Hip Resurfacing Articles

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

Hip resurfacing: The metal-on-metal bearing material is not the problem by Dr. Amstutz

COMMENTARY ORTHOPEDICS TODAY February 2012

http://www.orthosupersite.com/view.aspx?rid=91593

To the Editor:

The success of total hip replacement (THR) in the 20th century has been tremendous with improvements in the durability of new designs, bearing materials and fixation techniques. However, the young and active patients have historically had high revision rates compared with older, more sedentary patients, notably when the etiology of the disease is osteonecrosis. Despite great improvements in cementless stem fixation, hip resurfacing arthroplasty (HRA) has the advantages of replicating leg length and offset, and maintaining proximal bone unlike THR. Moreover, dislocation in THR remains a problem when small femoral heads are used. Resurfacing patients also do not report thigh pain as it sometimes happens after THR.

When it comes time for revision surgery, as should be expected for most young and active patients, whether treated with a resurfacing or a primary THR, the preserved bone stock with hip resurfacing provides more favorable conditions for a successful surgery and the technical difficulty of the conversion is comparable to that of a primary THR. This enables patients seeking to restore their previous lifestyle to be more active than with a THR, and numerous authors have reported high levels of physical activity in patients after hip resurfacing.

Preserving bone and replacing only the affected articular surfaces has always been and remains a worthy treatment goal, but the first generation of hip resurfacing suffered from the use of ultra-high molecular weight polyethylene sterilized in air, a material unsuitable for a large bearing size in young and active patients. Unfortunately, and because of the poor results of the materials used during that era, many become detractors of the concept of resurfacing.

The current generation of resurfacing devices uses a metal-on-metal (MoM) bearing because the volumetric wear is low, even with large diameter components, and the material permits manufacturing of thin one-piece acetabular components with porous ingrowth for cementless fixation.

Recent long-term data show that certain currently available hip resurfacing devices can reach up to 99.7% survivorship at 10 years in patients with good bone quality and implanted with large component sizes. The importance of patient selection for hip resurfacing and the key role of component size have been highlighted by the reports of several large centers and the findings of hip registries. However, improvements in surgical technique have considerably reduced the rate of aseptic femoral failures (femoral neck fractures and femoral component loosening) associated with the learning curve of the surgeons who pioneered the procedure, even with patients who have risk factors...

Read the Complete Comment here  http://www.orthosupersite.com/view.aspx?rid=91593

This is a transcript of a Live Chat in the Surface Hippy Chat Room with Dr. Mont on February 22, 2012

Welcome! You have entered [Doctor Chat] at 6:52 pm
[Pat Walter] 8:00 pm: Welcome to our chat with Dr. Mont of Baltimore, MD.
[Dr. Mont] 8:00 pm: Ready to go!

[Pat Walter] 8:01 pm: I'll start - what devices are you using now?
[Dr. Mont] 8:02 pm: I use various devices for standard total hip replacement----use Corin and Wright for resurfacing

[Dr. Mont] 8:01 pm: Welcome everyone--happy to answer any Qs about hip arthritis, pain, etc.

[hiphopinman] 8:02 pm: Dr. Mont, thanks for agreeing to answer questions on this forum 1) Do you advise against a return to impact activities (crossfit/running/etc) after a BHR ? 2) If so, why?
[Dr. Mont] 8:03 pm: I don't do BHRs right now. Though did about 400-500 in past. Many of my patients return to high activity sports after resurfacing or standard total hip replacement. A lot of it has to do with Rehab.

