While trying to research cement vs no cement I stumbled across a product made by finsbury has anyone else herd anything about this implant or has anyone got one "installed?"
That looks pretty cool (I don't know if cool translates to 'good' :) )
http://www.finsbury.org/documents/ADEPT-Technical-Bulletin12.pdf
the shorter stem is interesting too. I wonder what the rational is for the stem length in most current devices?
-Bernie
Yeah It does seem interesting I don't know but I think the shorter stem may make revision easyer?
The bone fixation beads look like a good way of providing a bone ingrowth surface.
I knew about it shortly before my HR a year ago (Finsbury Adept-cemented) and during my Finsbury research saw a Bulletin and became aware that they were involved in trials for this product. Spoke with my surgeon just prior to my op-as I was very interested but he wasn't one of the trial surgeons.
It would be very interesting to find out the state of play re-research findings, developments, planned use etc.
Toby
I may try and get some info from finsbury about it. I have seen some data from finsbury tho about wear of there other HR devices and it seemed to reckon on a life span of between 5-10 years which worried me. I Kay have read it wrong tho.
Coming from London, I never fancied a device call Birmingham, but a device called Finsbury does appeal. Did not know they did an uncemented version, or I might have requested it.
Danny you wrote-
'I have seen some data from finsbury tho about wear of there other HR devices and it seemed to reckon on a life span of between 5-10 years which worried me'.
I've read a lot of info from Finsbury and don't ever recall this-I'm sure that you may have read-please direct me to the source.
Thanks
Toby
ps lopsided-As a fellow Londoner I appreciate the wit-how's KDS's premier patient doing?
Quote from: toby on February 25, 2011, 11:21:11 AM
Danny you wrote-
'I have seen some data from finsbury tho about wear of there other HR devices and it seemed to reckon on a life span of between 5-10 years which worried me'.
I've read a lot of info from Finsbury and don't ever recall this-I'm sure that you may have read-please direct me to the source.
Thanks
Toby
ps lopsided-As a fellow Londoner I appreciate the wit-how's KDS's premier patient doing?
Simulator studies stop during the steady-state wear phase and often only extend to five million cycles which, depending on the patient's activity levels, only represents a lifespan of one to five years. The ADEPT® technical rationale is entirely based on clinical history dating back over 25 years.
This comes from the finsbury web site just look under the adept resurfacing section.
Hope this helps Danny
Today i called both finsbury and dupuy to ask about some info about this device but both refused to give me any! >:( so i have emailed the surgeon who did my arthroscopy in october to ask him to make enquireries for me. Ill keep you all posted if i manage to get any info about the device.
Danny
Quote from: Dannywayoflife on February 25, 2011, 01:43:42 PM
Simulator studies stop during the steady-state wear phase and often only extend to five million cycles which, depending on the patient's activity levels, only represents a lifespan of one to five years. The ADEPT® technical rationale is entirely based on clinical history dating back over 25 years.
This comes from the finsbury web site just look under the adept resurfacing section.
Hope this helps Danny
I've wondered about that. Numbers along the lines of .2 mm^3 of wear per million cycles steady state is tossed around for modern metal on metal large ball. Figure 3 million steps per year over the course of 20 years. That's 12 cubic millimeters. That is not an insignificant amount when talking about the tolerances required.
Quote from: einreb on March 02, 2011, 11:17:35 AM
Quote from: Dannywayoflife on February 25, 2011, 01:43:42 PM
Simulator studies stop during the steady-state wear phase and often only extend to five million cycles which, depending on the patient's activity levels, only represents a lifespan of one to five years. The ADEPT® technical rationale is entirely based on clinical history dating back over 25 years.
This comes from the finsbury web site just look under the adept resurfacing section.
Hope this helps Danny
I've wondered about that. Numbers along the lines of .2 mm^3 of wear per million cycles steady state is tossed around for modern metal on metal large ball. Figure 3 million steps per year over the course of 20 years. That's 12 cubic millimeters. That is not an insignificant amount when talking about the tolerances required.
can you put the figures into laymans terms? Was i right t be concerned about the potental life span of a resurfaceing?
Quote from: Dannywayoflife on March 02, 2011, 01:13:51 PM
can you put the figures into laymans terms? Was i right t be concerned about the potental life span of a resurfaceing?
