Some people will require a modified slowed down program of recovery. Typically this is required in people who have weaker bone, severe under lying deformities or significant bone loss prior to surgery. I can resurface most bad hips, but in the more challenging cases, a slower initial program is required to avoid complications. Most patients who fit in this group will still have an excellent outcome and be able to fully participate in impact sports after 6 months just like the more ideal candidates. The slow down program involves 6 weeks of crutches, one month of a cane, and limited walking until 6 months.

We do a complete bone strength analysis with a DEXA scan before surgery. We also measure vitamin D levels on all patients. About 40 % of the population is deficient. Long-term deficiency weakens the bones. In young men who are found to have low bone density we recommend having your doctor check your testosterone level and consider supplementing it if it is low. Our research has shown us that low bone density is the one factor that is most strongly linked to the two most common early complications of hip resurfacing: femoral neck fracture and femoral head collapse (some call this necrosis). We call these early femoral failures because femoral neck fractures always occur within 6 months of surgery and head collapse is almost always seen by the 1-year x-ray.

The only other factor that we have found to be linked to early femoral failures is body mass index (BMI) over 30. It does not matter if BMI is elevated because of fat or muscle. In my first group of 373 resurfacings we had about 2% early femoral failures. In the last one thousand, we have had one single case. This 20-fold improvement has been achieved by research into the causes of these complications and development of patient stratification protocols; NOT by patient selection. Many experts recommend doing resurfacing only on the “best candidates” (patient selection). We have instead taken the approach to modify patient management to allow all patients to benefit from resurfacing. Because we have nearly eliminated these complications, we have even expanded the indications for resurfacing to nearly all age patients.

Basically, the protocol is to measure the DEXA scan. If patients have a T score in the operated femoral neck less than 0, then they are given an oral bisphosphonate drug weekly for 6 months. If the T score is less than -1.5, we recommend a one-year bisphosphonate course as well as a longer period on crutches. If the BMI is 30 or greater we also recommend a 6onth course of bisphosphonates. There are other alternatives to bisphosphonates if you cannot tolerate these, but sometimes insurance companies are reluctant to pay their higher costs.