Metal ions

[Vicky]

Hi Luanna,

Yes, I have done a TON of and continue to do a ton of research in many different ways.  Sorry, I just pretty much glanced over this thread and didn't read every post so I didn't even read which implant you got.  Just someone mentioned to me about metal ions and a thread and I was trying to find his and couldn't but came across this one, so I wanted to make sure I put some facts on here. What sort of a hybrid did you get?  Is it still a resurfacing or is it a THR?  What is it made out of?  Do you know how long he had been implanting those particular ones,  or did he make one up just for you?  And how many of these has he put in so far?

In the UK, Derek McMinn is now implanting a ceramic BMHR which is the only device that is in between a BHR and a THR and does NOT invade the bone marrow or femoral canal.  Here's a photo that shows an x-ray of each BHR, BMHR and THR to give you an idea.  And hopefully within the next year, there will be a ceramic on ceramic BHR available. 

If you post something to me and I do not respond, please keep in mind that I am rarely on here, so email me in private if that happens.  I will try to check in every now and then to see if there are any posts to me. 

Vicky

[Dannywayoflife]

Vicky finsbury also have a ceramic on ceramic HR in the pipeline. The delta surf. I saw some pre clinical trial wear and stress results somewhere on line and they claimed it had equal strength to a regular metal implant.

[Vicky]

I think a lot of companies are working on that.  I have high hopes for Finsbury since they are the first company or folks that manufactured the BHR and their device is really the ONLY resurfacing device out there that is almost identical to the BHR. All the others are very different.  Those of you coming to my next Hippy gathering on February 4 where Derek McMinn will be my guest of honor will get to see several different devices, the BHR, the C+, the ASR and now the BMHR which I also just received!  I have all of these devices that I own now and can show to patients where you can touch and feel them and I can point out the huge differences in them. 

I had a choice of waiting for a ceramic on ceramic version or just having surgery.  I just did not want my right hip to get as bad as my left one did before doing something about it.  I am glad it is all behind me now and I am not still limping around in pain.  I really do not think there is a true metal ion issue IF you pick a proven device and it is placed correctly.  Is there a problem out there, yes, with defective recalled devices and malpositioned components which you would get with THR's or knees or any implant.  Keep in mind too that the very first pseudo tumor was found in a patient with a POLY THR device.  It was way worst than anything I have seen come out of a metal on metal device.  I saw the pictures at an orthopedic surgeon conference I attended.

Vicky

[Luanna]

Very interesting discussion.

Vicky, you asked what hybrid I have and it is Stryker X3 cup and BHR metal femoral component. It is an HR. Dr. Pritchett would have preferred a ceramic femoral component to go with the poly acetabular component but that was not available. Glad to hear that they are working on it. I too wanted to have the surgery and not suffer any longer. The poly used in the Stryker is very different than that used years ago. It resides inside a metal piece that attaches to the bone and the poly can be changed out without removing the metal part. Not something I want to experience but good to know.

Dr. Pritchett told me that Mr. McMinn is also using this comgination and has done about 20 for appropriate candidates. They will monitor and share outcomes and results when enough data become available.

I'll look forward to your Hippy gathering.  :)

Cheers,
Luanna

[B.I.L.L.]

I was researching the effects of metal ions and came across this video. If you haven't seen it before it's worth a look,  ;D
http://www.youtube.com/watch?v=LHtKMS1kjlo

[Aerial]

I was researching the effects of metal ions and came across this video. If you haven't seen it before it's worth a look,  ;D
http://www.youtube.com/watch?v=LHtKMS1kjlo

Hahaha!

[obxpelican]

That is some scary stuff for sure   ;D



Chuck

[ScubaDuck]

Bill-

That is great!  Someone really put some work into that one.

I know it is not a laughing matter for the small percentage that end up with the metal ion issue.  But the way some (NYT for example) portray it I am sure people have similar images in their minds.

Dan

[Dannywayoflife]

I wonder how many people have watched that and taken it as gospal truth?!

[B.I.L.L.]

I'm not worried anymore, nothing has even poked through my skin yet. Hahaha

[Anniee]

Very funny!  I'll have to watch out for those things poking through my skin and report them to my doctor!

[B.I.L.L.]

I wonder how many people have watched that and taken it as gospal truth?!

Perhaps one or two newspaper reporters ?  :)

[Tin Soldier]

That's creepy.  Hey for you guys in the UK, that reminds me of Mechano (UK version of Erector set).  I had a pretty sweet set when I was 9 when I lived near Manchester (UK).  I bet I could make up some freaky Halloween mask out of the stuff and clink and clank around the old folk's home and scare the hell out of people with implants.  That would horrible.  I wouldn't do that.

