|Transcript of Dr. Bose Chat in the Surface Hippy
Chat Room On August 16, 2008
[Pat Walter] 12:00 pm: I would like to Welcome Dr. Bose to the
Surface Hippy Chat Room.
Dr. Bose is one of the world’s best hip resurfacing
surgeons. He is from Chennai India. He has done over 1200 hip resurfacings.
[Pat Walter] 12:01 pm: Could you tell us when you started to do hip resurfacing
[Dr. Bose] 12:02 pm: Trained with Mcminn
& Treacy in the mid 90s. Went back to India and started in 2000
[stanley] 12:02 pm: Is there any news as far as developments in
[Dr. Bose] 12:04 pm: There are some
small improvements in many fronts. The major breakthrough will be a ceramic
resurfacing which is still a few years away.
[stevel] 12:05 pm: what time is it and what day is it in
India? If I had a complication after surgery, would I need to return to India?
Do you require a follow up visit and when?
[Dr. Bose] 12:13 pm: It is 9.30 pm in
Chennai. One does not
need to return for follow-up but needs to send x-rays at regular intervals
[stanley] 12:08 pm: Have you had any revisions from any AVN
resurfacings as of yet?
[Dr. Bose] 12:09 pm: We had one of our AVN patients revised
recently. This is the one that failed in about 370 AVN resurfacings.
[Dr. Bose] 12:12 pm: The failure in this particular patient was wrong
indication. He was only 19 yrs of age and we pushed the indication beyond our
[bjohncally] 12:09 pm: Do you
know if any of the devise manufacturers have made or are working toward a
metallurgy that will produce significantly lower metal ions in resurfacing
implants? To what extent do metal ions concern you today and which of the
devices is a concern to you today. Are ions produced by all the M/M articulation
devices? Have any of the devise manufacturing companies made any hip
resurfacing devices that are better?
[Dr. Bose] 12:11 pm: All companies are striving to reduce
metal ions. one of the ways to do is to make the femoral head metal harder than
the acetabular component
[Dr. Bose] 12:13 pm: No one has linked metal ions to deleterious
effects . However metal ion is a concern.
[wayne-o] 12:13 pm: Dr. Bose, Any advantages or disadvantages between ASR and
[Dr. Bose] 12:14 pm: The ASR is more suitable in small
patients and the BHR is more appropriate in large patients in my opinion
[Pat Walter] 12:15 pm: It that because of the size of the pin that goes into the
[Dr. Bose] 12:16 pm: Yes, the pin is the main reason. Also
the acetabular component is thinner in the small sizes making it a better fit
[paul] 12:13 pm: Hi Dr. Bose. I am about 1 year post resurfacing and still
working on range of motion. What are the structures that tighten up over the
course of the arthritis that I have seen referred to a the “hip capsule,” and
what is the best way to get regain full mobility in those structures?
[Dr. Bose] 12:15 pm: A variety of structures get tight
during the arthritic process. Swimming is a good way to regain ROM
[vickymm] 12:16 pm: Dr. Bose can you touch on the neck
capsule preservation, is it just as important for OA cases as in AVN cases?
[Dr. Bose] 12:17 pm: The neck capsule preservation is most important in non OA
cases and may be important in OA cases where the intervention is relatively
early. I think it is good to do in all cases if possible.
[Sofia] 12:17 pm: Could you explain why resurfacing is
more easy for revisions? why is it good to preserve femoral bone?
[Dr. Bose] 12:23 pm: Femoral bone preservation is critical
in younger patients as it leaves open other reconstruction option in future if
[Dr. Bose] 12:19 pm: Revision after resurfacing is the easy
surgery. One can retain the acetabular component and use a stem for the femoral
side with an appropriate head to match the acetabulam. This would be the easiest
revision one can think of.
pm: Is there any science supporting repair of the capsule in OA in otherwise
healthy active athletic type large framed males? Could it lead to AVN? Again are
there any studies proving this?
[Dr. Bose] 12:20 pm: Dr..Sugano from osaka has proved it
experimentally. This study is to be published very soon.
[drdsp] 12:20 pm: Can a revision be done again with a BHR
[Dr. Bose] 12:21 pm: Although in theory it
can be done , it does not work in practice and one will almost invariably need
to use a stem for a thr.
[donna] 12:22 pm: How do you feel about resurfacing the hips of
someone with one kidney? The ion issue?
[Dr. Bose] 12:24 pm: With one kidney resurfacing can be
done. It is the renal function which determines the suitability.
[donna] 12:25 pm: One healthy kidney. Is it worth taking the risk
[Dr. Bose] 12:27 pm: One needs a kidney
for much more important reasons than metal ion excretion. To get rid of
metabolic waste products. It is important to note that ions do not damage the
[bjohncally] 12:23 pm: If someone has a BHR today and the
placement of the components isn’t optimal leading to metal ions 100X normal –
Can the components be “adjusted” for a better fit? If not an option, can the BHR
be replaced with a different devise (ASR or Biomet), and/or would the BMHR be an
[paul] 12:23 pm: What about revising a
failed BHR femoral compnent to a BMHR femoral component?
