BHR

Welcome to Hip Resurfacing News

Hip Resurfacing News features up to date news about hip resurfacing, FDA approved devices, personal hip stories, experienced surgeons, video interviews and press releases. 

Hip Resurfacing came of age in the United States when the FDA approved the Birmingham Hip Resurfacing Device in May 2006. Since then the FDA has approved the Cormet Hip Resurfacing Device and the Wright C+ Device.  Orthopedic surgeons have been performing hip resurfacing surgeries since 1997 overseas. More than 140,000 people world wide have received hip resurfacings.

Looking for more information about Hip Resurfacing? Visit the

Surface Hippy Website - A Patient to Patient Guide to Hip Resurfacing


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

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.html

1st 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 Both devices have now been withdrawn from the market.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.

Smith & Nephew Press Conference about the Safety and Effectiveness of Hip Resurfacing with the BHR -
Birmingham Hip Resurfacing Device

Review by Patricia Walter

May 6, 2010

Introduction: Joseph M. DeVivo, President of Smith & Nephew Orthopaedics

Joseph M. DeVivo, President of Smith & Nephew Orthopaedics (NYSE: SNN, LSE: SN), the maker of the BHR Hip introduced the press conference and discussed the safety and effectiveness of the BHR.  He explained that over 125,000 patients worldwide have received a BHR since 1998. The BHR and the issue of metal sensitivity in patients with MOM (metal on metal) implants will be discussed. The purpose of this event is to deliver specific facts about the BHR and its unrivaled track record of success for active patients around the world.

Mr. DeVivo explained that information about hip resurfacing presented at the 2010 American Academy of Orthopedic Surgeons will be discussed.  Recently, there has been negative information in the press about metal on metal devices which includes hip resurfacing devices like the BHR.  The press has taken the failures of a few to cast doubts about all hip resurfacing.   It has omitted the successes of hip resurfacing and that 7 out of 10 surgeons performing hip resurfacing choose the BHR.  Smith & Nephew feel the BHR is a safe and effective device providing successful hip resurfacing for patients worldwide.

Derek McMinn, MD, British surgeon and inventor of the BHR

Derek McMinn, MD, pioneering British surgeon and inventor of the BHR hip explained that the BHR has been proven successful by peer review data and his own clinical data. There are four main pieces of evidence that show the success of the BHR:

1.   The Australian Orthopaedic Association's National Joint Replacement Registry - tracked every hip resurfacing since 1998.  Less than 1/3 of 1 percent of hip resurfacing failures are caused by an adverse tissue reaction.

2. In a 9 center Canadian study presented at the recent 2010 AAOS, 3 resurfacing patients out of 3400, less than 1/10 of 1 percent, experienced a tissue reaction.

3. Long Term data, from the Owestry outcome center, tracked 5000 BHR patients and now 518 BHR patients at 10 years of follow up. The study was carried out by 18 surgeons in 16 different countries. There was a 95% success rate at 10 years.

4.  Mr. McMinn’s own clinical data started in 1997.  He performed 3095 BHRs until end of 2009.  At 12 years follow up, he has a 96% survivorship.

Therefore, according to McMinn, those 4 pieces of data from a large number of surgeons and his own clinical experience shows the BHR works.  There have been adverse reactions reported in all of the studies, but these numbers are incredibly small. However, since MOM resurfacing has been going on in UK since 1991, when he did his first resurfacings, there have been a number of adverse reactions reported. One study from Oxford has over 30 presentations or publications of pseudotumors.  In 2008, one percent of their patients were affected by this condition. Mr. McMinn explained that we need to examine what has happened in Oxford. They presented and published 610 BHRs in 2008. Those patients were operated on by 7 consultants and 30 trainees resulting in a large input from inexperienced surgeons. We know, explained McMinn, from a presentation from the last academy meeting that they have reported on poor surgery. The inclination angle of the cup should be 40 degrees; however, the Oxford pseudotumor group reported angles from 10.1 to 80.6 degrees.  I need to stress, the high inclination angles up to 80.6 angles are completely unacceptable. Every BHR, Metal on Metal, Ceramic on Ceramic and metal on poly device will fail with that type of poor surgery.  

