Frequently Asked Questions

I am from Out of Town. Does this present any difficulties with my Care?

Most of our patients are from out of the area. We can accommodate your needs by collecting information in advance and coordinating your visits. Most patients make one trip to Seattle for the consultation and surgery and have a follow up visit and then rehabilitate under our supervision at home.

How many resurfacing procedures have you performed?

More than 10,000 including shoulders. I also perform other procedures such as hip and knee replacement. I also regularly perform shoulder replacement and resurfacing procedures.

Do you perform hip resurfacing procedures for women?

Yes. We perform nearly as many resurfacing procedures for women as men. Our results have been just as positive. More often women elect the soft polyethylene for their acetabular bearing.

Can you perform joint implant surgery for patients with metal sensitivity?

We treat metal sensitive patients frequently and successfully but we use alternative bearing surfaces.

What is the advantage of hip resurfacing over hip replacement?

The functional outcomes are better, the recovery is shorter and the bone is preserved for future use.

Why should I come to your program for care?

We offer the most experience in joint implant procedures. We have a published peer reviewed tract record of success.

Will insurance pay for my care?

Essentially every major insurance plan pays for hip resurfacing surgery. We have a reduced payment plan for cash payment as well.

Can I play sports after a joint resurfacing procedure?

Yes. We do not limit patients from sports participation

Will I still have my knee ligaments with a knee resurfacing procedure?

If your ligaments are present (or have been reconstructed) they will be preserved to give your knee full stability.

Will my hip come out of joint after a resurfacing procedure?

There is a very small chance this could occur and only with an unusual movement or injury.

Will my new joint last as long as I do?

In the vast majority of cases the answer is yes. Unlike total hip replacement which may fail within 20 years, there is not finite life span for hip resurfacing. Typically the procedure will last as long as the bone remains healthy.

How long will I be away from work?

For sedentary jobs just a couple of weeks. For heavy work 4 to 6 weeks is recommended.

How long will I be in bed after surgery?

Just a matter of hours as the effects of anesthesia wear off. You can use your new joint right away.

Will my surgery be "less invasive"?

Yes, new techniques limit the extent of surgery from what was done just a few years ago.

Will I receive new technology?

Yes, you will receive the newest metallurgy, ceramic or cross linked polyethylene.

Will my joint be replaced?

No. Your joint will be resurfaced. The old term is still often used but almost all your bone is kept and only the damaged surface is replaced.

How long will I be in the hospital?

Almost all procedures are performed on an outpatient basis. The recovery is faster and the risk of blood clot and infection is lower on ambulatory cases.

Which hospital will be used?

The Swedish Orthopedic Institute or the Ambulatory Center.

Will there be a need for banking of my own blood, or do you use a blood salvaging technique?

No blood donation is necessary. Blood transfusions are not necessary.

Are Resurfacing Implants FDA Cleared?

Only Metal on metal resurfacing implants are FDA cleared. We use a polyethylene hip replacement socket and a ceramic femoral resurfacing. Each part has a separate FDA clearance. Using the parts together is considered OFF LABEL by the FDA. This means it can be done at the surgeon's discretion based on unique patient needs.

Will my implant be Metal on Metal?

No. We offer only polyethylene and ceramic.

Have you had any failed procedures?

Yes, but very few and many fewer than a reported in the major registries. We have been able to successfully revise the relatively few number of failed situations. It is rare for the procedure to fail completely and a partial revision is all that is typically needed. The recovery is shorter for most revision procedures.

Do you have experience with revising hip resurfacing procedures?

We have extensive revision surgery experience. Some of the older implants did not perform at the same high level as current implants. We have experience with revising the ASR, Corin and Durom. The revision experience has been quite favorable with similar outcomes to primary cases.

Did you use any recalled prostheses?

We have revised revises successfully recalled metal on metal prostheses but did not place any. Temporary recalls through the FDA from manufacturing compliance issues have occurred with polyethylene. No polyethylene implants have failed from manufacturing defects.

When did you complete your BHR training?

In 2006 (before the US release). I originally learned hip resurfacing from Dr. Townley in the 1980s as a resident trainee.

What would be my "window of opportunity" time frame for having hip resurfacing?

Anytime symptoms warrant. Patients need to have resurfacing procedures performed while their bone remains healthy.

Is hip resurfacing new?

No, but it has greatly improved as the result of better instruments, implants and knowledge.

My orthopedic surgeon does not recommend hip resurfacing. Why?

