Re: negatives for hip resurfacing?

[Guest guest]

At 02:23 PM 7/13/2003 +0000, you wrote:

>I have already

>Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE study).

Do you mean Dr. Sparling? I've heard lots of good things about him.

> I have a lot of positive information, but the major negative I seem

>to find is that there is no long term data.

>Ideas?

Dave,

We know lots about the long term data on regular total hips in the younger,

more active population. Although there are exceptions, they tend to not

last as long, dislocation can be a problem, the number of revisions

required in a lifetime may exceed the capacity of the body to handle them,

etc. For me, that is a devil that I did not want to get to know. I am

quite happy to live with an unknown to avoid a known that could be so

devastating. Of course this is a bit more personal for me, as I have a

friend with bilateral THR's who has had NOTHING but problems. She is now

up to dislocation # 13 or 14 (I can't even keep count any more) in the last

five years. I'm thrilled with my two C +'s, my new life, pain free days,

etc.!!!

C+ 5/25/01 and 6/28/01

Dr. Boyd

Salem OR

[Guest guest]

Thank you for the reply, .

I am speaking of Dr. Sparling. He examined me June 24. He was totally

non-committal and " on the fence " for ceramic, regular or resurfacing.

I know he needs to be neutral and objective, but it didn't give me any

guidance. My concern is about any negatives, and I do agree with you on all

your points, below.

I guess it's mainly because I have so much respect for my regular orthopedic

surgeon, Lawrence Holland at Swedish Hospital in Seattle. He is totally

against resurfacing. Therefore, I want to know as many reasons as possible

why he may be so against this procedure. He trained with Anstutz at the

Joint Replacement Institute in UCLA, yet still is anti-resurfacing. I asked

him specifically why and he told me loosening and osteolysis (bone death).

I quit marathon running in 1995, quit Himalaya climbing, and quit Yosemite

rock climbing. I am professionally a physicist, professor, and about to

retire (57 yo). I would GREATLY like to resume easy mountaineering and easy

rockclimbing again.

Bless your heart for any information......

Dave Dailey

Edmonds, WA

>

> Reply-To: surfacehippy

> Date: Sun, 13 Jul 2003 09:27:28 -0700

> To: surfacehippy

> Subject: Re: negatives for hip resurfacing?

>

> At 02:23 PM 7/13/2003 +0000, you wrote:

>> I have already

>> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE study).

>

> Do you mean Dr. Sparling? I've heard lots of good things about him.

>

>> I have a lot of positive information, but the major negative I seem

>> to find is that there is no long term data.

>> Ideas?

>

> Dave,

>

> We know lots about the long term data on regular total hips in the younger,

> more active population. Although there are exceptions, they tend to not

> last as long, dislocation can be a problem, the number of revisions

> required in a lifetime may exceed the capacity of the body to handle them,

> etc. For me, that is a devil that I did not want to get to know. I am

> quite happy to live with an unknown to avoid a known that could be so

> devastating. Of course this is a bit more personal for me, as I have a

> friend with bilateral THR's who has had NOTHING but problems. She is now

> up to dislocation # 13 or 14 (I can't even keep count any more) in the last

> five years. I'm thrilled with my two C +'s, my new life, pain free days,

> etc.!!!

>

>

> C+ 5/25/01 and 6/28/01

> Dr. Boyd

> Salem OR

>

>

>

>

[Guest guest]

Hi Dave,

I am one of the few where there was little choice - it was a Resurface or

nothing really.......... years of atrophied muscles, plus infection

potential made living with a THR a very dodgy bet.........

There is a lady who pops in here between what sound like strenuous mountain

climbs, to tell us how well she is going........ it is wasn't too long ago

she had the op........... maybe you should do a little search back through

the posts and find her and have a chat.........she will be able to tell you

what you can look forward too mountain climbing wise.......

It seems that orthepedic surgeons the world over are not easy guys to change

procedures......... mine even grumbled about them being a pain when he wants

to show them new ways of having adventures with bones....... so you really

cannot expect to get too many straight answers from the general run of mill

OS........

Much of it comes down to your own understanding of how a body

works........which you sound like you may be able to figure quite

well..........and the idea of sticking a lump of metal down the bone marrow

of a bone for the hell of it..........when there is another option available

etc. You will be hard pushed in this forum to find anyone who will outline

actual negatives of it that happened to them, as most things that go wrong

are standard stuff that had every chance of happening with any op.....i.e.

infections, prothesis not getting to be quite properly placed........ There

is a great description of the op attached to Corin site that gives you a

pretty good idea of what happens during the course of the Resurface

op......... you can find similiar for THR and you will see all require some

degree of precision.

People against it latch on to this unknown trip but then the current things

used for THR don't seem to have been around too long either..... and sure

the femur head under the prothesis may die........this can result from a

crack happening during the op/ something later when we age / just plain bad

luck.........i.e. some people just simply don't seem to have good

maintenance supply to their femur head.........though that percentage

wearing a Resurface to date seems very small........ Others latch onto the

ions stuff and quote mysterious studies and set hares running. My doctor who

has studied it over time (this procedure has been happening in Aust for 4

years and people have been wearing metal prothesis of one description or

another a lot longer) says we are at about the same ions level as foundary

workers and there isn't any outbreak of cancer there.........

Myself, I got a new life...........even with dreadfully atrophied muscles

the prothesis never blinked dislocation wise. Everyone tells me I look about

10 years younger - always sweet words to anyone......... and my skin colour

drastically improved......... so I figure ions are good for me at

least.......smile.

If you want a real quick introduction to endless negatives I suggest you

place a post on Totalhip list........smile. Then sit and think about what

they are saying from your own knowledge of bodies..............

Edith LBHR Dr. L Walter Sydney Australia 8/02

>

>

> Thank you for the reply, .

> I am speaking of Dr. Sparling. He examined me June 24. He was totally

> non-committal and " on the fence " for ceramic, regular or resurfacing.

>

> I know he needs to be neutral and objective, but it didn't give me any

> guidance. My concern is about any negatives, and I do agree with you on

all

> your points, below.

>

> I guess it's mainly because I have so much respect for my regular

orthopedic

> surgeon, Lawrence Holland at Swedish Hospital in Seattle. He is totally

> against resurfacing. Therefore, I want to know as many reasons as

possible

> why he may be so against this procedure. He trained with Anstutz at the

> Joint Replacement Institute in UCLA, yet still is anti-resurfacing. I

asked

> him specifically why and he told me loosening and osteolysis (bone death).

>

> I quit marathon running in 1995, quit Himalaya climbing, and quit Yosemite

> rock climbing. I am professionally a physicist, professor, and about to

> retire (57 yo). I would GREATLY like to resume easy mountaineering and

easy

> rockclimbing again.

>

> Bless your heart for any information......

>

> Dave Dailey

> Edmonds, WA

>

> >

> > Reply-To: surfacehippy

> > Date: Sun, 13 Jul 2003 09:27:28 -0700

> > To: surfacehippy

> > Subject: Re: negatives for hip resurfacing?

