Cemented and Cementless - thought you might be interested

[Guest guest]

At my four month exam with Dr. Amstutz he indicated to me that they

used a cemented cap on the femoral head of one hip and a cementless

one on the other. Naturally I asked why not the same on both. He

indicated that they started using cement again a few years ago and

that the verdict was still out as to which method of fixation is

actually better. He said that rather than put all ther eggs in one

basket, they use one method on one hip and the other method on the

other hip - thus, taking a conservative approach.

I found this approach interesting and thought I would just share it

with the group.

Joe

Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

Is the finish on the inside of the cementless cap made to

accomodate bone ingrowth, or is it the same as the other side?

Don W

> At my four month exam with Dr. Amstutz he indicated to me that they

> used a cemented cap on the femoral head of one hip and a cementless

> one on the other. Naturally I asked why not the same on both. He

> indicated that they started using cement again a few years ago and

> that the verdict was still out as to which method of fixation is

> actually better. He said that rather than put all ther eggs in one

> basket, they use one method on one hip and the other method on the

> other hip - thus, taking a conservative approach.

>

> I found this approach interesting and thought I would just share it

> with the group.

>

> Joe

> Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

Hi Don

Good question - I don't know the answer though. I guess I was a bit

surprised when I first learned of it, and even then my only concern

was as to whether there was a problem which required a different

approach to one versus the other - and was told there were no

problems - secondly, whether there were any known disadvantages of

one versus the other.

I think I will shot an email to Dr. Amstutz and ask him. I will

report back what he tells me.

Joe

> > At my four month exam with Dr. Amstutz he indicated to me that

they

> > used a cemented cap on the femoral head of one hip and a

cementless

> > one on the other. Naturally I asked why not the same on both.

He

> > indicated that they started using cement again a few years ago

and

> > that the verdict was still out as to which method of fixation is

> > actually better. He said that rather than put all ther eggs in

one

> > basket, they use one method on one hip and the other method on

the

> > other hip - thus, taking a conservative approach.

> >

> > I found this approach interesting and thought I would just share

it

> > with the group.

> >

> > Joe

> > Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

I would also ask how many others that are of the dissimilar cap

cemented non-cemented configuration. One would think one should be

briefed on this preop.

Don W

> > > At my four month exam with Dr. Amstutz he indicated to me that

> they

> > > used a cemented cap on the femoral head of one hip and a

> cementless

> > > one on the other. Naturally I asked why not the same on both.

> He

> > > indicated that they started using cement again a few years ago

> and

> > > that the verdict was still out as to which method of fixation

is

> > > actually better. He said that rather than put all ther eggs in

> one

> > > basket, they use one method on one hip and the other method on

> the

> > > other hip - thus, taking a conservative approach.

> > >

> > > I found this approach interesting and thought I would just

share

> it

> > > with the group.

> > >

> > > Joe

> > > Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

If Amsutz is indeed using a cementless cap it is very interesting. I thought

the FDA protocol on this side of the pond requires cement and the Conserve

Plus is designed with 1mm space for its placement. Perhaps he is able to

test alternative techniques, or perhaps there is interest at Medical

in cementless devices since the C2K fits tighter and can already be used

cementless (in Europe) and Biomet in the US is working a cementless

resurfacing device.

It's important to keep in mind that we tend to want to know what device or

technique is " the best " . But what is really happening is the addition of

options, not a competition for a gold standard applicable to all. The

patient

population that qualifies for non-cemented resurfacing may be very limited

while the majority of resurfacing patients may continue to require cement

due to defects, cysts, AVN, Etc. that require some kind of " filler " .

Surface hippies are by definition eager for the next technological

development, but progress is much more like the branches of a tree than a

single line. The more options available, the better the surgeons can tailor

the best treatment to fit the patient.

It will certainly be better when surgeons can say with authority that one

patient would benefit from a non-cemented device and that another needs a

cemented one... with data and experience to back their recommendation!

For better or worse, we are the pathfinders for those that follow!

