Free Email Consultation
John S. Rogerson, MD- BHR trained 2006
with Mr. McMinn & Mr. Treacy
820 Hip Resurfacings to date ***
2 Science Court Suite 101
Madison, WI 53711
Phone (608) 231-3410
Fax (608) 231-3430
Hip Resurfacing: To Cement or Not to Cement – that is the Question! By: John S. Rogerson, MD April 2015
Dr. Rogerson’s Oct. 13, 2008 Chat Transcript
Dr. Rogerson Interview by Patricia Walter at Camelback Resort, Scottsdale, AZ April 30, 2011
Dr. Rogerson interviewed by Patricia Walter in AZ 2011. Dr. Rogerson discusses negative media coverage of hip resurfacing, metal ion issues, metal allergies, patient selection and great outcomes for BHR patients.
Dr. Rogerson Interview by Patricia Walter at the 3rd Annual Hip Resurfacing Course in Baltimore, MD Sept. 4-5, 2009
Dr. Rogerson interview by Patricia Walter in Baltimore, MD 2009. Dr. Rogerson of WI discusses hip resurfacing, patient selection, surgical approaches, hip resurfacing devices and recovery information.
August 28, 2009 Profile of John Rogerson, MD
Orthopedic Surgery at Meriter Hospital Directed by About
Face Director Jack Davidson
Dr. Rogerson discusses Hip Resurfacing, patient selection and patient recoveries.
1. Will you perform my hip resurfacing personally or
have an assistant do the surgery?
I perform all of the hip resurfacings personally, with
one of my two PAs as the first assistant. We have a
well-trained team at Stoughton Hospital involved with every
2. How many resurfacings have you done (not observed
or assisted with, or including hemi-resurfacings)?
As of October 7th 2014, I have now performed 770 hip
resurfacings since 2006.
3. Where did you train?
I trained with Dr. McMinn and Dr. Treacy in England in
2005, and also visited and scrubbed in with Dr. DeSmet in
Belgium in 2005. Prior to going to Europe for my training, I
visited Dr. Schmalzried, Dr. Mont, and Dr. Stachniw and
scrubbed in for surgery with those physicians in 2003 and
2004. I also performed metal-on-metal big femoral head
arthroplasty for approximately four years prior to starting
to pursue metal-on-metal hip resurfacing.
4. How many complications have you had?
In my series I have seen one superficial and two deep
infections. One deep infection started from a drain site,
and we no longer use percutaneous drains postoperatively.
The second deep infection occurred a year and a half after
the hip resurfacing procedure from an infected hernia
5. How many resurfacing failures with revision to
Total Hip Replacement (THR) have you had?
I have experienced three femoral neck fractures that went
on to revision: two from excess early high-impact activities
against medical advice and one later stress fracture well
below the prosthesis. I have had one revision secondary to
recurrent dislocation after falling off a bleacher at six
weeks post-op. I have had two deep infections, as noted
above, that required revision surgery. I have had one metal
allergy reaction with pseudotumor that required revision. In
my series since 2006 I have a 98.3% survivorship of the
prosthesis still functioning well.
6. How many loose acetabular cups have you had?
In my series I have had no acetabular cup loosenings or
loosening of femoral components. I have done one revision of
a resurfacing done in Belgium by Dr. DeSmet for a loose
7. How many times during surgery have you had to
change to a THR instead of resurfacing and why was the
I have had one case where the patient had significant
cystic changes in the femoral head, where preoperatively I
told him he had a 20% chance of getting a resurfacing, and
he wanted me to start out as if I was doing the resurfacing
to see if it was possible. It was not possible, and I
performed a metal-on-metal big femoral head arthroplasty for
him, and he has done well.
8. For what reasons would you switch from resurfacing
to a total hip replacement after starting the surgery? If
you switch, what device would you be using for a total hip
The reasons to switch would be inadequate bone quality
under the femoral head or inadequate fixation at the time of
surgery of the acetabular component, or a technical error
with notching of the femoral neck, which would make the
patient more susceptible for ultimate femoral neck fracture.
At the present time, I would use the Smith & Nephew titanium
Polar stem with an Oxinium head and a metal-on-polyethylene
9. What hip resurfacing device/prosthesis, do you use?
How long have you been using it, and why do you prefer it?
I have only used the Smith & Nephew Birmingham hip
resurfacing prosthesis since its FDA approval in 2006. Prior
to it receiving FDA approval, I performed one Wright Medical
hip resurfacing using a compassionate use permit. I
definitely prefer the Birmingham hip prosthesis compared to
others that are presently on the market. This relates to the
metallurgy of the prosthesis, particularly the acetabular
component, which is an “as cast” metal with large block
carbides and better wear characteristics than heat treated
metals. The precise instrumentation and the line-to-line fit
for the femoral component of the Birmingham is the best on
the market, and Drs. McMinn and Treacy’s 16-year results
with the BHR are very impressive when compared to total hip
arthroplasty results in young, active individuals.
