The materials used in the artificial implant may vary, but they often include metal, plastic, or ceramic. We aim to replicate this with our new design of metal-on-crosslinked polyethylene resurfacing as it offers us the ability to maximise polyethylene thickness while maintaining valuable acetabular bone stock. This work led us to explore other nickel-containing implants as a comparison. ( Log Out /  ® Birmingham Hip Resurfacing is a registered Trademark of Smith & DM: In the excellent publication from Baylisset al, The Lancet, April 2017, the lifetime risk of revision following a total hip replacement in men aged 50–54 years is 30 per cent. A modern artificial hip joint is designed to last for at least 15 years. All these patients are made fully aware of the unproven nature of these custom-made resurfacing devices, and the fact that they are not CE marked. OPN: Thank you, we look forward to following your progress. No patients among those with a stated penicillin allergy who were given cefazolin had an adverse reaction. Selfishly, we are only concerned with the performance of our own design, and so Catherine kindly demonstrated the results for the BHR. In all, she reported on some 11,386 metal-on-metal hip resurfacings of various designs. Hip Replacement Surgery . However, we are conscious of some reports of over penetration of bone cement with our original design, as well as the stem being disproportionate in volume in the smaller sizes. DM: We were motivated to come up with an explanation of potential contributors to this outcome. In the patients who are under the age of 50 years with a diagnosis ofPrimary Osteoarthritis, women have a 99 per cent implant survivorship at 20years, just ahead of men with a 98.5 per cent implant survivorship at 20 years. We had to get a porous titanium surface directly on to the crosslinked polyethylene without the use of a metal shell. Additionally, we subsequently published our experience in the < 50 years age group up to 14 years post-operatively with no loss to follow up. OPN: What about the femoral head, do you see any need for an alternative design or material here? She has collected data from 27 centres and13 countries in patients having all types of hip resurfacing under the age of50 years at surgery. The Inaugural International Advances inKnee Arthroplasty Meeting. We are pleased to have another keen hip resurfacing addict attempting to keep the technique alive. What has changed your opinion of this material? The McMinn team presented, ‘High incidence of nickel sensitisation at 10 years: A review of metal-on-metal arthroplasty.’ Pre-revision testing of metal-on-metal resurfacings for metal allergies revealed 75 per cent of these patients tested positive to nickel. The impact of patient-reported penicillin allergy on risk for surgical site infection in total joint arthroplasty. We and Jointmedica are aware of the heightened scrutiny surrounding the introduction of this class of orthopaedic implant and associated instruments. My husband is allergic to penicillin, and needs to have hip replacement surgery. OPN: It has now been over eight years since we last talked. The 3D designed Conformis Hip System Announced at the 2019 AAOS conference Designed to enhance operational efficiency for the surgeon and improve patient outcomes, the Conformis Hip System is the most advanced, patient conforming hip replacement system available Once we were convinced of highly crosslinked polyethylene’s potential viability in the resurfacing setting, we set off to solve the next problem. “I live in the city. This article is part of our new series, Currents, which examines how rapid advances in technology are transforming our lives. OPN: Is polyethylene hip resurfacing something we will be seeing on the UK market in the near future? Who says exercise is good for you? A new study finds that the community in which one lives influences whether they receive postoperative care and rehabilitation after elective hip replacement surgery in a facility or at home. The future of hip joint implants “Technology is always advancing,” says Dr. Hansen. Enter your email address to follow this blog and receive notifications of new posts by email. This new assessment tool was validated in a group of 222 patients who underwent revision hip replacement for recurrent instability. – A retrospective review of >4,900 patients who underwent THA or TKA found that 16.2% reported a history of penicillin allergy. We found it to be very interesting that this group of young women performed so well when all previously published data had shown the inferiority of MoM resurfacing in women. There can be no shortcuts to this process. Radiological assessment at that time showed11 (3.5 per cent) femoral and 13 (4.1 per cent) acetabular radiolucencies which we believe may be because of stress shielding at the acetabular component to host bone interface. OPN: When do you expect the product to be commercially available in the UK? I am seeking hip resurfacing data on patients over the age of 70. Same-Patient Trial Design Measures Incremental Improvements in TKA Outcomes. When a hip replacement surgery is performed, a damaged, worn-out hip joint is replaced with an artificial implant. RT: The 14th National Joint Registry report(NJR) notes a significant reduction in the use of Hip Resurfacings (less than 1per cent) and subsequently the increase in the use of traditional hip replacements in the younger active patient groups. Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. Very importantly, simulator studies have demonstrated that the wear of highly crosslinked polyethylene is very low with all femoral head sizes. DM: We will keep everyone at OPN up to date with our progress along the way. Keeping you up-to-date with orthopaedic news, Halt Bisphosphonates in Patients with an Atypical Femoral Fracture, Pediatric Limb-Lengthening: A Cautionary Tale. DM: To monitor this unproven concept as closely as we could,we took the precaution to embed RSA marker beads in the implants, and to seek consent from a small group of recipients to be part of our post implantation vigilance by undergoing RSA analysis as part of the follow up. Change ). When she looked at the male and female results in isolation, she reported 3,187 male patients with a Kaplan–Meier survivorship of 96.2 per cent to 20.1 years. Our results were fascinating. The most critical interface of a hip replacement, in terms of longevity of the implants, is the so-called bearing surface.2 This is the surface of the hip replacement that allows for movement between the ball and socket of the implant. As you mentioned, there are different options for medication if the patient is allergic to penicillin. Survival of the total cohort with aseptic revision as the endpoint was 95.5 per cent.The median modified Oxford hip score at ten years was 46 (48 being the best possible score), and the median University of California, Los Angeles score was 7.0. In our revision experience we have seen a number of cases of severe acetabular stress shielding behind the BHR cup at long- term follow up. When we look at the women we noted in the group over the age of50, survivorship falls to 92.7 per cent at 20 years, a stark contrast to women under 50 years who demonstrate a 99 per cent survivorship at 20 years. This serves two purposes in that a rigorous review of the company’s business plan and financial information has been undertaken and approved by the INNOVATE UK professionals, along with providing Jointmedica with a substantial contribution to the finances required to draw this project together. DM: Despite the wonderful results of the BHR outlined above, for a variety of reasons MoM resurfacing is on its way out. DM: The Jointmedica team has managed to secure project funding from the INNOVATE UK organisation. */. –A study comparing data from the American Joint Replacement Registry with national registry data from other countries found that cementless stem fixation with the use of ceramic and 36-mm heads was the current US preference, while non-US registries indicated that cemented implants and metal and 32-mm heads were used most commonly.2, Opioid Use DM: We turned our focus to Jointmedica Ltd, a company which had been formed shortly after MMT was acquired. ( Log Out /  The James A. Rand Young Investigator’s Award: large opioid prescriptions are unnecessary after total joint arthroplasty: a randomized controlled trial. Knee Replacement Video Playlist Knee Replacement Surgery Steps . OPN: The obvious question is what is next for Hip Resurfacing, will we see a resurgence? Our team is proud to offer the latest technology in hip replacement procedures – the Mako Robotic-Arm Assisted Total Hip Replacement. We had three infections and eight femoral head failures, but by far the biggest contributor were 15 metal reactions. My personal results, published at a minimum follow up of ten years,demonstrated the survival for male patients was 98 per cent. Over-reaming of the acetabulum to accommodate a thick component is unacceptable, much in the same way as reducing the articulation thickness with polyethylene materials below 3mm would be a concern for many of us. This should not happen again. RT: During the first two years of this new direction, Jointmedica has taken residence in a modest facility, grown the staffing compliment to include some old friends from our past business successes and, importantly, we have interfaced closely with the BeyondCompliance Group to ensure the safest possible introduction and evaluation of this technology. Many men were given unnecessary THRs, and once again the procedure was demonised by the poor outcomes and association with unsatisfactory designs.We do not see metal-on-metal making a comeback in our lifetime. The Company will be featuring the new 3D-designed Conformis Hip System as a key technology focus at the 2019 American Academy of Hip and Knee Surgeons annual conference November 7–10, 2019 in Dallas, TX. THA Dislocation –Pathology involving the spinopelvic relationship has dominated the recent literature on THA dislocation. We asked, can hip resurfacing work in this challenging group of patients? We feel our experience of success in this discipline, coupled with the team at Jointmedica, holds the best recipe for our future success with this device. Building A Successful Practice – IT Matters, Review: Second hip preservation cadaver course. Mr Joseph Daniel and the research team at the McMinn Centre set to work reviewing the causes of failure in all my female patients over the age of 50. Climbing the stairs of his 3-story … A typical hip replacement implant recreates the ball-and-socket of the normal hip joint with an artificial ball and an artificial socket. Patients with hip arthritis have difficulty walking, climbing stairs and performing routine daily activities. –Pathology involving the spinopelvic relationship has dominated the recent literature on THA dislocation. DM: Our combined experience with metal-on-metal hip resurfacing spans close to three decades, this experience has demonstrated that a cup 6mm OD/ID difference is optimal for metal-on-metal. It will be good to know that there are different options for him, if something does happen. Female patients under 55 years of age demonstrated a survivorship of86.5 per cent at 13 years. Comment*document.getElementById("comment").setAttribute( "id", "aca7b5f7fe5efcfe03ed084158cf7705" );document.getElementById("i142c91cad").setAttribute( "id", "comment" ); #mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; } Change ), You are commenting using your Facebook account. Derek McMinn and Ronan Treacy