Hip Resurfacing News

Iron Mike gets BHR with Mr. McMinn of the UK

13th January 2012

He has twice been Mr Universe and has played the tough guy in a variety of action movies, but when Mike Mitchell was floored by a hip injury it was Birmingham surgeon Derek McMinn who came to the rescue.

Fitness icon "Iron Mike", who appeared as a stuntman and action fighter in smash hit films Braveheart and Gladiator, had been suffering from severe osteoarthritis in his left hip but, true to his tough-guy image, had carried on regardless.

However, when the 56-year-old took a nasty fall while out on his yacht he found himself almost unable to walk and in danger of missing out on a new film he had just agreed to appear in.

Continue reading "Iron Mike gets BHR with Mr. McMinn of the UK"

Mr McMinn Addresses Negative Press Against Hip Resurfacing

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 Both devices have now been withdrawn from the market.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.

Prof. Yates of Australia Evaluates 2010 National Registry Info

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

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

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

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

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

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

I appreciate his help and input.

Pat

2011 Australian National Registry Results for Hip Resurfacing

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

Australian National Joint Replacement Registry 2011

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

Here is the BHR revision rate compared to other devices:

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

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

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

Andrew Lloyd Webber Has a Hip Resurfacing

January 20, 2012

...Andrew Lloyd Webber feels like a young man once again after undergoing hip replacement surgery.

The multi-millionaire composer has revealed he underwent the procedure a few weeks ago and has made a full recovery.

Lord Lloyd-Webber, 63, said: "I feel so much better. The best thing is that now I can exercise again, I can go swimming, which I love."

...Lord Lloyd-Webber had a hip resurfacing, which replaces diseased or damaged surfaces in the hip joint with metal implants.

It is designed to tackle arthritis - where joint cartilage is worn away, leaving bone rubbing on bone, which causes severe pain.

Less bone is removed for hip resurfacing, making it easier to repeat the operation or to have a total hip replacement in later years...

All The Threes - Mr McMinn Reaches 3333rd BHR Milestone

24th January 2012

On Tuesday, Mr McMinn reached a momentous milestone in his surgical career – implanting his 3,333rd Birmingham Hip Resurfacing. To mark the occasion, Mr McMinn invited colleagues from The McMinn Centre, Smith & Nephew and The BMI Edgbaston Hospital for an impromptu shindig at Bindles Brasserie in Worcester.

"I was so thrilled and surprised to reach this landmark number, I just had to go out and celebrate with colleagues who have made this all possible,” Mr McMinn commented. “The fact that my patients are doing so well and that the BHR has a 97% success rate at 14 + years in my practice, is a tremendous reward for everyone involved in this development."

The news comes at a crucial juncture as more and more patients are demanding highly experienced surgeons to perform their hip procedures. Before dinner, Mr McMinn gave a short presentation about the history and success of the BHR and the future of hip arthroplasty.

The milestone precedes another exciting occasion on the 2012 calendar – the 15th Year Anniversary of the BHR, which we will be reporting on this summer.

World Judo Medalists Open New Club After Hip Resurfacing

World judo medalists to open west-end club after hip resurfacing

Kevin Nagel, Post Sports Editor

Link http://www.burlingtonpost.com/sports/article/268172

Published on Jul 17, 2009

The husband and wife team of Ron and Tracy Angus has accumulated 19 medals in world masters judo competition over the years.

For Ron, who has 14 of them - 11 gold - there are two reasons why he still travels the world for such events. "No. 1, I like to compete," he said, while taking a break from a little one-on-one soccer play with his nine-year-old daughter, Chelsea. "No. 2, it keeps me realistic when I'm coaching people. If we don't test theories and training methods, we start going off track as coaches."

A nagging hip injury kept him in pain for 15 years and out of competition for the past four years until a hip resurfacing operation eliminated the suffering. It worked so well, he is back running and lifting heavy weights.

"I'm so happy with it, that's why I decided to get back into competition - I'm pain free," said Angus, 52...

READ MORE

Landis returning to racing after resurfacing
Link http://www.cbssports.com/cbssports/story/11970316

Landis not ready to ride into sunset
July 20, 2009
By Lesley Visser CBS Sports

Three years ago this week, his legs aching and his lungs on fire, Floyd Landis staged one of the greatest comebacks in the history of the Tour de France...

...His improbable ride that day was all the more remarkable because he was experiencing severe hip pain and avascular necrosis to the femur head (diminished blood supply - remember Bo Jackson?) as a result of a training accident in 2003.

Landis wrestled with what do - a complete hip replacement would have all but ended his chances to be a world-class cyclist again when his suspension was lifted this January. Landis decided to have a relatively new operation called the Birmingham Hip Resurfacing, which was performed in October of 2006 by surgeons from Smith and Nephew, the British jointmaker.

In hip-joint resurfacing, only the surface of the hip socket and femur ball are replaced. It is kind of a cap at the end of worn-out bone, sparing much of the original joint..

...It changed my life," said Landis, who hopes to compete in the Tour de France next year. "I've ridden almost 20,000 miles on my new hip. I have completely recovered."

READ MORE

Survey Results from Yahoo Surface Hippy Survey
The results of over 855 hip resurfacing patients who participated in the Yahoo Surface Hippy Survey are now available at the Surface Hippy Webiste.

The survey asked 40 detailed questions about the patients hip resurfacing experience and surgery. The survey is extremely interesting and fact filled about pre-op conditions, surgery information and post-op recoveries with return to sports and normal activities.

Click below to view the Yahoo Surface Hippy Survey

Yahoo Surface Hippy Survey Results

Increase risk femoral fracture with osteoporosis drugs
For Immediate Release: October 13, 2010 Media Inquiries: Karen Riley, 301-796-4674, karen.riley@fda.hhs.gov Consumer Inquiries: 888-INFO-FDA

   FDA: Possible increased risk of thigh bone fracture with bisphosphonates Labeling change adds warning about possible risks of long-term use of osteoporosis drugs

The U.S. Food and Drug Administration today warned patients and health care providers about the possible risk of atypical thigh bone (femoral) fracture in patients who take bisphosphonates, a class of drugs used to prevent and treat osteoporosis. A labeling change and Medication Guide will reflect this risk.

Bisphosphonates inhibit the loss of bone mass in people with osteoporosis. Bisphosphonates have been shown to reduce the rate of osteoporotic fractures -- fractures that can result in pain, hospitalization, and surgery-- in people with osteoporosis. While it is not clear whether bisphosphonates are the cause, atypical femur fractures, a rare but serious type of thigh bone fracture, have been predominantly reported in patients taking bisphosphonates. The optimal duration of bisphosphonate use for osteoporosis is unknown, and the FDA is highlighting this uncertainty because these fractures may be related to use of bisphosphonates for longer than five years.

The labeling changes and Medication Guide will affect only those bisphosphonates approved for osteoporosis, including oral bisphosphonates such as Fosamax, Fosamax Plus D, Actonel, Actonel with Calcium, Boniva, Atelvia, and their generic products, as well as injectable bisphosphonates such as Reclast and Boniva.

Labeling changes and the Medication Guide will not apply to bisphosphonates used for Paget's disease or cancer/hypercalcemia such as Didronel, Zometa, Skelid, and their generic products.

"The FDA is continuing to evaluate data about the safety and effectiveness of bisphosphonates when used long-term for osteoporosis treatment," said RADM Sandra Kweder, M.D., deputy director, Office of New Drugs in the FDA's Center for Drug Evaluation and Research. "In the interim, it's important for patients and health care professionals to have all the safety information available when determining the best course of treatment for osteoporosis."

Today's warning follows a March 10, 2010, Drug Safety Communication announcing the FDA's ongoing safety review of bisphosphonate use and the occurrence of atypical femur fractures. The FDA has since reviewed all available data on bisphosphonate use, including data summarized in the American Society for Bone Mineral Research Task Force report. The report recommended additional product labeling, better identification and tracking of patients experiencing these breaks, and more research to determine whether and how these drugs cause the serious but uncommon fractures.

Based on the FDA's review, the Warnings and Precautions section of all bisphosphonate products for osteoporosis will be revised, and the FDA will require the inclusion of a Medication Guide to better inform patients of the possible increased fracture risk.

The FDA recommends that health care professionals be aware of the possible risk in patients taking bisphosphonates and consider periodic reevaluation of the need for continued bisphosphonate therapy for patients who have been on bisphosphonates for longer than five years.

Patients taking bisphosphonates for osteoporosis should not stop using their medication unless told to do so by their health care professional. Those taking bisphosphonates also should report any new thigh or groin pain to their health care provider and be evaluated for a possible femur fracture. Patients and health care professionals should report side effects with the use of bisphosphonates to the FDA's MedWatch Adverse Event Reporting program at www.fda.gov/MedWatch or by calling (800) 332-1088.

For more information: FDA Drug Safety Communication Consumer Update: Possible Fracture Risk With Osteoporosis Drugs

New Alternative to THR for Active Patients

New Alternative To Hip Replacement Designed For Patients With Active Lifestyles

Main Category: Bones / Orthopaedics News
Article Date: 22 May 2006 - 0:00 PDT

There is a new option for patients suffering from hip pain who do not want to give up their active lifestyle. NewYork-Presbyterian/Columbia University Medical Center is one of the first hospitals in the U.S. to offer a new alternative for total hip replacement-hip resurfacing. The technique allows the orthopedic surgeon to shave and cap several centimeters of bone within the hip joint, helping to preserve bone and joint stability for young or active patients.

The Innovative Birmingham Hip Resurfacing? System preserves more of the patient's natural bone structures and stability, covering the joint's surfaces with an all-metal implant that more closely resembles a tooth cap than a hip implant. This approach reduces post-operative risks of dislocation and inaccurate leg length, and because the all-metal implant is made from durable, smooth cobalt chrome, it has the potential to last longer than traditional hip implants.

"Hip resurfacing is ideal for many of my young, active patients who suffer from hip pain. As we've seen greater numbers of younger patients and older patients that are physically active, there's been an increased need for an alternative to total hip replacement that accommodates their age and lifestyle," says Dr. William B. Macaulay, director of the Center for Hip and Knee Replacement at NewYork-Presbyterian Hospital/Columbia, and associate professor of orthopaedic surgery and advisory dean at Columbia University College of Physicians and Surgeons...

...NewYork-Presbyterian Hospital/Columbia University Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Columbia University College of Physicians and Surgeons. NewYork-Presbyterian/Columbia provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian, which is among U.S. News & World Report's top 10 hospitals nationally, also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical Center and its academic affiliate, Weill Medical College of Cornell University.

NewYork-Presbyterian Hospital/Columbia University Medical Center
627 West 165th Street
New York, NY 10032
http://www.nyp.org ...

