Doctors

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...

 

 

I am honored that some of my overseas patients have got together and made a plaque in appreciation of our hip surgery team and a donation for the Jay Coulter fund.

Gary Klein has come back to Chennai to get his second hip done. He brought the plaque and the donation.

I have attached a picture of the plaque.

With best regards

Vijay bose
chennai
Asian Regional Center for Hip Resurfacing (ARCH) Website
 

AAOS SAN FRANCISCO, March 7, 2008 - Some of the purported advantages of hip resurfacing over standard arthroplasty, though not all, seem to be real, researchers found in a randomized trial.

But other pluses in activity and function can probably be chalked up to patient selection bias and expectations, reported Martin Lavigne, M.D., of the University of Montreal, and colleagues, at the American Academy of Orthopaedic Surgeons meeting here.

In the randomized trial, patients who had hip resurfacing were significantly more likely to return to work and sports and had better step and hop test scores than standard arthroplasty patients did.

But functional scores and range of motion were no better than with hip replacement, the investigators found.

Hip resurfacing gained popularity with patients and some orthopedic surgeons on the basis of assumptions about better clinical function and ability to return to a high level of activity.

While retrospective cohort studies reinforced this perceived benefit, Dr. Lavigne said, "obviously there was a bias in the patient selection for hip resurfacing." Patients who sought hip resurfacing tended to be younger, more active, healthier, and expected a more active life after surgery, he said.

The newer procedure is still controversial among orthopedic surgeons despite rapid increases, commented Tom Schmalzried, M.D., of the Orthopaedic Hospital in Los Angeles, in a press conference where there was debate over the two approaches.

"The results of good, modern total hip replacement are really, really good," he said. "So for resurfacing to have a favorable risk-to-benefit ratio, you have to show you are getting something you don't get with total hip replacement."

For a more objective answer to this issue, Dr. Lavigne's group randomized 210 patients who were candidates for either procedure to undergo either uncemented 28-mm metal-on-metal total hip arthroplasty or hybrid metal-on-metal hip resurfacing.

All procedures were done by the same three surgeons with a posterior approach. Patients were informed which surgery they underwent only afterward.

Patients had a mean age around 50. Body mass index was higher in the total hip arthroplasty group.

Functional scores were slightly worse in the hip replacement group at six months (17 versus 11 on the WOMAC scale) but identical by two years (5 for both).

At six months after surgery, hopping on the affected leg was significantly easier for resurfacing group patients ("easy" or "very easy" 91.7% versus 78.9% and "difficult" or "impossible" 8.3% versus 21.1%, P=0.023).

Likewise, climbing stairs in a step test was easier at six months in the resurfacing group compared with the replacement group ("easy" or "very easy" 94.4% versus 76.3% and "difficult" or "impossible" 5.6% versus 23.7%, P=0.015).

Hip resurfacing group patients were also more likely to return to their prior work (96% versus 83%, P=0.02).

The young age of the patients made this an important outcome, Dr. Lavigne said.

Among the patients, 152 had data on activity level pre- and post-procedure.

Despite similar activity levels before surgery (P=0.22), more hip resurfacing than hip replacement patients returned to sports activities by one year after surgery (15% versus 7% high impact and 38% versus 28% moderate impact activity, P=0.022).

On a scale that included activities of daily living as well as sports, the difference tended to favor hip resurfacing but was not significant at one year (P=0.074).

"Both groups returned to a high level of activity," Dr. Lavigne said. "Hip resurfacing patients seem to be more active, but not as much as expected."

Type of surgery had no significant impact on what factors patients reported as limiting their return to sports activities, including implant protection, discomfort, fear of instability, and thigh pain.

Hip range of motion -- including total arc, arc of rotation, flexion-extension arc, and abduction-adduction arc -- was also similar for both groups among the 122 patients with data on this outcome (P>0.05).

Satisfaction with the procedure was uniformly high over time and across treatments.

While resurfacing is a more aggressive technique, Dr. Lavigne said, the rate of complications was similar between groups.

Long-term follow-up will be important to determine whether there are differences in need for revision between the procedures, he concluded.

Dr. Lavigne reported receiving research or institutional support from Zimmer, Stryker Howmedica, Biomet, DePuy, and Smith & Nephew and consulting for Zimmer.

