What Surgical Approach do you Use?
I like the posterior approach for the excellent exposure that it
provides (which is critical for the positioning of the implants)
and the ease of recovery for the patient. There are some who
believe a trochanteric flip (Ganz osteotomy) or anterolateral
approach are better for the blood supply, but we saw from Mr.
Treacy’s data that there wasn’t any difference in outcomes
between the posterior and anterolateral approaches. Also, the
recovery from the anterolateral and trochanteric flip tend to be
more difficult, with protected weight bearing and avoidance of
certain movements. Finally, if the muscles that were detached
during the anterolateral approach don’t heal back to the bone,
then this can be a serious problem. I don’t have much experience
with the anterior approach, so I can’t really comment on that.
A final word is that I think there are many ways to skin a cat,
and surgeons should use what they feel comfortable with.
How long do you feel it takes for the bone to be fully healed,
grow into the prosthesis?
For the socket, I believe it takes 3 to 6 months before the bone
is fully grown onto the implant. I believe the femoral bone is
something that continually remodels, since it is alive. I
believe that it is weaker initially after surgery, but
strengthens with gradual activity, to the point that it is
probably strong enough for impact activity at 6 months.
What Hip Devices Do You Prefer?
I still use the BHR, Conserve Plus, and Biomet Recap. I think
the devices are very similar, but the BHR has the longest track
record, which is very important to me. The other devices do have
the benefit of more sizes than the BHR for right now (at least
in the US), so there are some patients for whom they fit better.
