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This is a transcript of a Live Chat in the Surface Hippy Chat Room with Dr. Rogerson on Oct. 13, 2008
[paul] 8:12 pm: For someone in his mid 50s who works in an office
setting, about how soon can he return to work after resurfacing, assuming no
comps?
[Dr. Rogerson] 8:14 pm: Hi I’ve had
patients such as dentists back in two weeks but usually it is 3-4 weeks for full
days
[paul] 8:14 pm: For how long do most patients have
to defer driving post resurfacing?
[Dr. Rogerson] 8:15 pm: when they
can walk without crutches they can drive – usually 2-3 weeks
[paul] 8:15 pm: In resurfacing, can leg length be altered to
equalize it with the contralateral leg?
[Dr. Rogerson] 8:16 pm: very small amounts
[RH] 8:16 pm: Do your patients use TEDS and any other kind of
blood clot prevention
[Dr. Rogerson] 8:17 pm: yes. we use pump
stockings during surgery and teds and pumps after and enoxaparin
[paul] 8:17 pm: Do I need to donate blood preoperatively for a
resurfacing procedure?
[Dr. Rogerson] 8:17 pm: ?No, transfusions
are rare
[Ken Lazur] 8:17 pm: My Doc
said I have Hip Dysplasia and also arthritis involved and need total hip
replacement. Should I consider resurfacing. I am a runner and would like to
continue.
[Dr. Rogerson] 8:18 pm: you could
consider resurfacing
[paul] 8:18 pm: What is the
incidence of avascular necrosis post resurfacing?
[Dr. Rogerson] 8:18 pm: depends on how much
dysplasia
[Dr. Rogerson] 8:21 pm: in terms of dysplasia one needs to look
at the x-rays to really answer if resurfacing is preferred
[Dr. Rogerson] 8:19 pm: rare. in Mr. McMinn’s first 3000 he had one
case. I’ve had none yet in our first 340
paul] 8:18 pm: Approximately how long
does a resurfacing procedure take, assuming no comps?
[Dr. Rogerson] 8:20 pm: usually takes me about 1 hour 45 minutes
but I go slowly and carefully to not notch the femoral neck
[ahershberger] 8:21 pm: Can someone who was extremely flexible
expect to gain back the flexibility after having both hips done? ( I know this
is crazy but I could almost do the splits at the age of 46 and would like to be
close to that kind of flexibility.) My doctor said at 6 weeks I was in the 90%
of patients whatever that means. I am now 9 weeks post op.
[Dr. Rogerson] 8:22 pm: one could expect
to regain essentially normal motion especially if one is flexible before the
surgery
[Ken Lazur] 8:22 pm: would resurfacing handle the impact of running
[ahershberger] 8:22 pm: how long will it take
on average?
[Dr. Rogerson] 8:23 pm: shouldn’t try
to rush it but by 6 months is likely
[] 8:24 pm:
Do you primarily use the BHR – or do you use other devices too
[Dr. Rogerson] 8:25 pm: I have done one Wright Medical and all the
rest BHR
[Ken Lazur] 8:26 pm: would
resurfacing handle running?
[Dr. Rogerson] 8:26 pm: resurfacing is great
for eventual running
[Chuck] 8:26 pm: How
long on average does it take for your patients to tie their own
shoes?
[Dr. Rogerson] 8:27 pm: tying
shoes usually by 4-6 weeks
[] 8:26 pm: do your normally do both hips
at one time if needed – or do you space them a few days or weeks
apart
[Dr. Rogerson] 8:27 pm: I usually
space the 2 hips by 8-12 weeks
[] 8:27 pm: Some doctors
feel the heavy impact sports shorten the life of the hip device – how do you
feel about it?
[Dr. Rogerson] 8:28
pm: the survivorship at 10 years in McMinn’s series for osteoarthritis is 98.6%
so that slope suggest many will last a very long time
[RH] 8:28 pm: how old are your oldest hip resurfacing
patients?
[Dr. Rogerson]
8:30 pm: oldest patient was 81 and 71 but they were extremely fit for their age
and played high impact sports and wanted to continue
[Ken Lazur] 8:31 pm: Why would my doctor strongly suggest total hip
replacement and not resurfacing?