Dr. Schmalzried reported receiving research or institutional support from Stryker, DePuy, Johnson & Johnson, Corin, and Wright Medical Technology; receiving miscellaneous funding from Stryker, DePuy, Johnson & Johnson, Corin, Wright Medical Technology, Zimmer, and Smith & Nephew; receiving royalties from Stryker, DePuy, Johnson & Johnson, Corin, and Wright Medical Technology; holding stock options in Stryker, DePuy, Johnson & Johnson, Corin, Wright Medical Technology, Zimmer, Biomet, Bristol-Myers Squib, and Pfizer; and being a consultant for Stryker.

Primary source: American Academy of Orthopaedic Surgeons meeting
Source reference:
Lavigne M, et al "Range of motion after hip resurfacing and THA: A single-blind randomized clinical study" AAOS meeting 2008; Abstract 058.

Additional source: American Academy of Orthopaedic Surgeons meeting
Source reference:
Lavigne M, et al "A randomized study comparing surface replacement arthroplasty to total hip arthroplasty" AAOS meeting 2008; Abstract 056.

Additional source: American Academy of Orthopaedic Surgeons meeting
Source reference:
Lavigne M, et al "Return to sports after hip resurfacing and total hip arthroplasty: A randomized clinical trial" AAOS meeting 2008; Abstract 053.

Link
http://www.argusleader.com/apps/pbcs.dll/article?AID=/20080616/LIFE/806160306/1004/life

Ken Kuipers' hip pain started in 2006. At first, the 51-year-old Platte farmer tried to tough it out.

Even though a couple doctors recommended hip replacement, Kuipers wasn't ready to give in.

"I wanted to keep my own joint as long as possible," he says.

Doctors told him he could try cortisone injections, but Kuipers ruled that out because the shots were expensive and provided temporary relief. He needed to keep up with his animals and field work, so when the pain didn't ease up, Dr. Matthew McKenzie, orthopedic surgeon at the Orthopedic Institute, offered another option.

Kuipers was a perfect candidate for hip resurfacing, McKenzie says. People who are active, younger than 65 and have normal bone tissues have the best chance for success with the procedure, he says.

Doctors also consider the expected life span of the patient before deciding on the type of surgery performed. Hip replacements don't last forever.

"There is about a 20 percent failure rate in 25 years, depending on what study you're looking at," McKenzie says.

He has done the resurfacing procedure for about nine months, something that Orthopedic Institute added because patients were going out of town to have the surgery, he says.

A hip resurfacing procedure has the same goal as a standard total hip: Pain alleviation. Contrary to popular belief and Internet promises, the procedure is not less invasive or expensive nor does it mean a shorter recovery time.

With hip resurfacing, Kuipers faces six weeks of healing, the same time a total hip replacement would have taken. The newer surgery is not cheaper because new technology always costs more, McKenzie says.

The main reason to have a hip resurfacing is because it means less bone removal. "If it fails, you can revise it to a standard total hip," he says. "Anything to save bone is the right thing to do."

During a hip resurfacing procedure, the ball of the hip is machined down, a metal cap is fitted over it and a short anchoring spike is driven down the femur. The neck of the femur is preserved as well as much of the ball. The position of the implant and the patient's muscles hold the hip in place.

In a traditional hip replacement, the entire ball and joint is removed and replaced with an artificial joint, and a long rod is placed in the femur.

Kuipers' incision is 10 inches long, that compared with a hip replacement that is typically half that or less.

He was in the hospital for several days. He had the surgery on a Wednesday and went home Saturday. He had two physical therapy sessions on Thursday and Friday while in the hospital, says his wife, Donna. They taught him stretching and strengthening exercises to do at home.

He's using a walker right now.

"I'm just about ready to switch to a cane," he says.

The pain is better but different, he says. It's surgical pain from the muscles being cut. And he still needs pain pills to sleep.

At two weeks post-op, he had his first office visit where his staples were removed and his incision was looked over. Healing is progressing, and McKenzie gave permission to increase activity as tolerated.

"I was given the go ahead to get on a tractor," Kuipers says.That's exactly what he plans to do as soon as it dries out enough to get in the fields.

 

Hip, knee implant makers agree to pay $311M settlement

Link  http://blog.nj.com/ledgerupdates/2007/09/hip_knee_implant_makers_to_pay.html

Posted by John P. Martin and Jeff Whelan  September 27, 2007

The nation's largest manufacturers of hip and knee implants today agreed to pay $311 million to settle allegations that they bribed top surgeons to recommend their products.

