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Author Topic: Dr. Gross's New Study - What is the Best Bone Fixation Type?  (Read 5725 times)

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Pat Walter

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Dr. Gross's New Study - What is the Best Bone Fixation Type?
« on: February 11, 2011, 09:37:49 PM »
Dr. Gross has completed a new study: What is the Best Bone Fixation Type? -
A Comparison of cement vs. bone ingrowth.

The study can be seen here http://www.surfacehippy.info/grossreport1-11-2011.php 

It is very interesting and shows excellent results for the Biomet uncemented device and technique.
« Last Edit: February 11, 2011, 09:38:31 PM by Pat Walter »
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3/15/06 LBHR De Smet

obxpelican

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #1 on: February 11, 2011, 10:03:09 PM »
Pat,


Hey, thanks for the post, that's great news for the hippy community, maybe all along Dr. Gross was right about cementless over cemented.  Cementless sure does look promising for the future.


Chuck
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

danebuxbaum

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #2 on: February 11, 2011, 10:39:30 PM »
You should listen to what Dr. Brooks says about the cementless procedure. This was also brought up by Mr. Tracy in Birmingham who taught Brooks. (You can catch it in his interview with Pat). It has to do with the possible weakening of metal that undergoes a second superheating to apply the porous coating to the inside of the acetabular cup. It made sense to me. I heat copper wire all the time to soften it so that I can bend it around bonsai trees and it does get much softer at first and breaks more readilly upon bending than raw wire does. The Birmingham device is a single cast device so no part of the metal has been compromised by a second heating. Plus, according to Brooks, there has never been a single incidence of the cement failing in a properly applied femoral cap. Finally, for the cementless femoral cap to properly merge with live bone (yes it sounds great in theory, and probably can work great) the bone has to be perfect. If there is a dead spot the bone won't grow there. I would guess it would be almost impossible to look at a bloody cap during surgery and see if a small patch of bone was not still viable when surrounded by viable bone.

danebuxbaum

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #3 on: February 11, 2011, 10:42:40 PM »
Correction: The porous coating is added to the inside of the FEMORAL CAP. The acetabular cup is cementless in all resurfacing procedures.

obxpelican

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #4 on: February 11, 2011, 10:53:04 PM »
Those devices and all devices that are implanted go through strenuous wear tests, somewhere on Biomet's site they have the results.... I think you would have to walk to the moon to wear out any of the current implants on the market.

Yes, I've heard those who question the heat treatments, but it's always those who do not implant or sell Biomet.


Chuck
Chuck
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8-6-08

newdog

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #5 on: February 11, 2011, 11:16:38 PM »
<I heat copper wire all the time to soften it so that I can bend it around bonsai trees and it does get much softer at first and breaks more readilly upon bending than raw wire does.>

How can heating copper wire compare to the process of applying coating to metal? That is an "apples to oranges" comparison. After metal is heated it can be tempered (drawn back) to eliminate brittleness or the tendency to break or crack from being hardened. It's elementary knowledge and practice in the metal working trades. Biomet makes tested, high tech stuff. Do you think they would not know about the effects of heat on their products?

Why introduce a component or substance, in this case cement, when it is not necessary? If someone wants the cement type implants, fine, they do work well and have a good track record. I think you are just cheering for the "home team".
« Last Edit: February 14, 2011, 01:32:05 AM by newdog »
Steve, Dr. Gross bilateral, uncemented Biomet, January 10 & 12, 2011, Columbia S.C.

Lopsided

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #6 on: February 12, 2011, 02:26:12 AM »
I am not sure how a thread about the study of uncemented resurfacing has turned into a debate about heat treatment of the metal used.

Anyway, I had uncemented. For me it was almost as important as getting resurfacing at all. I had the C+ device, which is heat treated. Whether or not it is as hard as as cast, it certainly is much better than the grisly remnant of cartilage. It is impossible to know what will happen with the implant in ten years, twenty years, fifty years (wishfull thinking that I might live that long) but I chose uncemented because with my limited knowledge of materials it seems that it should last longer or even indefinitely.

