Frequently Asked Questions

Patient Education

Detailed hip information paper

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FAQ

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Interactive Patient Education

Patient education is an important process for health professionals and their patients to go through in an effort to give information to patients and their caregivers that can help in improving their health and quality of life. This tool is used by many physcians for general preventive education, health promotion, and to help patients better undersatnd their disease or condition.

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Scientific Publications
  • METAL-ON-METAL RESURFACING WITH AN UNCEMENTED FEMORAL COMPONENT.

    A seven-year follow-up study, J Bone Joint Surg Am 2008; 90 Suppl 3:32-7.

    Metal-on-metal hip resurfacing with hybrid fixation has been introduced as an alternative to standard total hip arthroplasty, especially for young and active patients. There are few studies in the literature on the midterm results of cementless femoral side resurfacing. The purpose of this study was to present our seven-year clinical results of a series of twenty cementless metal-on-metal hip resurfacing procedures.

  • MINIMALLY INVASIVE POSTERIOR APPROACH FOR HIP RESURFACING ARTHROPLASTY

    Techniques in Orthopaedics 2010; 25 issue 1: pp39-49.

    With the improvement of metal-on-metal bearings, hip resurfacing has become a viable option for hip arthroplasty in young patients. It is technically more complicated to gain access to the acetabulum while preserving the femoral head. In some countries, this type of bone-preserving hip arthroplasty is used in a substantial percentage of young patients.

  • INTRAOPERATIVE RADIOGRAPHS FOR PLACING ACETABULAR COMPONENTS IN HIP RESURFACING ARTHROPLASTY

    Clin Orthop Relat Res. 2011 Jun;469(6):1554-9.

    Various clinical and biomechanical studies suggest certain acetabular positions may be associated with higher wear and failure rates in modern metal-on-metal hip resurfacing arthroplasties. However, there are no widely available, reliable, and cost-effective surgical techniques that ensure surgeons are able to place an acetabular component within the safe range of inclination angles after hip resurfacing surgeries.

  • IS RESURFACING ARTHROPLASTY APPROPRIATE FOR POSTTRAUMATIC OSTEOARTHRITIS?

    Clin Orthop Relat Res. 2011 Jun;469(6):1567-73.

    High survival has been reported for resurfacing arthroplasty in patients with femoral deformities. Also, hardware removal may not always be necessary with resurfacing arthroplasty and may eliminate some of the difficulties performing total hip arthroplasty (THA) in patients with posttraumatic osteoarthritis

  • HIP RESURFACING IN PATIENTS WHO HAVE OSTEONECROSIS AND ARE 25 YEARS OR UNDER

    Clin Orthop Relat Res. 2011 Jun;469(6):1582-8.

    Young patients with osteonecrosis (ON) treated with THA often have suboptimal function and radiographic failure with eventual revision. Resurfacing may be an option because of potentially increased functionality and decreased radiographic failure, although neither has been confirmed in the literature.

  • COMPARISON OF UNILATERAL AND RAPIDLY STAGED BILATERAL HIP RESURFACING ARTHROPLASTY

    Acta Orthop Belg. 2011 Apr;77(2):203-10.

    The purpose of this study was to compare the clinical results and complication rates after unilateral vs. staged bilateral metal-on-metal hip resurfacing arthroplasty (HRA) when using a comprehensive blood management program, to determine if there was increased risk for staged HRAs.

  • COMPARISON OF FULLY POROUS-COATED AND HYBRID HIP RESURFACING

    A minimum two-year follow-up study, Orthopedic Clinics of North America.2011 Apr;42(2):231-9.

    The purpose of this study was to compare clinical and radiological outcomes of the first 191 fully porous-coated hip resurfacing arthroplasties with 96 hybrid hip resurfacing arthroplasties performed during the same period at a minimum 2-year follow-up to evaluate the initial fixation of uncemented femoral resurfacing components.

  • THE FIRST 100 FULLY POROUS-COATED FEMORAL COMPONENTS IN HIP RESURFACING

    Bull NYU Hosp Jt Dis 2011 Volume 69 (S1) - August 2011.

    Uncemented fixation of implants to bone is a proven technology in traditional hip arthroplasty surgery. However, cement fixation is currently the standard method for the femoral component in hip resurfacing.

