Dr. Justin Cobb (Professor), United Kingdom
1.) Hi Dr. Cobb, 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 went to see derek mcminn operate, and scrubbed in to understand how to do the operation in 2000. since then, i have been on the faculty of courses on resurfacing in the usa and canada as well as in europe and australia.
i have been to Garche outside paris to watch the Judet technique. it is possible for excellent surgeons, but would be impossible without the right equipment
2.) Do you do the neck capsule preservation technique in your surgeries?
i perform a circumferential capsulotomy, and reattach the posterior capsule using ethibond through bone sutures to the capsule and rotators, and to the glut max tendon
3.) Which approach do you prefer to use anterolateral or posterior?
i use a posterior approach
4.) What size do your incisions normally range in inches?
the incision length depends upon the size and musculature of the patient - between 4 and 10 inches on occasion. but the important point is how gentle you are being with the tissues, not how long the cut is
5.) Barring any complications, how many days in the hospital will a patient normally stay?
3-5 days depending on many factors. in the nhs, usually 3 days, privately it depends on who is paying for every extra night.
6.) What is your typical rehab protocol? 90 degree restriction? Walker” Crutches Cane? amount of time? Blood thinners? TED stockings? Ice? PT
'normal' rehab is for weight bearing as tolerated from day 1, no 'charnley' restrictions at all, so no 90° restriction, can sleep on side as soon as comfy. oral anticoags only, only extended if indicated.
7.) How long before a typical patient is allowed to drive a car, return to work?
driving depends on leg: right leg min 2 weeks, left leg if automatic, then as soon as they can get in and out safely and quickly.
8.) What is the recommended time you tell your patients before they can start to run again/do impact sports? Are there any sports you don’t want your patients to participate in after surgery? Out of the patients you have resurfaced what are some of the sports they have returned to?
not running or impact for 6-8 weeks. people do what they feel good doing, so lots of skiing, climbing, running etc
9.) What is your take on cementless (femoral) devices for resurfacing?
i only cemented 2 femoral components since 2003, and then only because the ha coated wasn't available. no problems without cement at all
10.) Do you have a cut off age for resurfacing patients or do you go on a case by case basis?
no absolute cut off. a 78 year old woman came for her 8 year check and wanted the other side resurfacing.... am trying to talk her out of it..
11.) What type of anesthesia do you use general or epidural or ?
anaesthesia is an anaesthetic choice. often epidural or spinal and v light ga
12.) 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 am sending a link to a tough case. because we always use 3d planning preop, we make the tough choices on the computer, not in the theatre.
anyone can have their hip planned, like architects plans, you can see them on the acrobot link
for people who have had a resurfacing and it hasn't worked out, it could be an asr, or it could just have been done not perfectly. this can be hard to measure, and accept. we offer an objective service that can help. check out www.jointanalysis.com
13.) Do you do bilateral surgeries same day, if not how far apart do you recommend?
bilat same day is fine for me
14.) What device do you prefer to use for hip resurfacing and why?
i use a cormet or an adept as they have good uncemented options. cemented hips have a higher mortality than uncemented ones, and offer no advantage in resurfacing in my experience. i have not revised one hip for loosening of the uncemented femoral component at all, in the last 7 years
15.) If you can’t perform a hip resurfacing – what THR device do you prefer and why?
i use a furlong with ceramic bearing as back up
16.) What do you consider an adequate number of surgeries for a doctor to be proficient at hip resurfacing?
it isnt the number its the technology. with image based navigation, my registrars are more accurate than 99% of trained surgeons