Danny,
Please don't read anything into my 'concerns'. I am actually a mechanical engineer, but that in no way means that I know what I'm talking about with this stuff. The point is that these devices do 'wear', but since all the long term stuff is pure simulation... we don't know how they wear in the body. My calculation is simple and may be completely off base. It says that after 20 years, the device will have lost a little over a centimeter square and 1 millimeter high of metal. Does it wear evenly and keep the required tolerances so that the bearing continues to 'float' on the lubricating joint fluid? If it doesnt, then it will wear faster, if it does... then it may last another 20 years :) I don't know.
I'm 40 years old. I used to run marathons. I will not run them with my resurfaced hip. I'm going to run on it to promote good bone strength, but I would like it to last a long time. I would love to get 25 years out of this thing. Hopefully then is a current bearing and stem that will then have a 25 year history with active patients.
The fact that the BHR is 14+ years old and seems to be holding up really bodes well for the longer term. There are stories of metal on metal devices lasting much longer than that.
many thanks for your reply. I am only 28 and fear that i will require a RS before im 30. I have been an active athlete for the last 15 years mainly martial arts but also a fair amount of running too! I would like to get back to some form of training post op but realise i may well have to slightly ajust my normal behaviour. I am mainly interested in this device because of the factits un cemented as that seems to be the future.
Danny,
Yes I had read this in the past. But I read it very differently. I thought that Finsbury were suggesting that other newer manufacturers/their competitors (like at the time the De-puy ASR) were using simulator studies with an insufficient number of cycles which would only equate to the the first1-5 years. But Finsbury instead were using their 25 years of clinical studies and HR experience in the development of and their confidence in the Adept. Remember, Finsbury worked on early MOM designs and with McMinn on the BHR from the beginning. The Adept is very similar to the BHR. So I think they're being critical of their inexperienced competitors whose predictions can only be based on simulator studies.
In relation to wear-see the McMinn lectures-he talks about minute based on all his extensive data from the last 15-20 years and predicts(as does my surgeon) that these devices will last a life time if perfectly placed.
Regards
Toby
I think I owe Dannyway a response on my post about the longevity of the MOM devices. I think it was in another thread but can't find it.
My surgeon, Jim Prichett in Seattle, WA, who has followed MOM and earlier poly on metal types, since the 80's, feels that at my age, 40, I should not assume that I will have to get a revision or go to THR within the next 40 years. Granted, we have very limited data on 40 years, actually, I think there are zero data for 40 years. He's not saying outright that the BHR that I have will last 40 years, but he's also not saying that there is any indication from 10 year case studies for Wright, S&N, and others, that these things will give out at 15 yrs, 20 yrs, or later.
I felt a little backed into a corner with regards to my decision on HR. My boys are going to be out of the house in 5 years. I made the choice to get my life back before that, even if I had to get a revision or a THR in 15 years. I was under the assumption that the MOM HRs will last 10 to 15 years and I was ok with that. I'm a scientist and I too would like to see real numbers. At 28 I can totally understand your concern on longevity.
BTW - the American Academy of Orthopaedic Surgeons Annual Conference just happened in San Diego. I just looked at the program and there were a number of papers/presentations on MOM HR. You might check out the program (300 pages :o) and see if there was anything on this topic.
toby&tin soldier,
thanks for the replys guys i really appreciate it. Im constantly looking for more and more research to read they do say knowledge is power!
To be honest if i got 20 years out of a RS i would be extatic!
My dad had both of his hips done with the old style plastic on chipboard small ball THRs nearly twenty years ago, and he is still doing well. True, he is not as active as younger people. So I would expect, and hope as I have got one, that a large ball high tech modern alloy metal on high tech modern alloy metal resurfacing should last quite a lot longer.
D.
The McMinn Centre website has lots of good info and history of resurfacing although I haven't looked at it recently.
moe
I'm still trying to find out some info about this device I've email my arthroscopy surgeon asking him to request some info for me and I'll update you all if and when I get any further info. If anyone else knows anymore about it though please do share
Danny out.
Quote from: toby on March 02, 2011, 03:57:00 PM
In relation to wear-see the McMinn lectures-he talks about minute based on all his extensive data from the last 15-20 years and predicts(as does my surgeon) that these devices will last a life time if perfectly placed.
Regards
Toby
Toby sorry to bother you but where can i find these mcminn lectures? Icarnt seem to find them!
