Dr. Gross has completed a new study: What is the Best Bone Fixation Type? -
A Comparison of cement vs. bone ingrowth.
The study can be seen here http://www.surfacehippy.info/grossreport1-11-2011.php (http://www.surfacehippy.info/grossreport1-11-2011.php)
It is very interesting and shows excellent results for the Biomet uncemented device and technique.
Pat,
Hey, thanks for the post, that's great news for the hippy community, maybe all along Dr. Gross was right about cementless over cemented. Cementless sure does look promising for the future.
Chuck
You should listen to what Dr. Brooks says about the cementless procedure. This was also brought up by Mr. Tracy in Birmingham who taught Brooks. (You can catch it in his interview with Pat). It has to do with the possible weakening of metal that undergoes a second superheating to apply the porous coating to the inside of the acetabular cup. It made sense to me. I heat copper wire all the time to soften it so that I can bend it around bonsai trees and it does get much softer at first and breaks more readilly upon bending than raw wire does. The Birmingham device is a single cast device so no part of the metal has been compromised by a second heating. Plus, according to Brooks, there has never been a single incidence of the cement failing in a properly applied femoral cap. Finally, for the cementless femoral cap to properly merge with live bone (yes it sounds great in theory, and probably can work great) the bone has to be perfect. If there is a dead spot the bone won't grow there. I would guess it would be almost impossible to look at a bloody cap during surgery and see if a small patch of bone was not still viable when surrounded by viable bone.
Correction: The porous coating is added to the inside of the FEMORAL CAP. The acetabular cup is cementless in all resurfacing procedures.
Those devices and all devices that are implanted go through strenuous wear tests, somewhere on Biomet's site they have the results.... I think you would have to walk to the moon to wear out any of the current implants on the market.
Yes, I've heard those who question the heat treatments, but it's always those who do not implant or sell Biomet.
Chuck
<I heat copper wire all the time to soften it so that I can bend it around bonsai trees and it does get much softer at first and breaks more readilly upon bending than raw wire does.>
How can heating copper wire compare to the process of applying coating to metal? That is an "apples to oranges" comparison. After metal is heated it can be tempered (drawn back) to eliminate brittleness or the tendency to break or crack from being hardened. It's elementary knowledge and practice in the metal working trades. Biomet makes tested, high tech stuff. Do you think they would not know about the effects of heat on their products?
Why introduce a component or substance, in this case cement, when it is not necessary? If someone wants the cement type implants, fine, they do work well and have a good track record. I think you are just cheering for the "home team".
I am not sure how a thread about the study of uncemented resurfacing has turned into a debate about heat treatment of the metal used.
Anyway, I had uncemented. For me it was almost as important as getting resurfacing at all. I had the C+ device, which is heat treated. Whether or not it is as hard as as cast, it certainly is much better than the grisly remnant of cartilage. It is impossible to know what will happen with the implant in ten years, twenty years, fifty years (wishfull thinking that I might live that long) but I chose uncemented because with my limited knowledge of materials it seems that it should last longer or even indefinitely.
Dr. Gross seems to be the main exponent of uncemented resurfacing, but there are other top surgeons doing it too. In answer to one of my questions Dr. De Smet said he expected to be doing it regularly. There will continue to be two schools of thought by the surgeons, but I am sure uncemented will become more popular.
After six months, I am most pleased with my resurfacing.
D.
Quote from: lopsided on February 11, 2011, 09:26:12 PM
I am not sure how a thread about the study of uncemented resurfacing has turned into a debate about heat treatment of the metal used.
I think there are a lot of emotions and motivations (conscious and subconscious) expressed in the device debates.
Quote from: lopsided on February 11, 2011, 09:26:12 PMI had the C+ device, which is heat treated.
Here's to hoping that they
all last us a long time...
That is reassuring to read! I'm less than two weeks to my uncemented surgery with Dr. gross!
Where is the like button on here for that comment?
I think people sometimes get the wrong idea when they hear something new in hip resurfacing, somehow they think we Gross (and Dr. DeSmet) hippies are saying that all other devices are inferiour when we speak of our cementless hips, that is simply untrue.
I say anything that can improve the great results of say the BHR is a good thing, anything that gives the surgeon one less thing to have to do during surgery is a good thing and if one or a few percent of the patients have better results why not?