  • PREVALENCE OF DYSPLASIA AS THE SOURCE OF WORSE OUTCOME IN YOUNG FEMALE PATIENTS AFTER HIP RESURFACING ARTHROPLASTY

    International Orthopaedics: Volume 36, Issue 1 (2012), Page 27-34.

    Smaller femoral component size has been implicated as underlying the risk factor that explains the higher failure rate in women who have a hip resurfacing arthroplasty (HRA). We suspect that the diagnosis of dysplasia may be a more important causative risk factor than either small component size or female gender.

  • CLINICAL OUTCOME OF THE METAL-ON-METAL HYBRID CORIN CORMET 2000 HIP RESURFACING SYSTEM

    AN UP TO 11-YEAR FOLLOW-UP STUDY J Arthroplasty. 2011 Sep 9. [Epub ahead of print].

    This report extends the follow-up for the largest center of the first multicenter US Food and Drug Administration investigational device exemption study on metal-on-metal hip resurfacing arthroplasty up to 11 years. A single surgeon performed 373 hip resurfacing arthroplasties using the hybrid Corin Cormet 2000 system.

  • RISK FACTOR ANALYSIS FOR EARLY FEMORAL FAILURE IN METAL-ON-METAL HIP RESURFACING ARTHROPLASTY

    THE EFFECT OF BONE DENSITY AND BODY MASS INDEX J Orthop Surg Res. 2012 Jan 10;7(1):1.

    The importance of appropriately selecting patients based on factors such as bone mineral density, body mass index, age, gender, and femoral component size has been demonstrated in many studies as an aid in decreasing the rate of revisions and improving the outcomes for patients after hip resurfacing arthroplasty (HRA).

  • IS THERE ADDED RISK IN RESURFACING A FEMORAL HEAD WITH CYSTS?

    Journal of Orthopaedic Surgery and Research. 2011 Oct 17;6:55.

    Femoral head cysts have been identified as a risk factor for early femoral failures after metal-on-metal hip resurfacing arthroplasty (HRA) based on limited scientific data. However, we routinely performed HRA if less than 1/3 of the femoral head appeared destroyed by cysts on the preoperative radiograph.

  • HIP RESURFACING WITH THE BIOMET HYBRID RECAP-MAGNUM SYSTEM

    7-YEAR RESULTS J Arthroplasty. 2012 May. [Epub ahead of print].

    The purpose of this study was to report our clinical outcome of a large series of metal-on-metal hip resurfacing arthroplasty (HRA) using the hybrid Biomet ReCap-Magnum system. This is a single-designer surgeon series with an average of 5 ± 1 years. Seven hundred forty consecutive hybrid HRAs were performed in 653 patients.

  • TOTAL KNEE ARTHROPLASTY WITH FULLY POROUS COATED STEMS IN THE TREATMENT OF LARGE BONE DEFECT

    J Arthroplasty. April,2013.

    Between February1999 and April 2006, 25 patients (28 knees) underwent a TKA by a single surgeon. At an average final follow-up of 7±2years (range, 3-10years), 34 (100%) of 34 fully porous stems had achieved bone ingrowth. However, one case (3%) had a component loosening due to the de-bonding of sheets of beads from the stem.

  • A SAFE ZONE FOR ACETABULAR COMPONENT POSITION IN METAL-ON-METAL HIP RESURFACING ARTHROPLASTY

    WINNER OF THE 2012 HAP PAUL AWARD J Arthroplasty. Mar 2013.

    A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculated based on implant size and acetabular inclination angle (AIA). For AIA below the RAIL, there were no adverse wear failures or dislocations, and only 1% of caseswith ion levels above 10 μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis.

  • COMPARATIVE STUDY BETWEEN PATIENTS WITH OSTEONECROSIS AND OSTEOARTHRITIS AFTER HIP RESURFACING ARTHROPLASTY

    Acta Orthop Belg. 2012 Dec; 78(6): 735-44.

    The purpose of this study was to compare the clinical outcomes of osteonecrosis (ON) and osteoarthritis (OA) patients after metal-on-metal hip resurfacing arthroplasty (HRA). We retrospectively reviewed our database and identified a study group of 122 HRA cases with the primary diagnosis of ON. A control group of 122 OA cases were randomly selected by a computer program to match the surgical date, gender and the femoral component type and size with the study group.

