I have done more than 600 metal on metal hip resurfacings/replacements since 2006.
I got certified to do Birmingham Hip Resurfacing after completing the BHR training course in Charlotte, NC in December 2006. After a trip to Dr. DeSmet in Gent, Belgium, I started to do hip resurfacings in February 2007. I have also visited a number of hip resurfacing surgeons, including Derek McMinn, over the years to improve my technique. I have lectured on hip resurfacing and have trained surgeons in this technique.
The second patient I performed a hip resurfacing on had less than 90 degrees of hip flexion and complained of pain with physical activities. I believe this was the result of a large CAM legion and an anterior rim osteophyte that I did not remove at the time of surgery. I performed an arthroscopy to clean out the osteophytes 9 months after surgery and the patient has had improved range of motion and no longer complains of pain.
I have also had to revise a cup that was not seated deep enough and five female patients with reactions to the metal on metal bearing. I have stopped doing hip resurfacings in women in 2010 since I believe the revision rate is increased (smaller component size, edge loading?)
Once in a patient with severe AVN. He was 28 and had been on systemic steroids for most of his life. During the surgery I was uncomfortable with the amount of necrosis (>50%) as well as the quality of the remaining healthy bone and decided against hip resurfacing.
In general we know preoperatively if a patient is a candidate for hip resurfacing. Factors like age, gender, activity level as well as bone quality and bone shape on the preoperative x-ray help me decide if a patient is a candidate. Occasionally one might encounter weaker bone than expected or face significant bone necrosis in patients with avascular necrosis. If I am at all worried that I might not be able to do the resurfacing I usually discuss this prior to surgery to include the patient in the decision process.
If a hip resurfacing is not possible I will use a ceramic on plastic standard total hip replacement.
I have been using the FDA approved Birmingham Hip Resurfacing (BHR) by Smith and Nephew. I prefer the BHR because of its FDA clearance, its proven track record and number of publications that have confirmed its excellent long term outcome. I have now 8 years of experience with this device and am happy with its outcome.
I use cemented femoral component fixation (resurfacing on the femur) and uncemented press fit fixation for the acetabular component. The excellent long term results of cemented femoral components published in the literature and my own experience suggest that there is no benefit in switching to uncemented fixation. Until the literature provides convincing evidence that uncemented femoral fixation has equally good results I do not believe that it has advantages for my patients.
I do cement the stem in patients with poor bone stock, with very small femoral components or patients I consider at particular risk for neck fracture. The literature seems to suggest that cementing the stem can reduce the risk of neck fracture in high risk patients. I also might consider cementing the stem in patients with avascular necrosis. However, I do not cement the stem in the majority of my patients.
Yes. I preserve the capsule and repair it at the end of the procedure.
At the Hospital for Special Surgery almost every Resurfacing Procedure is done using spinal anesthesia. This minimizes intraoperative blood loss, decreases the risk of blood clots and is also better tolerated by the patient than general anesthesia. I also use an intraoperative injection to minimize local pain
Usually the surgery takes approximately 1 hour.
A Hip Resurfacing is a metal on metal hip replacement. Because of its bearing components there are some specific risks to this type of surgery:
Although potential benefits of opting for a hip resurfacing over a total hip replacement include: higher post-surgical activity levels and reduced dislocation rates, it has to be assumed that revision rates are higher at 20 years compared to standard total hip arthroplasties.
I start intensive range of motion early after surgery to make sure you do not get stiff. We will discuss the specific exercises while you are in the hospital. Usually by 3 weeks you should be able to have excellent flexibility.
I will keep you on crutches full weight bearing for the first 2 weeks to protect your femoral neck and allow it to adjust to the new implant.
Usually after 1 week you will not need any narcotic medication during the day. You can drive a car whenever you are comfortable and are off narcotic medications.
Hospital for Special Surgery, 535 East 70th Street, NY 10021.
0.3% for primary total joint replacement surgery.
No, I have not had an infection following a hip resurfacing.
We use coated Aspirin 325mg twice a day for the majority of our patients. Please tell Dr. Boettner if you had a history of a blood clot or pulmonary emboli.
1 – 3 days
We will let you put full weight on the hip right away.
Please contact our office if you have further questions regarding this treatment option.
You can start exercising on a stationary bike by two weeks after surgery and can return to normal biking ca. 6-8 weeks after surgery. You can return to all sports without restriction 2 months after surgery. You can play golf 4-6 weeks after surgery after you saw Dr. Boettner in the office.
No, I let my patients return to all sport they did preoperatively. However patients need to understand that a resurfacing is a mechanical device and increased load might increase the failure rate at 10 and 20 years.