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Thursday, January 29. 2009
Northeast Ohio's Center for ... Posted by Patricia Walter
in Hip Resurfacing Articles at
09:31
Comments (0) Trackbacks (0) Northeast Ohio's Center for Orthopedics Now Offers Hip Resurfacing, a Bone-Saving Alternative to Hip Replacement SurgeryNortheast Ohio's Center for Orthopedics Now Offers Hip Resurfacing, a
Bone-Saving Alternative to Hip Replacement Surgery Link http://www.prweb.com/releases/2009/01/prweb1923314.htm Now, the Center for Orthopedics in Sheffield Village, Ohio, offers hip
resurfacing surgery to active Baby Boomers sidelined by arthritis. William B.
Stanfield, MD, performs this state-of-the-art procedure to help men and women
get back to the gym, dancing or the sports they love, with more freedom of
movement and less chance of dislocation than hip replacement surgery. Sheffield Village, Ohio (PRWEB) January 29, 2009 -- For active Baby Boomers
sidelined by hip arthritis, Northeast Ohio's Center for Orthopedics now offers hip resurfacing (http://www.center4orthopedics.com/procedures/hip-resurfacing),
a new option designed to give patients the pain relief of hip replacement
surgery -- without many of the drawbacks. Few U.S. orthopedic surgeons are trained to perform hip resurfacing surgery.
"Hip resurfacing is relatively new in the United States, though it's been done
in Europe for more than 10 years," says William B. Stanfield, MD (http://www.center4orthopedics.com/physicians/wstanfield),
medical director of The Center for Orthopedics, just west of Cleveland. Dr.
Stanfield, a board-certified orthopedic surgeon who specializes in joint
replacement and sports medicine, has been performing hip resurfacing surgery
since 2007. "Hip resurfacing reshapes the head of the thighbone or femur and resurfaces
it with a cobalt chromium metal cap -- much like capping a tooth," Dr. Stanfield
explains. "The femoral head is resurfaced -- preserving most of the bone --
rather than removing and replacing it as in hip replacement surgery. In hip resurfacing, a metal cup replaces the damaged surface of the hip
socket without the use of bone cement for fixation. The resurfaced thighbone is
almost identical to the size of the natural bone, resulting in a better fit
inside the hip socket than in total hip replacement. This gives patients greater
stability and more-natural hip performance. "Resurfacing is often a good choice for younger patients, as it allows them
to have a much more active lifestyle afterwards than hip replacement surgery,"
Dr. Stanfield explains. "Preserving more of the natural bone is also important
if patients need more hip surgery in the future." Hip replacement surgery has become very popular. In 2006, 482,000 Americans
had a total or partial hip replacement, according to the Centers for Disease
Control and Prevention -- but it imposes many restrictions on patients' physical
movement. Orthopedic surgeons caution hip replacement patients not to cross their legs,
raise their knees to less than a right angle to their torso, or turn their feet
excessively inward or outward. Forgetting these restrictions even once can lead
to an excruciatingly painful hip dislocation -- and may necessitate further
surgery. "Hip resurfacing isn't for every patient with hip arthritis," Dr. Stanfield
advises, "but it can be a wise choice for active patients under age 65 who have
good bone quality and suffer from arthritis." Case in point: fire battalion chief John Yatson, age 51. "The arthritis pain in my hip was keeping me awake at night," Yatson recalls.
