Dr. Mont Live Chat July 16, 2008
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This is a transcript of a
Welcome! You have entered [Hip Resurfacing] at 7:31 pm [L. Thomas] 7:54 pm: I am interested in hip resurfacing. I am having hip arthroscopy by Dr. Thomas Byrd (Nashville TN) in a couple of weeks. This is suppose to stall hip replacement for a while. I have a nickel allergy and I just wanted to find out your opinion of hip resurfacing and nickel allergies [Dr. Mont] 7:57 pm: Arthroscopies work if minimal to no arthritis –otherwise not too useful—–nickel allergies are probably ok since resurfacings have minimal to no nickel but you should probably be tested for cobalt and chromium before a metal-on-metal device if one has a metal allergy
[Pat Walter Moderator] 7:59 pm: I would like to introduce Dr. Mont. [Dr. Mont] 7:59 pm: Hi Pat–I want to thank you for setting this up and all your efforts on the patients behalf [Pat Walter Moderator] 8:00 pm: You are welcome.
[mjaklrsav] 8:00 pm: How do you determine somebody is allergic to chromium or colbalt? [Dr. Mont] 8:00 pm: Excellent question-traditional skin testing not great–there are blood tests at specialized labs [Pat Walter Moderator] 8:01 pm: When did you start to do hip resurfacing?
[Dr. Mont] 8:01 pm: 4-5 labs will do the blood tests from around the country [Pat Walter Moderator] 8:03 pm: What hip device do you normally use? [Dr. Mont] 8:03 pm: I use multiple devices; Conserve Plus, BHR, and Cormet [mjaklrsav] 8:03 pm: sticky with the allergy questions, what will the blood test show? high levels of colbalt chrome? [kstan] 8:03 pm: Greetings, Dr Mont & Thanks for this opportunity! I understand you use the Conserve Plus. What are the differences AND similarities to the BHR? [L. Thomas] 8:04 pm: I was patch tested before TKA in 06 for metal allergies. I was not allergic to chrome, cobalt, or titanium but I did have a strong reaction to nickel. A nickel free implant was used just to make sure. So if I have the blood test for allergies that would be the factor that would be evaluated? and not the patch test? [Dr. Mont] 8:05 pm: The blood tests show antigenic-antibody reactions to the metals tested from the patients blood–if positive one should not get metal on metal devices in my opinion [mjaklrsav] 8:05 pm: Can metal allergies cause hip bursitis? [Dr. Mont] 8:05 pm: I use all of the devices–they are similar but each has subtle differences in fixation surfaces, etc. [kstan] 8:06 pm: Do you have a long waiting list? [Dr. Mont] 8:07 pm: Hip bursitis typically does not occur from metal allergies but is possible [Pat Walter Moderator] 8:07 pm: Is hip bursitis common in the operated hip after resurfacing? [mjaklrsav] 8:07 pm: for me, yes
[Dr. Mont] 8:08 pm: Waiting list for questions here? No–for surgeries-No–Pat can give my number out [Pat Walter Moderator] 8:08 pm: Do you have an age limit for patients that can receive a hip resurfacing? [Dr. Mont] 8:09 pm: Hip bursitis can be common after any hip surgery—most of the time >99% it is self-limited and will go away by itself or with minimal non-operative treatment [stevel] 8:10 pm: My local orthopedic surgeon examined my left hip rays taken 8/6/07 and observed "marked osteoarthritis with joint space narrowing, large marginal osteophytes. Patient has essentially bone-on-bone arthritis and there are noted to be bone spurs extending into the femoral neck. He told me I wasn’t suitable for hip resurfacing because there should be no change in socket or defects in the femoral neck. Are bone spurs on the femoral neck a contraindication for hip resurfacing? [Dr. Mont] 8:10 pm: Most people use about 55 – 60 years as an age limit for surgery–however we just had a paper accepted for resurfacings on patients greater than 60 years and they did just as well as their younger counterparts [Dr. Mont] 8:11 pm: Age is a relative thing and this is a controversial topic [L. Thomas] 8:11 pm: I have found the recommendation for choosing an OS for hip resurfacing..OS needs to have 100 under his belt. How does the OS get 100 if you use that as a benchmark. What other qualifications do you think should be included in evaluating choice of OS for hip resurfacing? [Dr. Mont] 8:12 pm: bone spurs on femoral neck are not a contraindication for resurfacing–but obviously each x-ray would have to be looked at individually–almost all arthritis is associated with spurs on neck by the way [kstan] 8:13 pm: Are you training other surgeons in hip resurfacing and if so how does that work in the surgeries you perform? [Dr. Mont] 8:14 pm: Some OS can do the procedure well after less than twenty—others need more—hard question to answer—may have to do with the type of cases they are performing–are they gaining experience with straightforward hips first and then advancing as they gain experience which is correct way which is better than tackling hard cases too early [twinhipper] 8:14 pm: have you ever performed the surgical removal of the bursa as a last resort of hip bursitis? [Andy] 8:15 pm: Of the patients who experience failure of some sort, what is the average time between the complication or failure and revision (THP)? [Dr. Mont] 8:16 pm: I have surgeons observing me do surgery but they don’t scrub in–I have them watch me and take notes–other ways they train is by doing cadavers with me—that way the surgeries I perform are not compromised [stevel] 8:17 pm: My local orthopedic surgeon advised I wasn’t a candidate for hip resurfacing since there should be "no change in socket." I believe this applies to partial hip resurfacing. I believe total hip resurfacing allows change in socket. Is this true and how much change in socket is allowed? [sparky] 8:17 pm: Dr. Mont: Thank you for taking the time from your busy schedule to come here and help us understand how it is what you do, and how it gives us our life back. I have been following another of your patients that was outstanding at 5 months. I watched him walk, and couldn’t tell which leg you operated. He is younger than me, BMI on target, and excercised pre and post op. I am a lot older, my BMI was near 40 [Dr. Mont] 8:18 pm: I have performed about 5 surgical bursectomies in my career of over 7000 procedures—but most have been after revision surgeries—often when there was a wire-ing of the trochanter which was an older way to aproach hip which is rarely used today–most bursitis will respond to non-operative treatment–theraphy, occasional injections, etc. [sparky] 8:18 pm: The question is – I did not excercise pre surgery, and we both were at the same place at 5 months. [mjaklrsav] 8:19 pm: ok last question about hip bursitis,…so, if I am the 1% of the of hip bursitis that will not resolve itself, what should a doctor look for? I already had physical therapy, ultra sound, electro-stimulation, one steroid shot, anti-flammatory drugs, and the blood test will be in next week. The blood test will only show the levels of cobalt, chrome, & titanium. [Dr. Mont] 8:20 pm: Change in socket cant occur if doing partials–which are rarely done now—all arthritis generally involves socket changes—it is the extremes of bone loss that may not allow resurfacing since screw fixation is not optimal with resurfacing devices at present [L. Thomas] 8:21 pm: Can you have good bones and bad joints?