Mike Trautman

C2K, Kennedy, Sep 03

Re: Cemented and Cementless - thought you might be

interested

> Dr Amsutz did me this oct 2nd and did not use

> cement on the cap. Makes me wonder when the verdict

> will be in. Barry

[Guest guest]

hi-

this is interesting, the " cementless head " question.

i'm curious to hear what dr. amstutz has to say about it.

it's good to hear that the wright technologies implant is also

pursuing this option. it seems like a good idea in concept

because your bone would be fused directly to the implant

and not just to an intermediate material.

a few months back, when i was trying to make a determination about

where to go and what brand hip to get, i raised this question.

i e-mailed all three of the manufacturers with the inquiry of " cementless heads "

for resurfacing and didn't get much feedback. i also posted the question to this

group, it didn't get much response either, except from people who already have

a cemented head and fear thinking of alternatives.

what i did find out was that " corin cormet 2000 " produces a cementless head

and that a dr. villar in cambridge, england uses " cementless " heads exclusively

for his hip resurfacings. he has done about 250 of these over the last 3 years

and has no failures to date. he was a very nice guy and i was imressed with

how thoroughly he addressed my rather detailed questions.

but, response came quite a while after inquiring to him (about 2 1/2 months),

i had given up on pursuing this avenue and made my appointment with dr. de smet.

my surgery date is november 19....so, i guess i'm getting the cemented head

as the bhr does not produce a cemetless head to my knowledge.

i had also e-mailed dr. de smet previously about the " cementless head " question,

he responded within the hour (as usual), and emphatically stated that they just

don't work, so why would i want one. it's clear where he stands on the issue.

i still think however, that the cementless head idea sounds valid and

it seems that someone like me, in my 30's would benefit from this because

i should be able to quickly re-grow bone into the metal implant, and that once

the bond was formed, my chances of loosening would be reduced. this

seems important if i want to get 30-40 years out of it....or more.

the big question is, does our lifespan outlast the lifespan of the implant or

the life of the cement bond used in the implant? only the shadow knows.

i guess it is a question yet to be answered. i don't want to alarm anyone,

i'm getting a cemented head too, and i'm sure i will be happy assuming all goes

well. i just believe that these devices are in a state of evolution. the

technology

will always improve and develop with time.

but, my time is now, and i'm not getting a thr (yippee), i'm getting the next

better

thing. in 20 years, i'll bet they will be growing a hip resurface implant out of

my

own bone stock......and the fda will be dragging it's heels, and our insurance

companies will still be trying to squirm out of it's commitments.

limpingly, jeff

Re: Cemented and Cementless - thought you might be

interested

Hi Don

Good question - I don't know the answer though. I guess I was a bit

surprised when I first learned of it, and even then my only concern

was as to whether there was a problem which required a different

approach to one versus the other - and was told there were no

problems - secondly, whether there were any known disadvantages of

one versus the other.

I think I will shot an email to Dr. Amstutz and ask him. I will

report back what he tells me.

Joe

> > At my four month exam with Dr. Amstutz he indicated to me that

they

> > used a cemented cap on the femoral head of one hip and a

cementless

> > one on the other. Naturally I asked why not the same on both.

He

> > indicated that they started using cement again a few years ago

and

> > that the verdict was still out as to which method of fixation is

> > actually better. He said that rather than put all ther eggs in

one

> > basket, they use one method on one hip and the other method on

the

> > other hip - thus, taking a conservative approach.

> >

> > I found this approach interesting and thought I would just share

it

> > with the group.

> >

> > Joe

> > Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

> i had also e-mailed dr. de smet previously about the " cementless

head " question,

> he responded within the hour (as usual), and emphatically stated

that they just

> don't work, so why would i want one. it's clear where he stands on

the issue.

>

It would be nice to know why his opinion is so strong. But then

again that might be a " trade secret " .

Don W

[Guest guest]

Jeffery,

Your reasoning is sound and while I think the cementless option is valid

and will someday be a common procedure, you've made the same decision I did.

The fact is, cemented works and has a great track record. It is similar to

the standard technique in knee surgery, not THR. European surgeons with

twelve year of experience are glowingly confident that there patients will

have good long term results.

Dr. Villar was very accommodating and was a serious consideration for me

too. But the recovery circumstances and convenience of having it done where

I did were important factors too. It finally comes down to the " here and

now " . If I had waited until the FDA finishes the approval process and

non-cemented was commonplace, I would have lost years of my life and who

knows how much bone!

All the best with your surgery! I don't think you'll be disappointed!