> >

> > At 02:23 PM 7/13/2003 +0000, you wrote:

> >> I have already

> >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE

study).

> >

> > Do you mean Dr. Sparling? I've heard lots of good things about him.

> >

> >> I have a lot of positive information, but the major negative I seem

> >> to find is that there is no long term data.

> >> Ideas?

> >

> > Dave,

> >

> > We know lots about the long term data on regular total hips in the

younger,

> > more active population. Although there are exceptions, they tend to not

> > last as long, dislocation can be a problem, the number of revisions

> > required in a lifetime may exceed the capacity of the body to handle

them,

> > etc. For me, that is a devil that I did not want to get to know. I am

> > quite happy to live with an unknown to avoid a known that could be so

> > devastating. Of course this is a bit more personal for me, as I have a

> > friend with bilateral THR's who has had NOTHING but problems. She is

now

> > up to dislocation # 13 or 14 (I can't even keep count any more) in the

last

> > five years. I'm thrilled with my two C +'s, my new life, pain free

days,

> > etc.!!!

> >

> >

> > C+ 5/25/01 and 6/28/01

> > Dr. Boyd

> > Salem OR

> >

> >

> >

> >

[Guest guest]

At 02:04 PM 7/13/2003 -0700, you wrote:

>I guess it's mainly because I have so much respect for my regular orthopedic

>surgeon, Lawrence Holland at Swedish Hospital in Seattle. He is totally

>against resurfacing. Therefore, I want to know as many reasons as possible

>why he may be so against this procedure. He trained with Anstutz at the

>Joint Replacement Institute in UCLA, yet still is anti-resurfacing. I asked

>him specifically why and he told me loosening and osteolysis (bone death).

Many surgeons remember the early days of resurfacing, when the metallurgy

and the precision machining was not available as it is today. The early

resurfacing components (some of which are still being implanted today),

were metal/poly, and the large ball against the poly caused massive

osteolysis. He may have dismissed resurfacing at that time, and never

bothered to take a second look. If the brothers dismissed flight as

impossible after the first crash, we could still be driving everywhere, and

air travel might not exist as it does today.

As I said before, the biggest negative (IMNSHO) is the devil we don't know.

C+ 5/25/01 and 6/28/01

[Guest guest]

hi dave-

interesting story of this dr. sparling & dr. holland.

what you describe as " neutral and objective " from dr. sparling, sounds more

like " i don't know enough " & " i haven't finalized my contract with a thr

component supplier yet " . i wonder how many hip replacements has he done?

the fact that dr. holland trained with dr. amstutz and is against

resurfacing because of loosening & osteolysis seems inconsistent with the

statistical data that appears to be available. it seems to me that those

are also common reasons for thr failures. if he is concerned with these

issues, then does he avoid using cement fixation & polyethylene cup

components in the thr's that he installs? it is my understanding that these

materials are the main culprits in osteolysis and subsequent loosening. i

also was under the impression that progressive a.v.n. below the resurfaced

head component causing subsequent loosening was the main culprit of

resurfacing failures....not osteolysis.

i would be interested to hear exactly when he trained with amstutz (i.e. how

many resurfacings had amstutz done at the time), how many resurfacings &

thr's he himself has done and which manufacturer supplies his practice with

thr parts!!! i wonder what his opinion of large diameter metal on metal thr

components would be. i also wonder if he was somehow excluded from the list

of doctors currently doing the clinical trials.

they seem like a vague answers to me.....but then i'm a real skeptic.

skeptical in san francisco,

jeff

Re: negatives for hip resurfacing?

> >

> > At 02:23 PM 7/13/2003 +0000, you wrote:

> >> I have already

> >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE

study).

> >

> > Do you mean Dr. Sparling? I've heard lots of good things about him.

> >

> >> I have a lot of positive information, but the major negative I seem

> >> to find is that there is no long term data.

> >> Ideas?

> >

> > Dave,

> >

> > We know lots about the long term data on regular total hips in the

younger,

> > more active population. Although there are exceptions, they tend to not

> > last as long, dislocation can be a problem, the number of revisions

> > required in a lifetime may exceed the capacity of the body to handle

them,

> > etc. For me, that is a devil that I did not want to get to know. I am

> > quite happy to live with an unknown to avoid a known that could be so

> > devastating. Of course this is a bit more personal for me, as I have a

> > friend with bilateral THR's who has had NOTHING but problems. She is

now

> > up to dislocation # 13 or 14 (I can't even keep count any more) in the

last

> > five years. I'm thrilled with my two C +'s, my new life, pain free

days,

> > etc.!!!

> >

> >

> > C+ 5/25/01 and 6/28/01

> > Dr. Boyd

> > Salem OR

> >

> >

> >

> >

[Guest guest]

>

> If you want a real quick introduction to endless negatives I

suggest you

> place a post on Totalhip list........smile. Then sit and think

about what

> they are saying from your own knowledge of bodies..............

>

> Edith LBHR Dr. L Walter Sydney Australia 8/02

Just wondering if the qustion as to the need of the " fingers " of

PMMA under dome heads was ever answered (or even asked). Issue was

raised on the TotallyHip site.

Cheers,

Don W

[Guest guest]

> I found this website after much searching and 4 dr. visits. Osteo

> of rt hip, 1995. I am ready for THR, but hip resurfacing sounds

> sooooo good. Therefore what are the negatives? I have already

> visited the Joint Replacement Institute in LA, had exams, etc. and

> Swedish here in Seattle for ceramic, and Orthopedics in

> Vancouver, WA (who do resurfacing as part fo the IDE study). I

> have a lot of positive information, but the major negative I seem

> to find is that there is no long term data.

> Ideas?

> Dave in Seattle.

Dave,

Like the rest of us you will have to make the decision for yourself

as far as long term data is concerned. Nine years which is

approximately how long the data exists using European data was good

enough for me along with watching my dad suffer through 3 hip

replacements surgeries and numerous dislocations. Look at the data

for law suits on hip replacements versus hip resurfaces. That ought

to tell you something.

Jeff (C2K 01-03-03)

[Guest guest]

Hi ,

Your comment on THR and cemented fixings don't tally with Swedish data. Over

95% of their THR's are cemented yet they have less than half the USA revision

rate. The Swedish cemented statistics are substantiated by other sources.

Rog

Re: negatives for hip resurfacing?

> >

> > At 02:23 PM 7/13/2003 +0000, you wrote:

> >> I have already

> >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE

study).

> >

> > Do you mean Dr. Sparling? I've heard lots of good things about him.

> >

> >> I have a lot of positive information, but the major negative I seem

> >> to find is that there is no long term data.

> >> Ideas?

> >

> > Dave,

> >

> > We know lots about the long term data on regular total hips in the

younger,

> > more active population. Although there are exceptions, they tend to not

> > last as long, dislocation can be a problem, the number of revisions

> > required in a lifetime may exceed the capacity of the body to handle

them,

> > etc. For me, that is a devil that I did not want to get to know. I am

> > quite happy to live with an unknown to avoid a known that could be so

> > devastating. Of course this is a bit more personal for me, as I have a

> > friend with bilateral THR's who has had NOTHING but problems. She is

now

> > up to dislocation # 13 or 14 (I can't even keep count any more) in the

last

> > five years. I'm thrilled with my two C +'s, my new life, pain free

days,

> > etc.!!!