[Dr. Bose] 12:24 pm: the same applies. It will not be a good
idea to revise a BHR to a BMHR.
[Lori ] 12:24 pm: Several post-op hippies have
complained about squeaking in their resurfaced hip, can you help us understand
why this occurs? Does it put one at increased risk for metal ion shedding?
[Dr. Bose] 12:26 pm: Squeaking occurs due to complex
tribological reasons which are not universally agreed upon. Painless squeaking
which is transitory is of no significance.
[Dennis Cooper] 12:26 pm: I am 3 and 1/2 weeks post surgery. I am
now walking 3 to 6 miles per day. Is this too much? Is it safe to beginning
bicycling again, or would you recommend I wait a bit longer? If I need to wait,
when may I get back on the bicycle?
[Dr. Bose] 12:28 pm: you can start to bicycle provided it is
comfortable to do so.
[Dr. Bose] 12:26 pm: do you see many MRSA infections? and
what is you post op protocol for antibiotics for dental etc?
[Dr. Bose] 12:29 pm: I have not seen MRSA in any of my arthroplasty surgeries so
[stanley] 12:28 pm: what developments
are being done as far as ceramic implants?
[Dr. Bose] There are some small improvements in many
fronts. the major breakthrough will be a ceramic resurfacing which is still a
few years away
[vickymm] 12:28 pm: Dr. Bose you resurface a lot of
athletes, do you have any limitations to what a patient can do after surgery as
long as they are a straight forward case? When do you allow them to return to
[Dr. Bose] 12:30 pm: I think that 5- 6 months is the period
in which the bone adapts to the resurfacing- after which patients can do any
[Sofia] 12:29 pm: It is crucial in a
revision be operated by the same surgeon?
[Dr. Bose] 12:31 pm: It is certainly an advantage to be
operated by the same surgeon. However it can be done by other surgeons provided
the implant details are available.
12:31 pm: Do you know why McMinn asks patients to wait 12 months for impact
[Dr. Bose] 12:32 pm: McMinn has changed his protocol
recently. I will ask him when I meet him in Birmingham for the BMHR meeting in
2nd week of Sept.
[Lori ] 12:32 pm: Dr. Bose, I am almost 2 years post-op and doing
great (thanks to you) do you want me to send follow-up x-rays at 2 years?
[Hip Resurfacing]: good2go has entered at 12:32 pm
[Dr. Bose] 12:33 pm: Yes, Please. follow up x-rays are required at two yrs.
[stanley] 12:33 pm: if one of your patients has complications when
returning home , will you give consultations to local surgeon or does the
patient need to return to India?
[Dr. Bose] 12:33 pm: It would depend on the individual
situation of course
[wayne-o] 12:33 pm: What
is/are reasons that ASR is better for small patients?
[Dr. Bose] 12:34 pm: The Peg size is proportional to the
implant size. the acetabular size is thinner. the femoral component is also
[drdsp] 12:34 pm: Dr Bose, following
B/L AVN 2 yrs back , I had core decompression 1.5 years back. and my
has subsided only in the past 3 months after I stopped doing exercises. What are
your comments, should I stop
exercises or start again ?
[Dr. Bose] 12:35 pm: Obviously exercise is precipitating
your pain. It is good idea not to provoke it. Swimming may be a good alternative
[Dennis Cooper] 12:36 pm: Dr. Bose, how soon after surgery can a patient begin
to work at stretching in order to regain the ability to tie one’s shoe and put
on one’s sock? In other words, is there a minimum amount of time that must pass
before one can begin to apply pressure to stretch the tissues without a danger
of tearing something or causing a dislocation?
[Dr. Bose] 12:37 pm: Within comfort limits one can start
stretching immediate post-op.
[ahershberger] 12:38 pm: can a patient reasonably expect a similar
size incision on the second hip resurfacing as the first one?
[ahershberger] 12:39 pm: I meant one done in August the other in
[Dr. Bose] 12:38 pm: I should think so, unless the patient
has put on a lot of weight recently.
[vickymm] 12:38 pm: What is the oldest patient you have ever
resurfaced, also youngest?
[Dr. Bose] 12:40 pm: The oldest male patient is 72 and
oldest female patient is 70. They had exceptional bone stock. Age is not the
only criterion. The relative importance of age, activity level & bone stock in a
given pt. determines suitability.
[donna] 12:38 pm: Do you recommend doing both hips at the same
[Dr. Bose] 12:41 pm: I personally do not recommend bilateral
resurfacing as the stress on the patient is significantly more.
