I went to my doctor to see about getting both my hips resurfaced.My left hip is the worst. The bone in the socket is wearing away. My left hip ball actually sits up in the joint about a half inch or so. I also had a large cist on the top of my femur. Because of this he said he may have to do a THP. I also mentioned to him that my uncle went to his doctor in wisconsin. He told him that the metal ions are becoming a problem and he did not advise MOM. My doctor said that he knows a doctor in wisconsin that used to do 250 a year.He has cut that in half. My doctor cut the number he does in half.If you google THP on the internet and you look at some of the metal ion articles, there is some scary stuff there. My doctor said there are a lot of unknowns with MOM.He said if you do become one of the stastics. The problems can be very serious. My doctor wrote several articles on the benafits of hip ressurfacing and used to greatly promote it. He went to school in england for it and 2 scools in the us.Any way I am having second thoughts of resurfacing?.
If there are unknowns about metal on metal, there are far more unknowns about all other materials. In fact there is a lot known about metal on metal. And all the surface materials produce debris to some degree, and only metal can be removed naturally by the body (kidneys).
I was also bone on bone, with a cyst. I got a bone graft and resurfacing. My metal ion levels post op are equivalent for someone without implants.
I would say that a THR would be a great result for your surgeon, but not for you. Is that the statistic you want to be?
Bri,
Who is your doctor?
Where are you located?
Bri i aggree with what lop has said. I believe that the alloy used in HR has been in orthopedic use for about 70 years so theres more known about it than any other material im aware of. Its only realy been with the asr and poor surgeon placement of componants that ions have come to the fore and become an issue. If i were you i would seek a second opinion about your own case.
I think it speaks volumes that Derrick Mcminns patients arnt routeenly tested for ion levels.
All the best Danny
Hi Bri,
If you are a small boned female as I am then metal on metal is not the best option according to my surgeon. We went with polyethelene cup and metal femoral component. He would prefer a ceramic femoral component but one is not on the market that would suit his criteria and he'd have to have on go through an extensive testing program before he'd be able to use it and then monitor outcomes. He's worked with lots of people with small bone and I trust his judgement completely. He does not hesitate using metal on metal with men and large boned females.
My friend was over yesterday and she has metal on metal and her implant has been recalled. Luckily, she is very large boned and so far at 2 years her ion levels are within acceptable levels.
For us small gals (not saying you are small boned) finding a viable alternative to metal on metal is very important.
Best of luck to you. Keep us posted.
Luann
Quote from: bri on September 30, 2011, 11:10:26 AM
I went to my doctor to see about getting both my hips resurfaced.My left hip is the worst. The bone in the socket is wearing away. My left hip ball actually sits up in the joint about a half inch or so. I also had a large cist on the top of my femur. Because of this he said he may have to do a THP. I also mentioned to him that my uncle went to his doctor in wisconsin. He told him that the metal ions are becoming a problem and he did not advise MOM. My doctor said that he knows a doctor in wisconsin that used to do 250 a year.He has cut that in half. My doctor cut the number he does in half.If you google THP on the internet and you look at some of the metal ion articles, there is some scary stuff there. My doctor said there are a lot of unknowns with MOM.He said if you do become one of the stastics. The problems can be very serious. My doctor wrote several articles on the benafits of hip ressurfacing and used to greatly promote it. He went to school in england for it and 2 scools in the us.Any way I am having second thoughts of resurfacing?.
Hi bri, the metal ion issues are real, but as with many real things you need some information on it so you can put it in the right perspective. There is a lot of information on this site and others that speaks to this much better than I could, so there my only advice is to research this site and then use that to make up your mind.
In my opinion, the issues, while serious and a consideration should not deter you from looking more fully into hip resurfacing. I was told by two respected surgeons not to pursue HR due to metal ion issues.
In my research, I found that the metal ion issues in HR are caused by bad device placement, that those of us with proper cup placement are much less apt to have any problems with it. All devices have wear issues, some of the earlier non-metal devices had bad issues with wear generating fragmentation. I am not downplaying the impact of the metal ion problem on those who have it, but it seems that the incidence is very low when cup placement is done correctly.
