Cleveland_Clinic_Host: If you are a young, active person with arthritis of the hip that isn't improving with conservative treatment, hip resurfacing is an option to consider. Like hip replacement, resurfacing repairs the joint to relieve hip pain. Just a few millimeters of bone are shaved from the hip, and joint surfaces are then capped with metal implants. Resurfacing preserves more hip bone than replacement, yet makes it easy to do total joint replacement down the road if needed.
Results from long-term data show that it can last just as long as hip replacement in young, high-demand patients, with only 1 or 2 percent needing further surgery after ten years. Those patients who do need a second surgery have the excellent results of first-time hip replacement, with the stability and range of motion of a large metal on metal hip joint.
Since its FDA approval in 2006, over 600 hip resurfacing procedures have been performed at Cleveland Clinic Center for Hip Resurfacing at Euclid Hospital making the Center one of the busiest in the nation. Hip resurfacing is not for everyone. But for the active person with hip pain due to arthritis, hip resurfacing has many advantages over hip replacement and can lead to a return of normal lifestyle and activity.
Cleveland Clinic Center for Hip Resurfacing at Euclid Hospital has three outstanding Orthopaedic surgeons that perform hip resurfacing.
Peter Brooks, MD is a staff physician in the Center for Adult Reconstruction in the Department of Orthopaedic Surgery. He specializes in total joint replacement of the hip and knee, and hip resurfacing. He also maintains an interest in arthroscopy of the knee. Dr. Brooks completed his fellowship in orthopaedic surgery at Mount Sinai Hospital in Toronto.
Ulf Knothe, MD is a staff physician in the Center for Adult Reconstruction in the Department of Orthopaedic Surgery. He specializes in adult reconstruction, particularly hip and knee replacement. Dr. Knothe internationally trained at top U.S. and European orthopaedic centers joined Cleveland Clinic in 2002.
Daniel Single, MD is a staff physician in the Center for Adult Reconstruction in the Department of Orthopaedic Surgery. He specializes in general orthopaedics, including fracture care, sports medicine, total joint replacement of the hip and knee, and hip resurfacing. Dr. Single completed his residency in orthopaedic surgery at Cleveland Clinic in Cleveland.
To make an appointment with Dr. Peter Brooks, Dr. Ulf Knothe or Dr. Daniel Single at Cleveland Clinic Center for Hip Resurfacing at Euclid Hospital, please call 216.692.7750. You can also visit us online at clevelandclinic.org/ortho
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Peter Brooks. We are thrilled to have Dr. Brooks here today for this chat. Let’s begin with the questions.
Hip Resurfacing – Who is a candidate?
aflame: Is there an age limit for resurfacing?
Speaker_-_Dr__Peter_Brooks: My oldest patient is 80, but that was a very special circumstance. His circumstance was that his femur was crooked, and a total hip would have been very difficult. But it is true that the average patient does better with a resurfacing if they are less than 65 years of age.
Dakota11: What is the youngest patient you have performed a BHR?
Speaker_-_Dr__Peter_Brooks: My youngest patient was a 14 year old boy.
ski: I'm a 61 yr. old fire lt., former OSU football and baseball player. Am I a candidate for hip resurfacing rather than replacement?
Speaker_-_Dr__Peter_Brooks: The decision is based on your X-rays. You would need to come in for an evaluation.
eddieray: I have had my left hip replaced about 7 years ago. No problems. Now my right hip is giving me a lot of pain. I am currently participating in a research study called Protocol 025 which has given me little relief. My concern moving forward with hip surgery on my right leg is that I do not have lymph glands in my upper leg as they were removed 25 years ago as a precaution to cancer. I have swelling in my leg which I control with the use of a full leg compression stocking and daily use of a full leg compression pump. I am very active on my feet and this recent episode with my leg/hip pain is creating quite a challenge. I have had a history of cellulitis in my right leg which adds to the challenge of surgery. Is there good collaboration between the surgeon and circulatory specialist in a case similar to this or at least some history of other patients that have had a similar situation? Thank you.
Speaker_-_Dr__Peter_Brooks: How old are you and what do the X-rays show?
eddieray: The X-ray does show deterioration of the joint.