Mike Trautman

C2K, Kennedy, Sep 03

PS - One month I hear that Dr. Amsutz finds it important and neccessary to

extend the cement further down the post and that it's important for optimal

fixation. The next, I hear he is doing cementless resurfacing.* I'm not sure

whether there is some misscommuncation going on, or whether patients are

drawing false conclusions, or if Dr. Amsuts is trying a variety of

techniques without disclosure to this patients.

I'm sure he is an amazing surgeon and is following correct protocol in any

studies he is involved in. I think we are hearing reports second and third

hand about his work that may be confusing. I will be very interested to hear

if he comments on mixing cemented and un-cemented devices, but I'm a little

skeptical that this is really happening. I think the good Dr. may have told

the patient that one side of the resurfacing is cemented (the femoral) and

the other is not (the acetabular) which is true of most resurfacing. The

patient may have thought this meant that one hip was cemented and the other

not.

*PPS - I'm rambling on and on here but that's my nature... On my post op

X-ray there is a squiggly line of " cement " in the guide hole under the post

of the femoral cap. It would appear that Dr. K follows Dr. A's Rx to add

more cement in the post area and that some excess squirted past the post

into the central part of the femoral neck. I will be watching this area very

closely to see if there is any reaction to the presence of the cement by the

cancelous bone of the femur. I'm not sure if I agree with Dr. A's Rx here.

You might want to discuss this with your surgeon. Nitpicking for sure, but

hey, it's your hip and your fifty year hoped for service life!

All the best!

Mike Trautman

C2K, Kennedy, Sep 03

[Guest guest]

Joe,

It is instructive to read Dr Amstutz's published papers - I think it

was on the jri site that I saw them. He refers to the loosening of

cementless caps which they eventually put down to the early (in the

trial sequence) use of a different angle for the drilled guide hole

in the femoral head. I can't help wondering whether he has done this

to get a direct comparison between the two methods on a single

patient. I presume this would be quite legitimate in the US where

the procedure is still subject to Federal trial. Here in the UK,

where resurfacing is a standard procedure, we would certainly expect

a surgeon

to explain such a decision in detail to the patient.

Rgds

LBHR +20 months (Muirhead-Allwood)

> > > > At my four month exam with Dr. Amstutz he indicated to me

that

> > they

> > > > used a cemented cap on the femoral head of one hip and a

> > cementless

> > > > one on the other. Naturally I asked why not the same on

both.

> > He

> > > > indicated that they started using cement again a few years

ago

> > and

> > > > that the verdict was still out as to which method of fixation

> is

> > > > actually better. He said that rather than put all ther eggs

in

> > one

> > > > basket, they use one method on one hip and the other method

on

> > the

> > > > other hip - thus, taking a conservative approach.

> > > >

> > > > I found this approach interesting and thought I would just

> share

> > it

> > > > with the group.

> > > >

> > > > Joe

> > > > Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

I don't think one should speculate that the patient had hopefully

heard wrong. He said he would check with the good doctor and

report. Maybe we should just wait.

Don W

PS. Dr. Amstutz does drill (or has drilled)acillary holes

circumferentially around the main shaft for " additional fixation " of

the cement (in some cases?).

> Jeffery,

>

> Your reasoning is sound and while I think the cementless option is

valid

> and will someday be a common procedure, you've made the same

decision I did.

> The fact is, cemented works and has a great track record. It is

similar to

> the standard technique in knee surgery, not THR. European surgeons

with

> twelve year of experience are glowingly confident that there

patients will

> have good long term results.

>

> Dr. Villar was very accommodating and was a serious consideration

for me

> too. But the recovery circumstances and convenience of having it

done where

> I did were important factors too. It finally comes down to

the " here and

> now " . If I had waited until the FDA finishes the approval process

and

> non-cemented was commonplace, I would have lost years of my life

and who

> knows how much bone!

>

> All the best with your surgery! I don't think you'll be

disappointed!

>

> Mike Trautman

> C2K, Kennedy, Sep 03

>

> PS - One month I hear that Dr. Amsutz finds it important and

neccessary to

> extend the cement further down the post and that it's important for

optimal

> fixation. The next, I hear he is doing cementless resurfacing.* I'm

not sure

> whether there is some misscommuncation going on, or whether

patients are

> drawing false conclusions, or if Dr. Amsuts is trying a variety of

> techniques without disclosure to this patients.

