- When should I consider a resurfacing?
- How many resurfacings have you done? (not observed or assisted with or including hemi-resurfacings)
- Where did you train?
- How many complications have you had?
- What are the general complications of total hip replacement surgery?
- How many times during surgery have you had to change to a THR instead of a resurfacing and why was the change made?
- For what reasons would you switch from resurfacing to a THR after starting the surgery? If you switch, what device would you be using for a THR?
- What hip resurfacing device (prosthesis) do you use, how long have you been using it and why do you prefer it?
- Do you use cemented or uncemented? Why?
- Do you cement the stem?
- Will you be preserving my hip capsule?
- What anesthetic do you use?
- How long does the surgery take?
- What is the incision length?
- What are the specific risks of hip resurfacing compared to standard hip replacement using a ceramic on plastic bearing?
- What is your post-op protocol?
- What drugs/methods do you use for anti-coagulation after surgery?
- How long will I be in hospital?
- Find encouragement in our back in the game stories:
- Why should I have my surgery at the Hospital for Special Surgery?
When should I consider a resurfacing?
Hip resurfacing is a treatment option of young and active male patients. Whether or not to perform this surgery requires a careful evaluation of your individual situation and demands.
- Standard total hip replacement
- Resurfacing is most suitable for patients under the age of 55.
- No age restrication
- Postoperative: Tennis, Golf, Biking, Hiking
- Working out in the Gym
- Short distance (up to 2-3 miles) light jogging
- Postoperative: long distance running or competitive sport (Basketball in a league)
- Full contact fighting, Judo, etc.
- Waterski, surfing
- Extreme mogul skiing or Heli-skiing
- Construction work, work on roofs or unsafe environments?
- Repetitive Heavy Lifting (>75 pounds)
- Risk of postoperative dislocation?
- Repetitive Heavy Lifting (>75 pounds)
- Almost 0
- <1 %
- Minimally invasive?
- Higher revision rate for patients over the age of 60?
- Metal on Metal side effects like elevated metal ion blood levels?
- Yearly Follow up appointments required to check x-rays and metal ion levels
How many resurfacings have you done? (not observed or assisted with or including hemi-resurfacings)
Dr. Boettner has performed more than 600 metal on metal hip resurfacings since 2006.
Where did you train?
Dr. Boettner got certified to do Birmingham Hip Resurfacing after completing the BHR training course in Charlotte, NC in December 2006. After a trip to Dr. DeSmet in Gent, Belgium, he started to do hip resurfacings in February 2007. Dr. Boettner has also visited a number of hip resurfacing surgeons, including Derek McMinn, over the years to improve my technique. He has lectured on hip resurfacing and has trained surgeons in this technique.
How many complications have you had?
Dr. Boettner has performed over 600 hip resurfacings. He has had the following complications (1/1/2021)
- Cup Malposition requiring revision: 2 patients
- Elevated metal ion levels in male patients requiring revision: 2 patients
- Femoral Component loosening: 2 patients
- Femoral neck fracture within the first 5 years: none
- Deep Implant infection requiring implant removal: none
What are the general complications of total hip replacement surgery?
Although we have not seen a dislocation in our patients, Dr. Boettner assumes there is a small risk of dislocation following Hip resurfacing. Further complications of surgery can include intraoperative fracture, deep implant infection, blood loss requiring blood transfusion, leg length discrepancy, wound drainage, early femoral component loosening, implant loosening over time secondary to wear of the components or loss of fixation. Nerve injuries of larger nerves, like the femoral or sciatic nerve are possible and can result in significant pain, functional limitation (foot drop, knee weakness) and long term chronic sympathetic pain syndromes. Medical complications like deep venous thrombosis are possible and you will be placed on a blood thinner (usually aspirin). More serious complications like a pulmonary emboli, heart attack and stroke, etc. as well as bleeding complications are relatively rare. Our preoperative clearance program reduces the risk of serious complications significantly, and almost all of our patients today will avoid major medical complications because of our thorough preoperative medical work up.
How many times during surgery have you had to change to a THR instead of a resurfacing and why was the change made?
Once in a patient with severe AVN. He was 28 and had been on systemic steroids for most of his life. During the surgery Dr. Boettner was uncomfortable with the amount of necrosis (>50%) as well as the quality of the remaining bone and decided against hip resurfacing.
For what reasons would you switch from resurfacing to a THR after starting the surgery? If you switch, what device would you be using for a THR?
In general, Dr. Boettner will know preoperatively if a patient is a candidate for hip resurfacing. Factors like age, gender, activity level as well as bone quality and bone shape on the preoperative x-ray help him decide if a patient is a candidate. Occasionally one might encounter weaker bone than expected or face significant bone necrosis in patients with avascular necrosis. If he is at all worried that he might not be able to do the resurfacing he will discuss this prior to surgery to include the patient in the decision process.
If a hip resurfacing is not possible Dr. Boettner will use a ceramic on plastic standard total hip replacement.
What hip resurfacing device (prosthesis) do you use, how long have you been using it and why do you prefer it?
Dr. Boettner has been using the FDA approved Birmingham Hip Resurfacing (BHR) by Smith and Nephew since 2006. Dr. Boettner prefers the BHR because of its FDA approval status, its proven track record and number of publications that have confirmed its excellent long-term outcome. He started using the BHR resurfacing in 2007.
Do you use cemented or uncemented? Why?
