Dr. Gross Chat Feb. 17, 2009

Updated 2/18/09

This is a transcript of a Live Chat in the Surface Hippy Chat Room with Dr. Gross on February 17, 2009

[jimb] 7:06 pm: is it possible to look at x-rays after resurfacing to gage motions or ranges which might cause unveven wear, impingenment, or dislocation?..i've seen people doing yoga and such after hip surgery which might be okay for some placements and not others
[Dr. Gross] 7:08 pm: Jjimb the x-ray does not determine the range of motion
[Dr. Gross 2] 7:08 pm: in my experience people with arthritis hips have significant loss of motion typically. One year after hip resurfacing they return to the normal range of motion they had before arthritis started.
[Dr. Gross] 7:09 pm: x-ray component position does not determine activity level.  At 6 months most activities are ok, after 1 year all activities are ok.

[JohnC] 7:09 pm: Hi Dr Gross, Thanks for the great job you did resurfacing my hip back in June. I am skiing hard on the new hip eight hours every day, and it is going well. Understandably, this can make the new hip and other aging joints a little sore. Some doctors have expressed concern about the use of Celebrex and similar drugs regarding bone health and healing. Do you have any thoughts on the use of Celebrex after a resurfacing.
[Dr. Gross] 7:10 pm: it's ok to use celebrex or any other anti antiinflamatories. At this point you can do anything you want.

[stevel] 7:10 pm: Is it OK to return to downhill skiing (at all levels of skiing) at 6 months post-op?
[Dr. Gross] 7:11 pm: I would avoid the most extreme levels of skiing moguls and double black diamond until one year

[mariana] 7:10 pm: I had a cementless implant 4 months ago and all is well, but I still have restrictions on certain movements, are these restrictions to protect the bone growth into the implant or to protect the soft tissue repair?
[Dr. Gross] 7:12 pm: The soft tissue repair. The ligaments are primarily healed at 6 months and most activities can be resumed at 1 year.

[tofu] 7:13 pm: Any leg exercises that should be stopped before surgery, to let the thigh muscles not be so "fit", or is that a non-issue?
[Dr. Gross] 7:14 pm: tofu: this is a non issue

[mariana] 7:13 pm: what activities should be deferred for a year post op?
[Dr. Gross] 7:16 pm: Mariana: only the most extreme pounding and extreme range of motion should be delayed for a year such as full contact hockey, ski diving and the splits.

[bp] 7:15 pm: I'm a 60 year old small female with osteopenia. I'm very active (windsurfing, kiteboarding, motorcycling, skiing) . Both hips show bone on bone in x-ray. I'm on celebrex, but I think it's time. I want resurfacing but it seems it is not recommended for 60 and over. Is resurfacing going to be an option?
[Dr. Gross] 7:17 pm: bp: HSR is an option, I would recommend slower progression activities post op and treatment for osteopenia. Your risk of femoral neck fracture is only slightly higher than the normal 1%.

[TAYLOR_ED] 7:17 pm: I will be meeting you in two months, April 22. There is still a certain level of uncertainty as to whether or
not I am jumping too soon. When is it best to have resurfacing - before the pain hits too hard or before then.
[Dr. Gross] 7:19 pm: Taylor_Ed: If your x-rays are bone on bone and your lifestyle is limited then it is usually time for HSR. There is no harm in waiting unless you already have extreme bone loss.
[TAYLOR_ED] 7:18 pm: I have good days and bad days.

[shaun sexton] 7:18 pm: I have just about finished the forms on your website needed for a free email consultation. Tasks remaining include making copy of CD with my x-ray and taking to Fed-X station 30 miles away. My x-ray will be 6 months old this Friday, February 20, 2009. If it is no longer usealbe after that date, I don't want to bother you with it. May I send my information via email rather than Fed-X.
[Dr. Gross] 7:20 pm: shaun: 6 month x-rays are fine, you may e-mail them to Lee Webb instead of sending them Fed Ex, also attach the forms. Her e-mail address is on the website.

[mariana] 7:18 pm: how about stretching such as yoga with flexion beyond 90 degrees?
[Dr. Gross] 7:21 pm: mariana: stretching and yoga can be done at 6 months post op. You may bend past 90 degrees at 6 weeks post op.

