Make/type more important than realized?

[Happilyresurfaced]

Hi all,<O:p></O:p>
<O:p></O:p>
Reading through the many posts on forums in the world it strikes me that patients in general don't realize the importance of the make or type or resurfacing that the surgeon will give them. If the subject is taken up then the patients may many times repeat claims made by the manufacturer (or surgeon) that their particular device has better properties in one or more areas than other brands. Many of those claims just can't be proven yet but first need studying and long term follow up by independent hip registries to see if they really hold or not. So to go on claims like that does not seem wise.
One important factor however is hardly ever taken up, namely what the chosen make and type offer in the way of options (accessories) whenever a side step has to be taken, either in the initial operation or later when more work in the joint is required. <O:p></O:p>
Some of the 15 resurfacing makes on the market are very limited with the 'optional' hardware that they supply. Durom from Zimmer is one example. With on the other hand the good old BHR the patient can rest assure that a complete line of matching bits and pieces exists to tackle virtually any upcoming problem. BHR (and of course the BMHR just as well) is backed by a complete set of dysplasia cups of which the appropriate one can be placed in a patient with dysplasia or in stead of a failing cup or when the underlying bone has suffered trauma, without touching the other part of the implant. Revision operations from some other resurfacings than BHR will cause the patient to loose the complete resurfacing, while with BHR only one part may need exchange for another matching one. BHR heads can for instance be fitted on most of the modular shafts of common shaft manufacturers if something breaks down on the femoral side. <O:p></O:p>
With BHR the patient seems better of, with a higher guarantee that the original large metal on metal joint can be retained, regardless of the type of revision required. This dramatically shortens the operation time, danger of infection and trauma to the tissues, nerves and muscles.
The matching options that the BMHR offers is another good point when the patient and surgeon are not prepared yet to sacrifice the femoral neck.
Perhaps points to consider more when we decide on a surgeon and device?
Ron<O:p></O:p>

 

[Josephine]

Ron, is this information from personal research or are you connected with the medical profession in some way? Or another forum?

 

[Troweltalk]

Jo,

In speaking with my OS about this issue, he assured me that in the event I needed a revision of the femral head component due to femral neck collapse or perhaps a fracture in an accident, that unless something catastrophic happened to the cup, they wouldn't touch it. They would revise the femorial side with a new Birmingham stem and metal ball that would be a match to the existing cup. He said the only revisions he has done from a BHR have been due to fractures from automobile accidents, and that this matchup has worked beautifully.

But can't the same thing be said about any other hip system HR or THR? Don't they all have some level of interchagable components?

 

[Happilyresurfaced]

Hi,

First of all, what I wrote about is what I learned from my extensive contacts with many surgeons, patients and information found on the Internet as supplied by manufacturers and other sources. I have my own website and a support group, both initially started for Swedish hip patients but since I also made English and Dutch duplicates of the site patients from the whole world come and use some of the information there, in particular the large list on all the resurfacing surgeons in the world and any of their 'figures' that I can get hold of. (reliable additions always welcome!).

So I am not a medical pro but layman, but that doesn't take away the fact that I will surpass some of the orthopaedic surgeons in knowledge on some of the aspects surrounding hip resurfacing. Just about all of my free time goes into researching this and trying to help hip patients in some or other way. No financial gains anywhere, only costs and pure loss, but I gladly offer this if I know that many of those patients will therefore have a much better remaining life as a result. My technical background and interests helps here I suppose.
As BHR owner I know all about the lack of good guidance and the twisted ideas that some surgeons force on their poor patients. This is not some local phenomenon but still true all over the whole world, as patients report to me weekly. My efforts hopefully prevent them from falling for these traps.

And to 'Mudpro': Yes, if lucky the implant manufacturer will have at least some interchangeability options but if you look carefully you'll see that some have frightfully few options or even none whatsoever. Other components that I could think of would be specialized hardware that is capable to hold a cup in the acetabulum if an exchange to for example a dysplasia type cup is not wished yet for special reasons or just not available from that brand.
One more aspect is the particular cone type and size that the prosthesis manufacturer uses for his large heads, that is if he at all has a compatible THR head for the acetabular cup of his resurfacing device.
So if the patients have the time to investigate some of these aspects, they will make sure that a prosthesis is selected that offers them the safest future if anything unexpected was to happen.

