Cautionary study for some of us. I wish that this included more information on the nature of the failures. http://www.eurekalert.org/pub_releases/2012-02/aaoo-esa020812.php#
Great just what I want to read! >:(
Here is an abstract of the press release. See the original link for all information:
http://www.eurekalert.org/pub_releases/2012-02/aaoo-esa020812.php (http://www.eurekalert.org/pub_releases/2012-02/aaoo-esa020812.php)
Public release date: 8-Feb-2012 AAOS
Excessive sporting activity may impair long-term success of hip resurfacing
Patients should limit activities to maintain hip prosthesis
SAN FRANCISCO â€" ...the long-term effects of sports on a resurfaced hip were unknown.
In new research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), investigators surveyed 445 patients between one and five years after hip resurfacing. The type of activity, frequency and duration of the sessions, and intensity of participation were documented... Patients with an Impact Score (IS) lower than 50 had a revision risk rate 3.8 times lower than the patients with an IS of 50 or greater. Survivorship for patients with a lower IS score at eight years was 96.4 percent versus 88.8 percent.
Large amounts of high impact sporting activities â€" such as daily running or tennisâ€" can be detrimental to the long-term success of hip resurfacing arthroplasty...
If that's the case it makes me wonder why I bothered having a massive op to get my life back!
You had a major surgery to get your life back so you could be active and out of pain. If you had a THR instead of a hip resurfacing, your recovery would most likely be longer and you could have restrictions. Sometimes we can't go back to our youthful years, we have to modify our lives while enjoying our rebuilt bodies.
Pat
I certainly will not curtail my activities, for me it's going to be doing more and more not less and less, that includes possibly getting back to softball and basketball.
I'll take whatever I get.
Chuck
There in lies the problem. If I'm unable to return to my previous fitness levels then I'm unable to carry on in my job. Not only do I loose my way of life but my income also.
I thought there had been studies done that showed there was no effect of sporting activity on a device.
I am sure volleyball puts me on the high IS score side. Dr. Pritchett tell me he thinks the current BHR can take a lot so I will go with 88.8% and keep living my life and playing my sport that was never an option without the surgery.
Plus being 6'3" I figure I have big BHR. :D
Matt
This is a real bummer for sure. That being said I'm going to be back at Martial Arts in full swing and honestly take the risk. HOpefully I will be in the 88% and not the 12% of failures. I can promise you that I will put more stress on this hip than 95% of people out there. Hopefully I can get at least 15 years out of this thing.
It would be really useful to know the reasons for revisions.
This sort of thing does my head in. I was of the mond set that after 12 months I could go back to normal and not really have to worry about the dam thing for at least 15 years but seeing publications like this makes me think I might be in a wheel chair at 40!
If you look at this, the success rate for people with an IS score > 50 is 88.8, for < 50, 96.4. That means that the great majority of hippys will be fine no matter how active. It doesn't say how the activity score is computed, so a lot of stuff is undefined here.
Like Pete says, I'll take my 88.8 and walk with it if that's what it'll be. I'm sure that in the Australian registry you have folks who didn't take it easy on their HRs and they had 96.4, so we are just learning more and more about this.
Interesting, but it doesn't define impact scores or type of resurfacing. It also leaves out the influence of resurfacing placement on the revision rate.
Honestly, I'd see this as more encouraging than not. Study someone with healthy hips, Sitting on the couch is more probably more conducive to hips not wearing out than running everyday. Compare to a conventional hip replacement. They are not even running (or if they are, not for long). I'll take this surgery and these odds.
well put JimK, there's a lot of people out there in jobs that want to downplay the success of resurfacing. People tell me I should not fly paragliders because it's risky. I will continue to do what I want on my hip no matter what stats they bring out...... unless ther'es a SIGNIFICANT difference.
Like he said 88% as opposed to 96% is good news!
I think if you looked at the whole of the population who play sport and those who don't you'd get worse failure statistics and occurences of arthritis in the sporty types.
Life is for living...... I don't want to arrive at the grave with a perfectly preserved body but one that looks like I actually did a few things with it while I was here!