> >

> >

> > C+ 5/25/01 and 6/28/01

> > Dr. Boyd

> > Salem OR

> >

> >

> >

> >

[Guest guest]

Dave,

It is true that we are all guinea pigs in this procedure. My frame of mind was

simply that resurfacing makes sense-- especially when you consider that the

prosthesis resembles closely your own hip joint. As a physicist you must

recognize the dynamics of the joint and its load bearing. I am a dental

hygienist and understand that all bone is dynamic and constantly wears and

remodels due to stress and strain. It is incredible that a technique such as a

THR can mimic the joint as well as it does. Additionally, should a resurface

fail one has the opportunity to have a THR without the consequences that a

revision would have.

It is important however that you garner all the facts and make a decision that

you are comfortable with. In my situation I was told that a THR would put an

absolute end to my rock climbing. My surgeon sent me to a specialist for an

osteotomy. The research that I had done at the time made me realize that my

life would have severe limitations with a traditional total hip. When I was told

that I was no longer a candidate for an osteotomy I was crushed. The specialist

wanted to perform a polyethylene THR on me. I declined. Later I found out that

he knew all about resurfacing. In fact he was one of the speakers at the recent

Orthopaedic Surgeons convention in Montreal. I often wonder what he thinks about

resurfacing now.

It takes a lot of guts to fly in the face of a surgeon that you respect, but I

urge you to come to your own decision. I absolutely feel that most medical

professionals will sell what he/she is most comfortable with. You have by now

learned about the early failures of resurfacings. However data for metal on

metal resurfacings performed over the last 10 years is most favorable. I know

of few loosenings. I understand that bone death (AVN) is a theory. AS a

medical professional I hear many stories about revised and failed THR. Many of

my patients were saddened when they learned I had a hip replacement until they

heard some brief details. They did not want me in the same boat as their friends

and family. I am, of course, prejudiced towards my device which I have had for

10 months now. But I went from barely walking to hiking, cycling and climbing

5.11 again. It is ultimately the rest of YOUR life!

Sorry- this is an emotional plea- not purely factual. I realize that you are

looking for negatives, and I have none for you. I did my share of research- the

info is there. It's just as an avid rock climber speaking to another I think

you should carefully consider resurfacing. I know of a lady- ine- from

totally hip- who has a ceramic hip that Dr Swanson in Las Vegas did for her.

She is happy with it but has been advised not to climb outside due to chances of

dislocation. And Red Rocks is right in her back yard! I have absolutely no

restrictions from my OS and believe me-my hip is put to the test!

Good luck,

Rock climbin' Jude

LBHR De Smet 09/11/02

PS- We are sorta neighbors- I live in Washington as well.

Re: negatives for hip resurfacing?

>

> At 02:23 PM 7/13/2003 +0000, you wrote:

>> I have already

>> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE study).

>

> Do you mean Dr. Sparling? I've heard lots of good things about him.

>

>> I have a lot of positive information, but the major negative I seem

>> to find is that there is no long term data.

>> Ideas?

>

> Dave,

>

> We know lots about the long term data on regular total hips in the younger,

> more active population. Although there are exceptions, they tend to not

> last as long, dislocation can be a problem, the number of revisions

> required in a lifetime may exceed the capacity of the body to handle them,

> etc. For me, that is a devil that I did not want to get to know. I am

> quite happy to live with an unknown to avoid a known that could be so

> devastating. Of course this is a bit more personal for me, as I have a

> friend with bilateral THR's who has had NOTHING but problems. She is now

> up to dislocation # 13 or 14 (I can't even keep count any more) in the last

> five years. I'm thrilled with my two C +'s, my new life, pain free days,

> etc.!!!

>

>

> C+ 5/25/01 and 6/28/01

> Dr. Boyd

> Salem OR

>

>

>

>

[Guest guest]

Hi surface hippy's!

I also had a negative BHR experience in my country, the Netherlands.

My orthopedic specialist in the hospital nearby, dr Feenstra, was AGAINST

BHR. On a consult in november 2002, I showed him the information about

BHR and asked if this was better than THR (that's the only hip operation

he does). His reaction was: experimental and no longterm expectation of the

BHR. First I believed him. I was on the waitinglist for THR in the Netherlands

for 6 months, operation planned july/august 2003.

Later, in may 2003, I met mr. de Maris from the Netherlands, in the travel

agency I work and he told me the story of his BHR operation in Gent.

This event was for me the reason to react immediately and send an e-mail to

dr.Koen de Smet (I knew his website). I was surpised about his quick response

( 1 DAY) and the possibility of a consult: 2 DAYS LATER! The second surprise

came at my visit in his clinic: he advised to do the BHR operation. I said OK,

he was sitting behind his computer and said: operation June 27, in hospital

June 26. The fax of the hospital with room reservation is coming.. In my country

the procedure is much slower!

I am so glad I met this man (he is not on this e-mail group) and did the BHR

operation!

So everybody who has doubts THR or BHR: read all the stories and do

your research!

Ria, LBHR De Smet 27/06/03

Re: negatives for hip resurfacing?

> >

> > At 02:23 PM 7/13/2003 +0000, you wrote:

> >> I have already

> >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE study).

> >

> > Do you mean Dr. Sparling? I've heard lots of good things about him.

> >

> >> I have a lot of positive information, but the major negative I seem

> >> to find is that there is no long term data.

> >> Ideas?

> >

> > Dave,

> >

> > We know lots about the long term data on regular total hips in the younger,

> > more active population. Although there are exceptions, they tend to not

> > last as long, dislocation can be a problem, the number of revisions

> > required in a lifetime may exceed the capacity of the body to handle them,

> > etc. For me, that is a devil that I did not want to get to know. I am

> > quite happy to live with an unknown to avoid a known that could be so

> > devastating. Of course this is a bit more personal for me, as I have a

> > friend with bilateral THR's who has had NOTHING but problems. She is now

> > up to dislocation # 13 or 14 (I can't even keep count any more) in the last

> > five years. I'm thrilled with my two C +'s, my new life, pain free days,

> > etc.!!!

> >

> >

> > C+ 5/25/01 and 6/28/01

> > Dr. Boyd

> > Salem OR

> >

> >

> >

> >

[Guest guest]

hi rog-

the point i was trying to make is that polyethylene liners & cement fixated

stems in a thr is a bad combination.

both materials can cause osteolysis independently, and when in conjunction with

one another, the likelyhood of loosening of the stem component & cement

breakdown is clearly increased.......those are the facts,rog. cement fixation

exists for the convenience it provides doctors, not for the long term

performance for you the patient.

i wouldn't want a cement fixated stem type component put in my body, the only

advantage is that it gives almost instant fixation and can provide a more

conservative method of installation in people with more fragile bone stock.

other than that it can only produce complications because it prevents bone

material from adhering to the stem component....it and/or it's bond will

eventually lose integrity and fail. i would much prefer to have press-fit stem &

cup w/ HA and be careful for the first few months while my body fuses to the

device, creating a stronger bond than cement....it's a no-brainer if given a

choice.

i will only allow the best possible material combinations put in my body, why

compromise by accepting a solution which is convenient and beneficial for

someone other than me, the end user.

peace, jeff

Re: negatives for hip resurfacing?

