Delta Motion Hip Replacement

[deepika]

Hi,

I visited Dr Vijay Bose this weekend...for AVN of my right femoral head which has collapsed...Dr Bose suggested Delta Motion Hip Replacement he was hesitant about resurfacing...he said i am candidate for resurfacing but he says this new option suits me better since it has no metal ions issues, squeakiness and has Range of Motion similar to resurfacing...he says this new option will stay for 30 years..but its very experimental since its here from past 3 years only...Bose says he has already implemented it in more than 100+ patients...Is there anyone with experience of this new hip option...I have no doubts on Dr Bose's opinion but i am not sure what to do now...Any inputs will be greatly appreciated.   

[obxpelican]

Well..... having Dr. Bose do the surgery is a very positive thing as you are assured of having one of the best surgeons do your surgery.

Depuy does not have a very good track record considering the huge recall they just went through, time will tell for sure, although Bose has had really good luck with the ASR because of how good he is at getting the angles correct.

Until more data gets created you will never know.  I chose to have a new device implanted in me and so far so good.


Chuck

[morph]

Hi deepika,

Delta motion is my backup should I not be suitable for BHR during op. I believe it is very successful with large head improved range of motion. I know you can have this with the silent hip which is newish but conserves bone. Here is a response from Bose regarding this:

Hi Vicky ,
Thanks.
This gentleman raises some very valid points but slightly inaccurate.
Currently Femoral options can be divided into the following.
Resurfacing devices
Cervical stems.
Metaphyseal or short stem.
Metaphyseo- diaphyseal ( std stem).
Diaphyseal stem ( revision stem)

Of these options, the category that makes no sense to me is a short or metaphseal stem. I have had the opportunity to revise a few of these and invariably a revision stem ( diaphyeal is needed). Thus it offers no advantage over the well proven conventional std stem like the corail which again is revised by a revision stem. Therefore I do not use short stems in my practice. The cervical stems are a different story altogether.
There is no doubt that cervical stems like the silent and BMHR can be revised into a std stem. This is a huge advantage when one considers the ladder of reconstructive options. One must keep in mind that a resurfacing is also typically revised to a std stem. Thus looking exclusively from the complexity of revision view point , it would have the exactly the same advantage as a resurfacing.
Please do be mindful of the fact that no one would never revise a well functioning , well fixed stem. Thus removing a well fixed stem is a theoretical consideration though I am confident a neck osteotomy will easily cause the well fixed cervical stem to come out easily. Therefore the mechanisms of potential failure of cervical stems are loosening and fracture neck of femur. These conditions can be elegantly managed with a std stem.
No one would argue that the resurfacing would have the best load transfer from a bio-mechanical angle. Thus the patient who needs ultra high activity postop will be best served by a resurfacing. The other ones will always lag behind.
Both the silent and BMHR have been tested for the last 5-7 yrs and they have come out to be extremely successful in FEA & RSA studies. I have personally done The transfer of force that this gentleman refers to is applicable in a two dimensional diagram. However in real life which is 3 dimensional, the surgeon prepares a cone ( to seat the cervical stem) and the load transfer is designed to pass on to the neck of femur in a graded fashion with more tranfer proximally and less distally. Bone remodelling ofcourse will occur as in any devise.

The BMHR is an excellent devise as well. However it is married to metal on metal.The crucial advantage of the silent is the ability to use ceramic on ceramic bearing. The development of the large head ceramic cup ( deltamotion) has been a very significant breakthrough in hip arthroplasty. When one wants to avoid metal on metal like in young female patients the best option in my opinion would be a large head ceramic deltamotion cup coupled with a silent stem.
In my opinion the silent stem must never be used with a 28 or 32 head . Since the neck is preserved , it would cause a very poor head - neck offset resulting in impingement. Thus the silent was not very attractive till the development of the deltamotion cup. However the delta motion cup has helped us harness the bone conservation possible with the silent stem.
PS The ceramic on ceramic resurfacing is a few years away because the ceramic resurfacing cup has not yet been developed.

I hope this helps.

with best regards
vijay bose
chennai


My surgeon and Jeremy Latham have both used deltamotion succesfully.