I don't really care. i just want to heal up and run out. I will do 100 races with the device(s) then they can exchange it for whatever. I know I will not be able to a many sub 4 hour marathons but I'm going to get in a lot of good races, meet tons of cool people and have some fun.
"Everything that counts can't be measures and everything they can be measured doesn't necessarily count/"
-Einstein
Amen hipnhop I am with you.
Squash will def put me in the 88% & like most here, I'll take that to get my life back. Maybe my large 56mm head will give me an extra few percent!
It would be good to get some more detail on this, but at the end of the day a BHR will buy us all some pain free 'active' time & I too are not planning on arriving in my grave with a perfect body.... way past that point already!
I'm with Hipnhop. I just want to run some races. By May when I can start to run again, it will be three years off for me. At 61 years old, I seriously do expect these new hips to last the rest of my life but if I can run some competitive 5K and 5 mile races and get a few age group first's, I'll be happy with how ever long these hips last, get whatever they put in next and move on from there.
Well I for one am already in a higher category even if I never move a muscle again - being a 40mm head, small boned person of mature age but I'm not worried. I would like to see data separating out people like me and how the odds increase with the IS score for participants in my classification. On second thought....maybe I don't want to see those data. :o
This is only one study. Other researchers will need to replicate the findings before I take it too seriously.
Good to see people studying this though.
Luanna
I have been diligent in my cross training and strength work since my HR. I am supremely confident that I will be able to run in another month. The discipline to take things slow and steady and allow the hip to get even stronger should ensure that I'm able to get the most out of the implant.
Not enough data in the group of 475 patients to scare me away from what I came for. Selfishly, the only data that I need or want from here on out, is the data that I generate myself, with my improvement, and with my results -- right now that data indicates that an HR was the right choice for me and my family...I'd do it again tomorrow.
Curt
Right on curt (takes me back!) but I think you should change the legend on your avatar -- don't have cruddy cartilage no mo'
There are no guarantees in life. Without the hip resurfacing what would any of us be doing? It is our choice of activities that brought us here in the first place. This is no surprise to me. I guess somewhere in my reading and discussions with my surgeon it was clear to me that I had to respect my device and know that I could wear it out faster or slower depending on my activities. Unfortunately for me my hobby is bellydancing. What most people don't know is that bellydancing is so much hipwork, well at least the style I was doing: hip twists, circles and shimmies, which are a pistoning of the hips, oftentimes at doubletime speed. Our Saturday drill work for two hours at a time would beat the hell out of our hips. I will have to tone down my dancing and drop the drills. And not being a part of those drill classes leaves me ineligible for the dance troupe I had hoped to join. Those days are gone. But there is still so much of it I can do and with a THR that would not have been the case.
Having gone over the whole wear thing several times I really don't think that you could ever actuly wear one of these out. Use floyd landis for example when he had his HR done he was doing 30million + cycles a year if wear were a problem he Would have worn his out pretty sharpish! Also guys like Corey fulks the same aplys. If you listen to the northern lights debate Derrick Mcminn talks about a thr (a freeman device I think) that was revised after 26 years and it showed like only 20microns of wear! It was revised because the actabular cup loosened.
I think this study is more aimed at the impact side of things and my guess would be revisions due to loosened components .
Having posted the study that started this thread, I wanted to add to the positive attitude, and hopefully take some of the load off of Danny and others.
1. Forgive me for rounding the numbers, but 88.8% is pretty darn close to 90%, which is not that bad a number considering the options. It is a far higher success rate than studies would show could be expected with a THR subjected to high intensity sports (probably more like 68%). Even for people with all their original parts, participating in many of our sports carries with it some percentage of risk for debilitating injuries anyway; comes with the territory. Every year we lose a few skiers to life altering (or ending) injuries; don't plan to stop skiing.
2. Danny is correct, I have read other studies out of Europe which I believe were larger, that showed no correlation between activity and survival rates. There are studies, and studies, etc.
3. If we look at the other risk factors listed in this study, someone like Danny is going to be well back up into the 90+% range; he does not have a small component size, I think that he is probably not a skinny little thing, I am sure that Mr Treacy's technique is well past "1st generation", the study does not separate men from women (sorry ladies), and though the study does not list the brand of prosthesis, we know that Danny has the BHR on his side. With all of these other factors taken into account, it is clear that someone like Danny is not going to be anywhere close to the 88.8% number, since he does not share any of the other risk factors noted in the study.
