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Dr. Thomas Gross
7000+ Hip Resurfacings to date***
4500+ Uncemented Hip Resurfacings
1000+ Outpatient Hip Resurfacings
South Carolina Joint Replacement Center
Midlands Orthopedics
1910 Blanding Street
Columbia, S.C. 29201
Lee Webb, MSN, APRN, ANP-BC
Assistant to Thomas P. Gross, M.D.
803-256-4107 office,
803-355-2774 pager
803-331-6894 cell
803-933-6754 fax
Contact email: Ms. Lee Webb, MSN, APRN, NP
South Carolina Joint Replacement Center
Dr. Gross Begins Using the BHR Since Zimmer Stopped Manufacturing the Biomet Recap/Magnum Device
Posted on Dr. Gross’s Website and previously used by Dr. Gross 11/22/2024
Alternatives for hip resurfacing
The era of the Biomet Recap/Magnum has come to an end. Zimmer has stopped manufacturing this implant. After nearly 20 years of using this implant for hip resurfacing and posting the best long-term durability outcomes for any type of hip surgery, I will have to change. To continue performing hip resurfacing for all patients is becoming more challenging because of Zimmer’s unfortunate decision.
I will offer the BHR (Birmingham hip resurfacing) to men with good bone. Shorter men have a higher chance of needing a smaller implant (not available) and will sometimes get a backup total hip replacement (THR). Women and shorter men can choose to enroll in the Polymotion Hip Resurfacing study and receive this implant.
Certain patients with poor bone quality will no longer be candidates for hip resurfacing because both of the currently available implants feature cemented femoral components which have an excellent track record with good bone, but a higher failure rate in patients with osteoporosis or bone defects.
Other implants are in the development pipeline, but only limited options are currently available.
The BHR has been available for many years and has an excellent track record. It is an excellent choice for men who require a bearing size greater than 48mm. This is a hybrid metal-on-metal (MoM) implant. This means the femoral component is cemented and the socket is uncemented. Women cannot be done because the manufacturer (Smith Nephew) advises against it. I disagree with their opinion, but ignoring their instructions would pose too great a legal risk in our overly litigious society and its broken legal system. Also, the smaller sizes below 48mm that are usually required in women are just not made anymore. Women are just out of luck because of the decisions made by the men who run Zimmer and Smith Nephew and our broken legal system. Implant size is most related to patient height, therefore shorter men are also unable to get resurfacing. But in men with osteoarthritis (OA), the 10-15 year published outcomes by a select group of expert surgeons who have a similar skill level as I do have similar outcomes with the BHR implant that I have with the Recap/Magnum. I do not hesitate to offer this as an excellent alternative.
The Polymotion hip resurfacing by JointMedica and Exactech will be available as part of an FDA IDE trial beginning in February 2025. It is a hybrid implant with a cobalt chrome cemented femoral component and an uncemented vitamin E crosslinked polyethylene (VE XLPE) socket with a titanium porous coating. All sizes will be available. There will be some study restrictions. No patients over 64, no AVN, no severe dysplasia, no osteoporosis, no large femoral or socket bone defects. Also, this study will be conducted exclusively at our surgery center. Therefore, patients who require a hospital environment do not qualify. These are all patient groups that I previously did with the Recap/Magnum but can no longer offer resurfacing to. This represents less than 5% of cases. Only a small number of implants will be available for this study starting in February and ending a few months later when we have used up our implant allotment.
Zimmer has never been a friend of metal-on-metal resurfacing after their poor experience with the Durom implant. When Zimmer acquired Biomet 8 years ago, I suspected that they would kill Recap/Magnum. Fortunately, we got another 8 years of using this implant and I am now publishing the best long-term outcomes of any type of hip surgery with uncemented Recap Magnum. It is hard to believe that Zimmer would discontinue manufacturing the implant that has the best success rate of any implant ever made by Zimmer (or any other company). But there are similar long-term outcomes published with the BHR resurfacing implant in men.
