|Chat with Dr. Mont on August 13, 2008 in the Surface Hippy Chat Room
[Pat Walter Moderator] 8:00 pm: I am curious about why some doctors use general
some use spinal with light sedation.
[Dr. Mont] 8:01 pm: Spinal anesthesia is usually less taxing on
the body but can’t be used for long procedures.
[Dr. Mont] 8:02 pm: It only takes me about an hour to do a
resurfacing so I can use either
[Dr. Mont] 8:02 pm: However, if case is going to take longer than
2 hours you often need general or an epidural
[DianeM] 8:01 pm: Another question is the leg length
discrepancy – I read that having to “hammer” the femoral component onto the head
can result in a difference in length if the bone is not in good shape
[Dr. Mont] 8:03 pm: Resurfacings don’t make up for leg length
[Dr. Mont] 8:03 pm: Resurfacings usually leave you where you are
[Dr. Mont] 8:04 pm: in length–not sure what this “hammering”
means but doesn’t sound right–they are all hammered in–if they caused a leg
length problem then could be a fracture
[Gilden] 8:03 pm: With regards to recreational activities
post surgery, you’ve previously stated that you would recommend against any
activity that would involve pounding (running, basketball, etc.). I am a novice
downhill snow skier; if I take it easy on the slopes, would that activity be
[Dr. Mont] 8:05 pm: Many patients resume skiing and hunting after
resurfacing. I’m not a fan of skiing because of the problems with a potential
fall but I have many patients that ski anyway—for more personal answer would
have to contact me
[Dr. Mont] 8:05 pm: If wanted to ski seriously–would strengthen
muscles involved to the utmost
[Dr. Mont] 8:06 pm: There are certain machines that mimic skiing
motion and help you build up muscles—–don’t fall on the slopes!!!!!!
[stevel] 8:07 pm: Does the anterior approach provide less
chance of dislocation than the posterior approach (with neck capsule
preservation)? I am an avid skier and will undoubtly fall.
[Dr. Mont] 8:07 pm: If your a novice and take care without
extending past your limits after you have rehabbed your hip then I guess skiing
[bkaybrain] 8:07 pm: Is it really that important to not
take any vitamins that contain chromium and should everyone have blood work
periodically to monitor the chrome that we have from our hip resurfacing?
[Dr. Mont] 8:09 pm: I don’t think you should take vitamins for
chromium–what you get in diet is fine ….I don’t think routine metal ion
monitoring is necessary
[DianeM] 8:07 pm: Is it true that you cannot go past a 90
degree angle during the recovery period which I believe is at least 6 weeks on
[Dr. Mont] 8:10 pm: I don’t like past 90 first 5 weeks but then
allow full range of motion. This is a surgeon preference though and you should
get an answer from him/her–some restrict for 12 weeks–esp with posterior
[dapcpa2] 8:08 pm: Pat, first off thank you for all your
efforts with hip resurfacing. I am curious as to what the long term prospects
for all of us with the resurfaced hips? Will we all looking at revisions or do
you think our resurfaced hips will last the rest of our lives?[
Dr. Mont] 8:13 pm: Resurfacings will all last a
lifetime—-lol–especially if you take care of it. Seriously, we don’t know
life expectancy since they are only being done for past 8-10 years. Hopefully,
many will last greater than 20 years
[Gilden] 8:08 pm: How do you handle out of town patients
who come to Baltimore to have you do the surgery? Is that possible, and how
would follow-up be handled?
[Dr. Mont] 8:11 pm: Most of my patients with resurfacing come from
out of town—-if you send x-ray/phone number I will call you
[bkaybrain] 8:10 pm: Is it possible to wear down your hip
by exercising ex: squats, spinning, walking hills?[
Dr. Mont] 8:15 pm: We don’t know much about wearing of any
prostheses. I haven’t seen changes at 7 years in my most competitive
athletes–runners, skiers, etc. but we await longer-term follow-up
[Dr. Mont] 8:13 pm: If you want to come to Baltimore or
consider–my phone number at the office is (410) 601-8500. Ask for Terri,
Colleen, Jean, or Jill. I will be happy to call you if you send x-rays and a
[jaredmanders] 8:14 pm: Doc, any thoughts on stopping anti
inflammatory meds before surgery, How much before and will Tylenol arthritis be
ok? I understand Advil and others like Aleve will soften the bone as well as
mess with blood platlettes causing heavy bleeding during surgery.