Like so many others have said on this thread, I do not see this study changing the active lifestyle that my resurfacing has given me. However I do feel that it is important to share studies like this, so that each person can make their own decisions based on cumulative risk factors, and how much risk they are willing to accept in balancing the activities that we love.
Thanks for putting it like that John. When I first read the post I was having a bit of a bad day!
Although you are unfortunately wrong about one thing I'm far from skinny! I wish I was! Even when I'm in top shape I'm around 180-190 at 5'9". I am cursed by the stocky gene:-)
What do they mean when they say the Device fails? is it:
1. Loosening
2. High Metal Ion count
3. Bone Fracturing
4. Intense pain
I held on of those bad boys in my hand. If I threw it at a brick wall, ran over it with my car or dropped it from a 6 story building I dont think there will be a mark on it. I think it is less on the device than on it's placement and our willingness to give it time to fuse with out bodies.
Fair points hipnhop. I've read the thing again and the thing that sticks out to me is the "first generation surgery" bit.
Honestly, if I didn't try hip resurfacing with Dr. Gross in my hometown, I truly believe that would have been a mistake. I pray my hip lasts a lifetime but if not, I sure am glad I tried HR!
Do you think they would have recorded data such as:
-Prosthesis type
-Experience of Surgeon
-Reason for revision
445 is not a huge number to study. If it can be further quantified that would be good. Still a worth while study - just want more detail now. Sometimes I wish I didn't read so much!
Interesting how 7% drop has got us all talking though.
You would have thought so but it ain't in the write up I've read.
QuoteSurgeons should advise patients to limit their physical activity to levels that the device can sustain.
No one has commented on this little beauty at the end. Haven't many of our surgeons been advising us that it is okay to return to specific impact activities including running? I suspect that there is more to this story than this limited statement makes. For example, what role does bone density play. In other words, the device doesn't fail but the bone can't sustain the stresses.
It definitely gives me pause. But as several of you have said, there is limited information. Even in the case of other factors there is still over 88% HR survival.
I will stay up on the latest research and certainly not go crazy in the meantime.
Dan
I think that long term bone health is probably the big thing that will decide how long devices will last. And I for one make sure I get my calcium vit d&k and magnesium. I supplement calcium with the coral calcium capsules. Hopefully this will keep my bones health and my device in place.
I wish we knew what the some of the top HR doctors thought of this study. I was bummed out by the findings, but you have to do what you have to do. I still think its worth taking a chance, although I will admit I wish I needed a larger component. Oh well..lyn
3 days to go and this is what i get to think about now. hell should i just eat the pain or what? i thought this was the best for people that do physical labor for a living with many years to go @45. brad.
Brad count yourself lucky your original kit got you to 45 mine got me to 28!
Many times it's been said on here the most important factor is surgeon selection. Who's your surgeon what's there record like? What device are you getting?
Short of stem cell repair (which they have not perfected yet) hip resurfacing is the best possible outcome, for now.
When my left hip goes I am hoping they will at least use me as a test, we have a well known vet around here who has many dogs with good working hips via stem cell transplant.
Chuck
Quote from: midiowa on February 09, 2012, 08:38:11 PM
3 days to go and this is what i get to think about now. hell should i just eat the pain or what? i thought this was the best for people that do physical labor for a living with many years to go @45. brad.
Chuck it was my understanding that the stem cell thing was a fair way off. Is this not the case?
my surgeon is DR Devon goetz in Des moines ,Iowa. his credentials and surgery record looks great. he came recommended from university of Iowa doctor, was told hes very good and has done hundreds. but how many makes you good 100 500 1000?. what do ya do?
I've contacted several researchers involved in stem cell technologies as well as a couple BHR surgeons and there is quite a range of opinions on when the first true cartilage repair technologies are likely to become widely available. Anywhere from 5 to 20+ years depending on who is asked.
It seems to me no one knows when, but successful repair strategies of the kind that will help people with OA are likely at some point.