READ MORE

Acetabular Bone Loss by Dr. Vijay C. Bose
Acetabular Bone Loss by Dr. Vijay C. Bose

...The acetabular size is the most important factor which determines the choice of femoral head size in resurfacing and one never removes more acetabular bone in hip resurfacings. In other words if I would be performing a conventional hip replacement on a given patient instead of resurfacing, I would be using precisely the same size acetabular component in both the surgeries.

I would go as far as saying that if we are taking out more acetabular bone in resurfacing than in conventional hip replacement , then in my opinion there is no role for resurfacing and it must be discontinued immediately. Acetabular conservation is as important if not more than femoral bone conservation and all resurfacing surgeons recognize and acknowledge this fact. The ability to put large heads in resurfacing stems from the fact that thin shelled acetabular components are possible with the modern metal on metal bearings. However when one uses polyethylene it has to have a large thickness ,which in turn reduces the femoral head diameter , (assuming the acetabular outer shell diameter remains the same). The same argument holds true for ceramic on ceramic bearing to a lesser extent and therefore slightly large femoral head sizes than metal on poly is possible. However an anatomical size is currently possible only with metal on metal bearings...

READ MORE
Dr. Bose of Incia

Outsourcing to India Hip Surgery
Outsourcing to India hip surgery

05:21 PM EDT on Friday, June 22, 2007

By Felice J. Freyer Journal Medical Writer

When Anne Grant needed surgery on a painful arthritic hip, she didn’t go to a hospital in Rhode Island. She didn’t even go to Boston.

Instead, she packed her bags for India.

Yes, India — where Indian doctors and nurses performed the procedure that Grant wanted for a fraction of the cost in the United States. Five months later, the 61-year-old Providence woman says she’s walking and swimming without pain.

As surprising as her choice may seem, in heading to India, Grant joined tens of thousands of other Americans who are going overseas for medical care — to India, Thailand, Brazil, Singapore, to name a few places...

...“Our research showed us a very large group of aging baby-boomers were beginning to age into expensive treatment without being able to pay for it,” said Josef Woodman, author of a new book on the trend called “medical tourism.” Many are too young for Medicare but don’t have insurance — and they’re looking for help overseas.

Woodman estimated that last year, 150,000 Americans went abroad for medical treatments. Based on interviews with travel agents and reports from international hospitals, Woodman made the educated guess that half sought dental care in Mexico and cosmetic surgery in Brazil or the Caribbean, and the other 75,000 went for major, necessary procedures at international hospitals in Asia.

...Then, at a dinner party last year, her friend Lisa Grant — a neighbor, but no relation — mentioned that she, too, had a bum hip, and she was going to Belgium to have it fixed. From a 60 Minutes episode, Lisa Grant had learned about hip resurfacing, a new approach to hip replacement that preserves more of the thigh bone and is reputed to last longer. (See related story.) Although performed in Europe for more than 10 years, hip resurfacing is new in the United States, having received FDA approval only in May 2006.

Lisa told Anne about surfacehippy@yahoogroups.com, an Internet listserv rich with patients’ reports of their hip-resurfacing experiences. ..

Asked about Americans seeking cheaper care overseas, Lonks said, “You get what you pay for.”

He raised numerous concerns. “What happens if you have the procedure, come back to United States and you develop a complication? Who’s going to take care of it? Will your insurance cover it? … How do you know about the sterility and quality of their equipment? How about if you need a blood transfusion in India? … How about malaria? … How about typhoid or measles? Measles is a common disease in India.”

In an e-mail responding to The Journal’s questions about the risk of infections, Grant’s surgeon, Vijay Bose, said that “the patients are in a protected environment” and called the chances of catching something like malaria “very remote.”

“Over the last three years where I have been doing a large volume for American patients, we have not had a single case of malaria or other infectious diseases,” Bose wrote. He also said the hospital’s blood bank is comparable to any in Europe or North America, so patients who need a blood transfusion face the same low risks as anywhere. (Grant did not need any blood.)

As for the low cost, Bose had this comment: “I personally do not think that the cost is cheap in India. It is just the actual and appropriate cost for various procedures. The converse is true, it is artificially boosted and very high in the U.S...

...LARGE BUSINESSES and health insurers looking for lower-cost health care are watching the medical tourism trend with interest. But, says Mohit M. Ghose, spokesman for America’s Health Insurance Plans, the national trade group for health insurers: “What you have not seen is a rush by our sector to jump on board.”

He said insurers are worried about “legal and quality issues,” particularly who is responsible for patients’ care upon their return. Patients often cannot collect compensation if they are injured. So who will pay for the care at home if there are complications?

Ghose thinks the global competition will further boost a trend already under way in the United States — to develop “centers of excellence” that do many procedures, provide consumers information on how well they perform and compete on the basis of quality.

Ghose says he knows of only one health insurer that has gone as far as offering an overseas option to subscribers: BlueCross BlueShield of South Carolina.

In February, David Boucher, South Carolina BlueCross’ assistant vice president of health care, founded Companion Global Healthcare, a medical tourism agency that has a relationship with the Bumrungrad International Hospital in Bangkok. To address concerns about follow-up care, Companion contracted with a large network of South Carolina doctors to take care of patients when they return from overseas treatment.

“We’re not contemplating mandating care abroad,” Boucher stresses. “This is an option — we just want to help them make it a little bit easier.”

So far, South Carolina BlueCross’ offer to pay for medical care overseas has attracted lots of media attention and inquiries from other insurance companies — but no patients.

READ COMPLETE ARTICLE

South County Doctor Local Pioneer in Hip Resurfacing
South County doctor local pioneer in hip resurfacing 05:16 PM EDT on Friday, June 22, 2007 By Felice J. Freyer Journal Medical Writer

SOUTH KINGSTOWN

The guys wanted it. Guys in their 40s and 50s, who once spent hours playing tennis or doing karate, and who, now hobbled by arthritis, poured their energy into finding a solution to the pain in their hips.

They came to Dr. Robert C. Marchand, printouts in hand, minds made up, and said, I want this. What they wanted was hip resurfacing — a new alternative to total hip replacement that preserves more bone, and is reputed to last longer, withstand impact and allow a greater range of motion. Perhaps allowing for more years of karate kicks.

Marchand, who is with South County Orthopedics, had observed a hip resurfacing procedure in his wife’s native Germany. In Europe, he says, people are running marathons with hip-resurfacing implants. He thought his patients were on to something, and resolved to give them what they wanted.

He took a course last year in hip resurfacing in Boston and went to New York to train with a surgeon there. After persuading South County Hospital to buy the necessary equipment, he began doing the procedure last fall. So far, he has completed about 45 resurfacing procedures in people age 20 to 71. And he remains the only doctor in Rhode Island who will do it...

In the traditional treatment for arthritic hips, called total hip replacement, the surgeon saws off the top of the thigh bone, hollows it out and inserts a metal implant topped by a metal or ceramic ball, which rests inside a plastic cup implanted in the hip socket.

In hip resurfacing, instead of sawing off the top of the thigh bone, surgeons reshape it, preserving most of the natural ball. Then they cement a metal cap over the ball, which slides inside a metal cup pressed into the hip socket. Both are made of cobalt chrome.

Some think this metal-on-metal construction will last longer and withstand high-impact activities such as running. More bone is preserved, so that even if the implant does break down, the patient can then get a total hip replacement. Also, the ball is bigger, thought to be less likely to dislocate from the hip socket, and affording a greater range of motion.

All this makes the procedures especially popular with active baby-boomers. “They come in at six weeks [after surgery], cross their legs and put on their shoes,” Marchand says. “They say, ‘I haven’t done this in a year.’ ”

...EVEN AS patients exult, the debate continues among doctors. Dr. Scott Rubinstein, a Chicago orthopedist who favors hip resurfacing for appropriate patients, says many are discouraged from it by surgeons who don’t do the procedure.

“If someone’s interested in getting this done, they need to be evaluated by someone who does them,” Rubinstein said. “It’s certainly not appropriate for everyone. You need to look at this as one way to have your hip done. Like any surgery, there’s no right answer for everyone.”

In looking at the evidence, it may come down to a question of whether one sees the glass as half-empty or half-full. Rubinstein, like Marchand, finds the 10 years of data from Europe convincing. “I don’t think it’s going to be any worse than the other stuff. I personally think it’s going to be better,” he says. “It’s one of these time-will-tell kind of things.”

...Dr. John A. Froehlich, of University Orthopedics, who specializes in sports medicine and reconstructive surgery and practices at Rhode Island Hospital, also says he’s not ready for that bandwagon.

But he points out that patients are not facing a simple choice between old-fashioned total hip replacement and brand-new hip resurfacing. The traditional hip replacement technology has also been advancing, with procedures that preserve more bone, more durable materials, and smaller incisions.

He’s pleased with the results he’s getting with the latest versions of hip replacement. “I think I can give people a more predictable result the way I’m doing it,” Froehlich said.

With people now living into their 80s, and getting sore hips in their 50s, anyone who gets hip surgery is going to have to have it redone, perhaps multiple times, Froehlich adds. “No matter what they’re made of, they will loosen and wear. That is something that is not recognized by the public,” he says.

“There is no panacea.”

READ COMPLETE ARTICLE

Health Alert: Hip resurfacing vs. replacement
Health Alert: Hip resurfacing vs. replacement

July 5, 2007 04:48 PM EDT

NATIONAL - About 350,000 patients have hip replacement surgery every year. Some experts believe 45,000 thousand of them are candidates for a 'hip' new surgery.

Working in an emergency room keeps Ron Balliet on the run, but hip arthritis stopped him in his tracks.

Balliet says, "The pain - it just got so bad I couldn't deal with it anymore. I had to give up certain things. I couldn't play golf, I couldn't, I would ride my bike, I would be paying for it days later."

Ron's active lifestyle led to hip osteoarthritis.

"It just got kind of depressing you know. You feel your independence and all that go away."

Instead of total hip replacement surgery, Ron chose hip resurfacing. Rather than remove the end of the thigh bone and replace it with a metal stem, only a few centimeters of the bone are shaved off and it's capped with a small artificial metal joint.

Dr. Marc Umlas says, "The main advantage is that you preserve your own bone. You leave more of the patient's own bone in the hip." Which creates a more stable, mobile and natural joint.

"A number of patients have returned to running marathons, and playing tennis and skiing on these devices and that's a significant advantage, especially for a younger person who's used to being active and athletic and wants to go back and pursue those activities," added Dr. Umlas.

Good candidates must have strong bones. It's still major surgery, so expect to spend several days in the hospital followed by physical therapy.

"It was a life changing experience, because now I have full motion again. I really don't have any restrictions with movement," says Ron.

Many of these patients will still need full hip replacement surgery, but at least this procedure buys them time. Hip resurfacing should last about ten years.

