- Revision Hip Resurfacing Patients Have Better Outcomes Than THR Revision Patients
- Loose or Slipped Acetabulum Cups by Dr. Bose
- DePuy Orthopaedics Discontinuation of ULTAMET Metal-on-Metal
- Dr. Su responds to recent Lancvet Article about failoure rates
- Hip Resurfacing Problems
- Knowing the cause of resurfacing failure can ensure successful conversion to THR by Dr. Su
- I Have Bone Cysts, Can I Have a Hip Resurfacing?
- Bone Cysts by Dr. Scott Rubinstein
- Pseudotumours Risk For Hip Resurfacing Highlights
- DuPuy Reaches $2.5 Bln Deal To Compensate Revision Patients 2013
- Acetabular Revision in Hip Resurfacing by Thomas Gross MD 1/9/2015
- Acoustic Phenomena in Hip Resurfacing by Dr. Koen De Smet & Dr. Alessandro Calistri
- Dr. Dorr Memo to American Association of Hip and Knee Surgeons about the Durom Cup by Zimmer
- Femoroacetabular Impingement
- Revision of metal-on-metal resurfacing arthroplasty
- Dislocation of BHR by Dr. Bose
- Loose Acetabulum Cups by Dr. Bose
June 1, 2018 – BARCELONA, Spain – Total surface replacement may still be a viable hip arthroplasty option in young, active patients based on how well it fared in a study when it was revised to total hip replacement vs. primary THR that was revised to THR, according to a presenter at the EFORT Annual Congress…
…“Our study shows, therefore, that there is less blood loss, there’s a shorter length of stay and better function in patients undergoing revision of resurfacing as opposed to revision of a standard stemmed prosthesis,” Kent said… Read the rest
The issue of cup slippage in the immediate postop period is a controversial one.
While bone ingrowth takes around 6 wks. – the hydroxy apatite to bone chemical reaction can occur much more quickly.
If we surgeons feel that the cup is not perfectly tight ( press fit) during the surgery then we restrict activities for a 6 -8 wk period .This is done in the hope that no precipitating event would occur that would tilt the balance adversely till some stability occurs as we have not achieved primarily stability during surgery. I must say that most of these times we are able to ‘escape’ component loosening.
I have done this a few times in my very early cases , many years ago. Of course these days we get such spectacular fixation of the cup primarily that many of my patients are visiting the gym in 5-6 days following surgery.… Read the rest
DePuy Orthopaedics, Inc. Statement on
Discontinuation of ULTAMET Metal-on-Metal and
COMPLETE Ceramic-on-Metal Hip Systems
DePuy Orthopaedics, Inc., announced its decision
to discontinue sales of its ULTAMET
Metal-on-Metal Articulation and COMPLETE
Ceramic-on-Metal Acetabular Hip System
worldwide. The discontinuation will be effective
August 31, 2013. This will allow surgeons to
plan accordingly for upcoming surgeries. The
ceramic head used in COMPLETE will continue to
be available for use in other bearing surface
The metal liner that is being discontinued
is used in both ULTAMET and COMPLETE. The liner
is designed exclusively for use with DePuy’s
PINNACLE Acetabular Cup System, the PINNACLE
Cup is not impacted by this discontinuation.
The PINNACLE Cup System is one of the most
widely used and clinically successful modular
acetabular systems for hip replacement and will
continue to be offered with both medical-grade
plastic and ceramic liners.
The decision to discontinue ULTAMET and
COMPLETE was made in … Read the rest
I would like to take this opportunity to comment on the Lancet article, “Failure rates of metal-on-metal hip resurfacings: analysis of data from the National Joint Registry for England and Wales”, by Professor AW Blom, published on October 2, 2012.First of all, this is an observational scientific study with valid research design and questions; however, the conclusions point out the limitations of registry studies (more on this to follow). Overall the conclusions of the study do NOT find any new information that has not already been known since 2010: that certain hip resurfacing implants perform better than others; that females do worse than males with hip resurfacing; and that larger size implants have a lower revision rate. These key pieces of information have been well-known and discussed by experienced hip resurfacing surgeons with their patients for at least 2 years already. Furthermore, there
Knowing the cause of resurfacing failure can ensure successful conversion to THR by Edwin Su, MD
The shell can be retained in cases involving femoral neck fracture, femoral loosening or impingement.
