The painful metal-on-metal hip resurfacing 2009
A. J. Hart, FRCSG(Orth), Clinical Senior Lecturer & Honorary Consultant Orthopaedic Surgeon1; S. Sabah, BSc, Medical Student1; J. Henckel, MRCS, Clinical Research Fellow & Specialist Registrar in Orthopaedics1; A. Lewis, FRCS(Orth), Consultant Orthopaedic Surgeon1; J. Cobb, FRCS, Professor of Orthopaedic Surgery1; B. Sampson, MRSC, CChem, Director of Supraregional Trace Element Laboratory1; A. Mitchell, FRCR, Consultant Musculoskeletal Radiologist1; and J. A. Skinner, FRCS(Orth), Consultant Orthopaedic Surgeon2 1 Department of Radiology Imperial College, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. 2 Department of Orthopaedics Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.We carried out metal artefact-reduction MRI, three-dimensional CT measurement of the position of the component and inductively-coupled plasma mass spectrometry analysis of cobalt
1/1/2008Journal: Clinical Orthopaedics and Related Research Citation: 465:71-79, December 2007. Authors: Carolyn Anglin, PhD, PEng; Bassam A Masri, MD, FRCSC; Jérôme Tonetti, MD; Antony J Hodgson, PhD, PEng; Nelson V Greidanus, MD, FRCSC Femoral neck fracture is the most common short-term concern after hip resurfacing arthroplasty. Currently, there is little basis to decide between neutral and valgus placement.
We loaded 10 notched cadaveric femur pairs to failure; one side was implanted at 0[degrees] relative to the femoral neck and the other at 10[degrees] valgus. All 20 were dual-energy xray absorptiometry-scanned. Failure load correlated with bone mineral density.
Valgus placement increased the fracture load by an average of 28% over neutral for specimens with normal bone mineral density but had no effect on fracture
Is there added risk in resurfacing a femoral head with cysts?Thomas P Gross and Fei Liu 17 October 2011
AbstractBackground Femoral head cysts have been identified as a risk factor for early femoral failures after metal-on-metal hip resurfacing arthroplasty (HRA) based on limited scientific data. However, we routinely performed HRA if less than 1/3 of the femoral head appeared destroyed by cysts on the preoperative radiograph. This study was undertaken to analyze whether there was an added risk of early femoral failures in HRA when femoral head cysts were present. Methods This retrospective case-control study included 939 MOM HRAs operated by a single surgeon with use of the posterior minimally invasive surgical (MIS) approach between November 2005 and January 2009. Patients with all
A Safe Zone for Acetabular Component Position in Metal-On-Metal Hip Resurfacing Arthroplasty
THOMAS P. GROSS, MD, FEI LIU, PHD MIDLANDS ORTHOPAEDICS, P.A. COLUMBIA, SC, USA
Read Full Study by Clicking Here
Adverse wear reaction after metal-on-metal hip resurfacing has been described as a new failure mechanism. Established causes include poor
implant design, small implant size and acetabular malpositioning. The purpose of this study is to establish a safe zone of acetabular inclination angle (AIA) in order to reduce the high metal ion level rate after hip resurfacing.
761 cases in 613 patients with minimal two years follow-up had both metal ion levels and quality pelvis X-ray available in our database and are included in this study. The UCLA activity score, femoral shaft … Read the rest
|Refined Intraoperative X-ray Technique to Routinely Achieve
an Acetabular Inclination Angle < 50ºThomas P. Gross, MD
(d), Fei Liu, PhD (d)
Midlands Orthopaedics, P.A. Columbia, SC.6/5/2012INTRODUCTION
A steep acetabular inclination angle is the primary cause of adverse wear related failure with well-designed metal-on-metal bearing hip resurfacing arthroplasties (HRA). One recent study demonstrated that positioning acetabular components of stemmed total hip arthroplasties (THA) within the “Lewinnek safe zone” is difficult; only 62% had AIA within the safe zone. However, we have previously demonstrated that acetabular components for HRA can be placed with an AIA<55° in 96% of cases using intraoperative X-ray. We now report our results using a refined technique, suggested by our previous study, as well as a lower acceptable limit for inclination
|1: J Bone Joint Surg Br. 2005 Apr;87(4):463-4. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. Shimmin AJ, Back D. Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Victoria 3181, Australia. email@example.com Between April 1999 and April 2004, 3497 Birmingham hips were inserted by 89 surgeons. Fracture of the neck of the femur occurred in 50 patients, an incidence of 1.46%. Complete data were available for 45 patients in whom the incidence was 1.91% for women and 0.98% for men. The relative risk of fracture for women vs men was 1.94961 and this was statistically significant (p < 0.01).The mean time to fracture was 15.4 weeks. In women the fractures occurred at a mean of 18.5 weeks and were more likely|
|A new surgical robot is making medical undergraduates three
times more accurate during practice hip operations, according to pilot study to be discussed at a conference this week (8 February 2008).