>

> I'm sure he is an amazing surgeon and is following correct protocol

in any

> studies he is involved in. I think we are hearing reports second

and third

> hand about his work that may be confusing. I will be very

interested to hear

> if he comments on mixing cemented and un-cemented devices, but I'm

a little

> skeptical that this is really happening. I think the good Dr. may

have told

> the patient that one side of the resurfacing is cemented (the

femoral) and

> the other is not (the acetabular) which is true of most

resurfacing. The

> patient may have thought this meant that one hip was cemented and

the other

> not.

>

> *PPS - I'm rambling on and on here but that's my nature... On my

post op

> X-ray there is a squiggly line of " cement " in the guide hole under

the post

> of the femoral cap. It would appear that Dr. K follows Dr. A's Rx

to add

> more cement in the post area and that some excess squirted past the

post

> into the central part of the femoral neck. I will be watching this

area very

> closely to see if there is any reaction to the presence of the

cement by the

> cancelous bone of the femur. I'm not sure if I agree with Dr. A's

Rx here.

> You might want to discuss this with your surgeon. Nitpicking for

sure, but

> hey, it's your hip and your fifty year hoped for service life!

>

> All the best!

>

> Mike Trautman

> C2K, Kennedy, Sep 03

[Guest guest]

Yes, I will be very interested to hear if Dr. Amstutz is doing cementless

resurfacing. I would view that as a positive and certainly don't hope his

patient is wrong. I was just hypothesizing that hearing 'one side is

cemented and the other isn't' might apply to two sides of one joint instead

of two sides of one's body.

I hope we learn the facts!

Mike Trautman

C2K, Kennedy, Sep 03

Re: Cemented and Cementless - thought you might be

interested

> I don't think one should speculate that the patient had hopefully

> heard wrong. He said he would check with the good doctor and

> report. Maybe we should just wait.

>

> Don W

>

> PS. Dr. Amstutz does drill (or has drilled)acillary holes

> circumferentially around the main shaft for " additional fixation " of

> the cement (in some cases?).

[Guest guest]

Hi Jeff

Just a quick response to why you were not, or may not have been,

getting a response from the manufacturers to your inquiries. I first

learned of resurfacing when I came across the website for

Medical. I sent them an email detailing my problem with osteo

arthritus and asked if I might be a candidate for the Conserve Plus.

They phoned me back and said they could not discuss the prosthetic

with me beacuse it was not FDA approved and because it was in the

invetigational stages with the FDA. They said that only the doctor

and medical facility involved with the study could discuss it with

me, and then provided me with the name and telephone number of the

medical director of the Joint Replacement Institute.

So the lack of response you encountered may have to do more with the

FDA that a lack of responsiveness from the manufacturers.

Joe

Bilateral, C+, 5/8/03, Dr. Amstutz

> > > At my four month exam with Dr. Amstutz he indicated to me

that

> they

> > > used a cemented cap on the femoral head of one hip and a

> cementless

> > > one on the other. Naturally I asked why not the same on

both.

> He

> > > indicated that they started using cement again a few years

ago

> and

> > > that the verdict was still out as to which method of fixation

is

> > > actually better. He said that rather than put all ther eggs

in

> one

> > > basket, they use one method on one hip and the other method

on

> the

> > > other hip - thus, taking a conservative approach.

> > >

> > > I found this approach interesting and thought I would just

share

> it

> > > with the group.

> > >

> > > Joe

> > > Bilateral, C+, 5/8/03, Dr. Amstutz

>

>

>

[Guest guest]

Hi Don

Thanks for your comment. And I do intend to report back.

And you are correct about the drilling around the main shaft - Dr.

Amstutz showed me a very clear pic of the shaft with the suction

device shown inserted - which he indicated is also used to keep the

area clean of blood and any fluids for purposes of the cements

application.

Joe

Bilateral C+ 5/8/03

> > Jeffery,

> >

> > Your reasoning is sound and while I think the cementless option

is

> valid

> > and will someday be a common procedure, you've made the same

> decision I did.

> > The fact is, cemented works and has a great track record. It is

> similar to

> > the standard technique in knee surgery, not THR. European

surgeons

> with

> > twelve year of experience are glowingly confident that there

> patients will

> > have good long term results.

