Dr. Rogerson Chat Oct. 13, 2008

Updated 10/14/08

This is a transcript of a Live Chat in the Surface Hippy Chat Room with Dr. Rogerson on Oct. 13, 2008

[paul] 8:12 pm: For someone in his mid 50s who works in an office setting, about how soon can he return to work after resurfacing, assuming no comps?
[Dr. Rogerson] 8:14 pm: Hi I've had patients such as dentists back in two weeks but usually it is 3-4 weeks for full days

[paul] 8:14 pm: For how long do most patients have to defer driving post resurfacing?
[Dr. Rogerson] 8:15 pm: when they can walk without crutches they can drive - usually 2-3 weeks

[paul] 8:15 pm: In resurfacing, can leg length be altered to equalize it with the contralateral leg?
[Dr. Rogerson] 8:16 pm: very small amounts

[RH] 8:16 pm: Do your patients use TEDS and any other kind of blood clot prevention
[Dr. Rogerson] 8:17 pm: yes. we use pump stockings during surgery and teds and pumps after and enoxaparin

[paul] 8:17 pm: Do I need to donate blood preoperatively for a resurfacing procedure?
[Dr. Rogerson] 8:17 pm: ?No, transfusions are rare

[Ken Lazur] 8:17 pm: My Doc said I have Hip Dysplasia and also arthritis involved and need total hip replacement. Should I consider resurfacing. I am a runner and would like to continue.
[Dr. Rogerson] 8:18 pm: you could consider resurfacing

[paul] 8:18 pm: What is the incidence of avascular necrosis post resurfacing?
[Dr. Rogerson] 8:18 pm: depends on how much dysplasia
[Dr. Rogerson] 8:21 pm: in terms of dysplasia one needs to look at the x-rays to really answer if resurfacing is preferred
[Dr. Rogerson] 8:19 pm: rare. in Mr. McMinn's first 3000 he had one case. I've had none yet in our first 340

paul] 8:18 pm: Approximately how long does a resurfacing procedure take, assuming no comps?
[Dr. Rogerson] 8:20 pm: usually takes me about 1 hour 45 minutes but I go slowly and carefully to not notch the femoral neck

[ahershberger] 8:21 pm: Can someone who was extremely flexible expect to gain back the flexibility after having both hips done? ( I know this is crazy but I could almost do the splits at the age of 46 and would like to be close to that kind of flexibility.) My doctor said at 6 weeks I was in the 90% of patients whatever that means. I am now 9 weeks post op.
[Dr. Rogerson] 8:22 pm: one could expect to regain essentially normal motion especially if one is flexible before the surgery

[Ken Lazur] 8:22 pm: would resurfacing handle the impact of running
[ahershberger] 8:22 pm: how long will it take on average?
[Dr. Rogerson] 8:23 pm: shouldn't try to rush it but by 6 months is likely

[] 8:24 pm: Do you primarily use the BHR - or do you use other devices too
[Dr. Rogerson] 8:25 pm: I have done one Wright Medical and all the rest BHR

[Ken Lazur] 8:26 pm: would resurfacing handle running?
[Dr. Rogerson] 8:26 pm: resurfacing is great for eventual running

[Chuck] 8:26 pm: How long on average does it take for your patients to tie their own shoes?
[Dr. Rogerson] 8:27 pm: tying shoes usually by 4-6 weeks

[] 8:26 pm: do your normally do both hips at one time if needed - or do you space them a few days or weeks apart
[Dr. Rogerson] 8:27 pm: I usually space the 2 hips by 8-12 weeks

[] 8:27 pm: Some doctors feel the heavy impact sports shorten the life of the hip device - how do you feel about it?
[Dr. Rogerson] 8:28 pm: the survivorship at 10 years in McMinn's series for osteoarthritis is 98.6% so that slope suggest many will last a very long time

[RH] 8:28 pm: how old are your oldest hip resurfacing patients?
[Dr. Rogerson] 8:30 pm: oldest patient was 81 and 71 but they were extremely fit for their age and played high impact sports and wanted to continue

[Ken Lazur] 8:31 pm: Why would my doctor strongly suggest total hip replacement and not resurfacing?
[Dr. Rogerson] 8:31 pm: unsure
[Ken Lazur] 8:31 pm: I am 54
[Dr. Rogerson] 8:32 pm: . for high impact sports, I would definitely go with resurfacing
[Dr. Rogerson] 8:32 pm: and esp. at 54
[Dr. Rogerson] 8:30 pm: Impact sports will definitely shorten plastic socket devices. We don't know if it truly will shorten metal on metal devices

[Ken Lazur] 8:32 pm: Doc talked about metal bearing instead of ceramic
[[Dr. Rogerson] 8:33 pm: agree with metal on metal bearing. not enthused at all with ceramic on ceramic

ahershberger] 8:33 pm: Do you resurfacing doctors follow your patients with blood work to track the metal ions released in the body? Or is this something that we should ask our family docs to do?
[Dr. Rogerson] 8:34 pm: I don't routinely follow metal ions because there are very few labs that can and will do the tests.

