Hip Resurfacing News - BHR

Mr McMinn Addresses Negative Press Against Hip Resurfacing

nospam@example.com (Patricia Walter) — Wed, 01 Feb 2012 07:46:17 -0700

I received an email from Tom Phelan from the McMinn Center announcing the press release below by Mr. McMinn. This can also be found on Mr. McMinn's website
http://www.mcminncentre.co.uk/news-archive.html

1st February 2012
Metal-on-Metal Implants - Addressing the Negative Press

We have been receiving phone calls following recent press reports on failed metal-on-metal hip implants. We understand these sensationalist stories may cause anxiety among some patients. However, we would like to reassure our patients that these reports mostly concern failures with the DePuy ASR and the DePuy ASR XL, not the Birmingham Hip Resurfacing (BHR).

Many press reports imply these failures relate to all metal-on-metal hip resurfacings. A patient featured in a recent Daily Mail article, like many others, had a failed ASR. A critical point, omitted from the print version of the Daily Mail, can be found in the full on line version. As well as her ASR, the patient had a BHR on her other hip. She comments, "I've never had a minute's trouble from the Birmingham hip – if only I'd had it on both sides."

High failure rates with the ASR and ASR XL have been widely documented. Both devices have now been withdrawn from the market. Research indicates the side effects, such as muscle damage, are specific to the ASR and do not apply to the BHR which is a very different device.

Earlier this week, the MHRA (Medicines and Healthcare products Regulatory Agency) issued another statement about metal-on-metal hips, in which they say, "On the evidence currently available the majority of patients implanted with metal-on-metal hip replacements are at low risk of developing any serious problems.”

In addition to the MHRA’s guidance, we wish to emphasise that Mr McMinn’s results with the BHR show a 97% survival in men and women of all ages at 14.5 years. Furthermore, excellent results with the BHR have been documented in National Joint Registers from around the world.

Sadly, these ASR failures come as no surprise. Mr McMinn has been warning about the device since it went to market in 2003. You can see Mr McMinn’s argument against the ASR here http://www.mcminncentre.co.uk/research-lectures-debate.html. Furthermore, The McMinn Centre has put together several resources which address patients’ concerns and the differences between the ASR and BHR designs. These resources are as follows:

• The McMinn Research Team's detailed response to list of questions on metal-metal implants & metal ions provided by hip resurfacing users here
• The McMinn Centre’s response to a Channel 4 documentary on metal-metal hip replacements here http://www.mcminncentre.co.uk/metal-ions-questions-answers.html
• An interview with a patient who has now had his McMinn metal-metal hip resurfacing for 20 years here

If you do have any concerns, please call The McMinn Centre on 0121 455 0411.

BHR Recall by Smith & Nephew

nospam@example.com (Patricia Walter) — Thu, 16 Aug 2007 17:17:35 -0700

Smith & Nephew Hip Resurfacing Cups Recalled in U.K.

By Christopher Elser and Kari Lundgren

Aug. 16 (Bloomberg) -- Smith & Nephew Plc recalled 185 hip- replacement implants in the U.K. and U.S. after at least two patients were forced to have surgery to replace improperly fitting devices. The shares fell the most in more than a year.

Batches of the Birmingham Hip Resurfacing product were mislabeled, causing a mismatch between two implant pieces, the U.K. Medicines and Healthcare products Regulatory Agency said. Stephen Hallworth, a spokesman for the MHRA, said today that the agency didn't know how many patients were affected. The company said some devices may have been sold in Australia and Europe.

The recall comes as the London-based company's product, known as the BHR, is facing new competition in the U.S. from a similar system from Corin Group Plc and Stryker Corp. Smith & Nephew has been growing faster than the market for replacement hips and knees, helping it gain on Zimmer Holdings Inc., the world's largest implant maker. The BHR helped boost second- quarter hip sales in the U.S. by 50 percent.

``It's an irritant,'' Jack Scannell, a London-based Sanford C. Bernstein & Co. analyst, said in an interview. ``Smith & Nephew have had this market to themselves and have done very well. The ability to win and grow this market in the U.S. is more commercially important.''

Smith & Nephew doesn't know how many of the 185 devices have been implanted, said Jon Coles of Brunswick Group Ltd., an outside spokesman for the company. People who have already received the implants are being X-rayed to see if the devices are fitted correctly, he said.

