Re: Hip resurfacing failures

[Guest guest]

Wow - you are a great addition to this list. No doubt many

will be picking your brain for more information. I certainly plan on

checking out the websites you have directed us to. Thank you and

good luck with your hip.

Pamela

lbhr De Smet October 23, 2002

> We need to remember that what has brought all of us to this group is

> the failure of our " native " hip surfaces. If there was a simple one

> size fits all solution, there would not be so many disagreements

> about treatment and types of surgery.

>

> The metal on metal hip resurfacing technique looks like it will be

> an excellent choice for many people. All of us face the risk sooner

> or later that the resurfaced hip will fail. In many cases there is

> nothing which can be done to prevent it.

>

> Consider this: The femoral resurfacing component is dependent upon

> reshaping of the underlying bone, drilling a perfectly aligned hole

> in the bone down the center of the femoral neck. The " ball "

> component has an uncemented guide pin which slides into the hole and

> cement on the underside of the " ball " helps fix it into position.

> If this is done correctly, the forces created by our body weight

> will be properly transmitted down the leg.

>

> What can go wrong? The femoral neck is the weakest part of the bone

> in our hip. As we age, bone mass is lost (osteoporosis) and the

> area of greatest loss is in the femoral neck. This is the most

> common site of hip fracture in older people. It can sometimes be

> treated by operative placement of lag screws. However, if the hip

> has been resurfaced, total hip replacement is necessary.

>

> If the lower part of the femoral neck is damaged during resurfacing,

> the procedure may fail.

>

> What can we do? 1. Have a bone densitometry exam of Both HIPS and

> lumbar spine before surgery. If one hip has been operated, check

> the other side. If you have osteoporosis, a THR will be necessary.

>

> It is normal to be euphoric and exuberant about the way hip

> resurfacing will change your life. But protect your hip. Weigh the

> enjoyment of your activities against the risk of fracture as you get

> older.

>

> 2. If you have osteoporosis there are effective treatments (but

> these take a long time).

>

> 3. Prevent osteoporosis! The highest risk is in thin, caucasian and

> asian women. Smoking increases risk. men are at risk as well.

> Bone loss in women accelerates at menopause. The " old " Hormone

> replacement therapy is now in question due to cancer and other

risks.

>

> A safer group of medications, (selective estrogen receptor

> modulator) " SERM " , has been developed. In the US, the only

> available one is RALOXIFENE, marketed as " EVISTA " by Lilly. this is

> available only by presciption.

>

> HERE ARE SOME WEBSITES WITH GOOD INFORMATION ABOUT OSTEOPOROSIS

>

>

> USA: Main FDA WEB SITE http://www.fda.gov/default.htm

>

> Osteoporosis web sites:

>

> The International Osteoporosis Foundation:

> http://www.osteofound.org/

> This site has links to member societies from Argentina to Yugoslavia

>

> USA: the National Institutes of Health

> http://www.nlm.nih.gov/medlineplus/osteoporosis.html

>

> USA : National Osteoporosis Foundation

>

> http://www.nof.org/

>

> CANADA: Osteoporosis Society of Canada

>

> http://www.osteoporosis.ca/english/home/default.asp?s=1

>

> UK: National Osteoporosis Society

>

> http://www.nos.org.uk/

>

> AUSTRALIA: Osteoporosis Australia

>

> http://www.osteoporosis.org.au/html/index.php

>

> NEW ZEALAND: Osteoporosis New Zealand

>

> http://www.osteoporosis.org.nz/

>

>

> in North Carolina

[Guest guest]

Wow - you are a great addition to this list. No doubt many

will be picking your brain for more information. I certainly plan on

checking out the websites you have directed us to. Thank you and

good luck with your hip.

Pamela

lbhr De Smet October 23, 2002

> We need to remember that what has brought all of us to this group is

> the failure of our " native " hip surfaces. If there was a simple one

> size fits all solution, there would not be so many disagreements

> about treatment and types of surgery.

>

> The metal on metal hip resurfacing technique looks like it will be

> an excellent choice for many people. All of us face the risk sooner

> or later that the resurfaced hip will fail. In many cases there is

> nothing which can be done to prevent it.

