Doctors Articles

 

Addressing the Negative Press

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Updated Sepetember 6, 2011

There have been some recent articles in the press that have expressed some concern over Metal on metal and hip resurfacing in general.  To someone just reading up on the procedure, these articles can be very misleading.  Please keep in mind that the articles are written by a journalist (mainly Barry Meier) that wants to “sell” stories and not necessarily pass on good solid objective information.  The above mentioned journalist likes to write HALF truths.  I know for a FACT because he had called me personally and interviewed me for over an hour on the phone.  He asked me for the names of two patients who had hip resurfacing, one success story that was a female and one femoral neck fracture that was a female.  I gave him the names of Kathy the neck fracture and Melissa a gal who had her BHR for over 12 years and was extremely happy with her results.  Barry Meier NEVER even bothered to contact Melissa, the success story.  He ONLY chose to print the negative side of things in his first article that had within the title Women Red Flags about hip resurfacing.

I am sure you have read some of his work, he has come out with so many HALF truth articles since that first one, either warning women not to get the procedure, or overly emphasizing the VERY small percentage risk of neck fracture without talking about the causes or talking about the excess metal wear without mentioning that the main cause for this is due to surgeon malpositioning of the component.  He fails to mention that the very first pseuodo tumor was found in a patient who had a POLY THR device, not even a metal on metal device.

Also a lot about metal ions, using scare tactics and only quoting the one Oxford study that produced horrible results and a lot of Pseudo Tumors instead of mentioning the details behind that study including the fact that a lot of the surgeons in the study were only trainees and the fact that the components were placed at such ridiculous angles that anything installed that poorly would surely produce negative outcomes.  The ideal cup angle placement should be about 40 degrees and this Oxford study produced cup angles ranging from 10.1 degrees upwards to 80.6 degrees which is astounding and unacceptable.

The Press fails to mention the real important facts behind their claims.  IMO, and this is just that, my non-medical personal opinion, these articles are extremely biased, misleading and leave out way too many facts.  They are extremely one sided, written in a way to scare people off from an incredible procedure that if done correctly gives patients back our lives.  I sincerely hope that the author of some of these articles never has a hip problem or ever has a close family member, like his wife or sister or in the future his own daughter in need of hip surgery.

This procedure is amazing and I for one am an extremely happy patient that happens to be a female with mild dysplasia and extreme allergy to metal earrings and I am small boned.  My left BHR hip resurfacing is still going strong at close to 6 years post op (December 1, 2005).  It worked so well in my left hip, that I went back on December 6, 2010 to get my right hip done, so I am 9 months post op today from my right BHR hip.  My BHR’s literally gave me back my life, a full active life.  I have just started doing the P90X workout and could not imagine doing something that aggressive had I had a THR.

Potential patients researching their options should do their own research and discuss their options with Orthopedic surgeons that do BOTH procedures.  Doctors that have done at a minimum several hundred, preferably at least 500 resurfacings by now, since FDA approval was over 4 years ago.   Do not believe all that you read in the press.  Keep in mind that all Hip Resurfacing surgeons also perform THR’s but most THR surgeons do NOT perform hip resurfacing.

Here you will find what some prominent Orthopedic surgeons say to address this negative press….and HERE , as Paul Harvey would say…is the REST OF THE STORY

Below are video interviews with six world renowned Hip Surgeons.  Between the six of them, in May of 2010, they had performed more than 27,000 total hip surgeries and over 13,000 Hip Resurfacings, so by now, those numbers have gone way up.  The first one is with Derek McMinn, the inventor of the BHR device and is in three parts.

Derek McMinn addresses the 4Corners Dispatches program

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May 16, 2011

The Dispatches program ‘Going Under the Knife‘ aired on the 16th of May 2011 and ‘The One Show’ program aired on the 24th of May 2011 raise two or three important questions.

TV Programs ‘Dispatches’ and ‘The One Show’ highlighted failures with ASR resurfacings. Do these apply to the BHR as well?

These TV programs did a good job of bringing to attention the sad saga of failures with the ASR hip. Although the experience of only one Centre was highlighted, this experience with ASR failures is widespread. What the programs did not show was the experience of the same Centre with Birmingham Hip Resurfacings (BHR). Their data in the figure below clearly shows that wear‐related failures with the BHR are extremely low (1.3%) and that failures are highly implant specific. BHR is now being used in their Centre again.

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Six World Renowned Surgeons discuss concerns about Metal – metal Hip Resurfacing in Video Interviews

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Click here to watch six world renowned Orthopedic surgeons talk about the recent press regarding the concerns over metal on metal implants.   Between the six of them, they have performed more than 27,000 total hip surgeries and over 13,000 Hip Resurfacings.  Mr. Derek McMinn, M.D. , Dr. Edwin Su , Dr. Koen De Smet , Dr. Harlan Amstutz , Dr. Tony Nargol and Dr. Vijay Bose
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What is the Best Bearing Type by Dr. Thomas Gross

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What is the Best Bearing Type?            1/11/2011

A comparison of modern bearing types.
Thomas P. Gross, M.D.