All of us cementless patients realize this is a study, it could still go negative, but at this point it's very very doubtful as the numbers are really positive, especially since we've hit the 3 years mark in the numbers being tracked.
I believe that cementless will be the future of hip surgery.
Chuck
Quote from: einreb on February 11, 2011, 10:43:24 PM
Here's to hoping that they all last us a long time...
Dr. Gross is obviously the trailblazer with cementless implants. Now that his 2 year study has come out other doctors will follow with select cases to add with the data. Doctors who knew they had tried and true implants and techniques weren't going to jump ship until the data showed good results over time. Makes sense where there is debate. The screening may be different with cementless for other doctors, only perfect candidates without other bone issues seems likely. Doctors will use the best system for the patient. Just like when some of us don't know for sure our resurf won't
actually be a THR when we wake from surgery.
Quote from: littleb on February 12, 2011, 12:26:15 PM
Doctors who knew they had tried and true implants and techniques weren't going to jump ship until the data showed good results over time.
No, my dear little B, a few of the top surgeons have already decided to use uncemented and to collate their data, possibly long ago. It takes time for the manufacturers to produce a variation on an existing device.
Although Mr. Mcminn only does cemented Birminghams now, he experimented with uncemented (his interviews are on this site) in the early days of resurfacing. I am sure many other surgeons have considered it too, but do not have the influence over device manufacturers.
Wright are now producing an uncemented C+. I requested this in May 2010 from Dr. De Smet, having read (also on this site) of someone else getting this device from another surgeon earlier than that.
So while the surgeons, and us patients, are interested in Dr. Gross' results, across the world uncemented is already happening.
D.
I've just read Dr. Gross' study and I find it reassuring, but, I'm also aware that the skill of the surgeon is also a critical factor. A true study of cementless implants needs to be done with multiple surgeons. I believe Biomet has a research study going on right now with surgeons across the country, including Dr. Su. I'm looking forward to reading the results of that study.
Having said that, my left hip will not wait until all the studies come out. I decided to go with Dr. Gross. One factor was the cementless implants, the other factor, and perhaps the most important one, was the quality of the surgeon. It may very well be that the success of the Biomet devices, like the success that Dr. Bose had with the ASR, is purely the skill of a particular surgeon.
Mac
I think Dr. Gross has set the bar pretty high, especially knowing that he takes on more risky cases.
The numbers are really sounding good, knowing that doctors like DeSmet and Dr. Su are interested makes me feel even better.
LOL I hope that this all works out and cementless ends up well, I am riding on it, well ok, walking on it.
Chuck
Quote from: obxpelican on February 12, 2011, 10:11:15 PM
I think Dr. Gross has set the bar pretty high, especially knowing that he takes on more risky cases.
The numbers are really sounding good, knowing that doctors like DeSmet and Dr. Su are interested makes me feel even better.
LOL I hope that this all works out and cementless ends up well, I am riding on it, well ok, walking on it.
Chuck
I think there is an interesting line to walk here. There are lots of folks that have cemented hips. To project that un-cemented is now 'better' may come across as unnecessarily confrontational. I would hope that the cemented last just as long and they very well may. Maybe cemented will last 100 years and un-cemented will last 200 :)
For those that are looking to decide on a device and a surgeon... these results are something to take into consideration. History has not been particularly kind to cement long term, but that has been in shear!
For me... I like that it the Biomet has not had any of the ASR type failures and that the historically successful un-cemented bone fixation appears to be working. Ultimately I am happy to have a surgeon scheduled that is reasonably close to me, my insurance pays for him and he has a well documented good track record.
I think to some it may come across confrontational, but new techniques MUST be considered and discussed. This is like the stem cell technology, I believe within 5-10 years doctors will be able to transplant cells into the hip. How will we hippies react then? Some who have had their surgeries will be upset, some will deny that it will work, others like me will applaud it. I would love to be able to get a shot in my left hip instead of surgery. I know someday my left hip is going to fail, hopefully stem cell surgery for humans will be around then.
Will uncemented be successful? Maybe. Will it make a huge difference in results, probably not, maybe a 1-2% in long term results, maybe not. Who knows.
I think in the end most of us will end up being buried with our original implants, be it BHR, Biomet or any of the other brands of implants. This is assuming that those patients pick a VERY experienced surgeon, but that's another discussion for another day.