>

> Consider this: The femoral resurfacing component is dependent upon

> reshaping of the underlying bone, drilling a perfectly aligned hole

> in the bone down the center of the femoral neck. The " ball "

> component has an uncemented guide pin which slides into the hole and

> cement on the underside of the " ball " helps fix it into position.

> If this is done correctly, the forces created by our body weight

> will be properly transmitted down the leg.

>

> What can go wrong? The femoral neck is the weakest part of the bone

> in our hip. As we age, bone mass is lost (osteoporosis) and the

> area of greatest loss is in the femoral neck. This is the most

> common site of hip fracture in older people. It can sometimes be

> treated by operative placement of lag screws. However, if the hip

> has been resurfaced, total hip replacement is necessary.

>

> If the lower part of the femoral neck is damaged during resurfacing,

> the procedure may fail.

>

> What can we do? 1. Have a bone densitometry exam of Both HIPS and

> lumbar spine before surgery. If one hip has been operated, check

> the other side. If you have osteoporosis, a THR will be necessary.

>

> It is normal to be euphoric and exuberant about the way hip

> resurfacing will change your life. But protect your hip. Weigh the

> enjoyment of your activities against the risk of fracture as you get

> older.

>

> 2. If you have osteoporosis there are effective treatments (but

> these take a long time).

>

> 3. Prevent osteoporosis! The highest risk is in thin, caucasian and

> asian women. Smoking increases risk. men are at risk as well.

> Bone loss in women accelerates at menopause. The " old " Hormone

> replacement therapy is now in question due to cancer and other

risks.

>

> A safer group of medications, (selective estrogen receptor

> modulator) " SERM " , has been developed. In the US, the only

> available one is RALOXIFENE, marketed as " EVISTA " by Lilly. this is

> available only by presciption.

>

> HERE ARE SOME WEBSITES WITH GOOD INFORMATION ABOUT OSTEOPOROSIS

>

>

> USA: Main FDA WEB SITE http://www.fda.gov/default.htm

>

> Osteoporosis web sites:

>

> The International Osteoporosis Foundation:

> http://www.osteofound.org/

> This site has links to member societies from Argentina to Yugoslavia

>

> USA: the National Institutes of Health

> http://www.nlm.nih.gov/medlineplus/osteoporosis.html

>

> USA : National Osteoporosis Foundation

>

> http://www.nof.org/

>

> CANADA: Osteoporosis Society of Canada

>

> http://www.osteoporosis.ca/english/home/default.asp?s=1

>

> UK: National Osteoporosis Society

>

> http://www.nos.org.uk/

>

> AUSTRALIA: Osteoporosis Australia

>

> http://www.osteoporosis.org.au/html/index.php

>

> NEW ZEALAND: Osteoporosis New Zealand

>

> http://www.osteoporosis.org.nz/

>

>

> in North Carolina

[Guest guest]

Hi ,

Can I ask if this is a tested theory or speculation..........??? I hail

from a family where osteoporosis has appeared in a high percentage of the

females........i.e. grandma, mother, aunts and sisters..........sort of

ironical that they were brought up on dairy farms..............so I have a

fair interest in this topic.........

When I look at my xray with the BHR sitting on top of the femur head, and

snuggly covering the neck, it is hard to accept that it will be ever easy to

fracture the bone inside the compartment of metal and cement...........

(wishful thinking perhaps??)...........Actually when my son, who has done a

bit of study in this sort of thing at uni, looked at my xray he was quick to

point out that I was going to be far worse off with the nonresurfaced

hip.......it seeming to have a narrow neck on it......... which you rightly

point out is the most susceptable part..........and he felt that it would

take an awful lot to break the bone tucked up inside the BHR..........

So is this a study I can go look at, or speculation........ Is it just me

that ended up with it looking like that, or are BHR's different........???

Edith

>

> What can go wrong? The femoral neck is the weakest part of the bone

> in our hip. As we age, bone mass is lost (osteoporosis) and the

> area of greatest loss is in the femoral neck. This is the most

> common site of hip fracture in older people. It can sometimes be

> treated by operative placement of lag screws. However, if the hip

> has been resurfaced, total hip replacement is necessary.

