The transcript of the Dr. Mont chat is available here:
http://www.surfacehippy.info/mont-chat-feb-2012.phpBelow is a copy of the questions and answers
This is a transcript of a Live Chat in the Surface Hippy Chat Room with Dr. Mont on February 22, 2012
Welcome! You have entered [Doctor Chat] at 6:52 pm
[Pat Walter] 8:00 pm: Welcome to our chat with Dr. Mont of Baltimore, MD.
[Dr. Mont] 8:00 pm: Ready to go!
[Pat Walter] 8:01 pm: I'll start - what devices are you using now?
[Dr. Mont] 8:02 pm: I use various devices for standard total hip replacement----use Corin and Wright for resurfacing
[Dr. Mont] 8:01 pm: Welcome everyone--happy to answer any Qs about hip arthritis, pain, etc.
[hiphopinman] 8:02 pm: Dr. Mont, thanks for agreeing to answer questions on this forum 1) Do you advise against a return to impact activities (crossfit/running/etc) after a BHR ? 2) If so, why?
[Dr. Mont] 8:03 pm: I don't do BHRs right now. Though did about 400-500 in past. Many of my patients return to high activity sports after resurfacing or standard total hip replacement. A lot of it has to do with Rehab.
[6wkhip] 8:02 pm: Hi Dr Mont. YOu did my hip 6 weeks ago and I'm off the cane.. no limp either! It feels great!
[Dr. Mont] 8:04 pm: 6 week hip--I'm delighted for you-
[mslendzion] 8:02 pm: I have heard that the femoral head is weakest 3 months post op. Is this true, and if so, why and how long is the risk?
[Dr. Mont] 8:04 pm: Never heard of three month business----problems typically occur within first 12 weeks, but necessarily at three months
[DEB] 8:04 pm: I underwent bilateral core decompression surgery with stem cell infusion a bit over a year ago (December 2011). My symptoms had already stabilized and lessoned prior to this procedure, following a bout of extreme discomfort immediately after the sudden onset of symptoms in March 2011, which I attribute to a labral tear and subsequent severe edema in the left hip joint do cum* on MRI.
[DEB] 8:05 pm: To address the discomfort and limited range of motion I still experience in my left hip, I am currently scheduled for either a resurfacing procedure, utilizing the BHR device, or a THR, likely using the Anthology system from Smith & Nephew.
[DEB] 8:05 pm: I have received conflicting advice from different physicians concerning whether a resurfacing might be appropriate in my case, with some arguing in favor of a BHR in order to preserve bone and improve the course of likely revision procedures in the future, given my young age, and with others arguing that a BHR is too risky based on the likelihood that ongoing bone death due to avascular necrosis would cause the implant to fail prematurely.
[DEB] 8:06 pm: Versus your lecture handout from the 2011 AAOS annual meeting, which proposes to, "Avoid patients with rheumatoid arthritis or osteonecrosis." I wonder if your experience between the 2008 article and your address to the AAOS in 2011 led you to this conclusion.
[DEB] 8:06 pm: My questions: Do you continue to perform resurfacing procedures in cases of Stage IV avascular necrosis and might you think it a reasonable course of treatment in my case?
[DEB] 8:06 pm: Thank you very much for everything you do. And thanks very much to Pat for setting this up.
[Dr. Mont] 8:06 pm: Deb--would have to see x-rays to give you best advice---if no collapse, might still try to save--otherwise would do arthroplasty if bad symptoms, but might try to treat non-op first
[Dr. Mont] 8:07 pm: I use resurfacing often on osteonecrosis patients--in fact have done over 500, but also use standard THR--depends on scenarios, bone stock, age, etc.
[Dr. Mont] 8:08 pm: If handout said osteonecrosis then it was in error---rheumatoid yes, no unless totally collapsed lost head which is rare no
[mslendzion] 8:06 pm: Thank you. Why did you stop doing the BHR's?
[Dr. Mont] 8:10 pm: BHRs --no particular reason---they did well in my hands as well as other devices---I'm a strong believer in success of surgery is greatly dependent on successful technique
[Dr. Mont] 8:09 pm: Still do many resurfacings in Stage 1V cases--need to see x-rays
[Dr. Mont] 8:13 pm: Welcome--if want more specific answers can send films via e-mail to
Rhondamont@aol.com[mcapuse] 8:08 pm: how often one should do blood testing for metal ions levels after resurfacing
[Dr. Mont] 8:10 pm: do blood testing only if patients have painful symptoms
[hiphopinman] 8:09 pm: Dr. Mont - Hypothetically speaking of course, assuming young male with 50mm head or larger, OA primary diagnosis, good bone quality and ideal surgical placement.....Is 30 years survivabiltiy or longer achieveable
[Dr. Mont] 8:11 pm: hiphop--we don't know--but certainly possible--has to do with a lot of factors---technique, activity levels, weight--and we need to wait the years to really know results
[hiphopinman] 8:12 pm: What surgical technique are you currently utilizing for Hip resurfacing?
