Articles 2008

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?

November 03, 2008 

Link  http://www.rush.edu/webapps/MEDREL/servlet/NewsRelease?id=1115

Rush University Medical Center Study Finds More Complications in Women and in Males Over the Age of 55

CHICAGO - Hip resurfacing is often seen as a modern alternative to the more conventional total hip replacement, but new data from a study led by Rush University Medical Center suggest that a patient's age and gender are key to the operation's success.

In a review of over 500 surgeries performed in the U.S. using a hip resurfacing device recently approved by the Food and Drug Administration (FDA), the researchers found that the majority of serious complications occurred in women of all ages and men over the age of 55. The most common complication, and the most serious, was a fracture of the femoral neck, the slender area of bone just beneath the head of the femur.

The study has just been published online and will appear in the January 2009 issue of Clinical Orthopaedics and Related Research.

"The ideal patients for hip resurfacing are males under the age of 55. They have the fewest, and the least serious, complications," said Dr. Craig Della Valle, lead author and a specialist in joint reconstruction at Rush University Medical Center. "Patients may be eager to take advantage of technological innovations, but for older individuals, a conventional hip replacement is generally more appropriate."

The researchers analyzed data for the first 537 hip resurfacing surgeries performed in the U.S. after the Birmingham Hip Resurfacing implant, manufactured by Smith & Nephew, was approved by the FDA in October 2006. The majority of the patients suffered from severe osteoarthritis. All 89 orthopedic surgeons involved in the procedures had undergone training required by the FDA before conducting their first cases. Their level of experience with hip surgery varied. Some were joint replacement specialists; others were general orthopedic surgeons.

Serious complications occurred in 32 of the 537 cases, including 10 cases in which the femoral neck fractured after surgery, a problem not seen with conventional hip replacements. Such fractures require additional surgery.

Nine of the fractures in the study occurred in patients who were either female or older than 55 at the time of the implant. Eight of the fractures occurred when the surgeon was relatively inexperienced with the procedure (within the surgeon's first 10 cases).

According to Della Valle, age and sex are probably linked to the incidence of such fractures because of bone quality and quantity.

"Patients who are older or who are female tend to have softer bone," he said. "Also, men on average have larger bone structures, with a greater surface area for securing the implant."

The study identified several other serious complications, including nerve injury, joint dislocation, fracture of the proximal femur (just below the femoral neck), loosening of the metal component in the joint socket, and deep infection.

The rate of complications, however, was similar to that found in other studies involving only orthopedic surgeons who had extensive experience with hip resurfacing. As a result, the authors concluded that the FDA-mandated training succeeded in teaching generalists the skills needed to perform the technically challenging hip resurfacing procedure, alerting them to possible complications and ways to avoid those problems.

In a conventional total hip replacement, orthopedic surgeons remove the head of the femur, or the ball of the hip joint, and replace it with a metal stem inserted into the thigh bone. They fit the socket of the joint with a metal shell that typically includes a plastic liner. In hip resurfacing, the femoral head remains, but its surface is reshaped to accept a rounded cap with a short stem that sits in the femur. A thin metal cup is pressed into the hip socket. Both components are made entirely of cobalt chrome, a metal.

Hip resurfacing is generally recommended for younger, more active patients out of concern that the traditional artificial hip might wear out during their lifetime and require a second replacement, a far more complicated surgery.

"Hip resurfacing has certain advantages over the conventional total hip replacement," said Della Valle. "It preserves more bone because the head of the femur is retained. It enables the patient to return to high-impact sports because the metal components of the implant resist wear and tear and can withstand the forces associated with activities like running. Some studies have also shown that hip resurfacing carries a lower risk of dislocation because the size of the ball component is larger."

"But despite its benefits, risks remain," Della Valle added. "Our findings suggest that we need to be cautious. This procedure is not ideal for everyone."

Link  http://cbs4denver.com/local/Colorado.News.Denver.2.556499.html

By Kathy Walsh
 Feb 15, 2007

DENVER (CBS4) ― Doctors at Presbyterian Saint Luke's Hospital have started offering a new type of hip surgery aimed to help baby boomers who are having pain in their hips earlier than normal. The Birmingham Hip Resurfacing System was approved by the Food and Drug Administration last May.

The new surgery is an alternative to total hip replacement and aimed at people under the age of 60.

"It is something that patients have actually been waiting to have done," said Dr. Cindy Kelly at Presbyterian Saint Luke's.

One operation CBS4 witnessed took 2 hours as Kelly prepares the hip socket, then hammered a new metal one into place. Kelly shaved the damaged bone on the hip ball, preserving it rather than removing it. She then glued and pounded in a new metal cover.

"Patients have full motion, really without the risk of dislocation," said Kelly.

The new procedure allows for more activity. Patients could be up and moving in 6 weeks, but need to wait a year before running.

One benefit is that if a patient needs another hip replacement, the thigh bone is largely intact.

The new resurfacing procedure may not be for everyone. Patients should always consult their own doctor.