[morph]

Ceramic bearings for total hip arthroplasty have high survivorship at 10 years.
D'Antonio JA, Capello WN, Naughton M.
SourceGreater Pittsburgh Orthopaedics Association, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108, USA. dantonioja@me.com

THA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial.
Hamilton WG, McAuley JP, Dennis DA, Murphy JA, Blumenfeld TJ, Politi J.
SourceAnderson Orthopaedic Research Institute, 2501 Parkers Lane, Alexandria, VA 22306, USA. billhamilton@cox.net

[Tim Bratten]

For what it's worth, I havs a large diameter ceramic on ceramic THR (head and cup by Adler Ortho, stem by Wright) that was placed in a revision surgery by Koen De Smet. So far (2.5 months post-op) the thing is working like a dream.
Cheers
Tim

[deepika]

Hi

Thanks for the replies...morph frankly i dint get much out of that medical reply of bose..but something i could understand is that

"looking exclusively from the complexity of revision view point , it would have the exactly the same advantage as a resurfacing"
-----means it may not matter if i go for Delta Motion or BHR from revision point of view

"When one wants to avoid metal on metal like in young female patients the best option in my opinion would be a large head ceramic deltamotion cup coupled with a silent stem"
-----May be this is one reason he is suggesting Delta Motion for me..

Still i tried my best to research on Delta Motion on the net for reviews but i hardly found anything...its still experimental i guess...this is what concerns me a lot...i surely don't want to go for revision surgery any soon..I am planning to gather more info for few more days and then decided about surgery..Dr Bose says we can expect Delta Motion to come for 30 years...i am not sure how much of it is really going to be true..

Did anyone suffer pain in the unaffected leg before surgery....since my left leg hurts more than my right leg(whose femoral head has collapsed)

Thanks,
Deepika

[morph]

Sorry if I confused you, I should have really included the question asked too. Basically he is responding about the depuy 'silent' which can be used with Delta motion.

From what I can gather the Delta motion is the ball-cup using the new Biolex delta ceramic from Ceramtec (google ceramtec). This can be used on standard stem, mini stem, 'Silent' type stem (as in the Bose response), or sometime in the future ceramic hip resurfacing.

If the delta motion is used with the Depuy 'silent' then this is bone conserving, but also newish.  The theoretical advantages of the biolex delta, with whatever stem, is that it is extra tough so a larger head can be used. This in turn gives all the benefits of ceramic plus more stability, range of motion and a natural feel.

I agree it has not been around long enough to gather enough data. A quick google came up with these two papers with revison data.

Ceramic bearings for total hip arthroplasty have high survivorship at 10 years.
D'Antonio JA, Capello WN, Naughton M.
SourceGreater Pittsburgh Orthopaedics Association, 725 Cherrington Parkway, Suite 200, Moon Township, PA 15108, USA. dantonioja@me.com

THA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial.
Hamilton WG, McAuley JP, Dennis DA, Murphy JA, Blumenfeld TJ, Politi J.
SourceAnderson Orthopaedic Research Institute, 2501 Parkers Lane, Alexandria, VA 22306, USA. billhamilton@cox.net.

Seems promising, but not perfect. I know this does not prove anything but there is a clip on youtube showing a surgeon playing golf with a biolex delta ball, and it appears unscathed.

I suppose the other options you have are the BHMR.

[Dannywayoflife]

I think the silent stem with a delta motion large head on it would be an interesting option. Could a HR be revised to a silent stem I wonder?

[morph]

Could a HR be revised to a silent stem I wonder?

That is what I was thinking Danny. So long as the bone density is good I can not think of a reason why not.

[Dannywayoflife]

Yes I would have thought it possible. It would depend on the mode of failure though. I was told by my arthroscopy surgeon who uses the silent hip and was one of the first chosen to trial it that I'd be able to run on a silent hip.

[morph]

Was that Jon Conroy or Marcellino Maheson by any chance? I know they are both trialling it in the UK.

[Dannywayoflife]

Was Jon Conroy he's been using the silent for a good few years now

[morph]

Did anyone suffer pain in the unaffected leg before surgery....since my left leg hurts more than my right leg(whose femoral head has collapsed)

deepika, I have suffered mild twinges and aches in my better leg. Probably due to the fact that my worse leg is shorter and my pelvis has nutated (twisted and tilted) and I have slight scoliosis of the spine - it all has a knock on affect. That and my better leg is doing alot more work bending down etc. But definately my worse leg takes the brunt of the pain.

[deepika]

Hi,

I sent a mail to Dr Bose regarding more details on Delta Motion...I am posting his reply here:

Thanks for the mail.
Yes, the deltamotion would give you comparable function like the hip resurfacing.

