20 year follow up study

[John C]

In a recent post on another thread, I read about a doctor who was reluctant to support resurfacing because he wanted to see 20 year follow up. Most people believe that there is only 10+ year follow up available, but there is a very interesting study published by Dr. James Pritchett, the leading resurfacing surgeon in the Seattle area. It reports on an early round of resurfacings that he was involved with in the 70's. Most people think of this early round as being somewhat of a disaster, now blamed on the plastic acetabular components that were used in many cases. What is interesting is the part of the report that relates to the few metal on metal resurfacings that were done at that time. They report that at an average of 27 years, THERE WERE NO FAILURES  in this group, reported as a 99% success rate. Pretty interesting stuff, that you never hear about. Also it is worth noting, that this successful group included a mixture of cemented and cementless femoral components, which should add an interesting note to discussions that claim that there is no history on cementless resurfacings. It is true that the components were a little different than what is available today, but the similarities are enough to include this study in any thorough discussion of metal on metal hip resurfacing.I believe that it available on Dr Pritchett's web site. I will also try to email the study to Pat, in case she wants to put it somewhere on the site.

[wayne-0]

Hey John,
I believe you were replying to my post about 20 yr study. Thanks for bringing this info to my attention. I may be able to use it if it is needed in my battle with the insurance robots.
                                            Thanks  Wayne

[Scott H]

Very interesting study. Pat can you shed light on this?

[Pat Walter]

Hi

Hip resurfacing as we know it today - metal on metal - was first done in 1997 my McMinn.

There have been other versions including himi-resurfacing which only placed a cap the femur bone and did not place a metal cup in the acetablum.  There might have been other versions that used plastic liners in the cup from the sound of the report and other early versions which are not used today. I don't know about that.

So early information does not apply to the devices we are receiving today that have both a metal cap and metal cup.

I have the 20 year study and many others posted on this page  http://www.surfacehippy.info/medicalstudies.php  The 20 year study is talking about hemi-resuracing.  I just took a quick look at it.

I hope that helps you understand the current version of hip resurfacing including the BHR, CHR, Wright C+, ASR, Biomet, Durom, etc. devices that we are all receiving now.

By the way, when doctors tell you how bad hip resurfacing is - they are normally remembering the early hemi-resurfacings which did not last very long.

Pat

[takilasunrise]

My ortho. surgeon had told me he was reluctant at first to perform the "new" hip resurfacing because of how many he had to fix from the surgeries done in the past that had failed.  But then he said once he started seeing how well the "new" procedures were going, he was ready to give them a try.  Although, I am not even a year into it, it's been a success to me! 

[John C]

Hi Pat,
I was happy to see that the study that I was referring to is already on your web-site. However, I am not sure about your reference to hemi-resurfacing, since the study  states that they actually excluded the 312 hemi-resurfacing cases that were done by the surgeons at that time, so they are not included in the report. The 99% success rate refers to devices "that have both a metal cap and metal cup" like we see today. It looks to me as though the biggest difference from todays components is that the ones used in this study used a slightly longer, and curved, stem on the femoral cap. To me, the real shame is that most surgeons who were around at that time are highly aware of the high failure rate attributable to the plastic cups, but very few are aware of the 99% success rate that was achieved in this study with metal on metal.
I could be wrong, but I believe that McMinn was doing resurfacings for a few years before 1997. My understanding was that he was using Cormet devices for a few years, until 1996, when he saw a higher failure rate show up, which he attributed to Cormet's switch to heat treating their components. It was at that point that he became involved with BHR, and started the current timeline for his 10 year results.

John

[Pat Walter]

Hi John

I am sorry if I scanned the article too quickly.  I did not take time to read it closely and thought it included the hemi-resurfacings.  I am so busy I don't have much time to read long articles.

I might also be wrong about the exact time McMinn placed the first hip resurfacing devices.

I am not good at remembering statistics, but I know he was doing them in 1997 and that he was using devices more similar to our current BHRs. The early Cormet was different than the recent Cormet according to new infomation that I will post soon.

I have some more information about the Cormet from Dr. Stulberg in Cleveland and from Corin to post. Just received it this afternoon.

I have so much "stuff" floating thru my head, I sometimes get mixed up.  At least the study is posted so anyone can read it themselves.

Pat

[Vicky]

The very first BHR that was implanted (same exact design as used today) was in July 1997.  So there is now over 11 years history.  The same doctors that say they require a 20 year history are probably using newer THR devices, if not, then they are using devices that are over 20 years old if they stand by what they claim and many of those only last 6 - 10 years before revision surgery is needed.  If a doctor ever tells you they want to see 20 years follow up, ask them how long the THR device they use has been around.

Vicky