Posted by Bryce Mursch

READ COMPLETE ARTICLE

Questions To Ask Your Hip Resurfacing Surgeon
This is a list of questions compiled by Pat Dukes, Vicky Marlow and members of the Yahoo Surface Hippy Discussion Group. Print it out and take it to the doctor with you.

You should ask your doctor as many of the questions that seem appropriate for your situation. Your doctor should be patient, willing to talk about what to expect and answer your questions. If he or she isn't, I would try to find a doctor that is open and helpful. There are many wonderful hip resurfacing surgeons that will answer any question you have. Having all your questions answered will give you peace of mind and will make your surgery much less stressful.

How many resurfacings have YOU done? (not observed or assisted with)
Where did you train?
How many complications have you had?
How many resurfacing failures with revision to THR have you had?
How many times during surgery have you had to change to a THR instead
of a resurfacing and why was the change made?
What device (prosthesis) do you use, how long have you been using it
and why do you prefer it?
Do you use cemented or uncemented? Why?
Do you cement the stem?

What anesthetic do you use?
How long does the surgery take?
What surgical approach do you use? Anterior or Posterior?
What is the incision length?
What is your post-op pain control plan?
What hospital do you use?
What is their infection rate?
Have any of your patients had infections that required IV antibiotics
following resurfacing?
What drugs/methods do you use for anti-coagulation after surgery?
How long will I be in hospital?
How successful have you been obtaining insurance approvals for
resurfacing?

What is the rehab protocol?
When will I be 100% weight bearing?
What assistive devices will I use for walking after surgery?
How long on 2 crutches, 1 crutch, cane?
What if any restrictions do you place on your patients after surgery
and how long do they last?
Will I be given any at home nurse or PT care?

How does my other hip look at this time?
If both hips are bad, how do you handle bilateral resurfacing?
Is there anything unusual about my hip that might present problems?
Do you have a resurfacing patient who you've done surgery on that I
could talk to about their experience?

What is your opinion of my returning to (whatever work or activities
you do)
Have you done resurfacing for anyone who has returned to these
activities?"

Metal Ion Study 2002

Medium Term Serum Cobalt and Chromium Levels in Patients with Metal-metal Resurfacing

NOTE: This paper was presented at the New Trends of Joint Reconstructive Surgery 2002 Meeting, comparing serum levels in a control group, conventional THR, McKee Farrar, MOM Hip Resurfacing, and MOM THR (Sulzer), which concluded that metal ion levels are higher at 1 year with a small diameter MOM THR (Sulzer) than with resurfacing. As the Sulzer device has been in use for over 15 years with no associated problems reported to date, this is further evidence that this is currently not an issue.

V Reddy MD† J Dorairajan MD† J Nevelos PhD* S Krikler PhD FRCS(Orth)†.
† University Hospitals Coven try & Warwickshire NHS Trust * Corin Medical†
Introduction
The conservative principles of hip resurfacing combined with very low wear metal-metal bearing technology may provide a very attractive solution for the younger arthritic hip. The long-term effects of the inevitable metal ion release however, remain a concern. Serum ion levels from metal-metal resurfacing hip patients were measured pre-operatively and then every year for up to five years.

Materials and Methods
All patients had had either a McMinn (1995-1996) or Cormet® (1997-) hip resurfacing (both manufactured by Corin Medical, UK) implanted by a single surgeon. Blood was collected using a standardised technique to ensure no metallic contamination. Chromium analysis was by graphite furnace atomic absorption (ETA-AAS) using a 4100ZL or A800 Perkin Elmer instrument. Cobalt was analysed by inductively coupled plasma mass spectrometry (ICP-MS). Measurements were taken from 39 patients with 7 of those having bilateral resurfacings. Pre-operative levels were only taken from 15 patients, and these were universally low (below 20nmol/l).

Results – General Population
In all patients the serum levels of cobalt and chromium increased following resurfacing although the extent of the increase varied greatly between patients. There was a general decrease in ion levels from ~2 years. The data shows a definite trend of decreasing ion levels after 3 years. This may be consistent with running-in wear and healing of the peri-prosthetic tissues providing a smooth, stable joint. The decline in serum level seems to start slightly earlier in younger patients (<40) than older patients (>60).

Discussion – General Population

Ion levels increase over the first two years before dropping to a generally low level.

Younger patients’ ion levels peak earlier than older patients – probably related to activity level.

There was no difference in ion levels between the McMinn and Cormet devices.

Bilateral resurfacings did not appear to elevate the ion levels significantly.

Insufficient sample numbers for statistical analysis.

Results – Outliers
The vast majority of patients studied had similar ion level release which remained below 250nl/l. There were, however three individual patients who had much higher ion levels which may cast light on possible causes of increased wear.

Case 1. Patient AP. 22 year old female at primary operation – Steep Acetabular Cup

Case 2. Patient LB. 42 year old female at primary operation Post operative Dislocation and Steep Cup

Case 3. Patient SM. 35 year old male at primary operation.

Discussion – Outliers
These cases were performed before the start of this study and so ion levels were not taken pre-operatively. Their levels were one or two orders of magnitude higher than the general population. (Note scale on the respective graphs). Also the ion levels show no sign of decreasing with time unlike the general population. Steep acetabular cup angles have been shown to be related to increased wear in hard-hard hip bearings (16) . Steep cups will also inevitably lead to an increased chance of dislocation (as in case 2). The large diameter heads used for hip resurfacing are naturally resistant to dislocation and Case 2 of this series remains the only dislocation to date in the senior author’s personal series of over 250 operations.

Conclusions
In the vast majority of patients with metal-metal hip resurfacing there is a small but early rise in serum metal ions over the first 2-3 years but the levels then gradually diminish over time .

Steep cups seem to be associated with increased levels, which could be due to wear and therefore increased ion release into the body.

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Scott Kopperud Martial Arts Video BHR Dr. Bose
Click Black Triangle in middle of photo to start video.

William Starret BHR Video Dancer 1999
Click Black Triangle in center of photo to start video

Hip Resurfacing Story about Joe Mitchell
Hip resurfacing

Updated: 8/11/2007 5:00:00 AM By: Diana Palotas

The pain in Joe Mitchell's right leg bugged him for years. It hurt more after he worked out.

Mitchell said, "I had all different kinds of therapies thinking it was muscular, when in the end it had nothing to do with that at all."

His chiropractor discovered it wasn't Mitchell's leg that was the problem -- it was his hip. And it was filled with arthritis.

At just 54, Mitchell was too young for a hip replacement.

He said, "The younger you are, the more they don't want to do the first one. So I was in that waiting period."

Mitchell didn't have to wait long. The Food and Drug Administration just approved a new procedure called hip resurfacing. It buys active baby boomers with worn-out hip joints another ten years or more before replacement.

Dr. Christopher Drinkwater of University of Rochester Medical Center said, "In the case of resurfacing, we just mill the femoral head and put a metal cap over the femoral head."

It's anchored by bone cement, held by muscle and ligament tension. A total hip replacement removes the femoral head and neck. Then a stem is placed in the canal of the femur which holds an artificial ball. Hip resurfacing preserves the bone in this area, so a future hip replacement can be done if needed.

Not everyone is a candidate for hip resurfacing because of concerns over bone density. Men, like Mitchell, need to be 65 and younger, women 55 and younger.

Like hip replacement, hip resurfacing is major surgery.

Attorney Joe Mitchell was back to work in six weeks.

He said, "It's just nice knowing something was wrong and now it's fixed. It's a nice feeling."

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BHR Recall by Smith & Nephew
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
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

Hip Resurfacing: A New Tool For Orthopaedic Surgeons
Hip Resurfacing: A New Tool For Orthopaedic Surgeons

By Nancy K. Crevier

Don Sweeney of South Salem, N.Y., and Albert Viscio of Redding are both men in their mid-fifties. Running, tennis, basketball, and even mountain climbing are activities they enjoy.

But about ten years ago, both men began to experience the discomfort that comes with osteoarthritis of the hip.

"The arthritis progressively became worse," said Mr Viscio, "and I found I had to reduce some of my activities."

Mr Sweeney developed increased mobility issues along with significant pain in his hips, until it became apparent a little over a year ago that he would have to take action, or face a debilitated future. Hip replacement surgery was performed on his left hip in 2005, and he then was told that his right hip would be a candidate for surgery in the near future.

When Mr Viscio had to cut short a climb to the summit of Mount Kilimanjaro in Tanzania in December of 2006 due to intense hip discomfort, he realized he had pushed his limits. "I knew it was time to address the problem," he said. Both men were candidates for hip surgery, joining the ranks of nearly 500,000 people in the United States who undergo the knife for reconstruction of hips damaged by arthritis. And both men were ideal candidates - relatively young, in good physical condition, and active - for a newly FDA approved hip resurfacing technique.

...For younger hip surgery patients, hip replacement is an operation that will probably be repeated in their lifetimes.

That is why Drs Sanjay Gupta and Robert Deveney, both affiliated with Danbury Hospital, are pleased to provide the hip resurfacing procedure, approved by the FDA just six months ago. Rather than completely removing the head of the femur as in hip replacement surgery, hip resurfacing preserves the femur head, reshaping it to save more bone. During surgery, a chromium cobalt metal cap is fit over the patient's hip ball and a metal cup, also made of chromium cobalt metal, is set into the pelvic socket.

Why It Works

The metal-on-metal construction of the replacement parts means less friction and longer life to the prosethic parts. Hip resurfacing preserves more bone than when traditional hip surgery is performed, an important factor if hip replacement surgery is required in the future.

Dr Gupta has been certified to perform this surgery in the United States since the FDA approved the procedure, but having practiced as a medical resident in the United Kingdom where hip resurfacing has been embraced for the past ten years, he was very familiar with the procedure. He participated in more than 25 surgeries while a fellow at The Hospital for Special Surgeries in Manhattan after coming to the United States, and has already performed two hip resurfacing surgeries since joining Orthopaedic Specialists of Connecticut in Brookfield in September 2006.

Beyond bone preservation, there are other advantages to hip resurfacing, said Dr Gupta. By preserving more of the femoral head, hip dislocation is less likely.

"Hip resurfacing gives patients a better quality of life," said Dr Gupta, "especially if they have a more active lifestyle."

With hip resurfacing, patients spend approximately three to six weeks on crutches to allow the bone to bond to the metal cap on the femur head, said Dr Gupta.

"Then they can do whatever they want, except contact sports, running, and jumping for one year. After that, I tell them they are free to do everything," he said. That is a far cry from the restrictions that come with hip replacement, when activities like jogging, gymnastics, and dancing are severely curtailed.

"This is a good choice for a very active person, someone under the age of 65 usually, who has good bone quality," Dr Gupta said...