Thanks Danny
My surgeon, Jeremy Latham uses finsbury adept cemented. He knows the engineers well (who made the original BHR) and may be able to shed some light, though he was not keen on the cementless femoral option when we discussed it.
Quote from: gary2010 on April 13, 2011, 07:24:38 AM
My surgeon, Jeremy Latham uses finsbury adept cemented. He knows the engineers well (who made the original BHR) and may be able to shed some light, though he was not keen on the cementless femoral option when we discussed it.
Why was he not keen on it?
i emailed Mr latham about this device, and he basicly stated that cementless femoral side dont work well and he dosent think they will make it in the market place. To which i pointed out the likes of DR Gross and Dr de smet. And he didnt say anything about them. Frrom what i can gather surgeons in general in the UK are very anti uncemented based on Mr Mcminns early trials. But obviously they were quite some years ago and science and technology has moved on significantly and now companys are able to manufacture a good bone ingrowth surface unlike when Mr Mcminn did his early uncemented.
Quote from: Dannywayoflife on April 13, 2011, 11:22:04 AM
i emailed Mr latham about this device, and he basicly stated that cementless femoral side dont work well ...
I hope they work, I have got one. Why should they not work? In the long term, there is on less thing to go wrong.
Quote from: Dannywayoflife on April 13, 2011, 11:22:04 AM
... and he dosent think they will make it in the market place.
Well that does not depend on him. The market is the patients, it is what we want.
Quote from: Dannywayoflife on April 13, 2011, 11:22:04 AM
From what i can gather surgeons in general in the UK are very anti uncemented based on Mr Mcminns early trials.
From what I gathered when I tried contacting them, was not too positive for English surgeons in general.
It does seem that Gary has done well though.
Quote from: Dannywayoflife on April 13, 2011, 11:22:04 AM
But obviously they were quite some years ago and science and technology has moved on significantly and now companys are able to manufacture a good bone ingrowth surface unlike when Mr Mcminn did his early uncemented.
Well I got uncemented, am happy with it, and when my other hip goes, I want the same.
D.
Mr Latham is a good surgeon but most surgeons over here seem to not want to advance the devices and are happy as things are. I agree that uncemented there is one less thing to fail in the longrun! Only time will tell I think!
Danny,
Sorry mate it appears that I didn't reply to your posting re- where the Mcminn lectures are (unless I emailed you off line can't remember-hectic time of late!).
Anyway, if you go the Mcminn site-then lectures at top of page-then on lectures page go to research at bottom. Here you will find a wealth of research including data on BHR wear rates and longevity.
Also, if I remember correctly-although others might be more informed, some surgeons in the UK used/might still be using the uncemented Corin (you might want to contact Corin directly). In addition Danny, if I didn't mention already, I heard a while ago that the very eminent Hip surgeon Richard Villar was doing his own studies on using uncemented. Unfortunately, from what I understand when someone emailed him to find out more it proved difficult to obtain any info.
I must say, I agree with you and many of our US buddies, I instinctively feel that Dr Gross has developed a winner.
Best
Toby
Mr. Villar was using the uncemented Corin as of Sep 2010. I sent an email to him at Spire Cambridge Lea Hospital. I was interested in his opinion of cementless devices and particularly his opinion of the Biomet Recap system, which is the implant that Dr. Gross uses. I received a reply back from the "Hip Fellow to Mr R. Villar," which indicated there was little data comparing cementless and cemented implants in the early years. The "Hip Fellow's" recommendation was to pick an experienced surgeon. He stressed though that the BHR had a long and reliable history.
Mac
I may email mr villla, Toby thanks for the directions mate I'll have a look when I get chance.
I agree that there is little data about cementless HR but it's proven with THR so it's not totally un known. What gets me is how are we ever going to gain data if surgeons won't try new things?
I hope that by the time I decide I need my hip doing that there will be more data either way.
Last I heard Mr Villar was still doing hemi-resurfacings. Obviously the bulk of statistical data relates to cemented BHR with as-cast metallurgy, and the Adept I have is pretty close to that; Mr Latham is unashamedly a disciple of McMinn and has tried to reproduce the procedure exactly.