Speaker_-_Dr__Peter_Brooks: I have operated on people with lymphedema. I have not had problems with them, but I imagine their infection rate is a little higher and maybe with blood clots as well. This would be true with total hip replacement as well as with resurfacing. If non-operative treatment is not enough for you, you can have surgery.
Yes, we do have a very strong relationship with vascular medicine.
MsKarin: If I have an allergy to nickel, can I still have hip resurfacing? Am I able to have this procedure of I am overweight?
Speaker_-_Dr__Peter_Brooks: I've resurfaced a number of people with nickel allergies. They are not very well understood. The sensitive cells in the skin (which react to nickel) may not be present in the hip. There is no test one way or another to see if there will be problems or not. I have resurfaced a dermatologist who was married to an allergist who had a nickel allergy.
Obesity is not a problem. My heaviest patient was 440 pounds.
Kimber: My husband is 36 yrs. old, and was told this past Sept. that he has severe arthritis in both hips. He has seen a specialist and they don't recommend hip replacement because he is young but suggested trying cortisone shots for the pain. If this procedure would be something for him are both hips done at the same time?
Speaker_-_Dr__Peter_Brooks: He is not too young for resurfacing. I usually do one hip at a time because it is safer and you have one good leg to protect the other one from fracture. I have done simultaneous bilateral resurfacing in carefully selected patients.
kit67: Hi: I have bone-on-bone arthritis in my left hip that causes little pain unless I flex in an extreme way. I am very active and work out a lot including swimming and spinning and weight lifting. There are things I cannot do because of my hip, like yoga, squats, lunges and anything high impact. How critical then is it then to go ahead with the resurfacing? I am worried about the effect on my other joints, like my right knee, and the effect my condition might be having on my posture too. I do feel compromised in activities, but not daily living. I know the problem is there and should do something about it, but when? In other words, is it "dangerous" not to do something about a serious joint problem when the problem is not seriously affecting one's life?
Speaker_-_Dr__Peter_Brooks: It does not sound like you are ready for surgery just yet. If the pain starts waking you up at night, it occurs every day and interferes with your quality of life, then have something done.
All surgery has complications. Only have it done if you really need it.
scottc2: My husband needs to have this done and he will be in to see you in March, but how long does the resurfacing last vs. a THR?
Speaker_-_Dr__Peter_Brooks: If he is under 55, it will last longer than an average total hip. If he is over 65, a total hip would be better. If he is in between, they probably last the same.
A resurfacing would give him a number of advantages. Advantages include removing less bone the day of surgery and preventing bone loss in the upper femur over the next several years. He would be less likely to dislocate his hip, less likely to have a leg length discrepancy, he would have better balance and if something were to go wrong, a resurfacing would be much easier to revise.
Jake: I am told I need a hip replacement and I am looking into what where and when I should do this.
Speaker_-_Dr__Peter_Brooks: You can make appointment to see one of the hip resurfacing specialists at Cleveland Clinic Euclid Hospital. The appointment line is 216.692.7751.
theresacort: 73 y/o male with osteoarthritis of left hip, symptomatic x 1 year, healthy, active, BMI at goal, recommendations re resurfacing procedure. Is this an option for him? Has anyone fitting this criteria ever been done? And if so what were the outcomes? Are there any studies to show where were they done and by what team/ M.D. Thanks.
Speaker_-_Dr__Peter_Brooks: I think the decision should be made on the patient's bone quality and activity expectations, not solely on their chronological age. I have resurfaced many people over the age of 65.
In general, I prefer hip replacement in patients over 65. If he is a marathon runner, tri-athlete or extreme tennis player, I would do a resurfacing. I probably have done 20 people over 65, out of more than 570 patients.
Hip Resurfacing Overview
eddieray: Why does it make it easier if a total hip replacement is needed later?
Speaker_-_Dr__Peter_Brooks: By doing a hip resurfacing, the femoral neck is not touched; just the femoral head is resurfaced. This means that the top 3-4 inches of bone is preserved. If something happens in the future and you need a total hip replacement, it would be a primary not a revision. This is very easy to do post hip resurfacing.
ski: Can a joint be too arthritic to be resurfaced?
Speaker_-_Dr__Peter_Brooks: You need to have enough bone in the femoral head and neck to be resurfaced. Some bad cases of trauma, AVN or Perthe's Disease cannot be resurfaced. As long as the general shape of the bone is close to normal, it can probably be resurfaced.