The problem is that the company (Smith Nephew) discontinued the smaller sizes and placed a restriction on using it for women because of the problem of metallosis that used to be more common in these situations. As you can read elsewhere on my website, I solved this problem of metallosis over 10 years ago by discovering a safe zone for placing these implants. This safe zone has been validated in thousands of patients. I still have not had any failures due to metallosis since 2009 in over 4000 consecutive cases. The BHR is safe in smaller sizes and women as long as you place the cup in the safe zone. For various reasons, the company is unwilling to reinstitute smaller sizes, remove the restriction on women, or develop an uncemented femoral component.
In summary, I will be using the BHR in men. At this point, there is still an unlimited supply of this implant system. Based on your height I can give you the odds that your hip will be too small for a BHR. However, the final decision will be made based on the actual measurement of your head size during the operation. If your head size is much smaller than 48mm I will not have the necessary implant in the BHR system and I will use an uncemented dual mobility THR as a backup. This has similar stability as hip resurfacing, but the THR stem will likely limit vigorous impact activity and heavy work and it will not last as long.
In women, the only US option is to have a Polymotion resurfacing. For full details see my position paper on this topic. This is a new implant that will be available as part of an FDA IDE study. All implant sizes are available. The costs for the procedure will remain the same as before. There will be an added requirement that you follow up in person here in Columbia at 4 intervals from surgery: 6 weeks, 6 months, 1 year, and 2 years. You will be contractually obligated to do this in writing. If you fail to show up, you endanger the study and subsequent implant approval. This will harm thousands of future patients who will not be able to have a resurfacing and will be condemned to a second-rate THR. Because of the cost of running an FDA study only a limited number of these will be available. Full approval which allows unlimited supply will likely occur in 2029.
Other implants are available in Europe. Dr Koen DeSmet in Ghent Belgium is conducting a trial of the hybrid ceramic on ceramic Resurf implant made by MatOrtho. Excellent early 2-year data has been published. Also, Prof Justin Cobb in London has just received European approval for his ceramic-on-ceramic uncemented H1 Embody implant. There is as of yet no publication of his data. Neither of these implants is available yet in the US. Both companies will most likely also need to undertake lengthy and costly FDA IDE trials to get approval to sell in the US. I will likely be involved in at least one of these.
With the very unfortunate withdrawal of the Recap/Magnum from the market by Zimmer, we have lost the implant with the best long-term implant survivorship data and the most versatility to address the most complete range of patient cases. No THR can come close to the functional and durability outcomes of hip resurfacing. The next best implant, which also has the most extensive data to back it up is the BHR, but this can only be used in limited patient types. Finally, Polymotion is a very promising new implant but has only short-term data to back it up. This is the only option for women and smaller men in the US.
You might ask, “If Dr Gross can no longer use the Recap/Magnum with which he has published the best outcomes for hip resurfacing in the world, and my next best option is the BHR, why not go to someone more experienced with the BHR?” My answer to this is that the most important factor in the outcome of any operation is by far and away surgeon skill. The implant used is maybe the next most important factor.
Three surgeons have published excellent long-term results with the BHR. Derek McMinn is retired, Ronan Treacy is still going strong in Birmingham, England, and Peter Brooks is semi-retired at the Cleveland Clinic in Florida. You can’t go wrong with either of these fine surgeons. No other surgeon in the US has published long-term outcomes using the BHR. So, you can take a leap of faith and choose someone who has done a lot of BHRs but has published no data. All other published long-term outcomes (10-15 years) in the world are inferior.
But doing a BHR vs. doing a Recap/Magnum is not much different for a surgeon skilled in this operation. The only real difference is cementing vs. press-fitting the femoral component. I have cemented the first 1000 hip resurfacings that I performed prior to switching to uncemented in 2007. I probably know how to cement a femoral component. In analyzing comparison data between cemented an uncemented femoral components it appears that the long-term failure rate is approximately 1% higher when cement is used. I now publish 98% 19-year implant survivorship with the Recap Magnum system; therefore, I estimate 97% 19-year survivorship if I use the hybrid BHR, perhaps better if I exclude high-risk cases with osteoporosis and osteonecrosis.