The more information that I got, the more it seemed that was a symptom of something that we as patients can avoid:
- Bad device placement, which is overcome if you select a good, experienced doctor, and be willing to travel to him / her.
- Bad devices. There is enough information now to select a device that has the least problems.
In my opinion only - The benefits of resurfacing outweigh the possible detriments. I think we all have to consider the possibility of a revision at some later time for any number of reasons, not just metal ion issues, so that is one outcome that I have mentally prepared myself for if it eventually happens. I remain optimistic that it won't, since I think HR is a superior technological approach to the problem, being as minimally invasive as it is. As an engineer, I believe in leaving as much of the original structure that your body has as is possible. If THR is indicated and you've gotten several opinions, well, that is it, but this is a big step, and I would not turn my back on something as promising as HR without fully checking it out.
Pat has put contacts in here with very prominent HR practitioners who have excellent results and some accept copies of your X-Rays to give you their (free) opinion - please take advantage of that to let some serious knowledge and brainpower into your decision. In the end, the decision is your own and everyone here respects that, but my advice is to get as much information as is possible. Good luck.
Bri, you can google almost any medical issue on the internet and find all kinds of scary stuff! To get GOOD information, you need to make sure the sites you look at are reputable, and not just people with no real knowledge stating their own opinions and fears. Get the best information you can, and consult some of the top resurfacing surgeons. As Hernan says, several of them will provide you with their opinion free of charge if you send them your information, including the advantages and disadvantages of resurfacing versus total hip replacement. All these surgeons also perform THR, so they have nothing particular to gain by steering you towards resurfacing if you are not a good candidate for it.
I would be very interested to know who your doctor is.
Bri - not sure how much research you've done, but there is a lot of really good info on this forum regarding the metals issue. Most experienced surgeons believe the problem (as Lop and Hern and others point out) is placement of the components not the alloy. The alloy (CoCr,...otherwise known as Vitallium) has been around since 1932 (according to Wiki). I think it was used in artificial joints in the 50s or so. There was a population from England in the early 70s (Mckee Farrerr?) that had MoM HRs. I believe they had pretty good results. Anyway, McMinn, Gross, Pritchett, and a number of other well known surgeons could explain in detail the history of the MoM HR hip. None of them are running away from MoM HR and they expect it to be around for quite some time and continue to expect to see excellent results from it.
Take a look at metals info provided by Pat on this website, read up on the McMinn Centre website, review Pritchett's paper on metallosis, and take a look at the interviews of doctors like Gross and others, and there is a lot more on the sibject out there also. Stay away from lawyer's websites that like to present feable arguments on thin data. Good luck.
Bri have you watched the video interview Vicky marlow did with Derrick mcminn? It's on her site I think it's on you tube also. Worth a watch.
I echo what others have said. A good surgeon should be able to get the placement right and thus avoid an issue with metal ions. I was very concerned with this but got an excellent explanation from my surgeon. I was on the fence with metal on metal until I really looked into it. They can take x-rays inter-operatively to assure good placement. Choose a doctor with a lot of experience.
Quote from: Luanna on September 30, 2011, 12:02:31 PM
For us small gals (not saying you are small boned) finding a viable alternative to metal on metal is very important.
Cannot disagree with you more Luann (even though I am a boy, and I believe Bri is too). The best surgeons manage to resurface small boned women with equal success.
It is not size of bones and gender that matters. It is the correct placement of the device.
D.
Bri,
I think the majority of the people here all looked at the risk including the metal ion reaction and were first directed to THR I know I was.
After all the risks I came to the conclusion that I wanted to play volleyball and be as active as I was before being only 43 and resurfacing would give me the strongest joint with the most natural movement and the choice was clear.
Also when you read all the problems that can come up with either THR or HR the one that did if for me was that I could always cut my femur and get a THR later, but when the bone its gone its gone. I'm at 8 weeks and already starting training to get back to the activities I love.
Just ones athletes view.
