Dr. Marwin Interview
Scott E. Marwin, MD, FAAOS– BHR trained Mc Minn 2006
3000 Hip Resurfacings to date***
Associate Professor of
Orthopaedic Surgery
NYU/Hospital for Joint Diseases
410 Lakeville Rd., #303
New Hyde Park, NY 11042
T: 516-216-5782
F: 516-216-5786
Website
What Hip Resurfacing Device Do You Prefer?
Smith and Nephew Birmingham Hip Resurfacing Implants (BHR)
What Surgical Approach Do You Use?
I use the Direct Lateral Approach to the hip. This is an anterior dislocation. I like the approach because it increases stability (reduces dislocation), AND provides excellent exposure of both the acetabulum and femoral head.
Do you have a cut off age for resurfacing patients or do you go on a case by case basis?
65 for males. 55 for females. Plus, I will not resurface a female who is child bearing age. Therefore, the window for females is very small in my practice. Also, any female I operate on must have bone densitometry. The study must
be normal.
How do you feel about cementless devices? Do you prefer cemented and why?
What I really prefer is to follow the well developed data supporting the BHR including fixation techniques. Therefore, I like the cemented femoral component and the noncemented acetabular component. This is a technique developed by years of trial-and-error by McMinn and Traecy. The technique is supported by data internationally. I’m not interested in any noncemented
femoral fixation.
Does the length of incision influence the rehabilitation?
I use a standard total hip skin incision of approximately 4 – 5 inches. I do not do MIS (minimal skin incision).
Does the length of incision influence the rehabilitation?
Rehabilitation is NOT affected by skin incision length in my practice.
Do you preserve the hip capsule during your hip resurfacing surgeries?
Because I do a direct lateral approach, NO capsule is resected. In other words, the entire capsule is preserved.
What is your typical recovery time after resurfacing, what is your typical rehab protocol? Crutches for ? amount of time? 90 degree restriction?
Functional recovery is actually an individual issue. However, it is amazing how fast my patients recover compared to similar patients who have total hip replacements. Hip precautions including 90 degree restrictions are lifted at 2
weeks following surgery. I start the patient on crutches weight bearing as tolerated right after surgery. I wean the patient to a cane then to nothing as fast as possible. I want the patient off all aides 4 – 6 weeks after surgery. Actually, I want them driving their car within 3 – 4 weeks after surgery. I want my patients in outpatient PT as fast as possible. There is no neck fracture.
What is your typical recovery time after resurfacing, what is your typical rehab protocol? Crutches for ? amount of time? 90 degree restriction?
Functional recovery is actually an individual issue. However, it is amazing how fast my patients recover compared to similar patients who have total hip replacements. Hip precautions including 90 degree restrictions are lifted at 2
weeks following surgery. I start the patient on crutches weight bearing as tolerated right after surgery. I wean the patient to a cane then to nothing as fast as possible. I want the patient off all aides 4 – 6 weeks after surgery. Actually, I want them driving their car within 3 – 4 weeks after surgery. I want my patients in outpatient PT as fast as possible. There is no running or jumping for 6 months to reduce the risk of femoral neck fracture.
What type of anesthesia do you use general or epidural or ?
I use general anesthesia because I want the
patient paralyzed to adequately move the lower extremity to get
exposure.
How long do you feel it takes for the bone to be fully healed, grow into the prosthesis?
6 weeks for bone to grow into the acetabular
component. 6 months for the femoral neck to adequately remodel
What is the recommended time you tell your patients before they can start to run again/do impact sports?
Running and jumping starts at 6 months. None
before 6 months to reduce the risk of femoral neck fractures.
Where did you train for resurfacing? Who trained you?
I trained in Birmingham, England with Derek
McMinn
A patient can go to
orthodoc.aaos.org/scottmarwin to learn about my practice.