Very large cysts in the femoral head can predispose to femoral neck fractures.
Dakota11: Is it correct that this procedure has only been approved by the FDA since '06, I thought it was approved in '96?
Speaker_-_Dr__Peter_Brooks: It was developed in the early 1990's in the UK. The Birmingham design was finalized in 1997. After it was bought by a large US company in 2004, they applied for FDA approval and the Birmingham device was approved in 2006. Since then, the Cormet Hip Resurfacing Device was approved in 2007 and the Conserve + (also called C+) in November 2009.
Kimber: How does cost compare of that of a traditional hip replacement?
Speaker_-_Dr__Peter_Brooks: The device costs more, but most of that cost should be covered by insurance. The surgeon fee is identical to that of a traditional hip replacement.
ski: Dr. Brooks, does worker's comp cover this procedure?
Speaker_-_Dr__Peter_Brooks: We have done worker's comp patients that have had the hip resurfacing procedure approved.
Dakota11: How long between hips do you recommend? What if there is a blood clot complication? Thank you for your time.
Speaker_-_Dr__Peter_Brooks: Three and a half to four months between surgeries. We do watch for blood clots, do testing and medicate patients to prevent blood clots.
kit67: As a patient needing either a THR or resurfacing, and I think I speak for others also seeking treatment for hip arthritis, I find it extremely confusing and disappointing that patients seem only to be steered toward that procedure which an orthopedist favors even though he/she may be knowledgeable about both; instead of being steered toward that procedure which truly would benefit the patient the most. What is a patient supposed to think when one top orthopedist in the area STRONGLY recommends one procedure; and another top orthopedist strongly recommends the competing procedure (assuming the patient is a candidate for either procedure)? Whose opinion is a patient supposed to believe?
Speaker_-_Dr__Peter_Brooks: Surgeons who have not taken the training course in hip resurfacing, which is required by the FDA to do the procedure, may not be completely current on all of the evidence.
Many years ago, hip resurfacing was done using metal and plastic and the results were awful and left a bad reputation for resurfacing.
Surgeons who do both procedures are in a unique position to advise an individual which procedure is best for them. It is an unfortunate fact that if a surgeon does not do hip resurfacing, he/she may tend not to recommend it. Not all surgeons are like that but some are.
Patients should use every resource available to them, like this web chat, or other forms of Internet reading to educate themselves. I recommend visiting http://www.surfacehippy/ as a non-biased educational resource.
Brian_R: I was referred to the Lorain campus orthopedics office and was diagnosed with avascular necrosis in both hips. I asked about hip resurfacing and was told there was not enough bone there and that replacement was my only option. I am a 40 yr old male and am very concerned about returning to an active lifestyle including sports, bicycling, jogging, and work etc. Should I ask for further testing to be sure or is he correct? What are the differences like cost, recovery time, infection and other risks? I am not overweight. 6'3" 175 lbs. Your answer is very important. Thank you.
Speaker_-_Dr__Peter_Brooks: Your question is very important too. I have resurfaced a lot of people with avascular necrosis, but in general no more than 1/3 - 1/2 of the femoral head is involved. With more than that, you need to have a total hip. This can be judged on plain x-rays or MRI.
MargRM: What tests are conducted for diagnosis?
Speaker_-_Dr__Peter_Brooks: Hip X-rays and sometimes a bone density screening or an MRI is needed to determine the quality of the bone.
greenhorn: I am 57 years old and have had a right hip problem for over 2 years. My arthritis doctor says I should look into a hip replacement. Can you tell by X-rays or a MRI if I am a candidate for hip resurfacing or do you determine that after opening up the hip? Also is there what they call non-invasive hip replacement where there is less muscle cut and recovery time is quicker? Do you also do that?
Speaker_-_Dr__Peter_Brooks: I can almost always tell from regular x-rays, the only exception would be AVN. I have never yet had to change to a total hip replacement in the middle of a resurfacing.
The surgery is performed through a muscle splitting approach. The incision is slightly longer that a total hip. No muscles are cut, making recovery easier.
kit67: I have a shallow hip socket, my socket covers 75% of the ball of my femur, and that is why I have arthritis. Is that condition called hip dysplasia (a condition you stated earlier is a concern when considering resurfacing)?
Speaker_-_Dr__Peter_Brooks: Yes it is.