[6wkhip] 8:02 pm: Hi Dr Mont. YOu did my hip 6 weeks ago and I'm off the cane.. no limp either! It feels great!
[Dr. Mont] 8:04 pm: 6 week hip--I'm delighted for you-

[mslendzion@comcast.net] 8:02 pm: I have heard that the femoral head is weakest 3 months post op. Is this true, and if so, why and how long is the risk?
[Dr. Mont] 8:04 pm: Never heard of three month business----problems typically occur within first 12 weeks, but necessarily at three months

Continue reading "Doctor Chat with Dr. Mont Feb. 22, 2012"

Prof Yates of Australia sent me several of his studies.  I am posting a link to a copy of his paper -

Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision
12,093 replacements from the Australian Joint Registry

http://www.surfacehippy.info/pdf/Prossser-yates-AOS-2010-resurf-risk.pdf

We need real information to evaluate the outcomes of hip resurfacing and Prof Yates has done an excellent job of analyzing the 2010 information.

Prof Yates contacted me with his info and offered me the use of his presentations.

Professor Piers Yates
MBBS(Hons) BSc(Hons) MRCS FRCS(Tr & Orth) FRACS(Ortho)
Over 300 hip resurfacings since 2001, trained by Jeremy Latham, Gordon Bannister, Treacy
Murdoch Orthopaedic Clinic, Suite 10
St John of God Hospital Murdoch
100 Murdoch Drive
Murdoch 6150
Western Australia
Tel: 08 9312 1135
Fax: 08 9311 4183
piersyates@hipandkneeperth.com.au
www.hipandkneeperth.com.au

I appreciate his help and input. 

Pat

 

A copy of the 2011 Australian National Joint Replacement Registry is located here:

Australian National Joint Replacement Registry 2011

I am posting this because people need to know the statistics I quote are not my opinion, but based on actual information from the National Directories.

Here is the BHR revision rate compared to other devices:



Please note the 6.3% revision rate at 10 years for the BHR.

Here is the hip resurfacing overall revision rate by male and females.  Please note that all small men and women both have the higher revision rates than larger people based on head size of HR components (9.3 for males, 11.2 for females).  All larger females and males have the same similar low revision rates (3.7 for males, 3.9 for females @ 7 years) .  Hip Resurfacing works great for larger people.  It also works for most smaller people, but you really need to use only the very, most experienced surgeons for good outcomes.



There is a great deal of information in the national registry, but this is really the important information in my opinion.  That is why I always use the 96% retention rate for the BHR worldwide.  It is actually higher in some other studies and surgeons personal series.

Changing a tire at two weeks post op is not a good idea. We often forget that we are healing after major surgery and do things without thinking. Please think before doing any strenuous activities shortly after surgery. I think the people that do "really dumb things" realize it very quickly! Anyone that had major surgery and wants to do heavy work any time within the first six weeks is going to pay a big price including a possible revision due to a femur neck fracture or component movement. No matter how much you warn people, they just can't understand the impact such major surgery has on their bodies. You can't force your body to heal or be strong after it has been sliced and diced. I would caution people to be careful even beyond the six weeks up to six month period. Most surgeons will let patients do normal activities at six months, but warn that it takes a full year for the body to heal completely after a hip replacement. Why go through a recovery from major surgery and then take a chance on having a revision. Makes no sense, but neither do the actions of many people.

Please think before acting. Get help when you are faced with any problem that means you need to exert your new hip to lift a lot of weight. One man recently posted that he fixed a flat tire when he had surgery two weeks before. Fixing a flat tire to be on time to an appointment is not as important as going thru another surgery for a revision because you fractured your femur neck. Please think before performing strenuous activities. There is nothing more important than your own health if you want to continue to be active and be there for your family.

Often parents are tempted to lift their children after hip surgery. Lifting could mean that you are going to crack a femur, dislocate your hip or move an acetabular cup component. Any injury to the femur bone, surrounding tissue or muscles could result in a revision. Each revision surgery after your first hip replacement becomes more difficult than the original surgery.

THR Revision Information

We need to remember that the time to recovery and let our bodies heal is actually very small when compared to a lifetime. Healing and becoming strong again will allow you to be active with your children once again. They will understand that you are healing and will look forward to the time when you are able to be a full time parent without pain.

A member of my Hip Talk Discussion Group http://www.surfacehippy.info/hiptalk/ asked why it took surgeons so long to learn how important the angle of the acetabular cup angle is during hip resurfacing surgery. Incorrect placement of the acetabular cup has caused many failures of hip resurfacing resulting in revisions to total hip replacements.

