|
Saturday, November 26. 2011
Approaches in hip resurfacing
The path that surgeons choose to arrive at the hip joint is called the
"approach". There are many different basic approaches used for hip resurfacing.
None has been proven to be superior to others based on valid scientific
research. Basically, I recommend that a surgeon use the method that he/she is
already most comfortable with when performing standard total hip replacement and
modify it as needed for the more complex hip resurfacing operation. My preferred
approach is the posterior. This is used in at least 70% of hip resurfacings done
worldwide. The next most common approach is the lateral (two versions:
anterior-lateral and direct-lateral). Finally the direct anterior and the Ganz
(or trochanteric, or internal dislocation) approach are far less commonly used.
All of these approaches are adapted slightly by different surgeons.
Continue reading "Dr. Gross discusses the Gantz vs other surgical approaches "
Wednesday, November 23. 2011
Three years ago, I was next on Dr. Jinnah’s list for hip surface replacement. If you read my experience log following the surgery, you know it was largely successful. It took one year before I felt confident strength to try jogging a 3-miler in a park. I worked up to it and the run was wonderful: to know that I could run if I needed to do so, and that without pain brought great joy, and a once-for-all release from the NEED of jogging.
After running most of my life and escalating during my 40’s to over 30 marathons, and50 & 70-mile ultras including a 100-mile run during a Relay for Life event, I thought I would never be released from my harrier addiction. Come on, you runners, you know it is an addiction when we must have it to feel satisfied. But, after I accomplished that Monumental 5K, I knew running was no longer something I had to have to live a fulfilled life.
On the positive side, I stay very active walking, biking, working in the yard, and all without pain. I have kept the weight off – one of the reasons I was running from all those years. Also, on the positive side, I don’t think about the hip.
The downside is that there was some nerve damage during the procedure with continued numbness from the outside of the ankle and moving up to the knee. It is not noticeable unless I have overdone it all. It is not unusual to walk 4 miles a day and not feel the numbness. Actually, I have to concentrate on the sensation to notice it, but this damage was the most difficult part of the recovery, the attributing factor to the pain I mention in my recovery log.
For those considering the surgery, I highly recommend it. It delivered me from constant pain during and following any walking or yard work to the renewed privilege of performing daily tasks without pain. I stated after the surgery that if I only had one year of relief, it would be worth it. Now, that satisfaction has tripled.
Many thanks to Pat for her invaluable website! It had been a long time since I visited it, but I remember visiting multiple times each day prior to the surgery and during recovery. The website was like a doctor-on-call with all the great advice and knowledge. Thanks to all the contributors who helped me through the process. I hope I don’t have to return to the site as a patient-to-be, but if I do, I know the website will again become a valuable tool in preparation for that second surface replacement.
Thursday, November 17. 2011
Updated August 2011
Dr. Gross 2011 Summary of Outcomes for 2500 Hip Resurfacings
Dr. Gross has now performed over 2500 Hip Surface Replacement (HSR)
procedures over the last 12 years. Most failures occur during the first 6 months of the healing period. However, there is a
slow rate of failure that occurs over time. Therefore the overall failure rate increases for a group of patients as the length of follow-up
increases. In our recent publication in the Journal of Arthroplasty 2011, we reported that our Corin Hybrid HSR achieved a 93% survivorship
at 11 years follow-up. Longer-term data is not available. Multiple improvements have been made since this initial patient group.