10. Do you use cemented or uncemented and why?
I use an uncemented acetabular component and a cemented
femoral head component, which is the standard with the
Birmingham hip resurfacing. At the time of surgery, one sees
frequently many femoral heads that are deformed and very
sclerotic, and do not have good cancellous bone on the
superior flattened portion of the femoral head. I believe
that these types of arthritic heads do better with a very
thin cement mantle within the femoral head component that
evens out the forces on the femoral neck and assures good
fixation in bone that would otherwise be compromised because
of its sclerotic nature.
11. If both hips are bad, how do you handle bilateral
I have not done a bilateral hip resurfacing during the
same setting. There has been one reported case of a patient
rolling over for the second side, and with impaction of the
acetabular component on the second side a fracture of the
femoral neck component occurred on the first side. I
generally wait at least eight weeks between procedures.
12. Do you have other hip resurfacing patients that I
could talk to about their experience?
I have multiple patients that are enthusiastic to talk to
prospective hip resurfacing candidates. They are both male
and female, and come from all walks of life and have every
conceivable activity demands. Prospective BHR patients may
call the office at (608) 231-3410 to receive this
13. What is your opinion of when I can return to work
and other activities, including sports?
Patients generally can return to a sedentary job in two
to three weeks from the time of surgery. For more vigorous
work, realistically it would be four to six weeks, and for
any high-impact activities I restrain patients for six
14. Have you done resurfacing for anyone who has
returned to high-impact activities?
I have had patients return to just about every
conceivable sporting activity, including power
weightlifting, Ironman and endurance contests, mountain ice
climbing, martial arts, barefoot, slalom, and snow skiing,
swimming, biking, basketball, tennis, handball/racquetball,
15. Will you be preserving my hip capsule?
I do use a hip capsular preservation technique which
preserves the circulation along the posterior femoral neck
as much as possible, and is meticulously repaired at the
closure of the case.
16. What anesthetic do you use?
General anesthetic with complete muscle relaxation, with
the patient in a lateral decubitus position on the operative
17. How long does the surgery take?
2 to 2½ hours. I use an extensive skin closure technique
utilizing Stratafix (a barbed sub-cuticular stitch),
reinforced with Prineo mesh and Dermabond glue. This takes a
little longer, but it avoids skin staples and is more
resistant to infection.
18. What surgical approach do you use? Anterior or
I use a posterior approach, which I feel has less risk
for injury to the gluteus medius tendon and avoids a
postoperative abductor lurch gait pattern. Trochanteric
osteotomy and an anterolateral approach that releases the
gluteus medius is at much higher risk for developing
postoperative limp, in my experience. Another reason I like
the posterior approach is the exposure that one can attain
for the femoral head and the ability to effectively use the
stylus to get the femoral head guide wire in exactly the
19. What is the incision length?
Usually, about 6-8 inches in length, and is shorter in
20. Do you use staples, self-absorbing stitches,
I use absorbable sutures and an arthroscopic anchor, and
two non-absorbable sutures in the upper tendinous portion of
the gluteus maximus repair. I use an absorbable suture in
the fascia lata and subcutaneously; and a barbed
sub-cuticular stitch for the skin, reinforced with Prineo
mesh and Dermabond glue. I have not used drains since having
one infection from a drain site early in our series. Usual
blood loss is 250-300 cc, and the postoperative hematoma
(black and blue) generally is minimal.
21. What is your post-op pain control plan?
I use long-acting Marcaine instilled around the deep
tissues and the incision. Post-operatively the day of
surgery I typically use the acute pain dosing regimen for
Celebrex, along with IV Ofirmev (acetaminophen). Oral
oxycodone and IV dilaudid are utilized for breakthrough pain
as well. Post-op day one and beyond I typically switch to
oral hydrocodone as needed and Celebrex daily. Patients may
switch from hydrocodone to oral acetaminophen when pain is
under good control typically after 3-5 days. I also use
large gel ice packs around the incision and anterior thigh
post-operatively for swelling and pain control.
22. What hospital do you use?
Stoughton Hospital in Stoughton, Wisconsin, with the
post-operative HipHab rehab program in downtown Madison at
Capitol Lakes rehabilitation facility. See my website at
for more information about my HipHab rehab program.
23. What is your infection rate?
I have had no infections while practicing at Stoughton
Hospital, and their infection rate is extremely low. The two
previous immediate post-operative infections occurred when I
was practicing at another hospital. This makes my overall
post-operative infection rate 0.2%.
24. Have any of your patients had infections or
required IV antibiotics following resurfacing?
I use peri-operative IV antibiotics at the time of
surgery and for the first 24 hours thereafter. I had one
immediate post-operative superficial infection that required
an incision and drainage and IV antibiotics for six weeks,
with resolution of the infection and maintenance of the
prosthesis. I have had to perform one revision arthroplasty
from a deep resurfacing infection that was seated from the
drain site immediately post-op. I no longer use percutaneous
drains post-operatively. I have had one late infection that
seated a hip resurfacing from an infected hernia repair a
year and a half post-op that required revision in another
25. What drugs, methods do you use for anticoagulation
During the operative procedure, when blood clots usually
form, I use sterile Kendall thigh-high pump stockings on
both legs. Post-operatively, I use an oral anticoagulant
(Xarelto) for three weeks, followed by one month of aspirin
81 mg per day. With this regimen, I have not had a
recognized DVT or pulmonary embolus.
