What approach do you choose to use the
posterior approach or anterior
and why?
I use the posterior approach to the hip for
resurfacing arthroplasty for a couple of reasons. It is felt to
be a 'muscle sparing' operation which in younger and more active
patients is advantageous. The other reason is that it is the
approach with which I am most familiar. It gives me the ability
to place the components in their appropriate location/alignment
with the best visualization. I believe that either approach is
acceptable and that a surgeon should use the approach that is
most familiar/comfortable for them to implant the prostheses
appropriately.
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?
I feel that it takes on average 6 - 12 months for
the bone to fully ingrow with the acetabular component. Many
patients show radiographic evidence of ingrowth in the 3 month
range but the majority take
6-12 months to show maximum ingrowth of bone. The amount of
impact to which the prosthesis is subjected has some bearing on
the rapidity of ingrowth also. I advise my patients not to run
or engage in high impact for 6 months post-operatively. The
femoral neck regains its strength at that point in time.
What is your take on cementless devices for
resurfacing?
My current preference is to use a
'hybrid' type of resurfacing with a press fit porous ingrowth
acetabular component and a cemented femoral head component.
Currently research has shown this is the optimal combination for
longevity and survival of a hip resurfacing arthroplasty. Mr.
Derek McMinn has shown cementation of the femoral component to
be more successful over cementless/press fit femoral head
components.
Which resurfacing device do you prefer to
use and why?
I prefer to use the Birmingham Hip
Resurfacing arthroplasty components because they have the
longest track record and the success rates are excellent. I have
also use the Conserve femoral head resurfacing component for
hemi-resurfacing.
Do you have a cut off age for resurfacing
patients or do you go on a
case by case basis?
I evaluate each patient individually and consider
many factors including age when advising a patient to undergo a
hip resurfacing vs. total hip arthroplasty.
Age is only one factor (albeit important) that goes into the
decision making for resurfacing arthroplasty.
Other considerations are patient activity levels, activity
expectations and aspirations, bone density, medical history and
medical conditions, medications used on a chronic basis and body
habitus in addition to other factors.
Do you preserve the neck capsule?
I do
preserve the neck capsule and repair it at the conclusion of the
operation. I think it helps maintain blood supply and also
decreases the risk of dislocation in the early post-operative
period.
What size incision do your normally give
your patients for
resurfacing?
The incision size varies depending on
the patient's body habitus but my intent is to make it as short
as possible yet allow for visualization of the operative filed
and appropriate implant alignment and placement.
What is your typical recovery time after
resurfacing, what is your
typical rehab protocol? Crutches for ? amount of time? 90
degree
restriction?
The typical recovery is 3 days in the
hospital (2-4 days range) with patients up and out of bed with
physical therapy as soon as possible.
Patients begin to weight bear as tolerated immediately and use
crutches for as long as they are needed for comfort and safe
ambulation. Most patients feel using crutches for about 3 weeks
is advantageous for ease of walking and speeding recovery. I
advise patients to follow the 90 degree restriction for 6 weeks.
What type of
anesthesia do you use?
The anesthesia of choice at my
hospital is a spinal anesthetic admixed with a long acting
narcotic (Duramorph) and then a general anesthetic for the case.
The purpose of the spinal anesthetic is to decrease the amount
of general anesthetic delivered by the anesthesiologist and more
importantly to aid in pain control post-operatively.
The spinal narcotic allows for significantly less narcotic to be
used in the first 24 hours post-operatively. An epidural
anesthetic is also a possibility but we have had great success
with the spinal narcotic approach for pain control.
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 in Calgary, Canada with Jim
Powell MD and prior to doing my first BHR did a cadaver implant
and have subsequently been to another meeting that incorporated
a cadaver lab. All of these experiences have been very
informative and educational.
Cindy Kelly MD
The Denver Clinic for Extremities at Risk
Colorado Limb Consultants
(303) 837 - 0072
