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This is a transcript of a
Live Chat in the Surface Hippy Chat Room with Dr. Gross on February 17,
2009
[Chuck] 7:01 pm: Hi Dr. Gross, what do you know
about Mid Head resection surgeries – when do you think they will be approved
here and can they be used for revisions for hip resurfacing
[Dr. Gross] 7:06 pm:
I have no idea when mid head resections will be available, there are many stem
uncemented arthoplasties available for revision of hip resurfacing. I am using
these now. These use 3″ uncemented
implants.
[jimb] 7:06 pm: is it possible to look
at x-rays after resurfacing to gage motions or ranges which might cause unveven
wear, impingenment, or dislocation?..i’ve seen people doing yoga and such after
hip surgery which might be okay for some placements and not
others
[Dr. Gross] 7:08 pm: Jjimb the x-ray does not determine the
range of motion
[Dr. Gross 2] 7:08 pm: in my
experience people with arthritis hips have significant loss of motion typically.
One year after hip resurfacing they return to the normal range of motion they
had before arthritis started.
[Dr. Gross] 7:09 pm: x-ray
component position does not determine activity level. At 6 months most activities
are ok, after 1 year all activities are ok.
[JohnC] 7:09 pm: Hi Dr Gross, Thanks for the great job you did
resurfacing my hip back in June. I am skiing hard on the new hip eight hours
every day, and it is going well. Understandably, this can make the new hip and
other aging joints a little sore. Some doctors have expressed concern about the
use of Celebrex and similar drugs regarding bone health and healing. Do you have
any thoughts on the use of Celebrex after a resurfacing.
[Dr. Gross] 7:10 pm: it’s ok to use celebrex or any other anti
antiinflamatories. At this point you can do anything you want.
[stevel] 7:10 pm: Is it OK to return to downhill skiing (at all
levels of skiing) at 6 months post-op?
[Dr. Gross] 7:11 pm: I would avoid the
most extreme levels of skiing moguls and double black diamond until one
year
[mariana]
7:10 pm: I had a cementless implant 4 months ago and all is well, but I still have
restrictions on certain movements, are these restrictions to protect the bone
growth into the implant or to protect the soft tissue repair?
[Dr. Gross] 7:12 pm: The soft tissue
repair. The ligaments are
primarily healed at 6 months and most activities can be resumed at 1
year.
[tofu] 7:13 pm: Any leg exercises that
should be stopped before surgery, to let the thigh muscles not be so “fit”, or
is that a non-issue?
[Dr. Gross] 7:14 pm: tofu: this is a non
issue
[mariana] 7:13 pm: what
activities should be deferred for a year post op?
[Dr.
Gross] 7:16 pm: Mariana: only the most extreme pounding and extreme range of
motion should be delayed for a year such as full contact hockey, ski diving and
the splits.
[bp] 7:15 pm: I’m a 60 year old small
female with osteopenia. I’m very active (windsurfing, kiteboarding, motorcycling,
skiing) . Both hips show bone on bone in x-ray. I’m on celebrex, but I think
it’s time. I want resurfacing but it seems it is not recommended for 60 and
over. Is resurfacing going to be an option?
[Dr.
Gross] 7:17 pm: bp: HSR is an option, I would recommend slower progression
activities post op and treatment for osteopenia. Your risk of femoral neck
fracture is only slightly higher than the normal 1%.
[TAYLOR_ED] 7:17 pm: I will be meeting
you in two months, April 22. There is still a certain level of uncertainty as to
whether or
not I am jumping too soon. When is it best to have resurfacing –
before the pain hits too hard or before then.
[Dr. Gross] 7:19 pm: Taylor_Ed: If your x-rays are bone on bone and your lifestyle is limited then
it is usually time for HSR. There is no harm in waiting unless you already have
extreme bone loss.
[TAYLOR_ED] 7:18 pm: I have good days and bad
days.
[shaun sexton] 7:18 pm: I have just about
finished the forms on your website needed for a free email consultation. Tasks
remaining include making copy of CD with my x-ray and taking to Fed-X station 30
miles away. My x-ray will be 6 months old this Friday, February 20, 2009. If it
is no longer usealbe after that date, I don’t want to bother you with it. May I
send my information via email rather than Fed-X.
[Dr. Gross] 7:20 pm:
shaun: 6 month x-rays are fine, you may e-mail them to Lee Webb instead of
sending them Fed Ex, also attach the forms. Her e-mail address is on the
website.
[mariana] 7:18 pm: how about stretching such as yoga with flexion
beyond 90 degrees?