Link News Website
Delegates at the British Society for Computer Aided Orthopaedic Surgery Conference will hear that results from a pilot study saw graduates 95 per cent more confident using this robotic technique than when using conventional surgical methods in training.
Professor Justin Cobb, Head of the Biosurgery and Surgical Technology Group at Imperial College London, conducted the trial on 32 undergraduate medical students at Imperial College London from December 2006 to December 2007. The pilot study tested whether planning before an operation, combined with the latest robotic navigation equipment could increase the
Hospitals more specialized in orthopedic surgery show better outcomes for hip and knee replacement February 17, 2010 Click Here to read full article A recent study of Medicare data by University of Iowa investigators indicates that hospitals with a higher degree of orthopedic specialization provide better outcomes for patients undergoing hip or knee replacement surgery.The findings, which appear in the online version of the British Medical Journal, were based on a retrospective study of nearly 1.3 million Medicare beneficiaries aged 65 years and older who had hip or knee replacement procedures between 2001 and 2005 at 3,818 U.S. hospitals. The investigators grouped the hospitals into five categories according to their degree of orthopedic specialization. Orthopedic procedures accounted for 10.5% of admissions at the average… Read the rest
Hip resurfacing patients with groin pain report improved results Read Complete Article by clicking here
Illical E. HSS J. 2012. doi:10.1007/s11420-012-9299-3.October 11, 2012 A cohort of patients who experienced groin pain after metal-on-metal hip resurfacing reported improved outcomes at mid-term follow-up, according to recent research. “Groin pain post hip resurfacing has a multi-factorial etiology and in the vast majority of cases improves over time with no significant functional limitations,” Emmanuel Illical, MD, FRCSC, and colleagues stated in the study abstract…
…At minimum 63-month follow-up, the patients reported improved mean pain rating, WOMAC and UCLA scores, according to the abstract.UCLA scores increased from 6.4 to 6.9 and mean pain rating score improved from 5.2 to 2.5 at the latest follow-up…… Read the rest
|Optimal acetabular cup positioning is attained in less than 50% of cases, study reportsMarch 9, 2010 NEW ORLEANS – High-volume surgeons are more likely than low-volume surgeons to attain optimal cup positioning for total hip arthroplasty, but both groups still attain optimal cup positioning less than half of the time, according to a study presented here. The findings were presented by Bryan Jarrett, BS, at the 56th Annual Meeting of the Orthopaedic Research Society. Jarrett said the purpose of the study was to attempt to correlate the influence of various patient factors – body mass index (BMI), age, gender and primary diagnosis for the total hip arthroplasty (THA) – with the positioning of the acetabular cup. “Cup positioning and implant positioning are extremely important|
What is Phonophoresis?Phonophoresis is the use of ultrasound to enhance the delivery of topically applied drugs. Effectively, medicines contained within or under the ultrasound gel are pushed by the sound waves of the ultrasound and driven deep below the skin. Phonophoretically administered medications can penetrate the body much deeper than those massaged by hand over the surface of the skin. Some medications can be delivered phonophoretically. The process is dependant on many, many factors. For example, the type of drug and its molecule size are critical. The drug molecule has to be just the right size to be picked up by the ultrasound waves and the right size to pass through the body tissue. As well, the medicinal molecule can’t react with the ultrasound
Florian-D. Naal, MD*, Nicola A. Maffiuletti, PhD, Urs Munzinger, MD and Otmar Hersche, MDFrom the Joint Center, Schulthess Clinic, Zurich, Switzerland Published on May 1, 2007 Background: No information is available concerning patients’ sports activity after hip resurfacing arthroplasty. Hypothesis: Patients treated by hip resurfacing arthroplasty will be able to achieve a high level of sports activity. Study Design: Case series; Level of evidence, 4. Methods: We surveyed 112 patients by postal questionnaire to determine their sporting activities at a mean of 23.5 (range, 9–40) months after hip resurfacing surgery. Data were also analyzed separately for older and younger patients and women and men, respectively. Results: Of 112 patients, 110 participated in an average of 4.6 sport disciplines after surgery, compared
Outcome of hip resurfacing may be dependent on experience
By Gina Brockenbrough February 27, 2009
LAS VEGAS — A new study links outcomes of hip resurfacing to the hospital volume of resurfacing cases and, thereby, the surgeon’s experience.To evaluate the impact of operative volume on hip resurfacing outcomes, Andrew J. Shimmin, MBBS, FAOrthA, and colleagues used the Australian Joint Registry to identify nearly 9,000 hip resurfacings performed at 196 hospitals between September 1999 and December 2006… ..They found that 74% of hospitals performed fewer than 30 procedures during the 7-year study period, while 64% of hip resurfacings were performed at 16 “high-volume” hospitals, or those that performed more than 100 cases. Overall, the researchers found that 3.1% of resurfacings were revised… …They then
Computer-Assisted Vs Conventional
Volume 24, Issue 3, Pages 341-350 (April 2009)
Jose Rafael E. Resubal, MD, FPOA, David A.F. Morgan,
Received 16 June 2007; accepted 17 December 2007.