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Wednesday, February 15. 2012
Read more here: http://www.orthosupersite.com/view.aspx?rid=92453
Although metal allergy with total joint replacement exists, the prevalence of
this condition is unknown, according to Joshua J. Jacobs, MD.
"Metal allergy [with] orthopedic implants has been well documented in
isolated cases," Jacobs said during his presentation at the American Academy of
Orthopaedic Surgeons 2012 Annual Meeting/Orthopaedics Research Society
symposium. "The true prevalence is unknown. Clinically significant
symptomatologies seem to be rare in total knee replacements and
metal-on-polyethylene total hip replacements, but much more common in metal-
on-metal total hips.
Based on case reports and device literature, Jacobs said that metal allergy
exists and has been seen as a temporal association. It can have different
presentations and many involve a rash. In some examples, patients suffer skin
reactions after implantation of total joint replacement devices. In other cases,
the reaction goes away after the implant is removed for nonunion or refracture,
only to return after re-implantation.
"In my mind, those sorts of cases prove to me that this is a real clinical
entity," Jacobs said.
Using patch testing, 14% of the general population would be sensitive to
nickel and 10% would be sensitive to cobalt and chromium. However, Jacob said
that patch testing may be flawed because it may have no bearing on what is
occurring happening in deep tissues.
"Metal-on-metal allergy is the cause of clinical symptomatology, such as pain
and swelling," Jacobs said. These allergies present as skin reactions such as
dermatitis, or patients may have a history of allergy to jewelry. The responses
to these allergies can present as stiff knees, pseudotumors, necrosis or
unexplained pain, Jacobs said.
"In patients with metal-on-metal surface replacements, there is a direct
correlation between serum metal levels and metal sensitivity determined by
[lymphocyte transformation testing] LTT," Jacobs said. "Current diagnostic
methods, both patch testing and in vitro, do require more robust clinical
validation, but it can be useful in preop screening for patients with in vitro
metal allergies when there is a history of reaction to jewelry." Reference:
Monday, February 13. 2012
Posted at: 02/13/2012
By: Robin De Wind
Read full story here:
http://www.whec.com/sports/stories/S2495034.shtml?cat=566
Older athletes are staying more active in their adult years, even after their
playing days are done. A procedure that allows you to play without pain is
gaining in popularity...
You would never know by watching him, but Doug Hendee used to have severe pain
in his right hip...
Hendee found Dr. Christopher Drinkwater, an orthopedic surgeon at the Evarts
Joint Center at Highland Hospital. He specializes in a relatively new procedure
called hip resurfacing...
During hip resurfacing, only the damaged part of the head of the femur is
removed and replaced with a metal cap while replacing the hip socket with a
metal cup.
...Doug Hendee, he is a tri-athlete, teaches spinning four days a week, play
lacrosse and works out, pain free...
There are no long term results on hip resurfacing, but it appears it can last 10
to 14 years...
Monday, February 13. 2012
Published Thursday, Feb. 09, 2012
LONDON, February 9, 2012 -PRNewswire/ - Smith & Nephew (NYSE:SNN; LSE:SN), the global medical technology business,
today announced the results of a new study for its BIRMINGHAM HIP™
Resurfacing (BHR) System. The study, carried out at the request of the FDA,
followed the progress of the first 400 BHR patients in the United Kingdom
and found that after 10 years, 99% were either satisfied or extremely
satisfied with their BHR procedure.
"These results further exemplify why the BHR Hip is unlike any other
metal-on-metal implant," says John Soto, Senior Vice President for Smith &
Nephew's Global Hip Franchise. "Not only does the BHR Hip offer all the
advantages of hip resurfacing, including bone-conservation, greater range of
motion and decreased risk of dislocation, but it does so while maintaining
implant survivorship rates that are on par with, or in some patient
populations even better than, traditional total hip replacement which has
long been considered the most successful orthopaedic surgical procedure for
relieving chronic pain."
In addition to patient satisfaction, the 10-year BHR data showed:
- The Oswestry Modified Harris Hip Score (OMHHS) averaged 92.5 points
– demonstrating excellent long-term clinical implant function.[i]
- The implant survival rate according to the Kaplan-Meier analysis was
95.9% - well exceeding the 10-year survivorship threshold of 90% for
implants as established by the National Institute for Health and
Clinical Science (NICE)[ii]
- A radiographic success rate of 99.7% was observed by independent
radiographic review.
Continue reading "New Clinical Results Further Distance the BIRMINGHAM HIP™ Resurfacing System From Failed Metal-on-Metal Hip Implants"
Monday, February 13. 2012
Nicolas Fouilleron, MD,
Guillaume Wavreille, MD,
Nima Endjah, MD and
Julien Girard, MD, PhD (j_girard_lille@yahoo.fr)
February 1, 2012 Abstract Background: The ability to return to sports activities (especially
running) after hip resurfacing arthroplasty seems to be very important for young
and active patients who have developed osteoarthritis. Purpose: To assess the quality of return to sports after hip resurfacing
arthroplasty by examining the time spent running, weekly mileage, and the
possibility of returning to competition in a series of patients. Study Design: Case series; Level of evidence, 4. Methods: A prospective, consecutive series of 202 patients (215 hip
resurfacings) was assessed to evaluate the possible resumption of running
activity (time spent, weekly mileage, return to competition). Of this initial
cohort, 40 patients (43 resurfacings, 21%) practiced running preoperatively.