Avascular Necrosis (AVN)
mirosj: Can resurfacing be done for someone with AVN?
Speaker_-_Dr__Peter_Brooks: It can be resurfaced with AVN, but it depends on the amount of damage of the femoral head.
The 10 year results in avascular necrosis are not as good as with osteoarthritis, but they are not bad , 90% with AVN and 98% OA who got resurfaced are still fine after 10 years.
mirosj: Is AVN visible with X-rays? Or must an MRI be done to know if AVN is present?
Speaker_-_Dr__Peter_Brooks: Sometimes AVN is very obvious on X-rays, but other times an MRI is necessary to determine the extent of the AVN.
mirosj: Can the extent of AVN be determined through MRI that allows the physician to make a definite decision on BHR/THR?
Speaker_-_Dr__Peter_Brooks: Even plain X-rays can allow that decision.
Jake: I have been diagnosed with avascular necrosis in my right hip. I have had x-rays recently and an MRI a few years back. My physician said he thought there was too much bone loss to do a hip resurfacing. I just want a second opinion because it would sound like resurfacing would be less invasive.
Speaker_-_Dr__Peter_Brooks: Feel free to make an appointment. You can bring your X-rays or we will get new ones. Many people with AVN can have resurfacing. The phone number to call for an appointment is 216.692.7750
Hip Resurfacing and Women
suzzy: What are the concerns with hip resurfacing and women?
Speaker_-_Dr__Peter_Brooks: There are several concerns. Women are generally smaller than men and we know that larger bearings lubricate better and may last longer. If you compare men and women of the same size, that gender difference disappears, as shown by the Australian National Joint Registry. It appears more to be related to size itself than gender.
Women, however, are more likely to have osteoporosis and that may increase the risk of femoral neck fracture in the first year after surgery. Women are also more likely to have hip dysplasia which can become tricky to resurface and especially if they are small, it has to be done exactly right.
Women, who intend to become pregnant in the future, should probably not be resurfaced because of the unknown effects of metal ions on a developing fetus.
I have resurfaced 150 women between the ages of 30 and 67. Many had osteopenia. A few had osteoporosis. Not a single one has sustained a femoral neck fracture or needed revision at this time.
Finally, women are also more likely than men to have a nickel allergy, but the significance of that is unknown.
salor99: I am a 40 year old female who had hip surgery when I was only 2 days old due to an infection that lodged in my hip, I am now in tremendous pain, and have been old I need a hip replacement but the doctor was leery due to the fact that he wasn't sure that if I needed later surgeries there wouldn't be enough bone available. How long would hip resurfacing last? Since I did have a previous surgery would this be an option for me? What should be my next step?
Speaker_-_Dr__Peter_Brooks: As long as your bone is still adequate, you could be a candidate for resurfacing. You should plan any future pregnancies, so get that done first!
Your next step should be to consult with someone who does hip resurfacing. You can locate a surgeon on http://www.surfacehippy.info/ Or call 216.692.7750 for an evaluation with my team.
salor99: I previously asked if hip resurfacing was for me; I had the prior hip surgery when I was 2 days old; here is what my X-ray report says: There is narrowing of the left hip joint. Also noted is narrowing of the right hip joint. The right femoral head is somewhat flattened and acetabulum does not cover the lateral aspect of the femoral head. This may be related to history of congenital hip dysplasia. Clinical correlation is suggested. No fractures or dislocations are noted. My MRI report says: There is advanced degenerative arthritis of the right hip joint. There is marked narrowing of the articular space with moderate periarticular osteophytosis, subchondral cystic change and subchondral sclerosis. There is bony remodeling of the femoral head. Thank you.
Speaker_-_Dr__Peter_Brooks: Sounds resurfacable.
randyd: Why is the direct anterior approach not used for this?
Speaker_-_Dr__Peter_Brooks: It is. It is a matter of surgeon preference. My preference is the anterolateral approach.
randyd: In order to expedite recovery, shouldn't the direct anterior approach be used? Why do I have to go to California to get resurfacing done with that approach?
