New study on activity levels

[Dannywayoflife]

Dan, you are the man but you are not in my category. You cant compete in the Bi-Tri. But dont worry. I'm putting you with all those THR folks - you'll dust them (LMAO).

Hip

BI Tri i love it! ;D

[johnd_emd]

It seems to me there are so many variables to a study conclusion like this.  Still, the results are very high in my opinion, in favor of those of us that have had active lifestyles, and want to maintain them.  First of all, you have results from the not-so-good surgeons mixed in with results from the good surgeons who get the devices put in correctly, and at the proper angles.  Also, each person and their activity is different.  You might have someone who is just really biomechanically unsound in the activity they do.  You get someone who has bad running biomechanics vs someone who is just genetically put together better, the first will probably more likely wear out a device before the later.  Remember, many of us who have had this operation done probably fit into one of two catagories; we're either really extreme with our activity level (which has caused our degeneration) or we have bad mechanics and physiology (which has caused our degeneration).  Some might have a combination of both.  I do believe too that results like this will vary drastically from surgeon to surgeon.  A large number of people who've seemed to have had problems, revisions, and premature wear issues, the device in many cases wasn't inserted correctly at correct angles.  I hope I picked a good surgeon and he told me what my angles were. 

[triathlete98]

Johnnd_emd...sweet set up on your bike.  Do you think you can get back to that acute hip angle again?  i just bought a P3 so hoping to be able to ride it steep after my BHR.

[johnd_emd]

triathlete98, 

That pic was just 4 months ago, and I just had my BHR put in 12 days ago.  At this point I'm staying very optimistic I will be able to go right back to that position post op.  If all goes well I don't see why I shouldn't be able too.  Feel free to PM me.  I see by your screen name you do triathlons.  I raced professionally for 8 years as a triathlete.  Now I'm just racing bikes, but still at 52 able to race elite P1-2 and Elite Masters 1-2 races. 

[Jeremy76761]

Just to make some points about the study that started this post. I have done some digging on this study.

1. It seems to have been lead by the inventor of the ASR device. His team would not have had permission to study other devices.

2. These results allow it to be argued that patient activity not surgeon skill or device design are the factors responsible for failure.

I'll leave the rest to your imagination. Personally, I don't feel this study reflects hip resurfacing and impact generally, especially not the BHR.

Jeremy

[johnd_emd]

I'm 13 days post op, and just read this article.  Doesn't worry me one bit.  I feel like I chose a good surgeon.  Therefore, I don't have any concerns. I know there's a risk with anything, but even still, 96% and 88%.  Come on, that's pretty high odds in our, my, favor.  Look at the last sentence, "Survivorship for patients with a lower IS score at eight years was 96.4 percent versus 88.8 percent."   

There's a lot to consider here.  First, this includes all devices that were in the study, not just BHR's.  We all know, many of the devices out there are inferior at best to Birminghams's.  Second, this study also includes early devices that were inserted by inexperienced doctors.  We all know that the person doing the surgery makes a huge, huge difference in outcomes.  There's a huge learning curve with these resurfacing devices and some of the better doctors have stats that are off the charts.  I'm willing to bet that if you took someone like Dr. Bose, I'd bet over 98-99% of all the thousands of resurfacings he's done are still doing fine.  There's a lot involved with this procedure.  One of the first things is patient selection.  I know the good doctors won't just do anyone.  They know the device, they have experience, and they will pick the patients it's best suited for, and then they insert them correctly. 

Keeping my head up and very optimistic about my outcomes.  Too many good outcomes and people out there with too many good stories not too. 

[Dannywayoflife]

As i said before in this thread. I have a gut feeling(not based on anything medical just my own intuitive guess) that one of the biggest factors in longterm longevity will be longterm bone health and quality.

[Jeremy76761]

What I'm trying to help everyone understand is that this study does NOT include BHRs. It probably does NOT include any devices other than the ASR!

As you can see by this abstract, the study was lead by Harlan.

http://www.abstractsonline.com/Plan/ViewAbstract.aspx?mID=2841&sKey=8f07675f-aadf-4b0b-baed-e7aabc4b0f69&cKey=7c32b727-acd9-44a7-bb88-909c43baf3c5&mKey=BA8AA154-A9B9-41F9-91A7-F4A4CB050945

People can't just get the rights to study whatever resurfacing tool they want just because they feel like it.

Correct me if I'm wrong, but for some reason, I just don't think Smith and Newphew gave Harlan the rights to study their device. Just a hunch.

;)


The study absract concludes "High levels of sporting activities can be detrimental to the long-term success of hip resurfacing arthroplasty, independently from other risk factors."

Thus, it lays the groundwork to argue that the ASR failed because of misuse of the device.