>

> If the lower part of the femoral neck is damaged during resurfacing,

> the procedure may fail.

>

[Guest guest]

Sorry, your evaluation of your xrays is speculation and wishful

thinking.

The BHR covers the remnant of the shaped femoral head, not the

neck. Fractures commonly occur at the base of the neck, the

intertrochanteric region or below a THR. I have seen fractures

through a THR which is far more substantial that a BHR. With chronic

stress and metal fatigue, the weakest point will eventually break.

The link below is to the Australian summary which you can also find

through the activejoints.com site

http://www.surgeons.org/asernip-s_net-

s/procedures/Metal_Hip_Resurfacing_Prosthesis.pdf

I will not have time to answer very many questions. I suggest that

you all look at the osteoporosis web sites which are quite good.

> Hi ,

>

> Can I ask if this is a tested theory or speculation..........???

I hail

> from a family where osteoporosis has appeared in a high percentage

of the

> females........i.e. grandma, mother, aunts and

sisters..........sort of

> ironical that they were brought up on dairy farms..............so

I have a

> fair interest in this topic.........

>

> When I look at my xray with the BHR sitting on top of the femur

head, and

> snuggly covering the neck, it is hard to accept that it will be

ever easy to

> fracture the bone inside the compartment of metal and

cement...........

> (wishful thinking perhaps??)...........Actually when my son, who

has done a

> bit of study in this sort of thing at uni, looked at my xray he

was quick to

> point out that I was going to be far worse off with the

nonresurfaced

> hip.......it seeming to have a narrow neck on it......... which

you rightly

> point out is the most susceptable part..........and he felt that

it would

> take an awful lot to break the bone tucked up inside the

BHR..........

>

> So is this a study I can go look at, or speculation........ Is it

just me

> that ended up with it looking like that, or are BHR's

different........???

>

> Edith

>

> >

> > What can go wrong? The femoral neck is the weakest part of the

bone

> > in our hip. As we age, bone mass is lost (osteoporosis) and the

> > area of greatest loss is in the femoral neck. This is the most

> > common site of hip fracture in older people. It can sometimes be

> > treated by operative placement of lag screws. However, if the

hip

> > has been resurfaced, total hip replacement is necessary.

> >

> > If the lower part of the femoral neck is damaged during

resurfacing,

> > the procedure may fail.

> >

[Guest guest]

Sorry, your evaluation of your xrays is speculation and wishful

thinking.

The BHR covers the remnant of the shaped femoral head, not the

neck. Fractures commonly occur at the base of the neck, the

intertrochanteric region or below a THR. I have seen fractures

through a THR which is far more substantial that a BHR. With chronic

stress and metal fatigue, the weakest point will eventually break.

The link below is to the Australian summary which you can also find

through the activejoints.com site

http://www.surgeons.org/asernip-s_net-

s/procedures/Metal_Hip_Resurfacing_Prosthesis.pdf

I will not have time to answer very many questions. I suggest that

you all look at the osteoporosis web sites which are quite good.

> Hi ,

>

> Can I ask if this is a tested theory or speculation..........???

I hail

> from a family where osteoporosis has appeared in a high percentage

of the

> females........i.e. grandma, mother, aunts and

sisters..........sort of

> ironical that they were brought up on dairy farms..............so

I have a

> fair interest in this topic.........

>

> When I look at my xray with the BHR sitting on top of the femur

head, and

> snuggly covering the neck, it is hard to accept that it will be

ever easy to

> fracture the bone inside the compartment of metal and

cement...........

> (wishful thinking perhaps??)...........Actually when my son, who

has done a

> bit of study in this sort of thing at uni, looked at my xray he

was quick to

> point out that I was going to be far worse off with the

nonresurfaced

> hip.......it seeming to have a narrow neck on it......... which

you rightly

> point out is the most susceptable part..........and he felt that

it would

> take an awful lot to break the bone tucked up inside the

BHR..........

>

> So is this a study I can go look at, or speculation........ Is it

just me

> that ended up with it looking like that, or are BHR's

different........???