Agents gathered evidence that orthopedic surgeons routinely accepted lavish vacations, gifts and annual "consulting fees" as high as $200,000 from medical device makers in return for endorsing their implants or using them in operations.

The 30-month investigation, headed by federal prosecutors in New Jersey, marks one of the larger settlements of its kind and follows a wave of cases to spotlight questionable ethics within the health care industry.

"With these agreements in place, we expect doctors to make decisions based on what is the best interest of their patients - not the best interest of their bank account," U.S. Attorney Christopher Christie said in a statement.

The agreements covered five firms, including DePuy Orthopaedics, a subsidiary of New Jersey-based Johnson and Johnson. Together, the companies control more than 90 percent of the U.S. market in reconstructive implants, a billion-dollar field expected to surge in coming years.

Three of the manufacturers -- DePuy, Zimmer Holdings and Biomet, Inc. -- are based in Warsaw, Ind. The others are Stryker Corp., of Kalamazoo, Mich. and Smith and Nephew PLC, of London.

The civil settlements ranged from $169 million for Zimmer to $26.9 million for Biomet, based in part on the market share of each defendant, authorities said. Stryker will not pay any money.

In criminal complaints filed in federal district court in Newark, the companies admitted paying surgeons consulting fees that violated the federal Medicare Fraud Statute. The law prohibits companies from offering inducements to doctors who participate in Medicare. About two-thirds of the 700,000 knee and hip replacement surgeries performed each year are covered by Medicare.

As part of the agreement, each will also pay for a federal monitor to supervise their practices for 18 months. The monitors include former U.S. Attorney General John Ashcroft and the former U.S. Attorneys for New York and Los Angeles.
 

Dr. De Smet

Vicky Marlow, Patient Advocate/Technical Contributor, asks "What is your opinion on cementless devices for resurfacing?"


Maybe they are good, but we do not know yet. Cement is a shock absorber between prosthesis and bone or between prosthesis/ bone+cement/ bone, so maybe a good thing, certainly taking in account that Chrome Cobalt has not the same elasticity as bone and is quite stiff!

So

1. we have to wait and see

2. certainly not all patients would be good to do uncemented

3. history has shown that cemented resurfacing works very well.

Greetz   KOEN

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Read More Doctors Opinions About Cementless Hip Resurfacing Here

New Doctor Video Interviews on Surface Hippy Website

Meet the Hip Resurfacing Doctors and listen to them discuss Hip Resurfacing

Resurfacing emerges as possible option to hip replacement
By Mary Jo Feldstein
ST. LOUIS POST-DISPATCH
05/07/2008

Read Complete Story Here

The procedure gives many patients the chance to relieve pain and stay active. Physicians caution their peers to select patients carefully and make sure they're capable of performing the complicated procedure.

"Patients should have a long discussion with their physician," said Dr. Jay Mabrey, chief of orthopedics at Baylor University in Dallas and chairman of the Food and Drug Administration panel that reviews orthopedic devices. "I spend more time in my practice talking people out of hip resurfacing than talking people into it."

Such restraint can be difficult as a few device makers put their marketing teams in gear to maximize this latest profit center.

Hip replacements typically only last two or three decades, leaving young recipients with few options for their golden years. Hip resurfacing, on the other hand, can preserve enough healthy bone for a hip replacement later on in life.

Here's the difference: During traditional hip replacement, both the head and neck of the femur, or thigh bone, are removed and replaced with metal or plastic implants. During hip resurfacing, the head of the femur is resurfaced with a metal hip "joint" and the rest of the thigh bone is left intact.

Patients who opt for hip resurfacing often return to some strenuous physical activity after surgery.

Goodman hasn't completed another marathon since his surgery a year ago, but he occasionally jogs shorter distances and he regularly attends high-energy spinning classes.

He isn't hip resurfacing's only cyclist. Professional cyclist Floyd Landis underwent the procedure before his contested Tour de France victory.

Resurfacing costs more than a traditional hip replacements, with a price tag of $10,000 to $12,000 versus about $8,000.

Patients, on average, have similar recovery times. Hip resurfacing patients who get better faster, generally do so because they were younger and healthier before the surgery than the average hip replacement patient, said Dr. Robert Barrack, an orthopedic surgeon with Washington University Orthopedics at Barnes-Jewish Hospital.

Hip resurfacing is not for everyone. Barnes-Jewish considers it ideal for active men and women under age 60. People with osteoporosis, diabetes and women who plan to have children are among the other classes of patients warned to stay away.

