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I have a large Patient to Patient website dedicated to Hip Resurfacing called   Surface Hippy.  About 8000 unique visitors a month  use the website to learn about hip resurfacing. Many don't have time to keep up with what's new in hip resurfacing, so I decided to place news media articles about Hip Resurfacing on the Hip Resurfacing News Website.  It is a place to quickly find out what is new and what is changing in the field of hip resurfacing.

Hip Resurfacing came of age in the United States when the FDA approved Birmingham Hip Resurfacing (BHR) in May 2006. Previous to the FDA Approval, hip resurfacings were done in Europe, Canada, Australia and other countries outside the United States. Orthopedic surgeons have been performing hip resurfacing surgeries since 1997 in most countries. Over 90,000 people world wide have received hip resurfacings.

Since the FDA Approval of the BHR and Cormet in the US, there are a large number of new surgeons learning the techniques and many people wondering if the surgery is right for them. There are new surgeons training, new medical studies completed regularly and general articles published in newspapers, magazines and in the media daily. Keeping up with all of the information becomes a real task for most people. People are trying to find pertinent information without spending hours and hours searching online - that is the purpose of  Hip Resurfacing News.

Patricia Walter - Owner/Webmaster of Hip Resurfacing News and Surface Hippy

Link  http://www.newsweek.com/id/46170

July 2006

At 42, Sally Seeley was barely able to walk. Diagnosed with osteoarthritis in her late 20s, she tried a range of treatments from water aerobics to Vioxx. But her condition only got worse. Finally, an orthopedic surgeon recommended total hip replacement. She worried that she was too young for such surgery, but she just couldn't stand the discomfort any longer. "The pain was gone immediately," says Seeley, now 49. Three months ago, she had her right hip done; she's already back at work.

Joint replacement was once considered a last resort for elderly patients who were immobilized. Now, thanks to improved artificial joints made from longer-lasting materials like titanium, patients in their 50s and younger are signing up in growing numbers. More than 600,000 hip and knee replacements were performed in the United States last year. While the average patient was well over 60 years old, the number of people younger than 65 getting the surgery has grown by 20 percent over the past five years. "Maybe 10 or 15 years ago, the threshold was the ability to walk or do errands," says Dr. Edwin Su, an orthopedic surgeon at the Hospital for Special Surgery in New York. "Now it's continuing to ski, golf or windsurf."

Doctors compare joint replacement to replacing tires on a car that's out of alignment. Over the decades, your weight can wear down your bones. This is especially true for patients with arthritis, where inflammation destroys the cartilage surrounding the joint, causing the bones to grind together painfully. In knee replacements, the most common joint-replacement procedure, doctors cut into the joint and remove the damaged portions of the tibia (the lower leg bone), patella (kneecap) and femur (thigh bone). They are replaced with metal and plastic components. The surgery lasts at least two hours and requires general anesthesia. Artificial knees generally last from 10 to 15 years. Hips are the second most commonly replaced joints, followed by shoulders...

 

March 2008

SAN FRANCISCO -  A study indicates that having a metal-on-metal bearing surface and performing high-impact activities preoperatively may be positive predictors for participating in high-impact sports after total hip arthroplasty.

To determine which patients would participate in high-impact sports activity following total hip arthroplasty (THA) and to examine the factors linked to participation in these sports, David R. Marker, BS, and colleagues submitted pre- and postoperative questionnaires to 303 THA patients who had a mean follow-up of 3 years.

The investigators found that 30% of patients participated in at least one or more high-impact sport postoperatively for an average of 4.3 hours per week.

A regression analysis revealed that a preoperative high activity level and metal-on-metal bearing surface were the only statistically significant factors to predict participation in high-impact sports postoperatively. Moreover, while a comparison of patients participating in high- and low-impact sports revealed similar preoperative Harris Hip Scores, the investigators discovered that the high-impact sport participating patients had higher postop Harris Hip Scores.

"There are many patients participating in these high-impact sports, up to 30% in our cohort," Marker said during his presentation at the American Academy of Orthopaedic Surgeons 75th Annual Meeting, held here. "The preoperative participation, as well as the metal bearing surface, were found to be predictive of postoperative participation. We found [in] the short-term follow-up that the high-impact sports patients had similar and better outcomes."

For more information:

Marker DR, Seyler TM, Ulrich SD, et al. High-impact sports after THA: Is the bearing type and independent predictor of activity level? Paper #16. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.

Smith & Nephew and Corin battle to win over America's hip generation

Link http://business.timesonline.co.uk/tol/business/industry_sectors/health/article3601581.ece

Smith & Nephew and Corin are both vying to win the key US market for hip replacements

Matthew Goodman

BEFORE he had surgery, Cory Foulk, a 49-year-old Hawaiian architect, found even everyday tasks such as getting in and out of the car caused him considerable pain. His condition, arthritis triggered by a cycling accident, had deteriorated over several years.