[Dr. Mont] 8:13 pm: Anterolateral or posterior
[Dr. Mont] 8:13 pm: Both work great
[cruzahome] 8:13 pm: I am 18 months out from a BHR with stem MOM THR. I have recently notice some minor clunking. I can't intentionally replicate it, it just occurs randomly when moving about. I also have started to have a low grade "burning" sensation in the hip area that comes and goes. Up to a month or so ago I didn't have any of these symptoms. Do you have any advice regarding how I should view this situation?
[Dr. Mont] 8:14 pm: What do you mean stem MOM with BHR--do you have a resurfacing or a full MOM hip?
[cruzahome] 8:15 pm: I went in for a resurfacing (Dr. Bose) but when he got in there he said the bone was too soft so he had to do a MOM THR
[Dr. Mont] 8:15 pm: Cruzahome---would see your orthopaedist--he needs to examine you---clunking could be from many reasons, maybe needs to do fluoroscopic eval--start from there---would not jump to any conclusions yet
[Dr. Mont] 8:16 pm: Are you in India---would see Dr. Bose
[mrohrbac] 8:15 pm: Hello Dr. Mont- you did RH 2009, then my LH May 2011. For both hips, terrific outcome! In fact, my goal was no outpatient PT after 1st visit (LH)- success! I've not followed up with your office- all continues great. fully functional; mild to moderate exercise every day. Any reason to call your office for a followup?
[Dr. Mont] 8:20 pm: Hi Ohrbach---would typically follow with 0ne year film, and then five year film if no symptoms---delighted that you are doing so well
[hiphopinman] 8:16 pm: What is your typical protocal (time since surgeryt) for a return to active stretching/yoga, and weightlifting over 100 lbs.
[Dr. Mont] 8:18 pm: hiphop-varies with patient---start heavy exercising at week 5-12---at 12 they start strengthening hips with special exercise---when can achieve these (usually by 6 weeks later) they are ready to do anything... Stretching/yoga can strat at 5-6 weeks unrestricted at that time
[cruzahome] 8:20 pm: Is a metal level blood test called for at this time? If so what lab do you prefer? Also, how to I ensure that the blood draw gets done correctly by local health care people?
[Dr. Mont] 8:21 pm: Cruz--see someone first--not sure I would do metal ions right now till we know what is going on--maybe a soft-tissue problem, etc.
[DEB] 8:21 pm: Dr. Mont, when you say "might try to treat non-op first," are you referring to physical therapy and possibly medications? Other things?
[Dr. Mont] 8:22 pm: Deb--have to see films---if still completely round head ---would not necessarily operate if other reasons for your decreased motion---also occasionally use tester local injections to id problem
[barrycally] 8:21 pm: Sorry Dr. Mont my Question was cut off ( too lengthly I guesss) anyway, you might want to look into the HipSextant devise if you haven't already - the Orthosite article listed a website( hipsextant.com) It looked quite compellling to me and I'd be interested in your opinion.
[Dr. Mont] 8:23 pm: HipSextant---you mean for acetabular positioning? not sure i need that and have some reservations about that device
[6wkhip] 8:21 pm: I read somewhere that donating blood once or twice a year may reduce metal ions circulating in blood from MOM hips. Would you advise that?
[Dr. Mont] 8:24 pm: 6weekhip--don't mind if you donate, but don't believe that this will reduce circulating ions--not logical and no data to support this
[cruzahome] 8:22 pm: OK. Do soft tissue problems indicate a problem with the hip implant itself?
[Dr. Mont] 8:25 pm: im not talking about deep soft tissue problems---more superficial---it band tightness, etc. that might have nothing to do with implant---that is why you need to get a thorough evaluation from a competent orthiopaedist
[DEB] 8:24 pm: Thanks. Head definitely doesn't look too round to my untrained eyes, but I will certainly try to get my films headed your way. Thanks again.
[6wkhip] 8:25 pm: ok. thank!
[Dr. Mont] 8:26 pm: deb--leave your phone number and I will call you when I get films
[mslendzion] 8:25 pm: I'm 6 weeks post op, so it is safe to stretch in ways that violate the 90 degree restriction? I cant reach my feet and am fearful to try to reach down there at this time.
[Dr. Mont] 8:27 pm: mslenzion----if you are my patient yes---but I can't advise if you are not and my patients send 6 week films to me before they get full green light
[barrycally] 8:26 pm: Re- HipSextant - Recalling he article I believe it is used for both acetabular and femoral component positioning - says it all but guarantees accurate component positioning...
