Published Articles

 

 

A Clinicoradiologic Study of the Birmingham Mid-Head Resection Device

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by Joseph Daniel, FRCS; Chandra Pradhan, FRCS; Hena Ziaee, BSc (Hons); Derek J.W. McMinn, FRCS

Abstract

This is a 1.2- to 5.3-year survival and clinicoradiologic study of patients with the Birmingham Mid-Head Resection (BMHR) device (Smith & Nephew Orthopaedics, Warwick, United Kingdom). Sixty consecutive hips implanted with this device between 2003 and 2007 were reviewed with hip outcome questionnaires, clinical examination, and radiographs at a minimum follow-up of 1 year. There were no revisions, mechanical failures, or signs of femoral neck stress shielding. All hips were functioning well and showed no significant adverse clinical or radiographic features. Birmingham Mid-Head Replacement offers the prospect of circumventing the need for a more invasive procedure such as hip replacement in patients who would benefit from a conservative arthroplasty but lack femoral head bone quality, which is a prerequisite for a successful hip resurfacing.

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Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis

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The results of conventional hip replacement in young patientswith osteoarthritis have not been encouraging even with improvementsin the techniques of fixation and in the bearing surfaces. Modernmetal-on-metal hip resurfacing was introduced as a less invasivemethod of joint reconstruction for this particular group.This is a series of 446 hip resurfacings (384 patients) performedby one of the authors (DJWM) using cemented femoral componentsand hydroxyapatite-coated uncemented acetabular components witha maximum follow-up of 8.2 years (mean 3.3). Their survivalrate, Oxford hip scores and activity levels are reviewed.
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Limiting hip resurfacing to appropriate patient population will aid in success

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ORLANDO, Fla. — Despite the problems seen with some hip resurfacing implants, hip resurfacing is still a viable alternative to hip replacement in appropriately selected patients, a surgeon here said.

“Many of the reasons not to perform hip resurfacing are based upon fear: fear of fracture, fear of difficulty of the technique, fear of metal reactivity and sensitivity. I implore you that we should not allow fear to triumph over reason,” Edwin P. Su, MD, said during a presentation at the 2010 Current Concepts in Joint Replacement Winter Meeting.

In support of hip resurfacing

Su presented several factors in favor of hip resurfacing. Hip resurfacing preserves bone, as was observed in a cadaveric study he and his colleagues performed that compared hip resurfacing and hip replacement to determine the extent of bone loss.

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Blood metal ion concentrations after hip resurfacing arthroplasty -ASR vs BHR

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A COMPARATIVE STUDY OF ARTICULAR SURFACE REPLACEMENT AND BIRMINGHAM HIP RESURFACING ARTHROPLASTIESThere have been no large comparative studies of the blood levelsof metal ions after implantation of commercially available hipresurfacing devices which have taken into account the effectsof femoral size and inclination and anteversion of the acetabularcomponent. We present the results in 90 patients with unilateralarticular surface replacement (ASR) hip resurfacings (mean timeto blood sampling 26 months) and 70 patients with unilateralBirmingham Hip Resurfacing (BHR) implants (mean time 47 months).

The whole blood and serum chromium (Cr) and cobalt (Co) concentrationswere inversely related to the size of the femoral componentin both groups (p < 0.05). Cr and Co were more strongly influencedby the position of the acetabular component in the case of theASR, with an increase in metal ions observed at inclinations> 45° and anteversion angles of < 10° and >20°.

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New data reinforces the proven safety and effectiveness of the BIRMINGHAM HIP Resurfacing System

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Orthopaedics T 901.396.2121
Smith & Nephew, Inc. F 901.399.5187
1450 Brooks Road www.smith-nephew.com
Memphis, TN 38116
News

80-percent of US surgeons choose the BHR hip as it outperforms all other metal-on-metal resurfacing devicesMemphis, Tenn. (May 3, 2010) – Recent new data1 presented at this year’s American Academy of Orthopaedic Surgeons (AAOS) annual meeting reinforces the BIRMINGHAM HIP™ Resurfacing (BHR) System as a safe and effective hip resurfacing device. The multi-site study, performed by orthopedic surgeons practicing at nine Canadian academic centers, showed that three years after surgery, 99.91% of their 3,400 hip resurfacing patients experienced no implant failure due to metal wear debris. The BHR Hip was the most used resurfacing device in this study.

