Resurfacing Guide

An exciting new alternative to total hip replacement is now available in the United States. Used successfully for years around the globe, the BIRMINGHAM HIP Resurfacing System have recently been approved by the Food and Drug Administration for use in the United States. Now, patients suffering from hip pain due to arthritis, dysplasia or avascular necrosis can benefit from its conservative approach to treatment.

Because this technologically advanced surgical procedure resurfaces, rather than replaces the end of your femur (thighbone), you may participate in more strenuous physical activity with an implant that is potentially more stable and longer-lasting than traditional total hip replacements. And if future revision surgery is required, it may be a less complex and less traumatic procedure.

In fact, a 1,626-hip study of the effectiveness of the technique found that 99.5-percent of patients responded they were “Pleased” or “Extremely pleased” with the results of their BIRMINGHAM HIP Resurfacing surgery.

Visit the following articles for information on Birmingham Hip Resurfacing:

1. Who is a Candidate for Hip Resurfacing

2. Diseases of the Hip

3. Non-Surgical Alternatives to Hip Resurfacing

4. The Procedure

5. The Implant

6. Hip Resurfacing Pre-Op and Surgery Day

7. Hip Rehabilitation after Surgery

8. Precautions after Surgery

9. Preventing Hip Resurfacing Complications

10. Frequently Asked Questions

After reading about Birmingham hip resurfacing, you may be interested to learn whether or not you are a good candidate for the procedure. Please take a moment to answer the following questions:

• Do I have a metal allergy?
  

  Hip Resurfacing

• Do I have insulin dependent diabetes?
• Do I have rheumatoid arthritis that is poorly controlled or that requires prednisone medication to treat?
• Do I have lupus?
• Do I have chronic kidney failure?
• Do I have other immuno-compromising diseases such as amyloidosis?

If you answered “yes” to one or more of the above questions, you are not a good candidate for hip resurfacing.

A total knee replacement involves cutting away the damaged bone of the knee joint and replacing it with a prosthesis. This “new joint” prevents the bones from rubbing together and provides a smooth knee joint.

Implant Components

Knee Implant

In the total knee replacement procedure, each prosthesis is made up of four parts.

The tibial component has two elements and replaces the top of the shin bone or tibia. This prosthesis is made up of a metal tray attached directly to the bone and a plastic spacer that provides the bearing surface.

The femoral component replaces the bottom of the thigh bone or femur. This component also replaces the groove where the patella, or kneecap, sits.

The patellar component replaces the surface of the knee cap, which rubs against the femur. The patella protects the joint, and the resurfaced patellar button will slide smoothly on the front of the joint.

The Procedure

Before you are taken to the operating room you’ll be given medication to help you relax, and the anesthesiologist will talk with you about the medications he’ll be using. In the operating room, you will be placed under full anesthesia. Once you are “under” Dr. Wackwitz will begin by making an incision in your leg to allow access to the knee joint. He’ll then expose the joint and place a cutting jig or template on the end of the femur, or thigh bone. This jig allows the surgeon to cut the bone precisely so that the prosthesis fits exactly. Once the femur is cut, the tibia is cut using another jig for proper alignment of the knee prosthesis. The undersurface of the patella is then removed.

Now it’s time to place the prosthesis. This begins with the femoral prosthesis, which is cemented in place using a special bone cement. Next the metal tray is attached to the top of the tibia. This will provide the weight-bearing surface of the femur. The plastic spacer is then attached to the metal tray. This will provide the weight-bearing surface of the femur. If this component should wear out while the rest of the artificial knee is sound, it can be replaced. This is known as a “revision.” Next the patellar button is cemented in place behind the knee cap. Finally, the incision is closed, a drain is put in, and the post-operative bandaging is applied.

Returning Home

You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees and straighten your knee.

At home you should begin ambulation with a cane as tolerated. Keep your incision clean and dry and watch closely for any signs of infection.

You’ll continue your home exercise program and go to outpatient physical therapy, where you will work on an advanced strengthening program and such programs as stationary cycling, walking, and aquatic therapy.

Your long-term rehabilitation goals are a range of motion from 100-120 degrees of knee flexion, mild or no pain with walking or other functional activities, and independence in all activities of daily living.

Osteoarthritis

Osteoarthritis is a progressive, degenerative disease in which the cartilage of the knee slowly wears away. Cartilage serves as insulation between the bones of the joint, and when the cartilage of the knee joint wears away due to osteoarthritis, the resulting pain and inflammation can be debilitating.

Your chances of osteoarthritis of the knee increase with age; the condition most often affects middle-aged and older people. Osteoarthritis may first appear between the ages of 30 and 40, though symptoms may not be present in the early stages. By the age of 70 almost everyone will have this type of knee arthritis.

Causes: The question of what causes osteoarthritis of the knee has not been answered. Prior knee injuries seem to increase the likelihood of osteoarthritis, but many people with knee arthritis have never had a serious knee injury. Osteoarthritis is the most common form of arthritis, and many people have a genetic predisposition to this chronic disease.