[Dr. Mont] 8:28 pm: barry---it's only as good as user---I think it is unnecessary (certainly in my hands not needed) and it does not guarantee anything---just another tool that can help---like many other positioning devices, navigation devices, etc.
[hiphopinman] 8:27 pm: Dr. Mont ----- Thanks again for your time ------ I wanted to readdress the issue of impact activities and the possible (I understand there is no long term data on this) impact on implant longevity ---- Would you advise something with a hip resurfacing (Disclosure: I have a BHR already and probably need the other side done as well in the near future) to avoid running?
[Dr. Mont] 8:29 pm: hiphop---if you need other side done already---then you can't run right now and I would avoid it because you would be putting too much undue stress on the resurfacing you did have done
[cruzahome] 8:27 pm: What should I expect my orthopedist to do to diagnose my situation. As I understand it radiology imaging doesn't show soft tissue damage, that you can have serious damage that doesn't show up until surgeon actually cuts you open.
[Dr. Mont] 8:31 pm: radiology imaging can include ultrasound and or MARAAZI techniques--artifact reduction to help diagnose various issues before cutting someone open
[BADHIPTOO] 8:28 pm: I have osteoarthritis both hips, W/additional injury to left hip (bone spurs, pain). Left hip is tolerable with NSAIDS and I limp at times. I still downhill ski on it in winter, and mountain bike in summer. Doctor says no downhill skiing after hip replacement but I know of folks who do. Is DH skiing as simple as a risk element that can be undertaken with care and willingness to accept possible dislocation? Would resurfacing or full replacement be preferred if skiing?
[Dr. Mont] 8:32 pm: I have over 100 skiiers with either hip replacement or resurfacing---they can do it easily after rehab---they assume the increased risks of a fall but many had the thr so that they can ski for which they are quite capable
[Dr. Mont] 8:33 pm: bad hip---have to see your whole picture--age, weight, how often skier, etc.
[mcapuse] 8:31 pm: How do you see the future of resurfacing in the next 5 years as far as implants evolution.
[Dr. Mont] 8:34 pm: many companies working on new hip resurfacing devices--hopefully without metal on metal articulation---with better wear characteristics
[TylerObermueller] 8:32 pm: Dr. Mont, Are you familiar with the Cormet system? If so what are the some of the things you like and dislike about it?
[eric] 8:35 pm: Dr. Mont, I am an active 290lb man a little heavier than my NFL days, but can someone with my weight do well with a hip resurfacing. Also, I am 44 years of age and don't drink or smoke.
[Dr. Mont] 8:35 pm: Cormet--I'm quite familiar with---performed > 1,000 with high success rate----easy to use device
[Dr. Mont] 8:37 pm: I have done three ex-NFL players with resurfacing--all did well--and I think that you are the smallest of the three---they were difficult (very muscular) but all done in straightforward---remember---6'4 or so 290 with much muscle is not really that overweight if that is what you are
[BADHIPTOO] 8:36 pm: IThanks-you Dr. Mont; 'm 61, have skiid, climbed, biked whole life, 203 lbs at 6'1". Expert skier but only 12-16 days a winter on vacation trips to resorts. Used to do a lot of skate nordic skiing, and would again if I could splay the left hip again to climb hills. I'm encouraged!
[Dr. Mont] 8:38 pm: Badhip -----Sounds like you're 61 going on 25 if you get your hip in order---you might be great candidate for either procedure---but you are the type that I typical do resurfacing on
[cruzahome] 8:37 pm: Could you comment on a statement I heard. They said that revision of a MOM THR due to metal issues is much more complicated than a revision of a resurfacing with the same metal issue and as such you need a surgeon who is very experienced in revisions as opposed to one who is mainly experienced in initial hip replacements. Is that generally correct?
[Doctor Chat]: crt has entered at 8:37 pm
[Dr. Mont] 8:39 pm: cruz----all of this depends on individual case----if both types of revisaions are caught early they should e straightforward for most cases---if they wait for years then they both can be difficult
[hiphopinman] 8:41 pm: Dr. Mont - What are your thoughts on a patient returning to Jiu Jitsu after hip resurfacing?
[Dr. Mont] 8:42 pm: hiphop---many patients return to various martial arts after resurf-----many instructors/champions/ etc. Should be no prob if rehab appropriately
[cruzahome] 8:41 pm: What is your opinion on ceramic implants at this point in time?
[Dr. Mont] 8:43 pm: I do ceramic on poly interfacec standard THRs quite often----newer ceramics doing great so far
[eric] 8:43 pm: I lost a little muscle, but my face is still pretty. Thanks for the response Dr. Mont. I will certainly come and see you when time comes. Only hope you are a Tampa Bucs or Jets fan. Have a wonderful evening.
