Hip Resurfacing News - Hip Resurfacing Issues

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 Both devices have now been withdrawn from the market.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.

Loose Acetabulum Cups in Hip Resurfacing by Dr. Bose

nospam@example.com (Patricia Walter) — Fri, 05 Oct 2007 06:35:29 -0700

The issue of cup slippage in the immediate postop period is a controversial one.

While bone ingrowth takes around 6 wks. - the hydroxy apatite to bone chemical reaction can occur much more quickly.

If we surgeons feel that the cup is not perfectly tight ( press fit) during the surgery then we restrict activities for a 6 -8 wk period .This is done in the hope that no precipitating event would occur that would tilt the balance adversely till some stability occurs as we have not achieved primarily stability during surgery. I must say that most of these times we are able to 'escape' component loosening.

I have done this a few times in my very early cases , many years ago. Of course these days we get such spectacular fixation of the cup primarily that many of my patients are visiting the gym in 5-6 days following surgery.

Achieving primary stability in the resurfacing surgery is more difficult as by definition there are no screws in the acetabular cup of a resurfacing as the entire cup is an articulating part ( monobloc ) cup. This is different from a cup in a THR where the surgeon can easily get additional stability by putting some screws if an adequate press fit is not achieved. Since a liner is always used in a THR cup , this is feasible.

Thus the early cup loosenings are certainly going to be more in resurfacings esp. when the surgeon is in the learning curve.

An extension of this concept implies, that surgeons who use screws routinely for the cups in the THR may find the resurfacing cup without screws more difficult to install.

Another issue is that if the cup is installed very loose , a fibrous fixation occurs - very similar to non-union in a fracture situation. If this occurs this will prevent bony incorparation of the cup permanently. This cup is at risk for many years following surgery. One of the things that we look for in the postop films is the bony incorporation ( osteointergration) of the cup.

with best regards
vijay bose
chennai
Asian Regional Center for Hip Resurfacing

Groin Pain after Hip Resurfacing

nospam@example.com (Patricia Walter) — Tue, 11 Mar 2008 09:02:28 -0700

Groin Pain seems to be a post-op problem for many people with hip resurfacing. Listed below are a selection of posts by people about their groin pain and what they have done to solve the problem.

But, if it's any help, my right hip took 18 months to settle down and 2 years before it stopped giving me trouble after a prolonged and/or intense workout. The trouble was a painful groin/front thigh which my surgeon diagnosed as bursitis. The workouts which caused trouble were anything involving lifting the thigh forward such as running or walking. It's fine now and causes me no trouble at all.

Tony

One thing that helps me to avoid a groin pain upon knee lifts, knee adduction & leg lifts is to first tighten my core, stretch out (lengthen the space between' the femur and the hip joint by pulling the femur out and lifting up at the hip' to the top of your head, thus creating plenty of room for making the movement.

Fran

I am now at the end of 8 weeks post surgery and I still have a' significant amount of pain in' my thigh, groin, back of thigh and knee. This is at rest as well' as walking - even more at rest' and during and after sitting.

Sandi

Sandi, This is a topic that we revisit from time to time.' Inflammation of the tendons, tendonitis, is one manifestation of' faulty prostaglandin bioactivity associated with inflammatory' precursors such as tobacco, alcohol, analgesics, and omega-6 fatty' acids. Not to mention deficiency of omega-3 fatty acids, vitamins,' minerals and circulation thereof. Get the circulation going with' calf contraction, quad contraction, glut contraction, in that order' while lying supine, 10x for about 4 seconds each, to recharge the' blood flow from the ground up, about 6x per day. And don't worry.' Worry adds to inflammation by its own variety of toxic' neurochemicals. You'll be fine, give it time.

Michael

As of late, I've been having lots of ache at top of my quad muscle and inner groin pain. My PT says my glutes are very weak , but I at present can't tolerate to do the exercises needed to strengthen.

Brian

I started with a new pain two days ago that is in my groin but towards the back of my leg. It is worse when I have to extend that leg or stretch that leg. Feels sort of like a tingle but worse, stops me in my tracks. Sometimes I think it feels muscular but other times I feel like it is in the bone. I've been great up to this point so I'm concerned. Anyone else know what I'm describing? Any advice?

