Interviewed by Vicky Marlow February 7, 2008

What approach do you choose to use the posterior approach or anterior and why?
I use the posterior approach to the hip for resurfacing arthroplasty for a couple of reasons. It is felt to be a 'muscle sparing' operation which in younger and more active patients is advantageous. The other reason is that it is the approach with which I am most familiar. It gives me the ability to place the components in their appropriate location/alignment with the best visualization. I believe that either approach is acceptable and that a surgeon should use the approach that is most familiar/comfortable for them to implant the prostheses appropriately.

Photo: Dr. Cindy Kelly MD

How long do you feel it takes for the bone to be fully healed, grow into the prosthesis? What is the recommended time you tell your patients before they can start to run again/do impact sports?
I feel that it takes on average 6 - 12 months for the bone to fully ingrow with the acetabular component. Many patients show radiographic evidence of ingrowth in the 3 month range but the majority take 6-12 months to show maximum ingrowth of bone. The amount of impact to which the prosthesis is subjected has some bearing on the rapidity of ingrowth also. I advise my patients not to run or engage in high impact for 6 months post-operatively. The femoral neck regains its strength at that point in time.

What is your take on cementless devices for resurfacing?
My current preference is to use a 'hybrid' type of resurfacing with a press fit porous ingrowth acetabular component and a cemented femoral head component. Currently research has shown this is the optimal combination for longevity and survival of a hip resurfacing arthroplasty. Mr. Derek McMinn has shown cementation of the femoral component to be more successful over cementless/press fit femoral head components.

Which resurfacing device do you prefer to use and why?
I prefer to use the Birmingham Hip Resurfacing arthroplasty components because they have the longest track record and the success rates are excellent. I have also use the Conserve femoral head resurfacing component for hemi-resurfacing.

Do you have a cut off age for resurfacing patients or do you go on a case by case basis?
I evaluate each patient individually and consider many factors including age when advising a patient to undergo a hip resurfacing vs. total hip arthroplasty.  Age is only one factor (albeit important) that goes into the decision making for resurfacing arthroplasty.  Other considerations are patient activity levels, activity expectations and aspirations, bone density, medical history and medical conditions, medications used on a chronic basis and body habitus in addition to other factors.

Do you preserve the neck capsule?
I do preserve the neck capsule and repair it at the conclusion of the operation. I think it helps maintain blood supply and also decreases the risk of dislocation in the early post-operative period.

What size incision do your normally give your patients for resurfacing?
The incision size varies depending on the patient's body habitus but my intent is to make it as short as possible yet allow for visualization of the operative filed and appropriate implant alignment and placement.

What is your typical recovery time after resurfacing, what is your typical rehab protocol? Crutches for ? amount of time? 90 degree restriction?
The typical recovery is 3 days in the hospital (2-4 days range) with patients up and out of bed with physical therapy as soon as possible.  Patients begin to weight bear as tolerated immediately and use crutches for as long as they are needed for comfort and safe ambulation. Most patients feel using crutches for about 3 weeks is advantageous for ease of walking and speeding recovery. I advise patients to follow the 90 degree restriction for 6 weeks.

What type of anesthesia do you use?
The anesthesia of choice at my hospital is a spinal anesthetic admixed with a long acting narcotic (Duramorph) and then a general anesthetic for the case. The purpose of the spinal anesthetic is to decrease the amount of general anesthetic delivered by the anesthesiologist and more importantly to aid in pain control post-operatively.  The spinal narcotic allows for significantly less narcotic to be used in the first 24 hours post-operatively. An epidural anesthetic is also a possibility but we have had great success with the spinal narcotic approach for pain control.

Where did you train for resurfacing? Who trained you? Did you observe after the initial training and/or do cadaver labs prior to your first patient?
I trained in Calgary, Canada with Jim Powell MD and prior to doing my first BHR did a cadaver implant and have subsequently been to another meeting that incorporated a cadaver lab. All of these experiences have been very informative and educational.