As a patient there are four reasons you should consider a metal-on-metal bearing total hip replacement or resurfacing:

  1. WEAR:  Low.
  2. BREAKAGE: Unbreakable bearing.
  3. STABILITY: Maximum stability of the joint.  Using a metal-on-metal bearing surface allows the manufacture of a large bearing hip joint that will not dislocate.
  4. BONE PRESERVATION: Resurfacing is only possible with this bearing type. This allows bone preservation and avoidance of a stem in the femoral canal.

Hip replacement has come a long way since the 1950’s. It has improved to the point where middle aged or older patients can expect a relatively long life out of the implants if they follow certain restrictions and don’t participate in high impact sports.

However, most implants are not good enough to allow full unrestricted activity at high demand levels.

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Mr. Derek McMinn on Pseudotumors

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Mr. Derek McMinn on Pseudotumors – May 2010 (taken from written interview)

A few centres have reported a phenomenon, which has been named ‘pseudotumors’ by a renowned orthopaedic hospital in Oxford. The term pseudotumor refers to a problem, whereby a hip resurfacing or a metal-on-metal hip replacement fails with a painful swelling or with collection of fluid around the hip joint. The word ‘pseudotumor’ has caused consternation among patients who were worried if this is some kind of a hidden cancer or a pre-cancerous condition. These need to be put into perspective.

First, let us be clear that these reactions have nothing to do with cancer. Second, there isn’t a single artificial hip system metal, ceramic or plastic, that does not generate wear debris and all types of wear debris have been associated with these pseudotumor-type adverse reactions. Third, it is now becoming apparent that in a majority of cases of pseudotumors, the primary reason for the development of these reactions is excessive material being worn out from the device because they had been fixed in a skewed fashion in the first place. No artificial hip device lasts long unless it is placed in an optimal position. The components that had been removed in Oxford were tested in a highly sophisticated laboratory. It was found that in every case with a pseudotumor, the wear pattern in the components suggested edge-loading i.e. the components had worn excessively in an unnatural manner because of their placement in an unfavourable position. In components which did not show edge-loading i.e. those components which had been placed in the correct position to start with, no one had developed a pseudotumor.

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Metal wear on metal on metal implants by Dr. Thomas Gross

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The controversy regarding adverse wear in metal-metal bearings
Thomas P. Gross , MD 3/5/2010

I have used over 3000 metal bearings in primary total hip and hip resurfacing as well as revision
surgery. I have revised 2 for adverse wear 7 years after implantation. I know that most other high
volume hip resurfacing surgeons have a similar experience. The revisions were straightforward
and the patient enjoyed the same rapid and complete recovery as if she had a primary hip
replacement.

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Hip Resurfacing vs THR by Mark Bloomfield

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Posted by Mark Bloomfield on hipsrus Message board on April 20, 2009

Have not been here for a while, but thought it time to post something, especially after attending the recent British Hip Society meeting in Manchester.

Which, by the way, was poorly attended by what would be regarded as the doyens of UK hip surgery. Mostly new consultants, registrars or other ‘training’ grades. Not sure why. Maybe everyone is feeling fatigued by the credit crunch, the declining state of the NHS etc.

I have now done over 1000 hip resurfacings. Practically all the Birmingham device marketed by Smith & Nephew. So I thought I would share what I think about the technique right now. This is not a scientific paper and the views expressed are my own. I suppose I could ‘prove’ most of what is written below by suitable references in the literature, but some is instinct or gut feel. So it could be wrong, but chances are high the views expressed are accurate!

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Hip Resurfacing by John O’Hara

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HIP RESURFACINGS
by John N O’Hara FRCS FRCSI MCh
April 22, 2010

NOTE:  The Birmingham Hip Resurfacing was originally manufactured by the same company that is now manufacturing the Adept, so when he refers to Adept the design and metallurgy is the same for the BHR

The original or very first resurfacing that we know of was made of solid Teflon on both sides.  It was designed by John Charnley, who was dissatisfied with the results and changed instead to develop metal on plastic hip replacements.

Although John Charnley’s experience with Teflon was poor, other surgeons in the sixties and seventies, such as Heinz Wagner in Nuremberg and Michael Freeman in London, experimented with metal on plastic resurfacing.  This was little better than Teflon on Teflon resurfacing.

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Mr. Derek McMinn Published Papers

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A five-year radiostereometric follow-up of  the Birmingham Hip Resurfacing arthroplasty

A new approach to the hip in revision surgery

A technique for removing an intrapelvic actabular cup

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Birmingham Hip Resurfacing vs. Conserve Plus Metal-on-Metal Hip Resurfacing

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A surgeon’s perspective By Dr. Koen de Smet

Click here to download pdf file.

 Posted by at 8:04 pm