Dr. De Smet
When can I go up and down stairs?
You should learn to walk stairs with the physiotherapist at the hospital a few days after the operation on ndividual basis.<… Read the rest
Features information from patients and doctors
Psoas tendinitis is an important reason for groin pain in resurfacing surgery. This is peculiar to resurfacing as the cup for resurfacing is a very large profile ie half a sphere. Nearly all THR cups are only portions (arc) of a hemisphere.
Hence if the antero-posterior orientation i.e., version of the cup is marginally off the ideal, it would not be a problem with THR. However in resurfacing, due to the very large profile, if the version is less than ideal the ant edge of the cup will protrude out of the bony front wall of the acetabulum. The psoas tendon will rub on this and patients will typically complain of … Read the rest
|by Dr. Michael Broder|
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7/03/08 Dr. Lichtblau of Quebec
The anterior vs. posterior debate isn’t going to be resolved by one study of electrode blood flow. Most surgeons would agree that blood flow to the femoral head (most of which comes backwards via the femoral neck) is theoretically better preserved through an anterior approach. Much of this info comes from the work of Ganz, who did a lot of cadaver dissection to prove this. Having said that, there doesn’t seem to be any evidence whatsoever that one approach or the other leads to a higher incidence of the femoral head dying after resurfacing surgery (so called ”avascular necrosis”).
McMinn and Treacy, who have together the largest series of resurfacings in the world, both use the posterior approach, and there
The NCP (Neck Capsule Preserving) Approach which is increasingly being adopted by surgeons world wide was developed at ARCH by Dr. Bose. This facilitates a faster recovery due to the repair of the capsule. The vascularity of the critical regions of the head and neck is also preserved in the NCP Approach.
Dr. De Smet
Do you preserve the hip capsule during your hip resurfacing surgeries?
[Koen De Smet ANSWER/] YES AND I THINK YOU SHOULD
Saving the capsule is good with a THR because it may decrease the rate of dislocation. In regular THR it can go either way saving or not. Due to the technical needs of the resurf procedure the
capsule must be fully opened and partially removed. … Read the rest
One must remember that with a resurfacing or a THR – one is not aiming to give supra normal movement. One is merely trying to restore normal movement present before the onset of hip arthritis.The head- neck offset is an important determinant of ROM. This is restored by a properly done resurfacing even in patients who have a poor head neck offset as in FAI ( femoro – acetabular impingement. Hence full restoration of ROM is consistently possible in a resurfacing. A big ball THR has an abnormally high head neck offset due to the thin neck. Thus in theory a big ball THR can produce supra normal movement . However this is neither desirable or feasible in clinical practise as the
7/03/08 Dr. De Smet of Belgium
Does the length of incision influence the rehabilitation?
No! A bigger incision does not mean that there will be more damage to the muscular structures. On the contrary, if you need a bigger incision to get better exposure, the placement of the implant can be done more precisely. Even with an incision of 30 cm you are able to walk well after 24 hours.
In the resurfacing procedure the incision is longer than THR (15 – 30 cm/6-12 inch) because of technical-anatomical reasons (saving the femoral head). The length of incision has no influence in the postoperative rehabilitation.
Which approach do you use?
For the resurfacing procedure I always use the posterolateral approach for technical reasons. For a classic
Dr. Bose – I have bone cysts, can I have a hip resurfacing?
The presence of a cysts by itself is not a contraindication for resurfacing. It does not preclude resurfacing automatically. One must keep in mind that cyst formation is a natural occurrence in osteoarthritis and is very common though the extent, quantity & location may vary.
Cysts are of course much more common and invariably present in AVN. The assessment of certain technical factors would the real issue. This is based on the amount of residual bone after head preparation. Some resurfacing prosthesis are thicker at the top and tend to replace more bone in the head of the femur than other prosthesis. This is a great advantage in managing cysts as at … Read the rest
- Will My Neck Capsule Be Preserved?
- Will I Have Stitches or Staples?
- Can I have a MIS hip resurfacing?
- Incision Length by Dr. Lichtblau
- Will My Neck Capsule Be Preserved?
- Incision Length by Dr. De Smet of Belgium
- FAQ Surgical Questions
- What are the important angles of components in hip resurfacing
- What surgical approach is best – posterior or anterior?
It is a commonly used statement that a BHR is as ‘stable’ as a normal hip. However this is a highly qualified statement. This statement is true only if the following criteria are met:1. Native angles, inclination , offsets and all anatomical parameters have to be replicated.. If this is not done fully and only accuracy of say 80% is obtained – then the stability is likely to be approx in the region of 80% only. Having said this ,even in this situation, the stability is likely to be many times that of a conventional THR. Therefore I would not call it a surgical error. As surgeons, we get better and better at this replication as we gain experience.
2. The capsule … Read the rest