THR Surgeon research / advice

My questions for you are what kind of activity level do you wish to have after surgery? Are you a man or woman? How old are you? I would advise you to look into hip resurfacing if you are a man, under 70, and want to keep a very active lifestyle. Even if you have 2 of these 3 I’d consider it. Don’t chop off the head head of your femur if you don’t have to. Good luck!
https://www.arthroplastyjournal.org/article/S0883-5403(25)00250-5/fulltext

@closer0043 raises some excellent questions.

Resurfacing is a good option for some but not for all.

You posted a lot of questions but no answers. It is not helpful to ask these questions if you don't know what answer you desire.

Here are mine:

Volume: at least a hundred, preferably hundreds or thousands of the exact procedure you would do on me.

Method: Superpath or STAR as first choice; Anterior as second choice.

Material: Titanium or oxidized zirconium would be my choice.

Return home; Most go home same day after outpatient surgery.

Hello,
I don’t know where you live so my recommendation may not be doable. I had a total hip replacement by Edwin Su, MD at Hospital for Special Surgery in NYC. He specializes in hip snd knee replacements and does revision surgery too. He does not participate in Medicare so I paid for my surgery. I followed his post surgery guidelines and participated in PT. Resumed golf, tennis within 3 months and running after 6 months.
His bio can be found on hss.edu and www. edwinsu.com. Reach out if you have questions. Good luck!

@crankyknee
My surgeon, Jimmy Chow, also does not take insurance and has withdrawn from Medicare. He is the primary inventor of the Superpath method of minimally invasive hip replacement. Four years ago he replaced my left hip and I had no post surgery pain. Interestingly, seven months ago he replaced my right knee and, again, I had no post surgery pain.

There are a few great ones out there. Finding one can be a challenge.

For the 3rd surgery on the same hip, I asked about going to a rehab hospital.

Here are my criteria:

1) minimally invasive method: subvastus or mid vastus;
2) Does NOT use a tourniquet;
3) Does partials, totals and revisions;
4) Uses a robotic assistant;
5) Gives me a bicruciate retaining implant (very rare; probably unique to me);
6) Corrects my alignment with a Functional alignment or at least a kinematic or inverse kinematic alignment; not a mechanical alignment;
7) EXTENSIVE SUCCESSFUL EXPERIENCE DOING THE EXACT PROCEDURE THE SURGEON WOULD INTEND TO DO FOR ME;
8) Has great hands; and
9) Has a great mind.

If you find a surgeon who does all of this, your chance of a pain free or minimal pain recovery will be maximized. I did. My magician replaced my left hip four years ago and my right knee seven months ago and I had zero pain each time.

Why these criteria?
1) avoids cutting the muscle and tendon and having to sew them back at the conclusion of the operation. Less trauma and therefore less pain.
2) Recent research shows that a tourniquet is not necessary and may even be counter productive. It can cause post surgery thigh area pain for weeks after the surgery.
3) The reality is the converse of what would seem natural. Doing a partial is actually a more complex surgical procedure than doing a total. Doing revisions is much more difficult and many hip/knee surgeons don't do them. So finding a surgeon who does all three helps.
4) A robot adds precision. If the replacement is a simple total replacement, a robot is not necessary in the hands of a skilled surgeon. But if anything out of the ordinary comes up, it is really nice to have the aded precision. In addition, a Functional alignment pretty much requires a robot as it includes doing soft tissue adjustments.
5) In 99+% of TKRs, the ACL is removed and in many the PCL is also removed. In a BCR the ACL and PCL are retained and protected. But the surgery is more complex, the implant is different, and most surgeons can't and don't do it. I am aware of only three surgeons in the US who do it: my guy here in Phoenix; one guy in Seattle and one in Chicago. But there is still a choice to be made between retaining the PCL or replacing it as well. The retaining version, CR or cruciate retaining, seems to have slightly better results than the version that replaces the PCL (PS or Posterior Stabilized).
6) I was severely misaligned before the surgery. Traditionally, TKRs involved what is called "mechanical alignment". Draw a straight line down the leg and that is the alignment. But most of us don't actually walk that way. So more recently surgeons have started using newer methods to try to restore natural alignment. That resulted in the three methods I cited. Kinematic and Inverse Kinematic involve cutting the femur and tibia to try to restore natural gait; Functional adds soft tissue adjustments.
7) There is a reason this one is all caps. IMHO, and that of my magician, this is the single most important criteria. For example, if a surgeon normally uses a tourniquet, if he offered to skip the tourniquet for me (and use tranexamic acid instead), I would NOT want that as he would not be experienced at that process.
8) Important but along with #9 the most difficult to discern. One pretty much has to infer it based on reviews, scientific papers, interviews, other doctor referrals, etc. One of my ideas for finding a great surgeon is to see who other doctors, especially good ones, use for themselves and their loved ones. Before my knee surgery I was in the office of my rheumatologist when he got a phone call and apologized explaining that it was his wife and she was getting a hip replacement the next day. Well...of course...her surgeon was mine!
9) Same as for #8. Look for scientific papers and patents. My surgeon, for example, has more than fifteen patents and is the primary inventor of the Superpath method of performing a minimally invasive hip replacement.

Hi Steve,
Many, many thanks for the detailed info you shared. It is a great resource for me as I prepare questions for my surgeon, Edwin Su at HSS..
I have a subchondral insufficiency fracture in my knee. According to my research that may make me ineligible for bicruciate retaining implant. I would like to retain my tendons. Dr Su uses CORI system. I will
also ask about tourniquet. I believe anesthesia manages blood loss through medication.
Thanks again Steve.

@steveinarizona .what is Superpath or STAR?

They are both new minimally invasive methods for doing a total hip replacement.
My surgeon is the prime inventor of the Superpath method; STAR is a variant of the Superpath method:
https://pmc.ncbi.nlm.nih.gov/articles/PMC11899374/
https://pmc.ncbi.nlm.nih.gov/articles/PMC9318286/