Author Topic: BHR versus ASR (Read 13210 times)

austin.m · « **on:** March 20, 2008, 12:43:28 AM »

Anyone have a point of view as to the relative merits of these two systems? Does it matter?

Pat Walter · « **Reply #1 on:** March 20, 2008, 07:14:33 AM »

Hi

There has been some controversy between surgeons over the 2. The ASR is newer and I was told by my doctor, Dr. De Smet of Belgium who has done over 3000 hip resurfacings, that some of his peers overseas were having problems with the ASR. They were having too many revisions after using them to THRS.

That is not always true of some of the US doctors. More doctors overseas in India and other countries tend to use the ASR.

It is not FDA approved in the US, so it is not normally used here.

Most of the doctors prefer the BHR since it is the most widely used hip device. The Wright C+ is also used a lot, but again not FDA aprpoved in the US.

Here are some articles about it http://www.surfacehippy.info/bhrvsasrpage.php

I personally wanted to stick with the hip device that was most used and had the most history and got a BHR.

Pat

austin.m · « **Reply #2 on:** March 21, 2008, 11:24:53 AM »

Pat - thanks for this. My doctor is planning to use the Depuy ASR, so I'm assuming that it is now FDA approved. He forwarded a white paper and, as you say, it seems that there's a balance between the benefits of improved design versus the potential negatives associated with a shorter track record. Based on what I could find, it seems like a good trade-off to me, plus - if it's the one he's used to it's the one he should stick with.

Pat Walter · « **Reply #3 on:** March 21, 2008, 04:30:31 PM »

Hi

It is not FDA approved in the US as a system. The doctors use FDA approved components to be able to have the insurance cover the cost of it as a complete hip resurfacing device. Dr. Gross explains the difference here about how the components are approved - not the system http://www.surfacehippy.info/fdaapproval.php

What doctor are you going to use?

The doctors in India and Canada tend to use the ASR more than the US doctors. I think Dr. Schmalzried and a couple others use the ASR. I have not had many people write about it, so you will help me and others learn more.

Pat

EdK · « **Reply #4 on:** February 24, 2009, 10:48:52 AM »

my wife has an ASR and is very happy with it. we're going back to India to have her other side done in a few weeks, and i presume Dr. Bose will also use the ASR for the other side.

Dr. Bose indicated that he would decide once surgery was underway, and because he has equal confidence in both the BHR and the ASR is boils down to a question of fit. since my wife has smaller hip sockets we were comforted to know that that our surgeon had this range of possibilities.

Dr. Bose himself has addressed this issue on this site:
http://www.surfacehippy.info/doctorinterviews/boseinterview.php#Which_is_better_a_BHR_or_an_ASR

obxpelican · « **Reply #5 on:** February 24, 2009, 11:33:13 AM »

Ed,

You're going to find that as long as it's an FDA approved device and the doctor is a good doctor like Bose you're going to turn out ok. Millions of dollars are spent on R&D on the devices so that they perform up to standard. I've never heard of a MOM FDA approved device that cause someone to have a revision unless there was some manufacturing defect.

I think Dr. Bose like many of the other top doctors if you gave them an old rusty broom handle for an implant you would be walking straight lines no time..... folks, it's the indian, not the bow and arrow. (no pun intended)

Everyone wants to say their device/doctor/hospital/rehab facility is the best, it's natural especially when your outcome turns out well.

Chuck

EdK · « **Reply #6 on:** February 24, 2009, 01:30:15 PM »

Dr. Pispati also weighs in:

http://www.surfacehippy.info/asrvsbhrpispati.php

the ASR is FDA approved, and the data does not bear out the rumor stated in post #2:

http://www.surfacehippy.info/asrhip.php

obxpelican · « **Reply #7 on:** February 24, 2009, 01:53:42 PM »

I personally think it has more to do with the training of the doctor, his experience and how well the company trained the doctor to perform the surgery with that device.

No device is going to have a perfect record, especially if the implants are not precisely placed inside the acetabulum and on the femoral head.

I've heard too many really good doctors like Rogerson say that the can have equal results with various devices.

Chuck

Bionic · « **Reply #8 on:** February 24, 2009, 01:56:31 PM »

In Dr. Schmalzreid's recent chat, I recall him saying that the ASR implants had tighter clearance than the BHR ones. He said the smaller clearance caused them to give off fewer metal ions.

