2012 Hip Resurfacing Information from Australian National Registry

[Pat Walter]

I made up a summary of the information for Hip Resurfacing from the 2012 Australian National Registry.  The full pdf takes a very long time to load, so I took the important information from it about hip resurfacing. 

http://www.surfacehippy.info/2012-aoanjr-hip-resurfacing-information.php

Full pdf can be seen here  http://www.dmac.adelaide.edu.au/aoanjrr/publications.jsp?section=reports2012

I also added information from the 2012 National Registry for Total Hip Replacement at the bottom of the summary.  The reason I did that was to let people read the revision rates for THRs by device, sex, size and age. The information is important because it shows that THRs also are not perfect hip replacement devices and in many cases, not any better than hip resurfacing. There are many variables in both THR and hip resurfacing which depend on the size of the person, the sex of the person, the age of the person and the device used.

Hip Resurfacing still looks very good to me for the right candidate.  Hip Resurfacing can also be used for people who don't have the best outcomes by the registry when done by the top, most experienced hip resurfacing surgeons.  It is a big decision for each person as to what they think is best for them and what the surgeon thinks is best for them.

The BHR resurfacing prosthesis has a cumulative percent revision at 11 years of 7.1%.

Pat

[Dannywayoflife]

Very interesting stuff thanks pat.

[Tim Bratten]

One very interesting point from the data is that if you compare the 10 year revision rate in hip resurfacing with the rate of revisions for THR in patients < 65 years, hip resurfacing actually does better than THR. I think it's important to realize that, since HR is almost exclusively done in younger, more active patients. Comparing the overall THR rate with the HR rate hides this fact. In particular, the data shows that for younger (< 65) male patients, HR is working significantly better than THR, especially with the BHR.

On the other hand, the female revision data looks disappointingly high. However, it seems to me that De Smet and some of the other HR gurus, aren't having this many problems with their female patients. Perhaps a very highly developed surgical technique is even more important for smaller boned women? At any rate, I think it's important that potential female patients are aware of the much higher risk.

[Dannywayoflife]

It would be interesting to know how many of the failures were actually down to poor surgical technique. It states the biggest reason for failure is lysis/loosening how many of these were down to poor cup placement? Metal allergy how many were due to edge loading? Femoral neck fractures how many due to notched necks or disrupted blood supply? If they ever managed to review each case in this kind of detail I think the figures would be much closer to 100% for the real good surgeons.

[bluedevilsadvocate]

I have often wondered what the failure rates were for THRs in the early years when surgeons were just learning how to perform the surgery and place the THR components and probably various devices were used which were ultimately found to be unsatisfactory.  I would not be at all surprised if the failure rates for THRs in the first decade were higher than the failure rates for resurfacings during the first decade.

[tanker]

Pat,

Ref: Table HT78, Yearly Cumulative Percent Revision of Primary Total Resurfacing Hip Replacement. Is the BIOMET device reflected here? I don't see it spelled out.
V/R, tanker

[Pat Walter]

Hi Tanker

I don't think the Biomet is included or they would have listed it clearly. 

The registries are very specific about where there information comes from.

Pat

[John C]

Hi tanker,
I believe that the Biomet device is referred to as "Recap". Biomet is the brand, and Recap is what Biomet calls their resurfacing product. The numbers do not look good for Recap, but when I dug deeper into past registries, it appears that very few have been done, which would lead me to think that they were not installed by surgeons with a lot of experience with them, which could possibly explain the numbers. Also the high failure rate at 1 year, would lead me to think that femoral neck fracture was a common cause of failure, which would indicate inexperienced surgeons.

[tanker]

Thanks John C,

Would I be correct in assuming that these ''Recap" numbers do not reflect the work of one Doctor Gross in the good ol US?

[Pat Walter]

Please understand this information is from the 2012 Australian Orthopaedic Association National Joint Replacement Registry  The US does not have a national registry to collect information from US surgeons and devices used by them.  Therefore, no US surgeons were included in the information.  It is only for surgeons and patients in Australia.  Too bad the US doesn't have one.  No one wants to put there stats out publically in the US, I believe, because there are too many possible lawsuits.  We are a sue crazy country.

Pat

[Dannywayoflife]

I do think it's strange the US don't have a register. It's an important part of developing new devices etc

[stephen1254]

Interesting that a loosened cup is the number one cause of revisions. That would seem to be an individual thing - the bone just doesn't grow into the cup. I wonder what the rate of "loosened cups" is among the various brands of implants?

[Dannywayoflife]

I think bone failing to grow into cups can be for several reasons. The durom device it was well know that it was a problem with the device. I've heard that an early return to impact can inhibit bone ingrowth and on growth. And I suspect poor surgical technique can also impact on this.

[hernanu]

Interesting that a loosened cup is the number one cause of revisions. That would seem to be an individual thing - the bone just doesn't grow into the cup. I wonder what the rate of "loosened cups" is among the various brands of implants?

I think this is why the current focus on metal ion issues is misplaced. There is no doubt that metal ion issues are a problem and need to be addressed, but if you follow the results from this registry, while important as a cause of failure, it is not as prevalent as the top two, which involve attachment to the bone itself.