Ron

 

[Josephine]

Jo,

In speaking with my OS about this issue, he assured me that in the event I needed a revision of the femral head component due to femral neck collapse or perhaps a fracture in an accident, that unless something catastrophic happened to the cup, they wouldn't touch it. They would revise the femorial side with a new Birmingham stem and metal ball that would be a match to the existing cup. He said the only revisions he has done from a BHR have been due to fractures from automobile accidents, and that this matchup has worked beautifully.

But can't the same thing be said about any other hip system HR or THR? Don't they all have some level of interchagable components?

Indeed they do, Mud. In fact, there can be hybrids that include long stems, longer stems and even a stem with a TKR! All would be able to be employed without interfering with a pre-existing stable cup. That's standard practice.

 

[Happilyresurfaced]

Indeed they do, Mud. In fact, there can be hybrids that include long stems, longer stems and even a stem with a TKR! All would be able to be employed without interfering with a pre-existing stable cup. That's standard practice.

....

I think that the point is missed here. The problem is that we are talking about the availability of large metal heads. Fact is that not many manufacturers that supply a resurfacing implant also offer large metal heads that will suit their own size range of resurfacing cups.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
Perhaps someone would then be so “clever” to use a head of another manufacturer but then you run in many compatibility problems like differences in manufacturing process (cast/forged and others methods), also differences in spherity, alloy, hardness and roughness. Any or all of those factors applicable will increase wear and production of undesired byproducts.<o:p></o:p>
<o:p> </o:p>
If available and properly matching the cup in question, a ceramic or plastic insert may be fitted. But this will of course render the resurfacing’s advantages useless by stepping down in diameter to 38, 34 or even the old 28mm.<o:p></o:p>
So foremost a revision solution would have to be sought that tries to retain the properties and advantages of the resurfacing.<o:p></o:p>
I for one would much rather retain the large size metal on metal joint (almost guaranteed if a BHR or BMHR were initially selected) than to adept the cup in any way to accept a THR head of much smaller diameter.<o:p></o:p>
<o:p> </o:p>
The hybrid or modular shafts are in my opinion not utilized properly if they aren’t used in combination with a matching large metal head for patients that have a good and rock solid resurfacing cup in the acetabulum. But as said the heads are not produced by all manufacturers.<o:p></o:p>
<o:p> </o:p>
Therefore back to my point of the initial post, each patient still in the selective stage would do well to investigate if the resurfacing make that the surgeon intends to place actually offers this: all the required options to ensure that a possible future adaption or revision becomes the least invasive while guaranteeing that it can continue as a large metal on metal joint (with it’s inherent advantages).<o:p></o:p>
The words from a surgeon “I think that you will be safe with this one” or similar expressions should not be accepted unless hard proof can be given in the form of data from the prosthesis manufacturer. After all, the quality of your future may depend on the choices made then. <o:p></o:p>
Ron<o:p></o:p>

 

[PRGal]

Actually, not to be argumentative here, but I believe Jo answered MudPro's question dead on.

In the event of a revision where Manufacturer X's cup is stable & doesn't need replacing, there will be a compatible stem & ball in Manufacturer X's product portfolio to fit the existing cup.

 

[Josephine]

No surgeon would dream of mixing components from different manufacturers. It just wouldn't happen as the manufacturer's liability would be totally negated. And for my part, any operating department I have ever had charge of, I would not even countenance the products being in the theatre at the same time. Was my rule numero uno!

On an historical note, McKee's hips were supplied with matching serial numbers and at the start of the operation, it was part of our routine to check with the surgeon that cup and stem numbers matched.

I was trained on that very early in my career.

In any case, I think all of this is a job better left to the surgeon. Make sure you have a good chap and you get a good product fitted. Otherwise it's like requiring patients to be as expert as the doctors. Why hire a dog and bark yourself?

 

[Happilyresurfaced]

One of the very reasons for my post was just the fact that large heads are definitely not supplied by every of the 15 avaialble resurfacing makes. This is not a guess but fact and gotten from some of the worlds best known specialists and sometimes their reason for skipping those resurfacing makes.
And anyway, as I wrote initially, some of those manufacturers don't supply much of the other 'gear' either like special cups and other dedicated hardware for in the event that the cup does come loose.
That was also my reason for writing the heading: "Make/type more important than realized?"