Interestingly, a lead researcher at one of Canada's leading hospitals in Toronto stated that the goal it to produce a "toolkit" of options for people with various problems. "Maybe" these will include biological replacements for people who already have a resurfacing. I wouldn't hold my breath, but she did say this may be possible.
A major turning point will be when researchers graduate from animal to human models, she told me. It seems this is all about proving safety, funding, and politics.
Quote from: midiowa on February 09, 2012, 09:01:53 PM
my surgeon is DR Devon goetz in Des moines ,Iowa. his credentials and surgery record looks great. he came recommended from university of Iowa doctor, was told hes very good and has done hundreds. but how many makes you good 100 500 1000?. what do ya do?
Personally I don't just think the number of resurfacings is important but there record. The world average retention rate is 96% so to me that means if they average 96% there average and if it's over then there good if there under personally I wouldn't use them.
On the numbers thing most interviews I've seen with the top surgeons say they felt the learning curve levelled out at around 1000 but they always continue to get better with experience.
I've read that they are talking about human studies within the next few years, this was in the last year or so, they are already getting great results with animals.
Hopefully all we will need is nothing more than a shot in the hip and 6 or 8 weeks later your hips is like new.
I am hoping that the stem cell research they are doing on animals will transfer to humans soon, I feel a twinge in my left hip all the time now.
Chuck
I'm at seven weeks so I'm no expert, but...
I feel really well and am not suffering the pain I had suffered since 2004.
My five-year-old son and 15-month-old daughter don't know anything about joint replacement (and I hope they never do).
All they and my wife know is that dad is smiling a lot and the grimace is gone...
I'm a really big fan so far and need not return to anything extreme (therein maybe threatening the longevity of the device).
Long-term, pain-free family fun is blessed contentment for me...
There's always some moralistic person who comes along and wrecks the fun for us selfish self focused buggas!
Jon - You're right.... I have 3 young kids that I LOVE playing with & can't wait to let them tackle me to the ground without worrying about landing like a glass man.
Quote from: Kiwi on February 09, 2012, 10:08:29 PM
There's always some moralistic person who comes along and wrecks the fun for us selfish self focused buggas!
Jon - You're right.... I have 3 young kids that I LOVE playing with & can't wait to let them tackle me to the ground without worrying about landing like a glass man.
Kiwi:
I pursued endurance sports for 20 years to manage stress, tough work relationships and excess energy.
Right now, I just want to do cool stuff with my wife and kids...
I don't know enough about morals, but I do know how much I love my family...
No one really knows how long this BHR stuff will last, but I'm thrilled to get what I get...
My son and I will start surfing together for the first time in just a few months. I can only hope that my daughter likes sports too!
Jon,
Sounds like some bloody good moral values to me.
My oldest plays tennis, rugby & cricket & is only 6.5 years old. He wants to do soccer & martial Arts as well!
My 4 & 1 yr old will be thrown into the mix shortly, so any sport I do will heavily involve my kids!
You'll have fun with the surfing.
"Families that play together stay together!"
Quote from: Kiwi on February 09, 2012, 10:48:19 PM
Jon,
Sounds like some bloody good moral values to me.
My oldest plays tennis, rugby & cricket & is only 6.5 years old. He wants to do soccer & martial Arts as well!
My 4 & 1 yr old will be thrown into the mix shortly, so any sport I do will heavily involve my kids!
You'll have fun with the surfing.
"Families that play together stay together!"
Great stuff! Gotta love these kids...
More fun by the day!
I step away from here for a day and fall so far behind. I gotta get a piece of this.
Danny - I hear you on your concerns. A bunch of us here are in our 40s or more and to be rather frank, you're an idiot if you think you can keep up at mid 20 yr old levels after 40. I'm not just talking about joints, I'm talking about the whole body. Pat and Chuck said it well in that it's not bad to slow down a little. Although, I'm still looking forward to playing soccer, which is pretty high on the IS. I would be stuck on a bike if I had a THR, I like bicycling, but I want to run and play soccer and maybe even ski and jump out of a helocopter, land on a steep snow-covered slope 20 feet below, to begin an epic extreme ski run down Mt St Elias, AK (wouldn't that be sweet?). I don't think my surgeon had that in mind when he said I could return to pre-OA activities.
