Uncemented vs. Cemented HR for Grappling and Running: Is either better?

[Canadian-Ice]

Hi All,

This is probably an old topic for many of you. Being new to this stuff, and having just read Dr. Gross's post about HRs where he referrs to uncemented being more durable, I am confused about which device is better for impact sports.

I love grappling (wrestling and BJJ) and also middle-distance running like 1 and 2 milers. My plan was to go to Dr. Bose but now I wounder if uncemented would be better. Does anyone have any ideas?

Related to this, does anyone know of any HRs, cemented or uncemented, that have required revision because of loosening or wear due to sports such as running?

Thanks everyone for this outstanding website.

[Dannywayoflife]

Hi mate the honest answer is there is no proof either way from what I've read. In theory un cemented is better but then in theory the asr was better and we all know how that turned out! There's a lot made of cement failure but that's normally associated with cemented THR. The BHR uses a unique cementing technique and McMinn and Treacy who have been using the BHR the longest have NEVER had a femoral loosening. Other cemented HR's use a different cement technique and have suffered loosening but not as far as I know with the BHR.

http://www.hipresurfacingsite.com/Ask-the-Doctors/20110621641/Ask-the-Doctors/Longevity-of-Hip-Resurfacing-With-statitstics-of-Cementless-resurfacing/menu-id-44.html

Check this video out mate!

[Jason0411]

My Bro had his left BHR 12 years ago, he works six days a week mostly on his feet and is a Third Dan at Karate (awarded this year) So I think that makes it pretty durable with cement. He is right handed so the left leg is the one he is normally pivoting on when kicking people in the head.
So I reckon cemented is pretty good.

Jas

[Dannywayoflife]

That's great jas! Have you watched that video mate? I love the sectioned femour  bit! 

[Jason0411]

Brilliant video really encouraging.

[Dannywayoflife]

Yeah I've watched that soooo many times I think it really gives confidence to patients. We keep saying it on here go to a top surgeon and chances are you'll have a great result!
I have a copy of a publication by McMinn and Treacy about the design and clinical results of the BHR and that's amazing! The thought and clinical associated data that went into the BHR is incredible!

[imgetinold]

Dr. Gross believes that. ultimately, the cement will be the most likely failure in resurfacing.

Like Danny said, there is no statistical evidence of that being the case.  Even so, I went with Dr. Gross because a) his skill level, and b) what if he IS right. 

Either way you go, use a VERY experienced surgeon and you'll be fine.

[patrick_d]

There is evidence in the literature to support the idea that the cement would be the likely failure point.  Additionally, there is more and more evidence to suggest that many of these bone cements cause bone necrosis. 

And from a purely mechanical perspective, adding glue doubles the number of material interfaces that must survive over time.

It has long been agreed upon by doctors and device manufacturers that the acetabulum component should not be cemented in place, so it seems logical that a properly designed and installed femoral component could also be uncemented.

I think in a very few years you will see that most re-surfacing doctors will be using all uncemented devices.

[Canadian-Ice]

Wow, thanks a lot for the responses.

It's clear then, the research is not yet there to show whether there is a significant difference between cemented and uncemented durability with various activity levels. In theory, uncemented will last longer.

But I thought, Danny, your video was very inspiring and demonstrates a lot of failed attempts with the uncemented. I might stick with the more conservative option until the data is better. But as mentioned, any of the top surgeons will give a great result, seems to me at least 20+ years but probably over 30+ years  by which time who knows what alternatives will be available.

What evidence is there of bone necrosis or other problem with cement, however? Does this include the BHR?

[patrick_d]

If you do a quick Google search on "bone cement and necrosis" you will find a number of papers and articles.

Also, I have a friend and former colleague that has done a fair bit of work with stem cells that pointed out this issue to me prior to my surgery.  So if you also Google search on "bone cement and necrosis and stem cells" you will find more papers and articles.

And this effect is really not dependent on the type/style of device that is glued using the bone cement, it is just a behavior of the cement itself.

All just more information to help you make a good decision for yourself.

[John C]

I just enjoyed watching Mr McMinn's video posted above. In fairness, there was one thing that was not clearly pointed out. I believe that his cementless femoral components did not have any type of surface structure for bone ingrowth, nor did they have hydroxyapitite (sp?) coating to stimulate bone ingrowth. These are key to the modern cementless components, and some surgeons have argued that the lack of these factors may explain the poor success of Mr McMinns short venture into cementless femoral fixation.
I agree that there is not enough data to show if there is an advantage either way, but Mr McMinn's early experiments with cementless femoral components should not be included in any comparisons, since they had none of the current technology to establish bone ingrowth. I think that it would have been fair to note this clearly in the video.

[Canadian-Ice]

Uh-huh, kind've like comparing general registry THR data with elite surgeon HR data.

[Dannywayoflife]

The exothermic reaction can be an issue but once again I think it's down to surgeon skill. Ask the likes of Bose, Treacy, McMinn etc how many bone necrosis cases they've had due to cement I doubt It's an issue for them.

[Baby Barista]

In one of Dr. Su's videos, he mentions that part of the reason they do a thorough lavage of the wound after cementing the femoral component... is to cool the cement and cap to prevent necrosis. I think this is fairly common practice among the leading surgeons.

[Canadian-Ice]

2 things to love about Dr. Gross.

#1. Lots of data

#2. He provides resurfacing to a variety of patients.