Hip Resurfacing News - Articles 2009

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

nospam@example.com (Patricia Walter) — Wed, 17 Mar 2010 09:36:02 -0700

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 Mechanics³ 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.

Mr. Bloomfield responds to the The Times Article: "Is hip resurfacing the best solution for arthritis?"

nospam@example.com (Patricia Walter) — Wed, 20 Jan 2010 11:24:11 -0700

Mr. Bloomfield responds to the The Times Article: "Is hip resurfacing the best solution for arthritis?"

Let's start at the beginning!

Fact No. 1 : Nothing is as good as nature's own. Nothing can ever replicate the perfection of your native, original hip - before it became diseased. One day, maybe we can grow you a new one, then this debate will be irrelevant. Everything else is a compromise. Some compromises are better than others, and it depends on the individual patient, their activity or age, as well as the experience of the surgeon and the quality of components used.

Fact No. 2: However you 'spin' it, Conventional total hip replacement or THR is effectively an amputation of the head & neck of the femur. No if's and's or but's. Once it is gone, that's it, no going back. So, even if hip resurfacing [I call it BHR as I only use the Birmingham device] has a SLIGHTLY higher failure rate than THR, it is still worth thinking about the preservation of your femoral head & neck. The younger or more active you are, the more important this thought becomes.

Fact No. 3: The article only looks at revision rates when comparing BHR to THR. It says nothing about other, more subtle problems with THR like dislocation. OK, dislocation maybe rare with THR and almost unknown with BHR, but it is still a great concern in the early recovery phase. The fear of dislocation with THR drives the rehabilitation in the first few weeks and greatly restricts the advice the surgeon can give patients. Patients have to be given guidance to avoid dislocation which is often more onerous than is strictly required so that everyone can 'cover their backsides' so to speak. With BHR, my team is now [or should be!] telling MOST patients there are no special or onerous restrictions. Patients can sleep on their sides. They do not need raised toilet seats at home. They do not need to worry about dislocation because it is almost impossible. It allows the patient to recover full range of motion earlier and more safely. Unless there are concerns about bone quality, patients can be told to get back to activities of daily living as fast as their body allows. The only thing we have to be a bit cautious about is high impact stuff like running or jogging, football, rugby, skiing and the like. These can be allowed after the 3 or 4 month x-ray and if surgeon is happy that the danger of neck of femur fracture has passed.

The other, very subtle and impossible to quantify downside of THR is that surgical invasion of the femoral medullary canal forces marrow contents into the bloodstream. The bone marrow of the long bones is where your body makes all your blood cells. Red ones, white ones and platelets. It is why dogs love the marrow of a bone so much - it is rich in fat and protein. Forcing this marrow fat, rich in immature blood cells and other proteins, triggers an inflammatory cascade in the leg around the whole length of the femur and in the lungs which filter the globules before they would enter the circulation to the brain or other major organs. When severe, this phenomenon is called fat embolism. BHR dramatically reduces this embolisation phenomenon and is why I feel quite happy doing bilateral BHR when the patient has bilateral disease, but I would be very, very careful or wary of bilateral THR on the same day. In fact I tried bilateral THR several times before BHR came along and had lots of trouble. Done over 30 cases of bilateral BHR now and never regretted it. A truly astonishing operation as patients take only one or 2 more days to go home as compared with a single side BHR. i.e the recovery time is not doubled.

Fact No. 4: Some of us have always instinctively realized this, but BHR is exquisitely sensitive to accurate component positioning, and the exact metallurgy/manufacture of the components. THR can be put in quite sloppily and still work. At least for more than the 3 years the Times article is looking at. The figures in the UK National Registry are for all surgeons, using all the currently available hip resurfacing prostheses in varying mix. One should look ONLY at high volume, experienced surgeons to get the true picture. I wish I had the time and energy to look in detail at my own series, but it is certainly less than 4% failure at 3 years! The other trouble is that McMinn has already published large, detailed series so does the world need yet another one? McMinn's own figures, particularly in the under 55's are so good, many thought he must have fabricated them. I think less than 1% 'failure' at 5 years, not 3 years. This is the problem with raw statistics: they are so easily used like a drunk man uses a lamppost - more for support than illumination.

