Hip Resurfacing News - BHR

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

nospam@example.com (Patricia Walter) — Wed, 17 Mar 2010 09:55:36 -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

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.

ASR Discontinued by DePuy

nospam@example.com (Patricia Walter) — Fri, 26 Feb 2010 17:17:09 -0700

The status of DePuy Orthopaedics’ ASR platform as Feb. 2010

Last fall of 2009, DePuy decided to discontinue ASR® XL Acetabular Head System and DePuy ASR® Hip Resurfacing Platform (not available in the U.S.) worldwide. As a result of declining demand for the ASR platform and other market factors, DePuy is in the process of phasing out this platform to focus on the development of next generation hip replacement and resurfacing technologies that best meet the needs of surgeons and patients.

DePuy wants to assure patients who have been treated with a device from the ASR platform that there will be options available to them in the future should they need a revision:

· If a patient who had received the DePuy ASR® XL Acetabular Head System for total hip replacement requires a revision surgery, the acetabular component could be revised with the Pinnacle Hip Solutions platform, which would be compatible with an existing well-fixed femoral stem.

· As with any hemi-resurfacing prosthesis, including the DePuy ASR® hemi arthroplasty, a patient requiring a revision procedure would generally be treated with a total hip replacement.

· For patients outside the U.S. treated with DePuy ASR® Hip Resurfacing (not commercially available in the U.S.), DePuy intends to maintain an inventory of ASR XL heads outside the U.S. for use on compatible DePuy femoral stems. This will allow surgeons outside the U.S. the option of retaining a well-fixed ASR Cup when appropriate as part of the revision procedure.

Lorie Gawreluk
Vice President, Worldwide Communications
DePuy, Inc.

Smith & Nephew's Strong Profits Beat Expectations

nospam@example.com (Patricia Walter) — Fri, 12 Feb 2010 10:12:42 -0700

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.

Paul Jacobson Bilateral Dr. Su Dec. 1, 2009

nospam@example.com (Patricia Walter) — Wed, 20 Jan 2010 11:28:10 -0700

I'm 10 days out of bi lateral hip resurfacing with Dr. Su. Can't say enough good things about Dr. Su.

My hips feel strong enough to stand with no issues and no crutches 7 days out. Post surgery, he told me my hips were a mess, and I had pretty big cuts, around 14 inches per leg. I went on a strong natural product regiment right out of surgery, only taking pain killers for a few days, and trying to avoid everything else. I used natural wound healing products and probiotics so my GI system would be normal.

There's no sugar coating the first 7-10 days after surgery. It's hard work and a lot of discomfort, but it's not from pain per se. It's that it's hard to sleep, and you're confined to bed most of the time with both hips having been done. However, with PT, stretching etc, you can recover fast and feel a lot better.

Once you get past the first week, things improve daily. I got my staples out on the 10th day, which is a big improvement. Starting tomorrow I expect even bigger improvements daily, as I'll really begin focusing on regaining flexibility.

HSS is excellent and you can't find a better doctor than Su.

December 27, 2009

I’m 3.5 weeks out of bi lateral surgery with Dr. Su. I’ve been on a stationary bike for a week, no resistance, up to 20 minutes a day, and another 20 minutes walking on a treadmill. I started driving just short of 3 weeks out of surgery, although I get stiff when I’m in the car too long. I’ve had no pain, just discomfort around trying to regain flexibility. I still can’t put socks on (although I got lucky a couple of times), but I’m able to walk without crutches, including stairs. My physical therapist recommended I buy a cane that’s more for hiking, so I got one that collapses made by Leki called the Wanderfreund, and tossed the crutches. I’ve got 2 14 inch scars because my hips were so bad, and yet, I cannot believe how fast I’ve progressed since surgery. The absolute worst time for me was just the discomfort post surgery (not bad pain), and getting the pain meds out of my system (even after stopping all opiods 3 days after surgery), so I could pass the stairs test to leave HSS. Now, it just feels like I have to work hard on flexibility, so I can push the endurance part of rehab. Each day seems to get a little better, and I frankly, I’m surprised at how well things have gone. Still can’t say enough good things about Dr. Su, and for those considering doing both hips at the same time, I’d say the experience has been way better than I expected, and he’s got to be a doctor you consider. In the beginning, the improvement comes every 3-5 days, but as time progresses, I’ve found improvement daily. You wake up and suddenly you can do something you couldn’t do the day before. I fully expect to be back on all non impact sports soon.

Paul Jacobson Bilateral Dr. Su Dec. 1, 2009

nospam@example.com (Patricia Walter) — Wed, 20 Jan 2010 11:28:10 -0700

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

Jonna Ramey RBHR Dr. Klug 2009

nospam@example.com (Patricia Walter) — Wed, 20 Jan 2010 11:21:59 -0700

Jonna Ramey

Right BHR 2009 Dr. Klug

I had surgery on November 10, 2009. I am 4+ weeks post-BHR surgery on my right hip. Dr. Raphael Klug of Kaiser Roseville CA was my surgeon.