Link  Click here to read complete story

August 7, 2008

Europe's largest medical devices firm, Smith & Nephew, which manufactures hip implants in Birmingham, has posted better-than-expected second-quarter earnings as revenues hit £500 million for the first time, boosting its stock.

The group confirmed its outlook for the full year, including the impact of problems at its Plus Orthopaedics, where the company revealed it had uncovered "unacceptable" sales practices three months ago.

Chief executive David Illingworth said: "We have generated quarterly revenues of $1 billion (£512 million) for the first time, as a result of a very solid performance across all of our businesses."

"In Reconstruction we have seen good growth in both our hip and knee product lines; in Trauma the actions we have taken in sales management have begun to pay off; Endoscopy has delivered double-digit revenue growth and in Advanced Wound Management we have outperformed the market. We are confirming our guidance for the full year and we believe that the long term outlook for our business is excellent," he added.

In Orthopaedic Reconstruction, global hip revenue growth was a solid seven per cent due to good contributions across all products and regions.

The Birmingham Hip Resurfacing System now has an estimated 3.5 per cent share by volume of the total US hip market after only two years in the market.

Investors welcomed the performance.

Nomura Code analyst Charles Weston said: "All the divisions did well on their sales and they've confirmed that the sales hit from Plus will be $100 million (£51 million), which is effectively positive because there are no new negatives."

Pre-tax profit rose to £80 million from £75.3 million a year earlier. Sales were £512 million, an underlying increase of eight per cent, or 23 per cent on a reported basis.

Link  http://www.star-telegram.com/376/story/822867.html

By RICKY TREON

Calf roping is no longer a young man's sport for Jeff Copenhaver.

It was, back when he was 9 and dreamed of being a world champion. Back when he went to his first national finals 13 years later, and when he competed in that prestigious event for the last time at 29.

But now, at 59 years young, Copenhaver has decided to return to calf roping competition, something he thought he'd given up long ago.

Copenhaver, who runs the Cowboy Church at Billy Bob's in Fort Worth and also works with kids, did win that world championship in 1975 and he continued to be one of calf roping's premier competitors and teachers for two more decades.

It seemed age had finally caught up with Copenhaver in 1995, when it became too painful to mount a horse. And at the time, not being able to practice calf roping in any capacity was something he could deal with.

"I really didn't think I had any more desire to do it," he said of the skill that he'd nearly perfected throughout his life. "I was just minding my own business in 2006. And then, bam, the desire came back."

Copenhaver said that desire was subtle at first. But in October 2006, he scheduled a double-hip resurfacing, a new procedure that allows less bone removal and more mobility than a total hip replacement. The hope was to eliminate the pain and regain the abilities he thought he'd lost forever.

Turns out he had to wait until the following August to finally have his surgery done by Dr. Theodore Crofford at Fort Worth's Texas Hip and Knee Center.

It was tough, waiting all that time, he said.

Copenhaver hasn't had any complications after the surgery last Aug. 27 and said he's feeling better physically than he did at age 36 when he'd last sat in a saddle.

"They know so much more about the body and how it works nowadays," Copenhaver said. "I'm just way more fit."

So fit that he wants to start competing again. Though it sounds like a pipe dream, Copenhaver is doing everything he can to make sure he doesn't end this comeback disappointed or hurt.

Riding a horse and roping a calf is hardly like riding a bike.

"It's going to take a certain length of time to get riding again with an edge," he said. "The hip is just now, at 11 1/2 months, starting to feel strong again"...
 

Link  Read Complete Story by Clicking Here

By JOHN R. PULLIAM  GateHouse News Service

Aug 08, 2008 GALESBURG — Dr. Myron Stachniw is celebrating his 30th year practicing in Galesburg.

Stachniw had his first office hours here on July 5, 1978. He earned his bachelor’s degree from what was then the University of Illinois Chicago Circle in 1969, then graduated from medical school in Wisconsin in 1973. Stachniw did a surgical internship and a four-year orthopedic residency at the University of Illinois Hospitals, completing that in 1978, the same year he obtained his master’s degree.

Stachniw, a native of Racine, Wis., who attended high school in Chicago, admitted he had never heard of Galesburg before being asked by the Elks Club to do a Crippled Children’s clinic here.
The Elks had an agreement with the University of Illinois to send residents to various cities to conduct the clinics.

"I came here for the first time as a second-year resident and loved Galesburg so much that I kept on asking to do the clinics," Stachniw said. "I kept returning and, eventually, Cottage Hospital made me an offer to set me up in practice and I jumped at that chance."

His practice is now known at Midwest Orthopedic Services and is located in Cottage Medical Plaza, 834 N. Seminary St., Suite 406.

Stachniw feels Galesburg is the ideal size.

"Galesburg is a wonderful place to live and to practice," he said. "I can do as sophisticated medicine and surgery as I like, but yet enjoy the small town atmosphere."

Stachniw said he has had offers over the years to join orthopedic groups in larger cities but has not been tempted.