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FDA on Metal Metal Implants

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Follow-Up for Metal-on-Metal Hip Patients Developing Local Signs/Symptoms

Clinical and Imaging Evaluation

If you have a patient with the presence of local symptoms such as pain or decrease in joint function that appear more than three months after metal-on-metal (MoM) hip implant surgery, you should conduct a thorough evaluation.

  • Guide your clinical evaluation by the symptoms and physical findings, including an assessment for well-known emergent complications including joint infection, implant loosening, peri-prosthetic fracture and dislocation.
  • Recognize that localized lesions associated with reactions to metal debris may also present with pain or a variety of other signs/symptoms including:
    • Local nerve palsy
    • Palpable mass
    • Local swelling
    • Joint dislocation or subluxation
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Rethinking informed consent: Tell your patients of all the treatment choices available to them

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Duty to disclose material information is not limited by the fact that the proposed treatment or therapy is, or is not, surgical or physically invasive in nature.
By B. Sonny Bal, MD, JD, MBA; Lawrence H. Brenner, JD
ORTHOPEDICS TODAY 2009; 29:24

The editors gratefully acknowledge the contribution of Jeffrey A. Shane, MD, JD, in the preparation of this article.

The doctrine of informed consent continues to stir debate among physicians, ethicists, and courts. The origins of informed consent derive from the common law tort of battery, which is defined as the intentional harmful or offensive contact to another. Valid consent of the plaintiff negates an allegation of battery. Thus, absent a signed informed consent, a patient could sue a surgeon for battery even if the operation were properly indicated and expertly performed. Over the last century, this traditional understanding of informed consent and how it applies in the medical field has continued to evolve. . . . . . .
In this column we examine two recent legal decisions related to informed consent. The first was issued in Wisconsin and addresses the duty of a physician to inform patients of available options and alternatives to a proposed treatment. The second, from Maryland, illustrates how the concept of informed consent attaches to the continuing communication between a patient and physician during treatment. Both touch the boundaries of the doctrine of informed consent in the context of a health care provider’s

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Birmingham hip resurfacing IS ACETABULAR BONE CONSERVED?

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Excerpt:

“For age-matched women, the mean outside diameter of the Birminghamhip resurfacing acetabular components was 2.03 mm less thanthat of the acetabular components in the uncemented total hipreplacements (p < 0.0001). In similarly matched men therewas no significant difference (p = 0.77). A significant differencewas also found between the size of acetabular components usedby the two surgeons for Birmingham hip resurfacing for bothmen (p = 0.0015) and women (p = 0.001). In contrast, no significantdifference was found between the size of acetabular componentsused by the two surgeons for uncemented total hip replacementin either men or women (p = 0.06 and p = 0.14, respectively).This suggests that variations in acetabular preparation alsoinfluence acetabular component size in hip resurfacing.”

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Early resection of heterotopic ossification after total hip arthroplasty: A review of the literature

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K. DE SMET, C. PATTYN, R. VERDONK
Department of Orthopedics and Traumatology, Ghent University Hospital, Gent – Belgium

ABSTRACT: Early excision of heterotopic ossification was performed in 8 patients at an average of 10.2 months after total hip arthroplasty. All patients received a single irradiation dose of 7Gy the day before the operation, followed by oral indomethacin (3x25mg/day) for six weeks. Continuous passive mobilization under epidural anesthesia was started immediately post-operatively. At an average follow-up of 2 years none of them had radiographic or clinical evidence of recurrence. Consequently we recommend resection as soon as there are severe clinical implications, even when bone scans indicate immaturity of the heterotopic ossification and provided that the resection is combined with proper non-surgical treatment consisting of irradiation and oral indomethacin and immediate extensive rehabilitation
program. (Hip International 2002; 4: 383-7)

KEY WORDS: Heterotopic ossification, Resection, Total hip arthroplasty

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Treatment of Heterotopic Ossification

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Heterotopic ossification is defined as bone formation in nonosseous tissues. Heterotopic ossification usually occurs in trauma such as fractures and surgical procedures. Heterotopic ossification of the hip, for example, is the most common complication of total hip arthroplasty (THA). It can occur in as many as 53% of THA patients, and it causes postoperative disability from pain and limited range of motion (ROM) 7% of the time.1 Heterotopic ossification also is seen in neurologic disorders such as spinal cord and brain injury.
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Primary Ceramic-Ceramic THR vs Metal-Metal Hip Resurfacing in Active Young Patients

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Abstract

The purpose of this study was to compare clinical outcomes between ceramic-on-ceramic total hip replacement and metal-on-metal hip resurfacing arthroplasty in comparable groups of young active patients at a 3- to 6-year follow-up. The first 250 patients (mean age, 49.54 years) of a series of 930 resurfacing arthroplasties were compared clinically and functionally with a series of 190 patients (mean age, 46.76 years) with ceramic-on-ceramic uncemented total hip prostheses. The total Harris hip score was 97.9 in the resurfacing group vs 92.1 in the ceramic group. In the resurfacing group, 60.71% had a strenuous activity level vs 30.43% in the ceramic group.