I'm a 59-year old post-menopausal woman. Previous to my year of increasing hip pain and surgery, I was an active stone sculptor. Exercise for me consisted of water aerobics and walking. I had been experiencing unusual thigh pain. It was as if my muscles just gave out. I could barely walk. My general practitioner referred me to a sports doctor. The sports doc immediately steered me to an orthopedic surgeon in San Rafael who only did lateral total hip replacements. I got on his 3-month waiting list because I thought this was my only option. Then, I began to research.

I attended a lecture sponsored by Queen of the Valley Hospital in Napa at which two orthopedic surgeons talked about the benefits of anterior THR. At this lecture I learned that there was one surgeon at Kaiser Vallejo that performed anterior THR. I immediately got a referral from the San Rafael Kaiser surgeon, consulted with the surgeon in Vallejo, who said I was a good candidate for anterior THR and got on his 3-month surgery waiting list.

All of this research took months and my hip was getting worse by the day. The anti-inflammatory drugs I was taking were no longer controlling my pain. I hobbled with a very pronounced limp. It was so obvious that people stopped me on the street and asked me if I had a bad hip. Everyone was full of advice; much of it very helpful. All of it was pointing me toward an anterior total hip replacement. Then one night, at my neighborhood table tennis club, Jeff, a man with a deadly slam, told me that he had had a Birmingham Hip Resurfacing two years earlier. He had been an ardent soccer player before the BHR. Now he ran, exercised and had complete freedom of movement. He explained the difference between a BHR and a THR. His wife Linda told me about a great website called Surface Hippy and how it had really helped them. They whole-heartedly recommended their surgeon Dr. Gilbert in San Francisco. However, he wasn’t in the Kaiser system so I had to find a Kaiser surgeon that performed BHR surgery.

I went home and checked out Surface Hippy. Loved it! I went into the Kaiser member website and tried to find a surgeon in my area who performed the procedure. There was no information. I sent an email to the surgeon in Vallejo that I was scheduled with and asked if he did BHRs and was I a good candidate for one? He responded that he did not do them but would forward my x-rays to Dr. Baker in Oakland and Dr. Klug in Roseville. Both surgeons did BHRs.

Once I had the names of Kaiser surgeons who performed BHRs, I got back on the internet and did more research. I found an extremely informative video of Dr. Klug discussing the procedure at length. Subsequently, I received an email from my Vallejo surgeon. Dr. Klug had looked at my x-rays and was confident he could help me. I contacted his medical assistant and got on Dr. Klug’s 3-month waiting list for the initial consultation. Fortunately, there was a cancellation and I was able to see Dr. Klug in two weeks.

The initial meeting with Dr. Klug was informative. I appreciated his candor and experience. He has performed hundreds of BHRs. He was very clear, however, that while his goal for me was an anterior BHR, it was possible that I’d need a total hip replacement and he couldn’t make that call until he actually touched my bone. I agreed. For me this was an important consideration. I wanted a surgeon to have all the tools at his disposal for my benefit. Yes, my preference was the BHR but I wanted long-term success above all.

Did I mention, there was a three-month wait for the surgery? Since it was close to the Thanksgiving holiday, I stressed my strong desire to take any surgery cancellation that might occur. Even though his office is 2 hours from my home, I would drop everything, at a moment’s notice, to get the surgery done. Luck was with me. His scheduler called back in a couple weeks; someone had cancelled and I was having surgery four days later.

As it turned out, I did get a BHR. I was in the hospital 2 nights. Dr. Klug’s surgery team is hard working and bright. The staff at Kaiser Roseville was sharp, attentive, friendly and motivated. I really appreciated that. The physical therapist started me with a walker that I used for about 10 days. With the approval of my in-home physical therapist, I transitioned to a cane. Recovery is going great. Every day I walk further and longer and my stamina increases. I'm looking forward to weaning myself off the cane, getting back in the pool and on an exercise bike. I’m about two weeks away from being able to drive but I’m trying to be patient. And, I’m waiting for the rains to stop so I can begin sculpting stone again in my outdoor studio. Thanks Dr. Klug.

I read that there is a perception out there that some surgeons are generally reluctant to perform BHRs on post-menopausal women. I think it has more to do with each patient’s situation and the skill and expertise of the surgeon. Any responsible surgeon would refuse to perform a procedure if it wasn’t in the best interest of the patient. I'm proof that there are surgeons out there (like Dr. Klug) who are capable and comfortable working on us middle-aged and older broads.

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

nospam@example.com (Patricia Walter) — Tue, 05 Jan 2010 11:27:15 -0700

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 was97.5% (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.

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."