> >

> > Dr. Villar was very accommodating and was a serious consideration

> for me

> > too. But the recovery circumstances and convenience of having it

> done where

> > I did were important factors too. It finally comes down to

> the " here and

> > now " . If I had waited until the FDA finishes the approval process

> and

> > non-cemented was commonplace, I would have lost years of my life

> and who

> > knows how much bone!

> >

> > All the best with your surgery! I don't think you'll be

> disappointed!

> >

> > Mike Trautman

> > C2K, Kennedy, Sep 03

> >

> > PS - One month I hear that Dr. Amsutz finds it important and

> neccessary to

> > extend the cement further down the post and that it's important

for

> optimal

> > fixation. The next, I hear he is doing cementless resurfacing.*

I'm

> not sure

> > whether there is some misscommuncation going on, or whether

> patients are

> > drawing false conclusions, or if Dr. Amsuts is trying a variety of

> > techniques without disclosure to this patients.

> >

> > I'm sure he is an amazing surgeon and is following correct

protocol

> in any

> > studies he is involved in. I think we are hearing reports second

> and third

> > hand about his work that may be confusing. I will be very

> interested to hear

> > if he comments on mixing cemented and un-cemented devices, but

I'm

> a little

> > skeptical that this is really happening. I think the good Dr. may

> have told

> > the patient that one side of the resurfacing is cemented (the

> femoral) and

> > the other is not (the acetabular) which is true of most

> resurfacing. The

> > patient may have thought this meant that one hip was cemented and

> the other

> > not.

> >

> > *PPS - I'm rambling on and on here but that's my nature... On my

> post op

> > X-ray there is a squiggly line of " cement " in the guide hole

under

> the post

> > of the femoral cap. It would appear that Dr. K follows Dr. A's Rx

> to add

> > more cement in the post area and that some excess squirted past

the

> post

> > into the central part of the femoral neck. I will be watching

this

> area very

> > closely to see if there is any reaction to the presence of the

> cement by the

> > cancelous bone of the femur. I'm not sure if I agree with Dr. A's

> Rx here.

> > You might want to discuss this with your surgeon. Nitpicking for

> sure, but

> > hey, it's your hip and your fifty year hoped for service life!

> >

> > All the best!

> >

> > Mike Trautman

> > C2K, Kennedy, Sep 03

[Guest guest]

Hi Mike

Sorry but you've got it wrong. I did mean that the cap to one

femoral head was cemented, and the cap to the other femoral head was

not. I assure you my focus was very attentive when Dr. Amstutz gave

me his explanation, showed me the x-rays, and then showed me a pic

from the surgery.

And I will hopefully have more to report back once I hear from Dr.

Amstutz.

Joe

> Yes, I will be very interested to hear if Dr. Amstutz is doing

cementless

> resurfacing. I would view that as a positive and certainly don't

hope his

> patient is wrong. I was just hypothesizing that hearing 'one side is

> cemented and the other isn't' might apply to two sides of one joint

instead

> of two sides of one's body.

>

> I hope we learn the facts!

>

> Mike Trautman

> C2K, Kennedy, Sep 03

>

> Re: Cemented and Cementless - thought you

might be

> interested

>

>

> > I don't think one should speculate that the patient had hopefully

> > heard wrong. He said he would check with the good doctor and

> > report. Maybe we should just wait.

> >

> > Don W

> >

> > PS. Dr. Amstutz does drill (or has drilled)acillary holes

> > circumferentially around the main shaft for " additional fixation "

of

> > the cement (in some cases?).

[Guest guest]

Dear -

Am I correct in understanding that you were told of this different

method of fixation AFTER your op? If so, I'm gobsmacked.

Regardless of a surgeon's (or science's) desire to " compare

and contrast, " a full disclosure and description of the planned

procedure should be made to a patient pre-op so he can make a

fully informed choice.

Were you aware that Amstutz planned to fixate your second

femoral component without cement before consenting to

surgery? Or were you led to believe you were getting a

prosthesis fixated in the same way as the first and told later that

your second hip was cementless?

At any rate, I hope both hips give you a great run for your money.

Best,

Sheila

-- In surfacehippy , " joey94568 "

wrote:

> Hi Mike

>

> Sorry but you've got it wrong. I did mean that the cap to one

> femoral head was cemented, and the cap to the other femoral

head was

> not. I assure you my focus was very attentive when Dr. Amstutz

gave

> me his explanation, showed me the x-rays, and then showed

me a pic

> from the surgery.