give OPN an update on the hip replacement and hip resurfacing market. RT: When you consider our hip resurfacing design in isolation, I truly believe the orthopaedic community, and the wider industry in general, threw the baby out with the bath water. Given that alumina ceramic is twice as stiff as cobalt chrome, we do not believe that ceramic cups are the way forward. Relocation of the Knee Cap: In order to access the end of your thigh bone and shin bone, the knee back will be moved gently to the side of the joint. Those individuals with no metallic devices at all exhibited a 24 per cent sensitivity to nickel, those with metal-on-metal resurfacings 52 per cent, but the surprise for us was the metal-on-polyethylene total hip replacement group who demonstrated 57 per cent sensitivity. Osteoarthritis of the hip is the most common diagnosis that leads to hip replacement. It would not be sensible to be creative with the design of a new resurfacing acetabular component in relation to its angle of articulation or its ease of insertion. DM: Our experience with the cemented BHR femoral component has been rewarding over the years, we maintain the use of bone cement in this application is reliable and reproducible. DM: As you will know, our friend and colleague ProfessorJustin Cobb’s well publicised Ceramic on Ceramic H1 Hip Resurfacing Study is under way. RT: Yes of course, Catherine Van Der Straeten who is the Head of the Institute for Health Research and Innovation at GhentUniversity Hospital, has drawn together the largest international hip resurfacing database in the world. She presented her findings most recently at the ISTA 2017meeting in Seoul, Korea. DM: The data collected at the McMinn Centre suggests a difference in the age-based subsets between men and women. RT: When the NJR compared their own data with a view to the best performing hip resurfacing procedures by brand, they note a slightly better survivorship of between 92 per cent and 91 per cent. Our new design of femoral component addresses both these issues. Implant retrieval analysis showed an absence of high wear and edge wear in most cases. Any de… The new “Direct Anterior Total Hip” approach is a remarkable improvement in primary total joint replacement surgery. Derek managed to find a way around these issues. When Does I&D Beat 2-Stage Exchange in Second rTKA? As the cartilage wears out, pain and stiffness result. We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. OPN: Why do you believe these noticeable differences in women occur? Many people who have these debilitating symptoms because of hip arthritis will elect to undergo total hip replacement surgery.However, total hip replacement is not without its own risks and concerns, and therefore many people wonder if there are alternatives to hip replacement. Other conditions can also cause destruction of the hip joint, including: 1. Most hip replacements last well after the surgery was performed, with 90 percent lasting 15 years and 70 percent last 20 years, according to a new study. When we looked at aseptic revision as the endpoint, the survival for 195 men with primary osteoarthritis was 100 per cent at both ten years and14 years. With Jointmedica as a vehicle, we recruited a new Managing Director, changed the focus of the business and embarked on pulling together the infrastructure required to take on this new product development in an increasingly rigorous regulatory environment. We hope to publish on some specific case examples next year. DM: At the time of our first interview, highly crosslinked polyethylene had yet to establish itself as the bearing material of choice for use in primary total hip replacements. We are all aware of the significant change in relation to the world of metal-on-metal hip replacements and hip resurfacings, with several devices being withdrawn from the market or greatly restricted in their prescribed application. There turned out to be 502 patients in this group. OPN: What do you believe to be the optimal thickness of components for hip resurfacing? RT: Given the frequency of these custom-based referrals, we found ourselves disappointing several patients and interested surgeons with our inability to supply the custom implants more freely. They sign a specific consent form acknowledging these facts. OPN: Where do you see the hip resurfacing market going, will metal-on-metal make a comeback? At 13 years the survivorship for the under 55 males across all bearing types is 90 per cent. DM: Uncemented total hip replacement cups use a porous coated metal shell and a highly crosslinked polyethylene liner. As we have discussed, men in general perform well to 20 years with a metal-on-metal resurfacing. This month, Mengnai Li, MD, co-author of the September 18, 2019 “What’s New in Hip Replacement,” selected the five most clinically compelling findings from among the more than 100 studies summarized in the article. THA Dislocation We are being very circumspect with our introduction of this new technology. Hip replacement surgery (hip arthroplasty) has many benefits including relieving hip pain and restoring hip function. Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. Derek has identified some interesting findings in relation to female patients considering the potential effect of nickel sensitivity accumulated over time. Hip resurfacing history is tainted by numerous copycat devices that were rushed to market claiming equivalence, and in some cases, improvements to our original design. ( Log Out /  A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). RT: These devices have been employed in several useful settings where the use of a traditional total hip replacement would not be optimal in our practice, or in many cases accepted by the patients. 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