If you are a man: BHR with an increasing chance of a backup of UC dual mobility THR if you are shorter. Unlimited supply.
If you are a woman: Polymotion if you meet the study criteria above and are willing to commit to the required follow-up. Limited supply.
Patients with extensive bone loss due to wear or underlying deformity (severe dysplasia, Legg-Perthes), osteonecrosis, or osteoporosis can no longer be done. You will need to have a THR.
Predict your chance of being fit with a BHR implant
We have analyzed our database of over 7000 hip resurfacings and found that the factor that best predicts implant size is patient height. This is important for men who are contemplating a BHR implant. The shorter a man is the smaller his femoral head is. If the head is smaller than 48mm, no BHR implant is available that will fit. The table below lists the odds that you will be able to get a BHR:
Patient Height | Chance of an implant available |
|---|---|
| > 5’11” | > 99% |
| 5’8” – 5’10” | >97% |
| 5’ 6-”-5’7” | >93% |
| 5’3”-5’5” | >80% |
| 4’10”- 5’2” | >70% |
Is Ceramic on Ceramic Hip Resurfacing the New Gold Standard?
Thomas Gross MD 7/10/2021
Dr. Gross discusses the new ceramic on ceramic hip resurfacing devices and compares them to metal on metal hip resurfacing devises. His summary conclusion:
“I am also involved in CoC HRA development. If these become available in the US I will be involved in early trials. Avoiding the whole tiresome discussion of allergy/toxicity/metallosis would be nice. But if I needed surgery, I would personally choose the proven uncemented MoM HRA which has set the gold standard for hip implant survivorship in the world at 15-year 99% implant survivorship. Hopefully the theoretical pitfalls of ceramic: cracking, squeaking, and debonding of the socket porous coating will not doom the CoC HRA. Do you really want to take a chance, when MoM HRA works so well?”
Complete article is below.
- Metal on metal (MoM) hip resurfacing arthroplasty (HRA) as conceived by Derek McMinn and the late Harlan Amstutz in the 1990’s is unquestionably the proven gold standard for hip reconstruction in 2021.
- HRA is too challenging an operation for most joint replacement surgeons.
- Fear of metallosis is misplaced; but this fear is constantly fanned by most total joint surgeons because their alternative, total hip replacement (THR), is inferior by many measures: worse functional outcome, more residual unexplained pain, worse implant survivorship in young patients, higher rate of debris mediated failure, higher dislocation rate, and higher 10-year all-cause mortality.
- Metallosis with MOM HRA is a solved problem……just place the cup right.
- Trunion corrosion in THR is currently a much greater problem…. And far from being solved.
- There is no cancer risk with MOM bearings, metal allergy is a myth.
- Reversible mild metal toxicity has rarely occurred in past metallosis cases. Severe cardiotoxicity has never been reported in MoM HRA.
- Theoretical concerns with ceramic on ceramic (CoC) HRA are: cracking, squeaking, porous coating debonding.
- Two CoC HRA trials, Imbody H1 and MatOrtho ReCerf are in progress.
- Can a CoC HRA beat the current gold standard uncemented MOM HRA with 99% 15-year implant survivorship in over 5000 cases?
Hip resurfacing is a difficult operation to master and only a few dozen surgeons in the world are proven experts at this operation. Most joint replacement surgeons persist with the standard stemmed total hip replacement (THR) because of technical difficulty of HRA and fear of metallosis, even though THR is clearly inferior to resurfacing. HRA is definitely more technically challenging to perform and few surgeons have the opportunity to get trained. I learned it on my own starting in 1999 and have helped others learn it.
Dr. Gross’s Latest Hip Resurfacing Results Updated July 2020
Dr. Gross has now performed over 6500 Hip Resurfacing Arthroplasty (HRA) procedures over the last 20 years and currently performs nearly 500 cases/year.
