Dr. Rogerson Chat Feb. 9, 2009

Updated 2/10/09

This is a transcript of a Live Chat in the Surface Hippy Chat Room with Dr. Rogerson on February 9, 2009

[hipster58] 8:09 pm: I've been told that SOCKET POSITION IS most important, so I'm going to ask my Surgeon "how he will verify the position of
the socket".  So my question to you is, what is the correct method of determining the precise optimal socket position?
[Dr. Rogerson] 8:10 pm: the best way is to know the landmarks and use x-ray if any concerns 

[gratefulgee] 8:10 pm:  I have OA in both right knee and hip. All other things being equal, any thoughts on which one knee or hip should be done first. I'm thinking of resurfacing for hip.
[Dr. Rogerson] 8:11 pm: Hip first because a lot of knee pain can be referred from the hip

[] 8:11 pm: Why are there so many different recovery protocols between surgeons? It can become confusing as we compare activities and restrictions.
[Dr. Rogerson] 8:13 pm: Different protocols based on different philosophies and degree of risk a surgeon is inclined to take

[obxpelican] 8:11 pm: How long do your patients usually take heavy pain meds post-op?
[Dr. Rogerson] 8:12 pm:  2-3 days for narcotics and then Tylenol after that usually

[Ted] 8:12 pm:  Regarding age limitations. I'm a very active OB-Gyn whose tennis has been compromised by hip pain. Bones are excellent by Dexa. Great longevity in family. We have a surgeon in Rochester who has performed > 200 and according to the rep one of the best. would I be a candidate for this op and is this experience adequate?
[Dr. Rogerson] 8:13 pm: My oldest patient was 81 and he is still playing high impact sports

I woke up from my resurfacing procedure to find a 14" scar, with an explanation that I was "very muscular and tight, and they needed more room to move things out of the way in order to do the procedure."
[Dr. Rogerson] 8:14 pm: Better to make a longer scar and do the operation correctly than struggle with tight muscles and get the position wrong

My recovery has been normal when compared to most accounts I have read, i.e., off pain meds at about 2 ½ weeks, walking without a cane at

[] 8:13 pm: hi doc.I'm  46 had back surgery 1990, played basketball all my life, even after my back surgery. Now my hip can't move. Had x-rays and MRI  but I became an insulin dependent diabetic and have retinopathy. would you still go ahead with the surgery?
[Dr. Rogerson] 8:15 pm: if bone density is ok with diabetes and kidney function is excellent, one could proceed with BHR
[] 8:16 pm: what about fatty liver
[Dr. Rogerson] 8:21 pm: fatty liver would be a concern
[Dr. Rogerson] 8:14 pm: insurance will usually not pay

[] 8:14 pm: Why would such a large incision be used and what affect would it have on rehab?
[Dr. Rogerson] 8:17 pm: One has to make the incision long enough to move the head anteriorly. In heavy or very muscular patients it can sometimes take that much.
[Dr. Rogerson] 8:17 pm: De Smet uses a long incision on everybody

[hipster58] 8:14 pm: Socket Positioning. So it's all experience, there are no Hi Tech devices for alignment?
[Dr. Rogerson] 8:18 pm: x-rays during surgery are some times necessary. Computer navigation is just being refined
[Dr. Rogerson] 8:19 pm: Computer Navigation also requires pins into the pelvis which can cause pain and possible complications

[hipster58] 8:16 pm:  For resurfacing, do you prefer any specific manufacturer's prosthesis?
[Dr. Rogerson] 8:20 pm: I use BHR but the Cormet has also been FDA approved

[] 8:18 pm: What other issues would result in a patient requiring narcotic medication (oxicodone) for two weeks vs those who only need it for 3 days post op?
[Dr. Rogerson] 8:20 pm: I usually don't find the length of the incision correlating with the pain that closely but more the swelling and bruising after the operation
[Dr. Rogerson] 8:22 pm: swelling and rehab program and pain threshold
[Dr. Rogerson] 8:21 pm: would want to check the kidneys closely

[jimbo] 8:19 pm: How long post surgery can one be relatively certain (or at least less fearful) of hip dislocation due to immature healing of the muscles and tendons that were cut to reach the resurfacing site.
[Dr. Rogerson] 8:22 pm: one should be careful for the first 8-10 weeks on the position of the hip so as not to dislocate

[] 8:21 pm: In recovering in the weeks after surgery, what is typically the most difficult muscle and function to return to normal? Is it more effective to improve ROM or strengthening to help recovery? My lateral stability is what seems to be difficult to get back. Is the capsule slow to heal, or certain muscles around it?
[Dr. Rogerson] 8:23 pm: hip flexion lying down is the slowest
[Dr. Rogerson] 8:24 pm: lateral strength usually comes back if the abductor is not injured

[deserthippy] 8:24 pm: Hey Dr Rogerson, Spencer in Tucson here. Just a testimonial on what's possible from this surgery which you performed 6/26-08. I am back to running and lifting regularly. Just ran a 6:30 mile and squatted 215lbs. Just wanted to say thank you.
[Dr. Rogerson] 8:25 pm: Great

