Very interesting info from Derek McMinn on revisions, possibly SAVE your resurf?

[Vicky]

Hi everyone,

I thought you would find this information very interesting.  On SOME cases only, there is a possibility now of saving the resurfacing by revising the cup only.  This is probably NOT the case with a recalled device like the ASR unfortunately because you will want to remove the defective device, but that would be something to check with the surgeon, like Derek McMinn on. 


On Sep 12, 2011, at 10:30 AM, Derek McMinn wrote:

"Hello Vicky,

Cup breakout can easily be addressed by cup only revision. I used to get this with the Corin device I used and I've successfully carried out several cup only revisions over the past 20 years.  A large inventory needs to be available for revision surgery including thicker cups, dysplasia cups and  THA cups with a BHR (or whatever other resurfacing device has been used) compatible liner. Much better to get on and revise the patients hip than mess around with MRI's & metal ion tests. Delay will only serve to guarantee edge wear of a loose vertical cup. (Vicky's comment, this is in the case of a slipped cup ONLY)

With the BHR in a series of 3205 cases until Dec 2010, I've had 2 late cup loosening 9 & 12 years post-op- no early breakouts. Early breakout with the BHR cup is either caused by poor surgery with a poor primary fix or too early return to high activity before cup osseo-integration happens.

Best regards
Derek


I hope it will be helpful to a lot of you and I am so sorry many of you are having to deal with this issue, my heart really goes out to you.

Vicky

[einreb]

One question that's been floating around in the back of my head is why a 'redesigned' ASR cup could not be manufactured with proper coverage and clearance.  Its my understanding that the cup is the main culprit.  Its a pity that they have to chop of the femur and the cap because the cup is installed too steep and the design doesn't leave much room for error.

Revisions require removal of the cup anyway.  I realize the cup removal during a revision is easier since they chop of the ball and have better access... but if cup only revisions are being done (I think Gross is doing this too), pity ASR the resurfacing cant be saved.