Read Dr. Gross’s Complete Update thru July 2020 here:
https://surfacehippy.info/dr-grosss-latest-hip-resurfacing-results-updated-july-2020/
The Continuing Controversy About Hip Resurfacing For Women
by Thomas P. Gross MD July 4, 2015
Young women who desire a more functional hip replacement were recently dealt a large blow when the smaller sizes of the Birmingham Hip Resurfacing (BHR) device were withdrawn from the market by Smith Nephew Richards because the 10-year revision rate for women was higher than for men in most large registry analyses. (The major national registries are Australia, Combined Scandinavia, and Great Britain).
Joint implant registries estimate an overall failure rate for different implants when used by the average surgeon in a country. Specialist surgeons can typically perform better than these data suggest.
Hip resurfacing is a treatment for severe hip arthritis that results in a nearly normally functioning hip. Scientific studies demonstrate that patients walk more normally in gait studies, and are more likely to be able to resume full impact sports if they have a hip resurfacing rather than a traditional stemmed total hip replacement.
Generally women have smaller hip joints than men and require the smaller sized implants. There is no way to make the larger ones fit. The only alternative, if no smaller sized hip resurfacing implants are available, is to amputate the whole femoral head and then perform a standard total hip replacement (THR). I would estimate 70% of women and 20% of men will now not be able to choose a hip resurfacing arthroplasty (HRA).
It is difficult to know from the preoperative x-ray for certain what implant size will be needed. If patients are now scheduled for a BHR, they may end up with a standard stemmed THR instead of a resurfacing once the surgeon has opened the hip and found that the hip requires a smaller size than they thought.
There is no doubt in young men. Resurfacing is more functional and more durable. All men under 60 should have resurfacing if there were enough qualified surgeons available.
In women there is a dilemma: Do you choose a more functional hip that has a higher chance of failure by 10 years? Unfortunately women are loosing the opportunity to decide for themselves. The decision is being made for them by implant companies and the policies promulgated by the FDA. On the other hand, the failure gap between men and women is much lower in the hands of experienced resurfacing surgeons (than in registry data) My data now shows a 98% 8-year implant survivorship in women. Very few THR studies can match this in young patients.
Read Complete Article Here: https://surfacehippy.info/hip-resurfacing-and-women-by-dr-gross-2015/
Dr. Gross and Hip Resurfacing 2016
I lead the nation in hip resurfacing. I began performing metal-on-metal total hip resurfacing arthroplasty (HRA) in 1999. With the retirement of Dr. Harlan Amstutz, I now have the longest track record of performing this operation in the United states. I have performed over 3500 HRA, which is the fourth largest series in the world. In the rare patients that are not resurfacing candidates, I perform large metal bearing total hip replacements (THR). Patients who are worried about rare adverse metal wear failures can choose a ceramic / cross-linked polyethelene THR also done using a minimally invasive technique.
My published track record is one of the best in the world. In unselected patient series of hip resurfacing, we have published ten-year implant survivorship of 93% with the Corin Hybrid system, 97% 7-year implant survivorship with the Biomet Hybrid system, and most recently 98% 6-year survivorship with the uncemented Biomet system in peer reviewed scientific journals. Currently 6-year survivorship is 99% in men and 96% in women. For large metal bearing total hips, survivorship is 97% at 8 years.
I have pioneered many advances in hip resurfacing:
- The worlds first fully porous uncemented components
- Prevention of of early femoral failures (current rate of 0.15%)
- Elimination of acetabular fixation failures in dysplasia (none since 2007)
- The worlds only scientifically robust guideline for acetabular component positioning
- Intraoperative x-ray technique for achieving accurate acetabular component position
- Elimination of adverse wear failures (pseudotumors) (none in hips done since 2007)
- Minimally invasive posterior approach (4inch incision)
- Outpatient surgery (no hospital stay)
- Successful revision surgery for hip resurfacing (96% 6-year survivorship)
Hip resurfacing is the best solution for near normal reconstruction of the hip joint in severe arthritis. It is more complex to perform than standard hip replacement. Many excellent hip replacement surgeons have become interested in hip resurfacing in the last 10 years but have given up performing this operation because they encountered too many complications. This has led many experts to claim that “hip resurfacing does not work”. But a number of surgeons worldwide have been able to show superior results with HRA as compared to THR. Currently there are probably less than 10 surgeons in the US who continue to perform significant numbers of these cases with good results. If you are interested in the higher functional potential of this operation, be careful to choose your surgeon wisely.