  • CURRENT STATUS OF MODERN FULLY POROUS COATED METAL-ON-METAL HIP RESURFACING ARTHROPLASTY

    Arthroplasty. J Arthroplasty. 2013 May 13. pii: S0883-5403(13)

    Between March 2007 and July 2010, 1000 consecutive fully porous coated hip resurfacing arthroplasties (HRA) were performed by a single surgeon in 871 patients. The average length of follow-up was 3 ± 1 years. Three cases (0.3%) in three patients showed adverse wear related failures. Another 17 (1.7%) failures were identified at the time of this study. Using any failure of any component as the endpoint, the survivorship rate was 98.8% at two years and 97.4% at five years.

  • INCIDENCE OF ADVERSE WEAR REACTIONS IN HIP RESURFACING ARTHROPLASTY

    A single surgeon series of 2,600 cases. Hip International. 2013 May-Jun; 23(3): 250-8.

    A single surgeon performed 2,559 metal-on-metal hip resurfacing arthroplasties in 
2,109 patients. The Corin Cormet 2000 (393 cases) and Biomet Recap implants (2,166 cases) were used in our series. In this study, the adverse wear failure (AWF) rate was 0.27%. At 10 years postoperatively, our Kaplan-Meier cumulative revision rate for AWF was 1% for all patients, 0.2% for men, 2.6% for women, and 9% for patients with a diagnosis of dysplasia.

  • REDUCING THE RISK OF EARLY FEMORAL FAILURE AFTER METAL-ON-METAL HIP RESURFACING ARTHROPLASTY

    European Orthopaedics and Traumatology Accepted.

     

  • OUTCOMES AFTER REVISION OF METAL-ON-METAL HIP RESURFACING ARTHROPLASTY

    J Arthroplasty, Accepted.

    We report the results of 58 hip resurfacing arthroplasties (HRA) revised by a single surgeon with an average of 5.2±2.6 years follow-up. The four most common causes for revision were acetabular component loosening, femoral neck fracture,femoral component loosening, and adverse wear related failure (AWRF). In 95% of cases (55/58), the revision bearing was a large metal-on-metal type including in all seven AWRF cases; three cases were revised to ceramic-onpolyethylene. There were two repeat revisions due to acetabular component loosening.

Abstracts

  • MY THREE TIPS TO START HSR

    Abstract for the Third Annual US Comprehensive Course on Total Hip Resurfacing Arthroplasty in Baltimore, MD, September 2009: SESSION 7: TIPS TO GET STARTED by Thomas P. Gross, M.D.

  • IN FAVOR OF A CEMENTLESS FEMORAL COMPONENT

    This lecture reviews the advantages and disadvantages of cement vs. cementless (porous) fixation in general and speculates why cement fixation was initially chosen on the femoral side of hip resurfacing. The possible advantages of uncemented fixation are discussed.

  • MINIMALLY INVASIVE POSTERIOR

    Traditionally, a larger more extensive approach has been required for hip surface replacement (HSR) than for standard stemmed total hip replacement. As we have gained experience with HSR, a minimally invasive surgical technique (MIS) using the posterior approach has been developed.

  • THE UNCEMENTED FEMORAL COMPONENT IN HIP SURFACE REPLACEMENT

    This lecture reviews the 15 year history of modern metal-metal hip surface replacement as it relates to uncemented femoral components. The results of McMinn, Wagner, Villar, Spriggins and Griffin, Fern are reviewed. The specific types of implants used are highlighted.

Latest Outcomes

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. However, 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. However, 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

Updated 2/2024

In my (Dr. Gross’) opinion, Hip Resurfacing Arthroplasty (HRA) is the best way to reconstruct a severely arthritic hip. It is more complicated to perform than a standard Total Hip replacement (THR); therefore, few surgeons are willing to offer this procedure. In the major joint registry reports, THR has better implant survivorship in most groups of patients (except in men with osteoarthritis who are under 60 years old).

However, registries measure outcomes for average surgeons. The average surgeon performs less than 2.5 HRA cases/year. This is not adequate to be an expert. In reports by high-volume hip resurfacing surgeons, results are much better than the registries suggest.