McMinn explains that the adverse reactions for hip resurfacing are reported from 2 categories:

1. Poor results from well established BHRs put in badly causing edge loading, high metal wear and an adverse tissue reaction to lots of debris.

2. Poor results from implants that don’t work. The  4^th generation devices such as the Durom and ASR devices have both been associated with much higher failure rates than the BHR both on individual surgeon reports and Australian national registries. The adverse tissue reactions to the ASR are particularly prevalent. The UK reports around 7% revision rate for ASR resurfacing.  ASR THR mom failures are also double than other devices.  So the UK regulatory bodies are faced with reports of devices that are poor and adverse tissue reactions by well established devices put in badly.

Edwin Su, MD, of the Hospital for Special Surgery

Edwin Su, MD, of the Hospital for Special Surgery, agreed about the importance of hip resurfacing in the lives of patients.    After training with Mr. McMinn and Dr. Amstutz, he has completed over 1300 hip resurfacings with majority being BHRs.  I can say with authority that this procedure can be a life restoring event for the patients. Metal on Metal hip resurfacing done with precise technique and a well designed implant can work.  In appropriate patients, hip resurfacing can achieve nothing short of miraculous life changing results.  Hip resurfacing allows patients to return to active pain free lives. Certain patient types do better with resurfacing than others.  Good solid bone stock means you will do well.  Poor bone stock means there is an elevated risk of a femoral neck fracture. This is common knowledge    Patients under age 65 have best bone stock.  92.7% of all resurfacings are in patients under 65.  Patient selection is very important.  The data shows men do better than women.  Women require smaller components and are more difficult to align during surgery.  Also women’s bones are less dense, so some women are not ideal candidates for hip resurfacing. Australian shows 80% resurfacings are in men.  Resurfacing works better in men than women. Women of child bearing years are not recommend to have hip resurfacing.

Dr. Su explained about the issue of Implant alignment.  If the components are misaligned, there will be an increased risk of metal wear because the surfaces will not be properly lubricated during regular physical activity. There is a resulting risk of adverse tissue reactions and possible revision surgery.  Although this is true for most hip replacement surgery, it is especially true for resurfacing since the implants are less forgiving due to their precise manufacturing.  This rate of adverse tissue reactions is extremely rare in resurfacing and less than ½ of 1 percent.

The literature, explained Dr. Su, shows experienced surgeons who have undergone appropriate training, can place a hip resurfacing device correctly.  A surgeon not doing them on a regular basis has a greater chance of not achieving optimal results. It’s that simple explained Dr. Su.   This is true in any surgery in any specialty. While some implants perform better than others, good outcomes with hip resurfacing most often are achieved by experienced surgeons who have received excellent training and are careful in patient selection.  Dr. Su has offered hip resurfacing since 2006 and has seen spectacular results since then.

Scott Marwin, MD, an orthopedic surgeon with New York University's Hospital for Joint Diseases

Dr.  Marwin explained that the use of the BHR, after 12 years use worldwide and 4 years use in the states, remains an exciting option for some patients.  It has never been suggested for all hip replacement surgery.  Fewer than 10% of all patients are candidates.  Fundamentally, it is a bone conserving procedure and saves a significant amount of healthy bone.  Preservation of the basic structure of femur retains the natural size and angles of the joint and reduces any possibility of leg length discrepancy after surgery.  Also patients’ soft tissue doesn’t have to adjust to a different set of shapes and kinematics that comes with a THR. Many patients forget which side has the BHR implant.  Hip resurfacing also retains the patient’s anatomy which decreases the possibility of a dislocation. In a THR, the long metal neck can act like a lever on the edge of the metal cup and dislocate the ball out of the socket.   The natural femoral neck retained during hip resurfacing means incidence of dislocation is extremely rare.  If a resurfacing patient needs a revision, they can receive a matching THR component to match the existing cup.  Hip resurfacing reduces wear and leads to a longer life for the implant as compared to a THR.  Dr. Marwin has implanted more than 750 hip resurfacing devices and can see what they can do for the active patient.