Three years ago, though, he had a hip replacement. US doctors had been reluctant to carry out the procedure on such a relatively young patient, but Foulk went abroad and found a British surgeon prepared to do the work using a new type of implant that had yet to make its way to America. The new hip was made by Smith & Nephew, the FTSE 100 medical-equipment group.

Bloodless hip surgery at GSMCH

Link  http://www.punjabnewsline.com/content/view/9315/38/

Tuesday, 18 March 2008

CHANDIGARH: Bloodless hip surgery would be performed at the Gian Sagar Medical College and Hospital, near here, with an internationally acclaimed orthopaedic surgeon Gursharan Singh Chana visiting the hospital regularly every two months.

Disclosing this here Tuesday, Dr Sukhwinder Singh, vice-chairman of the Gian Sagar Educational and Charitable Trust, said that Dr Chana, who is settled in the United Kingdom, would visit the GSMCH every two months.

He would train orthopaedic surgeons in bloodless hip surgery for which a 15-day training course would be organized every two months.

Dr Sukhwinder Singh said that Gursharan Singh Chana, a doctor of Indian origin, would deliver a lecture on minimal invasive surgery for total hip replacement and hip resurfacing at the Gian Sagar Medical College and Hospital on March 20.

He said that Dr Chana would interact with the faculty of the GSMCH on March 20 morning and in the evening he would address orthopaedic surgeons of Patiala. On March 21, he would be interacting with orthopaedic surgeons of Chandigarh and on march 22 he would have an interactive session with orthopaedicians of Ludhiana.

Dr Sukhwinder Singh said that an internationally acclaimed orthopaedic surgeon, Dr Chana has devised a minimally invasive approach to hip joint to carry out total hip replacement and hip resurfacing. He has devised Chana reamer handle to allow accurate surgery of the hip joint.

Dr Chana is presently working as a consultant orthopaedic surgeon at the Royal Orthopaedic Hospital, NHS Trust Birmingham, since October 2002.

Dr Chana has the vast experience of carrying out the over 2500 total hip replacements, over 2000 total knee replacement, over 1500 hip resurfacing, 200 hip replacements using minimally invasive surgical approach, 200 hip resurfacings using minimally invasive hip resurfacing.

Over the last two years he has been involved in developing instrumentation and implants for hip resurfacing procedure to be carried out using a minimally invasive approach through Comis Orthopaedics, a company based in Yorkshire.

The implant is being used currently in the U.K. This implant is the only one of its kind that can be delivered using a minimally invasive approach with obvious benefits of early discharge from hospital, blood transfusion is not necessary in 95 per cent of patients and the patients tend to return to normal activities at an earlier stage compared to patients who undergo open surgery. The average incision size is 7 cm. with this approach as opposed to 20 cm. using an open approach.

What is the BMHR and Why do we need it?

View Youtube Video about BMHR by Mr. McMinn by click below:

BMHR Video Part 1

BMHR Video Part 2

BMHR Video Part 3

Derek McMinn talks about the Birmingham Mid Head Resection prosthesis and its applied use in patients with Avascular Necrosis.

For patients with osteonecrosis involving a larger volume of the femoral head, an uncemented short-stemmed prosthesis, the Birmingham Mid Head Resection, BMHR, (MMT Ltd, Birmingham, United Kingdom, now Smith and Nephew Orthopaedics Ltd, Bromsgrove, United Kingdom) was developed.

Mr. McMinn has implanted about 40 BMHRs to date March 2008.

Illustration showing the three types of prostheses implanted in patients with femoral head avascular necrosis

Nerve palsy 'a vexing complication' in total hip replacement

Link  http://www.orthosupersite.com/view.asp?rID=25738

1st on the web (January 17, 2008)
January 2008

LAHAINA, Hawaii — While the overall incidence of nerve palsy resulting from total hip replacement remains low, patients undergoing revision surgery have a threefold risk for nerve injury, and women are at a higher risk than men.

Thomas P. Schmalzried, MD, of St. Vincent Medical Center in Los Angeles, said that in an analysis he conducted with colleagues S. Noordin, MD, and Harlan C. Amstutz, MD, of more than 34,000 total hip replacements (primary and revision), there were 359 nerve palsies — a 1% overall prevalence. However, the incidence among revision surgeries escalated to 2.5%, (0.9% for primary cases), and patients with developmental dysplasia of the hip (DDH) demonstrated a 5% risk for nerve palsy.

Even more alarming: nerve palsy occurred in women nearly twice as much as men, he said.

