More Positive HR Results

[GIBLET88]

Hi all,
After being on this board for several months, one thing I have learned is that the the surgeon is much more important for hip resurfacing than many other procedures. When I read results of Drs. Gross, De Smet, Bose, etc. it is obvious that they thoroughly understand patient selection and are meticulously experienced HR surgeons. One can easily get discouraged reading the NY Times or other surgeon commentaries against hip resurfacing.
It was refreshing to read the results of Dr Su which were excellent!
Please see article below from Orthosite which provides the data, great stuff for those considering having the procedure:

Surgeon’s experience with hip resurfacing shows 1.3% complication rate
The retrospective study, which analyzed 925 hip resurfacings performed by Edwin Su, MD, between 2004 and 2009 with a minimum follow-up of 2 years, looked at three implants: Wright Medical’s Conserve Plus Total Resurfacing Hip System, Biomet Orthopedics’ ReCap Femoral Resurfacing System and Smith & Nephew’s Birmingham Hip Resurfacing System. Conserve Plus and the Biomet ReCap were used as part of clinical trials, while the Birmingham hip was used after FDA approval of the implant in 2006. Clinical scores and radiographs were obtained at 1 month, 3 months, 1 year, and every subsequent year. The hips in the study had a minimum of 2 year follow up, both radiographically and clinically.

“[The Conserve Plus hip] was not FDA approved by our government between 2004-2008, so we had to petition for each patient to have the device, limiting the numbers of patients receiving that implant,” Su, from the Hospital for Special Surgery in New York, said during his presentation at the 12th EFORT Congress 2011.

Su received training from some of the pioneers of hip resurfacing, in both California and Europe, to gain the experience necessary to perform the procedures. He used a posterior approach during the procedures and was careful to preserve the retinacular vessels and soft tissues to prevent the need for reoperation. The implant specific guides were used to ensure central positioning within the neck to prevent notching, and cemented femoral fixation was used, the study stated.

The study showed 12 revisions (1.3%) at a minimum followup of 24 months. The K-M survival curve overall for the procedure, using all 3 different implants, was 98.6% at 68 months. Su noted that these results compared favorably to other published papers that describe short-term failure rates of 8% and 13% for the procedure. The Conserve Plus series had six revisions out of 157 cases (3.8%), which involved two cup loosenings, three femoral loosenings and an adverse metal reaction. The Birmingham series had six revisions out of 748 cases (0.8%), and the ReCap had no revisions.

Limitations for the study include the limited amount of data collected for certain implants, such as the ReCap, which had 20 implants compared to the Conserve Plus (157 implants) and the Birmingham series (748 implants). The Conserve Plus series also had a longer follow-up compared with the Birmingham series.

“For a surgeon contemplating adopting resurfacing, one must be concerned about the learning curve,” Su said. “The exposure is more difficult, it is more time-consuming, and it is more sensitive to technical errors.” However, with careful patient selection, proper surgical training, and a good implant, the success rate can be excellent.

Reference:
Su E. A single US surgeon experience with the adoption of hip resurfacing using 3 different implants. Paper #1140. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.
Berend KR, Lombardi AV, Adams JB and Sneller MA. Unsatisfactory surgical learning curve with hip resurfacing. J Bone Joint Surg Am. 2011; 93S:89-92.
Mont MA, Seyler TM, Ulrich SD, et al. Effect of changing indications and techniques on total hip resurfacing. Clin Orthop, 2007;465:63-70
Edwin Su, MD, can be reached at the Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021; 202-606-1128; email: sue@hss.edu.
Disclosure: Su provides consulting services for Smith and Nephew Inc. on hip resurfacing products. Smith and Nephew Inc. and Biomet Inc. have provided research support for studies involving hip resurfacing.

[GIBLET88]

BTW, the link:

http://www.orthosupersite.com/view.aspx?rid=89618

[Woodstock Hippy]

Great report!  You always want to go to the best doctor that you can, with HR it becomes even more critical.  I can only tell you how good I feel after my surgeries Tuesday.  I will take my recovery very slowly, but next summer I plan on having a lot of fun.