The best thing to me is to bring focus on all of the reasons for failure. I don't want any hippy facing a revision, so the more we learn about the way to avoid and deal with these issues, the better for all of us. I have never thought, though that the way to deal with problems with something good is to avoid doing it altogether. HR is so good to me, that if there are issues with it, we work on it to make it better. That includes THR, since we are really all together on this.

The total number of revisions over ten years, with all surgeons (experienced and not, skilled and not), patients, aftercare and conditions for HR still are above 90%. I imagine that the more skilled surgeons demand better conditions for surgical care, take care to ensure the aftercare of their patients and give realistic limitations over the course of the recovery; all of that leads to better results than that. Just an article of faith in my part, but based on the positive results in my life and from seeing many hippies here being delivered from pain.

[Marco Polo]

I think it is interesting to note how well the Recap acetabular device performs when used for total hip replacement. In fact it has the lowest failure rate of any of the devices when used in combination with the M2a head surface. I would assume this is the same acetabular device Gross is using with the Magnum uncemented femur cap for his resurfacings.

[lori.36]

Pat,  what size is your head size.  I am a 46mm so from what I am reading I have a 14% chance of needing a revision is 11 years?  Is that what you get.  I know it is all statistics, but I am curious about you.  Because you are a woman and you have had your BHR for 10(?) Years?
What do you do to keep everything working perfect as far as exercise, stretches? 
Thanks Lady

[hernanu]

Pat,  what size is your head size.  I am a 46mm so from what I am reading I have a 14% chance of needing a revision is 11 years?  Is that what you get.  I know it is all statistics, but I am curious about you.  Because you are a woman and you have had your BHR for 10(?) Years?
What do you do to keep everything working perfect as far as exercise, stretches? 
Thanks Lady

Hi lori, I'm not Pat and wouldn't come close to pretending to be her, but here's some things that I noticed in the study:

I've attached from the Australian registries the revisions as analyzed by device size and gender. These are actual number of people who were at risk over the years.

One thing you can see pretty quickly is that the bulk of the revisions happened in the early years. The majority during the first year, with decreasing numbers at risk as the years passed. This seemed to hold true for both genders and for the size of the device. So while the cumulative  number is impressive ( >9%) after ten years, it doesn't mean that the failure rate is 9% in your tenth year, but that all of the failures added up tally to that amount by the time ten years go by, and the failure rate for people with devices by that time is very low.

So what I get from this, (and I have a love hate relationship with statistics - they often confuse me) is that the number of failures drop to about 50% of the first year amount or slightly more by five years, then drop to about 6% of the first year amount for women and 4% of the first year amount for men by 10 years. It becomes a diminishing amount by the 10 year mark. 

So longevity works for you, the longer you are a hippy, the more likely you are to remain that, no matter what your gender, device size. So no gender bias here, it gets better as time goes by (cue Casablanca music  ).

An interesting aside - they broke down revisions by province, and some provinces had a high percentage (Tasmania) while others (Victoria) had very low. It hints at pools of better trained staff which may have better outcomes, so it backs what we've been saying about using more experienced and committed staff for HRs.

Hope that helps...

[Tin Soldier]

Good info Hern - and this is why most surgeons are asking for you to make a visit at the 4 year mark.  If you haven't seen problems by then your chances of seeing problems later on are greatly diminished. 

Also, on hinting on surgeon experience, I would think the very experienced surgeons would be happy to promote their business by quoting their own stats at least for revisions.  Generally they get better results than the registries show.

[Pat Walter]

Hi Lori

I am a large woman at 5' 8"  I was 61 when I had my BHR done.  I am 68 now.

My femoral head is 50 mm diameter

My acetabular cup is 56 mm diameter

Guess I am luck to be  a big woman with large bones 

I don't really do much of anything special.  Dr. De Smet said he wanted his patients to walk, walk and walk.  I did quite a bit along with some bike riding, lawnmowing and yard work.  I never did anything special.  I took pt here for a few times, but they let me go since I was so far ahead of the THR patients.  I used one crutch for 3 weeks and was walking about 1 mile a day when I got home at 9 days post op.  I was sight seeing in Belgium at 5 days post op.

I always feel I should do more, but am pretty busy just living my life the best I can.  I had open heart surgery 2 years ago for a new aortic valve and that really slowed me down for more than a year.  I was so bad before the surgery, I really could not hardly walk from the living room to kitchen without being out of breath and tired. 

So I am finally really pretty healthy, but my other hip is really starting to bother me and I now fight a-fib from my valve surgery.  Both hands need carpal tunnel surgery from me playing music all my life, being really physically active and do a whole lot of typing for the websites. 

It seems as you get older, you get one thing fixed and something else comes along!  So my message is to REALLY REALLY enjoy those new hips and spend time being happy, not worrying about when you might need a revision.  You need to enjoy every day with what you have since in reality - you only have the present.   

Enjoy, have fun.

Pat

[John C]

  You need to enjoy every day with what you have since in reality - you only have the present.   

Enjoy, have fun.

Pat

Great advice Pat. In regards to your last sentence, I could not resist sharing one of my wife's favorite sayings: "Yesterday is history, tomorrow is a mystery, today is a gift; that is why they call it the 'present'." (With due credit to "Kung Fu Panda")