- Mr. Derek McMinn, The McMinn Centre for Joint Replacement Surgery, Birmingham, UK
- Dr. Edwin Su, Hospital for Special Surgery, New York, NY
- Dr. Peter Brooks Cleveland Clinic, Cleveland OH
- Dr. Kusuma, Grant Medical Center, Columbus, OH
- Dr. Ray Wasielewski, Grant Medical Center, Columbus, OH
Dr. KusumaDr. Kusuma explained that hip resurfacing is a better choice for active people than a total hip replacement. Patients are able to resume their activities and sports as they did before their hip problems with hip resurfacing. Patients under 65 are good candidates if their bone density is good and there is not a lot of dysplasia, as often occurs in women. Hip resurfacing is an excellent first choice for the younger patient in case a revision is every required later in life. Revision from a hip resurfacing to a THR is a much easier surgery for the patient than a revisions from a THR to another THR which would require a much longer femoral stem and difficult surgery. Dr. Kusuma performed a live Birmingham Hip Resurfacing Surgery for the audience via live TV. He and Mr. McMinn, Dr. Su and Dr. Brooks all commented on the different steps that were taken during the surgery. They discussed how and why they did certain steps differently. Dr. Kusuma used some instruments that the other surgeons did not while the other surgeons used techniques that Dr. Kusuma did not. Dr. Brooks has designed a series of plastic mushroom templates to check his component placement which he explained later in his talk.
Mr. McMinnMr. McMinn explained that hip resurfacing is better option that a total hip replacement because:
- Hip Resurfacing patients have a higher and better activity level and gait than THR patients
- Hip Resurfacing patients have a lower cancer rate
- Hip Resurfacing patients have a lower death rate and complications of heart attacks and problems
Dr. SuDr. Su explained that normally the best candidates are usually men under 50 and women that are larger and not of childbearing age. Small women have a poorer retention rate the men in general and especially larger men. The best outcomes in hip resurfacing are with larger head sizes for the BHR device which are used for larger men and women. Dr. Su uses a posterior approach with a method that does not require any restrictions like the 90 degree rule after surgery. He allows running and high impact sports after full healing.
Dr. BrooksDr. Brooks explained that the BHR is excellent because it’s acetabular cup is round, not egg shaped as most other hip resurfacing devices. Not all device are the same. The ASR, which failed and was removed from the market, was not deep enough, distorted in the acetabular cup component and was not round. Surgeons need to understand the actabular cup shape to properly set it at a correct angle. Edge loading causes high metal ions. There is a small area within the bearing acetabular cup about the size of a quarter that is the bearing surface that becomes worn over time. If cups are not placed at proper angles due to poor judgment, hip dysplasia or other reasons, the quarter sized wear pattern moves from the center of the cup towards the edge. This edge wear causes high metal ions and debris leading to pain and revisions. Edge loading also occurs in metal on metal total hip replacement devices. These are the devices that are most talked about in the media as causing problems. Hip Resurfacing is included by the authors of the negative media when the components are not properly set causing high metal ions. Dr. Brooks discussed the best outcomes were for men, but with a great deal of care and planning, smaller women can be done successfully. Most women have a small to large degree of dysplasia when they are younger and this causes problems in placing the acetabular cup properly. In some cases, severe dysplasia can only be treated with a total hip replacement. Dr. Brooks now does CT scans of women to see the amount of dysplasia that is present. He can then tell what changes need to be make in acetabular cup placement or decide that a THR would be best. Young women of child bearing ages are not offered hip resurfacing in most US surgeon practices. There have been studies showing that metal ions can cross the placenta to enter the babies body. The studies show this is not great, but surgeons don’t want to take chances. Women that have hip resurfacing sign a paper saying they are not able to bear children any longer. Dr. Brooks reviewed his series of 1800 hip resurfacings with an excellent record. He had a few revisions due to one femur neck fracture, several acetabular cup problems and a couple infections. An excellent record. He explained that femur neck fractures, which were thought to be the biggest problem with hip resurfacing in the past, were no longer the problem since the surgery techniques now used help to prevent neck fracturing. He did explain that if a patient starts to do repetitive motions like running or leg presses too early, they can actually fracture the femur neck. Sometimes the fractures will heal and sometimes they won’t. He explained it by showing a paper clip. If a person opens up a paper clip and tries to break it in half on the first try, they can’t. If they continue to bend it back and forth, it will eventually fracture and break. This is how repetitive motion can cause a fracture in a femur neck and did for one of his patients that was doing a lot of early leg presses! He thought patient outcomes are better than for hip resurfacing than THRs because many hip resurfacing patients are active and younger. Best outcomes occur by:
- Choosing an experienced surgeon
- Being a good candidate by age, sex, size and bone density
- Using an excellent hip resurfacing device like the BHR with an excellent retention rate as reported by the national registries and surgeons own series of patients.