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Learn from others to minimize learning curve with hip resurfacing arthroplasty

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Added March 2, 2010

A surgeon with extensive hip resurfacing experience finds its indications narrower than for THR.

Orthopedic surgeons experienced in hip resurfacing know that performing the procedure correctly is associated with a fairly steep learning curve. To help minimize that curve, a surgeon speaking at Orthopedics Today Hawaii 2010 discussed how his resurfacing results improved over time.

“There is no need for every surgeon to repeat the learning curve. Because there is now so much information out there, if you know what was learned by those before you, you do not have to repeat the learning curve,” said Thomas P. Schmalzried, MD, section editor for joint replacement on the Orthopedics Today Editorial Board.

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Study Shows Hip Resurfacing a Viable Option for Younger Patients

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AAOS 2009: Study Shows Hip Resurfacing a Viable Option for Younger Patients

March 4, 2009 (Las Vegas, Nevada) — Patients who have undergone hip resurfacing report significantly better quality of life, less pain, and more satisfaction a year after their surgery than those who underwent total hip replacement, according to a study presented here at the American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting.

When it came to functional activities, more patients who received hip resurfacing than [who received] total hip replacements were very satisfied with their surgeries,” said lead researcher Elizabeth Anne Lingard, MD, from Freeman Hospital, in Newcastle Upon Tyne, in England. There was also a trend among hip-resurfacing patients toward more satisfaction with recreational activities, although this did not reach significance, Dr. Lingard said.

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With Warning, a Hip Device (ASR) Is Withdrawn

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By BARRY MEIER

Published: March 9, 2010

A unit of Johnson & Johnson, just months after saying it was phasing out an artificial hip implant because of slowing sales, has warned doctors that the device appears to have a high early failure rate in some patients.

The action by the company, DePuy Orthopaedics, follows more than two years of reports that the hip implant, which is known as the ASR, was failing in patients only a few years after implant, requiring costly and painful replacement operations.

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Optimal acetabular cup positioning is attained in less than 50% of cases, study reports

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March 9, 2010

NEW ORLEANS — High-volume surgeons are more likely than low-volume surgeons to attain optimal cup positioning for total hip arthroplasty, but both groups still attain optimal cup positioning less than half of the time, according to a study presented here.

The findings were presented by Bryan Jarrett, BS, at the 56th Annual Meeting of the Orthopaedic Research Society.  Jarrett said the purpose of the study was to attempt to correlate the influence of various patient factors — body mass index (BMI), age, gender and primary diagnosis for the total hip arthroplasty (THA) — with the positioning of the acetabular cup.

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Soft tissue reactions to metal-on-metal hip arthroplasty are due mostly to surface wear

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The relationship of wear and tissue reaction is linked to joint size and orientation, not gender.

By Robert Trace
ORTHOPAEDICS TODAY EUROPE 2009; 12:6

MANCHESTER — Researchers reported that adverse soft tissue reactions following metal-on-metal hip arthroplasty are typically due to increased wear of the bearing surfaces, and patients with smaller femoral heads may be particularly susceptible to these complications.

In an independent center study, David J. Langton, MRCS, and colleagues in the Joint Replacement Unit at the University Hospital of North Tees in Stockton, England, reviewed 155 Birmingham Hip resurfacings (BHR, Smith & Nephew) performed between 2002 and 2009 (mean follow-up, 60 months). They also studied 420 articular surface replacements (ASRs) and 75 total hip replacements using ASR XL implants (both DePuy Orthopaedics) with S-ROM stems (DePuy Orthopaedics) with a mean follow-up of 35 months.

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FDA gives Wright Medical approval to market Conserve Plus resurfacing system

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Excerpt:

By Susan M. Rapp
1st on the web (November 10, 2009)

The Conserve Plus Total Hip Resurfacing System, manufactured by Wright Medical Group Inc., Arlington, Tenn., has been cleared for marketing by the U.S. Food and Drug Administration (FDA), the company announced yesterday.