> >

> > At 02:23 PM 7/13/2003 +0000, you wrote:

> >> I have already

> >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE

study).

> >

> > Do you mean Dr. Sparling? I've heard lots of good things about him.

> >

> >> I have a lot of positive information, but the major negative I seem

> >> to find is that there is no long term data.

> >> Ideas?

> >

> > Dave,

> >

> > We know lots about the long term data on regular total hips in the

younger,

> > more active population. Although there are exceptions, they tend to not

> > last as long, dislocation can be a problem, the number of revisions

> > required in a lifetime may exceed the capacity of the body to handle

them,

> > etc. For me, that is a devil that I did not want to get to know. I am

> > quite happy to live with an unknown to avoid a known that could be so

> > devastating. Of course this is a bit more personal for me, as I have a

> > friend with bilateral THR's who has had NOTHING but problems. She is

now

> > up to dislocation # 13 or 14 (I can't even keep count any more) in the

last

> > five years. I'm thrilled with my two C +'s, my new life, pain free

days,

> > etc.!!!

> >

> >

> > C+ 5/25/01 and 6/28/01

> > Dr. Boyd

> > Salem OR

> >

> >

> >

> >

[Guest guest]

" It takes a lot of guts to fly in the face of a surgeon that you

respect, but I

urge you to come to your own decision "

Hi,

I just wanted to add my two cents worth here as far as deciding

whether or not to listen to the advice of your OS.

I am 32 so resurfacing offers real advantages in terms of saving bone

and low dislocation risks etc. etc. For a certain time I was

convinced that I would choose to have a BHR more or less as soon as

possible, in other words as soon as I found the surgeon....but I

didn't feel ready to go for THR and felt that it was BHR or

nothing...just more waiting and hobbling.

I consulted with five OS specialists, one in the UK, our famous

friend in Belgium, and three local specialists, two of which are the

most senior orthos in my country.

BHR is possible in my case but nobody really wants to do it due to

leg lenght and bio mechanics that cannot be restored with a

resurface. I insisted, I went from one OS to another but although

they all proposed different implants according to their own

experience, none of them were convinced that BHR would be right for

me.

I have experienced hip surgery and I have some knowledge of what is

available to me, whether it's poly, ceramic, MoM or whatever as I

have been researching this for a year now. I am not qualified however

to decide that I know better than these professionals. I am only

qualified to know what I feel about what these specialists tell me.

I am scheduled for a custom built large head MoM in October and I am

happy with my decision to do it. I am sure that these surgeons are

reluctant to give me a BHR because it could well last a lot longer

than expected which would mean I would be stuck with a short leg and

weak muscles (bio mechanics will never allow for 100%) indefinitely.

Anyway, my advice is also to be prepared to fly in the face of a

surgeon you respect, if you are not 100% convinced of what they are

proposing. Sooner or later you will figure out what's best.

Casey

[Guest guest]

Hi mikey,

Obviously somebody as Corin sells them............smile....... see their web

site and discussion group.

Edith

> --who uses press-fit stems to resurf...mikey t- In

surfacehippy ,

> " jeffrey trapold " <jefftrapold@c...> wrote:

[Guest guest]

Just a couple of things to add to Jude's observations, which I agree with.

Before I went to an orthopaedic surgeon in Vancouver, B.C., I had done a lot of

research on this site and had, fortunately, already been told by Dr De Smet that

I was a good candidate for a resurf. I wanted to see a local OS on the off

chance that I could get it done locally by a good surgeon and not have to pay an

arm and a leg. Thsi OS had only done a few resurfs and he said that I was not a

candidate for a resurf and he tried to talk me into a type of THR. If I hadn't

done my research ahead of time, and had a favourable response from Dr De Smet, I

would probably have gone along with his advice - it was difficult to disagree

with a specialist. As it was, it did give me pause for reflection, and I

emailed Dr De Smet to clear up a couple of the serious reservations that the

local surgeon raised, and he was really wonderful at relieving any anxieties I

had. I told the local doc of Dr De Smet's favourable decision and he admitted

that with Dr De Smet's experience, I might be okay for a resurf with him. There

was also a comment on this site awhile back that Dr De Smet said that the first

100 resurfs were a learning curve. In other words, a lot of OSs are not going

to feel comfortable doing resurfs for a looooong time, and are gong to recommend

the 'tried and true' THRs.

One other big factor for me is the longevity of a resurf. The device itself

will last forever, unlike most THR devices, and I don't know about you, but I

don't want to repeat surgery anymore than I have to. If I was just going to do

nothing more strenuous than walking, I suppose I'd be happy with a THR, and it

would last ma;ybe 15 or so years. But I want to go cross-country skiing, do

weight training, hiking and other strenuous stuff, and I don't want to worry

about a dislocation.

The other scary thing about a THR is that I've seen a lot of them where the

person is still left with a limp which never goes away. Apparently this is

because the device that surgeons use is basically 'one size fits all' and it

doesn't fit all, as every one has different size acetabular cups.

And lastly there's the problem which arises if you have to have the THR

redone (revision) after a few years when it's worn out- they have a higher

failiure rate than the original....eeek.

Hope this helps. God luck with your decision.

Sharry

RBHR De Smet 27/08/03

Re: negatives for hip resurfacing?

>

> At 02:23 PM 7/13/2003 +0000, you wrote:

>> I have already

>> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE study).

>

> Do you mean Dr. Sparling? I've heard lots of good things about him.

>

>> I have a lot of positive information, but the major negative I seem

>> to find is that there is no long term data.

>> Ideas?

>

> Dave,

>

> We know lots about the long term data on regular total hips in the younger,

> more active population. Although there are exceptions, they tend to not

> last as long, dislocation can be a problem, the number of revisions

> required in a lifetime may exceed the capacity of the body to handle them,

> etc. For me, that is a devil that I did not want to get to know. I am

> quite happy to live with an unknown to avoid a known that could be so

> devastating. Of course this is a bit more personal for me, as I have a

> friend with bilateral THR's who has had NOTHING but problems. She is now

> up to dislocation # 13 or 14 (I can't even keep count any more) in the last

> five years. I'm thrilled with my two C +'s, my new life, pain free days,

> etc.!!!

>

>

> C+ 5/25/01 and 6/28/01

> Dr. Boyd

> Salem OR

>

>

>

>

[Guest guest]

--who uses press-fit stems to resurf...mikey t- In surfacehippy ,

" jeffrey trapold " <jefftrapold@c...> wrote:

> hi rog-

>

> the point i was trying to make is that polyethylene liners & cement fixated

stems in

a thr is a bad combination.

> both materials can cause osteolysis independently, and when in conjunction

with

one another, the likelyhood of loosening of the stem component & cement

breakdown is clearly increased.......those are the facts,rog. cement fixation

exists for

the convenience it provides doctors, not for the long term performance for you

the

patient.