Jim

I'm six months post-op and still occasionally experience what I call "growing pains." Not only are your muscles recovering from the surgery, but also from years of not working fully (atrophy due to loss of mobility), regrowing those muscles (hypertrophy), and unlearning those bad habits we developed to compensate for our hips (e.g. one-legged squats to pick stuff up, limping, etc.). There's a lot of growing and retraining going on. So, it's like when we were kids - we have growing pains again! :)

Kathy

Dancing and Hip Replacements

nospam@example.com (Patricia Walter) — Thu, 05 Jul 2007 04:21:32 -0700

Hip Replacements

I went to college eager to dance. I knew then that my body wasn’t built to do what it was asked to do in training—I didn’t have sufficient turnout, and my hips were tight, but I pushed myself physically to rise to every challenge. Years after I left SUNY Purchase as a dance major, I danced 10 seasons with Donald Byrd/The Group. Every rehearsal and performance was thrilling, but it was like working out on a technical battleground with no medics and no relief in sight.

One day I was a healthy 39-year-old dancer, the next day I was a crippled 40-year-old. It happened that quickly, and just as dramatically. I left Byrd in 1998 with minor pain in my right hip. I was frustrated by being the lone 40-year-old among a company of 20-somethings, so I thought the pain in my hip was stress-related. After Byrd, I signed a year-long contract with the road company of Joseph and the Amazing Technicolor Dreamcoat. Halfway through that year, after having jumped off a three-foot platform eight shows a week, the ache that I thought was stress-related became more serious. At first the pain in my hip inhibited me from working fully. Eventually it stopped me from working altogether. I went to two doctors, who concurred: I needed to stop dancing and consider hip replacement surgery. My career of more than two decades was over.

I cried for a month. I hid in my apartment, drinking heavily and watching movies on TV. Without dance, I didn’t want to live. What other skills did I have? I had never waited a table in my life (which I shamelessly boasted about during my career). I went from being the lucky dancer who was always working to someone who had no income.

Since that depressing day in the doctor’s office, I’ve heard of other dancers who have had hip replacements, including Judith Jamison, Arthur Mitchell, Gelsey Kirkland, Gary Chryst, Bebe Neuwirth (see “Vital Signs,”), and, as I’ve come to realize, many of my friends...

Neither the Arthritis Foundation nor the American Academy of Orthopedic Surgeons has statistics on the number of dancers with hip replacements. However, Dr. Robert Buly adds, “If a patient has a predilection to develop arthritis, it may be hastened by a prolonged dance career, which puts significant stresses on the body.”

...Orthopedic surgeon Dr. William G. Hamilton, who treats dancers from both New York City Ballet and American Ballet Theatre, says that it’s a mistake to draw conclusions about the source of hip pain. “Although arthritis of the hip seems to be more common in dancers, there is little hard data to support this. The classic story about Suzanne Farrell is a good example. When her hip went bad at the end of her career and she had to have it replaced, the press blamed it on the severity of the Balanchine technique that she had danced all of her life. She said, ‘No one bothered to ask me about it, but my father had bad hips and had to have them both replaced.’ Shortly afterwards, her other hip went bad and also had to be replaced...”

...Is arthritis of the hip a sign of the times in the dance business? No one knows the answer, but we do know that many of us have it. It may have been a painful dance, but it’s not painful anymore. I’m still dancing!

Michael Blake, who has danced with Murray Louis and José Limón, teaches movement for actors at Rutgers University and HB Studio. He continues to dance with PARADIGM...

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Hip Resurfacing Compared to THR for Young Patients

nospam@example.com (Patricia Walter) — Wed, 26 Sep 2007 15:24:57 -0700

Comparative Arthroplasty Alternatives for the Young Arthritic
By Thomas P. Schmalzried, MD
ORTHOPEDICS 2007; 30:756
September 2007

Thomas P. Schmalzried

Hip resurfacing is embraced by patients. In principle, the attraction is similar to smaller incisions: patient satisfaction is related to the degree of invasion of their body.