 

Summary by Joseph M. DeVivo

 The BHR is different than other MOM devices on the market that are not performing up to standard. The BHR outperforms the gold standard for THRs in the core patient age group. Hip resurfacing gives patients their active life style back.  BHR preserves so much healthy bone that it feels like a normal hip. More information can be found a www.hipsresurfacing.com

Question and Answers from Audience

Question:  Terry Stanton, AAOS.  Concerning the medical device alert in Britain - is it warranted and correctly crafted?

Answer: Dr. Su - It casts a general concern over MOM usage, but does not speak specifically to the BHR.  BHR has its own clinical data and has not produced the type of concern other MOM device have.  It stands on its own according to worldwide sources.

Q: Surgeon inexperience and poor technique – more globally in the US, what factor will it play?

A:  Dr. Su - Where the BHR is concerned, as part of the FDA approval, it has mandated a very high level of training.  Every surgeon is trained to same protocol.

Q: Canadian Study presented in New Orleans – follow up was 3 years. Comment on how solid the evidence is since the follow up is shorter.

A.  Mr. McMinn - Important to look at what happens in first 3 years in hands of a new group of surgeons to hip resurfacing.  The Oxford Group is reporting adverse reactions to metal debris in the early years. It is highly significant how a new group of trained surgeons get on.  The fact that there are an incredibly low number of incidents of adverse reactions in a 9 center study with over 3000 patients speaks volumes for the devices and training of the surgeons.  The longer term results are more important. The Australian registry has over 8000 people with an incredible low incidence of adverse reactions with survivorship at  95% for BHR at 8 years.  The Oswestry registry with 518 patients at 10 years, shows a  95.4% implant survivorship.  Phenomenally good results.  In my own group, adverse reactions have occurred in 0.3% of my whole group.  Out of 3095 BHR patients thru 2009, there were 10 adverse reactions.  Unlike the Oxford Group, all the revisions have been fine. None were associated with soft tissue destruction.  These were in the main, fluid collections requiring a bearing change to solve the problem. The patient made a totally uncomplicated recovery.  I saw adverse reactions much later.  Oxford was showing them 2 or 3 years after surgery. 

Q. Metal sensivity and pseudotumros are always curious problems.  In terms of devices, is there is less metal release in different devices?

A. Mr. McMinn - It is very clear who gets the pseudotumors. The retrievals from the Oxford Group show pseudotumors were associated with aged wear of the acetabular cup.  With normal lubrication and normal wear, there are no pseudotumors.  Clearly,  if you want a MOM device to fail,  implant it badly or design it badly so you get age loading and age wear which results in a high metal volume of debris early on.

New Data Reinforces the Proven Safety and Effectiveness of the BIRMINGHAM HIP Resurfacing System

80-percent of US surgeons choose the BHR hip as it outperforms all other metal-on-metal resurfacing devices

MEMPHIS, Tenn., May 3 /PRNewswire-FirstCall/ -- Recent new data(1) presented at this year's American Academy of Orthopaedic Surgeons (AAOS) annual meeting reinforces the BIRMINGHAM HIP™ Resurfacing (BHR) System as a safe and effective hip resurfacing device. The multi-site study, performed by orthopedic surgeons practicing at nine Canadian academic centers, showed that three years after surgery, 99.91% of their 3,400 hip resurfacing patients experienced no implant failure due to metal wear debris. The BHR Hip was the most used resurfacing device in this study.

This week, the Hospital for Special Surgery (HSS) in New York City will be holding a medical education course titled "Total Hip: Replacement and Resurfacing" on May 7 and 8 for leading hip surgery specialists from across the U.S. Chairing the course will be Edwin Su, MD, of the Hospital for Special Surgery, and the teaching faculty will include pioneering British surgeon Derek McMinn, MD, inventor of the BHR hip.