>

> i wouldn't want a cement fixated stem type component put in my body, the only

advantage is that it gives almost instant fixation and can provide a more

conservative

method of installation in people with more fragile bone stock. other than that

it can

only produce complications because it prevents bone material from adhering to

the

stem component....it and/or it's bond will eventually lose integrity and fail. i

would

much prefer to have press-fit stem & cup w/ HA and be careful for the first few

months while my body fuses to the device, creating a stronger bond than

cement....it's a no-brainer if given a choice.

>

> i will only allow the best possible material combinations put in my body, why

compromise by accepting a solution which is convenient and beneficial for

someone

other than me, the end user.

>

> peace, jeff

>

>

>

>

> Re: negatives for hip resurfacing?

> > >

> > > At 02:23 PM 7/13/2003 +0000, you wrote:

> > >> I have already

> > >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE

> study).

> > >

> > > Do you mean Dr. Sparling? I've heard lots of good things about him.

> > >

> > >> I have a lot of positive information, but the major negative I seem

> > >> to find is that there is no long term data.

> > >> Ideas?

> > >

> > > Dave,

> > >

> > > We know lots about the long term data on regular total hips in the

> younger,

> > > more active population. Although there are exceptions, they tend to

not

> > > last as long, dislocation can be a problem, the number of revisions

> > > required in a lifetime may exceed the capacity of the body to handle

> them,

> > > etc. For me, that is a devil that I did not want to get to know. I

am

> > > quite happy to live with an unknown to avoid a known that could be so

> > > devastating. Of course this is a bit more personal for me, as I have

a

> > > friend with bilateral THR's who has had NOTHING but problems. She is

> now

> > > up to dislocation # 13 or 14 (I can't even keep count any more) in the

> last

> > > five years. I'm thrilled with my two C +'s, my new life, pain free

> days,

> > > etc.!!!

> > >

> > >

> > > C+ 5/25/01 and 6/28/01

> > > Dr. Boyd

> > > Salem OR

> > >

> > >

> > >

> > >

[Guest guest]

hi mike-

i don't know if they do cementless resurface head installations....i'm curious

to know.

i just said that if i end up needing to get a thr (if a resurface job won't

work)....then i want one with a press-fit stem component (without cement) and

large diameter metal on metal head. this will be my back-up device prior to

surgery, just in case i wake up with a thr instead of a resurf.

it seems to me that the loading stresses are totally different for the surface

stem & the femural shaft stem, this is why the cement makes me nervous for a thr

stem fixation, because it has to bond and hold in shear every step you take, so

if it gets weak, any weight bearing will contribute to further break-down of the

bond. this seems alot less of an issue with the loading on a resurfaced head

component, the prosthetic is loaded in compression against your bone which is a

better scenario for the integrity of the bond.

what i want clarified is this....how much cement is used when installing the BHR

resurfed head component?

is it only in the stem shaft, thus leaving alot of surface area on the underside

of the resurf head component for HA coating to promote bony ingrowth to occur

and create a natural bond directly to the metal?

or do they goop the cement across the entire underside of the metal head

component like they show in the animation from the grossortho.com website (i'm

not sure which brand they use)?

if any one knows, please let me know.

thanks, jeff

Re: negatives for hip resurfacing?

--who uses press-fit stems to resurf...mikey t-

In surfacehippy ,

" jeffrey trapold " <jefftrapold@c...> wrote: ...a bunch of stuff

[Guest guest]

Hi Jeff

Peace!

I am thoroughly respecful of you making your choice as indeed I am of anyone

doing so!

I have 2 x BHR so I am not biased to THR as a patient.

In the USA there seems to be an attitude that cemented hip prosthesis is taboo.

Elsewhere in the world it is common to have cementation - 95% of THR's in Sweden

are cemented..

My concern is that at one stroke all this data has been rubbished and comments

made that will worry patients that have had such prosthesis.

The Swedish report says that of the cementless types they do, there is a higher

risk of loosening - this is factual data used as a reference the whole world

over. Their data shows that for cemented prosthesis from 1979 - 2000 the

revision burden is 7.4%; for cementless from 1992 - 2000 the revision burden is

27.3%. It is published in English at AAOS (American Academy of Orthopaedic

Surgeons) meetings . It is fact.

What concerns me is that people may get worried over comments. Everyone is

entitled to choose what they want but shouldn't gloss over the facts.

Cementless resurfacing has been tried and the UK results put before the AAOS.

Loosening again being a factor for failure in the cementless type.

I don't wish to stop anyone making an educated choice but it should be done

knowing all the facts. National statistics somehow take precedence over those

mouthed by the odd OS and I am replying to put the minds of those who have had

cemented prosthesis at ease.

I repeat I'm not in the process of stopping you doing as you wish. Just showing

the other side of the coin.

Re: negatives for hip resurfacing?

> >

> > At 02:23 PM 7/13/2003 +0000, you wrote:

> >> I have already

> >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE

study).

> >

> > Do you mean Dr. Sparling? I've heard lots of good things about him.

> >

> >> I have a lot of positive information, but the major negative I seem

> >> to find is that there is no long term data.

> >> Ideas?

> >

> > Dave,

> >

> > We know lots about the long term data on regular total hips in the

younger,

> > more active population. Although there are exceptions, they tend to

not

> > last as long, dislocation can be a problem, the number of revisions

> > required in a lifetime may exceed the capacity of the body to handle

them,

> > etc. For me, that is a devil that I did not want to get to know. I

am

> > quite happy to live with an unknown to avoid a known that could be so

> > devastating. Of course this is a bit more personal for me, as I have

a

> > friend with bilateral THR's who has had NOTHING but problems. She is

now

> > up to dislocation # 13 or 14 (I can't even keep count any more) in the

last

> > five years. I'm thrilled with my two C +'s, my new life, pain free

days,

> > etc.!!!

> >

> >

> > C+ 5/25/01 and 6/28/01

> > Dr. Boyd

> > Salem OR

> >

> >

> >

> >

[Guest guest]

thanks roger,

your feedback is much appreciated.

it's hard to get all the information straight and process it correctly, that's

why i love this board.

i'm sure the cemented devices are adequate if installed properly. conceptually i

like the idea of

eliminating an additional foriegn material and allowing for bone ingrowth. but

i'm sure that is not always feasible.

i want to be able to take control of these decisions and not blindly follow the

doctor's whim. they screwed up

my knee and ankle by misdiagnosing my previous injury and thus mistreated me. is

it a coincidence that

now i have a problem with my hip?......so this time it's hard for me to trust

anything a doctor says, so i will take

nothing for granted and try to arm myself with as much data as possible. the

doctor will have to earn my trust in

person and have a back up plan that i completely understand before any cutting

and sawing and hacking and

reaming and pounding and cementing and stitching and bandaging

occur......uuuuggghh!! i can hardly wait.

anxiously, jeff

p.s. i went with my father the doctor to the hospital an career day back in

junior high school,

i went to observe, i ended up having surgery.......the following day at school,

i had to stand up

in front of my civics class and give my little report. short and concise, it

read like this :

" i wish not to join the medical field, and here is the scar to prove it !! "

Re: negatives for hip resurfacing?