Dr Devany's R&D The procedure was modified over the years in the United Kingdom, though, until the present metal-on-metal design became a positive option highly regarded there for the past ten years.

In 2006, Dr Deveney traveled to Canada to study the newest hip resurfacing techniques with Ronan Treacy, a colleague of Derek McMinn, the developer of the Birmingham Resurfacing technique that is most widely used. The changes he observed since his initial experiences with hip resurfacing were primarily in the design of the prosthetic, rather than the surgical technique itself.

"What is so exciting is that hip resurfacing is preserving the femoral head, allowing patients to function at a high level. Their range of motion is greater, and there is a lower risk of hip dislocation than with traditional hip replacement," Dr Deveney said. "What is really appealing to patients is the activity level and recovery level that is faster due to improved surgical techniques, rehabilitation, and the improved designs. We have people up and walking the same day as surgery. They are often in outpatient therapy by the fourth day, and I tell them that they can drive whenever they feel comfortable."

Previous to newer developments, initial recovery often meant a time period of three to five months before patients were comfortable returning to daily routines.

"Now, I would say that many patients are back to their normal routines, back to work, three to four weeks after surgery," Dr Deveney said.

There is an extremely low wear rate with the new metal-on-metal ball and joint construction used in hip resurfacing, and that means that the surgery has the potential of lasting much longer than the ten- to 15- year life expectancy of the plastic and ceramic metal combination used in conventional hip replacement surgery. The longevity of the metal replacement parts means that many hip resurfacing patients may never face hip surgery again.

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Dislocating a BHR by Dr. Bose
Hi Pat,

Thanks for the mail.

Of course I remember you very well. I direct patients frequently to your remarkable website when they are seeking specific information.

It is a commonly used statement that a BHR is as 'stable' as a normal hip. However this is a highly qualified statement.

This statement is true only if the following criteria are met.

1. Native angles, inclination , offsets and all anatomical parameters have to be replicated.. If this is not done fully and only accuracy of say 80% is obtained - then the stability is likely to be approx in the region of 80% only. Having said this ,even in this situation, the stability is likely to be many times that of a conventional THR. Therfore i would not call it a surgical error.As surgeons, we get better and better at this replication as we gain experience.

2. The capsule should be repaired to capsule preferably as it restores the joint 'proprioception'( or position sense). This would kick in the event of a potential dislocation as it would in a normal hip. If the capsule is repaired to bone , it is many times better than doing nothing but does not achieve the proximity to the stability of a normal hip. Again it is not a surgical error if capsule to capsule repair is not done but one cannot expect natural stability.

3. Other factors that can potentially cause dislocation like impingement must be carefully addressed . The most common offender is the non -restoration of the head neck offset

One must keep in mind that the BHR is the Ferrari of hips and the conventional THR is an old fiat.

Even if the Gear knob of a ferrari is not the right size for the driver it shows up because it is pushed to the limit and built for performance. However even if the chassis is broken in an old fiat , it would probably go unnoticed by the owner as it is never 'pushed' for performance. There are many patients after THR s with trochanteric non-unions going on for many years without even being aware of it!

Coming to the specifics of this patient.- The Relocated BHR is likely to be stable with time and is unlikely to affect longevity. THe only issue is that this patient must avoid extremes of movement to prevent another episode.

I hope this helps

with best regards vijay bose chennai Hip Resurfacing India Dr. Bose Website

Shaving hips instead of replacing them
Shaving hips instead of replacing them gives patients more running time

Sam Whiting Sunday, July 30, 2006

Arthritis has eaten away all the cartilage on Frank Stonich's left hip, so he was pleased to hear he'd be the first person in California to receive the ball-and-socket being introduced by Dr. Robert Gilbert of California Pacific Orthopaedics & Sports Medicine.

The device, called the Birmingham Hip Resurfacing System, (BHR) is less invasive than total hip replacement because it saves the knob at the top of the thigh bone. Instead of being sawed off, the head of the femur is shaved to fit under a shiny hat that looks like a mushroom. Approved by the FDA on May 10, resurfacing has been shown to have a faster recovery and leave a greater range of motion than replacement, "Wow. It's kind of neat and kind of scary at the same time,'' Stonich, 58, was saying an hour or two before being wheeled into surgery on the third floor of the California Street Campus of California Pacific Medical Center. This being the last day he could complain about his old hip, he didn't mind piling it on. "I can't sit or walk for any kind of length. I can't go upstairs, can't do anything," he says. "It's messing up my spine. Its messing up my knee and it's shortened my leg."

While Stonich is in getting prepped, Gilbert, 65, explains that resurfacing was common in the early 1980s, involving a ball on the femur and a cup in the socket attached to the pelvis. Back then the socket was plastic, and metal-on-plastic either didn't work or wore out. Gilbert did 29 of these before abandoning the procedure.

It took another 20 years for him to return to resurfacing. What convinced him was the highly polished Cobalt Chrome. "Now that we have metal-on-metal articulations we can go back to it," Gilbert says, "because metal-on-metal works."

As proof, he cites 60,000 BHR surgeries done since 1997, when it was perfected by its inventor Derek McMinn, operating in Birmingham, England. McMinn has done 3,000 himself, and Gilbert went over to Birmingham to train with McMinn last March.

They call orthopedic surgery "human carpentry," and for his first BHR Gilbert has brought along some muscle. First there is his partner in surgery, Dr. Peter Callander, 41. Next to him is Dr. Marc Thomas, an Australian rugby player and surgeon, who has gone over to the other side and now represents Smith & Nephew Orthopaedics, manufacturers of the BHR, based in Memphis.

"It's the premiere device in hips, no doubt," says Thomas, who has been in on 1,000 of these operations, though in British-style understatement, says, "I've done a few." Backing up Thomas is Matt Bouza, who played eight years in the NFL and is Northern California Sales Director for Smith & Nephew.

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New Surgery Available in Toledo Ohio
Health Alert: New hip surgery available in Toledo

WTVG--August 17, 2007 - In today's health alert a cutting edge surgery is now available in Toledo. It's for younger patients in need of hip replacement surgery. Doctors say Birmingham hip resurfacing has a lot of advantages for patients, including quicker recovery, the preservation of more of the leg bone, and the ability to continue to live an active life.

It looks seem enough, but a stroll down the hall at the University of Toledo Medical Center is somewhat of a miracle for 50-year-old Rick Janicki. About three months ago, he says he couldn't walk or do just about anything without crippling hip pain shooting down his right leg and up his back. Normally a very active man, he says he felt useless.

In late May, Rick had surgery, not to replace his hip, but to resurface it. Doctor Haleem Chaudhary is one of the first surgeons in the entire country trained in the new Birmingham hip resurfacing technique. He capped the head of Rick's femur, like a dentist would cap a tooth.

More of the leg bone is preserved with resurfacing, as opposed to the traditional hip replacement, which requires sawing off the top of the femur.

Dr. Chaudhary says, "Additionally, it has a much larger head than a typical hip replacement and that gives the advantage of a higher range of motion."

And less of a chance of dislocation.

"After Birmingham's hip replacement and after the healing process is done, I don't really put any restrictions on patients, in terms of their activity or their range of motion."

The procedure lasts one to two hours and patients can return to normal activity by six weeks. Dr. Chaudhary spares the major muscles around the hip during surgery, which also helps patients recover faster. Rick goes to physical therapy. He says he feels good. In fact, at times, he says he forgets which hip was resurfaced. Dr. Chaudary says this surgery isn't for everyone. He says good candidates are under sixty-years-old, with a diagnosis of osteoarthritis, and good bone stock.

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Learning curve may be longer than thought for placing hip resurfacing components
Learning curve may be longer than thought for placing hip resurfacing components

It took surgeons 55 to 60 cases to get femoral components within ?5? of planned placement.

By Susan M. Rapp ORTHOPEDICS TODAY 2007; 27:12 May 2007

British and Australian researchers collaborating on a prospective study identified a longer-than-expected learning curve to accurately perform hip resurfacing arthroplasties.

Hip surgeons taking part in the study, all of whom had performed more than 1,000 hip surgeries, found they had to complete three-times more resurfacing surgeries than they expected in order to place the femoral hip resurfacing components within ?5? of the desired neck/head angle, said Diane L. Back, FRCS.

The surgeons had initially estimated their learning curve at 10 to 20 cases, Back told Orthopedics Today.

"The results actually showed that it took 55 to 60 cases for most of our surgeons to get the femoral component where they actually planned it," she said.

...Four surgeons participated Back and colleagues prospectively analyzed the first 100 hip resurfacing procedures of four consultant orthopedic surgeons, three from Australia and one from the United Kingdom.

They performed all procedures with the recently reintroduced Birmingham Hip Resurfacing System [Smith & Nephew]. The FDA approved the implant for sale in the United States last year.

All surgeons used standard instrumentation and a posterior approach. Investigators focused on femoral component position, but also analyzed notching and other complications.

To determine how accurately they placed the femoral components, surgeons first marked the ideal implantation site on preoperative radiographs. Investigators then calculated the corresponding neck/head angle.

...The longer-than-expected learning curve has huge implications for surgeons' success with this type of hip replacement, Back told Orthopedics Today.

"Hip resurfacing is good. I think that is well proven. You have to choose your right cases, but it does take you longer than you expect to learn. I think medico-legally it does have some implications."

For example, surgeons just learning the procedure should tell patients they are at the beginning of their learning curve and have not done many of the procedures, she said.

In the United States where orthopedists begin practicing after completing fewer hip replacements than surgeons in the United Kingdom or Australia, "It actually means their learning curve may take them 10 years to get out of," Back said.

Back said she wonders how, with the worldwide trend toward reduced orthopedic training hours, many new surgeons would be able to accrue enough cases to become proficient with the technique.

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New Procedure Gives Middle Aged Foks an Alternative to a THR

New procedure gives middle-aged folks an alternative to full replacement

Chris Swingle Staff writer
Margaret Swift's hip pain was so bad by age 40 that she gave up softball. She struggled to walk up hills on the golf course. She limped giving tours of Woodcliff Hotel & Spa in Perinton, where she works in marketing.
"I'd do one hour of yard work, and I'd come in the house in tears," says Swift, now 43, of Penfield. She eventually needed prescription painkillers to get through the day.
Her first orthopedic surgeon diagnosed degenerative bone disease but said that Swift was too young for hip replacement surgery. That's because an artificial hip could wear out after 15 or 20 years; redoing it is more difficult than first-time hip replacement and generally less successful. The surgeon recommended she use a cane as needed, lose weight to help her joints and switch to low-impact exercise such as swimming.
"I couldn't believe that was the answer," says Swift.

