Is it Time for Cementless Hip Resurfacing by Dr. Girard

[Pat Walter]

Dr. Girard gave me permission to post this article. Dr. Girard had done 1450 hip resurfacing with 400 cementless with Wright Conserve Plus Cementless

The Abstract is below and the link to the full article is here:

http://www.surfacehippy.info/cementless-hip-resurfacing-dr-girard-2012.php

Abstract
Background: Metal-on-metal bearing with cemented femoral component and cementless acetabular fixation is the current standard in surface replacement arthroplasty (RSA) of the hip. Because of concerns about the long-term survivorship of cemented stems in conventional hip arthroplasty, it seems logical to achieve cementless fixation on the femoral side with RSA. Questions/Purposes: The goals of this review were to evaluate clinical and radiological data reported from previously published cementless RSA series. In addition, we intend to review author’s preliminary experience with Conserve Plus cementless devices specifically assessing the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels measured in follow-up.

Methods: A references search was done with PubMed using the key words "cementless hip resurfacing", "cementless hip resurfacing prosthesis", and "femoral cementless hip resurfacing". Additionally, the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels were measured in 94 cementless Conserve Plus© devices in 90 patients (68 males and 22 females) with a mean age of 41.1 years (18– 59). Mean follow-up was 13.1 months (8–16).

Results: No revision was performed during the observed follow-up. Neither radiological signs of loosening nor neck narrowing >10% were evident. Chromium and cobalt levels in whole blood samples rose respectively from 0.53 μg/l (0.1–1.7) to 1.7 μg/ l (0.6–2.9) and from 0.54 μg/l (0.1–1.4) to 1.98 μg/l (0.1–2.. Conclusions: Cementless "fit and fill" femoral-side fixation, which seems to be potentially evolved and design-related, should be considered for future hip-resurfacing device generations.

[Woodstock Hippy]

This seems like a solution looking for a problem.  I know that Dr Gross has great success with a cementless femoral component but is there any evidence of the cemented components failing.  I'm certainly no expert but I do see that Dr Gross's patients have a very long recovry period compared to patients with a Birmingham hip.  Is there really any advantage to the cementless hips compared to the BHR?

[einreb]

This seems like a solution looking for a problem.  I know that Dr Gross has great success with a cementless femoral component but is there any evidence of the cemented components failing.  I'm certainly no expert but I do see that Dr Gross's patients have a very long recovry period compared to patients with a Birmingham hip.  Is there really any advantage to the cementless hips compared to the BHR?

What long recovery period?  His post op protocol is not that different than others and he's a 'run at 6 months' guy. 

Historically, cement is something that ortho devices have continued to move away from. The original use of cement in resurfacing was because the manufacturing technology to get porous in-growth with the right coating on the inside of the cap did not exist in the 90's when he BHR was 'invented'.

Who knows though... maybe the cement in compression will let it last the life of the recipient.  Lets hope they both work. 

-Bernie

[Dannywayoflife]

You can't really compare the use of cement in the old THR to tye BHR. Also if you look back as mark bloomfield explains in his video interview. Cement was blamed for something they didn't understand at the time. However at 16+ years McMinn has yet to have a loosening from cement failure. Don't forget that the way cement is used in the BHR is totally different to any other resurfacing device

[Jason0411]

I thought the cenment in the BHR was for the initial fix then it relied on the bone growing to make it more solid. I bloody hope so cos when I buggered mine and crushhed the head I don't think my cement would have been doing much. I am presuming after the crush my bone has knitted together and stuck itself to anything available.
Jas

[Dannywayoflife]

Ask McMinn Jas there's no better man to give you a Gen answer!