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Dr. William Macaulay - BHR trained Mc Minn 2006
100 Hip
Resurfacings to date
Director CHKR
Center for Hip & Knee Replacement
Columbia University Medical Center
622 West 168th Street, PH 1146
New York, NY 10032
T: 212-305-6959
F: 212-305-4024
email:
wmacaulay@yahoo.com
Website |
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Dr.
Macaulay Profile |
Dr. Macaulay video interview by Vicky Marlow Freelance
Patient Advocate Volunteer May 2008
Dr.Macaulay Video Interview about Hip Resurfacing
Dr. William Macaulay Interview
May 10 in New York City
1.) Where did you train for hip resurfacing? Who
trained you? Did you observe after the initial training and/or do cadaver labs
prior to your first patient?
I have been performing versions of hip resurfacing for more than 5 years now. I
fell in love with the concept of total hip resurfacing while on the British
Traveling Fellowship (BTF, sponsored by the US Hip Society which every two years
sends two of the most promising young hip surgeons in the US to the UK), a four
week tour of 9 or 10 UK sites with a reputation for superior hip surgery. I was
quite surprised to see hip resurfacing being performed at 5 of those sites.
These patients were amongst the most enthusiastic about their surgery and theirs
surgeons) that I had ever come across. I came back to the US and started paying
more attention to presentations at national meetings reading more about.
Back to training….During the BTF, I visited Derek McMinn in Birmingham and
observed three cases (I observed approximately 10 other MOMHR’s at the 4 other
sites visited that performed them)….it seemed rather straight forward to me
since I had been resurfacing femoral heads for 4 years at that time; but, as I
observed seeing patients back in clinic, placing the socket (as part of a
metal-on-metal articulation, something I was taught previously did not work)
seemed to make the relief of pain more complete and long lasting. This
visitation to McMinn in 2004, however, did not “count” as official training;
therefore I returned to Birmingham for official training in March of 2006 to
observe cases by Ronan Treacey, the other BHR innovator. At this visitation I
saw techniques which would help me expose the hip better and complete the case
faster…by this time, I had been performing other MOMHR’s since March of 2005 on
a compassionate use basis. Shortly after the BHR was approved, I attended a
course at in Memphis in late May or early June of 2006 which involved cadaveric
BHR’s which made me even more familiar with the instruments, implants and
procedure.
2.) What surgical approach do you use the anterior or
posterior and why?
Partly because Mrs. McMinn and Treacey did it that way, but also because I had
been performing all my total hip and early resurfacing through a posterior
approach…it is still my contention that patients limp for less time following a
posterior approach as opposed to any other way. Very often my MOMHR patients put
aside their cane within 2 to 4 weeks.
3.) How long does a typical resurfacing surgery take?
The mean operative time (typical hip resurfacing) takes 1 hour and 14 minutes
(74 minutes “skin to skin”). Last week I did a flawless MOMHR on a thin person
in 54 minutes skin to skin (including a cosmetic subcutical closure on the
skin).
4.) Barring any complications, how many days in the
hospital will a patient normally stay
My average length of stay of MOMHR patients is exactly 2.23 days (I know because
we keep the data and will eventually publish it)
5.) What is your typical recovery time after
resurfacing, what is your typical rehab protocol?
Typical patients are 90 % improved in 4 to 6 weeks. Last week I saw a gent back
who got bilateral MOMHR’s (5 and a half weeks post surgery) who has squatting
over 700 pounds (against medical advice).
90 degree restriction?......I use 120 degree flexion restriction for MOMHR’s
after the spinal wears off (2 hours post surgery)…never seen a dislocation.
Walk?….usually one day
Crutches, Cane?.....usually off cane in 2 to 4 weeks
Blood thinners?....multimodal approach use aspirin for low risk patients
TED stockings?...none
Ice?.....as desired
PT?…..typically 6 wks
6.) How long before a typical patient is allowed to
drive a car?
…1-2 weeks left hip, 3-4 weeks right
return to work…self employed: fulltime at 3 weeks; hates/tolerates their job: 6
weeks
7.) How long do you feel it takes for the bone to be
fully healed,?
Grow into the prosthesis? ….3 months
What is the recommended time you tell your patients before they can start to run
again/do impact sports?.....4 months
Are there any sports you don’t want your patients to participate in after
surgery? …..sky diving is discouraged…other than that…no
Out of the patients you have resurfaced what are some of the sports they have
returned to?
Downhill skiing, windsurfing, cycling, professional dancing, paddle tennis,
tennis, squash, martial arts, weight lifting
8.) What is your opinion about cementless (femoral)
devices for resurfacing?
Will NEVER use one…cannot work as well
9.) Which resurfacing device do you prefer to use and
why?
Currently BHR: most experience with it most medium term survivorship data
10.) Do you have a cut off age for resurfacing patients
or do you go on a case by case basis?
Average age is 49.1 yrs (95% between 40 and 60); youngest is 17 (didn’t want
total hip), oldest was 76 (good bone)
11.) Do you preserve the neck capsule?
Yes, completely.
12.) What type of anesthesia do you use - general or
epidural?
Spinal or epidural (more than 95%)
13.) Are there any cases that you will not take in
particular, AVN, dysplasia, small cysts
I have done patients with each of these, but approach them VERY carefully.
14.) Do you do bilateral surgeries same day, if not how
far apart do you recommend?
I do them the same day.
15.) If you can’t perform a hip resurfacing – what THR
device do you prefer and why?
I occasionally will “bail-out” to a metal-on-metal (or ceramic on highly
crosslinked poly) THR, if the longterm survivorship of the MOMHR does not look
promising (based on bone quality to the touch and to the eye).
16.) What do you consider an adequate number of
surgeries for a doctor to be
proficient at hip resurfacing?
50 maybe (for some surgeons, they will never get to proficiency)
17.) How many hip resurfacings have you done to date
and how many do you do on a weekly basis?
87 BHR’s
8 Conserve Plus
32 other
Total: 127 (as of April 18th), roughly 1 to 2 per wk on average, but at busier
times 3 or 4)
18.) How successful have you been obtaining insurance
approvals for resurfacing?
Spotty early (prior to May 2006); no problem now.
19.) Do you test for metal allergies or bone cement
allergies?
Only patients who complain of skin irritation from costume jewelry
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