During a press conference and Q&A webcast on Thursday, May 6, at 3 p.m. US EDT, 8 p.m. GMT, Joseph M. DeVivo, president of Smith & Nephew Orthopaedics (NYSE: SNN, LSE: SN), the maker of the BHR Hip, will be joined by Dr. Su and Mr. McMinn, as well as Scott Marwin, MD, an orthopedic surgeon with New York University's Hospital for Joint Diseases. The panel will review current data confirming the safety and effectiveness of hip resurfacing and the BHR Hip. Smith & Nephew Orthopaedics will host the call, and additional details are at the bottom of this release.

The new study recently presented at the AAOS meeting aligns with previously released BHR Hip data from other prestigious sources and further addresses the metal wear debris concerns raised about metal-on-metal hip implants.  The BHR Hip's track record for longevity remains unchallenged in the literature, as well. These sources include:

• The Journal of Bone and Joint Surgery published in January of this year a study tracking 155 consecutive BHR patients over three years. The data showed no revisions of BHR Hips due to metal wear, but patients who received a competing metal-on-metal resurfacing device were revised within three years of surgery at a rate of 3.4-percent due to adverse tissue reactions.(2)
• The Australian Orthopaedic Association's 2008 National Joint Replacement Registry, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR Hips and found that less than one-third of one-percent may have been revised due to the patient's reaction to the metal component.(3)  
• The Australian Registry hip resurfacing data for 2009, 70-percent of which comes from BHR Hip procedures, indicates that for men under age 65, hip resurfacing performs at the same or a better rate than total hip replacement. This registry also shows that the BHR Hip remains successful in 95-percent of cases eight years after surgery, whereas no other implant performs better than 94.7-percent just five years after surgery.(4)
• Great Britain's Oswestry Outcomes Centre's patient registry,  which tracked 5,000 BHR Hips implanted by 148 different surgeons in 37 countries over 10 years (1998-2008), reports that the BHR Hip remains successful in 95.4-percent of all patient segments 10 years after surgery. This registry also reported that 98.6-percent of patients were "pleased" or "extremely satisfied" with their BHR Hip implants 10 years after their resurfacing procedure.(5)
• Mr. McMinn's clinical data, based on 3,095 hip resurfacing patients implanted between 1997 and 2009, shows that more than 12 years after surgery, the BHR hip remains successful in 99-percent of men aged 60 and over, and 97-percent for men under age 60.

"The BHR Hip's outcomes are remarkable when compared to other resurfacing devices," said Dr. Marwin. "The depth and consistency of the data collected globally shows the BHR Hip is truly different."

"For the right patients in my practice, hip resurfacing has proven to be an excellent choice," said Dr. Su. "They have extremely high levels of satisfaction after returning to their regular lifestyle."

To explain the patient advantages seen consistently in the literature, surgeons indicate the key differences between the BHR Hip and other resurfacing devices are its metal composition, its design geometry and its surgical instrumentation.

The BHR Hip has a unique metallurgy heritage which goes back more than 30 years and includes a first-generation metal-on-metal resurfacing process which contributes to long-term survivorship of BHR Hip recipients.

Additionally, the BHR Hip's design geometry replicates the natural hip's ability to pull the body's own joint fluids into the ball and socket interface, which is believed to be another source of its best-in-class performance.

Of particular importance during hip resurfacing surgery is the correct positioning of the acetabular cup, or hip socket. When this component is not properly aligned, studies show that metal wear can accelerate and resurfacing devices can fail before their time.  Surgeons believe that the instrument used to implant the BHR Hip is simpler and more accurate than other devices' instruments, and may contribute to its success.