[Dr. Gross] 7:21 pm: mariana: stretching and yoga can be done
at 6 months post op. You may bend past 90 degrees at 6 weeks post
op.
[David1201] 7:21 pm: HI Dr. Gross I
just crossed my six month point with your cementless resurfacing. I don’t even
know it’s in me compared to the other hip. No limp and I started jogging last
week. It’s been so long since I ran I pulled my calf muscle.
[Dr. Gross] 7:22 pm: David: Thanks for
the update and glad you are doing so well.
[tofu] 7:22 pm: Post surgery the first few days, can a bed be too
low? I know you are not supposed to bend beyond a certain point.
[Dr. Gross] 7:23 pm: tofu: Not
really with HSR, the hip is quite stable.
[emaxwell] 7:22 pm: how quickly after bilateral resurfacing can I
resume exercises such as riding a stationary bike or upper body
workouts?
[Dr.
Gross] 7:24 pm: emaxwell: You may do upper body workouts at any time,
stationary bike at 6 weeks with gradual progression.
[mariana] 7:25 pm: my recovery is going very well also, but I
still have start up pain and still have a slight limp is there any kind of rehab
to improve this?
[Dr. Gross] 7:25 pm:
mariana: How far post op are you?
[mariana] 7:26 pm: I am at 17 weeks post
op
[Dr. Gross] 7:28 pm: mariana: At this point you should be doing
side lying abductor exercises with weight, going to the gym using an abductor
weight machine, if you do not see improvement after doing one month of this I
would recommend a physical therapy referral.
[mariana] 7:29 pm: so the problem is the
abductors?
[mariana] 7:31 pm: I am doing
physical therapy now and have improved a lot but this has been difficult to
fix
[Dr. Gross] 7:32 pm: mariana: I suspect it
is your abductor muscle.
[bp] 7:27 pm: A recent article in Harvard
Women’s Health Watch referred to a study that found more femoral breaks in women
that had been on fosamax or actonel, citing an increase in brittleness. What are
your thoughts on this and would that affect resurfacing?
[Dr. Gross] 7:30 pm: bp: Fosamax has
been shown to decrease fracture risk in patients who are osteoporotic. We have
been using Fosamax for a year post operatively and have had no fractures in this
group to date. We still do not have enough follow up data to make a definite
recommendation about this. Hopefully in one more year we will be able to publish
our results.
[Bionic] 7:30 pm: Hi Dr. Gross: You
resurfaced my hip last Wednesday and I’m already feeling great! Fatigue from the
surgery is nearly gone. I’m just looking forward to moving from two crutches to
one, and getting moving again. Thanks so much for your fine
work!
[Dr. Gross] 7:32 pm: Bionic: Thanks
for the update, glad you are doing great. Don’t get tempted to over do things.
[Bionic] 7:35
pm: I’ll try to contain my enthusiasm. It’s just amazing how quickly the little
pains and twinges disappear and how quickly movement becomes
easier.
[gratefulgee] 7:32
pm: Do you recommend any type of exercise/strengthening regimen before
resurfacing surgery?
[Dr. Gross] 7:33 pm: gratefulgee: You can
practice on crutches, do upper body strengthening, and the Phase 2 hip
exercises.
[mariana] 7:32 pm: how long
after resurfacing is one at risk for femoral neck fractures?
[Dr. Gross] 7:34 pm: mariana: 6
months in my experience
[stevel] 7:32 pm: Is it OK to play racketball at 6 months
post-op?
[Dr. Gross] 7:34 pm:
stevel: Yes, start gradually.
[gratefulgee] 7:36 pm: For an out of
state patient (Ohio) how many and how often are follow-up visits
needed?
[Dr. Gross] 7:37
pm: gratefulgee: We prefer an on site visit at 6 weeks and 1 year, thereafter
all follow ups can be computer based. If you can not make the first 2 we can
also arrange to do these local but I prefer to see you in person.
[TAYLOR_ED] 7:37 pm: Can follow-up visits
be done remote with new XRAYs?
[Dr. Gross] 7:38 pm: Taylor_Ed: Yes,
follow up visits can be done remotely.
[mariana] 7:39 pm: are there any activities that you would not
recommend even after a year?
[Dr. Gross] 7:40 pm: mariana:
No, at 1 year there are no restrictions.
[TAYLOR_ED] 7:39 pm:
What is the average age of your resurfacing males? When is a replacement better
than resurfacing?
[Dr. Gross] 7:42 pm: Taylor_Ed: The average age of my patients
is 48. My opinion is after approximately 65 years of age. Diagnosis, bone
quality and bone defects are also important factors to consider.