Symptoms: The primary symptoms of osteoarthritis are pain in the knee, swelling and stiffening of the knee joint. In the early stages of osteoarthritis the pain may be mainly associated with activity. As the cartilage wears away and the bones of the joint rub against each other, pain can become more severe and constant, interfering with regular daily activities and disrupting sleep.

Treatment: In the early stages of osteoarthritis, treatment may involve several techniques. Behavioral and lifestyle changes including losing weight and changing routines to avoid painful situations can be very effective in relieving pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium may also provide relief from pain. Cox-2 inhibitors are also effective in providing knee arthritis pain relief. Physical therapy may improve muscle strength and joint mobility, reducing the symptoms of osteoarthritis in the knee. Joint fluid therapy such as SUPARTZ* brand hyaluronic acid may lubricate the knee and reduce the pain and swelling of the joint. Partial or total knee replacement surgery may be necessary as the disease progresses and daily functioning becomes more impaired.

Rheumatoid Arthritis (RA)

Unlike osteoarthritis, Rheumatoid knee arthritis involves inflammation of the lining of the joints, known as the synovium. Though less common than osteoarthritis, rheumatoid arthritis is among the most debilitating of the over one hundred forms of arthritis. Rheumatoid arthritis usually develops in middle age, but may occur in the 20s and 30s.

Causes: The exact cause of rheumatoid arthritis is unknown. It’s possible that a virus or bacteria may trigger the disease in people with a genetic predisposition to rheumatoid arthritis. Many doctors think rheumatoid arthritis is an autoimmune disease in which the tissue of the joint’s lining is attacked by the body’s immune system. It’s also possible that rheumatoid arthritis is caused by severe stress. The disease sometimes occurs after a life-changing event such as divorce, loss of a job or a severe injury.

Symptoms: The primary symptoms of rheumatoid arthritis include pain and swelling in the joints and difficulty moving. Other symptoms may include loss of appetite, fever, loss of energy, anemia, and rheumatoid nodules (lumps of tissue under the skin).

Treatment: Treatment of rheumatoid arthritis usually involves medications such as NSAIDs, aspirin and analgesics. In severe cases, surgery may be indicated to replace the knee joint with an artificial joint.

If you think you may have arthritis of the knee, contact our office for a complete evaluation and a discussion of the options available for treatment.

• Basic Information
• Reconstruction Surgery
• Rehabilitation
• A Perioperative Rehabilitation Program for ACL Surgery (PDF file)

“Tennis elbow” or lateral epicondylitis is a painful disorder caused by overstress of muscle tendon attachments to the bone (epicondyle). It produces symptoms of pain with wrist and finger extension and with gripping at the outside of the elbow or forearm.

Treatment requires medical attention as soon as the symptoms appear. Early attention usually prevents the development of a serious disorder.

Early treatment options include:

Elbow Anatomy

• Rest from excessive or abusive activity.
• Heat or cold applications.
• Braces or splints.
• Physical conditioning exercises.
• Physical/occupational therapy including ultrasound.
• Over-the-counter pain reliever.
• Prescription pain relievers.
• Non-steroidal anti-inflammatory medications.
• Physiotherapy, rehabilitation

Hip (Metal on Metal)

Many times individuals develop certain conditions that cause their hips to hurt.  Listed below are some common causes for discomfort in the hip joint region.

Osteoarthritis: Non-inflammatory degenerative disease of the joint is characterized by degeneration of cartilage.  The joints in our body are covered with a protective layer of cartilage, which acts as a natural shock absorber or cushion. Over time, this natural cushion may wear due to osteoarthritis; a disease causing the progressive deterioration of joint cartilage.  If the wear becomes significant, it can result in the painful condition of bone rubbing on bone.

Osteonecrosis: Literally, osteonecrosis or avascular necrosis means death of bone.  It occurs when an area of bone loses its blood supply.  Without blood, bones will break down and collapse.  Osteonecrosis of the hip joint accounts for more than 90 percent of all osteonecrosis cases.  Each year, between 10,000 to 20,000 people develop osteonecrosis in the US.  This disease is primarily seen in people 20 to 40 years old, with men being more susceptible.

Rheumatoid Arthritis: This condition occurs when the body’s own immune system attacks the synovial lining of the joints, just as it would foreign bacteria. Synovial fluid is a clear, smooth oil-like lubricating liquid that makes it easier for the joints to move.

Traumatic Arthritis: Traumatic arthritis results when the joint or the ligaments surrounding it are damaged by fracture, dislocation, or accident-related injury.  All arthritic conditions result in stiffness, swelling, and the loss of motion.  It becomes difficult to put pressure on the hip, and the joint becomes increasingly tender and swollen.  As time passes, arthritis of the hip can significantly affect the ability to walk.

To learn more about this procedure, please visit the sections below. If you think you may be a candidate for arthroscopic hip surgery, please contact our office.