So much of the 'failure' we are looking at is due to poor surgery, poor prostheses or a combination of both. Women are only more at risk because their hips tend to be smaller, therefore the precise positioning of components is more critical. Women also tend to naturally have slightly weaker or less dense bone than men, so their cups may not integrate as planned or they may fracture through the neck of the femur. Apart from that, I personally don't believe there is any great gender difference.

Fact No. 5 ALVAL or metal ion 'allergy' is very, very rare. Irritation from excessive metal wear from poorly positioned or poorly manufactured prostheses accounts for the vast majority of the so-called ALVAL being reported. It sounds to me like Andrea had excessive metal wear leading to predictable irritation, fluid accumulation around the hip, and pain. Andrea, I do not think you had true ALVAL. Indeed your surgeons tend to confirm this as they did not find the masses of inflammatory tissues and destruction that would have been present if you had true ALVAL. The Melissa test is useless for predicting who will get ALVAL. The Melissa test has been used to justify large scale extraction of dental fillings from people, particularly in Scandinavia, on the basis that allergy to the metal in the fillings was making these people ill. Mass hysteria on a quite fascinating scale, and remember for very tidy profit. ALVAL is not confined to BHR. It is a problem with any metal-on-metal bearing couple. If ALVAL is used as a reason to discredit BHR, then all metal on metal bearings would have to be suspect. Which would leave only metal or ceramic on polyethylene, or ceramic on ceramic.

So lets look at metal or ceramic on polyethylene. Polyethylene is basically like hardened wax. Soft and slippery. Under pressure and when heated, it deforms or flows, just like melting wax. You can make the wax a bit harder, but it is still wax. There are constantly new or improved polys on the market. We have been here before. Let's look at Hylamer, a trade name from De Puy:

Hylamer polyethylene was introduced in the 1990s as an alternative to conventional polyethylene. Its chemical and physical properties, and especially its high crystallinity, were claimed to improve resistance to wear. Initially Hylamer devices were sterilized by gamma radiation in air, then the technique was changed and gamma radiation was performed in the absence of oxygen. Clinical experience has shown the early loosening of some devices made from Hylamer.

The text understates the problem. Hylamer was an unmitigated disaster and has long ago been withdrawn. So I don't trust poly in any shape or form FOR YOUNG ACTIVE PATIENTS. I still use it for the more elderly and sedentary. It still works perfectly well in this group.

What about ceramic-ceramic? This is the best alternative if you cannot have metal-metal for any reason. BUT some ceramic hips squeak. So loudly they can be heard across a room full of people. Ceramic is brittle and although ceramic fracture is now rare, it still happens and is under-reported. Ceramic ages or oxidises in the body and this can then lead to higher wear rates as the ceramic surfaces lose their shine or surface finish. Finally ceramic-ceramic is a very 'hard' bearing couple with no 'give' or shock absorption. BHR will, in most situations, have a thin film of fluid which can be displaced to absorb shocks at bearing interface.

So, in summary: Yes, BHR will likely ALWAYS have a very slightly higher revision rate than THR at 3 or 5 years, when comparing like for like in terms of young active patients. But the increased risk should be of the order of 1% or less, in the hands of an experienced surgeon. Not the 7 to 14 times quoted. It is the 30 or 40 year comparative results that will tell a different tale!

BHR revision, if ever unfortunately required, will always be easier than THR revision. Pity the poor patient whose THR fails early, or even later, particularly if the femoral side needs to be redone - their surgeon has a much tougher job on his/her hands. And abandoning BHR in favour of THR would mean abandoning all the more subtle advantages of an anatomical-sized component sitting on top of your own preserved femur.

We need to focus on precise surgery, good patient selection, the very best metallurgy and manufacture, not scare ourselves into abandoning the most revolutionary development in the field of hip arthroplasty in the last 50 years.