[Ken Lazur] 8:34 pm: what is the difference between total replacement and resurfacing
[Dr. Rogerson] 8:37 pm: main difference between traditional THA and resurfacing is that you save and just shave the ball for resurfacing and don't cut off the neck and head like regular THA and the head size for resurfacing is much larger and doesn't dislocate much

[ahershberger] 8:37 pm: Do you have any concerns about resurfacing for women just prior to menopause especially if they are just above the cutoff for numbers bone density? What if they were to have some bone loss?
[Dr. Rogerson] 8:39 pm: I have done a large number of pre and just post menopausal females and have had no troubles -  just have to be careful to not notch the neck. The bone actually gets stronger in the neck after resurfacing

[wierdwood] 8:37 pm: Assuming good alignment what are the chances of femoral neck notching leading to a femoral neck fracture?
[Dr. Rogerson] 8:40 pm: if good alignment and no notching the chance of femoral neck fracture is very low. we have had none so far

[] 8:37 pm: Is it best to wait as long as possible for a hip resurfacing while trying everything possible. Or just get out of pain and off meds with a new resurfacing.
[Dr. Rogerson] 8:41 pm: there is a window for hip resurfacing before get too much deformity or head cysts -  need to follow the x-rays if waiting

[] 8:41 pm: Dr. Rogerson, I am due to send my 2 year BHR post-op x-rays to Dr. Bose in India. The cardiac surgeon I work for is willing to write the script for it. What should he order?
[Dr. Rogerson] 8:42 pm: AP pelvis and frog or cross table lateral

[] 8:42 pm: do you need to do MRs if your hips are really bad? or do x-rays tell you everything?
[Dr. Rogerson] 8:43 pm: I frequently order CT scans to evaluate the size and location of femoral head cysts
[Dr. Rogerson] 8:44 pm: If the cysts are too large I go to a metal on metal big femoral head

[] 8:44 pm: should it say right hip or does that compare both hips?
[Dr. Rogerson] 8:44 pm: AP pelvis is for both hips but say right for the lateral

[ahershberger] 8:45 pm: Is it common not to know about all of the cysts until surgery? My surgeon was surprised at what the x-ray didn't show
[Dr. Rogerson] 8:46 pm: sometimes one can be surprised but usually one has an inkling of the cysts and the CT scan really show them well
[] 8:46 pm: I heard that doctors can fill deep cysts? Is that true?

[Dr. Rogerson] 8:48 pm: sometimes yes but it depends on the size but more importantly the location of the cyst -  if it is superior on the neck at the junction of the metal to the bone it is a serious stress riser and will likely give a femoral neck fracture

[ahershberger] 8:46 pm: are ct scans routinely ordered? I did not have one.
[Dr. Rogerson] 8:48 pm: CT depends on your Dr

[RH] 8:48 pm: Do you think taking NSAIDS like Celebrex can deteriorate the bad hip more quickly? Or the meds don't bother a bad hip.
[Dr. Rogerson] 8:49 pm: I don't think Celebrex would deteriorate a bad hip more quickly.
[Dr. Rogerson] 8:50 pm: by the time a hip is bare bone the nsaid is only decreasing the inflammation of the joint and would have now effect on the articular cartilage

[RH] 8:50 pm: Do you normally try steriod shots in the hip capsule before doing a resurfaicng? How many would you do?
[Dr. Rogerson] 8:52 pm: yes on steroids for one or 2 times --never more than 3
[Dr. Rogerson] 8:52 pm: usually doesn't help after 3 times

[RH] 8:53 pm: Is it important to try to be in good physical shape before surgery? What would you suggest as good exercises
[Dr. Rogerson] 8:53 pm: very important. Swimming and biking and gentle yoga type stretches

[ronbole] 8:54 pm: what do you look for on the xray at the one year check-up after a BHR?
[Dr. Rogerson] 8:55 pm: look for any lucent lines at the socket or any thinning of the neck or change in position

[] 8:55 pm: Do you feel the surgical approach makes a difference in how quickly a patient recovers from resurfacing?
[Dr. Rogerson] 8:55 pm: yes.
[] 8:55 pm: What do you prefer and why?
[Dr. Rogerson] 8:56 pm: The lateral approach and anterior lateral where the trochanter or the abductor is cut can lead to a prolongs limp
[] 8:57 pm: You prefer the posterior approach
[Dr. Rogerson] 8:57 pm: I use the posterior approach just like Mr.McMinn and Treacy.

[] 8:57 pm: Does the size of the incision make any difference on the quickness of the recovery?
[Dr. Rogerson] 8:57 pm: I think dislocation is not really a factor and it spares the abductors
[Dr. Rogerson] 8:58 pm: not that much I do mine trough a 6-8 inch incision but the patients I sent to Dr De Smet came back with 15 inch incisions and did great also

[linda] 8:57 pm: Do you know which approach Dr. Su uses?
[Dr. Rogerson] 9:01 pm: I'm pretty sure Dr. Su uses the posterior approach since he did a surgical demo at the Miami meeting using it

[Ken Lazur] 8:58 pm: Do you cut any muscles or tendons with resurfacing?
[Dr. Rogerson] 8:59 pm: The short external rotators and the upper one half of the gluteus max are incised and later repaired with the posterior approach

[] 8:59 pm: another x-ray question: what would you put for the reason for the x-ray
[Dr. Rogerson] 9:00 pm: follow-up resurfacing hip replacement