It's probably a little easier for someone in their 40s and 50s to slow down. There's enough other crap in our lifes to make us appreciate everyday, it all becomes relative. I would be in a similar situation if I were 28 yrs old facing this. I guess I can't offer much more than that, other than the others have brought some good points about other factors that would be nice to analyze in this study. For now, I'm sticking with my plans to get back to soccer.
Tin,
I am a little more reflective about this study now. I was in a bad place mentally when I first read it. To be honest I think on reflection there are so many holes in the study that's it's worth is pretty much zero. It could quite easily manipulated as I'm sure often happens to help someone's own agenda.
The problem for me is that slowing down just isn't an option. I'm only really just getting squared away with a career and within my industry I need to be very physically robust. I am virtually unemployable outside of my current role especially in the current climate. So as you can imagine it's not just about my hobbies but being able to bring home the bacon so to speak!
On the hobbies front though( I discussed this with rob the other day) in the future I want to get back into boxing judo and submission grappling. Now these as far as I can see don't put massive torque through the hip joint like say running where 10x your body weight goes through your joints. So yes my proposed activity's are hard and at the high end of physical exertion they seem to me to be fairly hip friendly.
I have a feeling (non medical, just completely hern thinking) that you'll be fine. If you ever do need any revision, it will be in your late 40's , when you'll have a shot of stem cells at the clinic's drive up window. It's guaranteed, Danny. Then you'll get back to being the CEO of a security firm. It's just a feeling, but with your guts, deffo
Thanks hern, to be honest I really hope that I'm now finished with hip surgery for life! However if I got into my 50s and needed more surgery I'd take that.
Like you I have a gut feeling about the longevity of these devices like you it's not a medical opinion just a synopsis that I think makes sense. I think the major factor in the longevity will be longterm bone quality. I think the bones ability to cling on to the component is the major factor and I surmise that healthy well nourished bone will do that longer and better than bone of less quality.
"Return to Running Possible After Hip Resurfacing"
http://www.reuters.com/article/2012/02/10/us-running-hip-idUSTRE8191QP20120210
"New Smith & Nephew Device System"
http://www.sacbee.com/2012/02/09/4252287/polarcup-dual-mobility-hip-system.htm
Hi Jennifer,
Thanks for posting the links. I'm getting a page not found on the following:
http://www.sacbee.com/2012/02/09/4252287/polarcup-dual-mobility-hip-system.htm
Ooops, somehow I deleted the "l" on the end for .html
Try this:
http://www.sacbee.com/2012/02/09/4252287/polarcup-dual-mobility-hip-system.html
Lynne, thanks for this. 16 miles a week post op. Oh man, I am going to be doing some serious running. My post BHR game plan was to do a total of 20 miles per week but only a third on ground. 1/3 Deep Water Running and the other on Elliptical. So the study is pretty encouraging. Maybe I'm underestimating the miles I can really do. I don't know what this would translate to in terms of actual triathlon performance. I just know this. I DEFINITELY will be in the top 3 category of Bi-Lateral Hip Resurfacing athletes in every category (please don't join my races... but most of you guys aren't bi-lat so I don't have to worry). I'm making up my own trophies!!!!!
Hip
@HipnHop-
So does that mean I can only win half of a trophy since I am not a bi-lat? ;D
I just started running two weeks ago. It is great! I am ahoy with any mileage since I gave up the idea years ago that I would ever be able to run or do a triathlon. I know I probably won't be able to return to my highly competitive levels because of other commitments and interests. But just being able to finish a triathlon again will be wonderful.
Best wishes.
Dan
You're all probably aware of these facts.... not that you need more encouragement :)
http://www.physorg.com/news154959340.html
http://www.abc.net.au/health/healthyliving/stories/2009/06/09/2583342.htm
Cherz
Kiwi
Your welcome Hipnhop :)
Hence why those who play impact sports have hader bone. Hard contact sports actually mean your honey comb gets more compact so the holes are smaller and hence stronger. I have no doubt that the 15 years of muay Thai I've done is one of the reasons for my abnormal bone density:-)
I agree, Danny - we have all pounded our bodies in pursuit of what we do, one good thing is that it gives many of us good bone density. I think that's true of the lifting, martial arts and football I've done.