Causes of failure
“The cause of failure must be carefully assessed prior to the conversion surgery in order to ensure an optimal THR outcome,” Su said. He noted that femoral neck fracture is the primary cause of short-term failure in resurfacing procedures. He theorized that the rate of these fractures could be reduced with improved surgical techniques, careful patient selection and preoperative evaluation of bone quality. Inadequate acetabular fixation or the so-called “slipped cup” is another cause of early failure, which may also be related to surgical technique.
“The greatest cause of a mid-term failure is femoral component loosening and osteonecrosis probably plays a role in this,” Su said. “I think that component malposition is going to
Dr. Bose – I have bone cysts, can I have a hip resurfacing?
The presence of a cysts by itself is not a contraindication for resurfacing. It does not preclude resurfacing automatically. One must keep in mind that cyst formation is a natural occurrence in osteoarthritis and is very common though the extent, quantity & location may vary.
Cysts are of course much more common and invariably present in AVN. The assessment of certain technical factors would the real issue. This is based on the amount of residual bone after head preparation. Some resurfacing prosthesis are thicker at the top and tend to replace more bone in the head of the femur than other prosthesis. This is a great advantage in managing cysts as at the end of head preparation one is left with nearly 100% head support in a majority of cases. The cysts get reamed away in bone … Read the rest
|By Dr. Rubinstein|
2860 N. Broadway Suite 202
Chicago, IL 60657
|Cysts are very common in arthritic hips and can usually be|
seen on x-rays. Most of the time they are not a problem with
resurfacing because they are small and in the part of the bone removed in
milling the femoral head for a resurf. Most larger ones can be filled
with a cement of bone chips and still do a good resurf. The only cysts
that are problematic are those that erode the superior femoral neck
weakening the bone at a critical place. This can lead to fracture
with a resurf and that is an indication for a THR instead. They can
usually be seen on a pre op x-ray so I can tell the patient that a resurf
may not be possible and a decision can be made at surgery. In the one
July 11, 2008As the incidence of metal-on-metal hip resurfacing has increased in recent years, especially in younger patients, research published in the Journal of Bone and Joint Surgery – British Volume (JBJS-Br) discusses occurrences of “pseudotumours” as a result.The researchers estimate that approximately 1% of patients who have metal-on-metal hip resurfacings develop pseudotumours within five years of treatment. A pseudotumour is ‘a soft-tissue mass associated with the implant…neither malignant nor infective in nature’, but that causes pain and discomfort to the patient.Most worryingly for patients and doctors is that the causes of the tumours are unknown. The research discusses possible causes including ‘toxic reaction to an excess of particulate metal wear debris.’ The article stresses the need for further research to be done into the incidence of pseudotumours in patients who have had this treatment.The paper concludes that the incidence of pseudotumours must be
If an HRA has failed, I try to solve the problem by revising only the acetabular component whenever possible because HRA are functionally better than THR. If only the acetabular component is revised, the patient still has a HRA. If the femoral component is revised, the patient now has a THA.
Currently revising only the acetabular component with a metal/metal (M/M) articulation is only possible with the Biomet Magnum and SNR Birmingham implants. All others have been withdrawn from the market. Wright Conserve can still be revised in this way outside the US, because these perfectly good implants were only withdrawn from the hyper-litigious US market. The failed Depuy ASR and Zimmer Durom can be revised with a custom polyethylene (PE) bearing acetabular component. The only surgeon I know of who has access to these implants is Dr. Pritchett … Read the rest
By Dr. Koen De Smet & Dr. Alessandro Calistri
Acoustic Phenomena in Hip Resurfacing 2009 Koen De Smet, MD; Alessandro Calistri, MDAMC Ghent, Krijgslaan 181, 9000 Ghent, BelgiumBackground: While providing superior hardness and improved wear characteristics, hard bearings such as metal-on-metal, or ceramic-on-ceramics bearings have different lubrication properties than hard on soft (metal- or ceramic-on-poly) bearing couples. A failure in this lubrication mechanism in metal-on-metal resurfacing prostheses can lead to squeaking and has been reported by different authors. Other more frequently encountered acoustic phenomena in resurfacing are clicking, popping or grinding noises that patients may experience in different episodes of their prosthesis life.Methods: In a series of more then 2700 MOM resurfacings with different designs, the different acoustic findings, patient sensation and clinical exams/scores are reported. Patients are asked to report any noise or feeling in the 6 weeks, 1 year and 2 year follow-up.… Read the rest