Dr. Gross seems to be the main exponent of uncemented resurfacing, but there are other top surgeons doing it too. In answer to one of my questions Dr. De Smet said he expected to be doing it regularly. There will continue to be two schools of thought by the surgeons, but I am sure uncemented will become more popular.

After six months, I am most pleased with my resurfacing.

D.





Proud To Be Dr. De Smet's First Uncemented Conserve Plus, Left, August 2010

einreb

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #7 on: February 12, 2011, 03:43:24 AM »
I am not sure how a thread about the study of uncemented resurfacing has turned into a debate about heat treatment of the metal used.

I think there are a lot of emotions and motivations (conscious and subconscious) expressed in the device debates.

I had the C+ device, which is heat treated.

Here's to hoping that they all last us a long time...
40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

23109VC

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #8 on: February 12, 2011, 06:41:24 AM »
That is reassuring to read!  I'm less than two weeks to my uncemented surgery with Dr. gross!


Sean
Dr. Gross- Biomet uncemented, 2/23/11

obxpelican

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #9 on: February 12, 2011, 02:34:09 PM »
Where is the like button on here for that comment?

I think people sometimes get the wrong idea when they hear something new in hip resurfacing, somehow they think we Gross (and Dr. DeSmet) hippies are saying that all other devices are inferiour when we speak of our cementless hips, that is simply untrue. 

I say anything that can improve the great results of say the BHR is a good thing, anything that gives the surgeon one less thing to have to do during surgery is a good thing and if one or a few percent of the patients have better results why not?

All of us cementless patients realize this is a study, it could still go negative, but at this point it's very very doubtful as the numbers are really positive, especially since we've hit the 3 years mark in the numbers being tracked. 

I believe that cementless will be the future of hip surgery.


Chuck




Here's to hoping that they all last us a long time...
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

littleb

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #10 on: February 12, 2011, 05:26:15 PM »
Dr. Gross is obviously the trailblazer with cementless implants. Now that his 2 year study has come out other doctors will follow with select cases to add with the data. Doctors who knew they had tried and true implants and techniques weren't going to jump ship until the data showed good results over time. Makes sense where there is debate. The screening may be different with cementless for other doctors, only perfect candidates without other bone issues seems likely. Doctors will use the best system for the patient. Just like when some of us don't know for sure our resurf won't
actually be a THR when we wake from surgery.
RBHR
Dr. Su
8/19/10

Lopsided

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #11 on: February 13, 2011, 12:18:52 AM »
Doctors who knew they had tried and true implants and techniques weren't going to jump ship until the data showed good results over time.

No, my dear little B, a few of the top surgeons have already decided to use uncemented and to collate their data, possibly long ago. It takes time for the manufacturers to produce a variation on an existing device.

Although Mr. Mcminn only does cemented Birminghams now, he experimented with uncemented (his interviews are on this site) in the early days of resurfacing. I am sure many other surgeons have considered it too, but do not have the influence over device manufacturers.

Wright are now producing an uncemented C+. I requested this in May 2010 from Dr. De Smet, having read (also on this site) of someone else getting this device from another surgeon earlier than that.

So while the surgeons, and us patients, are interested in Dr. Gross' results, across the world uncemented is already happening.

D.



Proud To Be Dr. De Smet's First Uncemented Conserve Plus, Left, August 2010

Dayton96

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #12 on: February 13, 2011, 03:05:37 AM »
I've just read Dr. Gross' study and I find it reassuring, but, I'm also aware that the skill of the surgeon is also a critical factor.  A true study of cementless implants needs to be done with multiple surgeons.  I believe Biomet has a research study going on right now with surgeons across the country, including Dr. Su.  I'm looking forward to reading the results of that study. 

Having said that, my left hip will not wait until all the studies come out.  I decided to go with Dr. Gross.  One factor was the cementless implants, the other factor, and perhaps the most important one, was the quality of the surgeon.  It may very well be that the success of the Biomet devices, like the success that Dr. Bose had with the ASR, is purely the skill of a particular surgeon. 

Mac
Dr. Gross, Uncemented Biomet, Left, March 2011

obxpelican

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #13 on: February 13, 2011, 03:11:15 AM »
I think Dr. Gross has set the bar pretty high, especially knowing that he takes on more risky cases.