The Conserve Plus system is the third metal-metal hip resurfacing implant to be approved by the FDA in recent years.

“The approval permits Wright to market Conserve Plus in the original femoral and acetabular component configuration specified in its Premarket Approval (PMA) application and enables the Company to initiate efforts to introduce additional enhancements to the system which are currently only available outside of the United States,” according to a Wright Medical’s Nov. 9 press release.

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A Joint Venture Is the New Hip Thing

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By JAMES TARANTO

Warwick, England

I am a natural-born American, but part of me was made in England. I’ve come to this town, 25 miles southeast of Birmingham, to find out how.

The hum of machines is ubiquitous in the Smith & Nephew factory, where the floor is divided into “cells” the size of small rooms, each a self-contained assembly line making a particular part. Workers in a cell transform a dull-gray metal piece, cast at another facility, into a gleaming, perfectly shaped finished product, measured to an accuracy of a few microns. Every part is numbered, so that it can be tracked throughout its lifetime, and inspected and cleaned multiple times before shipment. I am grateful for this precision and care. Two of these parts — a ball and a matching socket — are now my right hip.

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Outcome of hip resurfacing may be dependent on experience

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By Gina Brockenbrough
1st on the web (February 27, 2009)

LAS VEGAS — A new study links outcomes of hip resurfacing to the hospital volume of resurfacing cases and, thereby, the surgeon’s experience.

To evaluate the impact of operative volume on hip resurfacing outcomes, Andrew J. Shimmin, MD, and colleagues used the Australian Joint Registry to identify nearly 9,000 hip resurfacings performed at 196 hospitals between September 1999 and December 2006. The investigators used revision as an endpoint for survivorship.

They found that 74% of hospitals performed fewer than 30 procedures during the 7-year study period, while 64% of hip resurfacings were performed at 16 “high-volume” hospitals, or those that performed more than 100 cases. Overall, the researchers found that 3.1% of resurfacings were revised.

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A Simple, Reproducible Method for Centering the Guide-Pin in Hip Resurfacing Arthroplasty

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By Jared R. Foran, MD; Scott T. Ball, MD
ORTHOPEDICS 2009; 32:896

With this technique, guide-pin placement and subsequent femoral head preparation can be performed accurately and efficiently without the need for additional instruments, navigation, or imaging.
Hip resurfacing arthroplasty has undergone a recent resurgence in popularity. A number of studies with short- to mid-term follow-up, as well as the Australian Hip Registry, have validated hip resurfacing as a viable alternative to traditional total hip replacement, particularly for younger, more active patients with good bone quality.

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Clinical outcomes after hip resurfacing associated with commitment to rehabilitation

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By Gina Brockenbrough
1st on the web (March 3, 2009)

LAS VEGAS — A new study links patients’ commitment to rehabilitation with functional outcomes and satisfaction following total hip resurfacing arthroplasty.

“We found that commitment to rehab correlates with improved function and satisfaction, a fact that has not specifically been discussed and not much looked at in the literature to date,” David R. Marker said during his
presentation at the American Academy of Orthopaedic Surgeons 76th Annual Meeting, here.

“Obese patients are more likely to be less committed to rehabilitation. Surgeonsshould be aware of these patients and perhaps need to help them out with theirrehabilitation. Finally, new protocols may be necessary for young metal-on-metalpatients who desire a quicker return to activity,” he said.

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With Warning, a Hip Device (ASR) Is Withdrawn

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By BARRY MEIER

Published: March 9, 2010

A unit of Johnson & Johnson, just months after saying it was phasing out an artificial hip implant because of slowing sales, has warned doctors that the device appears to have a high early failure rate in some patients.

The action by the company, DePuy Orthopaedics, follows more than two years of reports that the hip implant, which is known as the ASR, was failing in patients only a few years after implant, requiring costly and painful replacement operations.

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Concerns Over ‘Metal on Metal’ Hip Implants

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By BARRY MEIER
Published: March 3, 2010

Some of the nation’s leading orthopedic surgeons have reduced or stopped use of a popular category of artificial hips amid concerns that the devices are causing severe tissue and bone damage in some patients, often requiring replacement surgery within a year or two.

In recent years, such devices, known as “metal on metal” implants, have been used in about one-third of the approximately 250,000 hip replacements performed annually in this country. They are used in conventional hip replacements and in a popular alternative procedure known as resurfacing.

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Knowing the cause of resurfacing failure can ensure successful conversion to THR

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Added March 2, 2010

The shell can be retained in cases involving femoral neck fracture, femoral loosening or impingement.