Mean age at hip resurfacing arthroplasty was 50.7 years (range, 31-61 years). No
patients underwent revision surgery. A questionnaire was administered to assess
the number, type, and level of sports activities. Among patients who practiced
running, we determined, preoperatively and at last follow-up, their weekly
mileage and whether they were competitors. Results: At last follow-up, 33 of 40 patients (36/43 hips) still
practiced running (P = .74), with 91.6% of them resuming running. Mean average
recovery time before running at a level assessed as good by patients was 16.4
weeks (range, 5-36 weeks). The number of patients running more than 4 hours per
week increased from 18 to 23. Similarly, the time devoted to running at last
follow-up remained high (mean, 3.1 hours per week) with no statistically
significant difference from the preoperative period (P = .54). Moreover,
patients were still engaged in competition without statistical difference
between the 2 periods (P = .82). Conclusion: Running is possible after hip resurfacing, and runners can
even return to some level of competition, but this short follow-up series of hip
resurfacing in athletes should be interpreted with caution regarding implant
survival.
Original Link http://ajs.sagepub.com/content/early/2012/01/31/0363546511434564.abstract?sid=a3e99b45-2b1a-4e5f-95d3-365a704c95fa
Wednesday, February 8. 2012
Dr. Schmitt - pre 1000th Birmingham Hip
Resurfacing Surgery
Regional Specialty Center
Huron Valley - Sinai Hospital
1 William Carls Drive, Ste 120
Commerce Township, MI 48382
Wednesday, February 8. 2012
Optimal acetabular cup positioning is attained in less than 50% of cases,
study reports
March 9, 2010
NEW ORLEANS - High-volume surgeons are more likely than low-volume surgeons
to attain optimal cup positioning for total hip arthroplasty, but both groups
still attain optimal cup positioning less than half of the time, according to a
study presented here.
The findings were presented by Bryan Jarrett, BS, at the 56th Annual Meeting of
the Orthopaedic Research Society.
Jarrett said the purpose of the study was to attempt to correlate the influence
of various patient factors - body mass index (BMI), age, gender and primary
diagnosis for the total hip arthroplasty (THA) - with the positioning of the
acetabular cup.
"Cup positioning and implant positioning are extremely important to attain
long-term success," he noted.
Methods and measurements
The researchers compiled data from 2,063 patients who underwent a primary
THA, revision THA or Birmingham hip resurfacing from 2004 through 2008.
Postoperative anteroposterior (AP) pelvis and cross table lateral digital
radiographs were obtained for each patient, and the AP radiographs were measured
to calculate cup inclination and version angles. Version direction was
determined through the lateral radiographs.
Acceptable angle ranges were defined as 30° to 45° for abduction and 5° to 25°
for version. Study results
There were 1,954 qualifying patients, with 1,218 (62%) acetabular cups
falling within the optimal abduction range and 1,576 (87%) in the optimal
version range. There were 921 (47%) patients with both inclination and version
angles within the optimal ranges.
I n the combined analysis, low-volume surgeons showed a 2-fold increase in risk
for cup malpositioning compared with high-volume surgeons. Minimally-invasive
surgery, as an approach, showed a 6-fold increase in risk for cup malpositioning
when compared to the posterolateral approach. Obesity, defined as a BMI greater
than 30, showed a 1.3-fold increase in risk. Less than half
With patient influences taken into account, the high-volume surgeons
outperformed their low-volume counterparts, but both still attained optimal
ranges in less than 50% of patients.
"When we just looked at high-volume surgeons, 38% of the patients fell within
the optimal ranges," Jarrett said. "When we just looked at low-volume surgeons,
we saw that 26% of the patients were within the optimal ranges." •Reference:
Callanan M, Bragdon CR, Zurakowski D, Rubash H. An analysis of cup
positioning in total hip arthroplasty: quality improvement by use of a local
joint registry. Paper 362. Presented at the 56th Annual Meeting of the
Orthopaedic Research Society. March 6-9, 2010. New Orleans.
Wednesday, February 1. 2012
I received an email from Tom Phelan from the McMinn Center announcing
the press release below by Mr. McMinn. This can also be found on Mr.