[Vicky]

Spin on the old movie the Bionic Man!  LOL  Pretty funny if you ask me, anyone that would think for a second that this is actual fact needs to seriously consider how gullible they are.  If this were real, it would definitely be ALL over the news and Barry Meier for one would be all over it!  LOL.  I'm surprised, he wasn't a part of creating this.  Great for a Twilight Zone movie and perfect timing for Halloween.  :-)

Vicky

[obxpelican]

Bill is our local stand up comic..... this would be a boring forum without him for sure.



Chuck

[Jeremy76761]

I do not have a resurfacing although I probably will get one eventually. But I do want to respond to an assumption made on this site on a few occassions, with all due respect. 

The assumption that the top hip resurfacing surgeons, those with thousands of resurfacing surgeries, have the most credibility when it comes to the metal ion issue does not make sense. Very clearly, people with the longest track record of metal resurfacings are PRECISELY the people we should all expect to see promoting metal resurfacings. They are precisely the ones most likely to find metal ions a minor problem because they have vested years of their careers, their reputations, and their finances on metal ions NOT being a problem. If they thought metal ions were going to be a problem, they never would have done thousands of metal implants in the first place.

Yes, people with only 50 or 75 or 0 resurfacings are more likely to deter patients from resurfacings on the basis of metal ions. But it is dubvious to suggest that because of their lack of experience they are less credible than those who have done thousands. This is for the same reason that those with thousands of metal resuarfacings are not more credible. Quite cleary, surgeons -- be they Great or Small - who are concerned about metal ions in a major way will not continue to perform metal resurfacings, and certainly not thousands of them. A greater proportion of them are going to avoid metal resurfacings PRECISELY because they were concerned about such problems as metal ions in the first place. We should not assume that they are less capable as surgeons or worse surveyors of the record.

Surgeons with few resurfacings cannot be presumed to have less credibility than those with more with respect to metal ions. Let's just get that straight.

What is pursuasive is the evidence, the statistics. And beyond that, how those stats were calculated. If we can't discern that, then we have to rely on the lesser evidence of expert opinion. And for that, I'd consider those with experiences in resurfacings, but the most credibility must go to those with the least vested interest either way. Not being a medical researcher, I can only suggest we might be better off considering the heads of Colleges, such as the Orthopaedic Surgeon associations, Health Ministry recommendations, etc. Although let's face it, everyone, and I mean EVERYONE, has an axe to grind.

Even if 1/1000 patient's is adversly affected, organizations will lean towards caution because, from their point of view, patients' interest in unrestricted lifestyles is far less important than the organizations reduced liability if something does go wrong. 999 patients who can go back to impact sports means a whole lot less than 1 patient who makes a law suit.

Of course, one could apply this principle to the top MOM resurfacing surgeons as well, given their liability is moved up should ions pose a serious risk. But my point is not that they lack credibilty, only that they cannot be presumed to have any more credibility than those without this experience on the basis of having done thousands of resurfacings alone.

We know MOM devices have been implanted for decades, but we need a study to follow a couple thousand people over their lifetimes to have really viable and satisfactory evidence, in my view. Consider an 18 year old with a metal implant who lives to 88 years -- do we have the research to show us that after 70 years health is not adversely effected?  As far as I know, we don't have any such evidence.

Just a point that I felt has to be made. I'm sorry if I offended anyone and I don't mean to interrupt. There is a lot of good evidence posted. I just felt it important to address the record on this one.

[hernanu]

You make some very good points, Jeremy. I guess I differ slightly, but agree with you in some respects - I also don't get offended by what you're saying, since having dealt with OA, all of us have had to come to grips with unpleasant things.

To me, these are the salient points:

People do have a vested interest. If you have invested your time, emotional energy into a procedure, then you will defend that. It may not provide a surgeon with his or her main income, but it surely is a large part of their practice and gives them both financial and other incentives (prominence, etc.). I also think that as that doctor you should defend that, since if you are any kind of a moral person, you believe that it is doing good.

If you do have a vested interest, then it is your responsibility to keep that in mind if evidence contrary to your interest comes up. In this case, if significant number of failures were coming up, then it is your duty to reconsider your position. I'm sure you saw this when doctors began to see the impact of smoking, even though earlier they had thought nothing was wrong with it. It's why you don't see many dermatologists owning tanning salons.