Acetabular Revision in Hip Resurfacing by Thomas Gross MD 1/9/2015
January 9, 2015 THR= total hip replacement HRA= hip resurfacing arthroplasty
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 in Seattle. But I am not sure that a PE bearing HRA is better than a THR.
In the past, I preferred revising Biomet femoral failures with a Magnum M/M THR. This is no longer possible because Biomet withdrew the Magnum head because of a fear of inappropriate litigation in the midst of anti-metal hysteria. Now the best option may be a dual mobility head THR for femoral revisions. Other brands of HRA had poor trunions for their matching femoral stems and were withdrawn from the market for good cause. The Biomet Magnum trunion was unique and was NOT subject to corrosion from strain induced by a large head.
Read Complete article here: https://surfacehippy.info/acetabular-revision-in-hip-resurfacing-by-thomas-gross-md-192015/
A Safe Zone for Acetabular Component Position in Metal-On-Metal Hip ResurfacingArthroplasty: Winner of the 2012 HAP PAUL AwardFei Liu PhD, Thomas P. Gross MDMidlands Orthopaedics, P.A. Columbia, South Carolina
A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculatedbased on implant size and acetabular inclination angle (AIA). For AIA below the RAIL,there were no adverse wear failures or dislocations, and only 1% of cases with ion levels above10μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis. Seven hundred sixty-one hip resurfacing cases are included in this study. The UCLA activity score, femoral shaft angle, body mass index, weight, American Society of Anesthesiologists score, combined range of motion, diagnosis, age, gender, implant brand, AIA, bearing size, and duration of implantation were analyzed to determine the potential risk factors for elevated metal ion levels. These findings apply to sub hemispheric metal-on-metal bearings with similar coverage arcs as the Biomet and Corin hip resurfacing brands. Additional problems may occur when these bearings are connected with trunions on stems for total hip arthroplasty.© 2013 Elsevier Inc.
Read Complete Study Here: https://surfacehippy.info/pdf/hap-paul-award-dr-gross-2012.pdf
Dr. Gross Interview by Patricia Walter Dec. 3, 2012 in Columbia SC –
Hip Resurfacing vs THR
Dr. Gross Interview by Patricia Walter Dec. 3, 2012 in Columbia SC –
Choose an Experienced Hip Resurfacing Surgeon by Dr. Gross 2012
Dr. Gross Interview by Patricia Walter Dec. 3, 2012 in Columbia SC –
Uncemented Hip Resurfacing and Update by Dr. Gross 2012
Refined Intraoperative X-ray Technique to Routinely Achieve an Acetabular Inclination Angle < 50º Thomas P. Gross, MD (d), Fei Liu, PhD (d) Midlands Orthopaedics, P.A. Columbia, SC.6/5/2012INTRODUCTION
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 angle (AIA<50°). We wanted to determine how often the method allowed us to achieve an AIA in the “safe zone for HRA”. We also wanted to know if repositioning an acetabular component intraoperatively to achieve an ideal position made it more likely to shift postoperatively.
Read Complete Study Here: https://surfacehippy.info/refine-intraoperative-x-ray-technique-to-routinely-achieve-an-acetabular-inclination-angle-of-less-than-50-degrees-by-dr-gross-2012/
Incidence of Adverse Wear Reactions in Hip Resurfacing Study by Dr. Gross 2012
Conclusions
In summary our data suggests the following conclusions:
1.) Adverse wear related failures (metallosis) are rare with the Biomet and Corin HRA systems (0.27%, Kaplan-Meier 1% at 10 years). 2.) Pseudotumours not related to adverse wear are rare with metal bearings. 3.) Adverse wear failures were seen with the Biomet and Corin systems only if the AIA on standing pelvis xray was > 50 degrees. (5/7 failures had AIA>60). 4.) A Safe zone for placing the Biomet and Corin devices is: AIA< 50 degrees on standing pelvis xrays. This likely also applies to other well-designed systems. 5.) Adverse wear failures are more common in women, dysplastics, and when femoral components ≤ 48 mm are required. These factors are, of course, interrelated.