Dan, you are the man but you are not in my category. You cant compete in the Bi-Tri. But dont worry. I'm putting you with all those THR folks - you'll dust them (LMAO).
Hip
Quote from: hipnhop on February 12, 2012, 11:21:48 AM
Dan, you are the man but you are not in my category. You cant compete in the Bi-Tri. But dont worry. I'm putting you with all those THR folks - you'll dust them (LMAO).
Hip
BI Tri i love it! ;D
It seems to me there are so many variables to a study conclusion like this. Still, the results are very high in my opinion, in favor of those of us that have had active lifestyles, and want to maintain them. First of all, you have results from the not-so-good surgeons mixed in with results from the good surgeons who get the devices put in correctly, and at the proper angles. Also, each person and their activity is different. You might have someone who is just really biomechanically unsound in the activity they do. You get someone who has bad running biomechanics vs someone who is just genetically put together better, the first will probably more likely wear out a device before the later. Remember, many of us who have had this operation done probably fit into one of two catagories; we're either really extreme with our activity level (which has caused our degeneration) or we have bad mechanics and physiology (which has caused our degeneration). Some might have a combination of both. I do believe too that results like this will vary drastically from surgeon to surgeon. A large number of people who've seemed to have had problems, revisions, and premature wear issues, the device in many cases wasn't inserted correctly at correct angles. I hope I picked a good surgeon and he told me what my angles were.
Johnnd_emd...sweet set up on your bike. Do you think you can get back to that acute hip angle again? i just bought a P3 so hoping to be able to ride it steep after my BHR.
triathlete98,
That pic was just 4 months ago, and I just had my BHR put in 12 days ago. At this point I'm staying very optimistic I will be able to go right back to that position post op. If all goes well I don't see why I shouldn't be able too. Feel free to PM me. I see by your screen name you do triathlons. I raced professionally for 8 years as a triathlete. Now I'm just racing bikes, but still at 52 able to race elite P1-2 and Elite Masters 1-2 races.
Just to make some points about the study that started this post. I have done some digging on this study.
1. It seems to have been lead by the inventor of the ASR device. His team would not have had permission to study other devices.
2. These results allow it to be argued that patient activity not surgeon skill or device design are the factors responsible for failure.
I'll leave the rest to your imagination. Personally, I don't feel this study reflects hip resurfacing and impact generally, especially not the BHR.
Jeremy
I'm 13 days post op, and just read this article. Doesn't worry me one bit. I feel like I chose a good surgeon. Therefore, I don't have any concerns. I know there's a risk with anything, but even still, 96% and 88%. Come on, that's pretty high odds in our, my, favor. Look at the last sentence, "Survivorship for patients with a lower IS score at eight years was 96.4 percent versus 88.8 percent."
There's a lot to consider here. First, this includes all devices that were in the study, not just BHR's. We all know, many of the devices out there are inferior at best to Birminghams's. Second, this study also includes early devices that were inserted by inexperienced doctors. We all know that the person doing the surgery makes a huge, huge difference in outcomes. There's a huge learning curve with these resurfacing devices and some of the better doctors have stats that are off the charts. I'm willing to bet that if you took someone like Dr. Bose, I'd bet over 98-99% of all the thousands of resurfacings he's done are still doing fine. There's a lot involved with this procedure. One of the first things is patient selection. I know the good doctors won't just do anyone. They know the device, they have experience, and they will pick the patients it's best suited for, and then they insert them correctly.
Keeping my head up and very optimistic about my outcomes. Too many good outcomes and people out there with too many good stories not too.
As i said before in this thread. I have a gut feeling(not based on anything medical just my own intuitive guess) that one of the biggest factors in longterm longevity will be longterm bone health and quality.
What I'm trying to help everyone understand is that this study does NOT include BHRs. It probably does NOT include any devices other than the ASR!