Matt
Response to lopsided: I agree with you that placement is critical. However, I do have one of the top surgeons in the world and agree with him on his assessment derived from his research results. Time will tell. McMinn is using this combination on some patients now and outcomes will be shared when enough data is available.
Maybe should change my surface hippy name to Controversial Hybrid Hip. :)
Luanna.
Hybrid Hippy is hip.
Controversy is essential.
Luanna,
Dr Pritchett told me about the Hybrid hip but that it wasn't available in all the sizes and wouldn't be for at least 8 more years in the US because of the approval process.
Do you have any links you could send me on the Hybrid version, I am very interested. It sounds like it could be the future.
Matt
Hi Matt,
Here is a link to a few research articles written by Dr. Pritchett: www.pritchettorthopedics.com/articles.php
When I discussed my options with him he said that he would not use metal on metal with me (I'll have to ask him if there were other reasons besides my small bone size) when I see him at my 8 week check-in. His preference would have been to use ceramic ball with the Striker X3 polyethelene acetabular component but an appropropriate ceramic ball was not available. Perhaps that is what he is referring to when he told you that it is still 8 years out. He used a Birmingham metal femoral component with the Stryker X3.
When we talked about a ceramic and polyethelene combo he was not very optimistic that other surgeon's would initially jump on board. It sounds like the old polyethelene of years back failed quite a bit and gave it a very bad reputation. He's had good luck with the newer cross linked poly. He also did a study on heat generation and found that during activity the implants generated a significant amount of heat - enough to cause damage in some cases. The combo that generated the least amount of heat was ceramic and poly. I think you'll find the heat study at the link listed above too.
I'm optimistic and trust that his years and years of surgical experience and research will help ensure that I get a lot of wear out of this new hip. Toes and fingers crossed!!!!!
Luanna
When I talked to Dr. Gross about the metal ion issue he said problems associated with metal ions are very rare.
The local orthopedic dr. I was seeing who initially recommended hip resurfacing (he knew I needed it but told me he was not trained to do it), said metal ions are a current topic of concern, but he implied that many doctors are shifting to other materials for THR more as a precaution. Not because they know for sure metal ions are actually a problem.
I also have noticed that the orthopedic field seems to be one evolving experiment to some degree. It sounds like the field has used various materials at different points in the past decades, with varying degree of success...metal on metal, metal on ceramic, ceramic on ceramic, plastic on ceramic... Etc.
For long term durability I don't think anything is as good as metal on metal.
I think any substance has a potential for problems. I recall my local orthopedic doctor ,mentioning that there have been issues with plastic debris causing psuedo tumors in patients who had the plastic implants..I believe he called it polyethylene....or something like that.
Bottom line..any time you put a foreign object into tour body, there are risks that something could go wrong....you just want to minimize the risks and maximize the benefits.
I'm 38. I wanted an IMO,ant that might last my whole life...I as also in major 24/7 pain....
I asked about metal ions to a couple doctors, none of them felt it was a problem to be overly concerned about. My locoal doctor summed it up this way....he said if you were 75 years old, I'd recommend a non metal on metal option to totally avoid the possible issue....but at your age, the only implant that can last long enough is MOM..... He said if he were me, he'd do metal oh metal and not worry about it, as the incidence of problems is so low. Yes, if you get the problem, then it will suck...but what else do you do? Put in an implant that has a high chance of failing or don't fix it?
Find a good doctor, and your chance of problems is a lot lower.
Im at 7 months post op and feel like a million bucks! Friday I was in the gym, and did leg exercises (light weight!) and did 30 minutes on the elliptical..... zero pain ....andi was cooking on that thing! Yesterday went apple picking with the family, and pulled my 5 year old up and down hills in a wagon...no pain. I'm glad I fixed it.....my life is no longer ruled by hip pain...and my fingers are crossed the metal ion issue is never a problem.
good luck!
Sean, I heard the same thing from Dr. Gross. It is wonderful to hear that you are feeling so great!
OK, there are a lot of HALF truths being spread out there by the media as well as the attorneys that are in these class action suits.