Eventually she met with Dr. Hubert F. Riegler, one of two Rochester-area surgeons offering a new alternative: hip resurfacing. The procedure, approved last year, is aimed at younger adults — typically women ages 45 to 55 and men ages 50 to 65, or younger. (The guideline is younger for women because they tend to develop osteoporosis; once bones weaken, they're not appropriate for resurfacing.)
After those ages, patients get the more conventional full hip replacement. That surgery removes the entire ball at the top of the thigh bone and replaces it with an artificial one.
Hip resurfacing is like capping a tooth. The ball is reshaped — not removed — and capped with a metal prosthesis secured by a small stem. This approach conserves more bone, making a full hip replacement easier if needed later.
Local orthopedic surgeons who don't offer hip resurfacing give three reasons. The parts are new enough that nobody can be sure how long they will last. It's a more demanding surgery than hip replacement (requiring up to twice the time, a longer incision and moving and cutting through more muscles and tendons). And there's some concern about metal ions produced when the metal parts rub together. The ions are absorbed into the bloodstream and eliminated by the kidneys, so resurfacing isn't recommended for women who may become pregnant or people with weak kidney function...
...Riegler, chief of orthopedics at Highland Hospital, has done about 28 resurfacings in the past two years. He maintains that about one-third of the full hip replacements don't turn out well in young, active people because they're more likely to wear out or loosen the artificial joint during their lifetime. Resurfacing allows a greater range of motion, and the joint is less likely to dislocate, so its results so far are better for people pursuing recreational sports...
...The U.S. Food and Drug Administration approved Smith & Nephew's Birmingham metal hip resurfacing system in May 2006. Last month, the FDA approved a competitor, the Cormet 2000 hip resurfacing device from the British firm Corin Group, to be distributed in the United States this fall.
Of nearly 300,000 Americans who get hip replacements per year, 10 percent to 15 percent may be appropriate for resurfacing.

Resurfacing and total hip replacement are covered equally by health insurance, says Excellus BlueCross BlueShield. The costs for both differ by hospital, ranging from $12,300 to $22,000 in western New York, a spokesman says...
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Hip surgery With a Future
Hip Surgery With a Future
By Barnaby J. Feder
Correction Appended
Hip replacement, an operation that about 300,000 Americans undergo each year, is one of the great success stories of modern medicine.
But woe to those who outlive their artificial hips, which typically cannot be counted on to last more than 20 years or so.
Because it is difficult to extract and replace a worn-out or defective artificial hip, doctors routinely advise patients to put off hip replacement as long as possible. For middle-aged or younger people whose hips have been damaged by disease or injury, that typically means a punishing waiting game.
Now, though, an alternative to total hip replacement can offer an interim solution to many younger patients.
The alternative, called hip resurfacing, usually yields at least as many short-term benefits as a total replacement. It costs about the same and is typically covered by insurance.
And though many patients can expect to outlive the treatment’s effectiveness, hip resurfacing has the advantage of preserving enough healthy bone to allow for a future total hip implant.
“It’s nice to know that down the road, if necessary, it will be an original total hip — not a revision,” said Keith McDonald, a 54-year-old air traffic controller from Melville, N.Y., whose right hip was resurfaced late last month. This past Tuesday, just 15 days after the operation — and at least a week earlier than doctors would recommend — Mr. McDonald drove his car. “Every day I do more,” he said.
Tens of thousands of patients around the world have had hips resurfaced in the past decade. That includes some Americans who went overseas before the Food and Drug Administration started allowing it to be done in this country last May.
“The demand from patients and surgeons is tremendous,” said Brian Austin, of Smith & Nephew, the British maker of the F.D.A.-approved resurfacing system.
More than 400 surgeons in the United States have now been trained to use Smith & Nephew’s product, which is known as the Birmingham Hip System. Competing devices already sold overseas are expected to begin arriving in this country later this year...
...
“You should have pain every day before you even think about it,” said Dr. William B. Macaulay Jr., a Manhattan surgeon who performs hip resurfacing surgeries. “If you are doing it in people with moderate pain who just want to improve their tennis game, that’s crazy.”
Experts say that 10 percent to 15 percent of hip-replacement candidates may find hip resurfacing a viable alternative. But unless they are Web-savvy like Mr. McDonald, who learned about it only through his own Internet research, they may not have heard about the procedure...
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All About Hip Resurfacing by William Macaulay, M.D.

All About Hip Resurfacing
Hip resurfacing is all the rage in the orthopedic community these days. In fact, I had four different hospitals pitch me stories on it in the last year, independent of one another.
But is it right for everyone with chronic, debilitating hip problems? NYMD News panelist Dr. William Macaulay, attending orthopedic surgeon at New York Presbyterian Hospital/Columbia and director of Columbia's Center for Hip and Knee Replacement, has the answers below and after the break.
By William Macaulay, M.D.
You just turned 40 or 50. Your mind tells you you’re younger, but you feel older because you have real hip pain that won’t quit. You limp everyday. You do a little research and come across a new procedure called total hip resurfacing. Then you wonder: Is this the right procedure for me?
I hear the same story over and over from my patients. Looking for a solution to their hip pain, they have stumbled upon total hip resurfacing, which was approved for use in the U.S. in May of 2006. While many patients are ideal candidates for resurfacing, often I must inform them that hip resurfacing is not for everyone.
Hip resurfacing is not a new concept. Older, less successful versions of hip resurfacing came and went between the 1930s and 1980s, which included materials such as glass, plastic and stainless steel. These implants eventually failed under normal activity requirements. Advances in metallurgy and refinements in surgical technique have brought resurfacing back to the foreground of hip surgery.
Today, total hip replacement remains the gold standard, especially for patients over the age of 60 or 65 with severe, debilitating arthritis of the hip. However, for the younger and more active hip arthritis patient, the long-term success of THR remains a concern. Scandinavian hip registries (the U.S. does not yet have one) have shown that active total hip replacement patients under the age of 55 have a 15% to 20% chance of requiring a re-operation within 10 years.
As a 40 or 50 year old with severe hip pain, arriving at surgical intervention as your last resort, which option do you choose? As with most things, there are pros and cons to each.
The benefit of hip resurfacing is suggested by its name. The top of the thigh bone is preserved by reshaping and capping with metal (Figure 1) instead of replaced, as is the case with traditional hip replacements with a metal spike driven down the inside of the thigh bone ...
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Metal Ion Levels in Triathlete with Hip Resurfacing
Metal ion levels in a triathlete with a metal-on-metal resurfacing arthroplasty of the hip

R. De Haan, MD, Orthopaedic Resident¹; P. Campbell, PhD, Research Scientist, Associate Professor²; S. Reid, MD, PhD, Sports Medicine Physician³; A. K. Skipor, MS, Research Scientist⁴; and K. De Smet, MD, Orthopaedic Surgeon¹

1 ANCA Medical Center, Krijgslaan 181, 9000 Gent, Belgium.
2 J Vernon Luck Snr MD, Orthopaedic Research Center, Orthopaedic Hospital, 2400 S., Flower Street, UCLA, Los Angeles 90007, California, USA.
3 St. Helen’s Private Hospital, 186, Macquarie Street, Hobart, Tasmania 7000, Australia.
4 Department of Orthopaedic Surgery, Rush Presbyterian St Luke’s, Medical Center, Room 756, Cohn Research Building, 1735 West Harrison Street, Chicago, Illinois 60612-3833, USA.

A prospective study of serum and urinary ion levels was undertaken in a triathlete who had undergone a metal-on-metal resurfacing arthroplasty of the hip four years previously. The one monthstudy period included the final two weeks of training, the dayof the triathlon, and the two weeks immediately post-race. Serumcobalt and chromium levels did not vary significantly throughoutthis period, including levels recorded on the day after the11-hour triathlon. Urinary excretion of chromium increased immediatelyafter the race and had returned to pre-race levels six dayslater. The clinical implications are discussed.

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Hip Resurfacing Advantages by Dr. Barrack

Metal-metal Hip Resurfacing Offers Advantages Over Traditional Arthroplasty in Selected Patients

By Robert L. Barrack, MD
ORTHOPEDICS 2007; 30:725
September 2007

Total hip arthroplasty (THA) is among the most successful interventions in medicine. It is the best option for most patients with end-stage arthritis of the hip. However, THA has some limitations, and problems with THA are far from nonexistent. Revisions account for almost 20% of hip cases in the United States, and this number is growing.1 These revision cases pose a greater risk for patients.

Avoiding the need for revision would be a substantial benefit, and diminishing the morbidity should revision become necessary would be equally important. Potential problems also exist in performing a THA in many young, active patients, and hip resurfacing offers advantages in many of these areas.

Indications and Advantages of Hip Resurfacing
Managing Femoral Deformity and Suboptimal Anatomy

An uncommon, but useful indication for hip resurfacing is for patients with proximal femoral deformity, in whom a total hip can be difficult if not impossible (Figure 1). More commonly, suboptimal anatomy is an issue, as with patients in whom even the smallest stem requires reaming, which puts patients at long-term risk for stem fracture (Figure 2). Conversely, a large canal presents problems for implanting a cementless stem (Figure 3).

Avoiding Stress Shielding

The presence of a femoral stem inevitably causes some degree of thigh pain, which is more common with larger stems.2 Stress shielding occurs over time from nonphysiologic hoop stresses. The long-term sequelae include bone loss, thigh pain, and stem fracture. The only hip arthroplasty associated with maintaining or increasing bone density is metal-metal hip resurfacing.3

Preventing Limb-length Difference and Dislocation

The major long-term complications of THA leading to more morbidity, dissatisfaction, and lawsuits are limb lengthening and dislocation. With hip resurfacing, the incidence of dislocations is markedly less than with THA. In the Medicare database, 4% of THA patients experience a dislocation in the first 6 months following surgery.4

Retaining Bone Stock for Future Revisions

Another major advantage of hip resurfacing is retaining bone stock for future revisions. Conversion to a THA is more similar to a primary than a revision procedure in terms of operative time, blood loss, and clinical success.5

Enabling Patients’ Return to a High Activity Level

The most compelling argument in favor of hip resurfacing is activity level. The fastest growing segment of the THA marketplace is patients <55 years. These patients want to maintain an active lifestyle, and they shun limitations.

In a study completed this year, a survey of the leading hip surgeons in the United States was performed regarding what activities they recommend to their patients. Activities prohibited by approximately 80%, even with the new bearing surfaces or large metal heads, included virtually every activity that required any impact.6

In contrast, surgeons generally do not limit activities after hip resurfacing. In a recently published study, following hip resurfacing, 92% of patients participated in sports, and none gave up their preferred sport.7 This high level of activity apparently does not compromise the clinical result. In a study of 446 hips in patients <55 years who were given no activity restrictions, 90% of patients returned to sports, and there was only 1 revision in 2 to 8 years of follow-up.8

We are now dealing with a new generation of hip patients. They are more informed and involved, educated, and active. The concepts of maintaining bone and less activity restriction resonate with them. They know others who have had hip replacement, and they have researched all of the available data on hip replacement, including the data on new bearing options. A high percentage of these patients have rejected THA and prefer the resurfacing concept.

