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This is a transcript of a
Live Chat in the Surface Hippy Chat Room with Dr. Gross on November 11,
2008
[] 7:04 pm: Dr Dr. Gross you did my hip on August 6th and it
feels good so far, but sometimes I still have problems with other joints I read
somewhere that Ibuprofen can "soften bone" - if that is true can it hurt your
implant?
[Dr. Gross] 7:05 pm: Chuck, No, Ibuprofen is fine, it does not
soften bones.
[] 7:04 pm: Dr. Gross - I've been trying to get to the
bottom of a problematic right hip that shows no discomfort during activity
(hiking, running, cycling) but very sore 1-2 days after moderately intense
activity and has really sidelined me (normally very athletic) for the past 3
years; MRI indicates some osteoarthritis - does OA sometimes manifest like this?
Is there a chance that I am ready for HR?
[Dr. Gross] 7:07 pm: Barry, It is very difficult to say, you may
have impingement or some other problem of the hip. MRIs are not very reliable
for judging the amount of arthritis. I would be happy to review your case if you
send me your medical information and x-rays, see
www.Dr. Grossortho.com and contact us.
[] 7:04 pm: Can gradually increasing pain levels and
recovery times in a 63 years old male following strenuous sports activities be
indicators of progressive bone deterioration which may preclude HR at a later
time when pain levels become intolerable?
[Dr. Gross] 7:08 pm: Doug, Pain after activity does not necessarily correlate with bone loss, one must review
the x-ray.
[] 7:05 pm: How many surgeries do you feel doctor needs to do
to be proficient? I am in Atlanta and there are not a lot, if any, who have done
more than 15-20 that I know of
[Dr. Gross] 7:09 pm: emaxwell, 100 HSR would be a good benchmark.
[] 7:06 pm: I’ve been told that a critical piece of
criteria to take into account when choosing THR/BHR is stability of the
procedure over the life of the hardware being replaced. For this reason a THR
specialist that I consulted told me a MOM THR will distribute the weight load
more evenly to a greater area of the femur than a resurfacing femoral component.
It was explained due to its small stem, the stress moves more toward the outer
side of the cap, which would in-turn stress that edge, causing fracture.
[Dr. Gross] 7:11 pm: Rob, Unquestionably stress distribution to the
femur is more normal with a HSR than with a THR. Fractures only occur within
the first 6 months. The fracture rate for HSR is 1%, for a THR is 0.7% in the
femoral shaft.
[] 7:06 pm: Hello Dr. Gross I am a 47 year old 5'5 180
pound female with pins in my hip from a car accident 20 years ago. I was
schedule for a hip replacement last March because of a 10.5 hemoglobin count I
am now trying to get my hemoglobin up. would the pin in my hips prevent me from
possibly getting a resurfacing
[Dr. Gross] 7:12 pm: Katgirl 205, No, I have resurfaced patients
with similar problems as yours with no problem, I would need to see your
x-rays.
[Jeff] 7:08 pm: I have bone spurs in both hips, what would
be the best, most long lasting resurfacing to fix that problem? Thank you
[Dr. Gross] 7:14 pm: Jeff, Bone spurs are generally associated with
hip arthritis, I would recommend HSR if you are young and x-rays do indeed
reveal arthritis of the hip.
[] 7:08 pm: Dr Dr. Gross - Dall sheep hunting is very rigorous
(heavy loads, 85 lbs, in mountains). I notice Dr. McMinn advises patients to
delay running or downhill skiing until 12 mos. Several US surgeons allow all
activities after 6 mos. What do you think?
[Dr. Gross] 7:15 pm: Stevel, I allow virtually all activities at 6
months.
[] 7:15 pm: Does the insertion of the acetabular component
require more bone removal in a resurfacing procedure as opposed to a THR.
[Dr. Gross] 7:16 pm: Rob, I do both procedures and remove the same
amount of bone on the acetabular side whether it is a HSR or THR.