Hip resurfacing is more difficult to perform and special training is required. It also lakes longer and we do not charge more for the procedure. Most surgeons find total hip replacement quite satisfactory.

Do you see an increased risk of loosening of the cup component due to bone stock, and would that be the same for resurfacing as for total hip replacement?

There are more options for cup fixation with total hip replacement although the risk of loosening should be minimal with resurfacing.

Are there issues for resurfacing due to leg length?

Leg length is not addressed with the resurfacing procedure. It is very unusual for patients to have a significant leg length issue after resurfacing. Patients often feel the leg is longer at first since the wear of the joint results in gradual shortening over the preceding months or years.

With hip dysplasia, do you anticipate any need for bone grafting or screw fixation in the cup component?

We have the ability to perform this if needed.

What will the availability of the devices be in the next six months?

We have full availability of devices now. There are two new polyethylene devices in early release. I designed them both and one is available to our patients (limited release to just our center) now. The other is in Europe. 

Do you use spinal or general anesthesia resurfacing surgery?

The surgery can be done with either anesthetic. The choice of anesthesia used is generally decided by the patient and the anesthesiologist. Most patients prefer a spinal anesthetic with sedation that has them asleep during the procedure.

How long does an average resurfacing procedure take?

Usually between 1 and 2 hours.

Do you cut any muscle?

NO.

Which incision approach would you use for a case such as mine?

We use Piriformis-Sparing Superior approach. Patients seem to recover patients recover better with the superior approach.  While popular and easy for the surgeon our patients recover better without the HANA table. The have been injuries reported from the hyperextension and traction during surgery. There is late fibrosis from the tissue stretch from traction tables. Early recovery is good but there can be late ramifications. 

What do you use to close the incision?

Usually intradermal sutures (they don't need to be removed).

Do you anticipate any post-op weight-bearing restrictions?

No.

What are your other post-op restrictions and for how long?

Limit flexion to 90 degrees for six weeks.

How many resurfacings have you performed on dysplasia patients and how many of those would you consider successful?

Most of our patients have dysplasia and the results have been excellent.

How many planned resurfacings have you had to convert to THR during surgery?

None as of yet. We would do this though in the very unlikely event of an intraoperative fracture.

How many THR's a year/month do you perform?

It varies. Have performed approximately 12,000 joint implant procedures.

When did you complete your BHR training with Ronan Treacy?

January 2006. Trained on the TARA and C+ in the 1980's and 1990's.

Can you provide your personal statistics on your resurfacing successes and failures?

See the articles posted on this site.

What are the statistics of getting a post- operative infection at the hospital?

Less than a 1% chance.

Is there an increased risk of AVN with a femoral head deformity?

Yes. There is still a small risk.

Is there a risk of dislocation?

Yes, but this does not reach a percentage point as a risk. The risk is less than with total hip replacement.

Is there a risk of nerve damage?

Yes. 1%

Are there any unusual risks or complications as compared with THR?

Yes. Component positioning is more difficult with resurfacing.

How long would you anticipate a resurfacing to last for me?

The implants will not wear out. The main concern is the bone.

Do you see a possibility of any unusual device wear or load issues?

No.

Should I go out of the Country for Hip Resurfacing?

No. Hip resurfacing can be done here. We are concerned about the Americans that go abroad. We are not seeing that accurate follow-up of Americans that have gone abroad is occurring.

Is there anything I will not be allowed to do after my hip resurfacing procedure?

No. We have a number of professional athletes from a variety of different sports

Criteria for Resurfacing

• Educated patient who understands the risks and procedures.
• Relative youth and need for high activity.
• Good bone quality.
• Limited deformity (major bone loss and leg shortening cannot be effectively addressed with resurfacing).

When Should a Resurfacing not be performed?

• When there is major bone loss.
• When there is insufficient experience of the surgical team.
• When there is renal insufficiency or certain other medical conditions.

Are there Alternatives to Metal for Resurfacing?

We have performed more than 6200 hip resurfacing procedures using highly cross linked polyethylene over the last 23 years. We have no failures of this material (and none have been reported in the literature). Our wear simulator study found minimal wear in 30,000 cycles (equates to more than 20 years of active use in the body).

Is Shoulder Resurfacing an option rather than replacement?

Yes and this is almost always the better approach.  Resurfacing is less invasive and has a more runctional outcome.

Will my hip implant be cemented?

Hardly ever. Cementless total hips and shoulder are the norm. Cementless resurfacing is successful but OFF LABEL