Conclusion
Resurfacing is not for every patient or for every surgeon. However, it offers substantial advantages in properly selected patients. Because of this, metal-metal hip resurfacing has become the fastest growing arthroplasty procedure in the world in recent years outside the United States. With the US Food and Drug Administration granting approval in 2006 for one component, and approval for a second component pending, this trend will continue for the foreseeable future.

References

Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA. Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am. 2007; 89:526-533.
Vresilovic EJ, Hozack WJ, Rothman RH. Incidence of thigh pain after uncemented total hip arthroplasty as a function of femoral stem size. J Arthroplasty. 1996; 11:304-311.
Kishida Y, Sugano N, Nishii T, Miki H, Yamaguchi K, Yoshikawa H. Preservation of the bone mineral density of the femur after surface replacement of the hip. J Bone Joint Surg Br. 2004; 86:185-189.
Phillips CB, Barrett JA, Losina E, et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am. 2003; 85:20-26.
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.
Klein GR, Levine BR, Hozack WJ, et al. Return to athletic activity after total hip arthroplasty. Consensus guidelines based on a survey of the Hip Society and American Association of Hip and Knee Surgeons. J Arthroplasty. 2007; 22:171-175.
Narvani AA, Tsiridis E, Nwaboku HC, Bajekal RA. Sporting activity following Birmingham hip resurfacing. Int J Sports Med. 2006; 27:505-507.
Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004; 86:177-184.
Author
Dr Barrack is from the Department of Orthopedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.

“Orthopaedic Crossfire” is a registered trademark of A. Seth Greenwald, DPhil(Oxon).

Correspondence should be addressed to: Robert L Barrack, MD, Dept of Orthopedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 W Pavilion, St Louis, MO 63110.

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Hip Resurfacing vs Total Hip Replacement Study 2007

Study: Surface replacement arthroplasty may offer advantages over THA

Canadian investigators said hip resurfacing resulted in greater patient activity after 2 years.

By Robert Trace
1st on the web (September 19, 2007)
September 2007

SEOUL — Total hip arthroplasty is an established procedure with well-documented complication rates and clinical results, but surface replacement arthroplasty may offer additional clinical benefits to many patients, according to a group of Canadian researchers.

"We decided in 2003 to do a comparative study of hip resurfacing, or surface replacement arthroplasty (SRA), to the gold standard of total hip arthroplasty (THA), since we were not aware of any direct prospective studies out there comparing the two procedures," said Pascal-André Venditolli, MD, of the Maisonneuve-Rosemont Hospital in Quebec.

He and his colleagues randomly assigned 210 hips to receive uncemented metal-on-metal THA (103 hips) or a hybrid metal-on-metal SRA (107 hips). All surgeries were performed by three orthopedic surgeons, who used a posterior approach.

The researchers prospectively collected perioperative and postoperative data, and analyzed the clinical data for a minimum of 2 years.

Postop complications included three isolated traumatic dislocations and one recurrent dislocation in the THA group, which required acetabular cup revision. Two SRAs required revision for late head collapse. No postop femoral neck fractures occurred in the SRA group, he said.

There was one case of loosening at 6 months postop in the resurfacing group, which had shifted varus. There were also two cases of deep venous thrombosis in both patient groups, he said.

Although the investigators did not report a significant difference in surgical time between the two procedures, patients' length of stay in the hospital was significantly shorter for the SRA group compared to the THA patients — 5 days vs. 6.1 days for the THA group (P=.001).

"There was also a significant difference in return to work: 96% of the SRA patients returned to their previous work within 1 year vs. 83% in the THA group," Venditolli said.

Although patients in both groups demonstrated a high satisfaction rate and achieved similar WOMAC and Merle d'Aubigné functional scores, "SRA patients had better UCLA activity scores (7.1 vs. 6.3; P=.037) and returned to heavier activities (P=.035)" after 2 years, he said.

"This randomized study shows that SRA and THA present a similar complication rate, but distinctive complications," Venditolli said. "It also suggests that SRA results in better function and improved patient activity in comparison to THA.

"However, the effect of long-term fixation related to increased activity levels is unknown. Long-term follow-up is necessary to determine the survivorship of SRA over THA," he said.

For more information:

Vendittoli P-A, Lavigne M, Lusignan D, Roy A-G. A randomized study comparing surface replacement arthroplasty to total hip arthroplasty: 2-4 years follow-up. F028-2. Presented at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association. Sept. 9-13, 2007. Seoul.

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Osteonecrosis of the Femure and Hip Resurfacing

Osteonecrosis Of The Femur - Hip Resurfacing Surgery, Alternatives to Hip Replacement
By Alampallam Venkatachalam

Osteonecrosis is a condition due arising from a diminution of blood supply to bone. It affects most importantly the upper end of the femur. If left untreated it progresses to bony collapse and arthritis. The causes are many like alcohol abuse, steroid intake, Caisson's disease, Gaucher's disease.

The patient can experience sudden pain in the hips which radiates to the knee and can be confused for knee pain. Gait is painful. In early cases, x- rays are negative and MR scans are diagnostic. Treatment in the early stages is controversial and there are no clear guidelines.

Prolonged bed rest and crutch walking have not been shown to relieve pain or halt progression of the disease.

Treatment in late cases

Core decompression does ameliorate symptoms. It is minimally invasive and does not involve a replacement. If it fails then a replacement is possible at a later date.

Treatment in late cases with advanced destruction

Treatment is by a total hip replacement if bony destruction is extensive. A partial or total surface hip replacement is done if destruction is confined to the surface cartilage alone. Since it occurs in young individuals, a Surface Hip replacement is a better option as it conserves bony stock and a total hip replacement can still be done at a later date. Resurfacing of the hip is restricted to those cases of osteo necrosis where the amount of destruction is less than 30 percent of the head. Where it exceeds thirty percent, a new type of hip prosthesis called the Proxima hip is available in Chennai. This Proxima hip is an uncemented metal on metal large diameter bearing. It has been performed for avascular necrosis and other conditions like ankylosing spondylitis, post traumatic arthritis following acetabular fracture. Vascularised fiblar graft is done with the help of a microvascular surgeon.

The author trained with eminent Hip experts in Cambridge, Manchester and Livepool. He performs Hip replacements, Hip resurfacing, Proxima hip replacements, Osteotomies, Fracture fixation, Core decompression, Birmingham replacements at Bharathiraja hospital. Visit http://www.hipsurgery.in and http://www.kneeindia.com Contact him at 00 91 9282165002

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Hip Resurfacing Advantages over THR Study

Study: Surface replacement arthroplasty may offer advantages over THA

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Canadian investigators said hip resurfacing resulted in greater patient activity after 2 years.

By Robert Trace
1st on the web (September 19, 2007)
September 2007

SEOUL — Total hip arthroplasty is an established procedure with well-documented complication rates and clinical results, but surface replacement arthroplasty may offer additional clinical benefits to many patients, according to a group of Canadian researchers.

"We decided in 2003 to do a comparative study of hip resurfacing, or surface replacement arthroplasty (SRA), to the gold standard of total hip arthroplasty (THA), since we were not aware of any direct prospective studies out there comparing the two procedures," said Pascal-André Venditolli, MD, of the Maisonneuve-Rosemont Hospital in Quebec.

He and his colleagues randomly assigned 210 hips to receive uncemented metal-on-metal THA (103 hips) or a hybrid metal-on-metal SRA (107 hips). All surgeries were performed by three orthopedic surgeons, who used a posterior approach.

The researchers prospectively collected perioperative and postoperative data, and analyzed the clinical data for a minimum of 2 years.

Postop complications included three isolated traumatic dislocations and one recurrent dislocation in the THA group, which required acetabular cup revision. Two SRAs required revision for late head collapse. No postop femoral neck fractures occurred in the SRA group, he said.

There was one case of loosening at 6 months postop in the resurfacing group, which had shifted varus. There were also two cases of deep venous thrombosis in both patient groups, he said.

Although the investigators did not report a significant difference in surgical time between the two procedures, patients' length of stay in the hospital was significantly shorter for the SRA group compared to the THA patients — 5 days vs. 6.1 days for the THA group (P=.001).

"There was also a significant difference in return to work: 96% of the SRA patients returned to their previous work within 1 year vs. 83% in the THA group," Venditolli said.

Although patients in both groups demonstrated a high satisfaction rate and achieved similar WOMAC and Merle d'Aubigné functional scores, "SRA patients had better UCLA activity scores (7.1 vs. 6.3; P=.037) and returned to heavier activities (P=.035)" after 2 years, he said.

"This randomized study shows that SRA and THA present a similar complication rate, but distinctive complications," Venditolli said. "It also suggests that SRA results in better function and improved patient activity in comparison to THA.

"However, the effect of long-term fixation related to increased activity levels is unknown. Long-term follow-up is necessary to determine the survivorship of SRA over THA," he said.

For more information:

Vendittoli P-A, Lavigne M, Lusignan D, Roy A-G. A randomized study comparing surface replacement arthroplasty to total hip arthroplasty: 2-4 years follow-up. F028-2. Presented at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association. Sept. 9-13, 2007. Seoul.

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You, Too, Can Have A Bionic Body

You, Too, Can Have A Bionic Body

New materials and high-tech procedures are driving a surge in hip, knee and even ankle replacements.

Knee and hip replacements are serious surgeries, but increasingly, they're also a serious business. As the baby boomers' joints wear out, more of them are turning to orthopedic surgeons for the procedures. Docs now perform more than 450,000 knee replacements and 208,000 hip replacements a year, and rising numbers of them are done to boomers willing and able to pay $30,000 and up. By 2031, one study predicts, docs will perform more than 3.5 million knee replacements alone—a 673 percent increase from current numbers. It's as if an entire generation has taken Matthew 18:8 to heart: "If thy hand or thy foot offend thee, cut them off, and cast them from thee." And, apparently, sub in something better and keep going...

...Now, though, orthopedic surgeons can offer much better treatments. Most exciting is a strategy called "resurfacing," which has come to the United States within the last two years after proving successful in England. Well suited to ac-tive, younger patients, it holds back on replacing the entire joint (usually the hip), instead leaving a great deal of bone in place and covering it with a protective surface. "The pain relief is dramatic, even right away," says Moorman. And it doesn't require some types of traditional cement that can eat away at bone tissue, so it may be a more sustainable fix than a full replacement. Several new resurfacing devices are currently awaiting FDA approval...

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Hip Surgery in Belgium Video
Hip Surgery in Belgium Video

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Lynn Beyler Video of Hip Resurfacing Story in Belgium
Lynn Beyler's Hip Story Video featuring her hip reusrfacing surgery with Dr. De Smet in Belgium.