Our most recent cases use the Biomet uncemented Recap /Magnum. We report here the early results of the first 1000 done between
March 2007 and July 2010 with a 99.4% rate of follow-up (90% completely up to date on their follow-up, and 64 % achieving at least 2 years
follow-up). Not all complications lead to failure. Below is a complete list ofmajor complications (not just failures) in the first 1000
uncemented HSR using the Biomet system:
A.) Failures Requiring Revision Surgery (1000 cases):
1. Femoral neck fracture: 6 2. Early femoral collapse (avascular necrosis): 2 3. Failure of acetabular ingrowth: 5 4. Adverse wear failure: 2 5. Deep infection with loss of implant: 0 6. Recurrent dislocations requiring revision: 0 7. Femoral component loosening: 0 8. Acetabular component loosening 0 9. Subtrochanteric femur fracture 1 (related to hardware removal)
TOTAL: 16 1.6%
B.) Cases requiring significant repeat surgery (1000 cases):
1. Traumatic intertrochanteric fracture 2 (5 and 11 months postop): 2. Deep infection (cured): 2 2. Significant superficial infection (cured): 1 3. Frostbite from ice machine: 2
TOTAL: 7 0.7%
C) Other Complications (1000 cases):
1. Dislocations: 2 2. Pulmonary emboli: 3 3. Deep vein thrombosis: 2 4. GI bleed requiring transfusion: 1 5. Minor stroke: 1 4. Nerve injuries: 0 5. Postoperative transfusions: 0 6. Femoral notches: 0 7. Vascular injuries: 0 8. Deaths: 0
TOTAL: 9 0.9%
Continue reading "Dr. Gross 2011 Summary of Outcomes for 2500 Hip Resurfacings"
Thursday, November 17. 2011
November 16, 2011
Original Link http://www.orthosupersite.com/view.aspx?rid=89618
The retrospective study, which analyzed 925 hip resurfacings performed by
Edwin Su, MD, between 2004 and 2009 with a minimum follow-up of 2 years, looked
at three implants: Wright Medical’s Conserve Plus Total Resurfacing Hip System,
Biomet Orthopedics’ ReCap Femoral Resurfacing System and Smith & Nephew’s
Birmingham Hip Resurfacing System. Conserve Plus and the Biomet ReCap were used
as part of clinical trials, while the Birmingham hip was used after FDA approval
of the implant in 2006. Clinical scores and radiographs were obtained at 1
month, 3 months, 1 year, and every subsequent year. The hips in the study had a
minimum of 2 year follow up, both radiographically and clinically.
Continue reading "Dr. Su's experience with hip resurfacing shows 1.3% complication rate"
Monday, November 7. 2011
Watching Dr. Kusuma perform a live
BHR surgery
I had the opportunity to watch a live BHR hip resurfacing
surgery at Grant Medical Center in Columbus, OH on Oct. 7,
2011. The story below is from a layman's perspective
since I am not medically trained. I have written the story
so patients can understand the basic procedures during
surgery. I explain things so perspective patients can
understand them. I am not trying to write a technical
article on hip resurfacing surgery. It is my observations
about what was happening in the OR.
Watching a live surgery as an observer is quite different
than being a patient. As a patient, I never saw the inside
of an operating room. The special shot given to relax me
always put me to sleep before entering the OR. Being awake
and watching the staff the OR for a BHR surgery is very
interesting. The room is a beehive of activity. No one is
rushing but everyone is doing their job efficiently while a
little small talk occurs.
While the staff is preparing for the surgery, the Smith
and Nephew representative selects the proper sized BHR
device. He also selects one size larger and one size
smaller than the determined size to be used during the
surgery. A special room stores all of the Medical Devices
at the hospital. The representative from each medical
company keeps the shelves stocked for their own devices.
Continue reading "Observing a live BHR Surgery by Dr. Kusuma 2011"
Sunday, November 6. 2011
Dr. Palmer in Stillwater, MN did my BHR on Wednesday morning. I was home again on Friday evening. Things are going well so far. The Percocets keep me sort of groggy and borderline woozy but I'm already backing off of those. They put me on two weeks of Warfarin because the crappy insurance I have (ND CHAND) doesn't pay up front for prescriptions and I didn't have an extra $1500 right now. So, I have to go in and have my blood drawn locally for the INR twice per week.
I stepped a bit hard getting down the steps in my garage and felt a "click" in the BHR. I hope I didn't screw up anything. So, I'm checking with my sister in law (phlebotomist) and seeing if she can perhaps draw my blood at home the next few times.
Continue reading "Neil Martin Hip Resurfacing w/ Dr. Palmer 2011"
Sunday, November 6. 2011
Introduction by Patricia Walter:
Occasionally people have hip device
failures due to pushing too hard right after surgery or
doing hard impact sports or activities too soon. There are
stories of people with hip resurfacings that required
revisions to THRs. Dr. Broder, a hip resurfacing
patient and radiologist, explains why patients should be
conservative during their post op recoveries. Most
surgeons want patients to wait until at least 6 months to
return to normal sports and one year to high impact sports
like running. Using common sense, listening to your
surgeon's protocols and giving your body time to heal is
always the best approach to returning to a normal activity
level.
Dr. Broder explains:
I am Radiologist, and have been a member
of Yahoo surfacehippy discussion group since 2002. Over the
years we have had numerous members, especially young active
athletes, who have accidentally injured their prosthetic
hip.
Nuclear Medicine bone scans reveal
metabolic activity (new bone growth) persisting for up to 2
years in adults over 30 who sustain fractures, or have had
joint prosthetics. The reason is simple. As the bone heals,
new bone is produced by special cells, and tiny new blood
vessels (neovasculature) which very slowly grow into the
older bone, and the special surfaces of the prosthetic parts
designed for that purpose. Over time, other special cells
reshape the new bone, and eventually it is replaced with
thicker stronger bone tissue. In fact, over time, ALL the
bone in our body is being replaced slowly in response to
various stress factors, and maintenance. This is true of
many tissues in the body.
