Dr. Harlan Amstutz
Melissa Dubbs – Resurface 2/1994, Dr. Harlan Amstutz
Update: 1994 Metal on Metal cementless replacement
With permission from Melissa
Wed Nov 14, 2007 11:28 am
Scott Bennett emailed me and requested a status update to this board on my metal on metal, cementless surface replacement to the left hip, done by Dr. Amstutz in February of 1994 for advanced OA. I don't know what to say, other than 13 1/2 years later I am still pain free, with no problems. I rarely think about my surface replacement. I only occasionally wonder if the device will last my lifetime. Amstutz certainly sees no reason why it shouldn't last my lifetime. In 1994, I was a 37 yr old, 5' 4'' active woman weighing about 125 lbs. At 51, I am still about 125 lbs and still fairly active and can engage in any physical activitiy that I want. My main forms of exercise are cycling, swimming and walking/hiking. Since I never was a runner/jogger it was easy to take Amstutz's original advice about not running or jogging, post surgery.
In doing a quick look at this site, there seems to be a lot of discussion (sometimes heated arguments!) about cementless versus non cemented devices, which doctor to go to, which device to get, whether to have surgery in the US, UK, Europe, or Australia. I can't really weigh in on any of that, since in 1994, (which was pre-internet) there was only one game in town, and that was Amstutz. And with almost 14 years of distance, I can't quite get worked up about which procedure is better or will last longer. There's nothing I can do about it anyway. That said, I do know that if my device fails tomorrow, I will have options available that I didn't have almost 14 years ago, and am grateful for that.
Posted on Tue Jan 22, 2002 7:41 pm
Subject: 8 yrs ago at JRI . . .
I have read some of the posted messages here with interest and thought you might be interested in my experiences. I was part of Dr. Amstutz's original pilot program into Metal/metal surface replacements. See: http://www.jri-oh.com/hip-surgery/Surface.asp and figures 10, 13A, 13B and 13C (the replacement components/procedure I had done).
In February of 1994 I had a M/M cement-less surface replacement at JRI performed by Dr. Amstutz. At the time I was an active 37 year old woman with a diagnosis of severe OA (bone on bone). Eight years later I am still fully active, pain free, and have had no problems with the surface replacement. While I don't consider myself to be an "athlete",I ride horses every week and try to bike most weeks (rain, riding a horse is ok, not on a bike).
Unfortunately this all happened so long ago, I don't recall all of the particulars. I also rarely think about my replacement, or that my left leg is any different from my right. However my recollection is that I am one of 3 or 4 patients to have recieved completely cementless components, both femoral cap and cup. For sure, the femoral cap was cementless. I recall Dr. A spending a great deal of time showing the components to me and explaining why he believed that cementless fixation was superior and showed me how the bone would grow into the porous femoral cap.
I know that he no longer uses these components and began using the C+ components, which, based on the few emails I've read and his web site, are now cemented. I have no idea as to why he switched components or why the components are now cemented. I can tell you that as part of my own recovery process, given the cementless nature of the components, I was absolutely forbidden to do any sports/exercise, other than easy walking and paddling around in a pool for a full year. I clearly remember calling the office in August of '94 and begging to be allowed to go on a bike trip. No way. So my one year anniversary check-up was doubly sweet.
In 1994 this really was an experimental procedure. There was very little literature on surface replacemnts and most of it was negative. The only thing I really had to go on was Dr. A's complete confidence in the superority of surface vs TH replacements. For me, the decision to have it done was a no-brainer. I wouldn't be burning my bridges if I had the procedure done. (which, surprisingly, was completely covered by my insurance company). At worst, I viewed this as a stop gap procedure. If I ever needed to have a revison, I hoped that science would have advanced enough to offer me different, perhaps better options. But if I had a THR, I wouldn't even have the hope of different options.
I thank God that I was living in L.A. at the time of my diagnosis and that I persevered in finding out everything I could about hip replacements. It was only by chance that I discovered the option of a surface replacement. After being diagnosed at UCLA with hip disease in the fall of '93 and being told that the only option I had was a THR, I sought a second opinion at St. Johns hospital in Santa Monica. As part of the pre-consultation process, I was given a 50 page paper on the development into the treatment of hip OA. The paper included a one paragraph blurb about surface replacements. It stated that surface replacements had been tried, but had basically failed. It went on to state that Dr. A was the only doctor in the US still pursuing studies into surface replacements. Given that he practiced in L.A., I thought it wouldn't hurt to go see him. Once he explained the procedure to me, it seemed, almost intuitively, that this was the better option. And I really didn't agonize over the decision. The procedure just made so much more sense than a THR. Frankly, given the many advances that have been made since '94, it stills seems like a no brainer.
Now, the one confession I will make. I have been a terrible patient. About 3 years after the operation, I moved out of state and then back to the Bay Area. I hate to say how long it was until my next check-up. (Dr. A. had to use an investigator to track me down). However, as of my last checkup, a year ago, everything looks great. ROM is 10, pain is 10, activity level is 9. Having the surface replacement has been very positive for me and hopefully, it will last my lifetime.