The shares fell 36 pence, or 6.1 percent, to 552.5 pence at the close of trading in London. That's the biggest decline since April 2006. They've risen 3.7 percent this year.

The mismatched pieces can cause the implant to fit loosely, the MHRA said. Doctors should review post-operation x-rays to see if patients have improperly fitting implants, and consider another operation, the agency said. Unused products should be returned to Smith & Nephew, the agency said.

Last Updated: August 16, 2007 11:50 EDT READ COMPLETE STORY

BHR Recall PDF by Smith & Nephew

nospam@example.com (Patricia Walter) — Thu, 16 Aug 2007 17:36:08 -0700

This is the pdf BHR Recall announcement by Smith & Nephew. It describes which acetabular cups were marked incorrectly.

The notice was sent out on June 20, 2007

BHR Recall pdf by Smith & Nephew

Smith & Nephew Press Conference about the Safety and Effectiveness of BHR

nospam@example.com (Patricia Walter) — Thu, 06 May 2010 18:26:41 -0700

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

Review by Patricia Walter

May 6, 2010

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

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

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

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

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

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

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

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

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

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

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

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

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

Edwin Su, MD, of the Hospital for Special Surgery

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

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

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

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

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

Summary by Joseph M. DeVivo

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

Question and Answers from Audience

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

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

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

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

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

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

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

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

Welcome

nospam@example.com (Patricia Walter) — Wed, 13 Jun 2007 11:34:04 -0700

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

US Hip Resurfacing Implants Market: Product Penetration to Drive Growth

nospam@example.com (Patricia Walter) — Sun, 16 Aug 2009 06:04:51 -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.

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 06:36:02 -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.

What Equipment Will I Need At Home After Surgery?

nospam@example.com (Patricia Walter) — Sat, 21 Jul 2007 07:47:06 -0700

What Items Will I Need At Home After Surgery?

Everyone has slightly different needs. There are some basic items almost everyone needs and then there are things that some people want and others just don’t need.

Must Haves:

Crutches - Normally crutches are supplied by the hospital. I used elbow crutches and they are much easier to use than normal under the arm crutches. Overseas hospitals use elbow crutches while US hospital still normally use old fashioned under the arm crutches. If you have to be on crutches for a long time, I would suggest getting a pair of elbow crutches or at least a pair of the more modern underarm crutches available from many internet shopping stores.

Walker – some people that have bi-lateral surgery or special hip problems are required to use a walker. Whether you use crutches or a walker is up to your orthopedic surgeon.


Elbow Crutches	Millenium Crutches	Walker

Cane – Canes are often used after a crutch is no longer needed. A cane is a handy method of still having support if required. People often get tired on long walks and find it easy to carry a cane with them to offer assistance. A cane offers much less assistance than a crutch, but it does take weight off the operated leg. It is estimated that a cane will take almost 60% of the weight off the operated leg when used properly. A cane is used on the opposite side of the operated leg, is moved forward with the operated leg as it takes a step and planted about the same position in front of your body as your step.


Canes	Toilet Riser	Potty Chair

Toilet Riser – a toilet riser or potty chair with arms is a must after hip resurfacing surgery. Most patients are required to follow the 90 degree rule and sitting or rising from a normal height toilet seat will break the rule. Inexpensive toilet risers that look like big life savers are available at any drug store or discount store for about $20. Fancier versions or the potty chair with arms are much more expensive. The one problem with the plastic, inexpensive risers is they are not very big. A large man sitting on a toilet riser does not have much room to do his business. The inner diameter of the toilet risers is very small. They are fine for women, but often a problem for men. Men should check out their options before surgery to make sure they can comfortable use the toilet adapter.

Reacher - Many people like to have one or two reachers in case they need to pick something up from the floor. If you have a helper at home, you might not need one. You can also bend down and pick something up from the floor by placing your operated leg behind you and bending the other leg. I did that quite often when I had to feed dogs or pick anything up. Of course, you need to be careful not to lose your balance. The reason you need to place your leg in back of you when bending is to prevent yourself from breaking the 90

degree rule.


Grabber	Sock Putter On-er	Grab Bars	Tub Grab Bar

Sock Putter On-er – Some people find the sock putter on-er a great help. If you have a helper, you can probably get away without one. If you don’t go sockless and don’t have a helper, you will find the sock helper useful because again you are not to break the 90 degree rule. It is impossible to reach down to your feet to put socks on without breaking the 90 degree rule.