My answer to that questions of why it takes so long to learn if a hip device and/or surgical technique is successful is if anyone has worked in the engineering or design field, they will realize that usually the original design of a product or machine is never what the final design turns out to be. We are not machines that can determine perfect designs for anything. There are always unknowns. If you think about many things in our lives, they are always under constant change and updates. Car models are often changing, TVs are changing, cell phones, computers, etc. are constantly in change. Software for computers are always updating and changing. Athletes are always changing techniques to improve their skills. Musicians are always practicing to improve their skills. Medicine and joint replacement is not any different. Engineers are trying to design a device to replace a human joint while doctors are trying to place that foreign object in our bodies to act as the original equipment. This is not an easy task. There have been thousands of designs of hip devices over the years. The metals or plastics continue to change, the metallurgy changes, and the designs of the components change. There is nothing static about designs, they are constantly changing.

I learned from the many hip resurfacing conferences I attended, that it takes time for doctors to learn how the devices are actually working in patients. Typically it takes about 3 to 4 years for them to start to see trends about how the device has acted and how the bone growth has attached to the components. It takes time for the results to become statistics. So with any device, the wait period takes time and often by then, there has been a change in the device. So there are few devices of the same design left after a few years to compare results.

It simply is very difficult tracking the new devices and their results right after their implant. Many of the top experienced surgeons were placing the actabular cups at a good angle early on. They knew instinctively that the acetabular cup should be in a certain position to work well. I have always said and heard surgeons say the same thing, that surgical skill is more than a skill or learned process, it is also an art. It is like the great athletes that instinctively know what to do. They do learn and practice, but have a God given skill that places them way above many other athletes. The same is true with the really top surgeons. If you think about sports or activities you are personally really good at, you are not looking at the educational videos or books to learn how to throw a ball, play an instrument or type on a computer. Those with really good skills are able to do it almost without thinking. That's is the way it is with the top surgeons. They had an instinct about how things should work and were very successful. McMinn of the UK is doing that all the time as he develops devices. Many of the other top surgeons have helped develop hip devices and many of the surgical instruments to help place hip devices. A recent example of one is with Dr. Kusuma in Columbus. http://www.surfacehippy.info/observinglivesurgery.php  He wanted a better way to insure his placement of a BHR was correct. He developed a template system which no other surgeon had done before. Smith & Nephew are thinking of having him teach it to new surgeons.

There is a great deal of constant change with any hip device or any man made mechanical device. Designs keep changing and hopefully for the better. Skills and instruments to place joint devices keep changing and hopefully for the better. It is very complex and just takes time to develop excellent devices and how to place them exactly. The orthopedic surgeons keep track of their series of hip resurfacings and the National Directories  http://www.surfacehippy.info/nationalregistries.php keep track of hip resurfacing patients.  It takes time for all the statistics and results to accumulate and become tools to help learn about a hip device and a specific surgical technique.

Pat

Watching Dr. Kusuma perform a live BHR surgery

I had the opportunity to watch a live BHR hip resurfacing surgery at Grant Medical Center in Columbus, OH on Oct. 7, 2011. The story below is from a layman's perspective since I am not medically trained.  I have written the story so patients can understand the basic procedures during surgery.  I explain things so perspective patients can understand them.  I am not trying to write a technical article on hip resurfacing surgery.  It is my observations about what was happening in the OR.

Watching a live surgery as an observer is quite different than being a patient.  As a patient, I never saw the inside of an operating room.  The special shot given to relax me always put me to sleep before entering the OR.  Being awake and watching the staff the OR for a BHR surgery is very interesting.  The room is a beehive of activity.  No one is rushing but everyone is doing their job efficiently while a little small talk occurs.

While the staff is preparing for the surgery, the Smith and Nephew representative selects the proper sized BHR device.  He also selects one size larger and one size smaller than the determined size to be used during the surgery.  A special room stores all of the Medical Devices at the hospital.  The representative from each medical company keeps the shelves stocked for their own devices.