Mark

DePuy Acquires Finsbury Orthopaedics Ltd.

nospam@example.com (Patricia Walter) — Wed, 16 Dec 2009 08:54:35 -0700

DePuy Orthopaedics, Inc. Acquires Finsbury Orthopaedics Limited

WARSAW, IN – Dec. 11, 2009 – DePuy Orthopaedics, Inc. has announced the acquisition of Finsbury Orthopaedics Limited, a privately held UK-based manufacturer and global distributor of orthopaedic implants. Financial terms of the transaction were not disclosed.

With the acquisition of Finsbury Orthopaedics, DePuy gains several key products, including the DeltaMotion® Ceramic-on-Ceramic Hip System, the ADEPT® Metal-on-Metal Hip Resurfacing and Total Hip System, as well as the Medial Rotation Knee™ System, the Dual Bearing Knee™ System, the BOX® Total Ankle Replacement, Tuke Saw and multiple small joint reconstructive implant lines.

DePuy Orthopaedics leads the worldwide hip market in providing the most complete range of high stability, low wear total hip implants. Finsbury Orthopaedics has pioneered advanced high performance, large diameter hip bearings that feature proprietary ceramic-on-ceramic and metal-on-metal bearing technologies designed to address the unmet needs of active patients. With the addition of the ADEPT and DeltaMotion platforms to DePuy’s existing portfolio of advanced high performance hip bearings, DePuy offers a comprehensive range of hip bearing options for clinicians worldwide.

About the DePuy Companies

DePuy Orthopaedics, Inc., a Johnson & Johnson company, is a leading global provider of orthopaedic devices for hip, knee, extremities, and trauma, as well as bone cement and operating room products. It is part of the DePuy Family of Companies, which has a rich heritage of pioneering a broad range of products and solutions across the continuum of orthopaedic and neurological care. These companies are unified under one vision – Never Stop Moving™ – to express their commitment to bring meaningful innovation, shared knowledge, and quality care to patients throughout the world. Visit www.depuy.com for more information.

Dr. Schmitt Completes First Live Tweet of BHR

nospam@example.com (Patricia Walter) — Sat, 28 Nov 2009 11:00:05 -0700

Link: http://www.positivedetroit.net/2009/11/detroit-medical-center-completes-first.html

Dr. Schmitt of the Detroit Medical Center Completes First Live Tweet of Birmingham Hip Resurfacing Surgery

Friday, November 27, 2009

On Monday, November 24, the Detroit Medical Center (DMC) conducted a live surgery simultaneously on multiple social media platforms. The procedure, called Birmingham Hip Resurfacing (first of its kind on social media), was performed conducted at DMC Huron Valley-Sinai Hospital in Commerce Twp., MI.

Dr. Philip Schmitt, D.O., performed the 40-minute surgery, accompanied by a bevy of healthcare professionals from the DMC Huron Valley-Sinai Hospital staff. Dr. Schmitt was the first to perform the Birmingham Hip Resurfacing procedure in Michigan and is considered one nation's best practitioners, having completed nearly 600 operations to date. This particular procedure is ideal for patients between the ages of 40 and 60 years old who are active, but suffer from constant pains from arthritis or joint pain in the hips.

"Birmingham Hip Resurfacing is an exciting re-invention of technology, said Philip Schmitt, D.O., of DMC Huron Valley-Sinai Hospital. "Americans love new technology and at Huron Valley we embrace it for treating our patients. Adding Twitter as another teaching aid benefits everyone."

Wright Medical Group, Inc. Receives FDA Approval to Market Conserve Plus Total Hip Resurfacing System

nospam@example.com (Patricia Walter) — Mon, 09 Nov 2009 13:11:52 -0700

ARLINGTON, Tenn.-(BUSINESS WIRE) - Nov. 9, 2009 - Wright Medical Group, Inc. (NASDAQ: WMGI), a global orthopaedic medical device company, announced today that the United States Food and Drug Administration (FDA) has given approval to the Company to market its original CONSERVE® Plus Total Hip Resurfacing System. Now available in the United States, this innovative total surface arthroplasty system provides surgeons and their patients a bone-conserving alternative to traditional total hip replacement.