Dr. Gross has now performed over 6800 Hip Resurfacing Arthroplasty (HRA) procedures over the last 20 years and currently performs nearly 500 cases/year. The proven advantages of HRA are better function, longer implant survivorship, fewer dislocations, no thigh pain (from a THR stem), bone preservation, and longer life expectancy than THR patients.

HRA does not result in a normal hip. But, when done by an expert, it more nearly approaches a normal hip in biomechanics and function and patients are more likely to resume heavy work and impact sports than they could with a THR. Long-distance running is even possible for many (but not all) patients. Also, activities that require an extreme range of motion such as full squats, yoga, gymnastics, and ballet are possible because HRA has near-normal stability.

There are several other HRA surgeons in the world who have reported similar long-term implant survivorship data. There is only one single-surgeon report of ceramic-ceramic THR from Korea that can match the results reported here. Most failures occur during the first two years after surgery, which is why it is critical to severely limit activities in the first 6 months to allow adequate healing. After that, a patient can gradually return to completely unrestricted activity. There remains a slow rate of failure that occurs over time. But this does not seem to be affected by activity.

Therefore, the overall failure rate increases for a group of patients as the length of follow-up increases. Herein, we report implant survivorship, for all three of our HRA implant groups (we no longer use Corin or Biomet hybrid implants; we exclusively use Biomet uncemented implants). Not all complications lead to failure.

Below is a complete list of ALL major complications (not just failures/causes for revision) in the >5500 HRA cases performed using the Biomet uncemented system between 2007 and 2021. This allows a minimum of 2 years follow-up.

Group I: Failures (requires revision surgery) – TOTAL: 59/5684 (1.0%)

Cause of Failure/Revision

# cases

Femoral neck fracture 17
Failure of acetabular ingrowth 11
Adverse-wear related failure 4
Femoral head collapse (osteonecrosis) 3
Late acetabular loosening 5
Component Shift 4
Late Fracture 5
Early Infection 5
Unknown Cause (revised elsewhere) 4
Recurrent Instability 2
Unexplained Pain 5
Late Infection 1
Psoas Tendonitis 1

Group II: Complications (requires reoperation*) – TOTAL: 30/5684 (0.5%)

*implants are not removed during reoperation

Cause of Reoperation

# cases

Late Fracture ( > 6 months) 6
Early Fracture ( < 6 months) 5
Deep Infection (cured) 5
Hematoma 3
Fascia Failure 5
Superficial Infection (cured) 3
Other 2
Dislocation 1
Abductor Tear 1
Acetabular Cup Shift 1
Psoas Tendonitis 1

Group III: Other complications (conservative treatment) – TOTAL: 145/5684 (2.6%)

Complication

# cases

Acetabular component shift (nonsymptomatic) 30
Dislocation 26
Cardiovascular complication 20
Nerve Palsy/Injury 11
Urinary Retention 8
Spinal Headache 9
Other 7
Hematoma 5
Early Fracture ( < 6 months) 4
Late Fracture ( > 6 months) 4
Femoral Component Shift 4
Anxiety Attack 3
GI Bleed 2
Nausea/Vomiting 2
Unexplained Pain/Swelling 3
Severe Constipation/Diarrhea 2
Abductor Tear 2
Wound Dehiscence 1
Early Infection 1
Fascia Failure 2

Implant Survivorship – Includes ALL implant types*: 7000 cases over 20 years

*unless noted otherwise in each graph

Survivorship of hip resurfacing continues to improve as we gain more experience and identify measures to prevent failures. These survivorship curves give the reader an opportunity to see what the odds are that their implant will still be functioning at some time point after implantation.

We present three Kaplan-Meier survivorship curves: all implant groups, Biomet implants grouped by age, and Biomet implants grouped by sex. Unlike THR, HRA survivorship does not vary by age (overall 99.1% 16-year implant for both age groups).

Most failures occur in the first 1-2 years. If you make it to one year, your implant survivorship at 13 years is 99.6%. If you make it to 2 years, it is 99.8%. Dr. Gross' uncemented resurfacing implant survivorship beats all registry benchmarks for THR regardless of age or sex.