> >

> > At 02:23 PM 7/13/2003 +0000, you wrote:

> >> I have already

> >> Orthopedics in Vancouver, WA (who do resurfacing as part fo the IDE

study).

> >

> > Do you mean Dr. Sparling? I've heard lots of good things about him.

> >

> >> I have a lot of positive information, but the major negative I seem

> >> to find is that there is no long term data.

> >> Ideas?

> >

> > Dave,

> >

> > We know lots about the long term data on regular total hips in the

younger,

> > more active population. Although there are exceptions, they tend to

not

> > last as long, dislocation can be a problem, the number of revisions

> > required in a lifetime may exceed the capacity of the body to handle

them,

> > etc. For me, that is a devil that I did not want to get to know. I

am

> > quite happy to live with an unknown to avoid a known that could be

so

> > devastating. Of course this is a bit more personal for me, as I

have a

> > friend with bilateral THR's who has had NOTHING but problems. She

is

now

> > up to dislocation # 13 or 14 (I can't even keep count any more) in

the

last

> > five years. I'm thrilled with my two C +'s, my new life, pain free

days,

> > etc.!!!

> >

> >

> > C+ 5/25/01 and 6/28/01

> > Dr. Boyd

> > Salem OR

> >

> >

> >

> >

[Guest guest]

Go to Dr De Smets web site and you can download a video which details the

operation, including the cement application to the femoral component.

Jude

Re: negatives for hip resurfacing?

--who uses press-fit stems to resurf...mikey t-

In surfacehippy ,

" jeffrey trapold " <jefftrapold@c...> wrote: ...a bunch of stuff

[Guest guest]

Hi Jeff

It might be worth posting a question to Iain Dunbar on the Corin site

chat room. He is their marketing manager and I have found him very

responsive to any question I have posed there.

ine

...a bunch of stuff

>

>

>

[Guest guest]

Jeff, in your message you said...

> it seems to me that the loading stresses are totally different

for the surface stem & the femural shaft stem, this is why the cement

makes me nervous for a thr stem fixation, because it has to bond and

hold in shear every step you take, so if it gets weak, any weight

bearing will contribute to further break-down of the bond. this seems

alot less of an issue with the loading on a resurfaced head

component, the prosthetic is loaded in compression against your bone

which is a better scenario for the integrity of the bond.

My response:

Your analysis is excellent. The " Swedish data " notwithstanding, I have not

talked to any surgeon (4) or manufacturer's rep (2) who don't think that

non-cemented THR components are superior to cemented. Phisiologically, it just

makes sense that bone will form a better bond with the biocompatible and

physiologically inert surface of a metal insert than to a layer of PMMA plastic

interposed between the bone and the structural components of an artificial hip.

Yes, there is lots of date " proving " that cemented components work and last

well. But that data comes from the more typical THR patient population of older,

less active, lower demand patients that have recieved THRs after the proper

waiting period and expect little from their hips beyound being able to walk

through the mall relatively pain free.

As far as PMMA goes, you can experiment with it yourself and make up you own

mind on how " biocompatible " it is. Just go down to the local pharmacy and buy a

denture repair kit, or fingernail repair kit. Mix some up and have fun. Notice

it's good features - it's easy to use and it hardens rapidly. Notice it's bad

features - it's noxious as heck and releases all kinds of nasy fumes and

solvents.

I'm sure the OS's use a highly refined and purified version, but all this talk

about " Ion release " with MOM devices makes me chuckle when I comtemplate the

unknown complex organic compounds that might come out of PMMA cement as it ages.

I wonder just where the FDA was when some bright OS had lunch with his dentist

and figured out that denture plastic would hold a femoral stem in place while

the patient healed.

The only thing that PMMA " bone cement " does, is fill space...period. It fills in

the gaps between the bone and the device being implanted. It allows the patient

to " load the cement " while the bone is healing and get out of the hospital that

much sooner. It is a tremendous boon to insurance companies and national health

systems. (Hence much of my skepticism about that good old Swedish data)

Of course, patients love it for the same reasons! Who wants to hang around

waiting for bone to grow, while your muscles are atrophing and your life is on

hold? For low demand THRs in elderly or debilitated patients, cemented THRs do

just fine. (See the Swedish data) But for jounger, high demand patients, I think

there is a clear concensus that non-cemented is more appropriate and with " press

fit " designs, it appears that non-cemented devices have overcome the recovery

time factor.

> what i want clarified is this....how much cement is used when

installing the BHR resurfed head component?

There is a small difference in design between the BHR / Corin devices and the

device. In the BHR / Corin devices the cement is minimal thickness merely

filling in gaps. In the device, there is a 1mm designed in space for the

cement. Both designs seem to work just fine. Only time and good data will tell

if there is an advantage to either system.

At first glance, after my highly opinionated statements above, it might seem

like I would opt for the BHR / Corin designs since they include less cement in

total. Actually, in my experience (daily) working with PMMA in dental

prosthestics, I find that thin films of PMMA do not do very well. They tend to

separate or debond more easily and break or fragment more. It seems that a

certain thickness of PMMA is needed to maintain structural integrity and avoid

delamination.

This is nit picking to the highest degree. I would be perfectly happy to have

any of the three devices placed in my own hip tomorrow! I think they are all

finely designed and manufactured, and there are great results bountifully in

evidence that they all work and work well!

> is it only in the stem shaft, thus leaving alot of surface area

on the underside of the resurf head component for HA coating to

promote bony ingrowth to occur and create a natural bond directly to

the metal?

Amstutz has recently started coating the whole device. Previously he only placed

the cement in the cup portion. Apparently he feels the extra fixation is

important. I wonder if this is an accomodation to the early loading and high

early demands resurfacing patients place on their devices. (Pure speculation on

my part)

The next obvious question, is why not use cementless resurfacing cups on the

femur? Apparently this is becoming more common as indicated in the quote from

the Corin Group's discussion group: " some surgeons are now saying " why use

cement if it is not needed? " and in cases where the bone stock is good, an

uncemented head can be used. We supply our femoral heads in both versions, for

uncemented and cemented use. A few of our surgeons only ever use uncemented now

in all their cases. One in the UK has done hundreds this way - every single one

of which is doing well. "

The key for non-cemented resurfacing femoral component usage is patient

selection and surgeon's skill. A non-cemented cup must have intimate contact

with bone for successful osteointegration (boney ingrowth). Therefore the

patient must have " good bone stock " so that the femoral head can be shaped to

fit the cup with no voids or open areas.

Patients with grossly misshaped or cystic femoral heads need not apply. Surgeons

who have trouble controlling their instrumentation and judging the fit of the

device had better stick with cement too. Only patient, dedicated craftsmen with

good raw materials to work with should go " cementless " with resurfacing. The

great thing is that cemented resurfacing femoral components work well too!

