Hmmmm.... more decisions now about devices!

[jack]

Hi
I am experiencing some concern about the latest releases of findings regarding the different resurfacing devices and their statistics. I sounds like the BHR is far and above all others but the data seems a bit lacking to me.

For instance, when they say -

The Journal of Bone and Joint Surgery published in January of this year a study tracking 155 consecutive BHR patients over three years. The data showed no revisions of BHR Hips due to metal wear, but patients who received a competing metal-on-metal resurfacing device were revised within three years of surgery at a rate of 3.4-percent due to adverse tissue reactions

There is no mention of lack of surgical skills or presence of superior surgical experience which to me is the biggest factor in failure rates due to high metals.  Surely this is a much harder thing to track but it must be included in results in order to be completely accurate, right? Well, I guess it depends on the level of accuracy one is trying to achieve.

This statement-

The Australian Orthopaedic Association's 2008 National Joint Replacement Registry, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR Hips and found that less than one-third of one-percent may have been revised due to the patient's reaction to the metal component

Has no mention of the results from other devices for comparison. To be fair one would have to list out every competing device along with success rates and surgeon skill/mistakes along with any other factor that contributes to success or failure.


One could go on and on picking apart the data, or lack thereof, in these recent publications. Releasing a blanket statement that one product performs better than another without complete supporting evidence is, to me, not worth the paper it is printed on. One has to wonder if there are motivations……

In today’s world of political influences one has to wonder about everything, and I do mean everything. Maybe it is the skeptic in me as there truly is a deeply seated level of skepticism in me. I know it and deal with it but I think it has allowed me to survive otherwise possibly devastating situations in my life. It’s not something I was born with but rather have learned as a matter of exposure.

In any event, One has to place their faith in someone or something when certain times arise. One of these times for me is my upcoming resurfacing by Dr. Clarke in a couple of weeks. During our meeting back in November he stated that he would probably be using the Cormet device due to its ease of installment. While this is a very positive thing, and will probably enable precise placement of the devices (very critical), these recent publication releases have gotten me on edge about what device will be used. I have been searching and searching and reading and reading…..   

I am thinking seriously about calling the office and requesting that a BHR be used, but on the other hand I do want to feel comfortable and confident in my surgeon and his decisions on all levels of my surgery. It has been stated many times in my research to choose the surgeon first, and the device second. It sounds like good advice to me although if you get the best of the best surgeon, but a second rate device, you cannot get better than second rate results…..  ??!!??!!

Any thoughts on this subject are welcome….. 

[Pat Walter]

Hi Jack

I don't think there is any national registry or any documentation as to a surgeon's skill.  How would that be compiled?   Don't think that is anything you will ever see.  That is why there are sites and discussion groups like mine.  We are able to talk about our surgeon, their skills and our recoveries.  Unfortunatley, we don't have stats for surgeons like athletes.  Just input from other patients.

If you want a BHR - why don't you ask Dr. Clarke why he prefers the Cormet.  Listen and then decide what you want.  Many of the surgeons use several hip resurfacing devices.  Personally, I again like the device with the best track record.  There have been over 125,000 BHRs placed worldwide.  It is by far the most used and popular resurfacing device.  There are others, but it is up to the surgeon to decide what is best for you and what instrumentation they like the best.  For instance, Dr. De Smet likes the instrumentation for the Wright C+ better than the BHR.  Personal preference I would guess.  He helped develope some of the instrumentation.   Much of what is used overseas is not available in the US because it is not FDA approved.  We are very slow in our country in approving new devices, procedures and instruments.

If you are having nagging questions - ask your surgeon to answer them for you.

Pat

[jack]

Hi Jack

I don't think there is any national registry or any documentation as to a surgeon's skill.  How would that be compiled?  

Surgical skills persay would not be able to be compiled due to the subjective nature of it, but the reason behind a failure or revision surely could. Things such as steep angle placements and the resulting high metal counts and high wear levels could be documented, tracked, and associated with the specific device leading to a conclusion of why, say, 3% of a particular device failed....  see what I mean? Perhaps all new doctors in a particular region use one particular device and have a high incidence of misplacement...... or a thousand other scenarios.

[stevel]

Jack,

You need to pick your device and surgeon independently, and not rely on your surgeon to pick the device for you.
Some surgeons have a bias towards a certain device since they developed the device.
For instance, if you want a Biomet uncemented device, then go to Dr. Gross as he is the only one installing it in the US and is a developer.
He installs the cemented Biomet upon request, but what about the cemented BHR or Cormet?

I knew Dr. Su installed the cemented BHR, Conserve Plus and Biomet.  I requested a BHR because of the excellent, long term case history.
I picked Dr. Su because of his excellent skill as a surgeon with few complications and because the Hospital for Special Surgery was rated no. 1 in Orthopedics by US World News & Report for 2007 & 2008.
I also wanted to match a Dr. who installs a large volume of a device (familar with the instrumentation and rigging) and does the same surgical approach (posterior, anterior-lateral, direct anterior, etc.).
Dr. Mont routinely does the anterior-lateral approach and offered to do the posterior approach for me, but I felt more comfortable with Dr. Su since he routinely does the posterior approach.
I am not qualified to evaluate the skill of a surgeon who can do either approach.
My objective was to minimize the risk of error for all tangibles, and so far so good.