On the other hand, I had a recent conversation with Dr. Gross, in which he told me that tight clearance can also be a problem, and in fact was a problem with the first round of BHRs, since the acetabular implants would sometimes deform when impacted into bone and take on a slight football shape. This caused increased ions and wear.

So, I guess that means that the ASR implants may or may not release fewer ions. It seems to depend on whether they deform when they're impacted and probably to some extent on surgical skill and instrumentation.

obxpelican · « **Reply #9 on:** February 24, 2009, 03:21:44 PM »

I could see where tolerances if they are off some could cause issues, I guess it could even cause an implant to seize up? Who knows for sure, but I have heard the same thing regarding tolerances. Most devices today use a tolerance so that your synovial fluid acts as the lubricant like a piston in an engine, the device rides on the fluid as opposed to the metal to metal contact.

Off the record I've heard a number of doctors say that it's not the implant, it's the technique used to get it in place properly. Dr. Rogerson was pretty open to that fact on a recent chat and he's a very good hippie doctor.

I hope everyone does not get me wrong, when I hear the chest thumping that "my doctor/device is the best" I actually get a really good feeling inside, because I know that it's just one more successful surface hippy and that is certainly an awesome thing, especially since I am acutely aware of how much pain I went through. It's natural to think that your doctor is "THE BEST!", especially when you hear of so many good results.

BTW--- I know Dr. Gross is the best hip surgeon in the US.

Chuck

Bionic · « **Reply #10 on:** February 24, 2009, 03:40:44 PM »

... And he uses the best implants

.

wayne-0 · « **Reply #11 on:** February 25, 2009, 12:20:49 AM »

All I know is that I have two ASR implants and they are so far working excellent.My doctor told me that the instruments(tools)used for placement with the ASR are easier and better to work with.One other thing, the ASR has a narrower stem so it may be better for smaller boned people.

Wayne

Gav · « **Reply #12 on:** July 28, 2009, 06:14:22 AM »

I had some concerns to raise with my surgeon who will operate 4th Sept with DePuy ASR.

I asked him why he was using ASR and he said I could have any I wanted, as he had faith in all of the leading products. The Ramsay hospital where I am having surgery simply have ASR.

So I will stick with the ASR.

Gavin

Tommy · « **Reply #13 on:** July 28, 2009, 08:41:55 AM »

I to had a surgeon that prefered the ASR over the BHR. He like the bearing tolerance on the ASR but also said because there new there is sill more to learn. The BHR he said has a long track record with many preforming at high levels for a long time. I chose the BHR for the history behind it my surgeon was ok with that. He said it's more about who's doing it than which one you get.
Tommy

Tekka · « **Reply #14 on:** July 28, 2009, 01:09:07 PM »

Hi Gavin,

I am seven months post op and making good progress, I did loads of research before my LBHR and the only advice I can give is this......get the best surgeon you can and then get the best product you can.

I do not know a great deal about the ASR but I do know the BHR as a good track record and thats the most important issue mate, you want the best possible outcome, so don't leave anything to chance.

If you want to mail me direct I can give you my full story.

Regards

Terry

wayne-0 · « **Reply #15 on:** July 28, 2009, 02:25:58 PM »

The ASR sizes are every 2mm whereas the BHR sizes are every 4mm. So maybe there is a chance to get a tighter fit with the ASR. I have had both sides with the ASR for 8 months now and so far everything feels and works absolutley perfect.

Wayne

Gav · « **Reply #16 on:** October 21, 2009, 06:58:57 PM »

Hi all

I have a DePuy ASR right hip.

I'm 7 weeks post op on Friday and I can tell you things are going well. I'm back at the gym now. The only problems seem to stem from tenderness from the incision. My limp has almost disappeared, I'm back at work full time and driving to see my clients as required, so overall I'm pleased apart from som clunking due to my slack glute muscles!

I'll keep you posted.

Regards

Gavin

dw · « **Reply #17 on:** October 22, 2009, 03:17:52 PM »

Quote from: wayne-0 on July 28, 2009, 02:25:58 PM

The ASR sizes are every 2mm whereas the BHR sizes are every 4mm. So maybe there is a chance to get a tighter fit with the ASR. I have had both sides with the ASR for 8 months now and so far everything feels and works absolutley perfect.

Wayne

Really? I thought the BHR were 2mm increments as well. I'll have to ask my doc that when I see him next

stevel · « **Reply #18 on:** October 23, 2009, 02:22:24 AM »

The BHR is available in 2 mm increments according to the manufacturer's literature.

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Author Topic: BHR versus ASR (Read 13210 times)

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