[Dr. Mont] 8:43 pm: Im a Jets fabn---though not sure about their QB----gave the superbowl with their loss to Giants
[Pat Walter] 8:44 pm: Why do you think there is so much negative press against hip resurfacing
[Pat Walter] 8:45 pm: The discussion group spends a lot of time discussion it and wondering why there is not more positive info
[Dr. Mont] 8:46 pm: There are negative events with metal-on-metal implants, of which resurfacing is one type. Most people do great but when not implanted correctly, they are quite sensitive and fail miserably. In addition, two major manufacturer had recalls of specific MOM designs
[crt] 8:47 pm: so what devices do you use?
[Dr. Mont] 8:49 pm: Mostly Cormet,,, some Wright, have use al most all devices on market. I care more about how these are performed then the particular device
[Pat Walter] 8:48 pm: Are you using any mid head type of devices like the BMHR or mini hip
[Dr. Mont] 8:49 pm: I began using mini-stems like Corin Mini-stem in certain appropriate situations
[cruzahome] 8:50 pm: Do the ceramic on poly have the same projected "wear out" time frame as poly on poly.
[Dr. Mont] 8:51 pm: There is no poly on poly?
??
[Dr. Mont] 8:51 pm: ceramic on poly doing well at 5-10 year follow-up so far in most studies with most designs
[Pat Walter] 8:52 pm: do you have any squeaking problems with your ceramic on poly?
[Dr. Mont] 8:53 pm: Squeaking only really occurred with small number of ceramic on ceramic---not with ceramic on poly
[Doctor Chat]: JRiemer has entered at 8:53 pm
[Dr. Mont] 8:54 pm: Problem has mostly been eliminated with new designs even with ceramic on ceramic
[DEB] 8:54 pm: What's your take on ceramicized metal? Or are you including that when you say ceramic? I've been researching the "Oxinium" product in particular, which I believe is oxidized zirconium.
[Dr. Mont] 8:55 pm: What you are talking about, Deb, is under category of ceramic. Oxinium is in my opinion qa great product
[Dr. Mont] 8:56 pm: Pat--any other issues from your chat groups?
[Pat Walter] 8:56 pm: Whether everyone with hip resurfacing should have blood tests for metal ions
[Dr. Mont] 8:57 pm: Already answered--would only do these on patients with pain or other problems
[Dr. Mont] 8:57 pm: Also blood tests are often equiovocal and don't give a solid answer
[cruzahome] 8:57 pm: Sorry for the poor description. Is the life expectancy for ceramic on poly supposed to be greater than the "standard" THR
[Dr. Mont] 8:58 pm: standard THR--I think you mean metal on poly are now using metal on highly-cross-linked poly which is also a great material and both of these products will probably have similar great life-expectancy
[Pat Walter] 8:58 pm: There are always discussions about when they can run. Many surgeons don't want their patients to run. so there are always mixed opions on the patient's part
[Dr. Mont] 9:00 pm: Can't give absolutes on running. We have not seen a difference in our runners with resurfacing or standard THR when compared to sedentary individuals at mean 8 year follow-up both clinically and radiographically. So this is feasible, though I don't have real data after this time period---nor do I think other centers have it.
[Dr. Mont] 9:01 pm: So people run----though they assume some risk. I urge them to at least keep weight optimal and muscles rehabbed appropriately as well
[cruzahome] 8:59 pm: Can you get a large head with ceramic on poly?
[Dr. Mont] 9:02 pm: Ceramic on poly can have large 40 mm head and rarely higher with large-bone individuals---so yes this is feasible
[6wkhip] 9:00 pm: Dr. Mont, You've resurfaced both my hips now - 3 years apart - and I want to thank you so much!! After pain and limping for over 15 years my 58 year old hips feel 12 years old again. I will have to redefine myself as 'fit, flexible and active' rather than 'old, stiff and disabled'! Thank you!
[Dr. Mont] 9:02 pm: 6wwk---ty for your kind comments and I am happy that you are doing so well
[JRiemer] 9:00 pm: Dr. I have an appointment with you soon. It will be my first time seeing you. Should I bring xrays taken elsewhere or will you have them taken at your office anyway?
[Dr. Mont] 9:03 pm: jremer--we have x-ray capabilities--if your films are recent bring them and you may not need to shoot new ones
[Pat Walter] 9:01 pm: Thank You for taking time to answer our questions. We all appreciate having you visit and help us.
[Pat Walter] 9:03 pm: Thank You to everyone who participated. I hope you learned a lot and enjoyed the time with Dr. Mont
[Dr. Mont] 9:05 pm: I think we all should thank Pat for her tremendous efforts at putting this together and for being such a wonderful patient advocate