"I went for a few months straight where I got only two or three hours of sleep a
night. That's when I decided to get something done. "When my orthopedist looked at the x-ray of my hip, he said I'd be a good
candidate for hip resurfacing," says Yatson. After considering his options, he
decided to have his hip resurfaced rather than replaced. "I went in the hospital on a Monday morning, was up on my feet the next day
with the aid of a walker, and went home on Thursday afternoon," says Yatson. He
participated in a course of physical therapy after surgery to help restore his
normal movement. "Now I'm pain-free," he says. "I have no restrictions -- that's what sold me
on hip resurfacing. I'm even jogging a couple of times a week. When I'm ready to
get the other hip done, I won't hesitate." Yatson is very glad he didn't have a total hip replacement. "A guy I know had
a total hip replacement, and he dislocated his hip once while playing golf," he
recalls. "I think if someone has the option of hip resurfacing as opposed to a
total hip replacement, resurfacing is definitely the way to go. "Now I don't even give a thought to my hip," says Yatson. Thursday, January 29. 2009
Northeast Ohio's Center for ... Posted by Patricia Walter
in Hip Resurfacing Articles at
09:31
Comments (0) Trackbacks (0) Northeast Ohio's Center for Orthopedics Now Offers Hip Resurfacing, a Bone-Saving Alternative to Hip Replacement SurgeryNortheast Ohio's Center for Orthopedics Now Offers Hip Resurfacing, a
Bone-Saving Alternative to Hip Replacement Surgery Link http://www.prweb.com/releases/2009/01/prweb1923314.htm Now, the Center for Orthopedics in Sheffield Village, Ohio, offers hip
resurfacing surgery to active Baby Boomers sidelined by arthritis. William B.
Stanfield, MD, performs this state-of-the-art procedure to help men and women
get back to the gym, dancing or the sports they love, with more freedom of
movement and less chance of dislocation than hip replacement surgery. Sheffield Village, Ohio (PRWEB) January 29, 2009 -- For active Baby Boomers
sidelined by hip arthritis, Northeast Ohio's Center for Orthopedics now offers hip resurfacing (http://www.center4orthopedics.com/procedures/hip-resurfacing),
a new option designed to give patients the pain relief of hip replacement
surgery -- without many of the drawbacks. Few U.S. orthopedic surgeons are trained to perform hip resurfacing surgery.
"Hip resurfacing is relatively new in the United States, though it's been done
in Europe for more than 10 years," says William B. Stanfield, MD (http://www.center4orthopedics.com/physicians/wstanfield),
medical director of The Center for Orthopedics, just west of Cleveland. Dr.
Stanfield, a board-certified orthopedic surgeon who specializes in joint
replacement and sports medicine, has been performing hip resurfacing surgery
since 2007. "Hip resurfacing reshapes the head of the thighbone or femur and resurfaces
it with a cobalt chromium metal cap -- much like capping a tooth," Dr. Stanfield
explains. "The femoral head is resurfaced -- preserving most of the bone --
rather than removing and replacing it as in hip replacement surgery. In hip resurfacing, a metal cup replaces the damaged surface of the hip
socket without the use of bone cement for fixation. The resurfaced thighbone is
almost identical to the size of the natural bone, resulting in a better fit
inside the hip socket than in total hip replacement. This gives patients greater
stability and more-natural hip performance. "Resurfacing is often a good choice for younger patients, as it allows them
to have a much more active lifestyle afterwards than hip replacement surgery,"
Dr. Stanfield explains. "Preserving more of the natural bone is also important
if patients need more hip surgery in the future." Hip replacement surgery has become very popular. In 2006, 482,000 Americans
had a total or partial hip replacement, according to the Centers for Disease
Control and Prevention -- but it imposes many restrictions on patients' physical
movement. Orthopedic surgeons caution hip replacement patients not to cross their legs,
raise their knees to less than a right angle to their torso, or turn their feet
excessively inward or outward. Forgetting these restrictions even once can lead
to an excruciatingly painful hip dislocation -- and may necessitate further
surgery. "Hip resurfacing isn't for every patient with hip arthritis," Dr. Stanfield
advises, "but it can be a wise choice for active patients under age 65 who have
good bone quality and suffer from arthritis." Case in point: fire battalion chief John Yatson, age 51. "The arthritis pain in my hip was keeping me awake at night," Yatson recalls.