[ahershberger] 12:42 pm: What is the minimum time frame you recommend between
each of the resurfacings (bilateral)?
[Dr. Bose] 12:45 pm: I like to give a gap ideally of 6-8 wks when
the body builds up the blood and all other factors. Therefore if done this way
there is no requirement of blood if the pre-op level of HB% is normal.
[vickymm] 12:46 pm: But if a patient travels to you, you will do
bilateral a week apart? Where the entire stay would be three weeks, correct?
[Dr. Bose] 12:47 pm: Vicky , yes that is correct. Logistics
sometimes dictate that protocol and I have done it many times.
[stanley] 12:41 pm: The OS I see locally says he as 40%
chance of success with AVN resurfacing , why would he have such a lower success
rate than you and other surgeons who treat AVN cases.
[Dr. Bose] 12:42 pm: Prof, Yoo from korea and Dr. Sugano
from Japan have equally high success rates in AVN.
[Dennis Cooper] 12:42 pm: How long for bone in growth to be
completed regarding the acetabular component of the BHR? Is there bone
growth/development regarding the femoral component that will further stabilize
the femoral component? If there is, how long before it is complete?
[Dr. Bose] 12:43 pm: Remodeling after a resurfacing will
take 5-6 months to be complete.
pm: I have b/l AVN and I am contemplating BHR. I had a viral fever recently
following which I experienced sharp pain upon climbing steps and also on walking
sometimes, in the previously painless hip, what could be the reason ?
[Dr. Bose] 12:46 pm: Fever by itself can increase the
perception of pain. Sometime a reactive inflammation may occur.
[stevel] 12:46 pm: what incision length can I
expect? I am a 54 year old mesomorphic male, weight 195 lbs, height 5 ft 11 in
with severe arthritis in left hip with good bone stock.
[Dr. Bose] 12:47 pm: Anywhere between 10 and 15cms of
[ahershberger] 12:47 pm: so 3-4 months between surgeries will be
okay for bilateral surgery? Is the new hip ready to take over?
[Dr. Bose] 12:48 pm: 3-4 months between surgeries would
be more than adequate
pm: Sir,you advice physio before surgery?
Bose] 12:51 pm: Physio before surgery could be a double edged weapon. While
there is no doubt that strengthening the hip muscles would be of great benefit,
provoking hip inflammation by very rigorous activity is not good.
[Dr. Bose] 12:53 pm: Pre-op one needs to have hip muscle strengthening exercises
combined with cardio -respiratory conditioning.
[Pat Walter Moderator] 12:52 pm: Do strengthened
muscles make it difficult to dislocate the hip during surgery?
[Dr. Bose] 12:53 pm: No , dislocation will not be a
problem with strengthened muscles.
12:52 pm: what is the lead time for scheduling surgery?
[Dr. Bose] 12:54 pm: lead time for surgery in our unit is
[Dennis Cooper] 12:53 pm: My aunt just had THR surgery and now has
a leg length discrepancy. Leg length discrepancies seem to be commonplace with
conventional THR’s. Are leg length discrepancies impossible with the BHR
[Dr. Bose] 12:54 pm: leg lenghth discrepancies in a
resurfacing can occur in the learning curve of a surgeon.
[Dr. Bose] 12:55 pm: In THR sometime one is forced to lengthen the leg to get
soft tissue stability for a non anatomical small head
[stevel] 12:56 pm: for a avid downhill skier, is their an
advantage in low dislocations of anterior vs posterior?
[Dr. Bose] 12:57 pm: I do not think that there is any diference
in dislocation rates with anterior and posterior approach with resurfacing.
The diference in
dislocation rate vis-a vis approach was in relation to THR when post capsule is
[vickymm] 12:58 pm: What are the advantages of
posterior approach as opposed to the anterio lateral approach?
[Dr. Bose] 12:59 pm: Post approach preserves the
important muscle the abductors.
pm: So it makes for an easier recovery for the patients correct?
[Dr. Bose] 1:00 pm: yes, the recovery is easier and faster with the post
[Pat Walter Moderator] 12:58 pm: Thank You for taking
time to chat with us. We appreciate your effort to teach us more about hip
[Dr. Bose] 12:58 pm: Thanks everyone for chatting . I truly
enjoyed it. Thanks again for the opportunity
[Gary Klein] 1:00 pm: I recently had my 2nd successful hip
resurfacing with Dr. Bose. I also was able to contact “some” former patients
regarding contributions to two “very” worthwhile funds: The Jay Coulter Hip
Surgery Fund and DAST International, for patients who cannot afford the surgery
costs. Please don’t hesitate to contact Dr. Bose for information on The Jay
Coulter Fund, and Vicky Marlowe on DAST International! (Any donation would be
[Dr. Bose] 1:02 pm: My patients have been fantastic and I
wish them the best!