"Just like the lubricating barrier in a healthy hip, there is a natural fluid layer between the femoral head and the cup that the two metal surfaces glide across during physical activity," said Mr. McMinn. "If the surgeon malpositions the acetabular cup causing edge loading, the lubrication is lost. It's equivalent to running a car engine without lubrication oil. High wear will occur, resulting in premature failure. Overall, it is a combination of the metal composition, the design and the quality of the surgical technique that makes the BHR Hip the safest resurfacing implant on the market."

"The bottom line is that the BHR Hip is not like other metal-on-metal hip implants," said DeVivo. "Not only does it have the longest track record of any resurfacing device, but the most esteemed medical literature shows it outlasts other implants. It's in a class all its own – it's safe and effective, and is the best choice for active patients."



Footnotes

(1) Beaule PE, Smith FC, Powell JN et al. A Survey on the Incidence of Pseudotumours with MOM Hip Resurfacings in Canadian Academic Centres. Podium presentation # 665. Proceedings of the American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans LA. 2010

(2) Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AVF.  Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement, A CONSEQUENCE OF EXCESS WEAR. J Bone Joint Surg Br. 2010; 92-B: 38-46

(3) Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2008.

(4) Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2009.

(5) Robinson E, Richardson JB, Khan M. MINIMUM 10 YEAR OUTCOME OF BIRMINGHAM HIP RESURFACING (BHR), A REVIEW OF 518 CASES FROM AN INTERNATIONAL REGISTER. Oswestry outcome centre, Oswestry, UK.

About Us

Smith & Nephew is a global medical technology business, specialising in Orthopaedics, including Reconstruction, Trauma and Clinical Therapies; Endoscopy and Advanced Wound Management.  Smith & Nephew is a global leader in arthroscopy and advanced wound management and is one of the leading global orthopaedics companies.

Smith & Nephew is dedicated to helping improve people's lives.  The Company prides itself on the strength of its relationships with its surgeons and professional healthcare customers, with whom its name is synonymous with high standards of performance, innovation and trust.  The Company operates in 32 countries around the world.  Annual sales in 2009 were nearly $3.8 billion.

Forward-Looking Statements

This press release contains certain "forward-looking statements" within the meaning of the US Private Securities Litigation Reform Act of 1995.  In particular, statements regarding expected revenue growth and trading margins discussed under "Outlook" are forward-looking statements as are discussions of our product pipeline.  These statements, as well as the phrases "aim", "plan", "intend", "anticipate", "well-placed", "believe", "estimate", "expect", "target", "consider" and similar expressions, are generally intended to identify forward-looking statements.  Such forward-looking statements involve known and unknown risks, uncertainties and other important factors (including, but not limited to, the outcome of litigation, claims and regulatory approvals) that could cause the actual results, performance or achievements of Smith & Nephew, or industry results, to differ materially from any future results, performance or achievements expressed or implied by such forward-looking statements.  Please refer to the documents that Smith & Nephew has filed with the U.S. Securities and Exchange Commission under the U.S. Securities Exchange Act of 1934, as amended, including Smith & Nephew's most recent annual report on Form 20F, for a discussion of certain of these factors.

All forward-looking statements in this press release are based on information available to Smith & Nephew as of the date hereof.  All written or oral forward-looking statements attributable to Smith & Nephew or any person acting on behalf of Smith & Nephew are expressly qualified in their entirety by the foregoing.  Smith & Nephew does not undertake any obligation to update or revise any forward-looking statement contained herein to reflect any change in Smith & Nephew's expectation with regard thereto or any change in events, conditions or circumstances on which any such statement is based.

Trademark of Smith & Nephew.  Certain marks registered US Patent and Trademark Office.

A Consensus From The Advanced Hip Resurfacing Course, Ghent, June 2009 About Metal-on Metal Hip Resurfacing

K. De Smet, MD, Orthopaedic Surgeon¹; P. A. Campbell, PhD, Associate Professor²; and H. S. Gill, DPhil, University Lecturer in Orthopaedic Mechanics^{3 1} ANCA Medical Center (AMC-Ghent), Krijgslaan 181, 9000 Ghent, Belgium.
² UCLA/Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, California 90007, USA.
³ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK.