"I went for a few months straight where I got only two or three hours of sleep a
night. That's when I decided to get something done. "When my orthopedist looked at the x-ray of my hip, he said I'd be a good
candidate for hip resurfacing," says Yatson. After considering his options, he
decided to have his hip resurfaced rather than replaced. "I went in the hospital on a Monday morning, was up on my feet the next day
with the aid of a walker, and went home on Thursday afternoon," says Yatson. He
participated in a course of physical therapy after surgery to help restore his
normal movement. "Now I'm pain-free," he says. "I have no restrictions -- that's what sold me
on hip resurfacing. I'm even jogging a couple of times a week. When I'm ready to
get the other hip done, I won't hesitate." Yatson is very glad he didn't have a total hip replacement. "A guy I know had
a total hip replacement, and he dislocated his hip once while playing golf," he
recalls. "I think if someone has the option of hip resurfacing as opposed to a
total hip replacement, resurfacing is definitely the way to go. "Now I don't even give a thought to my hip," says Yatson. Friday, January 23. 2009
Landis to Return to Cycling After ... Posted by Patricia Walter
in Athletes Stories, Hip Resurfacing Articles at
09:35
Comments (0) Trackbacks (0) Landis to Return to Cycling After Hip ResurfacingLandis to Return to Cycling January 22, 2009 Link  http://www.nbcchicago.com/sports/more/Landis-to-Return-to-Cycling.html Floyd Landis is coming back to cycling, and says his sport will be better for
it. Saturday, January 17. 2009
The Future of the Orthopedic Devices ... Posted by Patricia Walter
in Hip Resurfacing Devices at
09:26
Comments (0) Trackbacks (0) The Future of the Orthopedic Devices Market to 2012
The Future of the Orthopedic Devices Market to
2012 (Global Markets Direct)
Author: Mike King Link http://www.live-pr.com/en/the-future-of-the-orthopedic-devices-r1048250674.htm
Published Date: 10/12/2008 The joint reconstruction (artificial joints)
market valued at $12.2 billion in 2008 will continue
to drive growth in the orthopedic devices sector.
The global joint reconstruction market is expected
to grow by more than 9% annually to reach $17.4
billion by 2012 and is forecast to contribute 45% of
the overall orthopedic devices market value by 2012.
The key growth segments within the join
reconstruction sector are gender specific knee
implants; and hip and knee resurfacing product
lines. The spinal non-fusion devices market valued at
$551 million in 2008 is forecast to grow by more
than 10% annually to reach $792 million by 2012
accounting for 15% of the spinal surgery market
value. Driven primarily by technological innovations and
strategic consolidations, the orthobiologics market
will continue to be in investors’ focus. The
orthobiologics market, valued at $5.4 billion in
2008 is expected to grow by 9.3% annually to reach
$7.5 billion by 2012. Orthobiologics is the fastest
growing segment within the orthopedic devices sector
with more than 100 products at different stages of
clinical development. Global Market Direct analysis
predict increased utilization of orthobiologics such
as bone morphogenic proteins and autologous growth
factors in orthopedic and spine surgeries to drive
segment growth in the next 5 years. Biodegradable implants are set to drive growth of
the trauma fixation devices market which was valued
at $2.2 billion in 2008 and is expected to grow by
6.5% annually to reach $2.8 billion by 2012. The global orthopedic devices market is set to
see heightened consolidation activity, driven
primarily by Mergers & Acquisitions (M&As) in the
joint reconstruction, spinal surgery and
orthobiologics market segments. In 2007-08, a total
of 42 M&A deals were signed in the orthopedic
devices market with joint reconstruction, spine and
orthobiologics companies’ together accounting for
70% of the deal volume, according to Global Markets
Direct’s medical equipment deals database. The
recent devaluation in market worth of small and
mid-cap companies in the orthopedic device sector in
light of the financial crisis is expected to trigger
fresh bouts of consolidation in the next 3-5 year
period. Innovations in minimally-invasive technologies
have enabled patients to now choose alternate
orthopedic procedures instead of the complex and
painful surgical procedures. The hip and knee
implants market is already witnessing this trend.