If we return to certain activities too soon, we will apply
forces that will produce microscopic fractures in the new
bone, and it may fail to completely heal. The complex
process of bone healing is delayed or completely fails. This
is a well known problem in treating fractures of any bone.
That is why cast material is applied, or other methods of
internal fixation (screws, plates, rods), or EXTERNAL
FIXATION methods are used to hold fractured bones in place.
Even slight mobility will result in mal-union, incomplete
union, or even complete NON-UNION which is a very serious
problem. Each person will heal at an individual rate
controlled by complex factors.
Every surface hippy has already arrived at the point where
the NATIVE HIP has failed.
New Hippys to be:
Don't put your new artificial hip at risk. Follow
instructions. Exercising too forcefully, too soon can lead
to failure of union of the new bone to the hip. This is
especially true of the uncemented portion(s). There is no
magic involved here. Once you have micro-fractured the new
bone, it may never heal properly.
I waited 11 months at age 58 before returning to skiing.
Best wishes,
Michael (MD in NC) (L) C+ 3/31/03
Sunday, November 6. 2011
I am not enthused about the Ganz trochanteric flip approach for several reasons. It was developed to be less injurious to the femoral blood supply. Koen DeSmet showed that with the modified posterior capsulotomy approach that he, Bose and I use that the blood supply compromise during is not much different than with a trochanteric osteotomy. Also, the incidence of AVN even with the much more extensive posterior capsular release that McMinn initially used is extremely low. We are now over 600 cases and have not seen a case of AVN.
Problems with any trochanteric osteotomy including the trochanteric flip all relate to injury to the gluteus medius attachment which results in an abductor lurch weak and awkward gait afterward. In this young and very active patient population, one is hard pressed to protect them for 6-8 weeks on crutches so the trochanteric bone can heal. If the patient is even relatively non-compliant, one is left with a lifelong limp that is impossible to fix. That is why the posterior approach became almost universal in America and the Charnley trochanteric osteotomy was abandoned. Paul Beaule recently reported on his series with trochanteric osteotomy and had a significant number of complications relative to the abductor mechanism.
In summary, this "flip" technique is a solution to a problem (AVN) that barely exists with the modified posterior capsulotomy approach and is associated with a significant number of "limps" and restrictions for a very active group of patients.
Dr. John Rogerson
Sunday, November 6. 2011
Comments by Dr. Vijay Bose
The ganz trochanteric flip is an excellent approach for doing open FAI surgery, for fixing fracture on the femoral head ( pipkin #) and for doing osteotomy of the femoral neck in post SUFE situations. In these non - arthritic situations a surgical dislocation of the hip is warranted without damaging the blood supply and I employ it routinely for these indications.
However its use in hip resurfacing is a bit of an overkill. It has been documented without a shadow of doubt that the post approach does not compromise the vascularity of the femoral head in an arthritic hip after resurfacing. Thousands of patients who have crossed the 10 yr mark with the post approach & BHR bear testimony to this.
Doing the ganz for resurfacing is a much more morbid procedure than a standard post approach. Any osteotomy will take more time to heal and recover function. The extended trochanteric osteotomy ( ETO) which is the bigger version of the Ganz flip will take about 6 months for the patient to regain function.
Intuitively the Ganz looks appealing as regards preserving blood supply but this issue is not relevant in an arthritic hip.
with best regards
vijay bose
chennai
Friday, November 4. 2011
Hi Pat,
You asked about the Ganz approach, which is also known as "surgical dislocation" of the hip for resurfacing.
This was described way back in 2001 by Prof. Reinhold Ganz in Berne, Switzerland. Resurfacing was being done in those days, although not so much by him, and he used it for all kinds of hip surgery from debridement to revision total hips. The key factor is that it is designed to preserve the blood supply to the femoral head. That is irrelevant in hip replacement because the femoral head is getting cut off anyway. In joint preservation procedures like FAI operations, labral repairs, removal of loose bodies etc and in hip resurfacing, it is important that the femoral head blood supply is respected.
Dr Ganz's major contributions have been his descriptions of the blood supply to the femoral head, and of femoroacetabular impingement (FAI) in the development of hip arthritis.
There is little question that the posterior approach routinely damages the blood supply to the femoral head. But there is also little question that this approach yields excellent outcomes in hip resurfacing, and is done by most US surgeons, about 80%. The pioneering surgeons McMinn and Treacy both use the posterior approach.
Continue reading "Dr. Brooks Compares theGanz Approach vs Other Surgical Approaches"
|