Abstract

We report the consensus of surgical opinions of an international faculty of expert metal-on-metal hip resurfacing surgeons, with a combined experience of over 18,000 cases, covering required experience, indications, surgical technique, rehabilitation and the management of problematic cases.

Introduction

The last decade has seen an increased use of metal-on-metal hip resurfacing arthroplasty as an alternative to contemporary total hip replacement (THR), especially for patients who wish to participate in high-demand activities. Metal-on-metal bearings are also being used more often for THR. In June 2009, the third Advanced Resurfacing Course was held in Ghent, with a faculty that included 21 orthopaedic surgeons whose combined experience included over 18,000 metal-on-metal hip resurfacing arthroplasties. As the meeting served to bring together surgeons, highly experienced in hip resurfacing, from Australia, Europe and the Americas, the opportunity was taken to establish consensus views on issues of required experience, indications, surgical technique and rehabilitation. The aim of this annotation is to disseminate these consensus findings in order to help surgeons who are considering metal-on-metal bearings for both resurfacing and conventional THR. The findings are presented as a majority opinion, with the percentage of the faculty in agreement given in parentheses.

Required experience

The use of metal-on-metal bearings for THR and resurfacing presents a greater technical challenge than that of conventional metal-on-polyethylene bearings. The consensus (81%) was that an orthopaedic surgeon should have a minimum experience of 200 conventional THRs before starting to use a metal-on-metal hip resurfacing arthroplasty. Opinion varied on the number of these operations needed to overcome the learning curve, and ranged from 20 (36%), to 50 (28%) and more than 50 (30%).

Indications

The overall view (100%) was that the ideal candidate for an metal-on-metal hip resurfacing arthroplasty is a relatively young man with normal anatomy and primary osteoarthritis. Being female was not, by itself, a contra-indication (89%), but use of a small femoral head (< 46 mm) was contra-indicated (70%). Being female and wanting to have children was a contra-indication (66%), as was being female and having a metal allergy (70%). Grossly abnormal anatomy, regardless of gender, was also agreed to be a contra-indication (83%). There was considerable debate about bone quality, the general view being that 'good' femoral bone is a prerequisite, but no agreement was reached on a working definition of acceptable quality.

Surgical technique

The majority opinion (56%) was that the best type of femoral placement guide is that which encircles the femoral neck. There was general agreement (63%) that the current acetabular placement jigs are inadequate. The overall preference (78%) was for cementing the femoral component with a thin cement mantle with fixation holes drilled in the femoral bone, use of pulsed lavage, and reduction of the hip in less than eight minutes from the start of mixing the cement.

Rehabilitation

Full weight-bearing can be allowed on the first post-operative day (73%) and patients should use crutches for as long as needed (57%). Six weeks is the optimal time to return to normal non-sporting daily activities (44%), and six months for returning to impact sports such as running or tennis (61%).

Managing problematic cases

It was difficult to achieve a consensus on this topic, and only the broad recommendations of the discussion are reported. It was generally agreed that these patients need to be followed up and those with symptoms investigated. There was no agreement on the diagnostic value of measurements of metal ions, but it was felt that  'high' concentrations of systematic metal ions indicated a problem with the articulation. Cross-sectional imaging and plain radiographs are required for the investigation of a symptomatic metal-on-metal bearing.

It is hoped that these consensus opinions will prove useful to orthopaedic surgeons and will lead to improved outcomes after surgery for hip replacement.

Smith & Nephew's strong profits beat expectations
February 2010

Smith & Nephew (S&N), the hips-and-knees maker, posted higher profits in the final quarter of last year after the replacement joints market stabilized.

The market suffered during the recession, but started to recover in the second half.

Traditional hip and knee ranges, like its Legion knee, did well, particularly in the US, while products designed for younger, more active patients, such as the bone-sparing Birmingham Hip Resurfacing System, were weak.