>

> Edith

>

> >

> > What can go wrong? The femoral neck is the weakest part of the

bone

> > in our hip. As we age, bone mass is lost (osteoporosis) and the

> > area of greatest loss is in the femoral neck. This is the most

> > common site of hip fracture in older people. It can sometimes be

> > treated by operative placement of lag screws. However, if the

hip

> > has been resurfaced, total hip replacement is necessary.

> >

> > If the lower part of the femoral neck is damaged during

resurfacing,

> > the procedure may fail.

> >

[Guest guest]

Hi ,

I finally accessed that article you mention - I have read it

before............ along with several others..........

I suspect you are misinterpreting the para about the warning by the

manufactures of the BHR prothesis........ if that is indeed where you are

getting your info about osteoporosis and resurfacing..........The article

states that they say it isn't recommended for use with older people with

osteoarthritis.......... I can fully understand that......... It seems that

most of the fractures that are recorded as happening, happen during the

actual hip resurface operation and become noticeable either then or within a

couple of weeks........ that seems to be pretty clear from that article and

any others I have read...........and given the banging, thumping etc that

goes on that is also pretty understandable that occasionally the surgeon

slips up..............

It also isn't hard to imagine that trying to do a resurface on someone with

osteoporosis would be a nightmare........ their bones would be very fragile

and easy to fracture.........thus the Manufacturers warning, though one

would wonder what surgeon would try a resurface in that situation..........

However, it is certainly a long jump to then say that this warning not to go

boring and grinding an older persons osteoporosis femur head/neck, means

that a successful resurface prothesis will let the neck fracture later if

one gets osteoporosis...........

There is nothing in that article that says that the neck of the resurfaced

hip is bare either as you are claiming........... it only says that they are

preserved in the operation............and I will keep repeating mine is

nicely tucked up under the BHR along with cement.........

Edith

> Sorry, your evaluation of your xrays is speculation and wishful

> thinking.

>

> The BHR covers the remnant of the shaped femoral head, not the

> neck. Fractures commonly occur at the base of the neck, the

> intertrochanteric region or below a THR. I have seen fractures

> through a THR which is far more substantial that a BHR. With chronic

> stress and metal fatigue, the weakest point will eventually break.

> The link below is to the Australian summary which you can also find

> through the activejoints.com site

>

> http://www.surgeons.org/asernip-s_net-

>

[Guest guest]

Edith:

You have totally missed the point. Everyone will experience bone

loss as we age. Osteoporosis results in fractures, most commonly in

the hip and spine. Total Hip resurfacing has only been done with the

current prosthesis for about 9 years. No one knows what the risk of

fracture is after resurfacing, but the procedure is not protective.

The long term studies will give us data in another 10 - 15 years as

we all age. The lifetime risk of hip fracture in Caucasian women,

for example, is about 17%. If a hip fracture occurs after

resurfacing, a THR will be necessary.

I suggest you ask your surgeon if he/she believes that your

resurfaced hip is at less risk if fracture than your " normal " hip.

Check out the osteoporosis sites for more information. I think the

Canadian one is very well organized.

To understand the anatomy better, look at the BHR, CORIN or WRIGHT

WEB SITES which show the details of the procedure including the

placement of guide pins, shaping the femoral head and drilling the

guide hole in the femoral neck.

Best wishes,

in NC

For any

> Hi ,

>

> I finally accessed that article you mention - I have read it

> before............ along with several others..........

>

> I suspect you are misinterpreting the para about the warning by the

> manufactures of the BHR prothesis........ if that is indeed where

you are

> getting your info about osteoporosis and resurfacing..........The

article

> states that they say it isn't recommended for use with older

people with

> osteoarthritis.......... I can fully understand that......... It

seems that

> most of the fractures that are recorded as happening, happen

during the

> actual hip resurface operation and become noticeable either then

or within a

> couple of weeks........ that seems to be pretty clear from that

article and

> any others I have read...........and given the banging, thumping

etc that

> goes on that is also pretty understandable that occasionally the

surgeon

> slips up..............

>

> It also isn't hard to imagine that trying to do a resurface on

someone with

> osteoporosis would be a nightmare........ their bones would be

very fragile

> and easy to fracture.........thus the Manufacturers warning,

though one

> would wonder what surgeon would try a resurface in that

situation..........