The approval permits Wright to market CONSERVE® Plus in the original femoral and acetabular component configuration specified in its PreMarket Approval (PMA) application and enables the Company to initiate efforts to introduce additional enhancements to the system which are currently only available outside of the United States. The Company intends to incorporate these innovative future product options into the CONSERVE® Plus System's femoral and acetabular component offerings via the PMA Supplement pathway.

Hip resurfacing may be ideal for young, active patients in need of surgical treatment for chronic pain. The CONSERVE® Plus system is designed to offer pain relief and restoration of function while retaining as much healthy bone as possible and preserving future surgery options, including a primary total hip replacement.

The approval follows a successful clinical trial involving more than 1,300 patients, including those enrolled under Continued Access protocols, providing patient data of CONSERVE® Plus clinical data in postoperative periods of up to eight years in length. Wright will commence surgeon training in the first phase of its U.S. introduction. The training is expected to begin immediately upon approval.

"Hip resurfacing represents a valuable alternative to younger, more active patients who desire a hip reconstruction that more anatomically mimics the natural hip," commented Patrick Fisher, Sr. Director of Marketing for Wright's hip franchise. "We have learned that this is an excellent option for patients who meet the criteria for hip resurfacing, and these individuals tend to be very enthusiastic and outspoken about their positive results."

About Wright

Wright Medical Group, Inc. is a global orthopaedic medical device company specializing in the design, manufacture and marketing of reconstructive joint devices and biologics. The Company has been in business for more than 50 years and markets its products in over 60 countries worldwide. For more information about Wright Medical, visit our website at www.wmt.com

Dr. Brooks of Cleveland Clinic Performs 500th Hip Resurfacing

nospam@example.com (Patricia Walter) — Fri, 30 Oct 2009 07:55:27 -0700

Cleveland Clinic Surgeon performs 500th hip resurfacing procedure at Euclid Hospital

Oct. 29, 2009

Dr. Peter Brooks, Chief of Surgery at Euclid Hospital, has performed his 500th hip resurfacing procedure, the most such procedures in the state of Ohio. Dr. Brooks was responsible for bringing this type of surgery to the area.

Hip resurfacing is an alternative to hip replacement surgery.

Approved by the Food and Drug Administration in 2006, this procedure is for young active people suffering from arthritis or previous joint injury. Resurfacing is for people who still have the majority of their bone intact, but who still feel the painful effects of arthritis or injury.

"This technique preserves more of the patient's bone, allowing them more range of motion to return to all activities, including running, climbing and other competitive sports," said Dr. Brooks. "Rather than replacing the entire hip joint, as in a total hip replacement, hip resurfacing involves shaving and capping only a few millimeters of the joint surface."

The best candidates for his resurfacing are active people under 60 with strong bone health, good kidney functions and no allergies to certain metals used in the implant.

For more information, Dr. Brooks or his colleagues can be reached at a recently opened hip clinic. Call (216) 692-4236 or visit the Euclid Hospital website www.euclidhospital.org

Eight locals sue hip replacement manufacturer over alleged defects

nospam@example.com (Patricia Walter) — Thu, 17 Sep 2009 07:43:27 -0700

Click Here to Read Complete Story

A hip replacement was supposed to cure Mary Shelton's pain. Instead, the Bakersfield woman replaced one pain with another.

Shelton and seven other local folks are suing the manufacturer and distributor of a hip replacement system.

Instead of being pain free, those suing felt strong pains in their groin areas for months, the lawsuits say...

All the suits are targeting the Durom Hip Resurfacing System. It's manufactured by Zimmer Inc. of Indiana...

The suits allege that the Durom system is defective because bone and tissues don't grow into them properly. A cup in the system has to be replaced with parts from another manufacturer, Faulkner said.

Zimmer stands behind their product. It's not defective, said Irvine attorney Michelle M. Fujimoto.

In paperwork filed with the court, the company says any problems can be blamed on the doctors who implanted the product, or on unusual conditions in the patients themselves...

The Durom system was first sold in 2006.