Younger patients were more likely to put off surgery than retirees because they did not want to take time off work or balked at the cost.

"Our largest business, orthopaedics, saw a good finish to a tough year," said chief executive David Illingworth. "Market conditions were a little less difficult than in the first half."

He said it’s too early to say when patients who deferred operations might have them done, and S&N is struggling to push through price increases as governments and private clients have tightened their budgets. But Illingworth was hopeful that the $12bn  global market for replacement joints would improve, with consumer confidence returning and unemployment now falling.

S&N expects revenues in orthopaedics to grow at the market rate this year after lagging in 2009.

Profits before tax rose to $175m in the fourth quarter from $162m a year earlier, with revenues 11 per cent higher at $1.07bn, helped by strong sales at the wound management division.

Analysts and investors welcomed the results, and the shares closed up 4.3 per cent at 660p.

The Influence of Head Size and Sex on the Outcome of Birmingham Hip Resurfacing

READ ORIGINAL STUDY BY CLICKING HERE

 The Journal of Bone and Joint Surgery (American). 2010
Callum W. McBryde, MD, FRCS(Tr&Orth)1, Kanthan Theivendran, MRCS1, Andrew M.C. Thomas, FRCS1, Ronan B.C. Treacy, FRCS(Tr&Orth)1 and Paul B. Pynsent, PhD1

1 Research and Teaching Centre, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, United Kingdom. E-mail address for C.W. McBryde: cwmcbryde@hotmail.com

Investigation performed at the Royal Orthopaedic Hospital, Birmingham, United Kingdom

Background Hip resurfacing has gained popularity for the treatment of youngand active patients who have arthritis. Recent literature has demonstrated an increased rate of revision among female patients as compared with male patients who have undergone hip resurfacing. The aim of the present study was to identify any differences in survival or functional outcome between male and female patients with osteoarthritis who were managed with metal-on-metal hip resurfacing.

Methods A prospective collection of data on all patients undergoing Birmingham Hip Resurfacing at a single institution was commenced in July 1997. On the basis of the inclusion and exclusion criteria,1826 patients (2123 hips, including 799 hips in female patients and 1324 hips in male patients) with a diagnosis of osteoarthritis who had undergone the procedure between July 1997 and December2008 were identified. The variables of age, sex, preoperative Oxford Hip Score, component size used, surgical approach, lead surgeon, and surgeon experience were analyzed. A multivariate Cox proportional hazard survival model was used to identify which variables were most influential for determining revision.

Results The mean duration of follow-up was 3.46 years (range, 0.03 to10.9 years). The five-year cumulative survival rate for the655 hips that were followed for a minimum of five years was 97.5% (95% confidence interval, 96.3% to 98.3%). There were forty-eight revisions. Revision was significantly associated with female sex (hazard rate, 2.03 [95% confidence interval,1.15 to 3.58]; p = 0.014) and decreasing femoral component size hazard rate per 4-mm decrease in size, 4.68 [95% confidence interval, 4.36 to 5.05]; p < 0.001). Revision was not associated with age (p = 0.88), surgeon (p = 0.41), surgeon experience (p = 0.30), or surgical approach (p = 0.21). A multivariate analysis including the covariates of sex, age, surgeon, surgeon experience, surgical approach, and femoral component size demonstrated that sex was no longer significantly associated with revision when femoral component size was included in the model (p = 0.37).Femoral component size alone was the best predictor of revision when all covariates were analyzed (hazard rate per 4-mm decrease in size, 4.87 [95% confidence interval, 4.37 to 5.42]; p <0.001).

Conclusions The present study demonstrates that although female patients initially may appear to have a greater risk of revision, this increased risk is related to differences in the femoral component size and thus is only indirectly related to sex. Patient selection for hip resurfacing is best made on the basis of femoral head size rather than sex.