"What this all says to me is that anatomy plays a role," he told attendees at Orthopedics Today Hawaii 2008, here. "Nerve palsy is a vexing complication. You might be doing what you usually do, but because of the variances in anatomy — if the nerve isn't where it usually is or if it takes a course around the hip joint different from where it usually goes — indirect injury may be the result."

He said the sciatic nerve is the most frequently injured nerve in THR, accounting for 79% of all nerve palsies. Injury to the sciatic nerve or the peroneal division of the sciatic nerve typically occurs proximally at the level of the hip joint.

Electromyography has demonstrated evidence of nerve injury in 70% of extremities following THR, he added.

"In our research, femoral nerve injuries tend to be more frequent when we use an anterolateral approach to THR," he said. This is because the femoral nerve is close to the anterior aspect of the hip joint and, consequently, to the anterior acetabular retractors.

Schmalzried said that if neuropathy is suspected in a THR patient, the orthopedic surgeon should consult with the neurologist.

"Be nice to your neurologist," he said. "He can help you validate your findings and identify the exact source or location of the nerve injury."

For more information:

Schmalzried TP. Nerve and vascular injuries associated with total hip arthroplasty. Presented at Orthopedics Today Hawaii 2008. Jan. 13-16, 2008. Lahaina, Maui, Hawaii.
 

Study: Surface replacement arthroplasty may offer advantages over THA

Canadian investigators said hip resurfacing resulted in greater patient activity after 2 years.

By Robert Trace
1st on the web (September 19, 2007)
September 2007

SEOUL — Total hip arthroplasty is an established procedure with well-documented complication rates and clinical results, but surface replacement arthroplasty may offer additional clinical benefits to many patients, according to a group of Canadian researchers.

"We decided in 2003 to do a comparative study of hip resurfacing, or surface replacement arthroplasty (SRA), to the gold standard of total hip arthroplasty (THA), since we were not aware of any direct prospective studies out there comparing the two procedures," said Pascal-André Venditolli, MD, of the Maisonneuve-Rosemont Hospital in Quebec.

He and his colleagues randomly assigned 210 hips to receive uncemented metal-on-metal THA (103 hips) or a hybrid metal-on-metal SRA (107 hips). All surgeries were performed by three orthopedic surgeons, who used a posterior approach.

The researchers prospectively collected perioperative and postoperative data, and analyzed the clinical data for a minimum of 2 years.

Postop complications included three isolated traumatic dislocations and one recurrent dislocation in the THA group, which required acetabular cup revision. Two SRAs required revision for late head collapse. No postop femoral neck fractures occurred in the SRA group, he said.

There was one case of loosening at 6 months postop in the resurfacing group, which had shifted varus. There were also two cases of deep venous thrombosis in both patient groups, he said.

Although the investigators did not report a significant difference in surgical time between the two procedures, patients' length of stay in the hospital was significantly shorter for the SRA group compared to the THA patients — 5 days vs. 6.1 days for the THA group (P=.001).

"There was also a significant difference in return to work: 96% of the SRA patients returned to their previous work within 1 year vs. 83% in the THA group," Venditolli said.

Although patients in both groups demonstrated a high satisfaction rate and achieved similar WOMAC and Merle d'Aubigné functional scores, "SRA patients had better UCLA activity scores (7.1 vs. 6.3; P=.037) and returned to heavier activities (P=.035)" after 2 years, he said.

"This randomized study shows that SRA and THA present a similar complication rate, but distinctive complications," Venditolli said. "It also suggests that SRA results in better function and improved patient activity in comparison to THA.

"However, the effect of long-term fixation related to increased activity levels is unknown. Long-term follow-up is necessary to determine the survivorship of SRA over THA," he said.

For more information:

Vendittoli P-A, Lavigne M, Lusignan D, Roy A-G. A randomized study comparing surface replacement arthroplasty to total hip arthroplasty: 2-4 years follow-up. F028-2. Presented at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association. Sept. 9-13, 2007. Seoul.

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Comparative Arthroplasty Alternatives for the Young Arthritic
By Thomas P. Schmalzried, MD
ORTHOPEDICS 2007; 30:756
September 2007

Thomas P. Schmalzried

Hip resurfacing is embraced by patients. In principle, the attraction is similar to smaller incisions: patient satisfaction is related to the degree of invasion of their body.

Hip resurfacing is driven by the Internet, with an Internet pro-resurfacing culture perceiving total hip replacement (THR) as an older technology and an older person’s operation. This perspective is fueled by the historical risk of dislocation, traditional activity restrictions, and concerns of component loosening with bone loss leading to morbid revision THR. There is a paucity of patient awareness regarding the outcomes of current-generation THR. In fact, there is a paucity of studies comparing current-generation THR and total resurfacing.