[] 7:15 pm: Assuming good bone stock and generally good
overall health, what is the oldest candidate that you would consider doing an HR
and why?
[Dr. Gross] 7:17 pm: doug noonan, Generally I do HSR on patients
under 65, but if bone quality is good and the patient has a strong desire to
have a HSR, I will do this procedure for them.
[] 7:17 pm: If you compare a MOM THR with a MOM
resurfacing, is there a difference in the size of the femoral component and if
yes, does this have any effect on range of motion
[Dr. Gross] 7:19 pm: Rob, The result with large bearing MOM THR &
HSR are the same. The advantage of HSR is bone preservation. Smaller bearing THR
or bearing other than metal have some compromises.
[Dr. Gross] 7:20 pm: Rob, there is no difference in range of motion
as long as you have a large MOM bearing.
[Jon] 7:17 pm: I have a grade 4 lesion in my acetabulum
but mostly suffer from pain in my lumbar spine. I've seen a physiatrist who is
perplexed by the symptoms (not explained by what he sees in scans of spine or
hip). Is it "normal" for problems in the hip to cause lumbar pain of uncertain
etiology?
[Dr. Gross] 7:21 pm: Jon, Many people with severe arthritis of the
hip have associated back pain that will resolve after the hip is fixed.
[charleswinslow] 7:17 pm: My question: I think I am 100%
in for Dr. Gross's no glue surgury on the resurfacing. Can Dr. Gross explain the
differences and advantages/disadvantages of the Birmingham product, Cormet,
BioMet and others.
[Dr. Gross] 7:22 pm: Charleswinslow, Only Cormet and Biomet offer
an uncemented implant. Only the Biomet is available in the US, the Biomet has
full porous coating, the Corin has only partial porous coating.
[Jeff] 7:17 pm: Thanks, Dr Dr. Gross. I am 39 years of age and
do have Arthritis in both. Seems like resurfacing might be an option.. What is
the acronyn HSR mean?
[Dr. Gross] 7:23 pm: Jeff, HSR means hip surface replacement. At
age 39 you should strongly consider HSR.
[JTKarp] 7:17 pm: Hi Dr. Gross - how is the track record
for cementless looking so far (how many procedures?, how many failures? any
attributable to fixation type?)
[Dr. Gross] 7:24 pm: JTKarp, I have done 400 procedures so far with
no fixation failures to date.
[] 7:19 pm: Hi Dr Dr. Gross - I noticed on your website that
you do not prescribe Physical Therapy post op. Can you explain why? Would you
write an order if your patient requested it?
[Dr. Gross] 7:25 pm: karenz, 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.
[] 7:21 pm: Dr. Gross, my X-rays are on the way to you,
but do to impatience, what would be the cause of pain, swelling, and stiffness
3yrs post op HSR.
[Dr. Gross] 7:26 pm: boatman, I really can not say at this point,
failed HSR are rare but I will be happy to review your case and contact you.
[] 7:22 pm: In over 65 patients, is THP generally favored
over HR because the THP will last longer or because the increased motion
benefits of HR are less important in the over 65 patient?
[Dr. Gross] 7:28 pm: doug noonan, Range of motion are no different
for HSR or THR if a large metal bearing is used. Complications are higher for
patients over 65 when HSR is done.
[Jeff] 7:26 pm: Oh great, thank you. Do you think a HSR
could last as long as I live or would they have to go in every 10 years and
repair? I have read that the data doesn't go beyond 10 years typically but I
would like your educated guess on the subject. Take your time in response. :)
Thanks!
[] 7:29 pm: Jeff - I have a patient story on the website
that has had her BHR for 16 years from McMinn
[Jeff] 7:31 pm: Walter: I guess BHR and HSR are the same?
[] 7:32 pm: No - BHR stands for Birmingham Hip Resurfacing
which is a device - HSR is a general term meaning hip surface replacement.