[Dr. Mont] 8:16 pm: Stop most anti-inflammatory 1 week before and
then Tylenol is fine. you can switch to other analgesics if you need them
[Dr. Mont] 8:16 pm: Advil and others may interfere with bleeding
so these and aspirin should be stopped 1-2 weeks before
[jaredmanders] 8:16 pm: Is Aleve the same as Advil in its
affects on the bone and blood?
[Dr. Mont] 8:19 pm: Tofranil is fine, other hip depends on extent
of pain–some people do it a week apart–others wait till fully recovered for
[Dr. Mont] 8:19 pm: Aleve, Advil, Naprosyn, nuprin, etc.–almost
all anti-inflammatory are same in that effect so treat equally
[dmashkuri] 8:15 pm: Dr. Mont and his team are wonderful..
He resurfaced both of my hips (June 06, Dec 06). The entire process was a
positive experience and I have been able to return to the active life style I
[Dr. Mont] 8:17 pm: Hey Douglas–I didn’t realize my fan club was
[bkaybrain] 8:16 pm: If my other hip is bothering on
certain days, would the med, tofranil hurt my bone in my resurfaced hip, and how
long should I wait until I have the other hip repaired.
[david] 8:17 pm: some people are performing at extremely
high levels of athletic competence after a resurfacing (national age group class
in cycling, triathlon, squash and handball, etc.).. can athletes who have a thr
potentially compete at the same level as those with resurfacing? if not, why?
[Dr. Mont] 8:20 pm: Yes–I have athletes that have a THE or a
resurfacing–in both cases have completed marathons, triathlons, professional
[Dr. Mont] 8:21 pm: However, I’d rather worry about revising a
resurfacing in a marathon runner than a standard THR–its easier
[sherry] 8:18 pm: Giant thanks to Pat and Dr. Mont for
their time & caring enough to give us hope. Have listened to surgeons say I need
hip replaced due to dysplasia but something has told me to put it off and work
on strengthening surrounding muscles & putting off the inevitable since am only
in my 40’s. Then I stumbled (sorry for pun) across this website and have hope.
Since each case is unique and Arizona doesn’t seem to have the experienced
docs—-What format for X-rays assuming my 3 year old films won’t do?
[Dr. Mont] 8:25 pm: No special format for X-rays—most disc will
open—need an antero-posterior and lateral view—-front and side
[stevel] 8:18 pm: what is the range of your incision
[Dr. Mont] 8:22 pm: Incision length depends on size of
patient—from 2 inches to 6 with an average now of about 4.5 to 5. For heavier
or more muscular patients can be larger.
[DianeM] 8:20 pm: I have always used the Stairmaster at
the gym because I get the best workout and I can still tolerate it somewhat – do
you think this machine has made my hip worse and should I discontinue using it
for now, and will it be a problem using it after my hip has been resurfaced?
[Dr. Mont] 8:23 pm: I like ellipticals better than
Stairmasters–much less wear and tear. Stairmasters generate a lot of force on
hip unless you put it on low resistance.
[Dr. Mont] 8:24 pm: Best exercises–swimming, bicycling,
elliptical–maybe Nordic Trac
[jaredmanders] 8:24 pm: Dr. Mont- Is it conceivable to do
some light traveling and sight seeing starting about 10 days after resurfacing
surgery? Given the patient was in excellent shape to begin with, will one
actually want to do this with caution or is this just plane crazy?
[Dr. Mont] 8:27 pm: Most of my patients do their own driving by 10
[Dr. Mont] 8:27 pm: They certainly can sightsee, etc. that early.
[Dr. Mont] 8:28 pm: I like everyone to get out of the car once per
hour to walk and stretch for 1 minute–probably a good idea for all of us
[david] 8:28 pm: its obviously difficult to make an
“apples to apples” comparison but what does the research suggest would be the
relative probabilities of success between a THR and resurfacing after an 8-10
year period (clearly it is somewhat unknown beyond that time frame)
[Dr. Mont] 8:31 pm: comparison depends on experience of surgeon,
patient selection, etc. However, certain subpopulations–young men–less than 50
years the survivorship is the same in the Australian registry at 5 to 8 year
follow-up between THR and resurfacings
[DianeM] 8:28 pm: How can you drive a car if you can’t
break the 90degree angle?