Indications for Total Hip Resurfacing
Total resurfacing and THR are not directly competing technologies. The indications for hip resurfacing are more limited. Not all patients who are candidates for THR are good candidates for resurfacing .

Categorically, total hip resurfacing should be considered for those patients at increased risk for failure of THR. Historically, such patients are young and healthy, with men being at greater risk than women. Patients who have been told they are too young for THR have embraced resurfacing. The operative parameters for conversion of a failed resurfacing to THR are similar to those for a primary THR.(1)

With current technology, the acetabular component size and position are essentially the same for total resurfacing and THR.2 The issues are on the femoral side and include:

Bone Density. The risk of femoral neck fracture following resurfacing is related to bone density, with an increased risk in women and men >65 years.3,4
Head-to-Neck Ratio. Because resurfacing occurs around the femoral neck, it is technically helpful to have a head-to-neck ratio >1.2.
Femoral Offset and Limb Length. With resurfacing, femoral offset and limb length cannot be changed to a practically significant degree; therefore, these parameters should be close to normal (>120° neck-shaft angle and limb-length difference within 1 cm).2
Focal Defects. Because focal defects undermine support for the component, large necrotic segments or cystic defects are undesirable.5
Hips that have all 4 of these criteria are arthritic hip grade (AHG) A, which is basically a normal hip with no cartilage. Grade B hips lack 1 factor, grade C hips lack 2 factors, and grade D hips lack 3 factors.6

Clinical Results

In our series of more than 350 consecutive total hip resurfacings(7),  there have been no femoral neck fractures. After a 2-year minimum follow-up, AHG was significantly associated with preoperative Harris Hip score (A>B>C), occurrence of mild to moderate postoperative pain (A<B & C), and hip range of motion. In other words, hips with a lesser degree of secondary arthritic changes had a higher AHG and a better outcome. The mean UCLA activity score was 8.2, but activity scores were higher for higher hip grades. These data support the selection criteria and also support relatively early intervention.

During the same period, we compared our first 50 consecutive hip resurfacings in 50 patients to 44 THRs performed in 35 patients.7 Surgeries were performed by the same surgeon using a posterior approach. The same postoperative protocol was followed in both groups with no activity restrictions; minimum follow-up was 2 years.

As one might expect, there were differences between the two groups. Average age was 46 years for resurfacing patients versus 55 years for THR patients. Resurfacing patients were predominantly men and taller, and had a lower body mass index.

Resurfacing patients had a lower preoperative Harris Hip score (ie, reported more pain), but they had a higher preoperative UCLA activity score and greater preoperative range of motion. The resurfacing patients had a lower mean ASA score (ie, better general health).

On average, it took 18% longer to perform the surface replacements than the THRs. However, total blood loss was 250 cc lower with the resurfacings (despite a larger exposure), probably because there was no femoral canal violation or bleeding. Less transfusions were given in the resurfacing group because of the lower blood loss and the better general health status of the patients. There was no significant difference in the length of hospital stay between the two groups.(7)

With regard to outcomes, hip resurfacing patients had the same 2-year Harris Hip score (97 versus 96). Hip resurfacing patients had greater functional improvement, resulting in a greater increase in the Harris Hip score. The resurfacing patients also had a greater increase in UCLA activity score and a higher postoperative SF-12 physical score. There was no difference between the groups in postoperative range of motion. In fact, the THR group had greater improvement. There was one dislocation in each group.

The bottom line is both technologies performed very well in our series. Because patient characteristics are the main determinant of outcome, we must be careful with simple technology-based comparisons.(7)

References 1. Ball ST, Le Duff MJ, Amstutz HC. Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. J Bone Joint Surg Am. 2007; 89:735-741.
2. Silva M, Lee KH, Heisel C, Dela Rosa MA, Schmalzried TP. The biomechanical results of total hip resurfacing arthroplasty. J Bone Joint Surg Am. 2004; 86:40-46.
3. Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br. 2005; 87:463-464.
4. Australian Orthopaedic Association National Joint Replacement Registry 2006. Available at: www.dmac.adelaide.edu.au/aoanjrr/ .
5. Amstutz HC, Beaule PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004; 86:28-39. 7. Fowble VA, dela Rosa MA, Schmalzried TP. A comparison of total hip resurfacing and total hip replacement patients and outcomes. Clin Orthop Relat Res. In press.

Correspondence should be addressed to: Thomas P. Schmalzried, MD, Joint Replacement Institute at St Vincent Medical Center, S. Mark Taper Bldg, 2200 W Third St, Ste 120, Los Angeles, CA 90057.

Comparative Arthroplasty Alternatives for the Young Arthritic READ COMPLETE ARTICLE