Finsbury adept cementless femoral head

[Dannywayoflife]

In relation to wear-see the McMinn lectures-he talks about minute based on all his extensive data from the last 15-20 years and predicts(as does my surgeon) that these devices will last a life time if perfectly placed.
Regards
Toby

Toby sorry to bother you but where can i find these mcminn lectures? Icarnt seem to find them!
Thanks Danny

[gary2010]

My surgeon, Jeremy Latham uses finsbury adept cemented. He knows the engineers well (who made the original BHR) and may be able to shed some light, though he was not keen on the cementless femoral option when we discussed it.

[Lopsided]

My surgeon, Jeremy Latham uses finsbury adept cemented. He knows the engineers well (who made the original BHR) and may be able to shed some light, though he was not keen on the cementless femoral option when we discussed it.

Why was he not keen on it?

[Dannywayoflife]

i emailed Mr latham about this device, and he basicly stated that cementless femoral side dont work well and he dosent think they will make it in the market place. To which i pointed out the likes of DR Gross and Dr de smet. And he didnt say anything about them.  Frrom what i can gather surgeons in general in the UK are very anti uncemented based on Mr Mcminns early trials. But obviously they were quite some years ago and science and technology has moved on significantly and now companys are able to manufacture a good bone ingrowth surface unlike when Mr Mcminn did his early uncemented.

[Lopsided]

i emailed Mr latham about this device, and he basicly stated that cementless femoral side dont work well ...

I hope they work, I have got one. Why should they not work? In the long term, there is on less thing to go wrong.

... and he dosent think they will make it in the market place.

Well that does not depend on him. The market is the patients, it is what we want.

From what i can gather surgeons in general in the UK are very anti uncemented based on Mr Mcminns early trials.

From what I gathered when I tried contacting them, was not too positive for English surgeons in general.

It does seem that Gary has done well though.

But obviously they were quite some years ago and science and technology has moved on significantly and now companys are able to manufacture a good bone ingrowth surface unlike when Mr Mcminn did his early uncemented.

Well I got uncemented, am happy with it, and when my other hip goes, I want the same.

D.

[Dannywayoflife]

Mr Latham is a good surgeon but most surgeons over here seem to not want to advance the devices and are happy as things are. I agree that uncemented there is one less thing to fail in the longrun! Only time will tell I think!

[toby]

Danny,
Sorry mate it appears that I didn't reply to your posting re- where the Mcminn lectures are (unless I emailed you off line can't remember-hectic time of late!).
Anyway, if you go the Mcminn site-then lectures at top of page-then on lectures page go to research at bottom. Here you will find a wealth of research including data on BHR wear rates and longevity.
Also, if I remember correctly-although others might be more informed, some surgeons in the UK used/might still be using the uncemented Corin (you might want to contact Corin directly). In addition Danny, if I didn't mention already, I heard a while ago that the very eminent Hip surgeon Richard Villar was doing his own studies on using uncemented. Unfortunately, from what I understand when someone emailed him to find out more it proved difficult to obtain any info.
I must say, I agree with you and many of our US buddies, I instinctively feel that Dr Gross has developed a winner.
Best
Toby

[Dayton96]

Mr. Villar was using the uncemented Corin as of Sep 2010.  I sent an email to him at Spire Cambridge Lea Hospital.  I was interested in his opinion of cementless devices and particularly his opinion of the Biomet Recap system, which is the implant that Dr. Gross uses.  I received a reply back from the "Hip Fellow to Mr R. Villar," which indicated there was little data comparing cementless and cemented implants in the early years.  The "Hip Fellow's" recommendation was to pick an experienced surgeon.  He stressed though that the BHR had a long and reliable history.

Mac

[Dannywayoflife]

I may email mr villla, Toby thanks for the directions mate I'll have a look when I get chance.
I agree that there is little data about cementless HR but it's proven with THR so it's not totally un known. What gets me is how are we ever going to gain data if surgeons won't try new things?
I hope that by the time I decide I need my hip doing that there will be more data either way.

[gary2010]

Last I heard Mr Villar was still doing hemi-resurfacings. Obviously the bulk of statistical data relates to cemented BHR with as-cast metallurgy, and the Adept I have is pretty close to that; Mr Latham is unashamedly a disciple of McMinn and has tried to reproduce the procedure exactly.