As you can see by this abstract, the study was lead by Harlan.
http://www.abstractsonline.com/Plan/ViewAbstract.aspx?mID=2841&sKey=8f07675f-aadf-4b0b-baed-e7aabc4b0f69&cKey=7c32b727-acd9-44a7-bb88-909c43baf3c5&mKey=BA8AA154-A9B9-41F9-91A7-F4A4CB050945
People can't just get the rights to study whatever resurfacing tool they want just because they feel like it.
Correct me if I'm wrong, but for some reason, I just don't think Smith and Newphew gave Harlan the rights to study their device. Just a hunch.
;)
The study absract concludes "High levels of sporting activities can be detrimental to the long-term success of hip resurfacing arthroplasty, independently from other risk factors."
Thus, it lays the groundwork to argue that the ASR failed because of misuse of the device.
That's what matters about this study as far as your hips are concerned.
Jeremy
Very interesting points jerramy. You may well have a point.
That is very interesting, Jeremy. Nothing like blaming the victim to deflect the blame on your own device. I'd love to know what devices they researched.
I don't know about anybody else, but my brain hurts from worrying about it. I have decided, maybe at my detriment, to take a break from the negative press about this. Especially since mine is a BHR done by Dr. Su, one of the top resurfacing surgeons in the world. I am going to follow my doctors protocol, try to err on the side of caution and not push the envelope with things like I have in the past, and let the chips fall where they may. When given the go ahead, I will return to what I loved to do. It is high impact at times so I will do that part of it in moderation from now on. No more hours of drills etc. If I feel the pain, no more masking it with nsaids, pain meds and ice only to continue, but will back off and listen to my body. When I first consulted with my doctor he did make it clear that there were no lifelong guarantees with the BHR, that it is a relatively new device and procedure compared to THR and that I could possibly down the road need to convert to a THR. But he also followed that up with the extremely low percentage rate that possibility presents and what I can do in the first several months of my resurfacing to help keep myself out of that category. So like others I am going to hope that I do not wind up in that minimal percentage of unfortunates and try to relax. It's hard though. I wake up every morning asking the question on when and how much I can push the envelope.
Jeremy,
Dr Harlan Amstutz was the developer of the Conserve and Conserve+ prostheses, so it is likely that these are the prostheses covered in this study, not the ASR. Dr Schmalzried, one of Dr Amstutz partners, was involved in developing the ASR, and installed many of them, but I don't see anything in the study that would indicate that his patients were included in the study.
I think that you are correct in assuming that there were likely no BHRs included in the study, but I do not see anything that would make me think that any ASRs were included either. My assumption is that if the study is of Dr Harlan Amstutz patients, most or all of the prostheses would be the Conserve Plus.
You will certainly find a history of lots of battling between Amstutz and McMinn over the Conserve vs. the BHR. My feeling is that the best unbiased comparisons have been presented by Dr DeSmet who has used both extensively.
I agree John. It is an interesting question, hope to have a good objective study done by some government involving all devices and broken down the way the national registries do it. A large sample and good structured research would be nice.
John, I agree that the devices covered by the study are not certain. However the design concept between the ASR, Conserve, and the others actually started with Harlan, under whom Schmalzried has worked in many ways at JRI. The design concepts between all these devices are all fundamentally similar in the way in which the beads are put into the device. BHR has a unique patented casting quite different from this group. Another reason why it is clear that this study does not reflect the BHR.
Edit: I, for one, agree wholeheartedly on the value of large scale "objective" studies by governments and, also comprehensive raw data registries on every device including detailed reports of activity levels and the other issues. Gimme the petition -- I'll sign it!
There's a very interesting video on the Mcminn centre website where Derrick shows the beads of a bhr under an electron microscope against the beads of "another" device(he doesn't say which). And the difference is astounding. The bhr has a far rougher surface than that of the devices which have sintered beads. Mcminn states that this provides a fantastic fixation in the bone as bone loves to actuly grow into this rough surface where as the smoother surface of the sintered beads doesn't allow such purchase by the bone onto the device.
Yes, Danny, that's exactly what I'm talking about. Part of me wishes McMinn et al. never patented their approach of keeping the beads and cup as one piece rather than sintering them on. But if they hadn't, I suppose there could have been other problems in variation. I'm going to check out that video you mentioned.
