe that I was doing the right thing. UNIVERSE, WHAT ARE YOU TRYING TO TELL ME??!!?