It looks like the BHR / Corin devices have the edge in non-cemented technology

because of their more intimate contact with the femoral head but I still give a

slight nod to the device if cement is used. The advantage in THR backup

systems goes to 's " Total " system because it's compatible with the C+ and

is FDA approved in the US.

In my ongoing search for the " best " among highly effective systems with

excellent design and support, I am at this point, this week... at least

today....

First choice:

's C+ (cemented femoral cup) with 's Total THR as my backup.*

Second choice:

Corin's C2K (if non-cemented is a good option for me)

Unknown possibility:

Biomet and possibly other manufacturers have non-cemented devices in the works.

*I list 's device as my first choice mostly because the THR backup system

is already approved in the US and this could make a big difference in insurance

coverage for me. I think all three resurfacing systems would be excellent

choices for younger, active, high demand hip patients!

DISCLAIMER - These are my opinions and limited observations mostly gleaned from

this discussion board and consultations with professionals in this area. I don't

claim any scientific knowledge or expertise (particularly when I speculate on

the cement issue) I do have strong opinions, but that is what they are!

Opinions!

I think anyone who reads the posts on this message board should take everything

they find here and scrutinize it carefully. We are mostly patients with limited

expertise and very personal viewpoints. The value of this message board is not

in definitive determinations of what methods and devices are " best " and

certainly not in making treatment decisions for individual patients.

The value of this group is in the spread of broad, general information on

resurfacing as an option, one of several, available to hip patients. And even

more, the highest function of this group may to provide encouragement and

inspiration to patients suffering from hip problems, particularly more active

patients who find the THR option unacceptable, and otherwise face years of

misery " waiting " for the time when THR is unavoidable.

Excellent thread guys!

MLTDMD

[Guest guest]

Jeff, a sidebar to the non-cemented femoral resurfacing head question....

You asked why various changes have beem made, specifically in the move towards

cementing the head and changes in the " spherocity " of the acetabular component.

Months ago, I came across some research that I've lost track of now. It

described some early efforts with non-cemented resurfacing devices in England

and reported that after suffering a 15% failure rate, the technique was

abandoned. 15% is unnacceptable to the patients whose devices failed, but the

other 85% may have results that are quite acceptable to them.

It was my impression that many of the early resurfacing patients were actually

in such poor condition that resurfacing would probably not be offered to them

today. Their failure rates may have been much lower with better patient

selection. At any rate, cementing the femoral head makes resurfacing surgery

less technique sensitive and availabe to a broader patient population.

The modifications to the acetabular cup have mostly been to reduce incomplete

seating of the component. Since the cup is dependent on intimate contact with

bone for " osteointegration " this is critical. Various fixation screws and fins

are used with THR cups to ensure fixation and close approximation of implant to

bone. Most manufacturers seem to have this worked out pretty well now and most

surgeons seem to understand the importance of adhering to their crtieria.

I'm intrigued by the cementless femoral cup and view it as a natural extension

of the techology, requiring only more experience and research to fine tune

present systems and designs for the most successful application. There are

questions about the physiology of the bone whithin the femoral component that I

really don't know about and that I suspect will be large issues for resurfacing.

Bone is an active tissue that requires a good blood supply to remain healthy,

much less to heal. Bone recieves it blood via internal (marrow) and external

(periosteum) sources. If you shave off the external surface of the femoral head,

you've just eliminated one of the sources of blood supply. If the vessels of the

marrow are compromised by AVN, diabetes, athrosclerosis or other conditions,

there will be less potential for osteointegrations (boney ingrowth) and a

cemented head might be a better solution.

I doubt many surgeons, much less insurance companies will volunteer to do the

screening, testing and metabolic scans that might be neccessary to determine the

potential for good bone physiology within the femoral head post surgically, so

the criteria will probably be more subjective.

Is the patient young, generally healthy with good circulation? Do they smoke?

Are they diabetic? Have they had any problems with healing broken bones in the

past? Is the radiologic comformation of the femoral head relatively normal? Is

there AVN or cystic development? How motivated is the patient to have

non-cemented over cemented?

These and other screening questions will probably be used to establish whether

non-cemented femoral resurfacing is appropriate for an individual patient. If no

" red flags " pop up, then my personal opinion is that a non-cemented femoral

resurfacing would be preferable over cemented.

BUT - I don't know... and I don't think the OSs know, what other conditions and

situations might make non-cemented devices fail. Does the removal of the

periostium reduce the blood supply too much? Does the insertion of the " stem "

dissrupt the marrow's blood supply too much? What goes on under the femoral cap

where x-rays don't penetrate and any direct examination is very invasive? These

are BIG questions.

When faced with the very good results we are getting with cemented femoral caps

in the very clear and encouraging present, do I want to be one of the first to

" try out " non-cementation? Do you? It's a very difficult question and I'm hard

pressed to answer it, as my surgery approaches.

I'm keeping my " ear to the ground " here in this discussion group and wherever I

can glean more information. What a great thing it is to be facing this now when

the choices are between good things instead of between THR and the misery of

waiting.

MLTDMD

[Guest guest]

thanks pauline!

i checked it out and there was a thread about this question with a great

response from Iain, he said that there were some doctors that are using

press-fit femoral heads as standard practice with great results. i learned that

cormet offers their femoral head in both cemented & non-cemented varieties. i

e-mailed him to find out who these particular doctors are. i plan on contacting

them to get their opinion and statistics on the matter. i'll relay anything i

hear just in case anyone is interested.

thanks again,

jeff

Re: negatives for hip resurfacing?

Hi Jeff

It might be worth posting a question to Iain Dunbar on the Corin site

chat room. He is their marketing manager and I have found him very

responsive to any question I have posed there.

ine

...a bunch of stuff

>

>

>

[Guest guest]

Has there been any info as to whether metal implants shed less wear

particles than other materials? (eg., ceramic) Do all OSs use the same cement,

which I assume also sheds wear particles? Also I wasn't quite clear on why you

said that cement has been given a bad name (wrongly). If it sheds particles like

all the other materials, isn't it just as bad as all the rest?

Sharry

negatives for hip resurfacing?

Hi Jeff

To reinforce what has recently posted I attach the following Canadian

site:

http://www.canorth.org/thumbsup.htm

There are a number of articles but the following is an excerpt from 'A Lasting

Bond'

A Lasting Bond

Tissue resorption at the interface of implant and bone - what clinicians call

" peri-prosthetic osteolysis " - remains the single greatest obstacle to

hip-implant longevity. When osteolysis continues unchecked, the bone around the

implant becomes porous and brittle. Components can loosen and eventually break

away from the surrounding bone. Usually the remaining bone of the femural shaft

is first to fracture and give way, since it's subjected to the combined

mechanical forces of weight-bearing and motion.

At first, scientists attributed the symptoms to " cement disease " - a localized

inflammatory reaction supposedly caused by the body's rejecting PMMA bone cement

as a foreign substance. This dominant school of thought inspired so-called

" cementless " implants, which rely on bone tissue's natural tendency to grow into

porous surfaces to form a strong and durable bond. The problem appeared to be

solved. Then in the 1980s, osteolysis caused several porous-coated stem-designs

to fail sooner, more severely and more frequently than cemented stems. Cement

disease had become " cementless disease. "

The answer came to light, you might say, in 1992 when scientists used a

special polarization microscope to examine activated white blood cells, called

macrophages, that were collected from patients undergoing hip-revision surgery.