We therefore conclude that hip resurfacing with Biomet and Corin implants (and likely most others with a similar bearing design) is safe and effective and is exceedingly unlikely to result in adverse wear failure as long as the acetabular component is placed such that the AIA is < 50° on standing AP pelvis xray. In women with dysplasia that require small femoral components there is less room for error in acetabular component positioning. Adequately designed components exist; it is now up to surgeons to learn to place them accurately and reproducibly to avoid adverse wear failures.
Read Complete Study Here:
Part 1 – Dr. Gross Interview by Patricia Walter
August 26, 2011 in Baltimore, MD at the 5th Hip Joint Course
Part 2 – Dr. Gross Interview by Patricia Walter
August 26, 2011 in Baltimore, MD at the 5th Hip Joint Course
Dr. Gross Interview by Patricia Walter
Sept. 5, 2009 in Baltimore, MD at the 3rd Hip Resurfacing Course
Dr. Gross Interview By Patricia Walter
2008 in Columbia SC
HIP RESURFACING SURVIVORSHIP
Thomas P. Gross, MD 2480 cases over 10 years August 2011
HIP RESURFACING SURVIVORSHIP
Thomas P. Gross, MD 2480 cases over 10 years August 2011
Survivorship of hip resurfacing continues to improve as we gain more experience and find measures to prevent failures. Theses survivorship curves give the reader an opportunity to see what the odds are that their implant will still be functioning at some time point after implantation. We have used three implant systems in the last 10 years. The first were hybrid fixation Corin devices (blue), the second were hybrid fixation Biomet devices (red), the latest are completely uncemented Biomet devices (green).
In the last 10 years we have learned what patients with particular characteristics are at higher risk for failure. The strategy of many experts is patient selection. If they avoid performing hip resurfacing on higher risk patients, their overall results will improve. I disagree with this defeatist strategy.
My improving results are not achieved by patient selection. I have always
practiced minimal patient selection and my criteria have not changed much over the last 10 years. Instead, my goal is to find treatment modifications to improve the results in patients that are traditionally identified as higher risk. In some cases, we have already accumulated scientific evidence of improved
results; in other cases, we still need more time to gather data to be certain that our treatment modifications have improved results. Examples of our innovations include:
1. Femoral neck fracture: stratifying risk of femoral neck fracture by bone density and BMI and treating higher risk patients with slower weight bearing and bisphosphonate drugs. We have demonstrated that this substantially reduces risk.
2. Failure of acetabular implant attachment: dysplasia patients
are at higher risk because of socket deformities. Use of Trispike acetabular components in severely deficient sockets has eliminated these failures in this high‐risk group.
3. Femoral cysts: Bone grafting cysts instead of filling them with cement has resulted in eliminating femoral cysts as a risk factor for failure in our patients.
4. Femoral Loosening: The major source of late failure in my cemented femoral components. We have demonstrated that uncemented femoral components are equally as good as cemented ones at up to four years follow‐up. Our hypothesis is that uncemented femoral components will be less likely to loosen in the long term.
5. Adverse wear failure: This has been linked to acetabular component position, particularly high inclination angles (AIA). We have developed an intraoperative XR technique that has lowered the chance of implanting a component with an AIA>50 from 26% to 4%. Recent improvements in our technique are focused on still further improvements in the odds of achieving ideal component position.
I have been performing hip resurfacing for over 10 years and have maintained an accurate database of current patients with an overall >90% rate of follow‐up. This chart presents the results for 2480 cases.
