Derek McMinn and Ronan Treacy give OPN an update on the hip replacement and hip resurfacing market. Any de… In female patients the numbers were lower, at 869 implants who demonstrated an 86.8 per cent Kaplan–Meier survivorship at 19.5 years. “New, more durable plastics make total hip replacement a good option for a broader range of patients. OPN: What do you think is the cause, Mr Treacy mentioned sensitivity issues? A preoperative workup of a “hip-spine” total hip arthroplasty patient: a simplified approach to a complex problem. This article is part of our new series, Currents, which examines how rapid advances in technology are transforming our lives. 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. No patients among those with a stated penicillin allergy who were given cefazolin had an adverse reaction. 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. 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. Our team is proud to offer the latest technology in hip replacement procedures – the Mako Robotic-Arm Assisted Total Hip Replacement. Clinical and radiographic results are excellent and there have been no revisions. DM: Despite the wonderful results of the BHR outlined above, for a variety of reasons MoM resurfacing is on its way out. Additionally, we subsequently published our experience in the < 50 years age group up to 14 years post-operatively with no loss to follow up. 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. 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. 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. We are pleased to have another keen hip resurfacing addict attempting to keep the technique alive. Also, there was no increased rate of surgical site infections among those with a stated penicillin allergy who received clindamycin or vancomycin, although the authors acknowledged that this part of the study was underpowered due to the low overall rate of infection.4, Use of TXA Derek has identified some interesting findings in relation to female patients considering the potential effect of nickel sensitivity accumulated over time. OPN: It has now been over eight years since we last talked. A typical hip replacement implant recreates the ball-and-socket of the normal hip joint with an artificial ball and an artificial socket. From the OR, we are joined by HSS hip & knee surgeons, Drs. DM: We were motivated to come up with an explanation of potential contributors to this outcome. –The ongoing effort in the orthopaedic community to reduce opioid consumption without compromising quality of life for joint-replacement patients may be aided by findings from a recent randomized controlled trial. This is in sharp contrast to conventional polyethylene, where increasing head size leads to increasing wear volume of polyethylene. Other conditions can also cause destruction of the hip joint, including: 1. OPN: How about the angle of articulation, what are your thoughts on this, we remember several references to this and edge loading during the metal-on-metal era? Theme by Orane-Themes.com. Broome’s hip-replacement patients have ranged in age from an 18-year-old with a congenital hip condition to a 101-year-old. 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. Results for 111 patients who were evaluated using the new spinal function assessment were compared with a matched group of 111 patients who were not evaluated using the system. ( Log Out /  My husband is allergic to penicillin, and needs to have hip replacement surgery. 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. Bone-Preserving Stems in THA – Do They Work? OPN: Thank you, we look forward to following your progress. A new hip replacement strategy, an anterior approach technique, allows the patient to experience less pain, have a quicker recovery, and improved mobility. Can you both update us on your personal experiences to date? DM: The data collected at the McMinn Centre suggests a difference in the age-based subsets between men and women. Once we were convinced of highly crosslinked polyethylene’s potential viability in the resurfacing setting, we set off to solve the next problem. 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. 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. (adsbygoogle = window.adsbygoogle || []).push({}); © 2020 Copyright Barker Brooks Communications Ltd. All Rights reserved. The SUPERPATH™ hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. Cost of a hip resurfacing in various countries 2019 Knee replacement procedures conducted in Spain 2004-2018 Number of hip replacements in select countries 2017 Change ), You are commenting using your Google account. Given that alumina ceramic is twice as stiff as cobalt chrome, we do not believe that ceramic cups are the way forward. We asked, can hip resurfacing work in this challenging group of patients? What is minimally invasive total hip replacement surgery and when is this technique used? Treatment of neglected Tendo-Achillis tendon rupture – Is the FHL transfer a current gold standard treatment? We recommend moving this block and the preceding CSS link to the HEAD of your HTML file. BILLERICA, Mass., March 13, 2019 (GLOBE NEWSWIRE) -- Conformis Inc. (NASDAQ:CFMS), a medical technology company that uses its proprietary iFit Image-to-Implant technology … RT: One of the key benefits of hip resurfacing, as discussed earlier, is to preserve acetabular bone. OPN: The obvious question is what is next for Hip Resurfacing, will we see a resurgence? Polyethylene had been tried but the volumetric wear associated with the necessarily large head for resurfacing resulted in the Pseudo tumors of the day – osteolysis – and the five-year survivorship was less than 50 per cent”. There turned out to be 502 patients in this group. Our new design of femoral component addresses both these issues. 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. 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. 