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Keith McDonald Hip Resurfacing Video
Keith McDonald Hip Resurfacing Video - Choosing a Hip Resurfacing - New York Times Video

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Why I Chose A Hip Resurfacing Instead of a Total Hip Replacement

Why I Chose A Hip Resurfacing Instead Of A Total Hip Replacement
By Pat Walter

My hip hurt, my body hurt and I needed a new hip. I had fought hip pain for almost ten years because I just did not want "half my leg bone cut off" to get a new hip replacement. It just did not make sense to me that doctors were still sawing off a big hunk of a femur bone to replace a hip. We sent men to the moon, had nuclear power and every kind of electronic device imaginable, so why are our operations still old-fashioned?

I asked myself that question quite often. One evening while visiting our local tavern, I was telling a gentleman my feelings about total hip replacement. I am not sure how the conversation started, but perhaps I was complaining about my hip pain. To my surprise, he told me that they don't have to saw off part of your femur bone to replace a hip any more. I was shocked. I had been doing some internet searching, but had not found information about hip resurfacing yet.

He explained that he had his hip resurfaced with Dr. Schmalzried in California in 2005. With hip resurfacing, the surgeon reshapes the top of your femur bone to accept a cap that is the same size as your original bone, he explained. The cap has a small stem which is placed into a hole that is drilled in the top of the femur bone. A small amount of cement is used to hold the cap in place until new bone grows under the cap. A matching metal cup is placed in the acetabulum of your hip to provide a bearing surface for the cap on the femur bone. It becomes a perfect metal bearing which replaces your injured or arthritic hip joint.

Hip resurfacing is major surgery just as a total hip replacement is. The basic difference is that the doctor does not saw off a major portion of your femur bone and drill a long hole into it to accept the long stem of a total hip replacement device.

Hip resurfacing is bone conserving. The reason that hip resurfacing is a better choice than total hip replacement for many people is that at some time in the future, you could require a revision. The actual hip devices don't wear out since they are metal, but the bone holding the hip device often deteriorates. The hip device becomes lose and very painful. A revision is then necessary to replace the old hip device. If a person starts with a hip resurfacing and at some point later in life requires a revision, then they have a complete femur bone for the surgeon to work with. If a person starts with a total hip replacement, then the doctor has to break apart the femur bone to remove the long steam of the old total hip device. The femur bone must be wired back together when the new stem is in place. Hip resurfacing allows a much easier revision later in life if it is required.

The second advantage of a hip resurfacing is that the hip device, due to it's large size, allows a person to return to any of their favorite activities without restrictions or possibility of a dislocation. The old fashioned total hip replacement devices used a very small diameter ball as compared to size of your natural femur bone. The small size of the ball would allow a hip to dislocate easily. The size of the hip resurfacing device is matched very closely to the original size of your hip, so any movements you make are much less likely to cause a dislocation. The hip resurfacing device is acting the same way your natural hip use to function.

I was sixty-one and still felt young when I needed a hip replacement. I had always been very active during my life playing tennis, ice skating, bike riding and participating in other sports. I wanted to remain active and did not want to worry about dislocating a hip after a total hip replacement. I had sixteen dogs and often got on the floor to groom and cut nails. I needed to be as active as possible and the only solution for me was hip resurfacing.

I had my hip resurfaced with a Birmingham Hip Resurfacing, BHR, in March 2006 with Dr. De Smet in Belgium. I did not have health insurance and could not afford surgery in the United States. Dr. De Smet is one of the best hip surgeons in the world and had done over 2400 hip resurfacings when I went to him. My surgery and medical costs were $13,500. The complete trip for my husband and I to Belgium, including the medical costs, was about $17,000. I felt this was the best investment I ever made in my whole life, an investment in my own health and well being.

Birmingham Hip Resurfacing, BHR, was not FDA approved in the United States until May 2006. The BHR had been used world wide for over nine years. Younger, active people all over the world were offered hip resurfacing instead of a total hip replacement. Over 90,000 people world wide have hip resurfacings and now I am one of them. Hip resurfacing has allowed me to be as active as possible without worrying about a dislocation. If you have hip pain and need a new hip, be sure to ask your doctor about hip resurfacing. Although the BHR is FDA approved, many doctors are not trained to do the BHR surgery. It is a more difficult surgery than a THR and requires training and experience. There are many sources available to learn about hip resurfacing like the Surface Hippy Website, a Patient to Patient Guide About Hip Resurfacing, the Yahoo Surface Hippy Discussion Group and many doctor and medical equipment websites.

About the Author: Patricia Walter had her hip resurfaced in March 2006. She is the webmaster and owner of several Patient to Patient Websites about Hip Replacement.

Hip Resurfacing News Features Up to Date News about Hip Resurfacing

Hips for You is a Patient to Patient Guide to Total Hip Replacement

Surface Hippy

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Choosing Hip Resurfacing and a Doctor

Choosing Hip Resurfacing and Choosing a Doctor
By Patricia Dukes Sent: Thursday, September 27, 2007 9:35 AM Question sent to the Yahoo Surface Hippy Discussion Group
Subject: Can you help me decide if I should choose a hip resurfacing or a THR and what doctor to use

You've found the right group to help you in your search. Most of us here have had resurfacing and we believe in it so much that we spend copious amounts of time trying to educate others.

In all likelihood, you can return to whatever sports or activities you want to. We've got people here doing every kind of imaginable activities, including hockey, handball, skiing, biking, horses, surfing, triathletes and runners.

I hope you are already looking through the Surface Hippy Website that you were referred to. It is full of much of the "basic" information that you need to understand resurfacing versus THR and to learn why most of us here think that the day will come when resurfacing will be the first option offered to everyone that qualifies.

THRs were developed for elderly, sedentary people. In the late 70s, younger people began appearing in doctor's offices with bad hips. The wisdom then, and for many of the older doctors now, was to advise patients to wait as long as possible until they could no longer stand the pain and then have a THR. That was because the doctors didn't want to limit their activities and because the doctor's were reluctant to start cutting off leg bones in people that they knew wanted to be active. As they began using THRs for younger, active people it became apparent that the surgery which had turned out to be a Godsend for many elderly, was failing at an unacceptable rate in younger, active people.

Resurfacing was developed as a bone conserving surgery for younger) active people who are not only likely to outlive a primary THR, but will probably outlive a secondary THR. It was developed to lower dislocation rate that was unacceptably high in active patients and to eliminate the thigh pain which is a significant lifelong issue with some THR patients.

Yes, resurfacing is a newer technology and some of the docs want to wait until it has a 50 year track record (it is now looking good at 15 years) before they begin offering it. Where does that leave you? With a prosthesis designed for elderly, sedentary people. Not good, do you think?

Now, hang with me here, there are some better THRs now on the market with large femoral ball which do lower the dislocation risk. New generation metal on metal has done away with the wear problem of poly/metal (which meant doing a surgery every time the poly cup began to wear out), and ceramic has to some extent improved to fix the shattering problem the earlier materials had.

BUT, and this is the very big point you must understand fully: If you have a THR and it fails or needs "revision" they must cut off even more of your leg bone to put in the new one. That second THR (THR revision) has a much higher likelihood of failure AND if you have to have one your activity level is going to have to diminish immediately and significantly. And, there isn't always enough bone left to do a third surgery.

If you have resurfacing, you keep your entire femur in tact. Only the surfaces of your femoral head and acetabular cup are "remodeled", smoothed and then covered with metal. Instead of a long spike extending down into your femur and changing the way your leg bone handles stress, you've got a little "stem" in the femur head. Your entire leg bone stays intact, and if at some later time you need a revision, you can have a primary THR in a surgery no more difficult than a primary THR would be in the first place. Resurfacing gives you a second chance at keeping your leg bone intact.

THR is the most extreme way (cut off the bone) to handle a surface problem. Resurfacing, keeps the leg bone it its natural state, while fixing the problem by replacing the SURFACE. I like the idea of only fixing what is wrong, not using the absolute most drastic fix for a problem that can be solved with a much less invasive solution.

One final thought. You must do away with the concept that the best doctor for you is a local doctor. With resurfacing, the best doctor for you is an experienced doctor, with a track record of good results and happy patients. He may be local, or possibly regional, or maybe across the country. Many people must travel to find a doctor that suits them. Up until the last couple of years, most people had to travel to find the doctor they wanted to do this difficult and challenging surgery. You want a doc with over 100 successful surgeries who is doing several resurfacing each and every week. You don't want a doc with 20 or 30 resurfs or one who is doing one resurf every few weeks in between THRs and other ortho surgeries.

You want a doctor who is convinced that resurfacing is an excellent choice for you and who WANTS you to have resurfacing. You want a doctor who says "I've done MANY cases like yours with excellent success". If a doctor says "I may be able to do it, or a THR is just as good" run, walk, limp, hobble, crawl out of that office - he's not the right doc for you.

We've got docs in the US who are very experienced and who will do an email or telephone consult for FREE. Also some of the best docs in the world will do email consults for FREE.

You've asked for a world expert, and I'm happy to put in a plug for my doctor - Dr Thomas Gross in Columbia, SC. He is considered by many to be one of the top in the world. People come from all over the country to have surgery with Dr Gross. He's approaching 1500 resurfs, he does cases many others won't, his office routinely handles out of town folks, he does 10 or more resurfs every week and he loves seeing young, active people hobble in the door with pain, worry and fatigue on their faces and 3 days later they are walking up and down the hospital hallway on crutches with a grin from ear to ear.

If you'd like to take a look here's his website. Look at Columbia HSR protocol. He does free telephone consults and he's a wonderful, kind, warm, caring man with a fabulous staff that really care.  www.grossortho.com

Resurfacing is a bone conserving surgery and we are the lucky people it was developed for - offering a second chance at the lives we want to have. I couldn't walk, stand, sleep, sit or breath without pain. I'm pain free and restriction free and at 57 that seems pretty darn good to me! Resurfacing - it is what you are looking for.

Pat(ricia)Dukes, Columbia, SC Dr Gross rBiomet 19June2006

Dislocation of a BHR by Dr. Bose
It is truly unfortunate that this lady has sustained a dislocation of a BHR.

It is a commonly used statement that a BHR is as 'stable' as a normal hip.
However this is a highly qualified statement.

This statement is true only if the following criteria are met.

1. Native angles, inclination , offsets and all anatomical parameters have to be replicated.. If this is not done fully and only accuracy of say 80% is obtained - then the stability is likely to be approx in the region of 80% only. Having said this ,even in this situation, the stability is likely to be many times that of a conventional THR. Therefore I would not call it a surgical error. As surgeons, we get better and better at this replication as we gain experience.

