I joined Midlands Orthopaedics in Columbia, South Carolina in 1994. My practice includes:
- Hip resurfacing
- Revision of failed hip resurfacing
- Minimally invasive hip and knee replacement
- Custom implants
- Unicompartmental knee replacement
- Large bearing metal-on-metal hip replacements
- Uncemented total knee replacement
- Revision of failed hip and knee replacements
I lead the nation in hip resurfacing. I began performing metal-on-metal total hip resurfacing arthroplasty (HRA) in 1999. With the retirement of Dr. Harlan Amstutz, I now have the longest track record of performing this operation in the United states. I have performed over 6500 HRA, which is the fourth largest series in the world. In the rare patients that are not resurfacing candidates, I perform large metal bearing total hip replacements (THR). Patients who are worried about rare adverse metal wear failures can choose a ceramic / cross-linked polyethelene THR also done using a minimally invasive technique.
My published track record is one of the best in the world. In unselected patient series of hip resurfacing, we have 89% 20-year implant survivorship with the Corin Hybrid system, 95% 16-year implant survivorship with the Biomet Hybrid system, and most recently 99% 13-year survivorship with the uncemented Biomet systems. Most recent 10-year implant survivorship is 99.7% in men and 99.2% in women. For large metal bearing total hips, survivorship is 97% at 8 years.
I have pioneered many advances in hip resurfacing:
- The worlds first fully porous uncemented components
- Prevention of of early femoral failures (current rate of 0.15%)
- Elimination of acetabular fixation failures in dysplasia (none since 2007)
- The worlds only scientifically robust guideline for acetabular component positioning
- Intraoperative x-ray technique for achieving accurate acetabular component position
- Elimination of adverse wear failures (pseudotumors) (none in hips done since 2007)
- Minimally invasive posterior approach (4inch incision)
- Outpatient surgery (no hospital stay)
- Successful revision surgery for hip resurfacing (96% 6-year survivorship)
Hip resurfacing is the best solution for near normal reconstruction of the hip joint in severe arthritis. It is more complex to perform than standard hip replacement. Many excellent hip replacement surgeons have become interested in hip resurfacing in the last 10 years but have given up performing this operation because they encountered too many complications. This has led many experts to claim that “hip resurfacing does not work”. But a number of surgeons worldwide have been able to show superior results with HRA as compared to THR. Currently there are probably less than 10 surgeons in the US who continue to perform significant numbers of these cases with good results. If you are interested in the higher functional potential of this operation, be careful to choose your surgeon wisely.
I also perform knee replacement using the latest techniques. Uncemented femoral components, uncemented tibial components in young patients with strong bone, antioxidant stabilized cross-linked polyethelene tibial bearings, MRI based guidance systems to optimize alignment. Partial knee replacements are also possible in certain patients with arthritis limited to one compartment of the knee. These are now also available as outpatient surgeries in selected young healthy patients.
Although I practice in South Carolina, most patients are from out of state and even from overseas. Typically only a few day stay in Columbia is required. We have perfected remote perioperative patient management. Typically only the immediate preoperative, the first postoperative follow-up at 4-6 weeks and the second at 1 year are done in Columbia. Long-term follow-up is continued remotely.
I developed the first fully uncemented hip resurfacing device with Biomet. I have been using it since 2007 with an excellent track record. I also developed the Biomet Magnum large metal bearing total hip replacement system, one of the few of this class that have a high success rate (Depuy and Zimmer recalls). I was the lead investigator of the first US FDA trial of hip resurfacing leading to approval of the Hybrid Corin Cormet 2000 device in 2007.
I completed a fellowship in joint replacement with Dr. William Bargar, Sacramento, California one of the world's foremost experts in custom implants and surgical robotics. Prior to that I spent 10 years at Johns Hopkins University for medical school and orthopaedic training.