In our recent multicenter international study (27 HRA centers in 13 countries), over 11,000 cases in patients under age 50 with multiple different metal-on-metal HRA brands showed a 90% 20-year implant survivorship (93% in men and 81% in women). For comparison, THA registries show approximately 80% implant survivorship at 10 years and 50% at 20 years in this age group.


Kaplan-Meier Implant Survivorship (All Implants): 16-year survivorship - Uncemented ReCap = 98.6%; Hybrid/Cemented ReCap = 95.1%; Corin = 85.3%

Note that the survivorship y-axis begins at 80%.
There have been no instances of adverse metal wear from any surgeries performed after 2009.

Kaplan-Meirer Implant Survivorship by Age at Time of Surgery (Uncemented ReCap) - 16-year Survivorship: Under 50 = 99.4%; Over 50 = 99%

Above is the survivorship curve separated by age group for our uncemented ReCap group. Note the y-axis starts at 90%.
There is no difference in survivorship or raw failure rate based on age, unlike the typical pattern found at many other surgery centers.

Kaplan-Meirer Implant Survivorship by Sex (Uncemented ReCap - Date of Surgery > 2010) - 13-year Survivorship: Male = 99.1%; Female = 99.1%

Many orthopedic surgeons exclude women from HRA because of poor published results. We, however, elected to investigate WHY implants in women were underperforming and to adjust implant design + surgical technique rather than exclude women from surgery. After the implementation of new protocols from 2007-2009, implant survivorship between men and women is no longer significantly different.

The implant survivorship data reported here far surpasses joint implant registry data from Britain, Sweden, and Australia (for both THR and HRA) where these types of data are kept. These are publicly available, and you can get access them online for free. Registry data can be thought of as average surgeon implant survivorship for purposes of a benchmark. But the most important factor in the outcome of any operation is individual surgeon skill. It is hard to know at which level a surgeon you are considering can perform. Anecdotal reports from a few patients or reputation are a poor substitute for data. Few surgeons provide written data such as I do.

Remember, implant survivorship is not the only factor that needs to be considered in deciding between THR and HRA. Other proven advantages of HRA include better functional outcomes, less residual thigh pain, fewer dislocations, bone preservation, and longer life expectancy.

Among Dr. Gross’ patient cohort, 98.7% report being satisfied with their surgery at 2 years postoperative. After all revisions, reoperations, and complications are accounted for, there are still approximately 3.4% of patients who experience moderate unexplained residual pain after HRA. The risk of moderate residual unexplained pain in THR is 20%. This means we cannot determine a specific reason why they are not satisfied. Some may have referred pain from their back, sacroiliac joint, or from soft tissue problems we are unable to diagnose.

In a THR thigh pain from the stem is a common cause of residual pain. Residual pain is a highly subjective data point. It may just represent the fact that HRA does not result in a normal hip. One person’s insignificant pain may be graded as moderate by another. If we can’t diagnose a cause of pain, we don’t recommend revision surgery for “unexplained” pain. If a revision is still performed, sometimes a patient improves, but most often they subject themselves to the risk of revision surgery and do not improve. There is no measurable difference in the speed of recovery between THR and HRA.

Since 2007 Dr. Gross has used primarily the Biomet Recap / Magnum uncemented metal-on-metal hip resurfacing system. The majority of the data presented here is for this system. The FDA has approved these implants for sale in the US. They are however NOT approved for use as a total hip resurfacing combination. Dr. Gross uses them for this “off-label” purpose.

The FDA regulates implant companies. The FDA does not regulate doctors. Once an implant is approved for sale, it can be used for any purpose that a doctor feels is best. When an implant company gets FDA approval for an implant, the company may only market and promote this implant for the “indication” that they have received from the FDA.

This is true even if there are scientific papers that demonstrate that this implant is safe and effective when used differently. Companies don’t generally want to spend the effort and expense to gain new “indications” from the FDA because doctors can already use them however they like and doctors generally rely on their own experience as well as scientific publication by their peers, rather than FDA guidelines. There are many examples of drugs and implants whose primary current use is not the original FDA “indication”. Basically, the FDA regulates drug and implant companies conduct, but has no jurisdiction over doctors. We have the education, training, and experience to use an implant or drug for whatever purpose we think is best.

