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Dr. Koen De Smet
6500 Hip Resurfacings to date ***
320 ReCerf COC Hip Resurfacings to date***
14,000 Hip Replacements to date***

Dr. De Smet’s Email: dr.desmet@heup.be

AMC
Anca Medical Centre
Xavier De Cocklaan 68.1
9831 St.Martens Latem (Deurle)
Belgium
+32 9 2525903

ANCA Clinic
Via Barnaba Oriani 32/30b
00197 Rome, IT
+39 06 6889 2472
Valle Giulia Roma Italy
https://ancaclinic.com/

AZ Zeno
Campus Knokke-Heist
Kalvekeetdijk 260
8300 Knokke-Heist
CI Knokke +32 (0)50 53 50 30
MCM +32 (0)50 53 30 00

Dr. De Smet’s Facebook Page  https://www.facebook.com/hipclinic/

March 7, 2025 – Koen De Smet Introduces New ReCerf Ceramic on Ceramic Hip Resurfacing at Anca Clinic

Full Information Available in Downloadable PDF: https://surfacehippy.info/recerf-info/RECERF2025.pdf

 

Article about Hip Resurfacing for Women and Small Men by Dr. De Smet 2015

 

Dr. De Smet Interview by Patricia Walter Sept. 5, 2009 in Baltimore, MD at the 3rd Annual Hip Resurfacing Course.

 

Dr. De Smet of Belgium interviewed by Patricia Walter in Baltimore, MD 2009. Dr. De Smet discusses hip resurfacing, the Birmingham Hip Resurfacing Device, patient selection, surgical approaches and patient outcomes after hip resurfacing. Dr. De Smet answers the following questions:

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 is 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 total hip replacement I changed after having performed 1800 procedures from lateral to posterolateral approach as well. The posterolateral approach does have many advantages:

1. The abductors (gluteus medius muscle) responsible for normal gait remains intact, so less patients suffer from permanent abnormal gait after hip prosthesis.

2. There is a much better view to place the components in a more correctly way (very important for revision surgery).

3. There will be less repetitive muscle damage in revision surgery; there are fewer patients with complaints of trochanteritis (irritation of the bursa) compared to the lateral approach.

The only disadvantage of the posterolateral approach is the larger incidence of dislocations in inexperienced hands/ learning curve.

What is your opinion about cementless devices for resurfacing?

Maybe they are good, but we do not know yet. Cement is a shock absorber between prosthesis and bone or between prosthesis/ bone+cement/ bone, so maybe a good thing, certainly taking in account that Chrome Cobalt has not the same elasticity as bone and is quite stiff!

So:
1. we have to wait and see
2. certainly not all patients would be good to do uncemented
3.history has shown that cemented resurfacing works very well

Do you preserve the hip capsule during your hip resurfacing surgeries?

Yes, and I think you should.

Why is Hip Resurfacing better than Total Hip Replacement?

Theoretic advantages are less bone destruction, less bone resection, normal femoral loading, avoidance of stress shielding, maximum  proprioceptive feedback, and restoration of normal anatomy. In addition, reduced risk of dislocation, less leg inequality problems, and easier revision should convince surgeons to favor metal-on-metal resurfacing.

Why does my hip squeak?

Also called peeping or “peepcreep”. The squeaking noises are produced due to a temporary lack of lubrication, a dry running of the metal-on-metal prosthesis.  It sounds as a non-lubricated creaking hinge of a door. The duration of the noise is normally less then 24 hours, and a one-time incidence.

It starts when the patient has an increase or change in activities. Stair climbing always generates or increases the noise. (Possible provoking activities: mountain climbing, mountain walking, chopping wood, etc).

It does not occur any more 2 years after surgery. Two year is the time interval that equals the running in period of a metal-on-metal friction couple. Running in means that the prosthesis is polishing itself. Immediately after surgery, the lubricant (lubrication film) between the 2 components of the prosthesis is blood. This will change to serum with our own proteins after a while. The percentage of patients where squeaking noises appear is about 1.5%.

It is a benign incident that goes away spontaneously and you do not need to panic. (let it know to your surgeon for statistical reasons!).

What Should I do for Pain?

We prefer ice packs, although both are effective to relieve pain. Both can be harmful in direct contact with the skin. It can damage the skin and even cause a severe burn. Never sleep with a heating pad on your hip. Ice can be used several times a day. Twenty minutes on, 20 minutes off, is the usual regime. In the first postoperative
weeks heat is not recommended.

How old is the BHR ?

BHR procedure is developed in 1996/97. The first metal-on-metal resurfacing is from Feb. 1991. The resurfacing is already 40 years old, metal-on-metal is 40 years old (the oldest dates from 1938!). Both ideas were put together by Mr. McMinn in 1989.

How old is the oldest Wright C+ hip?

The Conserve Plus design was introduced by Dr. Amstutz in 1995.

Oldest C+ hip dates from the year 1996.

Can both hips be operated at the same time?

In severe osteoarthritis of both (bilateral) hips a bilateral procedure can be done. Both hips are operated on the same day. Our experience today has not given more problems when this is performed in healthy people. A continuous epidural catheter and more blood transfusion are needed. Cell saver is used in these conditions. Patient has to be healthy, not obese, and the hip condition itself does not have to be severe.

What kind of physical therapy do you recommend for your resurfacing patients?

Everything like they feel. For general rehab you could take 6 weeks, 3 months. If patients want to progress harder they can have longer or more frequent physiotherapy, but this would then be more like fitness training ! Physiotherapy in resurfacing is more guiding the patients then making them to work out exercises too fast and too hard. Passive forced flexion of the hip should not be done. It will often lead to groin pain.

What is the normal recovery time?

1 to 2 weeks 2 crutches, 1 to 2 weeks 1 crutch. No cane. What is normal exercise? Actual daily living means 4 to 5 weeks. More strenuous activities can begin from then one, like patient feels for himself. Patient has to be his own barometer.

Will I have Stitches or Staples?

Normally staples are closing the wound. In young patients (ladies!) and on request the wound is getting closed intracutaneously.

Half of the stitches or staples are normally removed after 14 days. The remaining half is removed after 16 days.
Depending on the individual patient, one can decide to remove the staples later on. Staples are removed with a
special device.

In case of an intracutaneous suture, one only has to cut off one end of the suture. It is not the purpose to remove the complete suture because it is resorbable.

How long will my leg continue to swell and hurt?

The pain usually decreases rapidly during the first days, but discomfort can continue for a couple of months. The swelling is due to alterations in fluid return up the limb, and will gradually diminish, but may take a couple of months or longer. Mobilization, exercise, stockings and elevation helps.

What is the worst complication that you are aware of with resurfacing?

Fracture of the neck of femur. When it occurs, you get a stem with a big modular head. I have only one patient with this, but afterwards he is now, one of my happiest patients. In most of the series, all over the world, fractured neck of femur has an incidence of 1%.

What other complications might I be at risk for?

None more then with any other procedure: infection, nerve lesion, thrombosis,  death?

The chance of unequal leg length or dislocation is much lower than in THA.