...the company has reported that about 15,000 have been implanted across the nation

US Hip Resurfacing Implants Market: Product Penetration to Drive Growth

nospam@example.com (Patricia Walter) — Sun, 16 Aug 2009 09:04:51 -0700

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.

Hip Resurfacing is Viable Alternative to Hip Replacement

nospam@example.com (Patricia Walter) — Sat, 01 Aug 2009 13:23:50 -0700

Hip Resurfacing is Viable Alternative to Hip Replacement

Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery than those who had a total hip replacement.

PRLog (Press Release) - Jul 31, 2009 - Oceanside, NY – Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery than those who had a total hip replacement, according to a study presented at the American Academy of Orthopedic Surgeons (AAOS) 2009 Annual Meeting.

The study was based on data on the outcomes of 214 total hip replacement patients and 132 hip resurfacing patients that was recorded in a joint registry maintained at a single surgeon’s practice from 2003-2006. Orthopedic surgeon Dr. Elizabeth Anne Lingard of Freeman Hospital in Newcastle Upon Tyne, England, was the study’s lead researcher.

Each patient enrolled in the study completed a questionnaire preoperatively and one year after surgery. The questionnaire included the Western Ontario and MacMaster Universities Osteoarthritis Index (referred to as WOMAC, it is a 24-item questionnaire that is completed by the patient and focuses on joint pain, stiffness and loss of function related to osteoarthritis of the knee and hip) and the SF-36, a self-report questionnaire completed by the patient that measures health-related quality of life (and generates 8 subscales: physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health; and 2 summary scores: physical component and mental component). The patients also completed a questionnaire regarding satisfaction with their procedures and outcomes one year after surgery.

The study showed that one year after surgery both groups of patients experienced significant improvements in WOMAC and SF-36. Hip-resurfacing patients, however, posted significantly higher WOMAC scores for decreased pain symptoms. When asked about patient satisfaction with the surgery, a greater number of hip-resurfacing patients said they were satisfied with their ability to perform functional activities after surgery.

"The (Birmingham) hip resurfacing technique allows me to preserve more of the patient’s natural bone structures and stability," said Bradley Gerber, MD, Chief of Joint Replacement Surgery at South Nassau Communities Hospital. "I see hip resurfacing as the ideal solution for many of my younger, active patients who suffer from hip pain. As my patients are getting younger and younger, and are staying physically active much later in life, I've needed an alternative to total hip replacement that accommodates their age and lifestyle. Hip resurfacing is that alternative."

Dr. Gerber was among the first surgeons in the U.S. to perform the Birmingham Hip Resurfacing (BHR) technique. Rather than replacing the entire hip joint, as in a total hip replacement, hip resurfacing simply shaves off the damaged cartilage and bone and a metal cap is placed onto the head of the leg bone (femur).

Total hip replacement involves the removal of the entire femoral head and neck, replacing it with a metal ball, while the BHR leaves the head and neck untouched. It is the neck length and angle that determines the natural length of a patient’s leg after surgery. Since it is not removed and replaced with an artificial device during the resurfacing procedure, there is a greater likelihood of maintaining accurate leg length.

In addition, traditional hip replacements use a plastic socket compared to the BHR implant (which is a metal socket). A plastic socket wears down over time, and may need to be replaced surgically. In fact, it is a leading cause of follow-up surgeries.

The BHR is intended for patients suffering from hip pain due to osteoarthritis, hip dysplasia (a congenital disease that, in its more severe form, can eventually cause crippling damage and painful arthritis of the joints) or avascular necrosis (a disease resulting from the temporary or permanent loss of the blood supply to the bones, often leading to collapse of the joint surface), and for whom total hip replacement may not be appropriate due to an increased level of physical activity. For these reasons, Dr. Gerber feels the BHR is ideal for patients under age 60 who live non-sedentary lifestyles.

While the BHR implant closely matches the size of a patient’s natural femoral head (hip ball), it is substantially larger than the femoral head of a traditional total hip replacement implant. This increased size translates to greater stability in the new joint, and it decreases the risk of dislocation of the implant after surgery, which is a leading cause of implant failure after total hip replacement.