This is a perfectly legal and common practice. I am not even required to disclose off-label use to patients. I chose to do so because metal-metal resurfacing is a highly controversial practice. I use the Biomet Recap/Magnum in an off-label fashion and have the best implant survivorship in the published literature. If you prefer a device that is FDA “indicated” for metal-metal resurfacing, I would be happy to use the Smith-Nephew Birmingham Hip Resurfacing (BHR) device for you. It is the most used hip resurfacing device in the world market and has been studied the most.

But I can only implant this in men with a bearing size of greater than 48mm. These fit most men. Smaller sizes have been removed from the market and the manufacturer has placed a warning on the label against use in women. I have excellent outcomes in smaller-sized implants (with the Biomet system which is very similar in design) and in women and completely disagree with the manufacturer on this topic.

However, they simply do not supply the smaller sizes any longer. Even in women who need larger sizes, the manufacturer's labeling makes me unwilling to risk this due to our overly litigious country. In my opinion, the BHR has similar outcomes at 10 years in men with OA and good bone. Because of the cemented femoral fixation, it does not do as well in anyone with weak bone or bone defects (osteonecrosis, cysts) on the femoral side.

Past results do not guarantee future complication rates. Although the above represent the most common complications associated with this procedure, others could also occur. We continue to strive to make improvements and hope that these complication rates can be further decreased as we gain even more experience.

  • Dr. Gross is the operating surgeon (No trainee will perform your operation).
  • Dr. Gross developed the Biomet implants but no longer receives royalties for these implants.
  • Biomet Recap and Magnum components are FDA-approved. Use as a total hip resurfacing is however considered off-label.
  • Information from your treatment is used for research purposes, but you will not be identified.

If you have any questions about the above information, please don’t hesitate to ask.


2. Total Hip Replacement (THR)

The need for hip replacement continues to shrink as the complication rate for resurfacing falls. Hip resurfacing started 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 used to be 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 is a rare problem with the Biomet design. Because of decreased demand for large metal-bearing THR, Zimmer-Biomet discontinued the sale of this implant several years ago. I now use the best alternative which is a dual mobility ceramic/polyethylene bearing which is nearly as good.

With the large metal-bearing Biomet Magnum THR, I have a 97% 15-year implant survivorship (for patients average age of 60) with no dislocations, which far surpasses registry benchmarks (approximately 92% 10-year survivorship for a similar age group). Also, a standard total hip carries a 3% dislocation risk and a 1-5% trunion corrosion 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.

Failures in 211 cases – TOTAL: 2.8% raw failure rate 16 years postoperative

Failure

# cases

Failure of acetabular ingrowth 2
Trunion corrosion 2
AWRF due to acetabular malposition 1
Late infection 1

3. Revision of Hip Resurfacing

More complicated than primary surgery. Our results are very close to those of our primary resurfacing cases with a 96% 8-year implant survivorship. 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.

Current Topics
  • THE DURABILITY OF HIP RESURFACING

    A recent Article in the Lancet medical journal has criticized hip resurfacing arthroplasty (HRA) as less durable than cemented 28mm total hip replacement (THR). I take exception to the inappropriate conclusion that the authors drew from this highly flawed study.

  • SHOULD YOU HAVE UNCEMENTED HIP RESURFACING?

    Uncemented resurfacing components are a new development. The acetabular components used routinely are uncemented while the femoral components routinely have been cemented to bone.

  • CURRENT STATUS OF UNCEMENTED FEMORAL COMPONENTS IN HIP RESURFACING

    Minimal two-year follow-up outcome of uncemented resurfacing components are a new development. A Comparison of cement vs. bone ingrowth. At 2 years of follow-up cemented and uncemented femoral resurfacing is equivalent. Femoral cement failure is the most common late cause of failure in hip resurfacing (3% at 8 years). Wear-related failures with the Corin or Biomet implant systems are rare in my experience.

  • PERSPECTIVE ON METAL ON METAL TOTAL HIP REPLACEMENT

    As a patient, there are two reasons you should consider a metal-on-metal total hip replacement. 1) Extremely durable surface that is unlikely to ever wear out. 2) Stability of the joint. Using a metal-on-metal bearing surface allows the manufacture of a large bearing hip joint that will not dislocate.