"I plan to retire here," he said. "I would like to practice full time for another five years and then do part time, as long as I am healthy. I plan to retire in Galesburg but hope to travel."

Working in a smaller city has not limited his opportunities over the years. He said he developed an interest in joint replacements and has been able to take part in several clinical trials. He has helped design instruments and components for joint replacements.

"I was invited to be a clinical investigator for the hip resurfacing study and was one of 18 surgeons in North America" who first did the procedure.

Hip resurfacing is sometimes used as an alternative to hip replacement. It is a type of orthopaedic surgery that replaces a damaged or arthritic joint with something better or by remodeling or realigning the joint.

"I have had patients come to Galesburg from almost every state in the union, as well as Trinidad, West Indies, for hip surgery. I have also taught hip surgery in Chicago, Las Vegas and Memphis," he said.

Stachniw has continued teaching, helping other surgeons learn hip resurfacing procedures.
"Along with my wife, Reva, who is a nurse, I have conducted studies for the past 18 years for pharmaceutical companies, doing clinical trials on various medications associated with orthopedics. These are studies done for the FDA," Stachniw said.

Shortly after beginning his practice here, Stachniw had another opportunity, one he probably would not have minded missing. A traffic accident offered him the chance to show he truly believed in the quality of medical care here.

"When I was involved in a severe automobile accident in Chicago in 1980, I wanted nothing more than to return to Galesburg to get good health care," he said.

Stachniw has had an office party and a party with his family to mark his three decades of practicing medicine in Galesburg. He has never looked back.

"I have always felt that Galesburg has provided an exceptionally high quality of health care and that has continued to be the case," Stachniw said.

Link  Read Complete Story by Clicking HereBy JOHN R. PULLIAM  GateHouse News Service

Aug 08, 2008 GALESBURG — Dr. Myron Stachniw is celebrating his 30th year practicing in Galesburg.

Stachniw had his first office hours here on July 5, 1978. He earned his bachelor’s degree from what was then the University of Illinois Chicago Circle in 1969, then graduated from medical school in Wisconsin in 1973. Stachniw did a surgical internship and a four-year orthopedic residency at the University of Illinois Hospitals, completing that in 1978, the same year he obtained his master’s degree.

Stachniw, a native of Racine, Wis., who attended high school in Chicago, admitted he had never heard of Galesburg before being asked by the Elks Club to do a Crippled Children’s clinic here.
The Elks had an agreement with the University of Illinois to send residents to various cities to conduct the clinics.

"I came here for the first time as a second-year resident and loved Galesburg so much that I kept on asking to do the clinics," Stachniw said. "I kept returning and, eventually, Cottage Hospital made me an offer to set me up in practice and I jumped at that chance."

His practice is now known at Midwest Orthopedic Services and is located in Cottage Medical Plaza, 834 N. Seminary St., Suite 406.

Stachniw feels Galesburg is the ideal size.

"Galesburg is a wonderful place to live and to practice," he said. "I can do as sophisticated medicine and surgery as I like, but yet enjoy the small town atmosphere."

Stachniw said he has had offers over the years to join orthopedic groups in larger cities but has not been tempted.

"I plan to retire here," he said. "I would like to practice full time for another five years and then do part time, as long as I am healthy. I plan to retire in Galesburg but hope to travel."

Working in a smaller city has not limited his opportunities over the years. He said he developed an interest in joint replacements and has been able to take part in several clinical trials. He has helped design instruments and components for joint replacements.

"I was invited to be a clinical investigator for the hip resurfacing study and was one of 18 surgeons in North America" who first did the procedure.

Hip resurfacing is sometimes used as an alternative to hip replacement. It is a type of orthopaedic surgery that replaces a damaged or arthritic joint with something better or by remodeling or realigning the joint.

"I have had patients come to Galesburg from almost every state in the union, as well as Trinidad, West Indies, for hip surgery. I have also taught hip surgery in Chicago, Las Vegas and Memphis," he said.

Stachniw has continued teaching, helping other surgeons learn hip resurfacing procedures.
"Along with my wife, Reva, who is a nurse, I have conducted studies for the past 18 years for pharmaceutical companies, doing clinical trials on various medications associated with orthopedics. These are studies done for the FDA," Stachniw said.

Shortly after beginning his practice here, Stachniw had another opportunity, one he probably would not have minded missing. A traffic accident offered him the chance to show he truly believed in the quality of medical care here.

"When I was involved in a severe automobile accident in Chicago in 1980, I wanted nothing more than to return to Galesburg to get good health care," he said.

Stachniw has had an office party and a party with his family to mark his three decades of practicing medicine in Galesburg. He has never looked back.

"I have always felt that Galesburg has provided an exceptionally high quality of health care and that has continued to be the case," Stachniw said.

http://www.signonsandiego.com/uniontrib/20080715/news_1c15alivem.html

July 15, 2008 SAN DIEGO ALIVE

With more people in their 40s and early 50s being sidelined by severe osteoarthritis, a new technology – hip resurfacing as an alternative to hip replacement – is giving baby boomers a chance to stay active longer.