[David1201] 7:21 pm: HI Dr. Gross I just crossed my six month point with your cementless resurfacing. I don't even know it's in me compared to the other hip. No limp and I started jogging last week. It's been so long since I ran I pulled my calf muscle.
[Dr. Gross] 7:22 pm: David: Thanks for the update and glad you are doing so well.

[tofu] 7:22 pm: Post surgery the first few days, can a bed be too low? I know you are not supposed to bend beyond a certain point.
[Dr. Gross] 7:23 pm: tofu: Not really with HSR, the hip is quite stable.

[emaxwell] 7:22 pm: how quickly after bilateral resurfacing can I resume exercises such as riding a stationary bike or upper body workouts?
[Dr. Gross] 7:24 pm: emaxwell: You may do upper body workouts at any time, stationary bike at 6 weeks with gradual progression.

[mariana] 7:25 pm: my recovery is going very well also, but I still have start up pain and still have a slight limp is there any kind of rehab to improve this?
[Dr. Gross] 7:25 pm: mariana: How far post op are you?
[mariana] 7:26 pm: I am at 17 weeks post op
[Dr. Gross] 7:28 pm: mariana: At this point you should be doing side lying abductor exercises with weight, going to the gym using an abductor weight machine, if you do not see improvement after doing one month of this I would recommend a physical therapy referral.
[mariana] 7:29 pm: so the problem is the abductors?
[mariana] 7:31 pm: I am doing physical therapy now and have improved a lot but this has been difficult to fix
[Dr. Gross] 7:32 pm: mariana: I suspect it is your abductor muscle.


[bp] 7:27 pm: A recent article in Harvard Women's Health Watch referred to a study that found more femoral breaks in women that had been on fosamax or actonel, citing an increase in brittleness. What are your thoughts on this and would that affect resurfacing?
[Dr. Gross] 7:30 pm: bp: Fosamax has been shown to decrease fracture risk in patients who are osteoporotic. We have been using Fosamax for a year post operatively and have had no fractures in this group to date. We still do not have enough follow up data to make a definite recommendation about this. Hopefully in one more year we will be able to publish our results.

[Bionic] 7:30 pm: Hi Dr. Gross: You resurfaced my hip last Wednesday and I'm already feeling great! Fatigue from the surgery is nearly gone. I'm just looking forward to moving from two crutches to one, and getting moving again. Thanks so much for your fine work!

[Dr. Gross] 7:32 pm: Bionic: Thanks for the update, glad you are doing great. Don't get tempted to over do things.
[Bionic] 7:35 pm: I'll try to contain my enthusiasm. It's just amazing how quickly the little pains and twinges disappear and how quickly movement becomes easier.

[gratefulgee] 7:32 pm: Do you recommend any type of exercise/strengthening regimen before resurfacing surgery?
[Dr. Gross] 7:33 pm: gratefulgee: You can practice on crutches, do upper body strengthening, and the Phase 2 hip exercises.

[mariana] 7:32 pm: how long after resurfacing is one at risk for femoral neck fractures?
[Dr. Gross] 7:34 pm: mariana: 6 months in my experience
[stevel] 7:32 pm: Is it OK to play racketball at 6 months post-op?
[Dr. Gross] 7:34 pm: stevel: Yes, start gradually.

[gratefulgee] 7:36 pm: For an out of state patient (Ohio) how many and how often are follow-up visits needed?
[Dr. Gross] 7:37 pm: gratefulgee: We prefer an on site visit at 6 weeks and 1 year, thereafter all follow ups can be computer based. If you can not make the first 2 we can also arrange to do these local but I prefer to see you in person.

[TAYLOR_ED] 7:37 pm: Can follow-up visits be done remote with new XRAYs?
[Dr. Gross] 7:38 pm: Taylor_Ed: Yes, follow up visits can be done remotely.

[mariana] 7:39 pm: are there any activities that you would not recommend even after a year?
[Dr. Gross] 7:40 pm: mariana: No, at 1 year there are no restrictions.

[TAYLOR_ED] 7:39 pm: What is the average age of your resurfacing males? When is a replacement better than resurfacing?
[Dr. Gross] 7:42 pm: Taylor_Ed: The average age of my patients is 48. My opinion is after approximately 65 years of age. Diagnosis, bone quality and bone defects are also important factors to consider.