> However, it is certainly a long jump to then say that this warning

not to go

> boring and grinding an older persons osteoporosis femur head/neck,

means

> that a successful resurface prothesis will let the neck fracture

later if

> one gets osteoporosis...........

>

> There is nothing in that article that says that the neck of the

resurfaced

> hip is bare either as you are claiming........... it only says

that they are

> preserved in the operation............and I will keep repeating

mine is

> nicely tucked up under the BHR along with cement.........

>

> Edith

[Guest guest]

- what about hemachromatosis as a cause of early-age

ostea-arthrtis?

icedancer on 11/01/2003 23:25:47

To: surfacehippy

cc:

bcc:

" <icedancer, 11 January 2003,

11:25 p.m.

Contact:

Contact:

Re: Hip resurfacing failures

Wow - you are a great addition to this list. No doubt many

will be picking your brain for more information. I certainly plan on

checking out the websites you have directed us to. Thank you and

good luck with your hip.

Pamela

lbhr De Smet October 23, 2002

> We need to remember that what has brought all of us to this group is

> the failure of our " native " hip surfaces. If there was a simple one

> size fits all solution, there would not be so many disagreements

> about treatment and types of surgery.

>

> The metal on metal hip resurfacing technique looks like it will be

> an excellent choice for many people. All of us face the risk sooner

> or later that the resurfaced hip will fail. In many cases there is

> nothing which can be done to prevent it.

>

> Consider this: The femoral resurfacing component is dependent upon

> reshaping of the underlying bone, drilling a perfectly aligned hole

> in the bone down the center of the femoral neck. The " ball "

> component has an uncemented guide pin which slides into the hole and

> cement on the underside of the " ball " helps fix it into position.

> If this is done correctly, the forces created by our body weight

> will be properly transmitted down the leg.

>

> What can go wrong? The femoral neck is the weakest part of the bone

> in our hip. As we age, bone mass is lost (osteoporosis) and the

> area of greatest loss is in the femoral neck. This is the most

> common site of hip fracture in older people. It can sometimes be

> treated by operative placement of lag screws. However, if the hip

> has been resurfaced, total hip replacement is necessary.

>

> If the lower part of the femoral neck is damaged during resurfacing,

> the procedure may fail.

>

> What can we do? 1. Have a bone densitometry exam of Both HIPS and

> lumbar spine before surgery. If one hip has been operated, check

> the other side. If you have osteoporosis, a THR will be necessary.

>

> It is normal to be euphoric and exuberant about the way hip

> resurfacing will change your life. But protect your hip. Weigh the

> enjoyment of your activities against the risk of fracture as you get

> older.

>

> 2. If you have osteoporosis there are effective treatments (but

> these take a long time).

>

> 3. Prevent osteoporosis! The highest risk is in thin, caucasian and

> asian women. Smoking increases risk. men are at risk as well.

> Bone loss in women accelerates at menopause. The " old " Hormone

> replacement therapy is now in question due to cancer and other

risks.

>

> A safer group of medications, (selective estrogen receptor

> modulator) " SERM " , has been developed. In the US, the only

> available one is RALOXIFENE, marketed as " EVISTA " by Lilly. this is

> available only by presciption.

>

> HERE ARE SOME WEBSITES WITH GOOD INFORMATION ABOUT OSTEOPOROSIS

>

>

> USA: Main FDA WEB SITE http://www.fda.gov/default.htm

>

> Osteoporosis web sites:

>

> The International Osteoporosis Foundation:

> http://www.osteofound.org/

> This site has links to member societies from Argentina to Yugoslavia

>

> USA: the National Institutes of Health

> http://www.nlm.nih.gov/medlineplus/osteoporosis.html

>

> USA : National Osteoporosis Foundation

>

> http://www.nof.org/

>

> CANADA: Osteoporosis Society of Canada

>

> http://www.osteoporosis.ca/english/home/default.asp?s=1

>

> UK: National Osteoporosis Society

>

> http://www.nos.org.uk/

>

> AUSTRALIA: Osteoporosis Australia

>

> http://www.osteoporosis.org.au/html/index.php

>

> NEW ZEALAND: Osteoporosis New Zealand

>

> http://www.osteoporosis.org.nz/

>

>

> in North Carolina