The easyest way to find it is use the link below:
http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php (http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php)
It comes up with a title about cementless devices. He also shows a sectioned femoral component on the bone. It highlights how the cement works since watching that I really don't see my bhr going anywhere for a long time! Incidentally I didn't know until I watched another video by Mcminn that the cementing procedure is very different for devices like the C+ which apparently use high viscosity cement applied to the bone as opposed to low viscosity cement put in the cap then press fitted on the bone.
Cementless Devices - 20 year history by McMinn
http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php (http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php)
Pat
That looks like the one. It's a really good video. I keep watching it over and over.
The cementless issue is interesting. Dr. Pritchett like Mr. McMinn also has a long history of using cementless in the past and found that it did not meet acceptable success standards. I didn't realize that cement is used only on the femoral component but that makes sense. Learn something new everyday.
Mr. McMinn's data was interesting and his video presentation well done. Thanks Pat.
Luanna
Luanna,
There is another fantastic video you might like to watch that explains a bit of the history behind cement/cementless its Vickys interview with Mark Bloomfield. It's an awesome video!
Note added by Pat. Mr. Bloomfield's interview available on his interview page on Surface Hippy: http://www.surfacehippy.info/doctorinterviews/bloomfieldinterview.php (http://www.surfacehippy.info/doctorinterviews/bloomfieldinterview.php)
You mean implants that hardly get used may last longer than ones that get hammered ? Wow imagine that, who'd a thunk.... Guess I better sell the toys and start knitting.
NOT !!!!!!! ;) ;D
Sorry Bill, I just can't see how you'll knit and ride the motorcycle at the same time.
Quote from: Dannywayoflife on February 15, 2012, 09:05:43 PM
The easyest way to find it is to go to Vickys site and do a search for longevity.
http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php (http://www.surfacehippy.info/doctorinterviews/mcminn-cementless-resurfacing.php)
It comes up with a title about cementless devices. He also shows a sectioned femoral component on the bone. It highlights how the cement works since watching that I really don't see my bhr going anywhere for a long time! Incidentally I didn't know until I watched another video by Mcminn that the cementing procedure is very different for devices like the C+ which apparently use high viscosity cement applied to the bone as opposed to low viscosity cement put in the cap then press fitted on the bone.
I'm confused. Isn't Pat the owner/moderator of Surfacehippy not Vicky?
Hi Jennifer
Yes - I am the owner/webmaster of this Surface Hippy website. http://www.surfacehippy.info (http://www.surfacehippy.info) I started it 12/11/2005. I do all the work myself and work on the site as a full time job, often working in the evenings and weekends, too. I have thousands of hours of work into the site. Vicky started a website about 2 years ago and called it surfacehippyinfo.com She has since renamed it to hipresurfacingsite.
I make a big effort to offer much the same information as she does including my own video interviews with the top hip resurfacing surgeons. So when people are looking for information and links to it, I appreciate them using my website and info instead of sending people to another website. There is very little that I don't have posted on the main website other than some of her personal doctor interviews. I even have some of them when I think it is important such as the McMinn interviews. I know the same surgeons that she does and have access to almost all the same information. We are doing the same type of work, but my site started in 2005 and I work on it full time. I also pay for all the costs, always did and always will.
Pat
Thanks again Pat for this site, you have really helped so many people.
Thanks Pat for the reply! Wow that is essentially the same name as yours. Good thing she changed it.
Anyway, your work is invaluable.
With great appreciation,
Sorry to be the cause of any confusion. The reason being I didn't realise that Pat had these videos on this site aswell. I am not all that good at this interweb thing.
Thanks for the video, most interesting to see those pictures.
The bits I really found interesting were the photos from the electron microscope of the back of the BHR cup it's a much rougher surface than the sintered beads. I also have a interesting study by Mcminn and Treacy with some photos of recovered cups and the bone really does fill all the voids in the cup.
I also really liked the photo of the sectioned femoral component showing the cement micro lock. I really now see why Mcminn hasn't had a single case of femoral loosening!
I also didn't realise until watching the debate on the asr v bhr that most other devices use a different cementing regimen.