[linejudge42] 7:40 pm: Hi Dr. Gross, In a past chat, you mentioned that the resurfacing will not last a life time. You also mentioned that if you run, the prothestic's lifespan will be even shorter. Another leading surgeon has also stated to me that this prosthesis will not last a lifetime. I am curious. As the procedure in it's current form has not been around very long, and there is no data to say for sure it will fail (either the prosthesis or the cement), is it just an opinion that it will fail at some point?
[Dr. Gross] 7:44 pm: linejudge42: I never said it won't last a lifetime, at this point we only have 8 to 10 year data. Any statements about longevity are pure speculation. I suspect many HSRs will last a lifetime.

[bp] 7:43 pm: Do you know if it's going to be a battle with Blue Cross Blue Shield to get resurfacing as opposed to THP, and if so, what is the best approach?
[Dr. Gross] 7:45 pm: bp: usually HSR is approved as readily as any other type of total hip arthroplasty in my experience.

[emaxwell] 7:44 pm:  at what point is cup slippage no longer a significant risk in a cementless implant and how are the first cementless resurfacings you did looking compared to cemented?
[Dr. Gross] 7:46 pm: emaxwell: Do you mean the acetabular "cup" or the femoral "cap".
[emaxwell] 7:47 pm: femoral cap
[Dr. Gross] 7:49 pm: emaxwell: Regarding the uncemented femoral cap, at this point I have done over 600, the results are identical with the results of the cemented femoral components. There have been no failures of bone ingrowth to date. I have done 600 since March of 2007.

[linejudge42] 7:47 pm: Dr. Gross, will a release be coming out soon on the 2 year results of your trials with the cementless resurfacing? Is there an expected release date?
[Dr. Gross] 7:50 pm: linejudg42: It will be approximately one more year before we have enough follow up information to publish these results.

[karenj_m] 7:48 pm: Hi Dr. Gross, Karen Mitchell (04/02/08) here (your difficult case from Northern NY), just wanted to thanks again for getting rid of my 20+ years of pain. I still continue to improve, its amazing! Big hug to Lee and Nancy
[Dr. Gross] 7:50 pm: karenj_m: Thanks for the update and glad you are doing well.

[TAYLOR_ED] 7:49 pm: Have any of your patients reported groin pain problems after BHR?
[Dr. Gross] 7:52 pm: Taylor_Ed: I do not use the BHR, this is a brand name, I have less than 1% of patients with residual groin pain, I believe this is due to psoas tendinitis. This can now usually be avoided by careful acetabular component positioning.
 

[stevel] 7:52 pm: Can a misplaced socket (too steep an angle) be revised to retain the femoral cap for a BHR device?
[Dr. Gross] 7:55 pm: stevel: Yes, usually a socket component of any brand HSR device can be revised while retaining the femur, often a custom implant may be required. I would usually not recommend revising just for a steep angle unless there are some symptoms.

[karenj_m] 7:54 pm: Oh Dr. Gross, do you have anything in the works if a HR fails? Like McMinn's BMHR? Anything with Biomet?
[Dr. Gross] 7:56 pm: karenj_m: Biomet has a taperloc micro stem which is about 3 inches in length which we now use when revising femoral neck fractures. Biomet has no plans for a mid head resection device at this point.

[tomq] 7:55 pm: What symptoms are associated with a hairline crack in the femur after a HR?
[Dr. Gross] 7:57 pm: tomq: New onset groin pain with weight bearing is the most common symptom. If you have this, I would recommend you get on crutches, get an x-ray every week until a diagnosis is made or symptoms resolve. No other imaging studies are useful to make this diagnosis.

[bp] 7:56 pm: How much leg length difference be corrected with resurfacing?
[Dr. Gross] 8:00 pm: bp: It depends, in the vast majority of patients there is no significant increase in length in surgery. In certain cases where there is a deep protrusio or a high riding head with moderately severe dysplasia, I have lengthened the hip 1 to 2 cm, these are rare cases. The surgeon should be able to tell from x-rays in advance.

[Pat Walter Moderator] 8:00 pm: Dr. Gross - Thank You for taking time to chat with us. I know everyone appreciates your effort.
[Pat Walter Moderator] 8:01 pm: We always learn something new during each chat.
[Dr. Gross] 8:01 pm: I enjoyed the great questions. I look forward to doing this again.