Continue reading "Observing a live BHR Surgery by Dr. Kusuma 2011"

Introduction by Patricia Walter:

Occasionally people have hip device failures due to pushing too hard right after surgery or doing hard impact sports or activities too soon.  There are stories of people with hip resurfacings that required revisions to THRs.  Dr. Broder, a hip resurfacing patient and radiologist, explains why patients should be conservative during their post op recoveries.  Most surgeons want patients to wait until at least 6 months to return to normal sports and one year to high impact sports like running. Using common sense, listening to your surgeon's protocols and giving your body time to heal is always the best approach to returning to a normal activity level.

Dr. Broder explains:

I am Radiologist, and have been a member of Yahoo surfacehippy discussion group since 2002. Over the years we have had numerous members, especially young active athletes, who have accidentally injured their prosthetic hip.

Nuclear Medicine bone scans reveal metabolic activity (new bone growth) persisting for up to 2 years in adults over 30 who sustain fractures, or have had joint prosthetics. The reason is simple. As the bone heals, new bone is produced by special cells, and tiny new blood vessels (neovasculature) which very slowly grow into the older bone, and the special surfaces of the prosthetic parts designed for that purpose. Over time, other special cells reshape the new bone, and eventually it is replaced with thicker stronger bone tissue. In fact, over time, ALL the bone in our body is being replaced slowly in response to various stress factors, and maintenance. This is true of many tissues in the body.

If we return to certain activities too soon, we will apply forces that will produce microscopic fractures in the new bone, and it may fail to completely heal. The complex process of bone healing is delayed or completely fails. This is a well known problem in treating fractures of any bone. That is why cast material is applied, or other methods of internal fixation (screws, plates, rods), or EXTERNAL FIXATION methods are used to hold fractured bones in place. Even slight mobility will result in mal-union, incomplete union, or even complete NON-UNION which is a very serious problem. Each person will heal at an individual rate controlled by complex factors.

Every surface hippy has already arrived at the point where the NATIVE HIP has failed.

New Hippys to be:
Don't put your new artificial hip at risk. Follow instructions. Exercising too forcefully, too soon can lead to failure of union of the new bone to the hip. This is especially true of the uncemented portion(s). There is no magic involved here. Once you have micro-fractured the new bone, it may never heal properly.

I waited 11 months at age 58 before returning to skiing.

Best wishes,
Michael (MD in NC) (L) C+ 3/31/03

What is the Best Bearing Type?
A comparison of modern bearing types by Dr. Thomas Gross 1/11/2011

As a patient there are four reasons you should consider a metal-on-metal bearing total hip replacement or resurfacing:

1. WEAR: Low.

2. BREAKAGE: Unbreakable bearing. 

3. STABILITY: Maximum stability of the joint.  Using a metal-on-metal bearing surface allows the manufacture of a large bearing hip joint that will not dislocate.

4. BONE PRESERVATION: Resurfacing is only possible with this bearing type. This allows bone preservation and avoidance of a stem in the femoral canal.

Hip replacement has come a long way since the 1950’s. It has improved to the point where middle aged or older patients can expect a relatively long life out of the implants if they follow certain restrictions and don’t participate in high impact sports. However, most implants are not good enough to allow full unrestricted activity at high demand levels. To move to this next level requires an implant that satisfies all three of the above-mentioned requirements. Only metal-metal bearings have this potential. We will address all three issues in detail separately:

1.WEAR:

Failure due to the adverse effects of wear has been identified as one of the primary problems with traditional metal-plastic bearings. They are not durable enough for many of today's younger more active patients.  Traditional metal-on-plastic bearing devices have been shown to fail at a rate of thirty (30%) percent by seven years in this patient group.  Mostly these failures have been due to reactions to wear debris. Recently, several new bearing couples have been developed that are more resistant to wear:

Continue reading "Hip Replacement VS THRs by Dr. Gross 2011"