I've read all the arguments for and against different devices, but didn't really want to be a guinea pig, in a few months my bone density will be normal and I shall just forget about it for a decade or so. The new adept does appeal, and maybe I'll consider it when I need the other one done, but this has all gone so smoothly.. it would be a bastard if it fell out after 2 years!
I sincerely hope those who have cementless heads do well, and I respect them for pioneering the technique, as for the market, of course the surgeon stakes his reputation every time he fits one. Surgery is a combination of medical science and a craft skill, in my experience asking a tradesman to deviate from his accustomed practice is a good recipe for a cock-up.
Fair points well made Garry. The thing that I don't understand is that alot of surgeons seem happy just to stay in a stasis and don't want to try and improve how are new products and methods going to get developed and advancements made if everyone is happy with the present devices and methodology? From what I have read it's s fantastic treatment but it isnt perfect. There's always room for improvement!
Quote from: gary2010 on April 14, 2011, 11:27:33 AM
... in my experience asking a tradesman to deviate from his accustomed practice is a good recipe for a cock-up.
In that case, all the surgeons would have stuck to THRs, with small ball plastic on chipboard bearings.
Quote from: gary2010 on April 14, 2011, 11:27:33 AM
... it would be a bastard if it fell out after 2 years!
Does your device include the remote controlled explosive release bolts?
Fair play to you Dan, you may be braver than I. What I meant of course is that with an experimental device or procedure I would never be quite sure how long it was going to last. Only time will tell which of us lasts longest.
The problem as I understand it is torsional forces when rising from a squatting position. Were you given any additional restrictions? The cement has some elasticity I believe, and an antibiotic component.
Of course there will be innovations, driven by the more adventurous surgeons and patients, but some of these will inevitably fall by the wayside. From the surgeon's point of view, if you're going to take 10 grand off someone for an operation it's easier if you can quote a 99% + success rate.
I think we're only about 10 years away from being able to repair the whole joint with stem cells, which would render the whole process obsolete.
Gary,
I suspect you are right about being able to repair cartilage in the future. Of course, when I was a kid, I thought we would have people living on Mars and the Moon by now. Money, politics, and special interests sometimes get in the way of science. I would hope research is going on around the world on replacing damaged cartilage, but I can't help wondering if there are enough incentives out there to push the research forward, or if all the money invested in implants, including surgeon training, might not discourage new advances.
Mac
Yes I remember those films where robots did all the work while people enjoyed themselves. Don't get me started on politics!
Before I discovered resurfacing I contacted two scientists in this country, Charles Archer in Cardiff and Richard Oreffo in southampton, both working with stem cells for A.V.N. bone repair and to repair cartilage in the early stages of arthritis. My surgeon was involved in some of the trials with prof. Oreffo . I was told that total joint repair for OA is some way off but they are working in that direction.
Gary,
My surgeon had dinner with the gent from Southampton who is involved in the stemcell trials and he asked him about it(mostly because I'd shown him a news paper article on the trials) the bloke told him that there was alot of missreporting on the trial and they were a long way from having a solution to OA.
On another subject Gary I noticed in an old thread you posted on that mr Latham considered arthroscopy to be detrimental to a resurfacing. Is this deffinatly the case and did he mention why as I had arthroscopy 6 months ago!
Weakening of the femoral neck I think, my arthroscopy was an expensive and pointless exercise, which just caused me to waste another year, as soon as I started exercising again the arthritis returned. I've met people who did well after treatment for impingement but they were all a good deal younger than me. It frankly beggars belief that no one mentioned resurfacing in the first place as I was an ideal candidate for it.
BTW who is your surgeon? I have read that the biomet recap system has rather poor statistics, but I can't remember where, there's so much of it!
I also looked at stem cell treatment, and would have liked merely to have my worn out cartilage regrown and replaced. But that would not have helped with the bone spurs that were growing, or the cyst that was enlarging, or the impingement, or the slight dysplasia. And I think that with most, if not all patients that get resurfacing, it is not just the cartilage that is diseased with no effect on surrounding tissues.
If my right hip degenerates in ten years and stem cell treatment has advanced, I will still opt for resurfacing.
Hi Gary,
The surgeon who did my arthroscopy is Mr Jon Conroy from Harrogate. He is an excellent surgeon but not a RS surgeon. He has said I'd be an ideal candidate for it though. The op relieved lots of impingement as I couldn't hardly move before but I have full range of movement now but have arthritic pain instead of not been able to move.