1.) What
approach do you choose to use the posterior approach or
anterior and why?
I use the posterior approach because it provides the best
exposure for me and because it has been associated with
excellent results for hip resurfacing. I have, however, used
other approaches in the past including the antero-lateral
approach and a less invasive medial approach through an
incision hidden in the groin.
2.) How long do
you feel it takes for the bone to be fully healed, grow into
the prosthesis? What is the recommended time you tell your
patients before they can start to run again/do impact
sports?
From clinical and laboratory research, it would
seem that the acetabulum is generally adequately fixed from
an ingrowth perspective at about 3 months for most patients,
but this process evolves significantly more for 1 year and
then more slowly (like all living bone) for the rest of the
life of the patient.
3.) What is your
take on cementless devices for resurfacing?
(I am assuming that you are referring to cementless femoral
heads rather than the acetabula which, apart from some
notable exceptions, are all cementless). , I am not a big
fan of cementless femoral heads. I performed a number of the
Hydroxyapatite coated Cormet 2000 resurfacing devices
starting about 10 years ago when I was working as a Resident
and Fellow in Cambridge, England. Early reports of neck
thinning are of concern. They are, however, being used in
fairly significant numbers in Europe and I will await longer
follow-up results.
4.) Which
resurfacing device do you prefer to use and why?
I use the BHR because it is the most tried and tested. It
has, in my opinion, the most reasonable design rationale
relating to metallurgy, implant thickness, prevention of
impingement, as well as acetabular and femoral head
fixation. I do, however, think that we should try and
improve on the BHR as it, and all other resurfacings, have
instrumentation and design limitations.
5.) Do you have
a cut off age for resurfacing patients or do you go on a
case by case basis?
I go by a case-by-case basis. For example, my oldest patient
is an 80yo who competes internationally in Racquetball.
6.) Do you
preserve the neck capsule?
Yes, where possible. I try not to remove anything that does
not need removing in order to get the job done well.
7.) What size
incision do your normally give your patients for
resurfacing?
The size varies depending on the patient. Muscularity,
adiposity all play into the equation. Generally speaking, it
is usually a couple of inches longer than the equivalent
incision would be for a THR in the same patient.
8.) What is your
typical recovery time after resurfacing, what is your
typical rehab protocol? Crutches for ? amount of time? 90
degree restriction?
Weight bearing as tolerated day 1.
Crutches/walker until OK with a cane or no aids. Non impact
exercises from Day 1. Hip precautions for one month. Non
impact sports at 6 weeks (e.g. golf). Impact sports and
running at 6 months.
9.) What type of
anesthesia do you use general or epidural or ?
General or spinal anesthesia. I also use a post-operative
Painbuster catheter for 36 hours that infuses a cocktail for
medication directly into the wound. This is producing
excellent relief of pain without the generalized
side-effects from intravenous drugs.
10.) Where did
you train for resurfacing? Who trained you? Did you observe
after the initial training and/or do cadaver labs prior to
your first patient?
I trained for 18 months under the watchful eyes of Mr
Richard Villar in Cambridge, England. I did my first
resurfacing in 1997. No cadavers were involved at that
stage!
11.) Please tell
us when and how you got started with hip resurfacing?
My first resurfacing experience was as an orthopaedic
resident in 1997 at Addenbrooke’s, the teaching hospital for
Cambridge University in England. One of the consultant
surgeons at the institution, Mr Richard Villar, was a
proponent of the technology and I was exposed to both the
Cormet 2000 and BHR devices. In 2001, when I began the first
of my two adult reconstruction fellowships, I had the
opportunity to gain advanced training and independently
perform significant numbers of hip resurfacings while in
Cambridge. It was during this time that I became committed
to the technique.
12.) Did you
continue to perform resurfacing and expand on your training
after coming to the United States?
I moved to the USA in 2003 as the Director of Adult
Reconstruction at SUNY-Upstate Medical University in
Syracuse, NY. Due to FDA restrictions, resurfacing was
initially unavailable to me. In 2005, I began implanting the
Biomet Recap device which was undergoing FDA trials. In
2006, once FDA approval had been granted, I was able to
start using the BHR again. I have been using this device for
the majority of my patients ever since. In patients where I
feel more choices for head size may be useful, I have been
selecting the Cormet 2000 device.
I moved from the University to private practice in 2006 and
created a private research foundation within my new group.
One of my main goals in doing this was to advance the art of
hip resurfacing. As part of this move and with the intention
of providing patients with several resurfacing options, I
agreed to be a surgeon investigator in an FDA trial
evaluating the Zimmer Durom prosthesis.
Throughout the last 5 years I have been actively involved in
training and being trained in resurfacing techniques and
technology. Currently, I am assisting Stryker Orthopaedics
and Smith & Nephew as a surgeon educator and trainer for
their respective resurfacing devices.