Patients also need to find a qualified physician. Since it was only approved by the Food and Drug Administration two years ago, few surgeons are proficient in performing the procedure, which is considered more difficult than hip replacement.

Barrack said it takes about 50 cases to consistently achieve the best results. Because only 10 percent of patients qualify for resurfacing, Barrack estimates a surgeon would have to see 500 patients to reach the threshold.

That's a high volume of patients for a physician outside of a large medical center, Barrack said. He is a paid consultant for Smith & Nephew, a maker of hip resurfacing products, though the expertise he provides the company is related to other products.

Smith & Nephew's Birmingham Hip was the first FDA approved hip resurfacing product in the United States. It's been a solid product for the British company, driving growth in revenue and profit. The hip replacement market is worth about $2 billion, but Smith & Nephew had controlled hip resurfacing's estimated $20 million slice of the pie. Now, as other device makers work through the approval process, Smith & Nephew is facing new competition.

A concern is whether efforts by device makers to increase the market will encourage physicians with less experience to perform the procedure or recommend it to the wrong patients.

Mabrey said he's keeping this procedure for the most active of patients. A recent example is a triathlete who completed an Ironman competition a few months after surgery.

"That's the kind of person I aim for," Mabrey said.

Link  http://nwanews.com/nwat/News/64008/

BENTONVILLE — John Hill has run several Boston Marathons over the years, but crossing the finish line in 2006 was anything but pleasant.

Hill, a Bentonville resident for more than a decade and an executive with Nestle in Rogers, was accustomed to tackling the 26. 22-mile marathon in Beantown in as little as three hours, 27 minutes. But on April 17, 2006, Hill’s time skyrocketed to just shy of six hours. And he was in excruciating pain on top of that.

“ The only way I even made it to the finish line was to stop every so often and put more ice in my shorts, ” Hill recalls. “ I knew the end was near. It was going to be over for me. I wasn’t going to be able to run anymore. ”

Once a confident long-distance runner, Hill had been diagnosed with osteoarthritis prior to legging out the 2006 Boston Marathon. And at 44 years old, the condition had nothing to do with age. Instead, an extra piece of bone on Hill’s hip was rubbing against cartilage in the right joint of his hip, causing the protective material to deteriorate at a much more rapid rate than usual. The only surgical procedure being prescribed was total hip replacement — and that would mean giving up running altogether.

While attempting to stomach the fact that part of his life would soon be erased, Hill stumbled upon a story about a new surgical procedure called hip resurfacing. The procedure was so new, in fact, that it was not yet approved by the Food and Drug Administration, few had been performed in the United States, and the majority of insurance companies were not covering the procedure. Still, a glimmer of hope was ignited that has led to Hill holding on to the life he has always known.

On April 21, Hill, now 46, will be among the more than 20, 000 runners from across the country competing in the Boston Marathon. More importantly, Hill, who underwent the hip-resurfacing procedure 14 short months ago, expects to run the world’s oldest and most popular marathon pain-free, and even has his eye on finishing in under four hours.

“ If I think about it too much, I get overcome with emotion, ” Hill said. “ A year ago, none of this would have been possible. It wasn’t even imaginable. When you get a second chance at life like I have, you can’t help but feel humbled. I had already been told to start developing my exit plan from running. And in a few weeks, I’ll be doing the Boston Marathon. ”

The hip-resurfacing procedure, performed on Hill by Dr. Robert Barrack in St. Louis on Jan. 23, 2007, has been practiced in Europe for several years but has just recently started to gain acceptance in the United States. Rather than removing the entire hip, the resurfacing procedure introduces a special metal into the hip joint where the cartilage once was. As a result, bone-on-bone contact, which causes arthritis, pain and disability, is replaced by metal on metal.

The realization that he would not have to lose his hip meant Hill could continue to run marathons. But, more importantly, he would remain the father and husband he had been to that point in his life.

“ I coach my 6-year-old daughter (Mary Lou’s ) softball team, and there was a time when I was having trouble getting from one end of the field to the other, let alone running, ” Hill explained. “ I have a 9-year-old daughter (Sophie ) and an 11-year-old son (Brody ) that run AAU. I’ve always been right there, running with them. I enjoy being involved. My family is a priority. When my doctor performed the surgery, that was the thing I told him. I said, ‘ Now I can play with my kids. ’ ”

Read Complete Story   http://nwanews.com/nwat/News/64008/