Although hip resurfacing is becoming a popular option for surgeons treating young and active patients, the procedure carries a higher short-term failure rate than total hip arthroplasty, according to a New York surgeon.

At the 26th Annual Current Concepts in Joint Replacement Winter Meeting, Edwin P. Su, MD, described how surgeons can obtain good outcomes when converting a failed hip resurfacing to a total hip replacement (THR).
Causes of failure

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Optimal acetabular cup positioning is attained in less than 50% of cases, study reports

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March 9, 2010

NEW ORLEANS — High-volume surgeons are more likely than low-volume surgeons to attain optimal cup positioning for total hip arthroplasty, but both groups still attain optimal cup positioning less than half of the time, according to a study presented here.

The findings were presented by Bryan Jarrett, BS, at the 56th Annual Meeting of the Orthopaedic Research Society.  Jarrett said the purpose of the study was to attempt to correlate the influence of various patient factors — body mass index (BMI), age, gender and primary diagnosis for the total hip arthroplasty (THA) — with the positioning of the acetabular cup.

Read more…

Soft tissue reactions to metal-on-metal hip arthroplasty are due mostly to surface wear

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The relationship of wear and tissue reaction is linked to joint size and orientation, not gender.

By Robert Trace
ORTHOPAEDICS TODAY EUROPE 2009; 12:6

MANCHESTER — Researchers reported that adverse soft tissue reactions following metal-on-metal hip arthroplasty are typically due to increased wear of the bearing surfaces, and patients with smaller femoral heads may be particularly susceptible to these complications.

In an independent center study, David J. Langton, MRCS, and colleagues in the Joint Replacement Unit at the University Hospital of North Tees in Stockton, England, reviewed 155 Birmingham Hip resurfacings (BHR, Smith & Nephew) performed between 2002 and 2009 (mean follow-up, 60 months). They also studied 420 articular surface replacements (ASRs) and 75 total hip replacements using ASR XL implants (both DePuy Orthopaedics) with S-ROM stems (DePuy Orthopaedics) with a mean follow-up of 35 months.

Read more…

 

Metal-on-Metal Hip Resurfacing: The Effect of Component Position

D.H. Williams; U. Masood; and M.N. Norton
Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK.

Decreased head-neck ratio diameter and component malposition in total hip arthroplasty are factors known to result in impingement, increased rates of dislocation, wear and failure. In addition to these complications, impingement of the femoral neck on the acetabular component of a hip resurfacing may result in femoral neck fracture and loosening of the acetabular component. Little is known regarding the optimum femoral and acetabular hip resurfacing component position to avoid impingement.

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Position of Hip Resurfacing Component Affects Outcome

Position of Hip Resurfacing Component Affects Strain and Resistance to Fracture in the Femoral Neck

Abstract:

The Journal of Bone and Joint Surgery (American). 2008;90:1951-1960.doi:10.2106/JBJS.F.00788
© 2008 The Journal of Bone and Joint Surgery, Inc.

Thomas Parker Vail, MD1, Richard R. Glisson, BS2, David E. Dominguez, MD2, Kenichi Kitaoka, MD, PhD2 and Danielle Ottaviano, MEng2

 

 

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Popular Supplements Ineffective Against Arthritis

A two-year study of how well glucosamine and chondroitin sulfate slow cartilage loss in arthritis patients could not show that the popular nutritional supplements work any better than sugar pills.”We don’t have good evidence that it slows (disease) progression,” says rheumatologist Allen Sawitzke, professor of internal medicine at the University of Utah and lead investigator.  A two-year study of how well glucosamine and chondroitin sulfate slow cartilage loss in arthritis patients could not show that the popular nutritional supplements work any better than sugar pills.”

 

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Revision of metal-on-metal resurfacing arthroplasty of the hip -INFLUENCE OF MALPOSITIONING

THE INFLUENCE OF MALPOSITIONING OF THE COMPONENTS

R. De Haan, MD, Resident in Orthopaedic Surgery1; P. A. Campbell, PhD, Research Scientist2; E. P. Su, MD, Orthopaedic Surgeon3; and K. A. De Smet, MD, Orthopaedic Surgeon4 1 University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
2 J. Vernon Luck Snr MD, Orthopaedic Research Centre, Orthopaedic Hospital/University of California Los Angeles, 2400 South Flower Street, Los Angeles, California 90007, USA.
3 Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, USA.
4 ANCA Medical Centre, Krijgslaan 181, 9000 Ghent, Belgium.