Hip resurfacing is driven by the Internet, with an Internet pro-resurfacing culture perceiving total hip replacement (THR) as an older technology and an older person’s operation. This perspective is fueled by the historical risk of dislocation, traditional activity restrictions, and concerns of component loosening with bone loss leading to morbid revision THR. There is a paucity of patient awareness regarding the outcomes of current-generation THR. In fact, there is a paucity of studies comparing current-generation THR and total resurfacing.

Indications for Total Hip Resurfacing
Total resurfacing and THR are not directly competing technologies. The indications for hip resurfacing are more limited. Not all patients who are candidates for THR are good candidates for resurfacing .

Categorically, total hip resurfacing should be considered for those patients at increased risk for failure of THR. Historically, such patients are young and healthy, with men being at greater risk than women. Patients who have been told they are too young for THR have embraced resurfacing. The operative parameters for conversion of a failed resurfacing to THR are similar to those for a primary THR.(1)

With current technology, the acetabular component size and position are essentially the same for total resurfacing and THR.2 The issues are on the femoral side and include:

Bone Density. The risk of femoral neck fracture following resurfacing is related to bone density, with an increased risk in women and men >65 years.3,4
Head-to-Neck Ratio. Because resurfacing occurs around the femoral neck, it is technically helpful to have a head-to-neck ratio >1.2.
Femoral Offset and Limb Length. With resurfacing, femoral offset and limb length cannot be changed to a practically significant degree; therefore, these parameters should be close to normal (>120° neck-shaft angle and limb-length difference within 1 cm).2
Focal Defects. Because focal defects undermine support for the component, large necrotic segments or cystic defects are undesirable.5
Hips that have all 4 of these criteria are arthritic hip grade (AHG) A, which is basically a normal hip with no cartilage. Grade B hips lack 1 factor, grade C hips lack 2 factors, and grade D hips lack 3 factors.6

Clinical Results

In our series of more than 350 consecutive total hip resurfacings(7), there have been no femoral neck fractures. After a 2-year minimum follow-up, AHG was significantly associated with preoperative Harris Hip score (A>B>C), occurrence of mild to moderate postoperative pain (A<B & C), and hip range of motion. In other words, hips with a lesser degree of secondary arthritic changes had a higher AHG and a better outcome. The mean UCLA activity score was 8.2, but activity scores were higher for higher hip grades. These data support the selection criteria and also support relatively early intervention.

During the same period, we compared our first 50 consecutive hip resurfacings in 50 patients to 44 THRs performed in 35 patients.7 Surgeries were performed by the same surgeon using a posterior approach. The same postoperative protocol was followed in both groups with no activity restrictions; minimum follow-up was 2 years.

As one might expect, there were differences between the two groups. Average age was 46 years for resurfacing patients versus 55 years for THR patients. Resurfacing patients were predominantly men and taller, and had a lower body mass index.

Resurfacing patients had a lower preoperative Harris Hip score (ie, reported more pain), but they had a higher preoperative UCLA activity score and greater preoperative range of motion. The resurfacing patients had a lower mean ASA score (ie, better general health).

On average, it took 18% longer to perform the surface replacements than the THRs. However, total blood loss was 250 cc lower with the resurfacings (despite a larger exposure), probably because there was no femoral canal violation or bleeding. Less transfusions were given in the resurfacing group because of the lower blood loss and the better general health status of the patients. There was no significant difference in the length of hospital stay between the two groups.(7)

With regard to outcomes, hip resurfacing patients had the same 2-year Harris Hip score (97 versus 96). Hip resurfacing patients had greater functional improvement, resulting in a greater increase in the Harris Hip score. The resurfacing patients also had a greater increase in UCLA activity score and a higher postoperative SF-12 physical score. There was no difference between the groups in postoperative range of motion. In fact, the THR group had greater improvement. There was one dislocation in each group.