[hipster58] 8:24 pm:  BHR I'm afraid not of hip pain after surgery...but my lower back MR looks relatively good,  but spine can shift when I'm bending down w heavy loads and pulls my back out. I get excruciating pain can't move my lower extremities, and need to yoga out stretch and breath to return to normal. During my first colon exam my back when out, and took a day or two to recover.. I think it was the relaxing drugs they used that made the spine slip......ie may you suggest a operation anasthesia
[Dr. Rogerson] 8:26 pm: often the strain on the back is relieved after resurfacing to a large degree because the range of motion of the hip is so much better.
[Dr. Rogerson] 8:26 pm: would want complete muscle relaxation at the time of surgery for the back
[dvander@wilsonchristian.,] 8:26 pm: I can testify to that. My back strain is nearly gone!!!

[] 8:25 pm: Are metal ion issues any way a greater concern for otherwise healthy females in their early 50's than males?
[Dr. Rogerson] 8:27 pm: no difference vs male and female at 50

[] 8:26 pm: what can one do if they are not candidate for BHR or THR,  be it diabetic kidneys and or fatty livers etc.
[Dr. Rogerson] 8:27 pm: would go with traditional hip metal on plastic if bad kidneys and liver

[] 8:28 pm: Can you do both hips at the same time or do you recommend a time for rehab between when both need done?
[Dr. Rogerson] 8:29 pm:  I put 2-3 months in between. One of the complications reported was femoral neck fracture of the first hip when the socket for the second was impacted on the same day

[] 8:29 pm: In 20 years when my first BHR finally wears out, can I expect medical advancements to allow me another? I'd like to play basketball in the Octonarian League someday.
[Dr. Rogerson] 8:30 pm: yes Mr. McMinn is perfecting a "midhead" which may allow continued high activity
 
[hipster58] 8:29 pm: So about back going out, then no particular anesthesia may be better at preventing this?
[Dr. Rogerson] 8:31 pm: general with complete muscle relaxation would be best for back

[jimbo] 8:30 pm: I will be 11 weeks post surgery tomorrow and my operated hip still feels weak if I try to go up stairs without using the handrail. Is this normal or should I be bouncing up the stairs by now?
[Dr. Rogerson] 8:32 pm: a little slow on the stairs but if still improving would just keep on being active and go back into PT for strengthening

[] 8:30 pm: at 46 years old to have a THR and even a BHR,  will I need to have a second THR at some point in my life?
[Dr. Rogerson] 8:34 pm: no one can say for sure how long you will get out of any type of joint, but there is more ease of reversibility with BHR than regular total hip replacement

[] 8:31 pm: Does Smith & Nephew make a corresponding THR spike and ball that could be used in a revision of a BHR that would be compatible with an existing and otherwise solid BHR cup?
[Dr. Rogerson] 8:32 pm: Yes on the Smith & Nephew stem

[] 8:34 pm: I'm 8 weeks post-op and walking up to 2 miles at a time. I still have a achy tightness right on top of the hip that just doesn't seem to be getting any better yet. How long can I expect to go before that disappears, or does it ever disappear fully?
[Dr. Rogerson] 8:35 pm: It will disappear, but the time can vary. Keep massaging the area and get in the pool to loosen it up

[bgletizia] 8:36 pm: I am 54 and have OA in my right hip. I have already had a THR on my left hip in 1996 and want to go ahead with a hip resurfacing on my right hip (can’t take the pain any more and the limited ROM). My question is that there seems to be some differing views on cemented versus uncemented fixation of the femoral component used in hip resurfacing. I know that the majority of devices out there use cemented fixation. Do you think there is an advantage of one over the other?
[Dr. Rogerson] 8:39 pm: the issue of cement vs non cement is hot right now. In my experience there are a lot of hips that would not do well without cement because of the deformity and differing density of the head. Right now the only FDA approved hips are cemented and the track record for the uncemented is very short

[obxpelican] 8:36 pm: How long before you allow frog kicks in the pool?
[Dr. Rogerson] 8:39 pm: 8-12 weeks on vigorous frog kicking

[hipster58] 8:37 pm: when can I drive after my BHR
[Dr. Rogerson] 8:40 pm: if left hip, one can drive in 1-2 weeks, for right when one can walk without the use of canes

[] 8:38 pm: How much hip pain during these first weeks after surgery comes from scar tissue, and is massage on the hip the most effective way to help this, or does massage just promote blood flow to that area?
[Dr. Rogerson] 8:42 pm: massage loosens scar and promotes flow. Pain in the first few weeks is usually mostly swelling and bruising then becomes scar at about 2-3 weeks

[] 8:40 pm: Is there any scientific evidence that donating blood regularly can help reduce metal ion build up in your system?
[Dr. Rogerson] 8:44 pm: no scientific evidence that I know of but does make some sense.