I expect that if you interview Dr. McMinn, you will get positive feedback about resurfacing. This is the main focus of his career, it appears, and it has been successful so he feels correct in promoting it; statistically So Far, the facts bear him up. It does not preclude his talking authoritatively about it, since it is something that he has devoted much time and effort to. I would give his opinion a lot of weight both on the technical side and on the statistical side, since he would know his success rate (unless he's lying about that).

If someone has done 50 or 75 and then decided that it is not for him or her, then I believe we have to look at the reasoning for it, just as it is fair to look at the surgeons with a high rate. If they have done that few and their frequency of doing the procedure is low (a few every month), then they have been doing them for a couple of years. It is also not a huge part of their practice and if any issues come up, they would much rather stop doing something that may damage the other aspects of their business. It's just cutting an ancillary part of their work, not a challenge to all of it. It's easy for them to stop doing them, but it does not make them an authority on the technical aspect of it or on the statistical aspect of it. They may be very bright, but a tenuous involvement in it does not make them knowledgeable.

I agree that the statistics are the most important. The data so far only exists in large amounts for the last 5 to 10 years, although we have anecdotal evidence for longer (see the post about the 20 year old resurfacing). The compiling of registries and a truly representative sample of clients is vital. I would be the first to support a national registry in the US for any and all HR patients; this would allow us to have a real knowledgebase to support reports of any kind, but most importantly to address issues like metal allergy or metal ion issues. This takes the discussion away from the speculative and sensational into real fact based information that can help us as patients make real decisions.

One aspect of statistics is backwards looking, in that you can see what has happened and react to it. The other aspect is forward looking, to follow the trends established in knowledge we already have and project that into the future. If we have currently a success rate in the high 90 percent for HR, then unless a catastrophic element is introduced into the mix, the trend is that it will continue there. In the case of a new trend (like metal ion issues), the trend needs to be identified logically and methodically. Once it is proven in a statistically sound manner that this issue will catastrophically change the success rate of all MOM HR, then a red flag should be raised and the whole process reviewed or stopped.

Otherwise, it is just as irresponsible to stop a successful procedure without real data as it is to continue it in the face of adverse data.  Time goes on and patients who could have been helped with an HR will wind up with a THR. The THR itself has issues, so you could be trading one set of problems for another.

I do disagree that surgeons with a lot of experience have equal standing on HR issues than those with little or none. I am not likely to give weight to someone's opinion if they are not sophisticated in the procedures that they are talking about. If you assume moral integrity, I would take a car mechanic's opinion about my car than a motorcycle mechanic. They may both be mechanics, but one is a specialist in that thing that concerns me.

I completely agree that statistics are important, but since we don't have 70 years worth of it, we do need to take what we have and use it properly to project future results. In addition to that, the opinions of people, pro or con about MOM HR who have deep experience in the procedures does have more impact with me than those who don't. Just my opinion. I would, for example pay serious attention if Dr. McMinn were to turn about and decide that the procedure is too dangerous to carry out and apologized for promoting it.

In the end, as patients, we need to consider the alternative. I already did that, comparing THR issues vs. HR. It was not a lifestyle issue for me, since I don't consider it as lightly as picking a tie, but a vital consideration of the end result of THR revisions vs. HR revisions if I ever need to face them. I would rather have a useful 10 to 20 to ?? years of life with an HR than 15 with a THR and then face a much more difficult revision with most of my thigh bones gone. Ultimately I could have done without the athletics, since walking without pain was the goal, but what sold me was that I could eventually progress to a THR if needed.

[Anniee]

Jeremy and Hernan, you both raise interesting and valid points.  You've obviously given this issue a lot of thought!  I have nothing to add to the ion discussion, but in regards to your last statement about the insurance companies, Hernan, I do know that Dr. Gross charges the same for resurfacing as he does for THR. Don't know if other surgeons do or not...

[Luanna]

Great discussion. Even the top surgeons disagree about the metal ion issue. I understand that new data may be presented at the AAOS Conference in Feb that will refute some of the current thinking. Am. Assoc. Ortho Surgeons.   


"knowledge is power". Don't recall who said that. Time for my morning coffee.

Luanna 

[hernanu]

Jeremy and Hernan, you both raise interesting and valid points.  You've obviously given this issue a lot of thought!  I have nothing to add to the ion discussion, but in regards to your last statement about the insurance companies, Hernan, I do know that Dr. Gross charges the same for resurfacing as he does for THR. Don't know if other surgeons do or not...

I think you're right Annie, I revised my post, that takes away from the discussion.