[Dr. Gross] 7:32 pm: Jeff, BHR is a brand name, HSR is the
name of the procedure.
[mdelmatt] 7:32 pm: Dr. Gross: What is your take on HSR
and jogging? Do you permit it? At six months out? At 12 months?
[Dr. Gross] 7:34 pm: mdelmatt, I do not recommend marathon
running but light jogging is permitted.
[charleswinslow] 7:33 pm: How do the BHR technology and
the Biomet device compare?
[Dr. Gross] 7:39 pm: charleswinslow, 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.
[casey depersis] 7:34 pm: I am also curious about how to
advocate for myself with anesthesia? A lot of people post about the nausea
afterwards and I can't seem to contact an anesthesiologist prior to surgery so
how can I request care with my nausea/reaction? I am scheduled in LA with Dr.
Amstutz on 11/20 and really concerned about heaving reaction to anesthesia on
top of just trying to come to. Are there any special tips/requests for
anesthesia?
[Dr. Gross] 7:40 pm: casey depersis, I recommend spinal
anesthesia with sedation plus multiple pre-emptive anti-nausea medications, this
is my routine.
[kerry] 7:34 pm: Hi. I am new to all of this. I found this
site by accident when I was looking into this.I was born w/ a dislocated
hip.They didn't find it right away. I was walking actually. They had put a pin
in and I was in a body cast. Anyway, now I'm 34 and in pain constantly. I went
to a hip specialist last year and he recommended hip resurfacing.Told me to go
to a doc in Philly. I never went. I'm concerned about having this done at my
age. Will it cause more problems? Will I need to have it again?
[Dr. Gross] 7:41 pm: kerry, If you have severe arthritis, HSR
is your best option because it preserves bone while solving your problem.
[] 7:39 pm: Your answer to Mdelmatt's question was:
marathon not recommended. Was that in answer to the time frame 6 mos./12 mos. or
at any time in life post HSR surgery?
[Dr. Gross] 7:42 pm: Rob, 6 months running is okay.
[adam lee] 7:40 pm: Hi all, I am one of Dr. Gross'
patients with an uncemented component and I've had it over a year now. It still
works great.
[] 7:40 pm: Hi Dr Dr. Gross - My right leg has started to turn
outward due to my hip problem and now my knee gives me some trouble too. After
my HSR surgery will these things resolve?
[Dr. Gross] 7:43 pm: karenz, you have a severe external
rotation contracture of your hip this resolves after HSR.
[casey depersis] 7:43 pm: Can I call for this with the
anesthesiologist or is that only allowed by the Dr.? It's so hard to get in
touch with anesthesiologists they are like the phantom workers in hospitals? I
don't want to over step my bounds I just don't want to vomit for one or two days
running?
[Dr. Gross] 7:43 pm: casey, call the pre-operative nurse and
let her know you had nausea, she can relay to the anesthesiologist for you.
[Don Stephens] 7:43 pm: I have some bone cysts and spurs.
Do they preclude HSR? Thank you.
[Dr. Gross] 7:44 pm: Don Stephens, No unless the cysts are
extremely large.
[] 7:45 pm: Theoretically, and based on current 10 year
data, could a BHR last a lifetime for age 55 athletically active male (to say
age 90)?
[Dr. Gross] 7:45 pm: stevel, Theoretically yes.
[charleswinslow] 7:46 pm: I have had the initial
discussions with your staff and Tom
Mallory of Columbus Ohio. He is a friend of the family and with his parkinson
disease has been out of the
practice for a while. He quoted old numbers about failure of the HSR procedure
nearing 30%. I looked at your website which had some great answers, but wanted
your response.
www.Dr. Grossortho.com for others who are looking for the overview. I
think my question is why are many of the THR experts tied to old tech.
[Dr. Gross] 7:47 pm: charleswinslow, Tom Mallory is evidently
quoting you old data on metal plastic resurfacing which I agree, they were bad.