I have news for you too, surgeons may not dream but mixed use is (dumb enough) applied ! Just browse through the data of the available hip registries from different countries. The data does not go so far that even the particular surgeons are named but it is there! That is one of the reasons why I contacted people responsible for one of the registries and remarked on a whole bunch of oddities like that.

You wrote "Make sure you have a good chap and you get a good product fitted". Wasn't that exactly my message, to make sure that you get a good product? But how in the world would you know what a good product is if you haven't researched a little what the "product" is all about? So there again fits my "Make/type more important than realized"!
You can't have it both ways, you either investigate the device (and if you are wise also if it is backed by all the required odds and ends) or you don't and accept the consequences when troubles arise.
Ron

 

[Josephine]

But I think you're rather blinding people with science. My point was that by 'making sure you get a good chap' you will thereby ensure you have a good product. One is the result of the other. I don't think it appropriate or necessary to encourage people to think it's up to them to choose the product. You need skills, education and experience to be able to do that. Making people think it's their responsibility only puts unnecessary stress upon them when they have enough to cope with anyway.

I guess if you have any work done on your house or your car, you research on the internet to make sure the parts or materials they use are of suitable quality? Or do you employ the best workman you can find and trust his judgement to select them?

And what about people who have neither access to the internet nor the educational skills to undertake all that? Don't they end up having to trust the 'workman' they employ?

I think your premise is faulted.

 

[loggon]

Wow so right Jo.
I trust my OS completely. He was highly recommended by one of my doctors. The doctors referral got me in. I would never tell him what type of product to use as I would not appreciate him trying to tell me how to write a mal-practice insurance policy for him.

We pick those that do jobs for us because they are skilled in their
profession and if they were not, we should find one that is.

 

[Texas]

From my surgery, I know its all about the Dr. That is the key. I wish I would have checked mine a lil better !!!!!!!!!All And All it worked out fine........Hi Loggon....

 

[loggon]

Hey yep it is about the OS.

 

[hippain]

Durom from Zimmer is one example.

https://www.nytimes.com/2008/07/29/business/29hip.html?_r=3&hp

HipPain

 

[Judles]

Hip!! With all due respect....WE choose our doctors.....and THEY choose our prosthesis! We want experience, success and MORE experience!!! You can have the best prosthesis in the world......it will mean absolute spit if its not implanted skillfully!!! There is not a person here on the forum that would argue with that!!!! ,

 

[hippain]

Oh Judles,

I couldn't agree more that surgeon choice is most important thing in all of this. But I think with the above article and the recall of a device that some docs still use, we should also do some research on that, at least those interested in it. Sometimes docs have different devices, but of course if a doc doesn't know what he is doing no matter what, it will come out horrible. But then again if anyone got the Zimmer Durom cup in either a resurfacing or a THR, they have a high risk of it failing if it falls within the time period of the recalled devices, no matter how good the docs skills were.

HipPain

 

[Texas]

Hi Hippain,Welcome...Where in the US are you from? Just wondering. I try ask everyone . See if anyone is close.....I'm obviously from Texas...originally New York.............

 

[Troweltalk]

Much to my first doctor's credit, when I asked him about resurfacing, he admitted he didn't do it or know a whole lot about it, and suggested I meet with someone who did to explore my options. When I sought out a resurfacing surgeon, I looked for ones who were attached to the best orthopedic departments I could find (John Hopkins and Union Memorial), and I selected surgeons who did THR as well as resurfacing to get a balanced view, I met with two.

Both agreed resurfacing would be "their" first choice for me and explained in detail some of their protocols for selecting a resurfacing patient. Neither tried to sell me on resurfacing or out of it, in fact both said that if once they got in there, if they found an unexpected problem (i.e., cyst) that may diminish the potential for a good outcome with resurfacing, they would be fully prepared to abort the resurfacing procedure and proceed to install a full THR right then and there.

 

[loggon]

Now that is good surgeons Mud. The type that everyone should have. When I had my knee surgery, my OS said when he got in he would make the decisions that needed to be made. He advised me of several things he might run into and need to do.

Was OK with me as I trust him.

 

[Texas]

Mine tried to but I didnt want to know...Just do it...Ill find out later...terrible...lol