Chuck
Quote from: einreb on February 12, 2011, 11:03:38 PM
I think there is an interesting line to walk here. There are lots of folks that have cemented hips. To project that un-cemented is now 'better' may come across as unnecessarily confrontational.
Quote from: obxpelican on February 13, 2011, 08:59:41 AM
I think to some it may come across confrontational, but new techniques MUST be considered and discussed.
I agree. Maybe I didn't phrase that correctly. Its just that its all just a big experient at this point. Nothing is 'for sure' better. There are so many factors.... instrumentation, training, patient selection, etc.
I like to call what Dr. Gross is doing a study, an experiment to me is when they did the first hip resurfacing on a pig or other animal.
3 years with great results so far is a good study.
Again, time will tell and to really prove Dr. Gross's hypothesis it's going to take some time.
Chuck
Agreed, an experiment is hard to truly do with live subjects....you can't randomly assign subjectscto groups and holdingvall other variables constant is next to impossible. A study is the right term..
I'll take it though. What else do we have to go on?
My cementless hip goes in next week.... Cross your fingers for me! I also hope that everyone who has a hip resurfaced gets a lifetime out ofvtheir device...whether it's cemented or not. Each of us has to make a decision about what doc to see and what device to use, we make it based on the limited info we have, and once we make it....we move forward. Let's hope all our hips last a LONG LONG time!
It's looking better everyday that we all may keep our hip device till we pass on to that great golf course in the sky.
Good luck on your surgery.
Keep us all updated, let us know asap about the pain protocol too.
Chuck
I haven't read the study yet, but will, soon. I thought the most important part of cementless, vs uncemented is that the bone (in this case the femoral side) needs to have some decent blood flow to be able to lay in some fresh bone. Maybe I'm off, but I'm thinking of De Smet's paper on BHR vs C+. Maybe it was something Bose said in an interview,...it's all running together, ???. Somewhere, I saw some discussion on the aspect of necrosis from grinding and then capping the femur top. This is why the cup has been cementless for a long time, it doesn't lose the circulation as bad as the femur top. Seems to me that's why you would want cement. Maybe?
I do know that I lay done some bone, it's in my genes. Through most of my 20s and 30s I had elevated alkaline phosphatase, the enzyme that moves Ca. Luckily it wasn't bone cancer. I think that's part of the reason I have impingement. I'm not an expert here, but I think cement would be unnecessary if you have good blood flow, a porous surface, and some Ca, at least for me. You should see the knob on my big toe from breaking it some many times.
Dr. DeSmet is now doing cementless as are other doctors like Dr. Su.
Apparantly blood flow is not an issue, if it was we would be seeing massive failures from all the implants that Dr. Gross has performed. When notching occurs and the blood flow is damaged it's usually 6 months or less for neck failures to occur.
It's been 3 years with good results, of course 4 or 5 years would be better.
Chuck
Hi Tin Soldier,
You are absolutely right about questionable blood flow to the femoral head being one of the main arguments for using cement. Everyone agrees that the blood flow is affected during the surgery, and is reduced for awhile afterwards. Dr. Gross has referred to some studies that measured blood flow to the femoral head after surgery, that show that it usually does return to normal; I believe that it was over a matter of days, possibly weeks. It is also argued that the heat produced as the cement cures, may negatively affect vascularization as well, leading to hopes that cementless femoral heads may have better vascularization at the surface to aid in the necessary ingrowth.
I am of the hope that, since the cement is under compressional loads rather than shear loads as in a THR, both approaches will lead to long term success.
Good point, Gross's 10 year results did not appear to be overwhelming one way over the other. Pritchett says insurance, at least in the US, is not wholly supporting the cementless femoral component. Not sure on the financials with Gross and Biomet, but maybe they've got more support in the insurance world for the uncemented femoral component.
Now I'm bummed :( I had both hips done with cemented BHRs in 2010. The whole concept of no cement makes perfect sense. Going to SC for Dr Gross was not an option, sadly. Crap.
Don't be bummed, if you are doing fine your chances are good (cemented or uncemented) to have a great outcome.
Everyone has to realize the %s if this all works out like Dr. Gross things is a few % or less difference. I just like that it gives the doctor one less thing to do during surgery.
