UK article about banned metal on metal devices

[HippyDogwood]

Hi again,
Bearing in mind the article mentioned high revision rates for HR devices-so to get some accuracy-went straight to the latest UK National Joint Registry data 2012 which showed the following % revision rates for each device after 8 years:
Adept 8.7
ASR 26.9 (36.4 expected at 9 years)
BHR 6.61 (8.1 at 9 years)
Cormet 13.85 (16.34 at 9 years)
Conserve 12.22

Going to bed now but the above is well worth discussing. I've sure got some points to make.
Toby

Toby

Great info and would love to hear more. I'm not a hippy yet, but have been seeing Mr Latham hence good to see the relative performance of the Adept.

Putting my analytical hat on, wouldn't a sceptic say that these stats prove a point as I thought a THR had a like for like failure rate of sub 5% (i.e better than all of these). You then have to overlay that there are large nuances between THR & HR failures on demographics in that HR failure of large men aged 40-50 might be sub 1% if fitted correctly and THR could be 5%+ for the same group due to excessive wear and tear. The contrary could be true for a group that is better suited to THR, but generalising THR may have a better outcome on average, simply because it suits a wider range of circumstances and is not as technically demanding.

Debates of this kind are good for us "non-hippies" holding out, as just as you get your head around the whole thing, you see 2 or 3 threads here in the space of days with members either facing revision within 3 years (or 3 months for Bryan) or generally casting doubts in your mind. It's a big decision.

[Dannywayoflife]

For all those who say thr's are the answer to preyers. I point you in the direction of the paper published by Mr Treacy and Birmingham university that proves a link between the thr and mortality!!!

[Gazza2]

Toby, thanks for publishing that the high revision rate for the Conserve plus are a bit depressing for me personally.  I did look at the report and see that (Unsurprisingly) the BHR dominates all other implants in terms of numbers in the UK  (BHR 18,280,  C+, 1320,  the Cormet is 2nd most popular has only 3,629 patients reported).
I know there are leading "independent" surgeons who have chosen Conserve plus (Or Cormet) over the BHR (Dr De Smet published a paper on his preference for the C+ that is on this site somewhere).  And everything I have seen would indicate that other than the ASR device, there is no systemic reason for different failure rates between the devices listed, the predominant issue is surgeon placement angle and patient selection for HR (High failure rate with small head sizes). 

Based on those numbers none of the HR devices seem to meet the criteria the consultation document is proposing  which is less than 5% after 10 years.

One thing the statistics do not evaluate is the ease of revision,  my understanding is a HR revision is a much easier operation the THR revision,  this may explain some of the differences between THR and HR revision rates.

[hernanu]

That metric will be hard to meet for both HR and THR. Based on the results of the Australian registry, which follows a much larger sample (over 200,000 procedures), neither meet that demand:

THR revision at 11 years: 7.4%, HR revisions at 11 years: 9.8%

Results are cumulative, all devices, including high failure rates / recalled and all surgeons and patients.

For THR MOM components, only the pinnacle was less than 5% (at 4.4%) at 7 years. The worst was the ASR THR with a 44% revision rate.

I don't want to spam the site, but if you are interested, look at the report and you'll see most THRs fall within the 5-10% range at 7-11 years. No matter the components and materials (ceramic, etc).

The same seems to hold true at a slightly higher rate with HR.

So I guess my point is to consider the source. A study made with a small sample size or a very large sample size for a long term.

I've attached some information from the 2012 registry pertinent to this thread, but there is a wealth of information in there that may answer many questions. It's worth it to look if you're curious or concerned.

As always statistics are just that - massive compilations of averages. A highly experienced, skilled surgeon with a constant practice and the right device will be much more successful than the norm on either THR or HR.

[keepmovin]

I feel it's extremely difficult for most of us to make the decision as to which way to go when we find ourselves in this situation.  Will we ever know if we made the right or wrong decision when we choose to go either with a THR or HR?  I know I spent a lot of time researching my decision, but there wasn't a Dr. who was able to convince me one way or the other of my choice.  My decision was based a little on statistics-and Hern, you said it clearly that statistics are just a compliation of averages-, but more on the best Dr. in his field who felt extremely comfortable with his evaluation of my situation.  I received a lot of advice from many Drs. who looked at me as a statistic and not from a clinical perspective, what my expectations where, what my activity level is, overall, my general health level.

I looked for someone who was confident and comfortable and extremely capable of performing this skilled procedure.  Many of the other consults I had were from Drs. who were not comfortable with HR's and the discussions became very unprofessional.  Questions where not answered fully and completely.

I am 2 weeks out from my second resurfacing.  I look at it this way - I chose this based on the best available data available to me.  The last thing my surgeon said to me in the hospital was, everything went well, no complications, strong bones, great muscle quality, you are a good candidate for this procedure.  My plan is to go slow and steady in my recovery.  Going forward, I will treat these new hips with respect to my age, health and with appreciation that I'm not getting younger so I will take care on my choice of activity levels.

We all need to be at peace with our decisions and who's to say if we chose another path, it would have been more successful.   Look for the best qualified surgeon who feels confident with this procedure and who evaluates you thoroughly and together, as a team, you will have made the best decision for yourself.     