Speaker_-_Dr__Peter_Brooks: You can have a perfectly good recovery with any surgical approach. The biology of bone healing and risk of femoral neck fracture seems to be the same no matter how it is implanted. I prefer the anterolateral approach because that is what I am mostly familiar with. The muscles are split in the line of their fibers and heal quickly. No muscle is cut.
kit67: I recently read about an ongoing study in Denmark concerning the surgical approach--posterior vs. anterolateral. The theoretical advantages of the anterolateral approach were listed as: 1) preserve the blood supply to the femoral head and neck and improve implant longevity, and 2) spare the muscle tendons and ease patient recovery. Just wondering which approach is currently in use here in the states.
Speaker_-_Dr__Peter_Brooks: I use the anterolateral approach, like 20% of American surgeons for those reasons that you mentioned. 75% of US surgeons use the posterolateral approach, because that is what they are used to. Clinical studies show no difference in outcomes. The other 5% use the anterior approach and we have no long term data on that.
jscott08: If you have a bone spur on the hip ball can it still be resurfaced?
Speaker_-_Dr__Peter_Brooks: Yes. If the bone spurs interfere with the surgery or ROM after surgery, the bone spurs will be removed.
Dakota11: How is the metal attached to the bone glue/cement?
Speaker_-_Dr__Peter_Brooks: With the Birmingham system, the femoral head is cemented and the socket is press-fit porous metal. There is currently no cement-less devise for resurfacing approved by the FDA.
Dakota11: Are you aware of the Washington Post article discrediting BHR procedures providing that current research has revealed no difference between THR & BHR adding there are more risks and complications with BHRs?
Speaker_-_Dr__Peter_Brooks: Yes, I am aware of these articles. Like anything else, reports can have a slant one way or the other. Hip resurfacing has a higher and earlier failure rate than hip replacement, yet hip resurfacing has a number of important advantages. In the end the decision will be yours.
eddieray: Is the surgery only performed at the Euclid location? How about Medina General?
Speaker_-_Dr__Peter_Brooks: Most have been done at Euclid Hospital and some at our Main Campus., We do not currently operate at Medina Hospital.
rachael10: How many of these surgeries have you performed and how many have had complications?
Speaker_-_Dr__Peter_Brooks: I have 575 resurfacings at this time and only 1 revision. That individual had a femoral neck fracture at 8 weeks doing leg presses.
I have had 1 deep infection. There has been no component loosening, no dislocation and no deaths.
Dakota11: What might be considered as a normal hospital stay with your hospital?
Speaker_-_Dr__Peter_Brooks: Most patients will spend 3-4 days in the hospital recovering from hip resurfacing surgery. Patients are taught how to use crutches and do range of motion exercises. After 3-4 days if the patient is doing well, he/she will return home and continue rehabilitation.
aflame: My blood type is A-. Do you suggest that I make autologous donations prior to surgery?
Speaker_-_Dr__Peter_Brooks: Most of our patients donate 1 pint for their own use.
luvtoski: What are the anesthesia choices for this surgery?
Speaker_-_Dr__Peter_Brooks: At Cleveland Clinic we like to use a spinal anesthetic along with sedation that allows you to sleep during the procedure. Patients do very well with this combination, waking up with no pain and none of the same side effects of general anesthetic. Usually oral medication is used afterwards for pain control.
scottc2: How long does a typical surgery last?
Speaker_-_Dr__Peter_Brooks: Under 1 hour, but that of course depends on the experience of the surgeon.
MargRM: What type of exercise is recommended, pre and post surgery, how much should one push themselves if the structural damage is not seeming to be improved, however muscle strength is improving, just want to know how much is too much, causing greater damage?
Speaker_-_Dr__Peter_Brooks: Before surgery, try to stay as fit as you can. It is tough to do exercises when you are in pain. After surgery, we have very specific exercises we will teach you.
Kimber: Are there any limitations to the patient after they have recovered from surgery?
Speaker_-_Dr__Peter_Brooks: You are limited for 1 year to no running, jumping or heavy lifting. After that, there are no limitations at all.
randyd: What is the recovery process like. How long for each step?
Speaker_-_Dr__Peter_Brooks: Patients are partial weight bearing for the first 6 weeks using crutches. After that, they get back to normal activities but are not allowed to run, jump, and perform high impact activities or heavy lifting for one year. After one year, there are no restrictions.
Kimber: Is the range of motion different than the traditional hip replacement (which we were told the patient shouldn't bend at the waist to make the leg/legs more than 90 degrees?