Knee and hip resurfacing are potential options for
those who are seeking a more conservative
alternative to total joint replacement. This
bone-conserving approach results in a better range
of motion and less risk of dislocation than
traditional total replacement. Increasing awareness
among patient groups and orthopedic surgeons’
familiarity greater with minimally invasive
procedure techniques is likely to positively impact
the growth dynamics of the orthopedic devices sector
in the next 5 years. Sunday, January 4. 2009
Metal-on-Metal Hip Resurfacing: The ... Posted by Patricia Walter
in Hip Resurfacing Issues, Medical Studies at
20:31
Comments (0) Trackbacks (0) Metal-on-Metal Hip Resurfacing: The Effect of Component Position and Size on the Range of Motion to Impingement
Link http://proceedings.jbjs.org.uk/cgi/content/abstract/88-B/SUPP_III/432
2006 D.H. Williams; U. Masood; and M.N. Norton Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK. Decreased head-neck ratio diameter and component malposition in total hip arthroplasty are factors known to result in impingement, increased rates of dislocation, wear and failure. In addition to these complications, impingement of the femoral neck on the acetabular component of a hip resurfacing may result in femoral neck fracture and loosening of the acetabular component. Little is known regarding the optimum femoral and acetabular hip resurfacing component position to avoid impingement. In the first part of this study we analyzed the radiographic component position of 131 consecutive hip resurfacings. In the second part the effect of three component variables on the range of motion to impingement were analyzed using a dry bone model: Inclination of the acetabular cup Version of the acetabular cup Femoral head-neck diameter ratio The mean femoral-stem shaft angle in the first part of the study was 138° (range 121° to 158°). The mean acetabular inclination angle was 45° (range 30° to 63°). This wide range in position mirrors that described in the literature. The dry bone study revealed an optimum acetabular cup inclination tending towards 50° and an anteversion of 25°. A large diameter femoral head relative to the femoral neck resulted in a greater range of motion to impingement. A fine balance however exists, to remove a minimum amount of pelvic bone to accommodate a larger acetabular component with an ‘oversized’ femoral component. The acetabular resurfacing cup positions described allow the greatest range of physiological hip movement. New technology and improvements to existing equipment and techniques will hopefully lead to more accurate placement of hip resurfacing components minimising the risk of impingement and its complications in this high demand group of patients Correspondence should be addressed to SWOC, c/o Mr David Bracey, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ. Sunday, January 4. 2009
Does computer-assisted surgery ... Posted by Patricia Walter
in Hip Resurfacing Devices, Medical Studies at
20:29
Comments (0) Trackbacks (0) Does computer-assisted surgery improve accuracy and decrease the learning curve in hip resurfacing? A radiographic analysis.
Link http://www.ncbi.nlm.nih.gov/pubmed/18676940
2008 Seyler TM, Lai LP, Sprinkle DI, Ward WG, Jinnah RH. Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, USA. BACKGROUND: Hip resurfacing is a technically demanding procedure in which accurate positioning of the femoral component is critical to the avoidance of early implant failures. The purpose of this study was to assess the accuracy of computer-assisted placement of the femoral component and to evaluate the impact of computer-assisted surgery on the learning curve associated with this procedure. METHODS: The accuracy of positioning the femoral component was analyzed radiographically in hips undergoing resurfacing procedures performed by surgeons assigned to four different study groups: Group 1, in which the operations were performed with use of computer-assisted surgery by a fellowship-trained surgeon who was experienced in performing resurfacing arthroplasty (surgical experience, more than 250 hip resurfacings); Group 2, in which the operations were performed with use of computer-assisted surgery by senior residents who were inexperienced in performing resurfacing arthroplasty and who were closely supervised by faculty; Group 3, in which the operations were performed with use of conventional instruments by