McMinn's website http://www.mcminncentre.co.uk/news-archive.html1st February 2012 Metal-on-Metal Implants - Addressing the Negative Press We
have been receiving phone calls following recent press reports on
failed metal-on-metal hip implants. We understand these sensationalist
stories may cause anxiety among some patients. However, we would like to
reassure our patients that these reports mostly concern failures with
the DePuy ASR and the DePuy ASR XL, not the Birmingham Hip Resurfacing
(BHR). Many press reports imply these failures relate to all
metal-on-metal hip resurfacings. A patient featured in a recent Daily
Mail article, like many others, had a failed ASR. A critical point,
omitted from the print version of the Daily Mail, can be found in the
full on line version. As well as her ASR, the patient had a BHR on her
other hip. She comments, "I've never had a minute's trouble from the
Birmingham hip – if only I'd had it on both sides." High failure
rates with the ASR and ASR XL have been widely documented. Both devices
have now been withdrawn from the market. Research indicates the side
effects, such as muscle damage, are specific to the ASR and do not apply
to the BHR which is a very different device. Earlier this week,
the MHRA (Medicines and Healthcare products Regulatory Agency) issued
another statement about metal-on-metal hips, in which they say, "On the
evidence currently available the majority of patients implanted with
metal-on-metal hip replacements are at low risk of developing any
serious problems.” In addition to the MHRA’s guidance, we wish to
emphasise that Mr McMinn’s results with the BHR show a 97% survival in
men and women of all ages at 14.5 years. Furthermore, excellent results
with the BHR have been documented in National Joint Registers from
around the world. Sadly, these ASR failures come as no surprise.
Mr McMinn has been warning about the device since it went to market in
2003. You can see Mr McMinn’s argument against the ASR here http://www.mcminncentre.co.uk/research-lectures-debate.html.
Furthermore, The McMinn Centre has put together several resources which
address patients’ concerns and the differences between the ASR and BHR
designs. These resources are as follows: • The McMinn Research
Team's detailed response to list of questions on metal-metal implants
& metal ions provided by hip resurfacing users here • The McMinn Centre’s response to a Channel 4 documentary on metal-metal hip replacements here http://www.mcminncentre.co.uk/metal-ions-questions-answers.html• An interview with a patient who has now had his McMinn metal-metal hip resurfacing for 20 years here If you do have any concerns, please call The McMinn Centre on 0121 455 0411.
Monday, January 30. 2012
Prof Yates of Australia sent me several of his studies. I am posting a link
to a copy of his paper -
Outcome of primary resurfacing hip replacement: evaluation of risk
factors for early revision
12,093 replacements from the Australian Joint Registry
http://www.surfacehippy.info/pdf/Prossser-yates-AOS-2010-resurf-risk.pdf
We need real information to evaluate the outcomes of hip resurfacing and Prof
Yates has done an excellent job of analyzing the 2010 information.
Prof Yates contacted me with his info and offered me the use of his
presentations.
Professor Piers Yates
MBBS(Hons) BSc(Hons) MRCS FRCS(Tr & Orth) FRACS(Ortho)
Over 300 hip resurfacings since 2001, trained by Jeremy Latham, Gordon
Bannister, Treacy
Murdoch Orthopaedic Clinic, Suite 10
St John of God Hospital Murdoch
100 Murdoch Drive
Murdoch 6150
Western Australia
Tel: 08 9312 1135
Fax: 08 9311 4183
piersyates@hipandkneeperth.com.au
www.hipandkneeperth.com.au
I appreciate his help and input.
Pat
Sunday, January 29. 2012
A copy of the 2011 Australian National Joint Replacement Registry is located here: Australian National Joint Replacement Registry 2011I
am posting this because people need to know the statistics I
quote are not my opinion, but based on actual information from the
National Directories. Here is the BHR revision rate compared to other devices:  Please note the 6.3% revision rate at 10 years for the BHR.Here
is the hip resurfacing overall revision rate by male and females.
Please note that all small men and women both have the higher revision
rates than larger people based on head size of HR components (9.3 for
males, 11.2 for females). All larger females and males have the same
similar low revision rates (3.7 for males, 3.9 for females @ 7 years) .
Hip Resurfacing works great for larger people. It also works for most
smaller people, but you really need to use only the very, most
experienced surgeons for good outcomes.  There
is a great deal of information in the national registry, but this is
really the important information in my opinion. That is why I always
use the 96% retention rate for the BHR worldwide. It is actually higher
in some other studies and surgeons personal series.
Saturday, January 28. 2012
13th January 2012
More information at
the McMinn Center
He has twice been Mr Universe and has played the tough guy in a variety of
action movies, but when Mike Mitchell was floored by a hip injury it was
Birmingham surgeon Derek McMinn who came to the rescue.
Fitness icon "Iron Mike", who appeared as a stuntman and action fighter in smash
hit films Braveheart and Gladiator, had been suffering from severe
osteoarthritis in his left hip but, true to his tough-guy image, had carried on
regardless.
However, when the 56-year-old took a nasty fall while out on his yacht he found
himself almost unable to walk and in danger of missing out on a new film he had
just agreed to appear in.
Continue reading "Iron Mike gets BHR with Mr. McMinn of the UK"
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