Speaker_-_Dr__Peter_Brooks: Yes, because of the size of the femoral head the risk of dislocation is much lower with resurfacing. In addition, using the anterolateral approach, the risk is very low anyway. My patients are allowed to bend past 90 degrees the day of surgery and do not need any of the traditional "hip precautions" to avoid dislocation.
Hip resurfacing patient’s don't need a raised toilet seat and can cross your legs, bend and twist, etc.
jscott08: How long would take to get back to work if you are someone that works outside or construction?
Speaker_-_Dr__Peter_Brooks: Most people are returning to work within 6-10 weeks post surgery. If you do a very heavy, physical job there may be restrictions such as lifting over 40 lbs for up to 1 year. After 1 year there are no restrictions on any activities.
luvtoski: How long would I have to wait after having the surgery before I can begin walking for exercise?
Speaker_-_Dr__Peter_Brooks: You are on crutches for the first 6 weeks. After that you should return gradually to walking for exercise.
ski: Would successful completion of this procedure allow me to go back on company working on the fire truck and resume playing basketball and golf?
Speaker_-_Dr__Peter_Brooks: I have resurfaced a lot of firemen. They have all gone back to work and if they wanted to play basketball, I would allow that after 1 year.
luvtoski: What do you consider heavy lifting for woman who is 140 pounds. Can I lift my 25 pound grandchild?
Speaker_-_Dr__Peter_Brooks: We allow patients to lift up to 35-40 lbs after surgery so a 25 lb. grandchild would be fine.
randyd: I exercise for 45 minutes a day on a Stairmaster. Will I have to wait 1 year before exercising on it?
Speaker_-_Dr__Peter_Brooks: Yes - one year.
aflame: When can you begin driving?
Speaker_-_Dr__Peter_Brooks: We advise all patients if you are using crutches or a walker, you should not be driving for 6 weeks post-op.
Dakota11: I have heard of a patient going downhill skiing after 1 yr recovery, this seems a bit scary with potential dislocation or related injury - your concerns?
Speaker_-_Dr__Peter_Brooks: There is much less of a chance of hip dislocation with resurfacing compared to total hips. About 90% less risk. My resurfacing patients ski after 1 year, without restriction. My total hip replacement patients are confined to blue and green runs on the slopes.
MargRM: What are the contraindications, if any?
Speaker_-_Dr__Peter_Brooks: Active infection, women of child-bearing age, kidney failure, inadequate bone architecture or strength, advanced age.
Kimber: Can you please tell us what the typical length of hospital stay is, length of recovery and physical therapy would be?
Speaker_-_Dr__Peter_Brooks: Hospital stay is 3-4 days, then 6 weeks on crutches. Most patients do their own exercises without formal physical therapy. We teach stair climbing before discharge.
Kimber: Does your office have any type of payment plan set? We are self paying with no insurance. This is for both surgery and consultations?
Speaker_-_Dr__Peter_Brooks: Please contact our financial counselor for the department of Orthopaedics at Cleveland Clinic. There are payment plans available for special circumstances.
aflame: What is the infection rate for all hip transplants performed in your Euclid Hospital facility, as a percent; and, what systems do you have in place to hold down this rate? Do you test patients (nasal swab or blood test) for infection upon admittance?
Speaker_-_Dr__Peter_Brooks: The infection rate at Euclid Hospital for all total hips is under 1% for resurfacing, it is 0.2%.
We have some of the best infection rates you will find anywhere. We have a multitude of precautions against infection. We do not do nasal swabs on patients or staff as a routine.
Dakota11: How many BHR have you completed per doctor and where (with whom) have you received your training for this procedure?
Speaker_-_Dr__Peter_Brooks: I trained for the procedure in Birmingham England in 2006 and again in 2008. Dr. Single trained with me. I have done 570, Dr. Single has done about 15 and Dr. Knothe has performed 90 resurfacing procedures..
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Peter Brooks is now over. Thank you again for taking the time to answer our questions about hip resurfacing.
Speaker_-_Dr__Peter_Brooks: I enjoyed my time speaking with you today.
To make an appointment with Dr. Peter Brooks, Dr. Ulf Knothe or Dr. Daniel Single at Cleveland Clinic Center for Hip Resurfacing at Euclid Hospital, please call 216.692.7750. You can also visit us online at clevelandclinic.org/ortho
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This chat occurred on January 21, 2010.
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