[B.I.L.L.] 8:42 pm:  I had a right BHR 9-22-08, in January of this year. They deemed it a failure due to a cup angle of 65 degrees. At a little over 4 months I have clicking and knocking followed by a burning pain in the thigh and a numbness throughout the whole hip area. A revision is scheduled in march. Have you done cup revisions and kept the re-surfacing ?
[Dr. Rogerson] 8:44 pm:  I have not personally had to revise a cup in bad position yet but if the bone of the pelvis is thick enough it should be possible

[hipster58] 8:45 pm: How long before I can drive my kids to school after BHR?
[Dr. Rogerson] 8:46 pm: depends on which hip as above, but 1-2 weeks for the left and when off crutches for the right (usually 2-4 weeks)

[Bionic] 8:45 pm: Which muscles do you generally cut during the typical surgery
[Dr. Rogerson] 8:48 pm: Split the gluteus fibers longitudinally and release and repair the upper 1/2 of the tendon. Release and repair the piriformis tendon and the short external rotators

[Ted] 8:47 pm: Do you prefer spinal or epidural anesthesia vs general? Does general enhance the exposure or is it more dependent on body habitus?
[Dr. Rogerson] 8:48 pm: I prefer general because one can get better muscle relaxation and control the blood pressure better

[chillman] 8:48 pm: Do you feel there is a benefit to perusing arthroscopic surgery for bone spurs and torn cartilage? I realize that there may be issues that are not necessarily visible with x-ray/MRI that might make one or the other a better choice if all of the variable were apparently evident
[Dr. Rogerson] 8:50 pm: if there is not too much degenerative arthritis in the hip then arthroscopic is helpful, but if the arthritis is moderately severe the results with scope have not been impressive and would just proceed with resurfacing

[Pat Walter Moderator] 8:51 pm: Have you had any firemen, policemen or service men get resurfacing and then return to full active duty?
[Dr. Rogerson] 8:52 pm: yes for fire and policemen but have not operated on any servicemen yet
[Dr. Rogerson] 8:54 pm: patients are getting back to their previous recreations and occupations without difficulty

[Pat Walter Moderator] 8:53 pm: Have you done a lot of AVN cases?
[Dr. Rogerson] 8:55 pm: No. Dr Mont has probably done the most. They are the most unpredictable because hard to know how much of the head is involved sometimes
[Dr. Rogerson] 8:56 pm: Mr. McMinn's "Midhead" may be the best solution for AVN in the future because it eliminates all the AVN bone

[Bionic] 8:56 pm: Do you think that it's reasonable for people to expect to be able to run and jump on a resurfaced hip, or is that asking for too much?
[Dr. Rogerson] 8:57 pm: it is reasonable--run ,basketball ,tennis tetc.

[Pat Walter Moderator] 8:56 pm: Dr. Gross said he did a lot of men with FAI - do you see a lot of that too?
[Dr. Rogerson] 8:58 pm: yes for FAI. have done several that have failed arthroscopic femoroplasty by Phillipon
[Dr. Rogerson] 8:59 pm: Revised to resurfacing for failed FAI scope

[] 8:59 pm: Somewhere out there in cyberspace (forgot where) there is a video of a BHR patient jumping rope at just 2 weeks post-op. I find that not only foolish, but potentially building up false expectations. Am I overreacting?
[Dr. Rogerson] 9:00 pm: I would agree with foolish
[Dr. Rogerson] 9:00 pm: taking quite of a risk for femoral neck fracture

[B.I.L.L.] 8:59 pm: How do you position the cup ? Do you measure it with instruments or is it "Eyeballed" ?
[Dr. Rogerson] 9:02 pm: Cup position is positioned based on the anterior and posterior walls and the superior overhand and cup positioner determined with pre-op x-ray templating

[] 9:00 pm: Certain PT ROM exercises create clunking in my hip 31 days post op. Should these exercises be stopped or are they potentially going to cause problems with the clunking? (No pain)
[Dr. Rogerson] 9:04 pm: clunking can be from various causes. A thump can be felt early on with the iliotibial band on the outside of the trochanter and will fade. Also the psoas tendon can clunk deep inside and usually stretches out but if the clunk occurs when the hip is flexed and internally rotated that could mean subluxing and should be avoided. check with your doc

[chillman] 9:02 pm: Do you feel that there are specific tests that should be performed, in order for a patient or physician to determine if the patient should pursue resurfacing vs. arthroscopic? I have been lucky that I've not needed to see doctors with the exception of childbirth, so I'm not shopping for drs. I'm looking for information so that I can make an informed decision. I've seen 2 orthos, 1 chiropractor, and their opinions differ.
[Dr. Rogerson] 9:06 pm: would definitely get a ct scan to evaluate the impingement and the degree of arthritis and go from there

[Pat Walter Moderator] Thank You for participating in the Chat.  I know we have learned a great deal.
[Dr. Rogerson] 9:06 pm: My pleasure
[Pat Walter Moderator] 9:07 pm: You are welcome.