[Dr. Rogerson] 8:31 pm: unsure
[Ken
Lazur] 8:31 pm: I am 54
[Dr. Rogerson] 8:32 pm: .
for high impact sports, I would definitely go with resurfacing
[Dr. Rogerson] 8:32 pm: and esp. at 54
[Dr. Rogerson] 8:30 pm: Impact sports
will definitely shorten plastic socket devices. We don’t know if it truly will
shorten metal on metal devices
[Ken Lazur] 8:32 pm: Doc talked about metal bearing instead of
ceramic
[[Dr. Rogerson] 8:33 pm: agree with metal on
metal bearing. not enthused at all with ceramic on ceramic
ahershberger] 8:33 pm: Do you resurfacing
doctors follow your patients with blood work to track the metal ions released in
the body? Or is this something that we should ask our family docs to
do?
[Dr. Rogerson] 8:34 pm: I don’t routinely follow metal ions
because there are very few labs that can and will do the tests.
[Ken Lazur] 8:34 pm: what is the difference between total
replacement and resurfacing
[Dr. Rogerson] 8:37 pm: main difference
between traditional THA and resurfacing is that you save and just shave the ball
for resurfacing and don’t cut off the neck and head like regular THA and the
head size for resurfacing is much larger and doesn’t dislocate
much
[ahershberger] 8:37 pm: Do you have any concerns about resurfacing
for women just prior to menopause especially if they are just above the cutoff
for numbers bone density? What if they were to have some bone
loss?
[Dr. Rogerson] 8:39 pm: I have done a
large number of pre and just post menopausal females and have had no troubles –
just have to be careful to not notch the neck. The bone actually gets stronger
in the neck after resurfacing
[wierdwood] 8:37 pm: Assuming good alignment
what are the chances of femoral neck notching leading to a femoral neck
fracture?
[Dr. Rogerson] 8:40 pm:
if good alignment and no notching the chance of femoral neck fracture is very
low. we have had none so far
[] 8:37 pm: Is it best to wait as long
as possible for a hip resurfacing while trying everything possible. Or just get
out of pain and off meds with a new resurfacing.
[Dr. Rogerson] 8:41 pm: there is
a window for hip resurfacing before get too much deformity or head cysts – need
to follow the x-rays if waiting
[] 8:41 pm: Dr.
Rogerson, I am due to send my 2 year BHR post-op x-rays to Dr. Bose in India.
The cardiac surgeon I work for is willing to write the script for it. What
should he order?
[Dr. Rogerson] 8:42
pm: AP pelvis and frog or cross table lateral
[]
8:42 pm: do you need to do MRs if your hips are really bad? or do x-rays tell
you everything?
[Dr. Rogerson] 8:43 pm: I
frequently order CT scans to evaluate the size and location of femoral head
cysts
[Dr. Rogerson] 8:44 pm: If the cysts are too large I go to a metal
on metal big femoral head
[] 8:44 pm: should it say
right hip or does that compare both hips?
[Dr. Rogerson] 8:44 pm: AP pelvis is for both hips but say right
for the lateral
[ahershberger] 8:45 pm: Is it
common not to know about all of the cysts until surgery? My surgeon was
surprised at what the x-ray didn’t show
[Dr. Rogerson] 8:46 pm:
sometimes one can be surprised but usually one has an inkling of the cysts and
the CT scan really show them well
[] 8:46 pm: I heard that doctors can fill deep
cysts? Is that true?
[Dr. Rogerson] 8:48 pm: sometimes yes but it
depends on the size but more importantly the location of the cyst – if it is
superior on the neck at the junction of the metal to the bone it is a serious
stress riser and will likely give a femoral neck fracture
[ahershberger]
8:46 pm: are ct scans routinely ordered? I did not have one.
[Dr. Rogerson] 8:48 pm: CT depends on your Dr
[RH] 8:48 pm: Do you think taking NSAIDS like Celebrex can
deteriorate the bad hip more quickly? Or the meds don’t bother a bad
hip.
[Dr. Rogerson] 8:49 pm: I don’t think Celebrex would deteriorate a
bad hip more quickly.
[Dr. Rogerson] 8:50 pm: by the time a hip
is bare bone the nsaid is only decreasing the inflammation of the joint and
would have now effect on the articular cartilage
[RH] 8:50 pm: Do you normally try steriod shots in the hip capsule
before doing a resurfaicng? How many would you do?
