1.) Hi Dr. Schmalzried, 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 trained at UCLA during the time that Harlan Amstutz was there. I subsequently developed a canine model of hip resurfacing utilizing instruments and a prosthesis that I designed. I have been a surgeon is 3 different U.S. FDA trials of hip resurfacing systems.
Dr. Schmalzried
2.) Do you do the neck capsule preservation technique in your surgeries?
A more appropriate term is joint capsule, not neck capsule. I do preserve this as well as the synovium covering the neck. While this preservation of anatomy makes sense, at this time there is no data indicating that it makes a difference.
3.) 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?
For a surgeon who is good with that approach, resurfacing can be done. To date, there is no data directly comparing the risks and benefits of one approach to another for resurfacing. It’s really more about the skill of the surgeon than the approach.
4.) How long do you feel it takes for the bone to be fully healed, actually grow into the prosthesis?
There are a number of retrieval studies that demonstrate bone ingrowth can continue to accrue for up to 2 years in humans. Animal studies indicate that sufficient bone ingrowth to insure stability under physiologic loading occurs by 6 weeks in an implant that is initially well-fiwed.
5.) Barring any complications, how many days in the hospital will a patient normally stay?
2.
6.) What is your typical recovery time after resurfacing, what is your typical rehab protocol? 90 degree restriction? Walker” Crutches Cane? Amount of time? Blood thinners? TED stockings? Ice? PT?
The patient is the biggest variable in the process. “Fully recovered” is also patient dependent. Is the patient a homemaker or a professional athlete? I place no restrictions on my patients after surgery.
Segment on "The Doctors" March 24, 2010
7.) How long before a typical patient is allowed to drive a car, return to work?
As soon as the patient can get into their car, they can drive. Return to work is dependent on their occupation. Office job - within 2 weeks. Unrestricted heavy labor - after 3 months.
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?
Start impact activities at 6 weeks. Participate in impact sports after 3 months. No restrictions. All sports – you name it! One patient has even played basketball against me – and I don’t advise that for the faint of heart!
Dr. Schmalzried the Dunk
9.) What is your take on cementless (femoral) devices for resurfacing?
Promising if made well and implanted well.
10.) Do you have a cut off age for resurfacing patients or do you go on a case by case basis?
Case by case.
11.) What type of anesthesia do you use general or epidural or ?
Light general with a long-lasting epidural.
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?
Case by case.
13.) Do you do bilateral surgeries same day, if not how far apart do you recommend?
In some males with dense bone. Rarely in females (higher risk of FNF). Minimum 6 weeks in between.
14.) What device do you prefer to use for hip resurfacing?
The Conserve Plus or the Cormet implant.
15.) If you can’t perform a hip resurfacing – what THR device do you prefer and why?
Summit stem, Pinnacle cup – from DePuy, Johnson & Johnson.
16.) What do you consider an adequate number of surgeries for a doctor to be proficient at hip resurfacing?
I suspect that some skilled surgeons are good after only a few and some others never get it right. To date, there is no data to address this. A good surgeon with more than 50 cases is preferred, but a good surgeon with 5 cases is probably better than a marginal surgeon with 100 cases!