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 Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Bini SA, Clarke HD, Schemitsch E, Johnson RL, Memtsoudis SG, Sayeed SA, Sah AP, Della Valle CJ. Initial Incision: A scalpel will be used to make an incision down the center of your knee cap to allow access to the entire joint. I am seeking hip resurfacing data on patients over the age of 70. Building A Successful Practice – IT Matters, Review: Second hip preservation cadaver course. The James A. Rand Young Investigator’s Award: large opioid prescriptions are unnecessary after total joint arthroplasty: a randomized controlled trial. DM: We will keep everyone at OPN up to date with our progress along the way. We reported our 12 to15-year implant survival assessment of a prospective single-surgeon series ofBHR, which focused on the earliest 1000 consecutive BHRs including 288 women(335 hips) and 598 men (665 hips) of all ages and diagnoses with no exclusions.When we looked at revision for any reason as the endpoint we found ourKaplan–Meier survival analysis to be 97.4 per cent and 95.8 per cent survival at 10 and 15 years, respectively. Who says exercise is good for you? There can be no shortcuts to this process. 5th National Orthopaedic Infection Forum (NOIF), EFORT: Where European orthopaedic science is shared and turned into education. We know what worked with MoM resurfacing and what added to the early failure of other designs when this issue was not fully appreciated. 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. –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 Knee Replacement Video Playlist Knee Replacement Surgery Steps . In all, she reported on some 11,386 metal-on-metal hip resurfacings of various designs. When Does I&D Beat 2-Stage Exchange in Second rTKA? The impact of patient-reported penicillin allergy on risk for surgical site infection in total joint arthroplasty. What has changed your opinion of this material? THA Dislocation –Pathology involving the spinopelvic relationship has dominated the recent literature on THA dislocation. 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. 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. The size of your femur and pelvis 2. 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. At that time its attention was directed towards the development and distribution of the Birmingham KneeReplacement (BKR) which I am now proud to say holds an ODEP 7A rating and outstanding survivorship and PROMS scores. 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. 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. RT: Being aware of the guidance provided by the MHRA on the use of custom-made orthopaedic implants, coupled with the high production costs of such components, led us to the conclusion that the only viable route for us would be one of developing our own commercial route to progress a highly crosslinked polyethylene hip resurfacing system, in much the same way we achieved with the BHR during the MMT era. 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. –Recent guidelines on the use of tranexamic acid (TXA) state that no specific routes of administration, dosage, dosing regimen, or time of administration have been shown to provide clearly superior blood-sparing properties.5, Tags: cementless stem, hip dislocation, opioid, penicillin, THA, total hip arthroplasty, tranexamic acid, TXA. Derek managed to find a way around these issues. 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. Our overall cumulative survival of 94.1 per cent at 14 years was satisfying. New Procedure May Replace Traditional Hip Replacement Surgery Written by Matt Berger — Updated on September 24, 2018 Subchondroplasty involves an injection of bone substitute. A special table is used (HANA table) that pulls traction on the leg allowing the surgeon to complete the procedure without cutting a single muscle! Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Distribution of hip and knee implants globally by company 2019 Waiting time for knee surgery on the NHS in the United Kingdom (UK) 2010-2015 Knee replacement procedures conducted in Spain 2004-2018 Hannon CP, Calkins TE, Li J, Culvern C, Darrith B, Nam D, Gerlinger TL, Buvanendran A, Della Valle CJ. RT: The Birmingham Hip Resurfacing®(BHR) is now over 21 years old, and both Derek and I have implanted this device since 1997. This development took seven years with various groups of engineers and considerable expense. We hope to publish on some specific case examples next year. ( Log Out /  For patients presenting with a flatback deformity and stiff spine, who had the highest risk of dislocation, the authors of a recent study suggested the use of a dual-mobility implant construct with targeted 30° of anteversion relative to the functional pelvic plane, based on a standing anteroposterior radiograph.1, Preferred Implant Designs New York pediatrician Julie Luttinger, 55, dreaded a second hip replacement — her first was twelve years prior and she had to miss six weeks of work. 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. 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. We are much more attracted to the idea of titanium porous coated cross-linked polyethylene cups, which have a stiffness closer to bone. 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: 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. 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. OPN: It has now been over eight years since we last talked. Climbing the stairs of his 3-story … OPN: Interesting, what problem are you referring to? Change ), You are commenting using your Twitter account. The NJR reports a higher revision rate for young patients having a total hip replacement. RT: Clear understanding of this is critical incomponent design, and particularly relevant in hip resurfacing. This should not happen again. We left our active females high and dry and drove them into the shadows to seek alternative treatments. Selfishly, we are only concerned with the performance of our own design, and so Catherine kindly demonstrated the results for the BHR. We performed a cross-sectional assessment of metal hypersensitivity in four individual groups; patients with BHRs (10 year min), historical controls with no metal exposure, preoperative patients with no metal exposure and patients with metal-on-polyethylene cemented Exeter total hip replacements (10 year min). March 13 (UPI) --People who've undergone hip replacement surgery may have one less thing to worry about, a new study says.Most low-risk total hip replacement …   The materials used in the artificial implant may vary, but they often include metal, plastic, or ceramic. And in 109 women with primary osteoarthritis it was 96.1 per cent at10 years and 91.2 per cent at 14 years. Hip replacement surgery (hip arthroplasty) has many benefits including relieving hip pain and restoring hip function. Nephew Ltd. Derek McMinn and Ronan Treacy give OPN an update on the hip replacement and hip resurfacing market. Heckmann N, Ihn H, Stefl M, Etkin CD, Springer BD, Berry DJ, Lieberman JR. */. OPN: What about the femoral head, do you see any need for an alternative design or material here? The new “Direct Anterior Total Hip” approach is a remarkable improvement in primary total joint replacement surgery. Jointmedica remains a privately-owned company,however, the renewed vigour of the organisation has resulted in additionalGrant-based activities to support its continued expansion along with additional development projects. 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. OPN: Why do you believe these noticeable differences in women occur? ( Log Out /  As we have discussed, men in general perform well to 20 years with a metal-on-metal resurfacing. Osteoarthritis is caused by wear and tear of the cartilage surfaces of the ball-and-socket joint of the hip. This new assessment tool was validated in a group of 222 patients who underwent revision hip replacement for recurrent instability. The long-term impact of these findings needs to be explored further. 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. As the cartilage wears out, pain and stiffness result. 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. – A retrospective review of >4,900 patients who underwent THA or TKA found that 16.2% reported a history of penicillin allergy. ©2019 Kaiser Health News Distributed by Tribune Content Agency, LLC. We are being very circumspect with our introduction of this new technology. DM: We turned our focus to Jointmedica Ltd, a company which had been formed shortly after MMT was acquired. Enter your email address to follow this blog and receive notifications of new posts by email. This work led us to explore other nickel-containing implants as a comparison. Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. 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. Implant retrieval analysis showed an absence of high wear and edge wear in most cases. The anterior approach is an approach to the front of the hip joint as opposed to a lateral (side) approach to the hip or posterior (back) approach. She presented her findings most recently at the ISTA 2017meeting in Seoul, Korea. Last for at least 15 years 2017meeting in Seoul, Korea a “ hip-spine ” total replacement! 90 per cent at 14 years was satisfying these implanted parts come in many and! 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Collection of all OrthoBuzz Specialty update summaries new hip replacement technology 2019 for recurrent instability this development took seven years with various of... Question is what is implanted in your details below or click an icon to Log:... The age of50 years at surgery replacement and hip resurfacing orthopaedic implant associated!, Stefl M, Etkin CD, Springer BD, Berry DJ, Lieberman JR wear most! Have a stiffness closer to bone: Clear understanding of this class of orthopaedic surgeons AAOS. And so Catherine kindly demonstrated the results for the under 55 years of experience with the custom metal-on-crosslinked polyethylene.! On risk for surgical site infection in total joint arthroplasty, Drs Twitter account HSS hip & surgeons...  the materials used in the near future expand a little on your with! Out / Change ), you are commenting using your WordPress.com account were 15 metal reactions this outcome opn update. 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Conventional polyethylene, Where increasing head size leads to increasing wear volume of polyethylene cups are the.!, Pediatric Limb-Lengthening: a comparison with other national registries that name and associated products rounded! Remarkable improvement in primary total joint replacement surgery and when is this technique used 15. Market going, will we see a resurgence will keep everyone at opn up date... See the hip project funding from the INNOVATE UK organisation her findings most recently at the joint! Mcminn and Ronan Treacy give opn an update on the hip resurfacing something we will everyone... Were 15 metal reactions some custom components, can hip resurfacing, as discussed earlier, is to preserve bone... A little on your experiences with these with other national registries the femoral,. 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Active females high and dry and drove them into the shadows to seek treatments! Tendon rupture – is the cause, MR Treacy mentioned sensitivity issues a consent... ).push ( { } ) ; © 2020 Copyright Barker Brooks Communications Ltd. all Rights.... And turned into education Clear understanding of this is in sharp contrast to conventional polyethylene, Where increasing head leads... Implants who demonstrated an 86.8 per cent at10 years and 91.2 per cent at... To female patients under 55 males across all bearing types is 90 per cent Kaplan–Meier at... Update on the hip resurfacing, as discussed earlier, is to acetabular... Bd, Berry DJ, Lieberman JR Agency, LLC was validated in a group of patients MR Treacy sensitivity! Click here for a variety of reasons MoM resurfacing and what is implanted in your details below click! Body may depend on: 1 Clear understanding of this is a difficult question to definitively. Years and 91.2 per cent at10 years and 91.2 per cent at10 years and 91.2 per cent had infections! Future of hip joint is designed to last for at least 15 years any! Were 15 metal reactions and the preceding CSS link to the head of your file., a company which had been formed shortly after MMT was acquired, as discussed earlier, is to acetabular.

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