Macrophages act as the immune system's gatekeepers, sounding the alert for a

full-fledged inflammatory response when they encounter invaders. Macrophage

means " big eater " in Greek, and the name is apt, since these immune-system cells

gobble up foreign particles, protein fragments, bacterial by-products and so

forth, which they seek in the bloodstream and lymphatic system.

Under polarized light, the researchers noticed an unexplained colour shift in

the macrophage's innards - somehow the cells had acquired reflectors that

refracted light. The phenomenon could only be reproduced with other macrophages

harvested near hip implants. More powerful electron microscopy subsequently

revealed that the macrophages had consumed many, many, sub-micron particles (a

micron equals a millionth of a metre) of polyethylene plastic - indigestible

wear debris from the hip socket. Indeed, later experiments demonstrated that, if

wear particles of any kind - cement, metal, ceramic, plastic - in the right size

and in sufficient number are encountered by the immune system, it triggers a

foreign-body inflammatory response that can accelerate bone resorption. Thus,

the quest for the most elegant solution to osteolysis - a " no-wear " hip implant

- continues.

Rog

P.S.There are plenty more sites that say the same sort of thing. Once

cementation had been given a bad name (wrongly) mud sticks.

[Guest guest]

thanks rog!

i just read that canadian article.

it seemed clear to me though, that polyethylene was the main culprit refered to

in in this article for cases of osteolysis, cemented & non-cemented. i think it

is unfortunate that it does not refer to any metal-on-metal statistics. perhaps

this may show a difference in results, at least that is what the various hip

resurfacing websites tell us.

i would like to clarify my thinking/understanding on this, please tell me if it

seems off :

causes of osteolysis :

1. poly-metal = non-absorbable wear debris = macrophages = osteoclasts = bone

resorbtion = loosening = revision

2. poly-ceramic = non-absorbable wear debris = macrophages = osteoclasts = bone

resorbtion = loosening = revision

3. ceramic-ceramic = non-absorbable wear debris = macrophages = osteoclasts =

bone resorbtion = loosening = revision

4. cr-cobalt metal-metal = absobable wear debris = no concentration of particles

= no macrophages

conclusion : lack of polyethylene = lack of osteolysis = much lower failure

rates

acetabular cups :

1. any poly paticles present will comprimise any cup fixation

2. cemented fixation = bad

3. pressfit w/ porous surface & HA = good = standard practice

4. pressfit with screws = good = used when necessary i.e. dysplasia cup

conclusion : cup w/ no cement = current obvious choice

articulation combinations :

1. metal-poly = bad

2. metal-metal thr w/ cement stem = pretty good

3. metal-metal thr non-cement stem = very good

4. metal-metal resurf = better......regardless of cement/non-cement head

5. metal-metal resurf w/o cement head = still trying to find clear info to

address this specific question

general conclusions :

1. poly = bad

2. osteolysis is generally not a problem with metal-metal thr or resurf.

3. large diameter metal cup - metal head is desirable for better ROM & lack of

dislocation & natural feel.

4. resurf is more desirable than thr if you expect to live for 20 more years due

to eventual need for revision.

5. cement fixation of femoral resurf head is common practice with great results

for up to 10 years and probably more.

6. non-cement fixation of femoral resurf head is less common practice w/o clear

data for or against it.

now....i read something that stated that bone does not actually bond to acrylic

cement, the cement while in liquid form merely fills the nooks and crannies of

the bone at the time of bonding to create a really tight fit. true? not true?

i have also read on these boards and url's that bony ingrowth is a great bond,

because it it the strongest and that bone growth will persist as long as long as

there is not a contaminating susbstance like osteoclasts. true? not true?

i have also read that bone is an organic material that the body continually

absorbs & regenerates, unlike glue and cement.

and, that bone growth will bond to porous metal surfaces, but not to cement

surfaces. true? not true?

if someone would invent some form of organic bone bondo that acts as cement in

the short term and acts as bone food to encourage bone growth while it breaks

down and get absorbed, i'd be psyched....any bio-chemists out there?

one thing is for sure....nothing is perfect, but some things are preferable to

others after splitting hairs. i'm just asking the questions that will make me

feel as comfortable as possible in making a decision.

thanks, jeff

p.s. once upon a time it was thought that if you drill a whole in someone's

skull, the evil spirits will escape.

negatives for hip resurfacing?

Hi Jeff

To reinforce what has recently posted I attach the following Canadian

site:

http://www.canorth.org/thumbsup.htm

There are a number of articles but the following is an excerpt from 'A Lasting

Bond'

A Lasting Bond

Tissue resorption at the interface of implant and bone - what clinicians call

" peri-prosthetic osteolysis " - remains the single greatest obstacle to

hip-implant longevity. When osteolysis continues unchecked, the bone around the

implant becomes porous and brittle. Components can loosen and eventually break

away from the surrounding bone. Usually the remaining bone of the femural shaft

is first to fracture and give way, since it's subjected to the combined

mechanical forces of weight-bearing and motion.

At first, scientists attributed the symptoms to " cement disease " - a localized

inflammatory reaction supposedly caused by the body's rejecting PMMA bone cement

as a foreign substance. This dominant school of thought inspired so-called

" cementless " implants, which rely on bone tissue's natural tendency to grow into

porous surfaces to form a strong and durable bond. The problem appeared to be

solved. Then in the 1980s, osteolysis caused several porous-coated stem-designs

to fail sooner, more severely and more frequently than cemented stems. Cement

disease had become " cementless disease. "

The answer came to light, you might say, in 1992 when scientists used a

special polarization microscope to examine activated white blood cells, called

macrophages, that were collected from patients undergoing hip-revision surgery.

Macrophages act as the immune system's gatekeepers, sounding the alert for a

full-fledged inflammatory response when they encounter invaders. Macrophage

means " big eater " in Greek, and the name is apt, since these immune-system cells

gobble up foreign particles, protein fragments, bacterial by-products and so

forth, which they seek in the bloodstream and lymphatic system.

Under polarized light, the researchers noticed an unexplained colour shift in

the macrophage's innards - somehow the cells had acquired reflectors that

refracted light. The phenomenon could only be reproduced with other macrophages

harvested near hip implants. More powerful electron microscopy subsequently

revealed that the macrophages had consumed many, many, sub-micron particles (a

micron equals a millionth of a metre) of polyethylene plastic - indigestible

wear debris from the hip socket. Indeed, later experiments demonstrated that, if

wear particles of any kind - cement, metal, ceramic, plastic - in the right size

and in sufficient number are encountered by the immune system, it triggers a

foreign-body inflammatory response that can accelerate bone resorption. Thus,

the quest for the most elegant solution to osteolysis - a " no-wear " hip implant

- continues.

Rog

P.S.There are plenty more sites that say the same sort of thing. Once

cementation had been given a bad name (wrongly) mud sticks.