I for one am an extremely small boned female, my implant size is a 42/48. I wear a size 6 shoe, I am 5'3", my Mom who is only about 4'11" tall, full blooded Chinese, has larger fingers than I do, in other words, my bones are smaller than even hers, so my ring size is smaller, wrist is smaller, I can't wear her watches because they flop around on my tiny wrists and if she borrows a pair of my shoes, she stretches them out. So I am VERY small boned. You can place your middle finger and thumb around my wrist and they will easily touch, mine do and they overlap, that is how tiny my wrists are.
I ALSO have mild dysplasia AND I am a woman entering menopause AND I am extremely allergic to metal earrings. Oh AND I had a femoral head cyst this last time with my right hip! But I do have bones as strong as an Ox. :-) I got my left BHR implanted CORRECTLY and positioned right by Dr. Bose in India almost 6 years ago and even with all of the scare tactics out there today, I went back almost 10 months ago and got my other right side done, yes I went BACK to India, with all that I know today, I CHOSE to go back to him this time because I truly believe he is one of the best in the world, he sews back every single muscle and reattaches every tendon, etc. and he is one of the only docs I have ever heard of that the majority of his patients never get ANY bruising or swelling after their surgery. I had no bruising and no swelling at all with either of my hip surgeries, so you have to imagine the care he must take to accomplish that. This recovery has been nothing short of amazing, down to one crutch at 6 days, no walking aids by 3 weeks, practically running up and down my stairs by 4 weeks and had my full range of motion back by 3 months.
I knew practically nothing 6 years ago and was lucky enough to have picked one of the best surgeons in the world. Today, I have been told by multiple orthopedic surgeons that I am the most well educated patient in the world today. I have attended 4 cadaver labs, even one where I got to place my hand inside the cadaver, (it was SO cool!) watched quite a few surgeons in training plus the top surgeons teaching them during these labs and I have scrubbed in and observed a live surgery, standing only 5 feet away from the real patient having surgery.
I have attended more orthopedic surgeon conferences than any other patient in the world and I know all of the top hip resurfacing surgeons on a first named basis now, plus I have helped thousands of patients get their x-rays reviewed for free from a variety of surgeons worldwide, so I get to see and read the responses and opinions and look at all the x-rays and have learned a TON in the past six years.
Do you think with ALL of this knowledge that I have, that I would be stupid and go back 10 months ago and get another BHR if I thought for one second that it would be a danger to ME? Absolutely not. I would not have considered anything other than a BHR. Watch these six video interviews that specifically address the metal on metal and metal ion issues that I did last year with six of the world's top hip surgeons. At that time just between the six of them, they had done over 27,000 total hip surgeries, out of that, over 13,000 hip resurfacings. That is a LOT of experience between only six surgeons. And it is really cool because these interviews were filmed in Broadcast HD quality video.
And here is an entire section on metal ions, now if you have a recalled device like the Zimmer Durom or the ASR, that is a different story, and there is info on that here as well from the world expert on ASR's and revising them, Tony Nargol from the UK
Choose a SKILLED and experienced surgeon, remember NUMBERS ALONE do NOT tell the whole story, AND choose a PROVEN device. To me, think about it, it took 7 years before they recalled the ASR. I would not personally want a device with less than 7 years history and data behind it, but, that's just me.
A well placed implant like the BHR (which is the most proven resurfacing device out there today, has been around for over 14 years, and if you count the first prototypes, over 20 years with a great track record) and a skilled and experienced surgeon that does them on a REGULAR basis, to me, at least 500 total and at least a couple a week to keep up with it and attends these ortho conferences regularly to stay up on the latest news like cup angle placements. A well placed proven component could last a patient the rest of their lives. I plan on my BHR's lasting me the rest of my life and now I have two of them. :-)
Unfortunately even though I recently attended the same conference this year in May, I was unable to write an overview due to all the limitations and forms they made me sign stating that I would not and could not use any info from any of the slide presentations, anything I heard, etc. I mean, what CAN I write about? How nice my room was while I stayed there? LOL So i didn't bother wasting weeks of my time to write up another detailed overview just to have them say I can't publish it on my site. But the knowledge is still all in my head.