We have reviewed 42 patients who had revision of metal-on-metalresurfacing procedures, mostly because of problems with theacetabular component. The revisions were carried out a meanof 26.2 months (1 to 76) after the initial operation and mostof the patients (30) were female.

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Intraoperative Fractures: Rising Problems

By Michael E. Berend, MD; Todd Bertrand, BA

ORTHOPEDICS
2007; 30:750
September 2007

All hip surgeons have had the experience of completing a primary total hip arthroplasty (THA) only to discover a proximal femoral fracture just prior to reducing the hip. We can comfort our patients and ourselves that the outcome of a THA with a proximal femoral fracture is excellent with proper treatment and uncemented stem fixation. The purpose of this study was to examine risk fractures, treatment options, and outcomes in THA with proximal femoral fractures.

Fracture Risk Factors

As the number of uncemented THAs has  increased,1,2 there is no question the incidence of uncemented stem fractures has increased as as well.3 The risks for fracture during THA have been well studied. In their study, Schwartz et al4 found women were at higher risk for proximal femoral fracture with the AML stem (DePuy, Warsaw, Ind).

Changes in instrumentation and implantation have helped reduce the risk of fracture. Berend et al5 noted higher fracture rates in hips undergoing THA for a diagnosis other than osteoarthritis.

For full article Click Here

Leg up for Ex-Swedish Footballer

Express News Service
First Published : 15 Nov 2008 06:46:00 AM IST
Last Updated : 15 Nov 2008 09:58:53 AM IST

CHENNAI: Benny Axelsson started playing for the national Swedish soccer team at the age of 18. After a career that spanned more than a decade and saw Axelsson play against various European countries, his last few years have been far from a fairy tale.

Axelsson had severely damaged his left hip joint, through what doctors believe may be as a result of over use. “He developed osteo-arthritis, a condition generally seen in people over the age of 70. But sometimes, athletes and professional players develop it a few decades earlier, due to over use of the joint,’’ said Dr Vijay C Bose, consultant orthopaedic surgeon at Apollo Hospital.

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Zimmer Recall

The Evidence GAP

A Call for a Warning System on Artificial Joints

By BARRY MEIER
Published: July 29, 2008

Dr. Lawrence Dorr, a nationally known orthopedic surgeon in Los Angeles, realized last year that something was very wrong with some of his patients.

Months after routine hip replacements, patients who had expected to live without pain were in agony. “The pain was grabbing me around the back,” said Stephen Csengeri, who is 54, and a lawyer from Torrance, Calif.

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

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

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.

“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. “

For full article Click Here

Resurfaced hips converted to THA similar to primary

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Converting resurfacing arthroplasty hips to THA required similar operative times and length of postoperative hospitalization.

Hips previously treated with metal-on-metal resurfacing arthroplasty that require conversion to total hip arthroplasty can achieve short-term clinical and radiographic results similar to primary total hip replacement, according to a study by California researchers.

“The theoretical advantage of easy ‘revisability’ of a resurfacing arthroplasty is supported by our results,” the study authors wrote. “With the numbers studied, the procedure was similar to primary total hip arthroplasty (THA) in terms of operative time and blood loss. The radiographic results after conversion were also similar to those in the primary [THA] group in terms of osseointegration, the position of the center of rotation, femoral offset, stem position, and limb-length equality.”

For full article Click Here

Sports After Hip Resurfacing Arthroplasty

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Florian-D. Naal, MD*, Nicola A. Maffiuletti, PhD, Urs Munzinger, MD and Otmar Hersche, MD From the Joint Center, Schulthess Clinic, Zurich, Switzerland

Background: No information is available concerning patients? sports activity after hip resurfacing arthroplasty.

Hypothesis: Patients treated by hip resurfacing arthroplasty will be able to achieve a high level of sports activity.

Study Design: Case series; Level of evidence, 4.Methods: We surveyed 112 patients by postal questionnaire to determine their sporting activities at a mean of 23.5 (range, 9? 40) months after hip resurfacing surgery. Data were also analyzed separately for older and younger patients and women and men, respectively.

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Metal-on-Metal Hip Resurfacing: The Effect of Component Position

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D.H. Williams; U. Masood; and M.N. Norton
Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK.

Decreased head-neck ratio diameter and component malposition in total hip arthroplasty are factors known to result in impingement, increased rates of dislocation, wear and failure. In addition to these complications, impingement of the femoral neck on the acetabular component of a hip resurfacing may result in femoral neck fracture and loosening of the acetabular component. Little is known regarding the optimum femoral and acetabular hip resurfacing component position to avoid impingement.

