Re: Surgeon newbie

June 10, 2004

Mr McMinn's and Mr Treacy's experience with MOM hip resurfacing dates

back to 1991. Prior to that, Mr McMinn had observed good long term

survival of a long stemmed MOM THR from the 70's and 80's (Ring hip).

Ring moved away from MOM to polyethylene, and interviewed during his

retirement, he regretted this deeply. McMinn realised that if you

were lucky enough to get the MOM bearing just right, the wear rates

and frictional torque were low which translated into implant

longevity. He then decided to combine this observation with hip

resurfacing, a concept which had been tried by Wagner, Freeman,

Amstutz, and others including Charnley. Earlier designs of hip

resurfacing had used ceramic or metal on polyethylene or some other

soft material eg teflon. All these early designs were gradually

abandoned as failures rates were too high.

McMinn realised that to work well, MOM hip resurfacing needed a good

choice of metals and accurate machining. He used the expertise still

around from the days of the Ring MOM hip in making the first examples

of his resurfacing. Since then, the Birmingham group have learnt a

great deal about metallurgy and tribology: see the MMT site at

http://midmedtec.co.uk/tribology.htm. Tim Band, who works at MMT and

whom I have heard speak on several occasions, is one of the world's

foremost experts on MOM tribology and therefore the potential

differences between prostheses. Accept he may be biased but if you

hear him speak and analyse the available literature in this very

technical field you come away feeling that he knows why the current

BHR is designed the way it is and that you can have great confidence

that it is at the leading edge.

The papers that lead me to support BHR and worry about Conserve are

published in Journal of Bone and Joint Surgey in March, 2004.One in

the American volume, the other in the British volume.

http://www.ejbjs.org/cgi/content/abstract/86/1/28 (by Amstutz)

and http://www.jbjs.org.uk/ (see March 2004) By McMinn.

On the face of it there does seem to be a difference in results. The

$18 000 question is why.

> > Well got my knuckles rapped by some! Probably deservedly.

> > Sorry if offended anyone but joined group to have stimulating

> > discussion rather than just make friends.

> >

> > Cannot compete with the gravitas of some surgeons or their

> websites.

> > Does not mean they are always right. Can say I was a pioneer in

my

> > region and stuck to my guns re hip resurfacing. My unit now does

> > more BHR's than any other in UK outside Birmingham (3 colleagues

> > followed my lead). We do both private patients and NHS so we

cannot

> > be accused of simply wanting to get rich quick!

> >

> > Agree the prosthesis is only part of the story and surgeon

> > experience, skill and committment just as important. Pity that US

> > patients and surgeons do not have easy access to BHR or Cormet

> 2000.

> > If C+ beyond questioning why are so many going to Belgium? My

> point

> > is that hip resurfacing as a concept is " experimental " and

> > controversial enough so why introduce another variable by using a

> > prosthesis that did not come from Birmingham stable ? Worry

because

> > every week a rep comes to see me with a new design of hip

> > resurfacing that offers some or other " improvement " . Birmingham

> > group results are the best evidence we have so far. Accept it is

> > difficult for US patients to travel for surgery and C+ maybe only

> > viable option. Hopefully it will also stand test of time. As I

have

> > not designed my own hip resurfacing device(and probably never

will)

> > my choice is unbiased. Designers will naturally feel their device

> is

> > the best including Mr McMinn!

> >

> > When I chose a car for myself it had to be the new Mini . I

> > knew there would be all the teething problems of a new model and

> > there were a few hassles. Other owners gripe too. But I had the

> > first one at work and I still love its cheeky image. When I

choose

> a

> > new car for my wife and kids, I will look to manufacturers like

> > Mercedes or Volvo. They are too precious to me to take any

chances

> > with fashion. So there is a place for innovation and

> experimentation

> > but there is also sense in tradition and history. Depends on your

> > philosophy..............................

June 10, 2004

Dear Suzie,

Was his forwarding the names---even though they were ones you had

already told him about-a small example that you had managed to get

through to him?!

(Bet he's not the apologising type.)

Eleanor

Re: Surgeon newbie

Hey Fred! Thanks for your post. Over the weekend while driving to

our log cabin on the river far away I had a very unpleasant

conversation with my husband about resurfacing during which I wanted

to drive the car off a bridge so as not to deal with it any more! I

have e-mailed him many, many scientific articles, I have been

following a person with protrusio who is now 3 weeks post op re-surf

(in Germany) and I check out this web site and others every day.

I've about had it, Fred. He's never been interested in checking out

this web site nor has he bothered to look at my hip x-rays in the

Orthopedists office on the next floor in his medical building! Now I

will say that he has asked a few local OS's about resurfacing but

they are ALL opposed to it. Lately,(since yesterday and the

unpleasant conversation) he communicated with the and Nephew

rep here in Memphis and forwarded me the names of surgeons abroad

thought to be expertly skilled in resurfacing....one name was

Desmet! Of course I had been telling him that for months now! I've

always been a very strong, independent woman (it's a good thing, huh?)

and I will go this alone if I have to. Thank you ..and everyone

else, for listening to my whining. Susie in Memphis

> > > Real eyeopener scrolling old messages: waiting times in Canada

> > > unbelievable. Makes NHS look like pvt. medicine!

> > > My wait on NHS currently 13 weeks max. for consultation and

> surgery

> > > within 6 months of that- but only just hanging on to these

times!

> > > Do you all realise that there may be very significant

> differences

> > > between prostheses in terms of metallurgy and fixation? This

may

> > > affect the longevity of your resurfacing?

> > >

> > > Feel all should stick to either the BHR from MMT or

(grudgingly)

> > the

> > > Cormet from Corin. Personally would not touch the rest no

matter

> > > what anyone says! Let someone else be the guinea pig. In

> essence,

> > > stick with the only 2 designs that have a halfway decent track

> > > record.

> > > How's that for controversy!

June 10, 2004