That's what matters about this study as far as your hips are concerned.

Jeremy

[Dannywayoflife]

Very interesting points jerramy. You may well have a point.

[hernanu]

That is very interesting, Jeremy. Nothing like blaming the victim to deflect the blame on your own device. I'd love to know what devices they researched.

[lynne123]

I don't know about anybody else, but my brain hurts from worrying about it. I have decided, maybe at my detriment, to take a break from the negative press about this. Especially since mine is a BHR done by Dr. Su, one of the top resurfacing surgeons in the world. I am going to follow my doctors protocol, try to err on the side of caution and not push the envelope with things like I have in the past, and let the chips fall where they may.  When given the go ahead, I will return to what I loved to do.  It is high impact at times so I will do that part of it in moderation from now on.  No more hours of drills etc.  If I feel the pain, no more masking it with nsaids, pain meds and ice only to continue, but will back off and listen to my body.  When I first consulted with my doctor he did make it clear that there were no lifelong guarantees with the BHR, that it is a relatively new device and procedure compared to THR and that I could possibly down the road need to convert to a THR. But he also followed that up with the extremely low percentage rate that possibility presents and what I can do in the first several months of my resurfacing to help keep myself out of that category.  So like others I am going to hope that I do not wind up in that minimal percentage of unfortunates and try to relax.  It's hard though.  I wake up every morning asking the question on when and how much I can push the envelope. 

[John C]

Jeremy,
Dr Harlan Amstutz was the developer of the Conserve and Conserve+ prostheses, so it is likely that these are the prostheses covered in this study, not the ASR. Dr Schmalzried, one of Dr Amstutz partners, was involved in developing the ASR, and installed many of them, but I don't see anything in the study that would indicate that his patients were included in the study.
I think that you are correct in assuming that there were likely no BHRs included in the study, but I do not see anything that would make me think that any ASRs were included either. My assumption is that if the study is of Dr Harlan Amstutz patients, most or all of the prostheses would be the Conserve Plus.
You will certainly find a history of lots of battling between Amstutz and McMinn over the Conserve vs. the BHR. My feeling is that the best unbiased comparisons have been presented by Dr DeSmet who has used both extensively.

[hernanu]

I agree John. It is an interesting question, hope to have a good objective study done by some government involving all devices and broken down the way the national registries do it. A large sample and good structured research would be nice.

[Jeremy76761]

John, I agree that the devices covered by the study are not certain. However the design concept between the ASR, Conserve, and the others actually started with Harlan, under whom Schmalzried has worked in many ways at JRI. The design concepts between all these devices are all fundamentally similar in the way in which the beads are put into the device. BHR has a unique patented casting quite different from this group. Another reason why it is clear that this study does not reflect the BHR.

Edit: I, for one, agree wholeheartedly on the value of large scale "objective" studies by governments and, also comprehensive raw data registries on every device including detailed reports of activity levels and the other issues. Gimme the petition -- I'll sign it!

[Dannywayoflife]

There's a very interesting video on the Mcminn centre website where Derrick shows the beads of a bhr under an electron microscope against the beads of "another" device(he doesn't say which). And the difference is astounding. The bhr has a far rougher surface than that of the devices which have sintered beads. Mcminn states that this provides a fantastic fixation in the bone as bone loves to actuly grow into this rough surface where as the smoother surface of the sintered beads doesn't allow such purchase by the bone onto the device.

[Jeremy76761]

Yes, Danny, that's exactly what I'm talking about. Part of me wishes McMinn et al. never patented their approach of keeping the beads and cup as one piece rather than sintering them on. But if they hadn't, I suppose there could have been other problems in variation. I'm going to check out that video you mentioned.

[Dannywayoflife]

The easyest way to find it is use the link below:

http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php

It comes up with a title about cementless devices. He also shows a sectioned femoral component on the bone. It highlights how the cement works since watching that I really don't see my bhr going anywhere for a long time! Incidentally I didn't know until I watched another video by Mcminn that the cementing procedure is very different for devices like the C+ which apparently use high viscosity cement applied to the bone as opposed to low viscosity cement put in the cap then press fitted on the bone.

[Pat Walter]

Cementless Devices - 20 year history by McMinn

http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php

Pat

[Dannywayoflife]

That looks like the one. It's a really good video. I keep watching it over and over.

[Luanna]

The cementless issue is interesting. Dr. Pritchett like Mr. McMinn also has a long history of using cementless in the past and found that it did not meet acceptable success standards. I didn't realize that cement is used only on the femoral component but that makes sense. Learn something new everyday.

Mr. McMinn's data was interesting and his video presentation well done.  Thanks Pat.

Luanna