I do not check these boards that often, just randomly since I have my own support group, so if you want to contact me, you can either find me there, the link is on the upper right of my website or email me at vicky@ vmarlow.com just delete the space.
And all these NYT articles have one thing in common, the Author, Barry Meier, do NOT believe what you read that he writes, he ONLY writes HALF truths and leaves out extremely important facts. I have PROOF because he interviewed me and left out over 80% of what we talked about and only wrote about the negative.
Vicky Marlow
Hi Vicky,
Thanks for all the great info. You've done tons of research on this. We sound about the same size and oddly enough I have a weird reaction to some metal earings too.
There may be extenuating circumstances for the implant hybrid I received. I'll ask at my next checkup. I'm confident that Dr. Pritchett made the best choice for me at this time in my life. I wouldn't allow a less experienced or less successful doc mix and match parts!!!
Time will tell.
Luanna
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
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.
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
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
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
Quote from: B.I.L.L. on October 04, 2011, 01:38:40 AM
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!
That is some scary stuff for sure ;D
Chuck
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
I wonder how many people have watched that and taken it as gospal truth?!
I'm not worried anymore, nothing has even poked through my skin yet. Hahaha
Very funny! I'll have to watch out for those things poking through my skin and report them to my doctor!
Quote from: Dannywayoflife on October 04, 2011, 11:16:39 AM
I wonder how many people have watched that and taken it as gospal truth?!
Perhaps one or two newspaper reporters ? :)
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.
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
Bill is our local stand up comic..... this would be a boring forum without him for sure.
Chuck
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.
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.
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...
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
Quote from: Anniee on November 01, 2011, 11:18:05 AM
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.
Along the lines of the importance of looking at long range data with MoM bearings, there are studies out there that do look at the long term effects of MoM THRs on the health of patients. Though this is obviously not the same as HR, it does give us a look at the long range health effects from MoM bearings. I apologize for not having the links to these handy, but there are long term studies out there if you look. The ones that I read focused on major health issues such as cancer, and the bottom line from the ones that I looked at are that there were no long term health issues, and some even showed lower cancer rates for people with MoM prosthesis.
My point here is that when trying to get a handle on the long term effects of MoM bearings, we may not need to restrict our research to HRs with their shorter term results, but it may make sense to include long term data from MoM THRs.
Do I understand the issue correctly, in that the hazard of MoM particles applies equally to HR and THR?
Mac
If the elevated ion levels were a result of simple metal shedding from normal joint articulation, or a by-product of surgery when the heavy use of force necessary for correct placement might have led to some fragmentation, then indeed the risks from MOM resurfs and total hips could be expected to be the same.
However, elevated metal ions in resurfacings appear to be highly correlated with edge loading, which is rare in THRs. Of course, if the two components of a MOM THR were mis-aligned and edge-loading, they would shed metal in exactly the same way as an HR MOM. The difference is that such mis-alignments are rare in THRs. In part this is because the THR is an easier surgery -- having removed the femoral head, the surgeon has a wider field of access for accurate placement. But in addition, and more significantly, the removal of the top part of the femur includes the “shoulder†just below the femoral neck. This protrusion is heavily implicated as a cause of possible impingement, which prevents the components coming together smoothly and leads to edge loading.
Good points JMS. The thought behind my post was that for those that want to look at research on the long term effects of metal ions produced by well functioning hip prostheses, it would make sense to look at the longer term studies of MoM THRs, in addition to HR studies.
Dayton96; As we have seen with the ASR and the Durom products, there can be a huge variation in problematic ion issues, even from brand to brand, whether they be THRs or HRs. For example, I believe that large head MoM THRs that used the problematic ASR or Durom cups had similar ion problems to the HRs that used those cups. However, I would think that if we were to look at well functioning devices for the purpose of researching the long term effects of normal ion production, it would be reasonable to include studies of large head MoM THRs along with studies of HRs, since the articulating portions of the components are nearly identical. It is worth noting that most THRs do have the possible additional issue of metal ion production from the junction where the head sits on top of the stem.