The numbers are really sounding good, knowing that doctors like DeSmet and Dr. Su are interested makes me feel even better.

LOL  I hope that this all works out and cementless ends up well, I am riding on it, well ok, walking on it.


Chuck
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

einreb

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #14 on: February 13, 2011, 04:03:38 AM »
I think Dr. Gross has set the bar pretty high, especially knowing that he takes on more risky cases.

The numbers are really sounding good, knowing that doctors like DeSmet and Dr. Su are interested makes me feel even better.

LOL  I hope that this all works out and cementless ends up well, I am riding on it, well ok, walking on it.


Chuck

I think there is an interesting line to walk here.  There are lots of folks that have cemented hips.  To project that un-cemented is now 'better' may come across as unnecessarily confrontational.  I would hope that the cemented last just as long and they very well may. Maybe cemented will last 100 years and un-cemented will last 200 :)

For those that are looking to decide on a device and a surgeon... these results are something to take into consideration.  History has not been particularly kind to cement long term, but that has been in shear!

For me... I like that it the Biomet has not had any of the ASR type failures and that the historically successful un-cemented bone fixation appears to be working. Ultimately I am happy to have a surgeon scheduled that is reasonably close to me, my insurance pays for him and he has a well documented  good track record.





40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

obxpelican

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #15 on: February 13, 2011, 01:59:41 PM »
I think to some it may come across confrontational, but new techniques MUST be considered and discussed.  This is like the stem cell technology, I believe within 5-10 years doctors will be able to transplant cells into the hip. How will we hippies react then? Some who have had their surgeries will be upset, some will deny that it will work, others like me will applaud it.  I would love to be able to get a shot in my left hip instead of surgery.  I know someday my left hip is going to fail, hopefully stem cell surgery for humans will be around then.

Will uncemented be successful? Maybe. Will it make a huge difference in results, probably not, maybe a 1-2% in long term results, maybe not. Who knows.

I think in the end most of us will end up being buried with our original implants, be it BHR, Biomet or any of the other brands of implants.  This is assuming that those patients pick a VERY experienced surgeon, but that's another discussion for another day.


Chuck

I think there is an interesting line to walk here.  There are lots of folks that have cemented hips.  To project that un-cemented is now 'better' may come across as unnecessarily confrontational. 
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

einreb

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #16 on: February 13, 2011, 04:09:45 PM »
I think to some it may come across confrontational, but new techniques MUST be considered and discussed. 

I agree.  Maybe I didn't phrase that correctly.  Its just that its all just a big experient at this point.  Nothing is 'for sure' better.  There are so many factors.... instrumentation, training, patient selection, etc.

40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

obxpelican

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #17 on: February 13, 2011, 05:11:17 PM »
I like to call what Dr. Gross is doing a study, an experiment to me is when they did the first hip resurfacing on a pig or other animal.   

3 years with great results so far is a good study.

Again, time will tell and to really prove Dr. Gross's hypothesis it's going to take some time.


Chuck
Chuck
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8-6-08

23109VC

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #18 on: February 14, 2011, 02:37:28 AM »
Agreed, an experiment is hard to truly do with live subjects....you can't randomly assign subjectscto groups and holdingvall other variables constant is next to impossible.  A study is the right term..

I'll take it though.  What else do we have to go on?

My cementless  hip goes in next week.... Cross your fingers for me!  I also hope that everyone who has a hip resurfaced gets a lifetime out ofvtheir device...whether it's cemented or not.  Each of us has to make a decision about what doc to see and what device to use, we make it based on the limited info we have, and once we make it....we move forward.  Let's hope all our hips last a LONG LONG time!
Sean
Dr. Gross- Biomet uncemented, 2/23/11

obxpelican

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Re: Dr. Gross's New Study - What is the Best Bone Fixation Type?
« Reply #19 on: February 14, 2011, 03:06:23 AM »
It's looking better everyday that we all may keep our hip device till we pass on to that great golf course in the sky.

Good luck on your surgery.


Keep us all updated, let us know asap about the pain protocol too.


Chuck
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

 

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