[Dr. Mont] 8:29 pm: adjust the seat for 90 degrees–or can go a
little easy on restriction
[stevel] 8:29 pm: Resurfacing or wait? With mild to
moderate pain after elliptical exercise. I could delay surgery but more bone on
bone contact could preclude hip resurfacing. I want to maintain active lifestyle
– mountain climbing, downhill skiing, hunting. Isn’t hip resurfacing fairly
routine (for experienced surgeon) and I should proceed rather than wait?
[Dr. Mont] 8:33 pm: More bone on bone may not preclude
resurfacing–have to see x-ray–I usually urge waiting for resurf till you
really need it
[Dr. Mont] 8:33 pm: Usually put off surgery if don’t need it but
need to see x-rays and review whole picture individually
[bkaybrain] 8:30 pm: What approach is from the side of
your hip up over and down your butt? About 8 inches….
[Dr. Mont] 8:31 pm: side and down but probably posterior
approach–by the way is it a but or a butt?
[Dr. Mont] 8:26 pm: Anterior approach has less chance for hip
dislocation in my hands and in almost every published study. Does not require
capsule repair and can ease restrictions faster.
[Gilden] 8:30 pm: some established hip surgeons are very
negative about hip resurfacing (e.g., doctors at Mass General and some other
medical institutions). Why is this the case and is their skepticism justified?
[Dr. Mont] 8:35 pm: Resurfacing in previous generations of
devices–late 1970s and 80s had high failure rates–Mass General surgeons may
still remember that or may believe that this newer generation will repeat that
[Dr. Mont] 8:35 pm: newer experience has been vastly improved
[jaredmanders] 8:31 pm: As far as the sight seeing goes,
my family says I’m nuts to even think about it. Will I want to jump on a train,
bus, plane walk a few hours in a day, do the normal sight see thing but scaled
down. I hear all kinds of people say its ok but honestly will it be a bad thing
to push that kind of activity? My family is watching here. (:
[Dr. Mont] 8:36 pm: I can talk to you and your family at length
after see x-ray and review–too hard to type better answer here
[david] 8:36 pm: I don’t want to minimize the huge
benefits of an easier revision with resurfacing, but on average, would you say
your resurfacing patients “feel better” after surgery than you THR patients?
(not immediately after surgery but several years after surgery)
[Dr. Mont] 8:38 pm: My resurfacings on average feel much better
than standard THR—however, there may be a selection bias here–I do a lot of
athletes coming into procedure
[Dr. Mont] 8:39 pm: One study we did showed superior walking gait
characteristics of resurfacing vs. THR—-that’s what I observe–they generally
[jaredmanders] 8:37 pm: How long after surgery do you have
your patients on crutches or a cane? When can they also put 100% weight on
[Dr. Mont] 8:40 pm: cane or cutch for 5 weeks—many can and do
abandon them earlier but I like them to protect for 5 weeks—-gee they just had
their hip replaced
[Dr. Mont] 8:40 pm: Sometimes I have more trouble with the
patients that want to get on a tennis court in 2 weeks ands are non-compliant
[bkaybrain] 8:38 pm: I never knew the anterior approach
has less chance of dislocating, what may be the reason for that?
[Dr. Mont] 8:42 pm: Published studies show much higher dislocation rate
with posterior approach–not known exact reasons
[dapcpa2] 8:40 pm: Do you have any preference between a
cemented or cementless? Which will last longer?
[Dr. Mont] 8:43 pm: cementless has limited experience and must
still be viewed as extremely experimental–only 2 -3 published reports and 1st
generation had high failure rates–I would definitely go with cemented now
[Gilden] 8:40 pm: Doctors in my area who have recently
started resurfacing have not done that many of them (less than 100). How big of
an added risk factor does that relative inexperience add to the surgery risks?
[Dr. Mont] 8:44 pm: Different risks for different surgeons—some
are great after a few procedures–sometimes one needs many cases and can be a
high learning curve
[jaredmanders] 8:41 pm: You mentioned that your patients
can drive at 10 days post op. Is that with the right hip being resurfaced? The
Gas peddle hip?
[sherry] 8:42 pm: And should I be thinking about replacing
my 5 speed with an automatic ?
[Dr. Mont] 8:45 pm: What I said applies to an automatic—I can’t
comment too much on 5 speed—might want to wait 5 weeks for that or switch to
automatic at 10 days to two weeks
[city2south] 8:42 pm: Odd question but – what about riding
roller coasters 3-4 months post-op with excellent bone density (super bones)?
