Latest Results

Dr. Gross performs multiple types of joint replacement including revision surgery. We monitor all of our patient’s results long-term. The American population is highly mobile, and 80% of our patients come from outside of South Carolina. But we still manage to maintain up-to-date follow-up in 96% of cases (many of our patients do not feel the need to follow-up since they have excellent results with no pain; even if this is the case, we still recommend routine follow-up). We periodically update results for the most common procedures performed.

Survivorship Curves: We use the Kaplan-Meier method. This takes into account patients being lost to follow-up as well as deaths due to unrelated causes. Each failure is time weighted by this method. The resulting curve provides the odds of an implant still being in place in the patient at any chosen time point from surgery. Joint replacements are not permanent. The longer that you follow a group of patients, the higher the failure rate that you record. It is very difficult to compare previous results to more recent cases because of the difference in follow-up. But if techniques improve, the survivorship curve of the latest group of patients will be higher and flatter than the previous group. The following results are some of the best in the world; see our publication section  for comparison of these results to other surgeons.

1. Hip Resurfacing

We include three distinct groups for your review. The first was the Corin Hybrid from 2001-2005, the next was the Biomet Hybrid 2005-2007, and the final is the Biomet uncemented which we have used since 2007. You can see that results are improving in each group. It is difficult to prove the exact reasons for improvement. Some surgeons advocate patient selection to improve their results (perform total hips instead of resurfacing on higher risk patients). I disagree with this approach. I have focused on studying the root causes of hip resurfacing complications and then modifying both techniques and implants to improve results in all patients. My goal is to allow all patients to realize the advantages of hip resurfacing. The rising survivorship curves in unselected patients prove that my philosophy works.

  • Survivorship curve for all three implants, as of 2016. Note that the survivorship y-axis begins at 85%.
  • There have been NO instances of adverse metal wear since perfection of our RAIL guidelines in 2009.

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  • Below are survivorship curves seperated by age. Note the difference in y-axes. P-values less than 0.05 indicate that each new implant has outperformed its precursor, with our current uncemented ReCap option presenting the greatest survivorship.
  • Many centers report greater rates of failure in young, active patients than in their elderly population. Our surgical technique gives us better results than these centers, and we pride ourselves in providing an arthroplasty option which allows young patients to maintain their high levels of activity without compromise to implant durability.
  • Survivorship for the Cemented (C) ReCap implant at 10 years is 96% for patients over 50 and 97% for patients under 50 (no statistical difference)
  • Survivorship for the Uncemented (UC) ReCap implant at 8 years is 99% for both age groups.

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  • Our Biomet implants outperform the outdated Corin device. Below shows results of this device (cemented and uncemented included) grouped by gender. Note the y-axis BEGINS at 95%.
  • Many hip replacement surgeons opt to exclude women from receiving surgery because of poor published results. We, however, elected to find out WHY implants in women were underperforming and to CORRECT implant design and surgical technique instead of excluding women from surgery. After implementation of new protocols from 2007-2009, outcomes in women at our center have improved drastically (see our  publication section ). With continued collection of results, women are on track to present similar survivorship outcomes as men at our practice.

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2. Total Hip Replacement

The need for hip replacement continues to shrink as the complication rate for resurfacing falls. Hip resurfacing started out as a temporizing measure for younger patients to preserve bone. Most surgeons still prefer plastic bearing hip replacement to hip resurfacing. My first choice is usually hip resurfacing. In the few patients that are not good resurfacing candidates, my next choice is large metal bearing total hip replacement. Hip dislocations are completely eliminated by this choice. Other surgeons are reluctant to use these implants because of a fear of adverse metal wear related failure (AWRF). This has been a common failure mode among some brands (DePuy ASR recall 2010). But this a rare problem with the Biomet design. AWRF is now completely avoidable if you take advantage of our recent published data on proper cup positioning. A 28mm plastic bearing hip carries a 4-5% dislocation risk and requires permanent restrictions. I generally perform hip replacement in the very obese (BMI >35), patients older than 70 years, those with severe osteoporosis, or severe bone deformities.

  • Survivorship curve for Magnum THR
  • Failures n=198
  • Complications n=198

3. Revision of Hip Resurfacing

More complicated than primary surgery. Our results are very close to those of our primary resurfacing cases. Our most problematic group is revision for loose acetabular components. Other surgeons have had extremely poor results in revision for adverse wear related failures (AWRF). Using an approach of limited debridement and repositioning of new metal bearing acetabular components in more ideal inclination angles we have had a 100% success rate in this problematic group.

  • UPDATED PUBLICATION (as of 2016) IN DRAFT WILL INCLUDE:
  • Survivorship curve
  • Failures
  • Complications

4. Total Knee Replacement

Publications and data coming soon. Please see our Current Topics and Related Links on the subject.

5. Complex Revision Total Knee Replacement

Publications and data coming soon. Please see our Current Topics and Related Links on the subject.

Phone Consultation

If you are interested in determining if you are a candidate for surgery, please mail your completed new patient forms to the office and include a digital x-ray.

Dr. Gross will call you back to discuss your options.

Download New Patient Forms

Located in South Carolina

Irmo Office

1013 Lake Murray Blvd.
Irmo, SC 29063

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Columbia Office

1910 Blanding St.
Columbia, SC 29201

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