Read more…

Position of Hip Resurfacing Component Affects Outcome

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Position of Hip Resurfacing Component Affects Strain and Resistance to Fracture in the Femoral Neck

Abstract:

The Journal of Bone and Joint Surgery (American). 2008;90:1951-1960.doi:10.2106/JBJS.F.00788
© 2008 The Journal of Bone and Joint Surgery, Inc.

Thomas Parker Vail, MD1, Richard R. Glisson, BS2, David E. Dominguez, MD2, Kenichi Kitaoka, MD, PhD2 and Danielle Ottaviano, MEng2

 

 

Read more…

 

Popular Supplements Ineffective Against Arthritis

A two-year study of how well glucosamine and chondroitin sulfate slow cartilage loss in arthritis patients could not show that the popular nutritional supplements work any better than sugar pills.”We don’t have good evidence that it slows (disease) progression,” says rheumatologist Allen Sawitzke, professor of internal medicine at the University of Utah and lead investigator.  A two-year study of how well glucosamine and chondroitin sulfate slow cartilage loss in arthritis patients could not show that the popular nutritional supplements work any better than sugar pills.”

 

Read more…

Revision of metal-on-metal resurfacing arthroplasty of the hip -INFLUENCE OF MALPOSITIONING

THE INFLUENCE OF MALPOSITIONING OF THE COMPONENTS

R. De Haan, MD, Resident in Orthopaedic Surgery1; P. A. Campbell, PhD, Research Scientist2; E. P. Su, MD, Orthopaedic Surgeon3; and K. A. De Smet, MD, Orthopaedic Surgeon4 1 University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
2 J. Vernon Luck Snr MD, Orthopaedic Research Centre, Orthopaedic Hospital/University of California Los Angeles, 2400 South Flower Street, Los Angeles, California 90007, USA.
3 Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, USA.
4 ANCA Medical Centre, Krijgslaan 181, 9000 Ghent, Belgium.

We have reviewed 42 patients who had revision of metal-on-metalresurfacing procedures, mostly because of problems with theacetabular component. The revisions were carried out a meanof 26.2 months (1 to 76) after the initial operation and mostof the patients (30) were female.

Read more…

Intraoperative Fractures: Rising Problems

By Michael E. Berend, MD; Todd Bertrand, BA

ORTHOPEDICS
2007; 30:750
September 2007

All hip surgeons have had the experience of completing a primary total hip arthroplasty (THA) only to discover a proximal femoral fracture just prior to reducing the hip. We can comfort our patients and ourselves that the outcome of a THA with a proximal femoral fracture is excellent with proper treatment and uncemented stem fixation. The purpose of this study was to examine risk fractures, treatment options, and outcomes in THA with proximal femoral fractures.

Fracture Risk Factors

As the number of uncemented THAs has  increased,1,2 there is no question the incidence of uncemented stem fractures has increased as as well.3 The risks for fracture during THA have been well studied. In their study, Schwartz et al4 found women were at higher risk for proximal femoral fracture with the AML stem (DePuy, Warsaw, Ind).

Changes in instrumentation and implantation have helped reduce the risk of fracture. Berend et al5 noted higher fracture rates in hips undergoing THA for a diagnosis other than osteoarthritis.

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Leg up for Ex-Swedish Footballer

Express News Service
First Published : 15 Nov 2008 06:46:00 AM IST
Last Updated : 15 Nov 2008 09:58:53 AM IST

CHENNAI: Benny Axelsson started playing for the national Swedish soccer team at the age of 18. After a career that spanned more than a decade and saw Axelsson play against various European countries, his last few years have been far from a fairy tale.

Axelsson had severely damaged his left hip joint, through what doctors believe may be as a result of over use. “He developed osteo-arthritis, a condition generally seen in people over the age of 70. But sometimes, athletes and professional players develop it a few decades earlier, due to over use of the joint,’’ said Dr Vijay C Bose, consultant orthopaedic surgeon at Apollo Hospital.

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Zimmer Recall

The Evidence GAP

A Call for a Warning System on Artificial Joints

By BARRY MEIER
Published: July 29, 2008

Dr. Lawrence Dorr, a nationally known orthopedic surgeon in Los Angeles, realized last year that something was very wrong with some of his patients.

Months after routine hip replacements, patients who had expected to live without pain were in agony. “The pain was grabbing me around the back,” said Stephen Csengeri, who is 54, and a lawyer from Torrance, Calif.