>

> And I will hopefully have more to report back once I hear from

Dr.

> Amstutz.

>

> Joe

>

>

>

> > Yes, I will be very interested to hear if Dr. Amstutz is doing

> cementless

> > resurfacing. I would view that as a positive and certainly don't

> hope his

> > patient is wrong. I was just hypothesizing that hearing 'one

side is

> > cemented and the other isn't' might apply to two sides of one

joint

> instead

> > of two sides of one's body.

> >

> > I hope we learn the facts!

> >

> > Mike Trautman

> > C2K, Kennedy, Sep 03

> >

> > Re: Cemented and Cementless -

thought you

> might be

> > interested

> >

> >

> > > I don't think one should speculate that the patient had

hopefully

> > > heard wrong. He said he would check with the good doctor

and

> > > report. Maybe we should just wait.

> > >

> > > Don W

> > >

> > > PS. Dr. Amstutz does drill (or has drilled)acillary holes

> > > circumferentially around the main shaft for " additional

fixation "

> of

> > > the cement (in some cases?).

[Guest guest]

hi joe-

good point about the usa/fda issue w/ regards to wright medical,

maybe that's why i didn't hear back from them. i wish i had tried

more diligently with them.

here's a little rundown on what i did hear back from the 3 companies,

in case anyone is interested. i sent some detailed questions with

regards to the cementless issue, the training of the doctors in resurfacing,

specific sizes options of the implants, specific characteristics of the

underside of the head component (are there fins or ridges, is there HA coating,

is

there a rough or porocast surface...) and i also asked for specific information

regarding the choices for a stem fixated revision component.

midland medical technologies (BHR)-

the guy answered me pretty quickly, he referred directly to the information

on their website. when i pointed out that i had basically memorized the info

on there website, but that i also had some questions that are not covered in

the website, he said that he would send me a cd-rom with all other technical

data.....i waited 3 weeks and e-mailed him again, he then sent out the cd-rom

and wouldn't you know.....it was exactly what is on the website. nothing more

and nothing less. my subsequent inquiries to him went unanswered.

corin group (cormet hip resurfacing system)-

i went to their " interactive discussion group " and cruised this very helpful

message board. i recommend it to the curious folks, for sure. i posted a

question under a thread on the cementless head issue. i did not get a

response from the moderator....so i e-mailed him directly, he gave me the

name of dr. villar in cambridge.....that's the guy i mentioned in previous post.

they now have a new technical website www.cormet.com it mentions the

new cementless head option along with some updated info from a recent

conference. it too is worth checking out. i noticed that they have these pegs

in the acetabular cup to provide a more secure fixation into the pelvis, this

seems to address the same fixation issue that the bhr dysplasia cup.

wright medical technologies-

i filled out there request form on their website.

i got a packet in the mail with the same info as the website.

i e-mailed back with my detailed questions....i never heard back from them.

i guess i should have located their " international inquiry " section and e-mailed

their representitive in england directly.

i got to the point where i was tired of splitting hairs over the alleged

technical

advantages of one company over the other. i just hope to get back my mobility

and resume a decent level of exercise oriented activities. i hope too that i am

not acting in haste after deliberating for so long.

good luck joe, you are forging new territory for future hippies.

jeff

Re: Cemented and Cementless - thought you might be

interested

Hi Jeff

Just a quick response to why you were not, or may not have been,

getting a response from the manufacturers to your inquiries. I first

learned of resurfacing when I came across the website for

Medical. I sent them an email detailing my problem with osteo

arthritus and asked if I might be a candidate for the Conserve Plus.

They phoned me back and said they could not discuss the prosthetic

with me beacuse it was not FDA approved and because it was in the

invetigational stages with the FDA. They said that only the doctor

and medical facility involved with the study could discuss it with

me, and then provided me with the name and telephone number of the

medical director of the Joint Replacement Institute.

So the lack of response you encountered may have to do more with the

FDA that a lack of responsiveness from the manufacturers.

Joe

Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

Don,

There has been a trial of cementless BHR /McMinn prosthesis in the UK back in

the mid 90's and the statistics weren't as good. The Swedish with there THR

data came upon similar results. If you go back in the file about 6 months you

will see several postings on this subject.