Dr. Gross 2011 Summary of Outcomes for 2500 Hip Resurfacings
Dr. Gross has now performed over 2500 Hip Surface Replacement (HSR) procedures over the last 12 years. Most failures occur during the first 6 months of the healing period. However, there is a slow rate of failure that occurs over time. Therefore the overall failure rate increases for a group of patients as the length of follow-up increases. In our recent publication in the Journal of Arthroplasty 2011, we reported that our Corin Hybrid HSR achieved a 93% survivorship at 11 years follow-up. Longer-term data is not available. Multiple improvements have been made since this initial patient group. Our most recent cases use the Biomet uncemented Recap /Magnum. We report here the early results of the first 1000 done between March 2007 and July 2010 with a 99.4% rate of follow-up (90% completely up to date on their follow-up, and 64 % achieving at least 2 years follow-up). Not all complications lead to failure. Below is a complete list ofmajor complications (not just failures) in the first 1000 uncemented HSR using the Biomet system:
A.) Failures Requiring Revision Surgery (1000 cases):
1. Femoral neck fracture: 62. Early femoral collapse (avascular necrosis): 23. Failure of acetabular ingrowth: 54. Adverse wear failure: 25. Deep infection with loss of implant: 06. Recurrent dislocations requiring revision: 07. Femoral component loosening: 08. Acetabular component loosening 09. Subtrochanteric femur fracture 1(related to hardware removal)
TOTAL: 16 1.6%B.) Cases requiring significant repeat surgery (1000 cases):
1. Traumatic intertrochanteric fracture 2(5 and 11 months postop):2. Deep infection (cured): 22. Significant superficial infection (cured): 13. Frostbite from ice machine: 2
TOTAL: 7 0.7%C) Other Complications (1000 cases):
1. Dislocations: 22. Pulmonary emboli: 33. Deep vein thrombosis: 24. GI bleed requiring transfusion: 15. Minor stroke: 14. Nerve injuries: 05. Postoperative transfusions: 0
6. Femoral notches: 0
7. Vascular injuries: 0
8. Deaths: 0
TOTAL: 9 0.9%
A comparison of modern bearing types Dr. Thomas Gross 1/11/2011
Read Complete Article Here:
What is the Best Bone Fixation Type?
Dr. Thomas Gross 1/11/2011
A Comparison of cement vs. bone ingrowth Thomas P. Gross, M.D.
- At 2 years of follow-up cemented and uncemented femoral resurfacing is equivalent.
- Femoral cement failure is the most common late cause of failure in hip resurfacing (3% @ 8 years).
- Wear-related failures with the Corin or Biomet implant systems are rare in my experience.
- We have demonstrated that failure of bone ingrowth does not occur in a properly designed uncemented femoral resurfacing component (provided femoral neck fracture or osteonecrosis does not occur).
- Uncemented fixation of implants in stemmed total hip replacement surgery is more durable at 10 years than cement, especially in young active patients.
- Every patient who is a candidate for hip resurfacing is a candidate for an uncemented femoral resurfacing component.
- Most clinical data on hip surfacing to date is based on an uncemented acetabular component and a cemented femoral component.
- Uncemented femoral resurfacing components are now available from Biomet for any patient who desires them.
- Wright Medical is beginning initial studies on an uncemented femoral component.
- Corin has had an uncemented femoral component available in Europe for several years.
- I recommend uncemented resurfacing for every patient who is a resurfacing candidate; I don’t require cemented components or stemmed total hips as backups except in unusual circumstances (2/2300 = 0.23%)
- Combination of the Biomet Magnum and Recap components for total hip resurfacing is defined by the FDA as an off-label use.
Read Full Article Here:
https://surfacehippy.info/what-is-the-best-bone-fixation-type-by-dr-gross/
Dr. Gross responds to the controversy regarding adverse wear in metal-metal bearings 2010
I have used over 3000 metal bearings in primary total hip and hip resurfacing as well as revision surgery. I have revised 2 for adverse wear 7 years after implantation. I know that most other high volume hip resurfacing surgeons have a similar experience. The revisions were straightforward and the patient enjoyed the same rapid and complete recovery as if she had a primary hip replacement.
