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Monday, December 17. 2007
Hello
Pat Walter from Surface Hippies contacted me. I want to make it clear that I am not a qualified pathologist, nor a medical doctor, I am just a researcher with an interest in hip resurfacing and biomaterial compatibility. I run an independent implant retrieval research laboratory within the J. Vernon Luck Snr MD Orthopaedic Research Center at UCLA/Orthopaedic Hospital in Los Angeles. As such, I am the fortunate recipient of specimens and information from several orthopaedic surgeons, including Dr De Smet, who care enough about their patients to seek out knowledge to help solve patient problems, among which is metal sensitivity. I also want to emphasize that metal sensitivity to hip resurfacing replacements (or other hip replacements) is a problem that we (the orthopaedic community) are still learning about. (as well as the very much more common causes of problems with hip resurfacing such as fracture and loosening). Therefore, the material I include here should be considered preliminary and subject to change as more information is gained. That said, I hope your readers will find the attached description informative. Lastly, I would encourage the surface hippies to attend their regular follow up visits with their surgeons as the data obtained on the good as well as the problematical implants helps us all.
Sincerely
Pat Campbell PhD
Assoc Prof. UCLA/Orthopaedic Hospital
Allergy to Joint Replacements
(from www.metalsensitivity.com – due online in 2008)
Occasional reports of joint replacement implant failure because of an apparent allergy to one of the metals in the device have appeared in the orthopaedic literature ever since metal implants were used. (1-3) It is now recognized that a small number of patients will suffer from a form of allergy or hypersensitivity to constituents of the metal-on-metal bearings even in the absence of high wear or a known metal sensitivity (4-6). The term ALVAL (aseptic lymphocytic vasculitis associated lesions) has been coined to describe the histological features associated with an allergy-like reaction in the joint tissues. (7, 8) It should be noted that some pathologists object to the inclusion of the “vasculitis” part of this new name and vasculitis in the strict sense of the word is not a prominent feature of the lesions.
Continue reading "Allergy to Joint Replacements by Pat Campbell"
Monday, December 17. 2007
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Florian-D. Naal, MD*, Nicola A. Maffiuletti, PhD, Urs Munzinger, MD and Otmar Hersche, MD
From the Joint Center, Schulthess Clinic, Zurich, Switzerland
Background: No information is available concerning patients’ sports activity after hip resurfacing arthroplasty.
Hypothesis: Patients treated by hip resurfacing arthroplasty will be able to achieve a high level of sports activity.
Study Design: Case series; Level of evidence, 4.
Methods: We surveyed 112 patients by postal questionnaire to determine their sporting activities at a mean of 23.5 (range, 9–40) months after hip resurfacing surgery. Data were also analyzed separately for older and younger patients and women and men, respectively.
Results: Of 112 patients, 110 participated in an average of 4.6 sport disciplines after surgery, compared with 105 patients pre-operatively engaged in an average of 4.8 disciplines. About 26% performed sports 4 times per week or more—almost 60% for longer than 60 min at each session. A high proportion of our patients were still engaged in downhill skiing (51%) and in high-impact disciplines such as tennis (12%) or contact sports (22%). More than 50% of the patients commenced sports within the first 3 months after surgery. During activities, 70% were completely pain-free. The group of older patients (mean age, 60.2 years) participated in more different disciplines with a higher weekly frequency and longer session length than younger patients (mean age, 46.4 years).
Conclusion: The present study reports for the first time on the detailed sports activity and activity extent after hip resurfacing arthroplasty. Our patients could return to a high level of sports participation after surgery. Age-related differences were found that have not yet been published. Nevertheless, further follow-up is necessary to assess the influence of high-level activity on loosening and revision rates after hip resurfacing arthroplasty.
Monday, December 17. 2007
Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty
FOUR-YEAR RESULTS OF A PROSPECTIVE LONGITUDINAL STUDY
J. Daniel, FRCS, Director of Research1; H. Ziaee, BSc(Hons), Biomedical Scientist1; C. Pradhan, FRCS, Staff Orthopaedic Surgeon1; P. B. Pynsent, PhD, Director2; and D. J. W. McMinn, FRCS, Consultant Orthopaedic Surgeon1
1 The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham B15 3DP, UK.
2 Research and Teaching Centre, Royal Orthopaedic Hospital, Northfield, Birmingham B31 2AP, UK.
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This is a longitudinal study of the daily urinary output and the concentrations in whole blood of cobalt and chromium in patients with metal-on-metal resurfacings over a period of four years.
Twelve-hour urine collections and whole blood specimens were collected before and periodically after a Birmingham hip resurfacing in 26 patients. All ion analyses were carried out using a high-resolution inductively-coupled plasma mass spectrometer. Clinical and radiological assessment, hip function scoring and activity level assessment revealed excellent hip function.
There was a significant early increase in urinary metal output, reaching a peak at six months for cobalt and one year for chromium post-operatively. There was thereafter a steady decrease in the median urinary output of cobalt over the following three years, although the differences are not statistically significant. The mean whole blood levels of cobalt and chromium also showed a significant increase between the pre-operative and one-year post-operative periods. The blood levels then decreased to a lower level at four years, compared with the one-year levels. This late reduction was statistically significant for chromium but not for cobalt.
The effects of systemic metal ion exposure in patients with metal-on-metal resurfacing arthroplasties continue to be a matter of concern. The levels in this study provide a baseline against which the in vivo wear performance of newer bearings can be compared.
Monday, December 17. 2007
Doctors sell hip resurfacing to boomers
Updated: 2007-01-30 13:59
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WASHINGTON - Doctors are beginning to offer a new alternative to hip replacement, one aimed at younger, athletic baby boomers who've worn out their joints too soon. Now they no longer have to wait until they hit their 60s for a fix.
Continue reading "Doctors Sell Hip Resurfacing to Boomers"
Thursday, December 13. 2007
..on a cold and windy december morning, i was thinking the following on the way home from my first race back on the bike:
1) BHR Dr Bose: 4/12/07
2) Return home from resurfacing in india, walked 3 blocks: 5/02/07
3) First Win: western states time trial: 12/02/07:
...bless you pat, the website, and all the others who have inspired me-came before me...
...my life, AND my athletic life are back ! ...no, i'm not just jogging, i'm dropping some sub 6 minute mile running repeats on the track, and winning again on the bike, my first race back in the saddle ! (picture attached)
...to all of those who need to know, who wonder, who are putting it off, who are in pain, who need hope... the birmingham hip and dr bose in chennai india are awesome !
...i couldn't have done this without faith, without pat and the website, and dr bose's staff...
...now: ..you can do it too !
...i'll keep you posted about me earning my team usa spot back.
...believe !
gary kobat
Read More of Gary's Story
Gary Kobat Athlete and Trainer - hip resurfacing story with Dr. Bose of India 2007
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