2. The capsule should be repaired to capsule preferably as it restores the joint 'proprioception'( or position sense). This would kick in the event of a potential dislocation as it would in a normal hip. If the capsule is repaired to bone , it is many times better than doing nothing but does not achieve the proximity to the stability of a normal hip. Again it is not a surgical error if capsule to capsule repair is not done but one cannot expect natural stability.

3. Other factors that can potentially cause dislocation like impingement must be carefully addressed . The most common offender is the non -restoration of the head neck offset. One must keep in mind that the BHR is the Ferrari of hips and the conventional THR is an old fiat.

Even if the Gear knob of a Ferrari is not the right size for the driver it shows up because it is pushed to the limit and built for performance. However even if the chassis is broken in an old fiat , it would probably go unnoticed by the owner as it is never 'pushed' for performance. There are many patients after THR s with trochanteric non-unions going on for many years without even being aware of it!

Coming to the specifics of this patient.- The Relocated BHR is likely to be stable with time and is unlikely to affect longevity. The only issue is that this patient must avoid extremes of movement to prevent another episode.

I hope this helps

with best regards
Vijay Bose
Chennai
Asian Regional Center for Hip Resurfacing

Loose Acetabulum Cups in Hip Resurfacing by Dr. Bose
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

Navigation Reduces the Learning Curve in Resurfacing Total Hip Arthroplasty
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Clinical Orthopaedics & Related Research. 463:90-97, October 2007.
Cobb, Justin P FRCS; Kannan, Vijaraj MD; Brust, Klaus MD; Thevendran, Gow MD

Abstract:
Hip resurfacing is a novel technique with a substantial learning curve resulting in poor outcomes for many patients. We asked whether navigation would influence this learning curve and accuracy of implantation. Twenty medical students earning their degree in surgical technology participated in a randomized trial. We provided instruction about the surgical technique, including the use of conventional instrumentation, the use of a computed tomography-based planner for hip resurfacing, and a navigation system. The 20 students were then split into three groups undertaking these tasks in three different orders. Synthetic femurs replicated normal, osteoarthritis, slipped capital femoral epiphysis, and coxa valga. The mean error using the conventional method to insert a guidewire was 23[degrees]; using the computed tomography plan method it was 22[degrees]; and using navigation was 7[degrees]. Students produced similar accuracy, even in their first attempt, on difficult anatomy when provided navigation. Motivated students rapidly achieved an expert level of accuracy when provided with navigation. Learning a conventional method first did not improve performance, even in difficult cases. Our data suggest navigation may play an important role in reducing the learning curve in hip resurfacing arthroplasty and other tasks in arthroplasty in which a high degree of accuracy is clinically important.

(C) 2007 Lippincott Williams & Wilkins, Inc.

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Anterior Approach for Hip Resurfacing

Surgical Approaches for Hip Resurfacing
Peter Brooks MD
Cleveland Clinic

Most hip replacement and resurfacing surgery in the USA, about 80%, is performed through a posterior approach. About 20% of US hip surgeons prefer some variation of an anterior approach (antero-lateral, direct lateral, trans-gluteal, or true anterior). Anterior approaches are also more common in Europe and Canada.

In the posterior approach, the incision, dissection, and dislocation of the hip joint are all performed posteriorly (toward the buttock). The large gluteus maximus is split, and the gluteus medius and minimus muscles (hip abductors) are retracted, but not cut. A number of smaller muscles, the “short external rotators” including piriformis, obturator internus, gemelli, quadratus, and obturator externus, are cut, and the tendon of gluteus maximus may also be partially divided. With these out of the way, the posterior hip capsule is incised, and the hip is dislocated posteriorly by turning the foot toward the ceiling. The acetabulum and femoral head are then resurfaced, the muscles and capsule are repaired, and the incision closed.

In the direct lateral approach, (or trans-gluteal approach as it is also known), the incision is on the side of the hip, and from there the dissection proceeds towards the front of the hip joint. The hip abductors (gluteus medius and minimus) are split in the line of their fibers, peeled off the greater trochanter of the upper femur in continuity with upper fibers of the vastus lateralis, and retracted anteriorly, allowing the anterior capsule to be cut, and the hip to be dislocated anteriorly, with the foot pointing down to the floor. During closure, these muscles all tend to lie back where they belong, and since they have not been cut across their fibers, there is no tendency for their repair to pull apart. The antero-lateral approach is similar, but retracts or detaches, rather than splits, the abductors.

The true anterior approach can be adapted to hip resurfacing, actually better than for hip replacement, since exposure to the shaft of the femur is difficult (and not needed in resurfacing). It is not popular among surgeons who operate on adults, but is fairly common in pediatric orthopedics.

Different approaches have different issues. The posterior approach is very well known in the USA, and BHR developers Mr McMinn and Mr Treacy use it routinely as well. Theoretically it should have a higher dislocation rate, due to the fact that dislocation almost always occurs posteriorly, and this approach disrupts all the potential restraints to posterior dislocation. But dislocation after hip resurfacing is much less of a problem than it is with hip replacement, due to the very large head size. The blood supply to the femoral head stands a greater chance of damage through the posterior approach, since that is where the vessels mostly are. The important hip abductors (gluteus medius and minimus) are left completely intact.

The direct lateral (trans-gluteal) approach has the advantage of a lower dislocation rate, and less likelihood of damage to the blood supply of the femoral head. In addition, no muscles are actually cut across; they are just split, or teased apart in the line of their fibers, which should lead to more reliable healing. The exposure of the socket is a “straight shot”, since the acetabulum is an anteriorly facing structure. The disadvantages are that there is nonetheless surgical trauma to the abductors which, if substantial, could cause a limp. There are also reports of heterotopic ossification, although this may occur with any approach.

The true anterior approach can be associated with injury to a sensory nerve responsible for the side of the thigh (lateral femoral cutaneous nerve), and the location of the incision in the groin is not the cleanest part of the body. It is also by far the least commonly used of these incisions for adult hip surgery, so at least for the time being, we do not have a lot of data.

The main thing to keep in mind is that any of these surgical approaches can work just fine. All have been modified in many ways as surgeons find better ways to do things. The most important thing for a patient to decide is who will do their surgery, not how it will be done. The surgeon, drawing on his or her own training, experience and beliefs, will decide what works best in their hands.

Dr. Bose Article About Hip Resurfacing

Hip bone removal, a thing of the past

READ COMPLETE ARTICLE at The Hindu

The Hindu Oct. 11, 2007

CHENNAI: While the average age of those requiring hip replacement surgeries in the West is 65 years, in Asia it is around 35 years. Seventy per cent of those requiring the surgery in Asia are male.

People using steroids or those who have met with road accidents need it. Asians are genetically prone to arthritis. At Apollo Hospital’s Asian Regional Centre for Hip Resurfacing, the youngest patient was a 12-year-old girl who complained of pain and inability to move, consultant orthopaedic surgeon Vijay C. Bose said here on Thursday. Initially, patients complain of pain after a long walk but it gradually progresses so that they have pain even while resting, he told presspersons to whom he introduced his two American patients Roger Fiack and Paul Tarrell.

Gone are the days when orthopaedic surgeons removed the arthritic hip bone to relieve pain. One of the new methods is to introduce prosthesis without taking away the arthritic bone and ensure that normal life is not compromised.

At the Asian Regional Centre for Hip Resurfacing these procedures, known as Birmingham hip resurfacing (BHR) surgeries, are being done since 2000. “In the past seven years, Apollo has performed 1,000 BHRs and mid-hip resurfacing surgeries in contrast to the conventional 600 hip replacement surgeries,” said Dr. Bose. Mr. Fiack and Mr. Tarrell came to Apollo because American hospitals did not offer BHR surgeries until recently. The men, both in their early 60s, will return to their routine when they go home, Dr. Bose said.

READ COMPLETE ARTICLE at The Hindu

1000 Hip Resusrfacings Completed by Dr. Bose of India

Apollo performs 1,000 hip surfacing surgeries
Friday October 12 2007

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CHENNAI: Apollo Hospitals in the city has completed 1000 hip surfacing surgeries, a new technique which involves treating hip problems without hip replacement.

Hip surfacing is an innovative technique preserving bone in the hip in contrast to hip replacement, consultant orthopaedic surgeon at the hospital Dr Vijay Bose told reporters here.

"The surgery facilitates near normal hip function, enabling patients to be very active after surgery and free from any restrictions," he said.

It would be suitable for Asian patients as they could sit on the floor or go about their routine activities comfortably after the surgery, Bose said, adding it was also much longer lasting as it employed a metal on metal bearing.

He said the first hip surfacing surgery was done in May 2000. The youngest patient to undergo it was a 12-year old girl, three years ago.

The number of patients affected with hip problems was high among Asians, since they used more steroids for treating various diseases. "They use traditional medicines which contain a high amount of steroids, which cuts off blood supply to the hip and causes problems," he said...

READ COMPLETE ARTICLE at New India Press

Dr. Colizza of Morristown NJ Performs Birmingham Hip Resurfacing
NEW JERSEY SURGEON INTRODUCES UNIQUE ALTERNATIVE TO TOTAL HIP REPLACEMENT
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Innovative Birmingham Hip Resurfacing™ System preserves bone and joint stability for young, active patients

Morristown, NJ. (November 30, 2006) - Dr. Wayne A. Colizza of Morristown Memorial Hospital is among an exclusive group of surgeons in this country who have been trained in the remarkable new Birmingham Hip Resurfacing (BHR) technique. Rather than replacing the entire hip joint, as in a total hip replacement, hip resurfacing simply shaves and caps a few centimeters of bone within the joint.
Continue reading "Dr. Colizza of Morristown NJ Performs Birmingham Hip Resurfacing"

Tim Taylor Hip Resurfacing With Dr. Raterman in Florida

The Journey Back Begins
Posted By Erik Erlendsson at Oct 16, 2007 at 02:05 AM

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Lightning captain and two-time Stanley Cup champion Tim Taylor underwent hip resurfacing surgery on his right hip Sept. 6 to repair a degenerative condition that plagued him for much of last season. The surgery was performed by Stephen Raterman at University Community Hospital, and Taylor has begun the rehabilitation process as he attempts to become the first player in a contact sport to play after the procedure.

Continue reading "Tim Taylor Hip Resurfacing With Dr. Raterman in Florida"

DAST International's First Candidate Receives a Hip Resurfacing
News from Trad Spencer Oct. 19, 2007
Just wanted you to know my surgery was a complete success. I am already up and walking on crutches. We've met with Pat Dukes and her husband. They were extremely helpful. Dr. Gross is a wonderful man and his staff superb. So glad he did the surgery. Our rooms at the hotel were excellent. Today is Friday and we leave on Sunday for home. A big hug and thank you to you and DAST.

Sincerely, Spencer and family