I will not be using the silent stem as the stem will have a high failure rate with the large head of deltamotion.
It can be done if one is using the small conventional head.

The key to getting good function is the size of the head. Since the deltamotion will have a natural head size it will give near normal function.
The corail stem is a guaranteed success as it has a 25 yrs history and the design is very bone conservative though the head of the femur ( which is already collapsed has to be removed) . If one needs a revision it can easily be done.

However there is a good chance that you may not need the revision at all with the modern deltaceramic bearings.

The depuy recall is the ASR and should not be confused with the deltamotion.

The deltaceramic  is a game changer in hip surgery and it would be naïve not to harvest its advantage.There will be no postop restrictions whatsoever.

The fol is the gen pre -op advise that I give patients.
Please stop taking aspirin or other blood thinners a week before the scheduled date of surgery. If you are taking aspirin for stents in the heart etc, you must consult with your physician and change to low molecular weight heparin injections.
Painkillers ( NSAIDs) weaken bone and they are best avoided before surgery. An occasional one would be acceptable.\Tylenol( paracetemol) is the recommended substitute.
Smoking ( if you are a smoker ) should be discontinued immediately.
Hormonal treatment ( for women) must be stopped for a month prior to surgery .
All other medicines e.g. for diabetes, blood pressure and medical ailments must be continued till hospital admission.
Hidden infection in the body could be at 3 places ie the mouth cavity, urinary system and skin. It is important to sort this out well before surgery if there is any suspicion of these 3 potential sites harboring infection.
Exercise is good before surgery especially from a respiratory point of view. Hip abductor / extensor exercises along with knee quadriceps is good as preparation for the surgery. However overdoing it beyond pain limits may induce inflammatory changes in the hip which may be counterproductive
 
with best regards
vijay bose
chennai


Hope it helps others who have been suggested Delta Motion like in my case..

[Dannywayoflife]

Thats really interesting!! Thanks for that! Im amazed that he states zero restrictions for the delta motion too!!! amazing!

[morph]

Thanks deepika, that is good to know.

[Canadian-Ice]

Hi,

I asked Dr. Conroy whether BHR can be converted to Silent Hip and he said "not". He also said one should not run on a Silent Hip. Email from Dr. Bose was that Deltamotion not good for running as with other large ball devices. Not sure why the contradictions.

Sorry,

[Dannywayoflife]

Canadian-ice,
                   Im pretty sure that he told me I would e able to run on a silent hip (but could be wrong it was  a while ago!) I dont see why a BHR couldnt be converted to a silent hip as bhr's have been convereted to a bmhr (admitedly its not a regular thing but it can be done in certain cercumstances) and a bmhr is more conservative than the silent as some of the head is not resected where as with a silent the whole head is resected.
I wonder why Dr Bose would say zero restrictions and then say otherwise?

[dzr]

Hi,
I had a delta motion hip surgery done last June, by Dr. Bose and so far, i am very happy with it.  I have had no squeaks or other problems with it.  My hip is pretty much pain free and feels almost as good as it did before the damage caused by avn.  I had originally planned to get a BMHR, and during our discussion the night before surgery, Dr. Bose mentioned that if the avn extended down into the neck of the femur, a BMHR would not be possible and he would do the delta motion.  As it turned out, while I was on the operating table, he discovered that the avn did extend to the femur neck, requiring him to abort the BMHR plan and go with the delta motion.  I knew that the delta motion hip was a new product, but I put my trust in Dr. Bose, with his extensive knowledge and experience.  During our presurgery talk about the delta motion hip, Dr. Bose mentioned that the delta ceramic was a great improvement over the old ceramic.  He mentioned that he had taken a hammer and beat on a delta ceramic ball and when done, the delta ceramic ball was not dented, scratched, cracked or damaged in any way.  I was really impressed with Dr. Bose's opinion of the delta motion hip.  After I got home from the surgery, I discovered that there was a Youtube video about Dr. Bose's hammer session with the ceramic ball.  On the youtube web site it is listed somthing like "delta motion hip surgery rationale" parts 1,2, and 3.  The hammer treatment is on part 1.  Part 2 and 3 are a video of Dr. Bose doing a delta motion hip surgery on an actual patient.  These videos are very informative for anyone interested im a delta motion surgery (however a bit bloody and not for the squeamish).
 

[Dannywayoflife]

Dzr that's really interesting! The delta ceramic certainly is a game changer in hip surgery! Glad your doing well!
Danny