I've read all the arguments for and against different devices, but didn't really want to be a guinea pig, in a few months my bone density will be normal and I shall just forget about it for a decade or so. The new adept does appeal, and maybe I'll consider it when I need the other one done, but this has all gone so smoothly.. it would be a bastard if it fell out after 2 years!

I sincerely hope those who have cementless heads do well, and I respect them for pioneering the technique, as for the market, of course the surgeon stakes his reputation every time he fits one. Surgery is a combination of medical science and a craft skill, in my experience asking a tradesman to deviate from his accustomed practice is a good recipe for a cock-up.

[Dannywayoflife]

Fair points well made Garry. The thing that I don't understand is that alot of surgeons seem happy just to stay in a stasis and don't want to try and improve how are new products and methods going to get developed and advancements made if everyone is happy with the present devices and methodology? From what I have read it's s fantastic treatment but it isnt perfect. There's always room for improvement!

[Lopsided]

... in my experience asking a tradesman to deviate from his accustomed practice is a good recipe for a cock-up.

In that case, all the surgeons would have stuck to THRs, with small ball plastic on chipboard bearings.

... it would be a bastard if it fell out after 2 years!

Does your device include the remote controlled explosive release bolts?

[gary2010]

Fair play to you Dan, you may be braver than I. What I meant of course is that with an experimental device or procedure I would never be quite sure how long it was going to last. Only time will tell which of us lasts longest.

The problem as I understand it is torsional forces when rising from a squatting position. Were you given any additional restrictions? The cement has some elasticity I believe, and an antibiotic component.

Of course there will be innovations, driven by the more adventurous surgeons and patients, but some of these will inevitably fall by the wayside. From the surgeon's point of view, if you're going to take 10 grand off someone for an operation it's easier if you can quote a 99% + success rate.

I think we're only about 10 years away from being able to repair the whole joint with stem cells, which would render the whole process obsolete.

[Dayton96]

Gary,

I suspect you are right about being able to repair cartilage in the future.  Of course, when I was a kid, I thought we would have people living on Mars and the Moon by now.  Money, politics, and special interests sometimes get in the way of science.  I would hope research is going on around the world on replacing damaged cartilage, but I can't help wondering if there are enough incentives out there to push the research forward, or if all the money invested in implants, including surgeon training, might not discourage new advances.

Mac

[gary2010]

Yes I remember those films where robots did all the work while people enjoyed themselves. Don't get me started on politics!

Before I discovered resurfacing I contacted two scientists in this country, Charles Archer in Cardiff and Richard Oreffo in southampton, both working with stem cells for A.V.N. bone repair and to repair cartilage in the early stages of arthritis. My surgeon was involved in some of the trials with prof. Oreffo . I was told that total joint repair for OA is some way off but they are working in that direction.

[Dannywayoflife]

Gary,
        My surgeon had dinner with the gent from Southampton who is involved in the stemcell trials and he asked him about it(mostly because I'd shown him a news paper article on the trials) the bloke told him that there was alot of missreporting on the trial and they were a long way from having a solution to OA.
On another subject Gary I noticed in an old thread you posted on that mr Latham considered arthroscopy to be detrimental to a resurfacing. Is this deffinatly the case and did he mention why as I had arthroscopy 6 months ago!

[gary2010]

Weakening of the femoral neck I think, my arthroscopy was an expensive and pointless exercise, which just caused me to waste another year, as soon as I started exercising again the arthritis returned. I've met people who did well after treatment for impingement but they were all a good deal younger than me. It frankly beggars belief that no one mentioned resurfacing in the first place as I was an ideal candidate for it.

[gary2010]

BTW who is your surgeon? I have read that the biomet recap system has rather poor statistics, but I can't remember where, there's so much of it!

[Lopsided]

I also looked at stem cell treatment, and would have liked merely to have my worn out cartilage regrown and replaced. But that would not have helped with the bone spurs that were growing, or the cyst that was enlarging, or the impingement, or the slight dysplasia. And I think that with most, if not all patients that get resurfacing, it is not just the cartilage that is diseased with no effect on surrounding tissues.

If my right hip degenerates in ten years and stem cell treatment has advanced, I will still opt for resurfacing.

[Dannywayoflife]

Hi Gary,
          The surgeon who did my arthroscopy is Mr Jon Conroy from Harrogate. He is an excellent surgeon but not a RS surgeon. He has said I'd be an ideal candidate for it though. The op relieved lots of impingement as I couldn't hardly move before but I have full range of movement now but have arthritic pain instead of not been able to move.