[toby]

Hi again, thanks to Danny, Gazza and Hern-I agree with your sentiments/discussion points about the stat's and difficulties comparing HR and THR, below were my thoughts after posting.
Excuse any crude analysis here but based on the stat's I presented from NJR:
BHR-8.1% revision rate after 9 years-data based on all UK surgeons using the devise. Quick deduction from this-92% have enjoyed successful resurfacing and almost all will continue to have as the cumulative results year on year do not increase greatly. This figure also has to take into account surgeon learning curve. Additionally, many surgeons tried HR during this 9 year period and failed to master this more complex replacement method (particularly the disastrous Oxford Study). These surgeons have had a significantly detrimental affect on these statistics-great most now leave it to the experts! Over the last 9 years HR surgeons have learnt a lot re-patient selection/device placement etc So one would presume that fig's for more recent years would be closer to the Mcminn 98% etc.  Hence, I've an Adept despite not quite as good as the BHR  stat's, the same factors apply and the results are still pretty good, certainly not  justifying the alarm bells.

[chuckm]

If you read the opening line of the article, I think it tells a lot.

"NHS hospitals to be banned from fitting metal-on-metal hip replacements..."

And perhaps as a whole they should be banned if they can't get the difficult surgeries done right as a group.

I don't know much about the NHS hospitals but are they having poor results as a group using MOM hip replacement and resurfacing components?

I would not expect a national group like that to say MOM's can be really good but we are going to discontinue offering them because they are a little too difficult for our pool of surgeons as a whole to implant. Trashing MOM's is not unexpected in my opinion.
Chuckm

[B.I.L.L.]

For all those who say thr's are the answer to preyers. I point you in the direction of the paper published by Mr Treacy and Birmingham university that proves a link between the thr and mortality!!!

That's it , I'm done in here, too depressing. Good luck future hippies !

[Boomer]

Ronan Treacy and Derek McMinn responded jointly to the UK article on October 29 highlighting the success rate of the Birmingham Hip, which was essentially ignored in the article. Additionally, John Timperley FRCS and John Skinner FRCS of the British Hip Society responded the same day by reporting that the BHR has a failure rate of only 3% at 7 years for 55 year old males. Their letters can be read online by accessing the UK Telegraph. These are powerful voices doing their best to counter the incomplete reporting by the UK Telegraph staff.

These articles can be a bit scary. The problem is there are inexperienced surgeons doing hip resurfacing procedures on patients that fall outside the ideal candidate selection, and with unproven devices. It would be helpful if some of the news coverage would highlight the importance of patient selection, surgeon experience and the proper device instead of simply reporting overall poors results. Too much to expect I guess.

We can take comfort in the knowledge that if you have your BHR done by one of the top surgeons, and you follow the recovery protocol and love your new hip, you will probably enjoy a very active life.

I've got two Birmingham hips, and life is good. I have no regrets. I have my two year check up in early December. I'll report back then. Stay positive.

Boomer

[sharleen]

Thank you Boomer - I think that you have put a lot of people's minds at rest!

[Granton]

Reference Boomer's comment. The letter can found on the page linked to below. The page includes many letters on various topics, but the Treacy and McMinn one is there.

http://www.telegraph.co.uk/comment/letters/10409764/The-cost-of-scaring-workers-away-with-exaggerated-storm-reports.html

David

[obxpelican]

Danny,


Hey buddy, I am a little late to this thread please forgive me, please give me a cite on that comment about THRs.

Do you mean mortality as in large quantity of deaths or failures of devices?


Chuck

For all those who say thr's are the answer to preyers. I point you in the direction of the paper published by Mr Treacy and Birmingham university that proves a link between the thr and mortality!!!

[Jason0411]

I think it is mortality but I wouldn't worry if you think about the average age of thr patients against hr patients. It would stand to reason that more wouldn't out live the implants. :)

[Granton]

I think Danny is probably referring to this:

http://www.mcminncentre.co.uk/response-dispatches-program.html

See the paragraph immediately above "Summary".

David

[Jason0411]

Wow.

[Granton]

Note that it says the benefit persists after adjustment, but does not put a number on that.

[obxpelican]

I wrote to them asking them for information on the causes of the mortalities.


We'll see if they respond to my inquiry, seems strange that having a THR could cause for an increase in mortality.

Thanks


Chuck

[Granton]

Obxpelican

If the work has not been done any response would be speculative, I guess. Mr McMinn has expressed concern about fat and marrowbone being forced into the bloodstream by the action of forcing the femoral component of a THR down into the femur. Could be that?

As I said earlier, the difference once factors of age etc are adjusted for was not quoted. I bet it's a lot less than the unadjusted difference.

[obxpelican]

That is my thought, during the actual surgery, not long term after affects because once the bone forms around the stem it's essentially the same result except for the stress shielding and stress shielding is not going to kill you.

I was always with the understanding that the fat being forced into the blood stream causing issues a very rare thing.

I guess we're seeing lot's of changes to hip surgery, this will be interesting what happens in the future.


Chuck

Obxpelican

If the work has not been done any response would be speculative, I guess. Mr McMinn has expressed concern about fat and marrowbone being forced into the bloodstream by the action of forcing the femoral component of a THR down into the femur. Could be that?

As I said earlier, the difference once factors of age etc are adjusted for was not quoted. I bet it's a lot less than the unadjusted difference.