Currently less than 5% of my practice involves revision surgery. However, I have revised over 100 metal plastic replacements for excess wear. Furthermore significant wear related damage to the tissues is seen in virtually all metal plastic hip replacement or knee replacement revised for other causes.
A surgical group that has seen a surprisingly large number of wear‐related failures of metal bearing implants has coined the term “pseudotumor” when an inflammatory soft tissue mass is seen around the hip of a metal bearing implant. However, this inflammatory soft tissue reaction to metal wear debris is not much different than the inflammatory reaction that we have seen with plastic wear debris for many years.
Read Full Article Here:
Dr. Gross Live Chat Transcripts
A Seven-Year Follow-up Study Metal-on-Metal Hip Resurfacing with an
Uncemented Femoral Component Sept. 2008
Between 1999 and 2000, eighteen patients (twenty hips) underwent primary metal-on-metal hip resurfacing with uncemented femoral and acetabular components. One patient was lost to follow-up. This left eleven men and six women, who had a mean age of forty-five years at the time of surgery. Clinical and radiographic examinations were performed prospectively, and the results were analyzed.
Read Complete Study Here:
Dr. Gross Answers Questions about Hip Resurfacing and Surgery
100 HSR would be a good benchmark.
Several US surgeons allow all activities after 6 mos. What are your guidelines?
I allow virtually all activities at 6 months.
Does the insertion of the acetabular component require more bone removal in a resurfacing procedure as opposed to a THR.
I do both procedures and remove the same amount of bone on the acetabular side whether it is a HSR or THR.
Do you prescribe Physical Therapy post op. Can you explain why?
With the minimally invasive posterior approach no formal physical therapy is necessary. I think it can be counter productive in the first 6 weeks, after 6 weeks I am happy to prescribe this.
What is your opinion about running and jogging after hip resurfacing?
I do not recommend marathon running but light jogging is permitted.
What is the difference between the Biomet device and the BHR device?
I designed the Biomet device and feel the instrumentation makes it easier for the surgeon to implant because of their accuracy. Implants are thinner and require less bone removal. Biomet was the first to offer 2mm sizing with 12 implant choices, now it is the only one currently available with an uncemented component in the US.
What anesthesia do you normally prefer?
I recommend spinal anesthesia with sedation plus multiple pre- emptive anti-nausea medications.
Blood thinning is highly controversial, there are many acceptable alternatives. My preference is 10 days of Arixtra followed by one month of 81 mg aspirin. My DVT rate is less than 1% with no pulmonary embolism in 1500 cases.
How long before complete bone in growth has occured for the socket component?
I estimate the process is 90% complete at 6 months and 100% complete at 1 year post op.
Do you suggest Fosamax to increase bone density post op?
There is good basic science data in animals that Fosamax increases bone deposition around uncemented implants. Therefore, I recommend it in osteopenic patients.
What the safe levels of chromium and cobalt ions after hip resurfacing?
No one knows what safe levels are. These are normal elements in our body. They are elevated after placing metal implants. There is no value to measuring and following levels at this point.
What types of daily exercise do you suggest?
At 2 years virtually all exercise is good except possibly extreme repetitive impact sports such as marathon running. No one knows for sure.
Is recovery from a hip resurfacing slower than recovery for a THR?
The recovery is identical. I would recommend waiting 6 months to return to vigorous activity. I perform both resurfacing and THRs.
What amount and type of activity is helpful in the initial week after surgery? Is stretching important?
Walking is a great exercise for the hip, you should gradually be able to walk longer distances outside, I would be very careful with stretching, hip range of motion will return to normal with or without stretching.
How soon after resurfacing can one start stretching to regain
ROM? Do you recommend any type of physical therapy?
You may start stretching at 6 weeks, but no extreme flexion exercises for at least 6 months. Physical therapy is not required after a posterior approach, the muscles recover quickly with walking and a simple home
exercise program.
What activity should I be doing during the first week post op hip resurfacing surgery?
You should be up out of bed, walking around in your house, and sitting in a chair most of the day. Walking outside for one to two blocks a day is a good idea. You can gradually progress your walking from there. You should also ice and elevate.