The bottom line is both technologies performed very well in our series. Because patient characteristics are the main determinant of outcome, we must be careful with simple technology-based comparisons.(7)

References 1. Ball ST, Le Duff MJ, Amstutz HC. Early results of conversion of a failed femoral component in hip resurfacing arthroplasty. J Bone Joint Surg Am. 2007; 89:735-741.
2. Silva M, Lee KH, Heisel C, Dela Rosa MA, Schmalzried TP. The biomechanical results of total hip resurfacing arthroplasty. J Bone Joint Surg Am. 2004; 86:40-46.
3. Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br. 2005; 87:463-464.
4. Australian Orthopaedic Association National Joint Replacement Registry 2006. Available at: www.dmac.adelaide.edu.au/aoanjrr/ .
5. Amstutz HC, Beaule PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004; 86:28-39. 7. Fowble VA, dela Rosa MA, Schmalzried TP. A comparison of total hip resurfacing and total hip replacement patients and outcomes. Clin Orthop Relat Res. In press.

Correspondence should be addressed to: Thomas P. Schmalzried, MD, Joint Replacement Institute at St Vincent Medical Center, S. Mark Taper Bldg, 2200 W Third St, Ste 120, Los Angeles, CA 90057.

Comparative Arthroplasty Alternatives for the Young Arthritic READ COMPLETE ARTICLE

House Bill Would Create Artificial Joints Registry

nospam@example.com (Patricia Walter) — Tue, 30 Jun 2009 17:37:49 -0700

Link http://www.nytimes.com/2009/06/11/business/11device.html?_r=2&ref=business

Published: June 10, 2009

Two House Democrats introduced a bill Wednesday to create a national database of patients who received artificial hips and knees, a system already used in some other countries to track how patients fare, reduce unnecessary surgeries and weed out inferior products...

...Patient registries, in areas like orthopedics, are expected to play an important role in “comparative effectiveness” reviews that the Obama administration hopes will help identify which medical procedures and products work best.

..."I think it will improve patient safety and outcomes and get rid of poorly performing devices," said Representative Pascrell...

...Makers of artificial joints and a professional association of surgeons who use them say that they support the idea of such a registry. But they said they were working to create one outside of government and argue that it could be more effective than the legislative proposal..

Dr. Schmalzried discusses the ASR

nospam@example.com (Patricia Walter) — Tue, 16 Mar 2010 06:50:51 -0700

Advice to patients concerning the ASR

I suggest a few points that, I think, everyone can agree to (for any hip, including an ASR):

1. If you have pain or are in any way concerned - go see your surgeon.

2. There are some screening tests. Based on current experience, if blood (or serum) ion levels of Cr and Co are <5ppb, the likelihood a problem with the implant is low. If the level of either is >10ppb, the likelihood of a problem with the implant is increased. In either event, the next step would be an imaging study (ultrasound or MRI) to look for a fluid collection, or a cystic or solid mass - as evidence of an adverse local tissue response.

3. An aspiration of the joint may be appropriate a) to exclude infection as a cause of the joint dysfunction and b) the characteristics of the fluid may help in the differential diagnosis of a problem related to the metal-metal bearing.

I think that the first point is the most important. If you are concerned, go see your surgeon.

Thomas P. Schmalzried, M.D.

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.

Larger Cups and Optimal Positioning Produce Lowest Ion Levels Medical Study

nospam@example.com (Patricia Walter) — Fri, 08 Jul 2011 18:57:38 -0700

Larger cups and optimal positioning produced lowest ion levels and wear

In a review of 585 blood serum evaluations following hip resurfacing, only femoral size and cup inclination were found to have an effect on ion levels, according a study by orthopedic investigators.

The findings were presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons.

David J. Langton, MRCS, and his colleagues also found that the size of the coverage angle of the acetabular component contributed significantly to its tolerance of suboptimal positioning.

"Larger joints, it must be emphasized, tolerated suboptimal cup position," he said. "This must be taken into account in all analyses."

Inverse relationships

Using routinely obtained blood serum metal ion levels from patients under the care of the two senior authors of the paper being presented - both highly experienced hip resurfacing surgeons - metal ion results were analyzed regarding their relationship to femoral and acetabular component size and orientation, UCLA activity score, age, time post surgery and postoperative femoral head/neck ratios.