[Dr. Rogerson] 8:52 pm: yes on steroids for one or 2 times –never
more than 3
[Dr. Rogerson] 8:52 pm: usually
doesn’t help after 3 times
[RH] 8:53 pm: Is it
important to try to be in good physical shape before surgery? What would you
suggest as good exercises
[Dr. Rogerson] 8:53 pm: very important.
Swimming and biking and gentle yoga type stretches
[ronbole] 8:54 pm: what do you look for on the xray at the one
year check-up after a BHR?
[Dr. Rogerson]
8:55 pm: look for any lucent lines at the socket or any thinning of the neck or
change in position
[] 8:55 pm: Do you feel the
surgical approach makes a difference in how quickly a patient recovers from
resurfacing?
[Dr. Rogerson] 8:55 pm:
yes.
[] 8:55 pm: What do you prefer and
why?
[Dr. Rogerson] 8:56 pm: The lateral approach
and anterior lateral where the trochanter or the abductor is cut can lead to a
prolongs limp
[] 8:57 pm: You prefer the
posterior approach
[Dr. Rogerson] 8:57 pm: I use
the posterior approach just like Mr.McMinn and Treacy.
[] 8:57 pm: Does the size of the incision make any difference on
the quickness of the recovery?
[Dr. Rogerson] 8:57
pm: I think dislocation is not really a factor and it spares the
abductors
[Dr. Rogerson] 8:58 pm: not that much I do mine trough a 6-8 inch
incision but the patients I sent to Dr De Smet came back with 15 inch incisions and
did great also
[linda] 8:57 pm: Do you know which
approach Dr. Su uses?
[Dr. Rogerson] 9:01 pm: I’m pretty sure Dr. Su uses the posterior
approach since he did a surgical demo at the Miami meeting using
it
[Ken Lazur] 8:58 pm: Do you
cut any muscles or tendons with resurfacing?
[Dr. Rogerson] 8:59 pm: The short external rotators and the upper
one half of the gluteus max are incised and later repaired with the posterior
approach
[] 8:59 pm: another x-ray
question: what would you put for the reason for the x-ray
[Dr. Rogerson] 9:00 pm: follow-up
resurfacing hip replacement
[]What percent of your patients are from out of town?
[Dr. Rogerson] 9:02 pm: probably30%. we have
the HipHab program which is great for out of towners
[Dr. Rogerson] 9:04 pm: patients come for surgery and leave the
hospital on post op day 2 and go to a handicapped accessible appartment for
2x/day PT – one on land and the other in water. They leave at 6-7
days
[sroberts] 9:05 pm: it’s a great
facility
[] 9:03 pm: Do you have many patients post-op
with piriformis syndrome or sciatic nerve aggravation?
[Dr. Rogerson] 9:05 pm: no piriformis
that I’m aware . Have had 2 temporary sciatic irritations.
[] 9:03 pm: Can people send you an email with x-rays attached
digitally – or do you prefer that have an actually appointment in your
office?
[Dr. Rogerson] 9:07
pm: people almost always send me the x-rays and the medical history questionnaire
first and I then tell them if they are at least a candidate for resurfacing and
then they come in to see me
[Ken Lazur] 9:03 pm: Can you tell me if
you know Dr. Michael Langworthy in the Battle Creek Mich. area
[Dr. Rogerson] 9:05 pm: Don’t know Dr Langworthy
yet
[] 9:06 pm: any specific
post-op rehab exercises you recommend to avoid sciatic issues? We’ve had several
reports (including me) on surfacehippy.
[Dr. Rogerson] 9:10
pm: If the nerve is injured there are no specific exercise that really work
that well except for trying to continually actively that part. The muscles can
be electrically stimulated so they won’t atrophy while the nerve is growing
back. Time is the greatest healer when it comes to nerve
injuries
[Dr. Rogerson] 9:11 pm: Move the part and
time is the healer
[] 9:11 pm: That’s the truth!
Took 6 weeks to subside!
[Dr. Rogerson] 9:11 pm:
Good night all
[] 9:11 pm: Dr. Rogerson, Thank You again
for taking time to be with us.
[Dr. Rogerson] 9:11
pm: my pleasure
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