Melanie Cole (Host): Welcome to UAB MedCast. I'm
Melanie Cole. And joining me today is Dr. Scott Mabry. He's an orthopedic
surgeon at UAB Medicine, and he's here to highlight hip resurfacing, a
bone-preserving alternative to replacement.

Dr. Mabry, welcome back. You are a great guest and we're
happy to have you join us again. Up until recently, the gold standard of
treatment of end-stage hip arthritis for, what, the last 30 years has been
total hip replacement. Can you please tell us now about hip resurfacing as a
procedure that really is an alternative to total hip replacement where the bone
of the femur is preserved? Tell us a little bit about this procedure and the
evolution of it.

Dr Scott Mabry: Absolutely. And thanks for having me
again, Melanie. I really appreciate you guys. Hip resurfacing is an alternative
in some certain patients to total hip replacement. Like you mentioned, it is
bone-preserving in the sense that instead of replacing the entire head of the
femur and placing a stem, which the bone grows into, into the canal of the
femur, you actually just resurface the femoral head. And so, you're preserving
all of this bone in the femur. On the socket side of things, it's very similar
to a normal hip replacement. But the key here is that you're actually
preserving the head of the femur. And so, that allows for higher activity
level, it allows for a little longer lifespan of this hip. And if you ever did
have to convert this to a total hip replacement, it actually isn't too invasive
of a procedure in comparing that to like a revision hip replacement in someone
that goes from a total hip to a bigger total hip.

Melanie Cole (Host): Dr. Mabry, you and I have done a
few of these together, and one of the most important things I've learned from
you and that other providers hear as a main message is the importance of
patient selection. So when you're discussing with the patient and it's shared
decision-making, that hip resurfacing versus a total hip, who's a candidate and
what do you discuss?

Dr Scott Mabry: Yes. And that's very important that
you bring it up, especially in this patient population. Of all the things I've
spoken with you about, this is the one that is the most selective and it's
because of some trial and error in the past. The main thing with patient
selection here is that you have to have a pelvis that's large enough to
accommodate this hip resurfacing. They found that when they're putting these in
in smaller people in the past, they were having trouble with fracture of the
head of the femur and other issues like that. So, pretty much the only implant
company in the US that makes this, there's only one, only allows it to be
provided in males, and that's because the pelvises are large enough to
accommodate this hip resurfacing.

Other than that, the main thing that you're looking for in
these patients are someone that's actually going to benefit from the extra
stability. And so, you're really looking at these very high activity level
people, ranging from professional athletes to very high-level recreational
athletes. The normal average person that has arthritis and just needs to get by
and just kind of walks or jogs lightly won't see the benefit from a hip
resurfacing. It's going to be the people that need to run, jump, high impact
type of activities on a hip like this.

Melanie Cole (Host): That's really cool though, that
you're able to work with these high-end athletes. And as an exercise
physiologist, I've seen the direct results with some of the football players
and things I've been working with. So, can you speak a little bit about the
procedure itself? Is there a big learning curve since this is relatively new?
How much does the experience of the surgeon matter when it comes to your
outcomes?

Dr Scott Mabry: I'd say that's crucial. So, this
procedure had a lot of popularity 10 to 20 years ago, and then kind of lost a
little bit of popularity due to the fact that it is a metal head of the femur
and a metal socket. So, some of the metal on metal problems that we heard about
in the past from total hips are potential risk with this procedure. And that's
why getting those components in a perfect position to minimize those issues is
very important here.

So, there is quite a learning curve to this. I was fortunate
enough to train under another surgeon that did a quite a few of these, and so I
felt comfortable and was actually certified in my training to do this. You do
have to be certified to do this procedure. So, I think that's the real reason
that it's important to make sure you're getting this done by a surgeon that is
certified and has done quite a few of these.

Melanie Cole (Host): As you're speaking to other
providers and they are referring their patients to you for this unique
procedure, speak a little bit about recovery. You mentioned at the beginning,
and we've talked that it has the capacity for the patient to get back to that
higher level of activity and that it can have a longer lifespan in those
patients. I'd like you to speak a little bit about that recovery. What does
that mean for the patient and when are they able to get back? What's involved
in their physical therapy and after procedure?

Dr Scott Mabry: Yes. And that's an important thing
you bring up. So, the ultimate goal is to get these patients back to a very
high activity level, and that is done through the stability of the actual
components and the preservation of the bone as part of this procedure. Now that
being said, the actual surgery itself and the initial recovery is actually much
bigger than the total hip replacement. In order to appropriately position the femur
and the socket in such a way to do this procedure, you actually have to make a
longer incision, release more muscles and get great visualization of seeing
what you're doing because that component positioning is so important here. That
does mean that the first six weeks is probably on par with the normal total hip
replacement, but it really does take that full three months to get back to
normal activity and then you can start increasing the activity level to that
very high elite level athletic activity after that. So, the recovery period is
on par with a total hip, if not a little bit longer. But I think the benefits
long term for those high-level athletes, at least high-level recreation
athletes, is very important.

Melanie Cole (Host): I think so too. How have been
your outcomes?

Dr Scott Mabry: So, the ones of these I've done, I
think the patients do very well. It is usually a very highly motivated person.
And then like I have mentioned with some of the other podcasts we've done, if
you really are strict with your selection criteria and make sure that you're
doing this in an appropriate person, the outcomes are very good and people go
back to competitive tennis or high-level cycling. And it's very rare that these
wear out over time. And if there is ever a problem, it typically is that kind
of metal on metal problem after 10, 20 years or so.

Melanie Cole (Host): Well, you're right, they do tend
to be highly motivated, more disciplined, so they're going to stick to the post
procedure, you know, regimen because they really want to get back to their
activity. As we wrap up, I'd like you to speak about the uniqueness of what you
are doing at UAB Medicine and why other providers should refer to the
specialists there for something like hip resurfacing versus total hip
replacement.

Dr Scott Mabry: The uniqueness of this is that it's
an offering or a replacement option in a patient population that is worried
about going through with a total hip replacement because they may have to cut
back on their activity level or may have to give up on some of the things that
they're very passionate about.

And I think it's important for other providers that are
considering referring for this or at least seeing patients with those goals in
mind that this is a large surgery. This is a big surgery, it's a difficult
recovery, but it's important that these patients go to someone that has done
some of these and is certified to do a surgery like this in order to optimize
their outcome.

Melanie Cole (Host): I'm so glad you brought up the importance
of all of that, plus the certification need for the provider. That's such
important information. Dr. Mabry, thank you again. You're a great guest.

And for more information about hip resurfacing or to refer a
patient to UAB Medicine, you can call the MIST line at 1-800-UAB-MIST, or you
can visit our website at uabmedicine.org/physician. That concludes this episode
of UAB Med Cast. I'm Melanie Cole. Thanks so much for joining us today.