Rog

Re: Cemented and Cementless - thought you might be

interested

> i had also e-mailed dr. de smet previously about the " cementless

head " question,

> he responded within the hour (as usual), and emphatically stated

that they just

> don't work, so why would i want one. it's clear where he stands on

the issue.

>

It would be nice to know why his opinion is so strong. But then

again that might be a " trade secret " .

Don W

[Guest guest]

Very cool! What a great way to compare and investigate the two methods and

perhaps shed some light on a subject dear to many of us. Are the devices

's Conserve Plus or some other type? Have you noticed any differences

so far?

I hope that both hips last forever with no problems at all! That would be

the best news yet! This is not a competition after all. We all want the best

solution available.

Mike Trautman

C2K, Kennedy, Sep 03

Re: Cemented and Cementless - thought you might be

interested

> Hi Mike

>

> Sorry but you've got it wrong. I did mean that the cap to one

> femoral head was cemented, and the cap to the other femoral head was

> not. I assure you my focus was very attentive when Dr. Amstutz gave

> me his explanation, showed me the x-rays, and then showed me a pic

> from the surgery.

>

> And I will hopefully have more to report back once I hear from Dr.

> Amstutz.

>

> Joe

[Guest guest]

Rog. I did look back but ? One more question, the inside of the

femoral cap is prepared similar to the surfaces of the non-cemented

stem in coventional THR's to facilitate bony ingrowth?

Don W

> Don,

> There has been a trial of cementless BHR /McMinn prosthesis in the

UK back in the mid 90's and the statistics weren't as good. The

Swedish with there THR data came upon similar results. If you go

back in the file about 6 months you will see several postings on this

subject.

> Rog

> Re: Cemented and Cementless - thought you

might be interested

>

>

>

> > i had also e-mailed dr. de smet previously about

the " cementless

> head " question,

> > he responded within the hour (as usual), and emphatically

stated

> that they just

> > don't work, so why would i want one. it's clear where he stands

on

> the issue.

> >

>

> It would be nice to know why his opinion is so strong. But

then

> again that might be a " trade secret " .

>

> Don W

>

>

>

>

>

[Guest guest]

At 09:37 PM 10/30/2003 +0000, you wrote:

>Am I correct in understanding that you were told of this different

>method of fixation AFTER your op? If so, I'm gobsmacked.

>Regardless of a surgeon's (or science's) desire to " compare

>and contrast, " a full disclosure and description of the planned

>procedure should be made to a patient pre-op so he can make a

>fully informed choice.

All my papers say is that I am to have my hip replaced using the Conserve

Plus device. Nothing about cement or bone grafts or anything else. I

doubt very much that most people getting hip replacements have ANY idea

what type of device they are getting, much less anything about fixation or

anything else. I suspect that we are just SO much more educated about this

(and driven??!!) than the general hip population, that we have much more of

a " need to know " . My surgeon happily gives me copies of anything I want

(my op reports, x-rays, etc.) but I suspect I am in the minority of his

patients in requesting this stuff.

Cindy

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

[Guest guest]

Hi Mike,

The device is the Conserve Plus, and I am happy to report I have

noticed absolutley no difference between the two hips. I am still

waiting to hear from Dr. Amstutz and will post an update to what I

learn.

Joe

Bilateral, C+, 5/8/03

> Very cool! What a great way to compare and investigate the two

methods and

> perhaps shed some light on a subject dear to many of us. Are the

devices

> 's Conserve Plus or some other type? Have you noticed any

differences

> so far?

>

> I hope that both hips last forever with no problems at all! That

would be

> the best news yet! This is not a competition after all. We all want

the best

> solution available.

>

> Mike Trautman

> C2K, Kennedy, Sep 03

>

> Re: Cemented and Cementless - thought you

might be

> interested

>

>

> > Hi Mike

> >

> > Sorry but you've got it wrong. I did mean that the cap to one

> > femoral head was cemented, and the cap to the other femoral head

was

> > not. I assure you my focus was very attentive when Dr. Amstutz

gave

> > me his explanation, showed me the x-rays, and then showed me a pic

> > from the surgery.

> >

> > And I will hopefully have more to report back once I hear from Dr.