US Hip Resurfacing Implants Market: Product Penetration to Drive Growth

2009-08-14

The US hip resurfacing implants market valued at $57.3.million in 2008 is forecast to grow by 36% annually for the next seven years to reach $483 million by 2015

This growth is expected to be driven by an increase in awareness of the procedure, increasing clinical familiarity among surgeons and a favorable reimbursement scenario.

The fact that hip resurfacing offers a more natural feel, higher stability and lesser bone-loss makes it ideal for patients leading an active life.
Increasing awareness of the advantages that this procedure offers, through campaigns by both the manufacturers and social groups will drive the growth of the US hip resurfacing market. There has been a steady increase in the awareness of hip resurfacing, and it’s offering of an active life even after surgery, its shorter recovery period, lower costs of rehabilitation and its minimal bone loss factors. These advantages have positioned hip resurfacing as a primary treatment method for hip ailments.

The increasing incidence of osteoarthritis in the population group of 25-60 years is a major driver for the US hip resurfacing market. The increasing prevalence, now at 6% of the young patient population, is expected to drive growth in the US hip resurfacing market. Osteoarthritis, which first appears between the age of 25 and 40, is a very common disease in individuals aged 70 and above. Before the age 55, it affects men and women equally but after the age 55, the incidence is higher in women. Effectively, the large pool of male population between the ages of 25-40 with advanced or severe arthritis of the hip are expected to drive demand for hip resurfacing impalnts.
Smith & Nephew leads the US hip resurfacing market with its Birmingham Hip Resurfacing (BHR). Released in May 2006, the BHR had the competitive advantage of being the only available product for a full year until the market launch of Corin’s Cormet System in July 2007. Smith & Nephew cashed in on the first mover advantage with innovative marketing, surgeons education and competitive pricing. Renewed efforts towards capturing distribution channels and increased stress on surgeons education has allowed Smith & Nephew to capture 75% market share in the US hip resurfacing market.

Corin’s deal with Stryker for distribution of its Cormet resurfacing system played a major role in the sales of its device in spite of the late entry into the US market. Stryker is known to have one of the strongest sales forces in the US orthopedic devices market. This combined with Stryker’s strong brand identity as compared to the UK headquartered Smith & Nephew has allowed Corin’s product to effectively make inroads into the hip resurfacing market in the US.

For more information on this report click here:
www.global-market-research-data.com/Report.aspx?ID=US-Hip-Resurf ..

GlobalData, the industry analysis specialists’ new report, “US Hip Resurfacing Implants Market: Product Penetration to Drive Growth”, finds that an increasing incidence of osteoarthritis in the population group of 25-60 years will drive the growth of hip resurfacing implants market in the US. The report highlights the trend of traditional Total Hip Replacement (THR) shifting towards Hip Resurfacing as one of the key market drivers for the US hip resurfacing market.

Smith & Nephew 2Q Net Profit +15%; Deferrals Greater In Young

July 2009

LONDON  (Dow Jones)  Medical technology company Smith & Nephew PLC (SN.LN) Thursday July 30, 2009  reported a 15% rise in second-quarter profit, but said key products like its Birmingham hip resurfacing system are being disproportionately hit by the recession, as younger people are more likely to put off surgery than retirees.

Smith & Nephew said sales growth for replacement hips and knees is slow, as patients continue to put off going under the knife while worries about the economy persist. Growth in global sales of its knee products was 1% on the year, while the hip sales declined 1%.

The company said products like its Birmingham hip resurfacing system, or BHR, and its Journey knee implant have "a greater exposure" to the effects of the recession because the rate of deferrals for operations is highest among young, privately-insured patients.

Peers like Stryker Corp. (SYK), Johnson & Johnson (JNJ) and Zimmer Holdings Inc. (ZMH) have reported a similar softness in the multi-billion dollar a-year market for new joints.

Smith & Nephew said net profit for the three months to June 28 rose to $118 million from $103 million a year earlier, on revenue down 7% at $926 million.

That's just ahead of analysts' average forecast of about $117 million net profit.

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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.