We are now in a new era of HSR with 8 year results in MOM HSR.
[] 7:46 pm: Dr. Gross has there been any standardization
for anticoagulation therapy amongst your peers? Coumadin, Arixtra, Lovenox?
Lovenox and Coumadin?
[Dr. Gross] 7:50 pm: casey depersis, 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.
[] 7:49 pm: In the over 65 patient, are the complications
less for THP that for HSR?
[Dr. Gross] 7:50 pm: doug noonan, Yes, you are correct.
[charleswinslow] 7:49 pm: The other old data was wait as
long as possible for us yournger patients. Apparently with the new HSR procedure
we can be more active pain free and have the option open for the THR when we are
old fogies.
[Dr. Gross] 7:51 pm: charleswinslow, Correct, I agree.
[] 7:51 pm: I need both hips done, what sort of time in
between procedures?
[Dr. Gross] 7:55 pm: emaxwell, If you have good bone density
they can be done in the same week if you wish or staged 6 weeks to 3 months
apart depending on your time frame and preference.
[katwal] 7:52 pm: Dr. Gross, you did my hip resurf last
December. I have my one year followup with you on Dec. 9. My new joint is great,
but I have ongoing groin pain (psoas tendinitis probably) and upper buttock
pain. Lee Webb sent me a script for PT with phonophoresis of the groin. I
attended six of the prescribed sessions, but still have pain. Is there a psoas
bursa shot in store for me when I seen you on the 9th? If so, how much does it
hurt? Also, what do you think is going on with the upper buttock? Thanks.
[Dr. Gross] 7:52 pm: kerry, Pain running from the hip to the
ankle could be coming from the hip or back, you should have someone make a
diagnosis before starting treatment.
[Dr. Gross] 7:55 pm: katwall, Probably injection of your psoas
is the next step, this is not too painful.
[Brett] 7:55 pm: I had a resurf Aug 11 with Dr. Boyd and
the cup slipped and on my 1st post op appt 3 weeks later I had the cup replaced
with a 2 mm larger size. .I'm 47 with good bone, why did this happen? .He said he had
never had it happen in 660 resurfacings.
[Dr. Gross] 7:58 pm: Brett, This happens in about 1% of HSR or
THR. There are many reasons this can happen.
[] 7:57 pm: how long before complete bone in growth for
the socket component?
[Dr. Gross] 7:59 pm: stevel, I estimate the process is 90%
complete at 6 months and 100% complete at 1 year post op.
[jimb florida] 7:58 pm: Fosamax for bone density pre and
post op seems positive, negative, and everything in between according to
research reports. Have any further thoughts on this drug at this time? I find
it difficult to convince myself to take it.
[Dr. Gross] 8:01 pm: jimb florida, There is good basic science
data in animals that Fosamax increases bone deposition around uncemented
implants. Therefore I recommend it in osteopenic patients.
[] 7:59 pm: Is glucosamine advised for non-arthritic
joints, after a BHR?
[Dr. Gross] 8:04 pm: stevel, Scientific reports have shown
that glucosamine relieves the symptoms in joints with minor arthritis. It does
not repair or re-build cartilage.
[charleswinslow] 7:59 pm: Waiting for the one hip that is
killing me and the second which seems to be problematic but not so bad for now.
Will the technology get better should I wait for the OK hip?
[Dr. Gross] 8:03 pm: charleswinslow, Technology continues to
improve always, if your hip is bone on bone and problematic, I recommend you go
ahead and get it fixed.
[Bionic] 7:59 pm: In the one minute that remains, Dr.
Dr. Gross, do you think that the concern about metal ions is a serious reason that a
person otherwise in good health should avoid resurfacing?
[Dr. Gross] 8:02 pm: Bionic, No, there are at least as many
problems with plastic and ceramic implants.
[Dr. Gross] 8:04 pm: Thank you all, I enjoyed talking to you
all.
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