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Physician ties to medical device firms probed

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By Amy Lynn Sorrel, AMNews staff. Sept. 8, 2008.

A Pennsylvania lawsuit alleging that several medical device companies paid illegal kickbacks to physicians raises questions about doctors’ relationships with the industry and could signal elevated scrutiny of these ties.

A privately owned medical supply company accused five leading orthopedic device manufacturers of paying dozens of physicians, in the form of travel, meals, royalties and consulting fees, to promote the companies’ products.

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Metal-on-Metal Resurfacing of the Hip in Patients With Osteoarthritis

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J. Daniel, FRCS, Staff Orthopaedic Surgeon1; P. B. Pynsent, PhD, Director2; and D. J. W. McMinn, FRCS, Consultant Orthopaedic Surgeon1

Excerpt:
“The results of conventional hip replacement in young patientswith osteoarthritis have not been encouraging even with improvementsin the techniques of fixation and in the bearing surfaces. Modernmetal-on-metal hip resurfacing was introduced as a less invasivemethod of joint reconstruction for this particular group…..

“The extremely low rate of failure in spite of the resumption of high level occupational and leisure activities provides early evidence of the suitability of this procedure for young and active patients with arthritis.

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Metal Ions and Placenta

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Transplacental transfer of cobalt and chromium in patients with metal-on-metal  hip arthroplasty

A CONTROLLED STUDY

H. Ziaee, J. Daniel, A. K. Datta, S. Blunt, D. J. W. McMinn
From The McMinn Centre, and Birmingham Women’s Healthcare NHS Trust, Birmingham, England

Metal-on-metal bearings are being increasingly used in young patients. The potential adverse effects of systemic metal ion elevation are the subject of ongoing investigation. The purpose of this study was to investigate whether cobalt and chromium ions cross the placenta of pregnant women with a metal-on-metal hip resurfacing and reach the developing fetus. Whole blood levels were estimated using high-resolution inductively-coupled plasma mass spectrometry.

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Paying Workers to Go Abroad for Health Care

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SEPTEMBER 30, 2008 By M.P. MCQUEEN

Insured Americans are starting to see some unusual options in their health-provider networks: doctors and hospitals in Singapore, Costa Rica and other foreign destinations. In an effort to control rising costs, a small but growing number of insurers and employers are giving people the choice to seek treatment in other countries, a practice known as medical tourism. Until recently, most Americans who traveled abroad for medical care were uninsured, or were seeking procedures not covered by insurance, such as cosmetic dentistry or aesthetic surgery. Now, a handful of plans are beginning to cover treatment overseas for heart surgery, hip and knee replacements and other major surgical procedures.

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Femoral Neck Notching

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A Biomechanical Study of Femoral Neck Notching Using The Birmingham Hip Resurfacing

Introduction: It has been suggested that notching of the femoral neck during hip resurfacing weakens the proximal femur and predisposes to femoral neck fracture. We aimed to examine the effect of neck notching during hip resurfacing on the strength of the proximal femur.

Methods: A three dimensional femoral model was used and molded with a femoral component constructed from the dimensions of a Birmingham Hip Resurfacing. Multiple constructs were made with the component inferiorly translated in order to cause a notch in the superior femoral neck.

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Hip Surgery With a Future

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Ruby Washington/The New York Times
Dr. William B. Macaulay Jr. is one of this country’s leading practitioners of hip resurfacing. Since it is not any easier on a patient than a total replacement, he says a patient should have pain every day before even thinking about it.

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.

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Gait Analysis Of Metal On Metal Surface Arthroplasty

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Michael A Mont, MD Baltimore MD (a, e – Wright Medical Technology)
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This study compared gait kinematics of resurfacing patients to normal hips, osteoarthritic hips, and patients with standard hip replacements.  Metal-on-metal resurfacing is a type of hip arthroplasty in which there is conservation of the proximal femur. Little is known about the functional capabilities of patients with resurfacing. This study compared gait parameters of resurfacing patients with normal and osteoarthritic hip patients as well as those with standard hip replacements
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Learning Curve – Various Articles

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Low morbidity, few dislocations make hip resurfacing an option for young patients

“However, the role that proper surgical technique plays in resurfacing outcomes cannot be over emphasized. “Performing hip resurfacing is different than performing a total hip,” Beaulé said. And there is no getting around the learning curve.

Femoral neck fractures—a dramatic failure for patient and surgeon—is a technique-related complication that must be surmounted.

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