  • METAL IONS, A SCIENTIFIC REVIEW

    As a patient this is an excellent resource to know more about metal ions.

  • THE CONTROVERSY REGARDING ADVERSE WEAR IN METAL-ON-METAL BEARING

    I have used over 3000 metal bearings in primary total hip and hip resurfacing as well as revision surgery. I have revised 2 for adverse wear 7 years after implantation. I know that most other high volume hip resurfacing surgeons have a similar experience.

  • HIP RESURFACING: A DURABLE SOLUTION. NEW TECHNIQUES PRESERVE HIP FUNCTION IN YOUNG, HIGHLY ACTIVE PATIENTS.

    An energetic 35-year-old woman who manages a house full of kids and runs 10k races is not a candidate for hip replacement surgery, right? But what if she is?

  • HIP HEMIRESURFACING: THERE NO LONGER IS ANY ROLE FOR THIS PROCEDURE

    It is my opinion that there no longer is any role for this procedure. The FDA does not realize this; they continue to approve implants for hemi-resurfacing. Typically these femoral hemi-resurfacing implants are best used off-label together with an acetabular component for total resurfacing.

  • ARTHRITIS AND NON-OPERATIVE TREATMENT OPTION

    Arthritis simply means an inflammation of joints. Almost everyone has suffered from this at one point in their lives. There are many types of arthritis. Sometimes it only involves a single joint, other times it can affect many at the same time.

  • LOW BACK PAIN AND NON-OPERATIVE TREATMENT OPTION

    Pain in or around the lumbar spine is a common problem suffered by most people at some point in their life. Most episodes will pass with time and a few simple measures. If these conservative measures fail after one to two months trial, or if the problems become severe, I would recommend evaluation by a back specialist.

  • ACETABULAR COMPONENT INCLINATION ANGLE

    This is a complex issue that defies simple explanation in non-technical terms. The bottom line is that patients with hip resurfacing should not worry about this. They should keep their regular follow-up appointments with their surgeons to monitor their implant every other year.

  • WHAT IS THE BEST BEARING TYPE?

    As a patient there are four reasons you should consider a metal-on-metal bearing total hip replacement or resurfacing. Wear, breakage, stability, and bone preservation.

  • HIP RESURFACING vs. STANDARD TOTAL HIP REPLACEMENT

    There is much controversy among orthopedic joint replacement specialists about this topic. When summarizing the scientific literature, it appears that both resurfacing and replacement using modern bearings have a similar overall 95% survivorship rate at 10 years. Longer‐term results are not available.

  • HIP RESURFACING SURVIVORSHIP, 2480 CASES OVER 10 YEARS

    Dr. Gross has now performed over 2500 Hip Surface Replacement (HSR) procedures over the last 12 years. Most failures occur during the first 6 months of the healing period. However, there is a slow rate of failure that occurs over time. Therefore the overall failure rate increases for a group of patients as the length of follow-up increases.

  • REFINED INTRAOPERATIVE XR TECHNIQUE TO ROUTINELY ACHIEVE AN AIA < 50°

    A steep acetabular inclination angle is the primary cause of adverse wear related failure with well-designed metal-on-metal bearing hip resurfacing arthroplasties (HRA). One recent study demonstrated that positioning acetabular components of stemmed total hip arthroplasties (THA) within the “Lewinnek safe zone” is difficult; only 62% had AIA within the safe zone.

  • INCIDENCE OF ADVERSE WEAR REACTIONS IN HIP RESURFACING ARTHROPLASTY: A COMPARISON WITH THE OXFORD STUDY

    A steep acetabular inclination angle is the primary cause of adverse wear related failure with well-designed metal-on-metal bearing hip resurfacing arthroplasties (HRA).

  • BONE HEALTH AND HIP RESURFACING

    Osteoporosis is a chronic, progressive disease characterized by low bone mass, bone deterioration, and decreased bone strength leading to increased bone fragility, morbidity, and mortality.

  • HIP RESURFACING IN WOMEN

    Young women who desire a more functional hip replacement were recently dealt a large blow when the smaller sizes of the Birmingham Hip Resurfacing (BHR) device were withdrawn from the market by Smith Nephew Richards because the 10-year revision rate for women was higher than for men in most large registry analyses.

Talks & Lectures

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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