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Should You Have Uncemented Hip Resurfacing by Dr. Gross. Click link to learn more.
A Seven-Year Follow-up Study Metal-on-Metal Hip Resurfacing with an
Uncemented Femoral Component Sept. 2008
Between 1999 and 2000, eighteen patients (twenty hips) underwent primary
metal-on-metal hip resurfacing with uncemented femoral and acetabular
components. One patient was lost to follow-up. This left eleven men and six
women, who had a mean age of forty-five years at the time of surgery. Clinical
and radiographic examinations were performed prospectively, and the results were
analyzed.
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How many surgeries do you feel doctor needs to do
to be proficient?
100 HSR would be a good benchmark.
Several US surgeons allow all
activities after 6 mos. What are your guidelines?
I allow virtually all activities at 6
months.
Does the insertion of the acetabular component
require more bone removal in a resurfacing procedure as opposed to a THR.
I do both procedures and remove the same
amount of bone on the acetabular side whether it is a HSR or THR.
Do you prescribe Physical Therapy post op. Can you explain why?
With the minimally invasive posterior
approach no formal physical therapy is necessary. I think it can be counter
productive in the first 6 weeks, after 6 weeks I am happy to prescribe this.
What is your opinion about running and jogging after
hip resurfacing?
I do not recommend marathon
running but light jogging is permitted.
What is the difference between the Biomet device and
the BHR device?
I designed the Biomet
device and feel the instrumentation makes it easier for the surgeon to implant
because of their accuracy. Implants are thinner and require less bone removal.
Biomet was the first to offer 2mm sizing with 12 implant choices, now it is the
only one currently available with an uncemented component in the US.
What anesthesia do you normally prefer?
I recommend spinal
anesthesia with sedation plus multiple pre-emptive anti-nausea medications.
What Blood thinning method do you prefer?
Blood thinning is highly
controversial, there are many acceptable alternatives. My preference is 10 days
of Arixtra followed by one month of 81 mg aspirin. My DVT rate is less than 1%
with no pulmonary embolism in 1500 cases.
How long before complete bone in growth has occured for
the socket component?
I estimate the process is 90%
complete at 6 months and 100% complete at 1 year post op.
Do you suggest Fosamax to increase bone density
post op?
There is good basic science
data in animals that Fosamax increases bone deposition around uncemented
implants. Therefore, I recommend it in osteopenic patients.
What the safe levels of chromium and cobalt ions after
hip resurfacing?
No one knows what safe levels are. These are normal elements in
our body. They are elevated after placing metal implants. There is no value to
measuring and following levels at this point.
What
types of daily exercise do you suggest?
At 2 years virtually all exercise is good
except possibly extreme repetitive impact sports such as marathon running. No
one knows for sure.
Is recovery from a hip resurfacing slower than recovery for a THR?
The recovery is identical. I would recommend waiting 6 months to return to
vigorous activity. I perform both resurfacing and THRs.
What amount
and type of activity is helpful in the initial week after surgery? Is
stretching important?
Walking is a great
exercise for the hip, you should gradually be able to walk longer distances
outside, I would be very careful with stretching, hip range of motion will
return to normal with or without stretching.
How soon after resurfacing can one start stretching to regain
ROM? Do you
recommend any type of physical therapy?
You may start stretching at 6 weeks, but no extreme flexion
exercises for at least 6 months. Physical therapy is not required after a
posterior approach, the muscles recover quickly with walking and a simple home
exercise program.
What activity should I be doing during the first week post op hip resurfacing
surgery?
You should be
up out of bed, walking around in your house, and sitting in a chair most of the day.
Walking outside for one to two blocks a day is a good idea. You can gradually
progress your walking from there. You should also ice and
elevate.
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