Featured Speakers:

• Mr. Derek McMinn, The McMinn Centre for Joint Replacement Surgery,
  Birmingham, UK
• Dr. Edwin Su, Hospital for Special Surgery, New York, NY
• Dr. Peter Brooks Cleveland Clinic, Cleveland OH
• Dr. Kusuma, Grant Medical Center, Columbus, OH
• Dr. Ray Wasielewski, Grant Medical Center, Columbus, OH

The primary purpose of the 1st Annual Hip Resurfacing Meeting was to
introduce doctors and health care professionals to the positive outcomes of the
hip resurfacing with the Birmingham Hip Resurfacing Device. There has been a lot
of negative press against metal on metal total hip replacement and hip
resurfacing.  Also the poor results of the ASR are in the media everyday
due to the lawsuits.  If healthcare professionals understand hip
resurfacing and the excellent outcomes, they will be more likely to tell their
patients it is an excellent alternative to a total hip replacement.

Over 200 health care professionals attended the meeting along with
approximately 20 perspective patients.  The meeting was excellent and a
great success.  The audience was very receptive and interested in hip
resurfacing.  The questions and comments from the audience was very
positive.

Dr. Kusuma

Dr. Kusuma explained that hip resurfacing is a better choice for active
people than a total hip replacement. Patients are able to resume their
activities and sports as they did before their hip problems with hip resurfacing.  Patients
under 65 are good candidates if their bone density is good and there is not a
lot of dysplasia, as often occurs in women.  Hip resurfacing is an excellent
first choice for the younger patient in case a revision is every required later
in life.
Revision from a hip resurfacing to a THR is a much easier surgery for the
patient than a revisions from a THR to another THR which would require a much
longer femoral stem and difficult surgery.

Dr. Kusuma performed a live Birmingham Hip Resurfacing Surgery for the
audience via live TV.  He and Mr. McMinn, Dr. Su and Dr. Brooks all
commented on the different steps that were taken during the surgery.  They
discussed how and why they did certain steps differently.  Dr. Kusuma used
some instruments that the other surgeons did not while the other surgeons used
techniques that Dr. Kusuma did not.  Dr. Brooks has designed a series of
plastic mushroom templates to check his component placement which he explained
later in his talk.

Mr. McMinn

Mr. McMinn explained that hip resurfacing is better option that a total hip
replacement because:

• Hip Resurfacing patients have a higher and better activity level and gait
  than THR patients
• Hip Resurfacing patients have a lower cancer rate
• Hip Resurfacing patients have a lower death rate and complications of
  heart attacks and problems

Mr. McMinn presented a number of national registry studies to support the
excellent retention rates of the BHR compared to other hip resurfacing devices.
The BHR is far superior to other devices at 10 years.  The outcomes vary
for patient sex, age and cup size. Men have the best outcomes based on age and
sex.  Smaller men along with smaller women have the worst outcomes.
Larger women and men had similar outcomes.

Mr. McMinn said he will perform hip resurfacing for younger women of
childbearing age if they sign an agreement to not
have children until one year post op of surgery.

An alternative resurfacing implant for patients with sensitivity to metals
was thought to be
a ceramic-on-ceramic hip resurfacing device. Mr. McMinn looked at his own unsuccessful
series of five ceramic-on-ceramic hip resurfacings and looked at the widely used
the pink Delta Motion THR ceramic device made by Ceramtec. Ceramic contains
elements of metal and Mr. McMinn raises some concern over the potentially
harmful type of Chromium produced in the metal debris of a Delta Ceramic in
situ.

Looking towards the future, Mr. McMinn described how highly cross-linked
polyethylene is potentially the way forward. Polymix is a hybrid cup made of
conventional polyethylene and highly cross-linked polyethylene in the wear-zone.

Dr. Su

Dr. Su explained that normally the best candidates are usually men under 50 and women that are larger and not
of childbearing age. Small women have a poorer retention rate the men in general and
especially larger men.  The best outcomes in hip resurfacing are with
larger head sizes for the BHR device which are used for larger men and women.

Dr. Su uses a posterior approach with a method that does not require any
restrictions like the 90 degree rule after surgery. He allows running and high
impact sports after full healing.

Dr. Brooks

Dr. Brooks explained that the BHR is excellent because it’s acetabular cup is round, not egg shaped as most
other hip resurfacing devices.

Not all device are the same. The ASR, which failed and was removed from the
market, was not deep enough, distorted in the acetabular cup component and was not round.

Surgeons need to understand the actabular cup shape to properly set it at
a correct angle. Edge loading causes high metal ions.  There is a small area within the
bearing acetabular cup about the size of a quarter that is the bearing surface
that becomes worn over time.  If cups are not placed at proper angles due
to poor judgment, hip dysplasia or other reasons, the quarter sized wear
pattern moves from the center of the cup towards the edge. This edge wear causes
high metal ions and debris leading to pain and revisions.

Edge loading also occurs in metal on metal total hip replacement devices.
These are the devices that are most talked about in the media as causing problems.
Hip Resurfacing is included by the authors of the negative media when the
components are not properly set causing high metal ions.

Dr. Brooks discussed the best outcomes were for men, but with a great deal of
care and planning, smaller women can be done successfully.  Most women have
a small to large degree of dysplasia when they are younger and this causes
problems in placing the acetabular cup properly.  In some cases, severe
dysplasia can only be treated with a total hip replacement.

Dr. Brooks now does CT scans of women to see the amount of dysplasia that is
present.  He can then tell what changes need to be make in acetabular cup
placement or decide that a THR would be best.

Young women of child bearing ages are not offered hip resurfacing in most US
surgeon practices.  There have been studies showing that metal ions can
cross the placenta to enter the babies body.  The studies show this is not
great, but surgeons don’t want to take chances.  Women that have hip resurfacing
sign a paper saying they are not able to bear children any longer.

Dr. Brooks reviewed his series of 1800 hip resurfacings with an excellent
record.  He had a few revisions due to one femur neck fracture, several
acetabular cup problems and a couple infections.  An excellent record.

He explained that femur neck fractures, which were thought to be the biggest
problem with hip resurfacing in the past, were no longer the problem since the surgery
techniques now used help to prevent neck fracturing.  He did explain that if a
patient starts to do repetitive motions like running or leg presses too early, they can
actually fracture the femur neck.  Sometimes the fractures will heal and
sometimes they won’t.  He explained it by showing a paper clip. If a person
opens up a paper clip and tries to break it in half on the first try, they
can’t.  If they continue to bend it back and forth, it will eventually
fracture and break.  This is how repetitive motion can cause a fracture in a femur neck
and did for one of his patients that was doing a lot of early leg presses!

He thought patient outcomes are better than for hip resurfacing than THRs because many
hip resurfacing patients are active
and younger.

Best outcomes occur by:

• Choosing an experienced surgeon
• Being a good candidate by age, sex, size and bone density
• Using an excellent hip resurfacing  device like the BHR with an
  excellent retention rate as reported by the national registries and surgeons
  own series of patients.