[Dr. Mont] 8:22 pm: Two studies in the literature have not found any benefit of pre-operative exercise on eventual results of resurfacing or any hip replacement—so don’t mind if you exercise ahead of time but don’t feel obligated [kstan] 8:22 pm: I understand that cysts can render the bone unsuitable for resurfacing. What are the risk factors for developing cysts? [Pat Walter Moderator] 8:23 pm: What serious sports have your patients participated in after hip resurfacing. [jb2ranger] 8:24 pm: I am (was) an active male diagnosed with right hip OA seven years ago at 38. My Xray indicated possible spurring on the femar head. I stayed active for 6 years but now am feeling it bad. I have young children 5 & 7 and the thought of a THR scares me to death. What is the min femar size or max cyst size that I could still look forward to resurfacing. At what point in resurfacing recovery would I be able to walk 1+ miles and several stadium steps to get to my seat at football games. Thanks [Dr. Mont] 8:24 pm: mjaklrsav—please send more details to me–x-ray, etc. and will personalize an answer–this needs to be generic answers to questions for all [stevel] 8:25 pm: Why are metal ions are a concern when the concentrations are low (parts per billion?) and we have iron in the blood anyway? Sometimes we take iron supplements to increase iron in the blood to prevent anemia. [Dr. Mont] 8:26 pm: Almost all arthritis leads to cysts—its just a matter of degree–the longer you wait or tolerate arthritis in general the larger the cysts will become—sometimes patients may wait too long to get a resurfacing because the cysts erode away the bone stock on the femoral head—but these are typically very late stage arthritis [Dr. Mont] 8:27 pm: We do not know a lot about these low concentrations of metal ions at the present time [Andy] 8:27 pm: What percentage of patients develop complications from resurfacing and, on average, how much time elapses between the resurfacing and the revision? I understand that each case is different, but can you answer this on an average basis? [Dr. Mont] 8:29 pm: Concerning sports–many patients with standard total hip replacements as well as resurfacing participate in all sports– [Pat Walter Moderator] 8:30 pm: Many people want to run and even go back to running marathons. How do you feel about that. I am often asked about running. [Dr. Mont] 8:30 pm: We don’t yet know the long term effects of these sports (past 7 years) but I encourage patients to regularly exercise their hip muscles to unload the joint if they are going to participate [L. Thomas] 8:31 pm: After TKA it was recommended that I stop downhill skiing and singles tennis. Will there be more restrictions after hip replacement? [Dr. Mont] 8:31 pm: The best sports in my opinion are less impact—swimming, bicycling, elliptical—-these are probably fine—the higher impact sports are more likely to lower the lifespan of any implant [sparky] 8:32 pm: Thank you, Dr. Mont, about your pre-op excercise comments. I felt guilty I just could not do it, but was pleased I was at the same place a younger man was in his recovery at 5 Months. I have been loosing weight since surgery since my ravenous appetite has vanished. You told me I would loose the weight later, and you were right. Does the implant aid in weight loss with other overweight patients by curbing their appetites? [Dr. Mont] 8:33 pm: I don’t encourage running but the patients do it anyway–in one of our studies we found that 30% of patients returned to high impact sports–tennis, running, etc. after any hip arthroplasty [stevel] 8:34 pm: I am 54 years old active male with an arthritic left hip whose primary recreational activities are hunting and downhill skiing. I am most concerned about dislocation and premature wear using a total hip replacement. I can currently walk two 2 mile round trips each day and use a eliptical machine 35 minutes a day, every other day. I am now limited from walking down steep, uneven slopes. I have mild to moderate pain after overdoing it. Could I resume skiing and hunting after a hip resurfacing [Dr. Mont] 8:35 pm: I am sure if one has a successful result of any arthroplasty it may help patients be more active and lose weight—this makes sense. Unfortunately, in a few published studies patients still have average weight gains after joint replacements. [thieretm->Pat Walter Moderator] 8:35 pm: I have an active lifestyle and don’t want to miss a hockey season. If I wait till February will this increase the cysts erosion of the bone on the femoral head and reduce my chance of doing a resurface? Is it realistic to return to playing at a non contact level? [Dr. Mont] 8:36 pm: We just finished a study of over 200 patients after hip replacement and found an average weight loss for the group of 4%. The highest predictor of patients who lost weight were those who have active pre-operative lifestyles. [Dr. Mont] 8:38 pm: Many patients resume skiing and hunting after resurfacing. Im 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 [Andy] 8:38 pm: Do you prescribe a presurgical course of antibiotics or any other means of mitigating the risks of infection? [Dr. Mont] 8:40 pm: