Dr. De Smet Interview, Ghent, Belgium

1.) Hi Dr. De Smet, can you please first start out by telling us how you got started with Hip Resurfacing and give us a little background on your experience as a surgeon. Where did you train for hip resurfacing? Who trained you? Did you continue your training after starting resurfacing?
I saw 3 surgeries with DR.MCMINN in 1997. Started doing it myself 10 years ago 11th of September 1998. Have done more then 3000, and changed a lot since then with the best scientific base with not any reason based on money!
Conservative to the bone stock!!

SmetPhoto: Dr. De Smet

2.) Do you do the neck capsule preservation technique in your surgeries?
That is my invention, in the beginning everybody laughed, now everybody is talking about. It is been proven by the Oxford University that the modified posterior approach, much more then the neck capsule preservation, is needed when surgeons do the best approach to do a resurfacing with the BEST exposure to prevent MALPOSITIONING, which is the biggest worry in resurfacing today.

3.) Which approach do you prefer to use anteriolateral or posterior?
Anterolateral I did for 5 years in over thousands procedures. Have stopped this because of abductormuscles problems!

4.) What is your opinion on the Direct Anterior approach for hip resurfacing, not the antero-lateral approach where the incision is on the side but the Direct Anterior approach?
Direct anterior approach for hip resurfacing is marketing! Dr. or Prof. Piriou from Paris, the school that has over more then 30 years of experience with this approach, thousands of hips done by this approach thinks that resurfacing will fail and stopped being done! It is for me certain that this approach is only a marketing tool but crazy to use in the largest indication of resurfacing, being the young male muscular patient. The Birmingham group and myself do not see any problem with posterolateral approach, so why change.

5.) How long do you feel it takes for the bone to be fully healed, actually grow into the prosthesis?
6 to 9 weeks for the cup. For the bone to be fully healed at the femoral side it is 1 year

6.) Barring any complications, how many days in the hospital will a patient normally stay?
2 days after surgery

7.) What is your typical recovery time after resurfacing, what is your typical rehab protocol? 90 degree restriction?
No? THERE ARE NO RESTRICTIONS ANYMORE
Walker” Crutches Cane?
10 DAYS 2 CRUTCHES, 10 DAYS 1 CRUTCH
Amount of time? Blood thinners?
3 WEEKS SUBCUTANEUOUS HEPARINES
TED stockings?
3 WEEKS BELOW KNEE
Ice?
PT

8.) How long before a typical patient is allowed to drive a car, return to work?
2 WEEKS TO DRIVE A CAR. RETURN TO WORK DEPEND ON WHAT IT IS.

9.) What is the recommended time you tell your patients before they can start to run again/do impact sports?
3 MONTHS
Are there any sports you don’t want your patients to participate in after surgery?
NEVER ADVICE SOMETHING, NEVER FORBID SOMETHING.
Out of the patients you have resurfaced what are some of the sports they have returned to?
ALL WHAT YOU CAN THINK ABOUT.

10.) What is your take on cementless (femoral) devices for resurfacing?
HAVE MYSELF DESIGNED ONE WITH WRIGHT MEDICAL, but I am always honest! We should wait 3 years at least to be sure if it is working well, and even then! Today we have 10 years follow up with the cemented and it is doing great. It is possible it will be better, but we do not know yet!

11.) Do you have a cut off age for resurfacing patients or do you go on a case by case basis?
Case by case! Oldest female is 81, have not had any fracture in females in over more then 3000 cases, male patients 79 years of age!

12.) What type of anesthesia do you use general or epidural or ?
General or combined! Only epidural is not good enough for resurfacing!

13.) Are there any cases that you will not take in particular, AVN, dysplasia, small cysts. Maybe touch on some of the very difficult cases you have been able to resurface.
I have done anything with good results last 10 years. Some rules have to be followed. If done, resurfacing works well.

14.) Do you do bilateral surgeries same day, if not how far apart do you recommend?
I have done practically 100, and it works great. If not, 6 weeks should be left in between.
 
15.) What device do you prefer to use for hip resurfacing?
Today Conserve plus because it shows to be better then BHR, certainly in female patients. All other designs have not the 10 year follow up so we do not know yet!

16.) If you can’t perform a hip resurfacing – what THR device do you prefer and why?
Ceramic on ceramic Delta BIG HEADS, Works wonderfull!! Can probably stay for 100 years!

17.) What do you consider an adequate number of surgeries for a doctor to be proficient at hip resurfacing?
I have now done more then 3000, still find it difficult to do!