Going to Disney and wondering what my limits are.
[Dr. Mont] 8:46 pm: I don’t ride rollercoasters–too scaryo
[Dr. Mont] 8:47 pm: Except magic mountain—shouldn’t be a problem
after 5 months to do coasters if hip muscles rehabbed
[Pat Walter Moderator] 8:46 pm: This is a question that
has come up recently. In the case of a deep infection in a hip resurfacing or a
THR – are the doctors normally able to save the hip device? Do they normally
result in the removal of the hip device and a revision at a later date?
[Dr. Mont] 8:48 pm: Deep infections of the hip are typically
managed with revisions where a spacer is put in and converted to a revision.
However, if the infection is caught early post-operatively, the hip might be
salvageable by washing it out. There are many different scenarios. Often, what
is termed an infection, is just a superficial infection and not a deep infection
(to the joint replacement). These superficial infections can usually be treated
with local wound care or cleaning without affecting the device
[stevel] 8:46 pm: For out of town patients, what is the
typical recovery protocol (time period and phy therapy) before returning home?
[Dr. Mont] 8:48 pm: Can go home on 3rd day if out of town—had
one patient fly to Australia on post-op day 4
[bkaybrain] 8:46 pm: I definitely will consider you Dr.
Mont for my next hip resurfacing and recommend you to my friends that may be
having the surgery.
[Dr. Mont] 8:49 pm: Thanks bkay–do I know you outside chat?
[jaredmanders] 8:47 pm: Here’s an important question for
me. If patients travel out of town for resurfacing. How are they to follow up?
Can this be done by sending x-rays again and is that good enough?
[Dr. Mont] 8:50 pm: Most patients do great and follow-up is by
mailing X-rays and calls—I like to see patients at 5 and 12 weeks post-op but
out of towners skip 5 week visit (send x-ray) and I see them at 10-12 weeks to
help them plan rest of rehab and life
[Pat Walter Moderator] 8:49 pm: If a person was only born
with one kidney – could they have a hip resurfacing? Would there be a great risk
due to the metal ion issue? Could the person consider a bilateral resurfacing?
[Dr. Mont] 8:51 pm: I think with normal kidney function, a
resurfacing is fine. Many patients may not even know they have one kidney. I
don’t think I would do both resurfacings at same time but would wait a year
apart till the metal ions reach a steady-state. There is no definitive answer
though, as others might argue that the metal would put a patient at risk if
their kidney function deteriorated, but a lot of things would occur if kidney
went South. A ceramic-on polyethylene interface would avoid the whole is
[stevel] 8:50 pm: What is the infection rate at the
hospital you use?
[Dr. Mont] 8:53 pm: Low infection rate—I haven’t had hip resurfacing
infection in over six years (.greater than 1000)–two total had extenuating
circumstances (untreated toe infection, immunocompromised patient with prior
history)—so I’d like to stay lucky and not jinx myself–lol
[bkaybrain] 8:51 pm: Since I had AVN, caused by cortisone
shots, should I be extra cautious with the new hip? No, you don’t know me, I had
surgery in November in Belgium but would like to go somewhere closer for my
right hip, I’m from PITTSBURGH (Steeler country)….
[Dr. Mont] 8:56 pm: By Doug–call anytime. I treat a lot of AVN.
Usually not caused by shots?? However, associated with steroid use in general
(high dose) I have resurfaced over 200 patients with AVN and they are doing well
—one report at 6 year follow-up of my patients has 41 of 42 success and Dr.
Treacy’s report is also favorable.
[dmashkuri] 8:52 pm: Thanks Dr. Mont, see you in Dec for
my 2 year visit!
[stevel] 8:54 pm: Is the most debris generated by metal on
metal just ions? What about the squeaking during the break-in period?
[Dr. Mont] 8:58 pm: We don’t know much about squeaking in any hard
on hard surfaces–ceramic-ceramic or metal-on metal–it may be early wear or
bedding in which might be able to self repair in metal on ,metal according to
one recent report on metal on metal devices
[Dr. Mont] 9:01 pm: Pat—once again thank you—–you put
together a great service for the patients–probably see you in 2 weeks–same
time, same place
[Dr. Mont] 9:01 pm: by–all