In addition to the BHR, orthopedic surgeons at South Nassau’s Long Island Joint Replacement Institute specialize in custom-fitted total joint replacement as well as minimally invasive joint replacement surgery, such as the Uni-Knee® partial knee replacement and Image-Guided Knee Replacement technique. Minimally invasive joint replacement reduces trauma to surrounding tissue, blood loss during surgery, post-operative pain, and recovery time, leading to a speedier rehabilitation and return to daily activities. According to Dr. Gerber, the average length of stay of patients treated by the institute is less than 3 days, which is well below the national average.

The Joint Replacement Institute combines image-guided medical technology with minimally invasive knee replacement instrumentation. Image-guided surgical technology is used to determine the precise alignment of the replacement parts; improves the surgeon’s view of and feel for the surgical field and reduces the size of the incisions to perform a replacement.

Other procedures offered by the Institute’s physicians include reconstruction of foot and ankle injuries, pediatric orthopedics, hand and upper extremities, and meniscus cartilage transplantation and Carticel Therapy to correct recurring knee cartilage injuries.
For more information about the Long Island Joint Replacement Institute or to schedule a consultation, call 1-877-SouthNassau. www.southnassau.org.

American Joint Replacement Registry Created

nospam@example.com (Patricia Walter) — Thu, 30 Jul 2009 10:15:48 -0700

American Joint Replacement Registry Announced

American Academy of Orthopaedic Surgeons (AAOS) Creates Independent Organization

07/23/2009 Rosemont, IL

The American Academy of Orthopaedic Surgeons (AAOS) has incorporated the American Joint Replacement Registry (AJRR), a nonprofit organization dedicated to collecting and reporting on hip and knee joint replacement procedures. AAOS believes this proposed option is a patient safety best practice.

The goal of a national joint registry is to monitor device performance, thereby allowing early recognition of underperforming processes or devices and supporting continued clinical learning.

"In 2009, AAOS has made great strides in bringing the American Joint Replacement Registry to reality. We have now incorporated. And, we currently are in the process of forming project work groups to tackle data, governance and oversight issues." said John Callaghan, MD, first vice president of the AAOS and orthopaedic surgeon at the University of Iowa.

The AAOS has researched and determined the best course of action for starting and administering a national joint registry, one that would include:

privacy safeguards for patients;

legal protections for device makers and physicians;

a plan to begin capturing data as early as 2010; and

infrastructure to capture at least 90 percent of all procedures.

In 2006, there were more than 1 million hip and knee replacements performed in the U.S. Of these, approximately 7.5 percent were revisions, resulting in 77,000 procedures at a cost of more than $32 billion. A national joint registry will help doctors to more quickly identify poorly performing products and match patient procedures and devices to optimize outcomes. Therefore, the AJRR could help patients and payers save money and could limit the number of revision (or secondary) surgeries necessary. Based on the projected procedures through 2030, the potential savings could exceed $13 billion over 20 years.

Proposed by the AAOS and related stakeholders, the AJRR proposal calls for an independent, not-for-profit organization, funded by the proposing stakeholders -- orthopaedic surgeons, payers, government agencies, patient groups, hospitals and device manufacturers. The AJRR is estimated to cost $20 to $25 million to initiate.

"We now have a chance to put best practices, already benefiting patients in other countries, to work here in the U.S. For instance, registries in Sweden, Great Britain, Canada and Australia have seen up to a 10 percent reduction in revision rates. Even with a modest 2 percent decrease in the U.S. revision rate, this proposal would yield a savings of $652 million in one year," said David Lewallen, MD, chair of the AJRR Project Team and orthopaedic surgeon at Mayo Clinic.

Background: When a patient has a hip or knee implanted into his body, the device used was chosen by his orthopaedic surgeon based on the patient’s needs and lifestyle as well as the device’s performance. A device’s longevity is one of the factors that would be monitored by a national joint registry. A joint registry follows the artificial joint device throughout a recipient’s lifetime in a database with information about the patient’s demographics, as well as where and when the surgery took place.