Don't sweat it.
Chuck
Yeah don't be bummed. Its only a few % and for me, and maybe many others, insurance won't pay for an un-cemented femoral component.
Yep. So far the stats are great for the BHR and I hope they continue to be. I have read on this web site, and others, that the choice of the surgeon is just as important as the choice of a device. I didn't realize there were insurance companies that would not pay for a cementless device. I know BCBS will pay for the Biomet.
Mac
Insurance won't pay for uncemented femoral component?
I am getting the uncemented version from Dr. Gross and my ins is paying... Mi have a ppo, but I would think it would be the same whether you are ppo or HMO? I switched to the PPO so i could see dr. Gross....my HMO was going to send me to a dr with virtually zero experience....
Dr. Gross does not contract with HMO type insurance. HMO's have a very limited list of doctors and hospitals and Dr. Gross is not one of them. The only way would be if someone needs something done and the list of doctors or hospitals with the HMO cannot provide the needed care. Then the case has to go to an appeal board for approval. His website claims that there has been an approximately 50 % success rate with an appeal.
BCBS PPO pays for uncemented femoral components.
Ok, that makes sense. I had the HMO and they sent me to a guy who I was not goingto use, he had not enough surgeries under his belt...like 30....I changed to the PPO, I didn't even want to mess with the bs appeal crap.
My procedure will probably cost me a couple grand out of pocket...best money I will ever spend!
I'm still trying to get a handle on how much out of pocket I will end up spending. BCBS will only speak in general terms, although Dr. Gross' office was very clear how much out-of-pocket I could expect from him.
Bernie, you don't have BCBS by any chance do you?
Mac
Dayton, call the hospital and have them do a pre authorization, when I showed up to get my tests done the day before they had it down as to what the costs were going to be.
Yes, it's well worth the extra money to go to a good doctor, heck I probably spent a grand on travel alone between gas, food hotel and all the extra shopping my wife and daughter did while I was in the hospital.
Chuck
Dayton,
I have BCBS medical insurance.
Yes, I have probably about two grand between travel expenses and out of pocket co-pays, etc. It was very frustrating months before the surgery to get an answer on what the uncovered expenses would be. I knew that everything would not be covered 100 %, but I was worried there would be uncovered charges that I could not afford. Even within the BCBS network there are different coverages, it depends a lot on the employer. The hospital and Dr.Gross' office will give you a better idea on what things will cost.
Half of my approximate two grand total is a $1000 deductible it cost me as soon as I walked into the hospital the day of surgery. If I had my surgeries done in 2010, I would not have that charge. My employer changed our coverage Jan. 1,2011.
I was worried there would be uncovered charges in the thousands, but that was not the case. Hope this helps.
Chuck, I hope your wife and daughter bought you something while out shopping. LOL!
Steve (newdog)
I have a call in to the hospital but they haven't called back yet. As a lot of you know Dr. Gross' office gives you a pretty good idea what his expenses will be - the only wild card is whether or not Lee's fee will be covered. Steve and Chuck are right about not forgetting the cost of traveling to, and staying in, Columbia. The Residence Inn for five or six days can add up. Lee mentioned that the Residence Inn will give a "hospital rate," but I haven't checked into that yet. I'm not sure how it would compare to AARP or AAA.
Sorry buddy, the only thing I got was a toilet chair and the kit they sell ;)
Oh well, I came home almost pain free, and now totally pain free--- one caveat, the only good joint in my body is my hip that was operated on.
Chuck
Quote from: newdog on February 19, 2011, 10:40:56 AM
Chuck, I hope your wife and daughter bought you something while out shopping. LOL!
Steve (newdog)
Does anyone know of any surgeons who perform cementless RS in the uk?
There is a Mr. Richard Villar who uses a Corin cementless. He is at Spire Cambridge Lea Hospital. He can be contacted at: www.richardvillar.com
I contacted his practice by email last year when I was doing my research on cementless HR. I wanted to see if someone other than Dr. Gross, was doing successful cementless implants.
I had read about Mr. Villar authoring an article on cementless implants in the UK. One of his staff responded to my questions, although it took about a week to hear back.
I hope this helps.
^^^brilliant thanks I'll start to compose an email now. Really appreciate your help.
Danny