fellowship-trained faculty members; and Group 4, in which the operations were performed with use of computer-assisted surgery by a lesser experienced fellowship-trained faculty member (surgical experience, more than forty but less than seventy-five hip resurfacings) from Group 3. RESULTS: The range of error in varus or valgus angulation that was observed for navigated procedures was 6 degrees in Group 1, 7 degrees in Group 2, and 5 degrees in Group 4. Compared with the preoperative neck-shaft angle value, the mean postoperative stem-shaft angle value increased by a mean of 4.7 degrees in Group 1, 7.2 degrees in Group 2, 6.5 degrees in Group 3, and 11.6 degrees in Group 4. When compared with the use of standard instrumentation, the use of computer-assisted surgery reduced the number of outliers and facilitated valgus insertion. CONCLUSIONS: In the present study, computer-assisted surgery resulted in improved accuracy and precision in positioning the femoral component. In addition, computer-assisted surgery led to a reduction in the length of the learning curve for beginners in hip resurfacing and improved the surgeon's ability to perform this procedure safely. PMID: 18676940 [PubMed - indexed for MEDLINE] Sunday, January 4. 2009
Don't Wait Too Long for a Hip ... Posted by Patricia Walter
in Hip Resurfacing Articles, Hip Resurfacing Issues, HR Stories at
20:26
Comments (0) Trackbacks (0) Don't Wait Too Long for a Hip Resurfacing - You Could Miss The Window of Opportunity
Don't Wait Too Long for a Hip Resurfacing - You Could Miss The Window of Opportunity
By Ian Munro I am a retired 69 year old surgeon. For most of my life I had been super fit: competitive squash 5-6 times a week, heli-skiing, windsurfing, sailing, single handicap golf etc. I left it too late to have surgery and I find this is a common story (see Jimmy Connors, Jack Nicklaus, etc.) As there are now two options: BHR and THR, this has become important. Like most people, trouble started with discomfort in my right thigh on walking. Eventually I went to see an orthopaedic surgeon in Fiji. I was surprised when he examined me and then ordered hip X-rays. I had lost half the cartilage. The thickness on the outer half of my right hip. As a surgeon working a lot with bone, I knew that the glucosamine and chondroitin sulphate, needed for cartilage formation, are formed by the body. I deluded myself into believing that taking them orally would help – they had no effect. I also believed that a lot of walking would stimulate cartilage formation - again deluding myself. Gradually the pain got worse, going from thigh to knee to leg to ankle. After 2 years I got a cane. This helped. Then I had to progressively increase to 200mg Celebrex a day, plus occasional Tylenol. I am now a full time sailor going around the world with my wife. Maintenance and repairs are constant and require contortions of the hips into many awkward positions. Eventually I could no longer function in this life, so it was do something, or give up our life style. I was not afraid of surgery but I had never consciously realized that things could be so limiting that I had to get treatment. I started research and soon found BHR. Physiologically this was more logical and satisfying to me than a THR. I had excellent bone density, excellent muscle strength and I intended to live a physically active life for at least another 25 years!! A not unreasonable expectation as my mother died at 99! I had been a surgeon in Dallas, so after due research, I found Kurt Rathjen and wrote to him. He replied personally saying he had learned BHR in England. He had installed 134 BHR and had 1 major infection. These were good enough statistics for me so I arranged to fly back to see Kurt and have surgery 1 week later. Before leaving Malaysia, I had new X-rays taken of both hips, right knee, and both ankles ( a total cost of $85!). This was 3 years from my first X-ray showing trouble. I was appalled to find that I had no cartilage on the lateral side of the hip joint. It was not just bone on bone but disintegration and micro fractures of the femoral and acetabular surfaces. Kurt took further X-rays and this is when the bad news arrived. I had developed large cysts in the femoral head and acetabulum. Presumably the micro fractures had allowed the joint synovial lining to be forced into the bone. The synovium then expanded to form the synovial cysts. Kurt and I discussed the possibilities. One (unrealistic) possibility would be to scrape out the cysts, insert cancellous bone grafts, wait for 3 months forming new bone, almost non-weight bearing, then have a BHR. Obviously stupid. Secondly, I could have a BHR, ignoring the cysts. However, as the cysts were so large, there would be a significant risk of femoral neck fractures and neither Kurt nor I were interested in taking the risk. This meant a THR was the only sensible option. One advantage of the BHR is the very large femoral head and an acetabular cup that covers 80% of this head. This decreases the chance of dislocation. The standard THR has been a small femoral head and an acetabular cup that covers 50% of the cup and thus a higher chance of dislocation. I was delighted to find that Kurt uses a prosthesis that is similar to the BHR with a metal head and acetabulam. Over long term metal on metal would be more durable if lubricated. Think of a car or boat engine with constant motion for thousands of hours, working beautifully if well lubricated. Fortunately, your body physiology means you do not have to change the oil every 100 hours! So I had the THR, and expect it will me 25+ years. However, as yet, I am not sure that I will be able to reach the level of activity possible with a BHR. The moral of the story is: Get yearly X-rays. Once the cartilage is almost gone, or sooner, get surgery. Do not wait until disintegration occurs and cysts develop. Although a BHR is a relatively new procedure, it is physiologically and theoretically more sound than a THR- if the majority of the femoral head and neck are normal healthy bone. Conceptually, it really irked me that Kurt had to remove all the good normal bone of my femoral head, neck and shaft. Also if there is a problem with a BHR you can still have a THR. The reverse is not true. DO NOT WAIT. I wasted a year and a half – progressively limiting activities of going ashore to explore, or go for walks, visit restaurants etc. We went to Flores to see the Komodo dragons. Instead of going for a 5-10K walk with the guide, I was limited to an slow, brief half hour only seeing the dragons around the camp (wild but indolent). If I had been having yearly X-rays, I would have been able to have a BHR before cysts appeared. Don't Wait Too Long for a Hip Resurfacing - You Could Miss The Window of Opportunity By Ian Munro Modern surgery is safe in a good center and will get you back to a normal life. Some surgeons use minimalist exposure techniques with less muscle disruption resulting in a reputedly faster recovery. I had the standard approach but I am writing this 11 days post operatively and I am pain free all the time except for muscle ache during the three times daily exercise periods. I can see that within another week I will be pain free. Then mental discipline will have to take over in order to restrict activities. I have a non-cemented femoral stem and acetabular cup; in my opinion the only way to go. Progressively, over time, scar tissue will develop and adhere to the roughened outer surface of the prosthesis. By 6-8 weeks this starts to become significant. Over further time, the strength of the adhesion becomes stronger and stronger. If the periosteum of the femur was preserved at the time of bone removal, there is a good chance of developing bone adhesion to the prosthesis. This is more likely in a younger patient than myself. However, all joints of the body – normal or abnormal – are protected by the strength of the muscles around them. Prior to the onset of symptoms, I had enormous leg strength, balance and agility. All of this was lost by waiting so long. Beforehand I used to be able to jump from uneven rock to uneven rock along a seashore – even if slippery – knowing I would never fall. My muscle strength and balance meant I could always recover if I made an error. I wonder if I will ever get back to that again? Saturday, January 3. 2009
Hemi Resurfacing by Dr. Gross Posted by Patricia Walter
in Hip Resurfacing Articles at
20:45
Comments (0) Trackbacks (0) Hemi Resurfacing by Dr. Gross
It is my opinion that there no longer is any role for this procedure. The FDA does not realize this; they continue to approve implants for hemi-resurfacing. Typically these femoral hemi-resurfacing implants are best used off-label together with an acetabular component for total resurfacing. This highlights the fact that the FDA is not a good source of information when it comes to orthopedic expertise.
