In the past, the excellent early and middle-terms results after the mould arthroplasty of Smith-Petersen provided a significant popularity. Later, this technique faded in oblivion. After that the Wagner cup arthroplasty came to the podium followed by a new disappointment . Are we witnesses of a real renaissance or this is the repeating ondulation curve of success and failure of a technique ?
Birmingham Resurfacing Hip is the one that has the best results. Personally I performed a number of ASR's that has been proven a very bad choice as they were those that triggered the MoM debris and had a very high failure and revision rate. I had revised all and few, thank God, of the patients developed ALVAL. The longest survivorship of these were 30 months before revision. Very bad choice.......
Thank you, George, for your post. Meanwhile, I read an interesting news about a cup arthroplasty performed in 1948 on an English patient that survived 66 years. The patient is considered to be the one with longing lasting hip replacement and has got a Guinness Record Certificate. It is really nice to hear someting like that.
http://www.bbc.com/news/uk-england-bristol-35882053?SThisFB
This is why we perform the operations, my dear Panayot. We hope to give better quality of life. The problem is that sometimes and this is the most common result we are not so successful as Mr Newman was for his patient. This is the pity and this has to follow us for the years to come.
Of course the case described is a rare one. The majority of the cup arthroplasty cases have had poor results in a few years. Many times im my long professional road I have been convinced that the biological answer of the individual patient may be different. For example, sometimes patients with osteoporotic bones have done well a long period of time without need for revision and independently from the endoprosthesis type.
Dear Panayot you are so right. Biology is greater than the things we grasp. So I agree fully with you and point out that our scientific arrogance sometomes is our greater enemy. So I have burn myself with the MoM and feel so sorry about the inconvenience and sorrow I created to other people.
You may find this article useful:
http://www.ncbi.nlm.nih.gov/pubmed/25708400
Metal on metal hip resurfacing has its well defined role in select population. As concluded in above stated article- "There remains a role for MoM HR in young active male patients with primary osteoarthritis, provided the surgeon has sufficient experience in the procedure, the implant has an established record, and the patient is aware of the potential risks associated with MoM bearings and HR."
I definitely agree with George that it is our community's scientific arrogance that extended the indications for hip resurfacing leading to disastrous results in cases with extended indications and poor implant design (ASR).
I am not in general an advocate of MOM THA. However, one surgeon, Harlan Amstutz MD has a long and successful personal record in design of a MOM resurfacing system and its clinical use A key 2012 paper of his is attached. You can of course find more by googling e.g. harlan amstutz hip resurfacing.
Metal on metal does not work.
It didn't work in the 70s so why should it work now.
Fortunately I did not put any in.
Dr. Hope, I agree entirely with you. We may refer to the debate on the prosthesis of McKee and that of Charnley in the 70s. I do not understand the rediscovery of MoM prosthesis. I wonder to what extent it is linked to firma-based influence. I also did not implant any MoMs.
Probably worth differentiating between conventional MOM and resurfacing (stemless) designs, like that developed and used for decades by Amstutz. The interface geometries are entirely different, and that may help explain why Amstutz has had success. However, I think the Amstutz experience is an outlier and that MOM is to be avoided in general.
The hip resurfacing had gone into disrepute because of wrong and extended indications for which it was used like for AVN, Inflammatory arthritis etc. The true and the only indication for this procedure could be Primary OA of the hip, where the bone bed is vascular and strong to hold the prosthesis and being all the stresses. Moreover, the technique to resurfacing has very little margin of error and hence it is not a suitable surgery for a low volume or occasional surgeons.
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