Grab Bar By Toilet – I had my husband install a grab bar on the wall next to my toilet. I found it to be a great help in getting on and off the toilet. This is not required, but I am glad to have it installed. I have back problems and it helps to have a nice grab bar by the toilet.

Grab Bar by Shower or Tub – I found myself to be very unsteady for a few weeks after surgery. Getting in and out of the shower without help was a problem. I was 61 and not a spry as a younger person, but felt I needed to be very careful not to fall. A Grab Bar by the shower or tub would be a great help for most people, even if they have not recently experienced surgery.

Raised Bed – If you have a low bed, you will want to consider a way to raise your bed. Many of the newer beds and mattresses are fairly high and you can get in and out of bed without breaking the 90 degree rule. If your bed is low, raising your bed with special risers or just bricks or wood blocks, help getting in and out of the bed without breaking the 90 degree rule. Be careful that your risers are secure and your bed won’t slip off of them. Test them out before your surgery.

Silky Sheets – These are certainly not required, but some ladies like to use them because they are slippery and it makes sliding on and off the bed much easier. Some ladies just wear silky PJs to allow them to rotate easily when getting in and out of bed. Men sometimes like to wear nylon warm up pants so they can rotate or slide in and out of bed easily.


Ice Packs	Foam Mattress Pad	TEDS

Ice Packs – Ice packs are often used by many hip surgery patients. Ice helps reduce swelling and also pain. There are many varieties of commercial ice packs available that you can freeze in your freezer. Some people just use ice cubes in a plastic bag while others have used frozen bags of peas since they conform to your hip. The peas can be frozen over and over – Just don’t eat them after they have been thawed and frozen too many times!

Plastic Garbage Bags – Sitting on a plastic garbage bag when getting in and out of the car or bed makes it easier to rotate you body after surgery. It is often difficult to move your operated leg and body shortly after surgery.

Lazy Boy Type Recliner-Lounge Chair – Most people have a difficult time sleeping after hip surgery. Many people need to lie on their backs and it is often difficult to sleep in that position for days at a time. Many people find sleeping or napping in a nice recliner is a great help after surgery. I slept many nights in my Lazy Boy and took many naps in my favorite chair after surgery. Many people like the La Fuma recliner chairs after surgery. It is a personal choice as to which chair works best, but having some type of recliner is a definite help to most people.

Slip on Shoes – Many people find it much easier to use slip on shoes after surgery. You don’t have to worry about getting a helper to put them on and tie them for you.

Stool Softener– A stool softener or similar product is a must after surgery. Many people start to take them just before surgery. The anesthesia and narcotic based pain meds often cause severe constipation.

Nice To Have Items

Pillows – Extra pillows to put under your legs while you are lying in bed. Extra pillows under your legs make lying on your back feel much better. Also many doctors suggest you keep your legs elevated while laying down to help circulation and prevent blood clots. Dr. De Smet always suggests “toes above your nose when lying down.”

TEDS – An extra pair of TEDS comes in handy if you doctor suggests you wear them. An extra pair allows you to wash one pair while you are wearing the other pair. You definitely need a helper to put TEDS on. Some people are able to use the sock putter oner to put them on, but I have heard it is quite a struggle.

Foam Mattress Pad – Foam mattress pads on top of your mattress help make lying on your operated side and even your back much more comfortable. The closed cell foam tends to be too hot for many people, while others like the neoprene type egg carton foam.

READ COMPLETE ARTICLE

Hip Resurfacing - Time for a second look

nospam@example.com (Patricia Walter) — Tue, 08 Jan 2008 06:47:27 -0700

Link http://www.orthosupersite.com/view.asp?rID=25098

Newer implants with proper patient selection may make this a better procedure.

By Keith R. Berend, MD
ORTHOPEDICS TODAY 2007; 27:82
December 2007

In terms of hip resurfacing versus total hip arthroplasty, the questions we have to address are: Is metal-on-metal the right choice for the patient; Is the resurfacing more conservative; What are the indications for resurfacing; and Is the large head metal-on-metal total hip better in most patients than a resurfacing?

Keith R. Berend

Continue reading "Hip Resurfacing - Time for a second look"

New Data Reinforces the Proven Safety and

nospam@example.com (Patricia Walter) — Mon, 03 May 2010 17:58:51 -0700

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Footnotes

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

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

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

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

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

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

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