Hockey is always pretty contact so hard to gauge—would have to see x-rays but probably waiting 6 months does not change cysts appreciably but again one needs to know what x-rays look like today–if cysts already well formed this could decrease chance–most cysts are miniscule and this would be an irrelevant factor [stevel] 8:41 pm: Since I hunt, after a hip resurfacing, are there limits to how much extra weight (backpack) one should carry? [Dr. Mont] 8:41 pm: All patients in every hospital in the country get pre-operative antibiotics within 1 hour of surgery—mandated hospital rules which is a good thing [Pat Walter Moderator] 8:42 pm: Do you suggest antibiotics before dental work after resurfacing and for how long? [sparky] 8:43 pm: What causes Vitamin D levels to drop in some patients after surgery? [Dr. Mont] 8:44 pm: There is a difference in what a patient might be able to do, what they can do, and what they should do. If one exercises appropriately post-operatively almost every patient could get to close to normal function and be able to lift weights, backpacks, etc. This is not something I would necessarily encourage but the patient has to decide whether the risks of possible premature wear of their components are worth the benefits of the activity they love. [thieretm->Pat Walter Moderator] 8:44 pm: can we get contact information for where to send information to Dr Mont and the format for x-rays? [Dr. Mont] 8:45 pm: We do not have tremendous objective data on activities and wear and these relationships for any hip replacement devices [sparky] 8:46 pm: Pat: Thank you very much for setting up this chat. Your new software rocks! [Pat Walter Moderator] 8:47 pm: Thanks Sparky. Most of us older folks haven’t used chat rooms much. [sparky] 8:48 pm: Pat: I’m one of the older folks too. What makes life great is we never stop learning. [Dr. Mont] 8:48 pm: I like antibiotics for up to two years after any joint replacement. After two years only for procedures that lead to blood like endodontic surgery. This is also a controversial topic. We wrote two papers on this topic and only found possible dental related infections in patients that had oral procedures that were greater than 1 hour with blood loss that did not get antibiotics. The problem is that sometimes patients don’t know what they are getting from their dentist [kstan] 8:48 pm: Delay hip resurfacing or Proceed with hip resurfacing…what are the criteria to help make this decision? [Dr. Mont] 8:49 pm: Hip resurfacing or any hip replacement should be performed when there is hip arthritis that is not responsive to non-operative treatment modalities typically tried for a period of 6 months or more. Would you like me to elaborate further? [kstan] 8:50 pm: Do you recommend steroid shot intra-articularly? [Pat Walter Moderator] 8:50 pm: What typical treatments do you try first before surgery? [Dr. Mont] 8:52 pm: Many patients feel they need a hip replacement because they are told they have a limp and find out that they have arthritis of their hip. Many of these patients have minimal pain or it can be controlled by medications, activity modifications, hip strengthening exercises, and weight loss. A resurfacing or any joint replacement should be a court of last resort. [Dr. Mont] 8:53 pm: Gee this hour has flown by quickly [stevel] 8:53 pm: What hip resurfacing device do you install in your patients? [Dr. Mont] 8:54 pm: any unanswered qs that I missed? [Pat Walter Moderator] 8:54 pm: Do you want to end with a summary of why hip resurfacing is better than a thr? [Pat Walter Moderator] 8:55 pm: This was a previous question – Dr. Mont uses multiple devices; Conserve Plus, BHR, and Cormet [L. Thomas] 8:55 pm: Thanks Dr. Mont Your answers have helped me with the "if’s" I had [Andy] 8:55 pm: In addition to x-rays, what kind of medical evaluation is done to determine whether a patient is a sound candidate for resurfacing? [Dr. Mont] 8:55 pm: I try not to say one is better than the other but rather list out possible advantages and disadvantages of a resurfacing vs. a THR. [Pat Walter Moderator] 8:57 pm: I want to Thank Dr. Mont for taking time out of his busy schedule to Chat with us on the Surface Hippy Website. I know everyone appreciates the information he has shared with us.
[stevel] 8:57 pm: what is the service life of a THR for an active 54 year old male
[Pat Walter Moderator] 8:57 pm: Dr. Mont can be reached via email if you explain your situation, include x-rays and your home phone number. His information in on the main website. [Dr. Mont] 8:58 pm: Advantages of a resurfacing in my hands are (1) more range-of-motion, (2) less risk of dislocation, (3) more normal "feeling", (4) leaves options open for later conversion to standard THR, (5) Easy revision if necessaryt, (6) useful for certain deformities, (7) preservation of femoral bone stock [Dr. Mont] 8:59 pm: Disadvantages are (1) harder to do, (2) less follow-up–up to 10 years max, (3) risk of femoral neck fracture, (4) possible elevated metal ion in blood issues [Pat Walter Moderator] 9:00 pm: Thanks again Dr. Mont!
[Dr. Mont] 9:00 pm: My e-mail is
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