> > Amstutz.

> >

> > Joe

[Guest guest]

Wow. So you didn't know you got two different methods of fixation

either?

I still think a patient should be told up front so they can make an

informed choice.

We had a big scandal here in NYC a few years back involving the

" lopsided ladies. " Some very prominent plastic surgeons

decided to compare face lift techniques by using the established

method on one side of their face and a new lifting technique on

the other - without informing the patients that two different

procedures were being used so the docs could compare

results. Can you imagine anyone paying full price to consent to

such a thing?

I know my surgeon very specifically told me the femoral

component would be cemented and the acetabular side would

not. You make a good point, though. If I remember correctly,

Cindy, didn't you also have a leg length issue? I obtained my

surgical report for my p.t. to help him figure out my problem post

op but it was pretty cursory and not of much help. Sometimes

even when you request full disclosure, you don't get everything

you want or need. I guess it's always caveat emptor.

Best,

Sheila

>

> >Am I correct in understanding that you were told of this

different

> >method of fixation AFTER your op? If so, I'm gobsmacked.

> >Regardless of a surgeon's (or science's) desire to " compare

> >and contrast, " a full disclosure and description of the

planned

> >procedure should be made to a patient pre-op so he can

make a

> >fully informed choice.

>

> All my papers say is that I am to have my hip replaced using

the Conserve

> Plus device. Nothing about cement or bone grafts or anything

else. I

> doubt very much that most people getting hip replacements

have ANY idea

> what type of device they are getting, much less anything about

fixation or

> anything else. I suspect that we are just SO much more

educated about this

> (and driven??!!) than the general hip population, that we have

much more of

> a " need to know " . My surgeon happily gives me copies of

anything I want

> (my op reports, x-rays, etc.) but I suspect I am in the minority of

his

> patients in requesting this stuff.

>

> Cindy

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

[Guest guest]

At 06:59 PM 10/31/2003 +0000, you wrote:

>Wow. So you didn't know you got two different methods of fixation

>either?

Sheila,

If you're asking me, both my femoral components are cemented. One of the

acetabular components is cemented, and one is uncemented. This has

absolutely nothing to do with any study or anything else. It came down to

cement or not being able to use the C+ on that side. The size I have is

just a teeeeeeny bit loose on one part (bone stock issue) and the next size

would have gone right through my pelvis. I'll take the cement thank you

;-). I knew going into my second one that it was dicey at best, and that I

would likely come out with a grafting cage or worst case, a regular

THR. Thankfully, although for him it was a long and complicated surgery,

all worked out well. Also why I keep saying phooey to the notion that they

won't do complicated cases in the study!!!

Cindy

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

[Guest guest]

Let me get this straight - Dr Amstutz did not tell you he was doing this until

long after he did it? Isn't that unethical? It sure makes the hair stand up on

the back of my neck. Are we not by definition, guinea pigs, without consent?

Sharry

Cemented and Cementless - thought you might be

interested

At my four month exam with Dr. Amstutz he indicated to me that they

used a cemented cap on the femoral head of one hip and a cementless

one on the other. Naturally I asked why not the same on both. He

indicated that they started using cement again a few years ago and

that the verdict was still out as to which method of fixation is

actually better. He said that rather than put all ther eggs in one

basket, they use one method on one hip and the other method on the

other hip - thus, taking a conservative approach.

I found this approach interesting and thought I would just share it

with the group.

Joe

Bilateral, C+, 5/8/03, Dr. Amstutz

[Guest guest]

Let me get this straight - Dr Amstutz did not tell you he was doing this until

long after he did it? Isn't that unethical? It sure makes the hair stand up on

the back of my neck. Are we not by definition, guinea pigs, without consent?

Sharry

Cemented and Cementless - thought you might be

interested

At my four month exam with Dr. Amstutz he indicated to me that they

used a cemented cap on the femoral head of one hip and a cementless

one on the other. Naturally I asked why not the same on both. He

indicated that they started using cement again a few years ago and

that the verdict was still out as to which method of fixation is

actually better. He said that rather than put all ther eggs in one

basket, they use one method on one hip and the other method on the

other hip - thus, taking a conservative approach.

I found this approach interesting and thought I would just share it

with the group.

Joe

Bilateral, C+, 5/8/03, Dr. Amstutz