26. How long will I be in the hospital?
The patient is in the hospital for 2.5 days including the
surgery day before transferring to the HipHab rehab
27. How successful have you been at obtaining
insurance approvals for resurfacing?
At present, insurance coverage for hip resurfacing is
similar to total hip replacement, but may vary depending on
the patient’s policy. Please call my office at (608)
231-3410 to inquire about potential cost for the BHR
28. What is the rehab protocol?
See my website at
www.orthoteam.com for my unique and innovative HipHab
rehabilitation program that combines both land and warm
water pool PT.
29. What assistive devices will I use for walking
The first day or two you will be using two lightweight
forearm crutches, and usually after several days you go to
one forearm crutch on the non-operative side, and are
generally off crutches somewhere between 1½ to 3 weeks
post-op. Some patients require the use of a walker
immediately post-op until good balance is attained.
30. When will I be 100% weight bearing?
Usually between 1½ and 3 weeks post-op. The patient may
be weight bearing as tolerated immediately following the
procedure, unless otherwise specified. Patients should
continue using forearm crutches until there is no pain or
31. What assistive devices will I use for walking
Forearm crutches, as noted above.
32. How long on two crutches, one crutch, cane?
33. What, if any, restrictions do you place on your
patients after surgery, and how long do they last?
I allow patients to get back to walking immediately as
noted above; elliptical training at one to two weeks
post-op; stationary bicycling starting at three weeks
post-op; driving once the patient is off narcotic pain
medication during the day and can walk without pain; golf at
three months; and resumption of activities without
restriction at six months.
34. Will I be given any at-home nurse or PT care?
Because of our successful HipHab rehab program you will
not need any in-home nursing/ PT care. When patients leave
HipHab they are confident in returning home, they are able
to navigate stairs, as well as all activities of daily
living. Patients may continue with outpatient physical
therapy for gait training and strengthening when they return
home, and a prescription for this outpatient PT is given to
the patient at their pre-operative discussion.
35. How long do you feel it takes for the bone to be
fully healed, grow into the prosthesis, and what is the
recommended time you tell your patients before they can
start to run again/do impact sports?
The bone starts to grow into the acetabular component by
six to eight weeks and continues to remodel the proximal
bone of the femur and the femoral neck up to a year
postoperatively. I allow patients to get back to non-impact
activities very quickly, as noted above, but I have patients
avoid high-impact, and heavy lifting while torquing
activities for six months post-operatively. Each case is
individualized based on the patient’s bone quality and
pre-operative activity status.
36. Do you presently use metal-on-metal big femoral
If I am not doing the Birmingham hip resurfacing, which
retains the patient’s femoral neck and shaft in its original
state, I utilize the Smith & Nephew Polar stem with an
Oxinium femoral head mated to a highly cross-linked
polyethylene liner in a metal shell for the acetabular
component. There is increasing concern in the orthopaedic
community about the metal corrosion that can be produced
with cobalt-chrome-molybdenum heads on the modular neck of
either a titanium or cobalt-chrome stem. Because of this, I
am now using the Oxinium femoral head, which oxidizes on the
surface to ceramic. This produces much less wear on the
polyethylene liner compared to a cobalt-chrome-molybdenum
femoral head, and is not as brittle as a complete ceramic
37. What causes heterotopic bone growth?
Heterotopic bone growth can be caused by injury to the
muscle fibers during the operative procedure and bone debris
from the acetabulum and femoral head shaving. I have not had
any clinically significant heterotopic bone formation to
date. I utilize a specialized drape around the femoral neck
that captures all of the bone debris so that it does not
infiltrate the soft tissues around the hip.
38. Can you tell me if I’m a good candidate for hip
To find out if you are a good candidate for hip
resurfacing, proceed to my website at
and fill out the 3 required forms: HIPPA, Medical History
Questionnaire, Hip Questionnaire. Send these forms via
e-mail or mail along with a disc of your digital hip x-rays
(information about specific views required can be found on
Mail: John S. Rogerson, M.D., S.C.
Attn: BHR Analysis
2 Science Ct.
Madison, WI. 53711
I can determine 90% of the patients who are good
candidates with the above measures. Occasionally, a patient
may have some cystic changes in the acetabulum or femoral
head that would require that they obtain a CT of the hip to
determine the advisability of resurfacing. Patients who are
more local are usually seen in my office for physical
evaluation, x-ray analysis, and discussion. Out-of-town
patients that come from long distance engage in telephone
conversation before arriving in Madison the day before
surgery, and they see myself and one of my PA’s the
afternoon before surgery for exam and discussion prior to