Dr. Boettner use cemented femoral component fixation (resurfacing on the femur) and uncemented press fit fixation for the acetabular component (“socket”). The excellent long-term results of cemented femoral component fixation published in the literature and his own experience suggest that there is no benefit in switching to uncemented fixation.
Do you cement the stem?
Dr. Boettner does cement the stem in patients with poor bone stock, with very small femoral components or patients he considers at incfreased risk for neck fracture. The literature seems to suggest that cementing the stem can reduce the risk of neck fracture in high risk patients. He also might consider cementing the stem in patients with avascular necrosis. However, he does not cement the stem in the majority of his patients.
Will you be preserving my hip capsule?
Yes. Dr. Boettner preserves the capsule and repairs it at the end of the procedure.
What anesthetic do you use?
At the Hospital for Special Surgery almost every Resurfacing Procedure is done using hypotensive spinal anesthesia. This minimizes intraoperative blood loss, decreases the risk of blood clots and is also better tolerated by the patient than general anesthesia. Dr. Boettner also uses an intraoperative injections to minimize local pain.
How long does the surgery take?
Usually the surgery takes 45-60 minutes.
What surgical approach do you use? Anterior or Posterior?
Posterior Approach. There is no benefit of the anterior approach for resurfacing. All high volume hip resurfacing surgeons perform hip resurfacing through a posterior approach.
What is the incision length?
12-20 cm. Hip resurfacing requires adequate exposure for perfect implant position. While Dr. Boettner makes as small an incision as possible he see little benefit in compromising component position for the sake of a minimal incision.
What are the specific risks of hip resurfacing compared to standard hip replacement using a ceramic on plastic bearing?
A Hip Resurfacing is a metal on metal hip replacement. Because of its bearing components there are some specific risks to this type of surgery:
- Metallic Wear Particles: Aside from the usual and customary surgical risks, metal-on-metal hip implants carry additional risk. The implants are made of an alloy of Cobalt and Chromium (metals). The implants are made to be as frictionless as possible. However, everyday activities will inevitably create some friction and wear which can then result in metallic particles from the implant being released into the tissues surrounding the hip joint. In addition, residual matter from the metal particles may be absorbed and circulated through the bloodstream.
- Pain, Swelling and Inflammation: In certain circumstances metal-on-metal implants may generate more metallic wear particles than usual, causing build-up of metallic wear particles around the hip. This may cause pain, swelling and inflammation (“pseudotumor”) around the hip joint. Damage to the tissues around the hip joint is also possible. Revision surgery to remove the metallic wear particles and replace the metal-on-metal implant may be necessary to correct this problem.
- Allergic Reaction to Metal: Some patients have developed an allergic reaction to the metallic wear particles. The symptoms of an allergic reaction can be pain, swelling, and tissue damage. This can occur even when the amount of metallic wear particles is in the normal range. If a patient suffers an allergic reaction, revision surgery can be necessary to remove and replace the implant. Currently, there is no proven test to predict the risk of an allergic reaction.
- Organ Systems Issues: There have been reports of organ systems being affected, when metal ion levels in the bloodstream are higher than expected for a patient with a hip resurfacing implant. Vision, hearing, heart, brain and endocrine functions can also be affected. Some symptoms that have been reported include: blurry vision, loss of hearing, palpitations, loss of concentration, hypothyroidism and decreased kidney functions. If these symptoms develop after surgery, revision surgery to remove the metal-on-metal implant is necessary.
- Fetal Development and Women of Childbearing Age: There is limited data on the effects of circulating metal ions in the bloodstream upon fetal development. Therefore, it is not recommended that women of child-bearing age have a metal-on-metal implant. If a woman of child-bearing age were to have metal-on-metal implant, it is recommended that the amount of metal ions in the blood be checked prior to getting pregnant.
- Patients with small bones and therefore smaller components, patients with misaligned components, women and patients with preexisting metal ion allergies might be at increased risk for above complications. Currently the BHR resurfacing only is available for head sizes of 48 mm and above. If your hip is smaller, a resurfacing is not a good treatment option for you.
Although potential benefits of opting for a hip resurfacing over a total hip replacement include: higher post-surgical activity levels and reduced dislocation rates, it has to be assumed that revision rates are higher at 20 years compared to standard total hip arthroplasties.
What is your post-op protocol?
You will start intensive range of motion early after surgery to make sure you do not get stiff. We will discuss the specific exercises while you are in the hospital. Usually by 3-4 weeks you should be able to have excellent flexibility.
You will stay on crutches full weight bearing for the first 3 weeks to protect your femoral neck and allow it to adjust to the new implant.
Usually after 1-2 days you will not need any narcotic medication during the day. You can drive a car whenever you are comfortable and are off narcotic medications.
What drugs/methods do you use for anti-coagulation after surgery?
We use coated Aspirin 325mg twice a day for the majority of our patients. Please tell Dr. Boettner if you had a history of a blood clot or pulmonary emboli.
How long will I be in hospital?
Almost all of our patients will have this procedure outpatient.
Find encouragement in our back in the game stories:
Please find our back in the game stories on the HSS website. https://backinthegame.hss.edu/
Why should I have my surgery at the Hospital for Special Surgery?
Please find more information about the Hospital for Special Surgery here www.hss.edu/reasons-to-choose-hss.asp
Learn more about total hip resurfacing at hss.edu link: www.hss.edu/