[linejudge42] 7:40 pm: Hi Dr. Gross, In a past chat, you mentioned
that the resurfacing will not last a life time. You also mentioned that if you
run, the prothestic’s lifespan will be even shorter. Another leading surgeon has
also stated to me that this prosthesis will not last a lifetime. I am curious.
As the procedure in it’s current form has not been around very long, and there
is no data to say for sure it will fail (either the prosthesis or the cement),
is it just an opinion that it will fail at some point?
[Dr. Gross] 7:44 pm: linejudge42: I
never said it won’t last a lifetime, at this point we only have 8 to 10 year
data. Any statements about longevity are pure speculation. I suspect many HSRs
will last a lifetime.
[bp] 7:43 pm: Do you know
if it’s going to be a battle with Blue Cross Blue Shield to get resurfacing as
opposed to THP, and if so, what is the best approach?
[Dr. Gross] 7:45 pm:
bp: usually HSR is approved as readily as any other type of total hip
arthroplasty in my experience.
[emaxwell] 7:44 pm: at what point is
cup slippage no longer a significant risk in a cementless implant and how are
the first cementless resurfacings you did looking compared to
cemented?
[Dr. Gross] 7:46 pm: emaxwell: Do you mean the acetabular “cup”
or the femoral “cap”.
[emaxwell] 7:47 pm:
femoral cap
[Dr. Gross] 7:49 pm: emaxwell: Regarding the uncemented femoral
cap, at this point I have done over 600, the results are identical with the
results of the cemented femoral components. There have been no failures of bone
ingrowth to date. I have done 600 since March of 2007.
[linejudge42] 7:47 pm: Dr. Gross, will
a release be coming out soon on the 2 year results of your trials with the cementless resurfacing? Is there an expected release date?
[Dr. Gross] 7:50 pm: linejudg42: It will be
approximately one more year before we have enough follow up information to
publish these results.
[karenj_m] 7:48 pm: Hi Dr. Gross, Karen
Mitchell (04/02/08) here (your difficult case from Northern NY), just wanted to
thanks again for getting rid of my 20+ years of pain. I still continue to
improve, its amazing! Big hug to Lee and Nancy
[Dr. Gross]
7:50 pm: karenj_m: Thanks for the update and glad you are doing well.
[TAYLOR_ED] 7:49 pm: Have any of your patients reported groin pain
problems after BHR?
[Dr. Gross] 7:52 pm: Taylor_Ed: I do
not use the BHR, this is a brand name, I have less than 1% of patients with
residual groin pain, I believe this is due to psoas tendinitis. This can now
usually be avoided by careful acetabular component positioning.
[stevel] 7:52 pm: Can a misplaced socket (too
steep an angle) be revised to retain the femoral cap for a BHR
device?
[Dr. Gross] 7:55 pm: stevel: Yes,
usually a socket component of any brand HSR device can be revised while
retaining the femur, often a custom implant may be required. I would usually not
recommend revising just for a steep angle unless there are some
symptoms.
[karenj_m] 7:54 pm: Oh Dr. Gross, do you have
anything in the works if a HR fails? Like McMinn’s BMHR? Anything with
Biomet?
[Dr. Gross] 7:56 pm: karenj_m:
Biomet has a taperloc micro stem which is about 3 inches in length which we now
use when revising femoral neck fractures. Biomet has no plans for a mid head
resection device at this point.
[tomq] 7:55 pm: What symptoms are
associated with a hairline crack in the femur after a HR?
[Dr. Gross]
7:57 pm: tomq: New onset groin pain with weight bearing is the most common
symptom. If you have this, I would recommend you get on crutches, get an x-ray
every week until a diagnosis is made or symptoms resolve. No other imaging
studies are useful to make this diagnosis.
[bp] 7:56 pm: How much leg length difference be corrected with
resurfacing?
[Dr. Gross] 8:00 pm: bp: It depends, in the
vast majority of patients there is no significant increase in length in surgery.
In certain cases where there is a deep protrusio or a high riding head with
moderately severe dysplasia, I have lengthened the hip 1 to 2 cm, these are rare
cases. The surgeon should be able to tell from x-rays in advance.
[Pat Walter Moderator] 8:00 pm: Dr. Gross – Thank You for taking
time to chat with us. I know everyone appreciates your effort.
[Pat Walter
Moderator] 8:01 pm: We always learn something new during each
chat.
[Dr. Gross] 8:01 pm: I enjoyed the great
questions. I look forward to doing this again.
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