Langton reported an inverse relationship between metal ion levels and femoral size. A smaller acetabular coverage arc was associated with higher metal ion levels.

Another significant inverse correlation was noted by Langton between metal ion levels and contact patch to rim (CPR) distance. CPR is a measurement that relates the position of the articular contact patch with the patient in standing position to the cup rim. According to the abstract, CPR less than 5 mm is associated with a 50% chance of ion levels greater than 30 mg/L.

Words of warning

Langton warned the audience, "To increase metal ion levels as quickly as possible, use as small a bearing diameter as possible, use a cup with the smallest coverage arc, and combine very high anteversion with high inclination."
He concluded, "Cups placed with angles between 40° and 50° inclination and 10° to 20° anteversion have the lowest ion levels and the lowest rates of volumetric wear."

Reference:

Langton D, Jameson S, Joyce T, et al. A review of 585 serum metal ion results post hip resurfacing: cup design and position is critical. Paper 006. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.

Langton has received research or institutional support from DePuy, a Johnson & Johnson Company, DJ Orthopaedics; he has also received miscellaneous non-income support (e.g., equipment or services) from DePuy, a Johnson & Johnson Company.

Paula's Revision ASR to THR 2010

nospam@example.com (Patricia Walter) — Mon, 21 Feb 2011 16:34:26 -0700

ALVAL, PSEUDOTUMOUR, HYPERSENSITIVITY … WHATEVER YOU CALL IT, IT’S A REVISION TO THR

Having visited this site numerous times over the last few years, I thought it was time that I shared my experience with other past and future hip patients. I have recently undergone revision of my ASR to a THR because of a reaction to the metal on metal bearing. I know this issue is in the spotlight of the orthopedic hip community internationally just now as more patients emerge at the 3-5 year post-op mark with unique reactions.

I am a female and was diagnosed with osteoarthritis in my left hip when I was 33 years old (I am now 42). At the time I was an amateur triathlete competing at local events but struggling to meet training goals because of pain. Once I had the diagnosis at least I knew the cause, and also knew that heavy use of anti-inflammatory eased the symptoms. Ultimately however, whether I was resting or training the pain continued. In addition to the OA, I had some bone spurs and when I was 35 I agreed to have the spurs removed ("femoro-acetabular debridement") in the hope of alleviating impingement and delaying serious OA. My first major surgery.

After 12 months it was apparent that the debridement was unsuccessful and in fact the OA had worsened to the point where I was ready for a resurfacing. My second major surgery.

The resurfacing was wonderful in that it got me back to pain-free life; walking, sitting, sleeping, cycling. In fact I became a strong cyclist, riding over 100 km every Friday morning at a strong pace in our local peloton, and going on a number of international cycle-touring holidays. I kept trying to run – that was my ultimate dream. Once or twice over the years I managed to belt out 5 or 6 km, but usually I would start experiencing enough discomfort to make me walk after just a few hundred meters. I was still taking anti-inflammatory off and on for general aching in my left leg. Range of motion was definitely improved, although not to the point where I could, for example, sit with my legs crossed. I saw my orthopedic specialist quite regularly – both professionally at his clinic for follow-ups, and also socially as he is also a keen cyclist and we spent many hours chatting whilst spinning along at 30+ kph. My x-rays looked perfect.

At about the 3.5 year mark, I started to notice weakening in my hip flexor. I was dropping off the back of the peloton and couldn’t do anything to get stronger. I saw my physiotherapist and concentrated on strengthening the surrounding muscles for six weeks before confessing to my doctor that I was really facing problems. The only anomaly that was apparent on x-ray was re-growth of bony spurs, which we discussed removing.

Before another major surgery however, we decided to run a battery of tests … bone scan, bloods, MRI, CT, ultrasound. All these tests were inconclusive, except for the ultrasound which showed some fluid in the groin. It also showed that the tip of one of the screws remaining from my resurfacing procedure ("trochanteric flip") was protruding into my groin so we agreed to first try a less drastic approach of removing the screws. My third surgery.