[jack]

I have already selected my surgeon. I am going with Dr. Clarke in Syracuse NY. My initial visit found him saying that he would probably install the Cormet.... that was 6 months ago and I had not had any reason to doubt the device at the time, not that I doubt it now. With the recently released studies, I find myself looking at a blanket statement that the BHR is by far the best device out there, bar none, but yet there is no conclusive supporting evidence other than its the most widely used. They do tout low failure rates but without documentation as to why others have failed, I cannot make a sound decision on that type of statement and/or data alone.


For Example it could be that newer surgeons are using the other devices and not placing them correctly leading to failures... and thus up go the failure percentages, or not. It tends to make me wonder if I should insist on the BHR device and second guess my surgeon. That is probably not a good thing to do but I am thinking about it.

Allowing the surgeon to pick my device for me? Hmmm, well I have been researching this for a few months now but my surgeon has been doing this for many years and has performed nearly 1000 procedures by now. I guess the question is do I trust the guy enough to let him do what he thinks is best?  He certainly has more experience than I do to make a sounder judgment call. None the less I am pro-active in dealing with things and thus... here I am ranting about it  lol. I have a little time to decide but not a lot. I really want to get this done and behind me!

For all I know the Cormet could be a better device. I haven't found any data specific to the Cormet yet and have done extensive searching. If someone has this data please send me a link or post it here.

Anyway, thanks for the opportunity to rant here and actually put my thoughts in writing.... it helps   

[Margie]

Jack,
There are a few of us on this site that have had Dr. Clarke and a BHR. I didn't even think to ask, but I would have if I had read your post first. I know he does both, but when he said he would be doing a BHR or THR (IF necessary) I guess I just assumed that was how it was done, he picked what was best for each person. I just never had the question.
You are smart to be proactive in your care and you know the answer......ask. If you don't it will always be a question for you. Now that you have me wondering, I think I will also ask how he chooses which one for people at my 6 month visit. 
If you get the answer first please post it for us.

As always good luck to you,
Margie

[jack]

Thanks Margie and I will definitely post whatever I find or do. I still have a bit of work and thinking to do before I contact him. I want to get as many answers to my questions as I can worked out in my own mind first if possible. Besides, it keeps me out of mischief....  

[moe]

Jack, I would go with the BHR, as Pat said it has the longest and best track record, the Aussie registry shows this. I think the key is it's design and metallurgy, it has a large degree of coverage which makes it more tolerant of less than perfect placement. The "As Cast" condition eliminates the possibility of poor heat treatment. I work in the heat treating/metallurgy field and there can be some "less than perfect" outcomes with that procedure. Dr McMinn really had his act together when designing the BHR. Good Luck, moe

[jack]

Moe,

Thanks for the insight. I have pretty much decided on requesting the BHR although I will listen to what he has to say regarding the Cormet. It will be a tough sell and I doubt I will waiver. Now I just have to hope that I can talk to him before surgery..... will fill ya in.....

[jack]

First thing Monday I called the office and expressed my desire to the gal that answered. She in turn conveyed the message and called me back on Tuesday.

Looks like I will be getting the BHR! Dr. Clarke said that due to my size he would prefer to use the Cormet due to the ease with its instrumentation but would use the BHR is that is my desire. I am 6' 0" @ 250lbs. and big boned, large frame.

[resurface]

Just for the sport of it... I had a Cormet implanted May 6th.  It has been nothing short of amazing.  Guess what, it has nothing to do with the implant! Note by Patricia Walter: It does have something to do with the implant. Why has the ASR and Druom been removed from the market. Their high failure rate. Surgeon selection, surgical procedure / technique, patient fit, and following my rehab instructions to the letter will make the difference.  The data on the BHR is great. It has been around the longest.  It also has patents who have not done well.

How may failures or issues on this site overall are due to the implant?  As I have read this site, I reached the following conclusion, just about all the people with "issues" had the BHR or the Depuy ASR.  The ASR seems to be deliver implant related issues [product].   The BHR issues I bet are related to the factors of technique, patient selection, rehab, etc... not the implant.

My surgeon does both BHR and Cormet.  He selected the Cormet me.  He is comfortable with the implant and the technique. He is comfortable with the results that he can deliver.

Note by Patricia Walter:  No one on this site tells a doctor what to do.  No one on this site is medically trained.  The only thing I do is present information from published medical studies and National Registries.  The information is not my opinion - it is fact.  There are no products promoted here because they make revenue.  I am very offended you would say such a thing.  I worked on this website for over 3 years - full time days, evenings and weekends without ever making a penny. Who do you think paid all the expenses to keep this site running and updated?  I did. Who do you think paid me for all my three years of work on this site?  I did - so please don't tell people that devices are promoted because of revenues, they are discussed based on published data! Please remember that only 3 devices as a system are FDA approved - the BHR, the Cormet and the Wright C+  You can clearly look at the National Regsitries to see which device has the best record.  It is the BHR.  Not my opinion - the facts. All devices have had some failures.  The BHR has the least amoun of failures over it's 12 year period of use with a 96% survivorship. The best of all hip resurfacing devices. What concerns me is that non-MDs on this site are telling MDs what to do?  This site promotes one system and it is understood why... they provide revenue.  Your surgeon is hopefully reading the studies, attending seminars and training, talking to colleagues, following patients, etc. so that he / she can make the best decision for you.  

This is the last time that I will mention my implant.  I update my story seperately for all and I intend to do it week-to-week.  

Resurface