Hemi-resurfacing refers to resurfacing only the femur and letting this new metal surface rub against the cartilage or bone of the acetabulum. This is a bad idea.. There used to be one reasonable indication for hemi-resurfacing: the young patient with stage III Osteonecrosis. This means that the femoral head has collapsed, but the acetabulum has not yet developed cartilage deterioration. Hemi-resurfacing in this type of patient typically improves symptoms significantly, but does not give as good or as predictable pain relief as standard total hip arthroplasty. After the new metal head rubs on the acetabular cartilage for a few years, the cartilage wears out and the pain increases. . So why would any surgeon advise, or any patient choose hemi-resurfacing?. The answer is that in a young patient it may make sense to accept a less than perfect result (as far as pain relief goes) in exchange for bone preservation. Especially in the past era where metal-on-plastic bearings had a 30% failure rate in young patients at 8 years often with extensive bone loss due to osteolysis. Hemi-resurfacing in this scenario did make some sense. . The options now have completely changed. Now we have a number of modern bearing options for total hip arthroplasty and we also have metal-on-metal hip resurfacing. Failure rates in young patients with these options are 5% at 8 years without much osteolysis.. If the goal is bone preservation, then a total hip resurfacing is the operation of choice. For stage III Osteonecrosis, it now makes much more sense to also resurface the acetabulum and perform a total hip resurfacing rather than a hemi-resurfacing. The pain relief is much more reliable and the result is longer lasting than for hemi-resurfacing.. The only problem is implanting an acetabular resurfacing component with the femoral head in the way. This technically challenges the surgeon’s skills. Fortunately there are now numerous surgeons worldwide who have developed the skill required to do this routinely with a very low complication rate.. A patient with a modern hemi-resurfacing could probably be converted to a total resurfacing. Most modern components are manufactured to standards that would allow combining them with an acetabular component to convert to a total resurfacing. The hospital implant record would provide the necessary information to make this determination. Older hemi-resurfacing components were not manufactured to specifications to allow metal-metal bearing, and would need to be revised to total hip replacements if they were sufficiently painful.. Thomas P. Gross, MD Grossortho.com 12/16/2008 Saturday, January 3. 2009
Hemi Resurfacing by Dr. De Smet Posted by Patricia Walter
in Hip Resurfacing Articles at
20:42
Comments (0) Trackbacks (0) Hemi Resurfacing by Dr. De Smet
Koen De Smet ANSWER/ANTWOORD] In the US for long they were doing hemiresurfacings because full resurfacings were not working well and the Metal on Metal resurfacing was not FDA approved yet. The results indeed are not so good. The hipscores after a time are certainly not perfect, not what we can get with a total resurfacing!
The hemiresurfacing also is only kept for people with an avascular necrosis of the hip, not for any other condition, so the indication is not so big. The problem in these cases is that after time the metal head that is resurfaced will give osteoarthritis symptoms because it is wearing out the cartilage of the acetabulum. If the patient has had a hemiresurfacing that is a component that matches with a total MOM resurfacing and the size of the head is not put too big, they can have a full resurfacing done with the head implant kept on! Unfortunately this is not always possible and most of the time not possible.! There are indeed cases that can stay long with this device, hemiresurfacing, but it is certainly the minority. ! Looking into the indications to do a hemi, avascular necrosis is known to be a condition that gives the less good results in any prosthetic implant. (In my series with resurfacing and ceramic on ceramic in young people I can not state or proof this) ! Greetz KOEN Koen De Smet AMC Gent Anca Medisch Centrum - Anca Medical Center GHENT Hipsurgeon Krijgslaan 181 9000 GENT BELGIUM www.heup.be www.hip-clinic.com +3292525903 Saturday, January 3. 2009
Hemi Resurfacing by Dr. Bose Posted by Patricia Walter
in Hip Resurfacing Articles at
20:40
Comments (0) Trackbacks (0) Hemi Resurfacing by Dr. Bose
Hemi resurfacing in theory appears to be an atttractive idea. However experience has proved otherwise. In a hemi resurfacing, the metal cap articulates with the natural articular cartilage of the acetabular socket. This 'bearing" works reasonably in elderly inactive patients and fails rapidly in someone with an high activity level.
The metal on cartilage bearing is commonly use in a hemiarthroplasty of the hip which is done for femoral neck fractures in the elderly. This is probably one of the commonest procedures in orthopaedics all over the world. Elderly, sedentry patients have a high incidence of femoral neck fractures and typically they would receive a hemi arthroplasty. However if someone is a little younger and more active a hemiarthroplasty will cause destruction of the cartilage ( chondrolysis) and pain and it has to be converted to a THR. I have done many of these conversions. Therefore the world over surgeons would do a THR straight away in femoral neck fractures if the patient has a higher activity level.. Since resurfacing by definition is for younger active people, the metal on cartilage bearing is at a high chance of early failure. ( there have been some exceptions). Hence I would not use it in my practice. Some surgeons would argue that if the cartilage fails then they would convert to a total resurfacing. While the argument is valid in theory, technically a conversion of a hemi to a total resurfacing is complex.. I hope that this clarifies the issue.. with best regards. vijay bose chennai |
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