My Biggest Fear

My biggest fear is having a hip replacement. More specifically my biggest fear is going in for hip resurfacing and waking up with a hip replacement. Waking up from surgery and being told that it didn’t all go to plan.

I don’t actually have a problem with having a THR itself, although given the choice between keeping my femoral head or not, I go with keeping it! I think most would. But I know I cannot live with the arthritic pain as it is now and sometimes I think I would happily agree to some sheep’s cartilage or a leg transplant!

I didn’t realise until last week how much this had been sub-consciously playing on my mind. I had been ‘rummaging’ through the older archives on the surfacehippy group messages and had been reading a lot about revisions of BHR to THR, failures, dislocations, going in for BHR and waking up with a THR. Quite frankly I was voluntarily working myself up into a tizzy about it all when the realisation hit me – I am terrified of going in for one surgery and coming out with another. As soon as I had that eureka moment I was able to address it, and let the fear go. This is not without the help of some friends, but at this moment in time my anxiety has been significantly reduced. I’ve been sleeping soundly too.

I will go into my BHR surgery with an open mind. I really want a BHR, but if I do wake up and find that I am the proud new owner of a shiny THR, I will be temporarily disappointed but I’ll let go of it quicker. At the end of the day, it will serve its purpose. Many young people are very happy with their THR’s, I will not consider myself some sort of failure to be joining them if it enables me to get on with my life. There has been too much THR-bashing going on and I’m not surprised so many of us awaiting hip surgery are horribly anxious pre-op. I have a preference (BHR), others have theirs.

BHR versus THR

I decided I should highlight the differences between hip resurfacing (BHR) and total hip replacement (THR). Many people have asked me what BHR is and what are the differences to THR. This will also be a prelude to the next blog post.

Hip resurfacing is NOT where the orthopod goes into your hip and smoothes everything out, as the name might suggest. BHR is actually a metal-on-metal (MOM) hip prosthesis. It comprises a metal acetabular cup and a metal femoral head cap. The metal used is chromium cobolt nickel. THR's to date can be composed of metal and plastic, ceramic and ceramic, and the newer ones are large-head MOM. The biggest difference between a BHR and THR is in the femoral component of the prosthesis. In a THR, the head of the femur is amputated and a metal rod/spike is inserted into the femur which has a ball on the end acting as your new femoral head. In BHR, the femoral head is maintained, it is only reamed down ready for a metal cap to be firmly inserted over the top of the head.

Just for comparison here's a great image from the Mayo Clinic (http://www.mayoclinic.com/health/medical/IM03868):

BHR is therefore more bone conserving and is proving more beneficial to younger people with hip disease as it has allowed many to go back to more higher impact sports and activities compared to a traditional THR. However, it should be noted that the newer MOM THR's are allowing all ages to do exactly the same. The survival rates of BHR prosthesis have shown to be significantly higher than traditional THR at 10 years. But THR surgery has been around a lot longer than BHR (~15 yrs for BHR in UK; only since 2006 in the US), plus there is a skew in the age groups recieving either. So far the data falls in favour with BHR for younger people, but only time will tell.

I don't want to get bogged down with the pro's and con's here, I merely wanted to describe the main anatomical differences between BHR and THR.