I was only on a crutch for a few days, but the swelling and limping continued for months. My range of motion improved almost miraculously – it felt like a brick had been removed from my groin and I was sure this was a success! By three months though I still had a strange half-golf-ball sized lump over the trochanteric wound site and I still had pain. Back to the doctor, where alarm bells started ringing again. He excised the lump that same day … expecting to drain fluid but in fact finding dead tissue. My thigh was finally flat again but not for long … by the next day the lump was back.

Infection, cancer and loosening were all ruled out. A metal-ion test was requested of the pathologist, but seemingly there was nothing apparent. Things were not looking good but a definitive diagnosis was difficult.

Around this time there were a couple of European conferences which my doctor was attending, dealing specifically with hip resurfacing. He was able to talk to the presenting pathologist as well as a colleague of his who represented the European Advisory Committee for adverse reaction to MoM implants. Now the diagnosis was conclusive … classic symptoms and the only option was revision to a ceramic THR. Surgery number four.

(It turns out that the fluid – actually necrotic tissue – had drained from my hip joint and down through the holes left by removal of the screws to present on my outer thigh. An incredibly unusual scenario! I think if this hadn’t happened our next step would have been needle aspiration of the hip joint to get a sample of the fluid/tissue. I have a whole new appreciation for ultrasound.)

I am now at six week’s post-op. Again the surgery went perfectly (6.5 hours) and the x-rays look great. Definitely it has been the most difficult of all the procedures I have had, with a slower recovery. I am walking on one crutch, but thankfully can get in the pool and swim with the squad using a pull-buoy instead of kicking. I’m still taking pain meds and imagine I will need them and the crutch for another couple of weeks. For a semi-revision surgery though I think I am doing okay; I am at work and am planning on joining a gym this weekend to start getting some strength back in my legs. In a couple of months I will get back on the bike (maybe not in the peloton) and there is a surf-ski endurance race at the end of the year that I would like to train for.

Whilst I breezed through the previous surgeries I found this one very traumatic emotionally as well as physically. Over the months I have spent loads of time surfing the web for stories and information and experiences. I thought it was time to share mine. If anyone has been through this I would love to hear how your recovery is; and if anyone is facing this I would be absolutely happy to talk about it more.

Paula

ASR Recall by DePuy 2010

nospam@example.com (Patricia Walter) — Fri, 03 Sep 2010 06:24:25 -0700

DePuy has announced that it is voluntarily recalling the ASR™ XL Acetabular Head System and DePuy ASR™ Hip Resurfacing System. DePuy is providing the information below to help visitors with questions and concerns. Visitors are also invited to visit the DePuy website at www.depuy.com.

DePuy makes patient safety and health a top priority and is continually evaluating data about its products. Most ASR hip replacement surgeries have been successful. However, data recently received by the company shows that more people than expected who received the ASR hip experienced pain and other symptoms that lead to a second hip replacement surgery, called a revision surgery.
For this reason, DePuy Orthopaedics is recalling its ASR™ XL Acetabular Head System and DePuy ASR™ Hip Resurfacing System. This recall means additional testing and monitoring may be necessary in hip replacement patients. In some cases, patients may need additional surgery.
DePuy is working closely with health care professionals worldwide to contact patients with ASR hip implants. Most people with ASR Hip System implants do not experience problems, but it is important that patients with ASR Hip System implants be evaluated with by a surgeon. Patients with problems reported different symptoms with their ASR hip implant, including pain, swelling, and problems walking.

DePuy intends to cover reasonable and customary costs of monitoring and treatment for services, including revision surgeries, associated with the recall of ASR.

Click here for the press release

Click here for the patient information page on our web site

Click here for an image of the ASR Hip System

Medical Release Form:

Patients with an ASR Hip are asked to complete the form and bring it with them to the appointment to give their surgeons permission to share information directly with DePuy.

Click here for the recall notice

This notice was shared with hospitals and surgeons regarding the ASR recall.

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.

About Us

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

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

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