1. What is Hip Arthroscopy?
2. Who is a Candidate for Hip Arthroscopy?
3. Hip Anatomy and Function
4. Diseases of the hip
5. Non-Surgical Options
6. Reasons for Hip Arthroscopy
7. Preparing for Hip Arthroscopy
8. Surgery Day
9. Hip Arthroscopy Procedures
10. Post-Operative Care and Rehabilitation

“All I can say is… Wow! 
I flew out here from San Diego after researching hip resurfacing for a couple of years. I chose wisely.“
- Kent

Dr. Rogerson is among the first surgeons in this country and the first in Wisconsin to provide patients who suffer hip pain the remarkable new Birmingham Hip Resurfacing (BHR) technique. This alternative, which has been offered in Europe and other countries for more than a decade, finally won FDA approval in May 2006. It is the first FDA approved hip resurfacing system in the United States. Rather than replacing the entire hip joint, as in a total hip replacement, hip resurfacing simply shaves and caps a few centimeters of bone within the joint.

Dr. Rogerson

“This is one of the most exciting procedures I’ve seen in years,” explains Dr. Rogerson. “I see hip resurfacing as the ideal solution for many young, active patients who suffer from hip pain. We are seeing patients who, through either extremely physical work or leisure, develop arthritic hip pain. They don’t intend to slow down. BHR is an alternative to total hip replacement that accommodates both age and lifestyle. In the past, I’ve even encouraged patients to seek treatment in Belgium because I didn’t want them to have to wait any longer for this great option. Now they can be treated close to home.”

The bone-conserving approach of hip resurfacing preserves more of the patient’s natural bone structures and stability, covering the joint’s surfaces with an all-metal implant that more closely resembles a tooth cap than a hip implant. This approach reduces the post-operative risks of dislocation and inaccurate leg length, and because the all-metal implant is made from tough, highly finished cobalt chrome, it has the potential to last longer than traditional hip implants.

The Birmingham Hip implant is intended for patients suffering from hip pain due to osteoarthritis, dysplasia or avascular necrosis, and for whom total hip replacement may not be appropriate due to their increased level of physical activity. For this reason, most surgeons feel it will be ideal for patients under age 65 who live active lifestyles.

To learn more about this procedure, please visit the sections below. If you think you may be a candidate for hip resurfacing, please visit the Take the Next Step section to have Dr. Rogerson perform an initial assessment of your medical condition and x-rays without charge.

1. A Patient’s Guide to Hip Resurfacing
   
2. Rehabilitation at Meriter Hospital & HipHab
3. Reasons to Choose Birmingham Why the Birmingham Hip Resurfacing System. 
A Personal Message from John S. Rogerson, MD.
4. BHR Literature Review Important BHR statistics, warnings and precautions.
5. History of Hip Resurfacing
6. Patient Journals Read several stories about patients who have had the hip resurfacing surgery
7. Financial Information
8. In the News In this section we link to articles that feature Dr. Rogerson and Birmingham hip resurfacing.
9. Take the Next Step! After reading about hip resurfacing, you may be interested to learn whether or not you are a good candidate for the procedure.
10. Meriter Hospital’s Birmingham Hip Resurfacing Discussion Board Meriter Hospital is pleased to offer a public forum for discussing issues related to the metal-on-metal hip resurfacing procedure. Anyone who is interested in learning about the procedure, is scheduled for surgery or has completed the surgery is welcome to participate. Moderated by Dr. Rogerson.
11. We encourage each patient to learn as much as possible about the options available, in order to make an informed choice regarding his or her surgical options. The following Web sites may be useful to you during your research:
12. Birmingham Hip Resurfacing System Dr. Rogerson uses the Birmingham Hip Resurfacing System. This system is the only resurfacing device approved by the FDA. Visit this site for a patient guide to the surgery, patients’ stories, a free information kit and more.
13. SurfaceHippy This site is a hip resurfacing patient support group. Surfacehippy is a forum for sharing information and experiences among patients who have had hip resurfacing surgery. Anyone interested in learning about the procedure is welcome to participate.
14. SurfaceHippyInfo.com This site serves as a patient-to-patient guide to hip resurfacing. A physician listing is included in the site, as well as an interview of Dr. Rogerson by patient advocate Vicky Marlow.

Big Femoral Head (BFH) Stemmed Prosthesis

Total Hip Replacement

There are a variety of conditions that can lead to hip joint deterioration resulting in pain, reduced range of motion and decreased quality of life. Those conditions include:

• Osteoarthritis
• Rheumatoid Arthritis
• Osteonecrosis
• Traumatic Arthritis
• Non-Arthritic Trauma

As a treatment option, Dr. Rogerson may recommend total hip replacement surgery with a hip implant from Wright. Recent technology advances for hip surgery are the CONSERVE® Total Hip System with BFH® Technology, and the minimally-invasive PATH®  Technique.

For decades Wright had been the industry leader, pioneering new and better ways to address hip joint replacement – which is why Dr. Rogerson has put his trust in Wright. The prospect of hip replacement surgery is an important choice for all patients, so this information is provided as a resource to enable you to learn more about technologies and techniques of hip replacement surgery.

To learn more about this procedure, please visit the sections below. If you think you may be a candidate for BFH total hip replacement, please contact our office.

1) My Experience with Hip Replacement by Jimmy Connors.

2) Hip Anatomy.

3) Diseases of the Hip.

4) Total Hip Replacement.

5) Who is Wright?

6) Frequently Asked Questions.