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On Tue, 14 Feb 2012 07:27:19 +0530 (IST), hemant purohit <...@yahoo.com
Hi dear,
it is very sad to know that you have AVN in both the hips I also had AVN I went under the surgery when I was 27 now I am 31 four years passed.
I am very fine and I believe AVN is complex and you need a very intelligent surgeon. my surgeon was Dr. Bose he is expert in AVN cases and he has world record in dealing with AVN patients I believe.
he gives free consultancy over email. you can get his consultancy also for free. Good luck.
Hemant
--- On Sun, 29/1/12, elizannmarieb <...@yahoo.com
From: elizannmarieb <...@yahoo.comSubject: [surfacehippy] Need Advice From Young Adults Who Have Had Hip Resurfacing (25yrs or younger)
To: surf...@yahoogroups.com
Date: Sunday, 29 January, 2012, 6:50 AM
I am having hip resurfacing surgery in less than a month on my left hip and am only 20 years old. I'd like to know how the experience was undergoing hip resurfacing at such a young age, current activity level now, outcome, ect. Some of my major concerns are still being limited in exercise/activity after surgery because of the fear that my implant will wear faster.
For some background: I am a female, 20 yrs old and I have AVN in both hips caused by side effects of chemotheraphy (my right hip is currently at stage 1, left hip has collapsed a little). A year and a half ago I had a CORE Decompression in both hips, and a screw placed in my left femoral head because it had collapsed some. I've decided that the pain and limited activity have very negatively affected my quality of life to the point where I need a joint replacement. My doctor is one of the leading Pediatric Orthopaedic Oncology Surgeons at the University of Minnesota.
Thank you all very much :)
-elizannmarie
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On Mon, 13 Feb 2012 20:20:54 -0700, Amy Stengel <...@gmail.com
elizannmarie,
HOw many hip resurfacing surgeries has your surgeon done? I am sure he is
a great pediatric orthopedic oncologist but that is far less important than
whether he is an experienced hip resurfacing surgeon. At your age, you
really want to go to one of the best surgeons available who has done
hopefully hundreds of resurfacing surgeries. You need this to last you many
many years and it is not worth staying local for your surgery if you cannot
have it with someone with lots of experience. People on this site can help
you find a more experienced surgeon near you.
Good luck!
Amy
On Mon, Feb 13, 2012 at 6:57 PM, hemant purohit
<...@yahoo.com
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On Tue, 14 Feb 2012 05:31:10 -0000, "elizannmarieb" <...@yahoo.com
He is an expert in his field, and unfortunately I have reconsidered hip resurfacing surgery for a total hip replacement. I do have a screw in the afflicted hip, and the position of it would greatly increase my chances for the neck of my femor to break (and the fact that I'm a young female would already make those chances high).
I do have to say though my surgeon was recommended by my oncologist (who is head of Pediatric Oncology at Amplatz Childrens Hospital) and that I was a bit put off that I got less advice about surgical experiences than to examine who my surgeon is. In my case I fully trust him, so if I didn't I would have asked about finding a different doctor.
Thank you for your reply.
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On Tue, 14 Feb 2012 08:15:06 -0800, Moseman Don <...@aol.com
Elizannmarie:
Have you sent your x-rays to Vicky Marlow? She has worked with some of the world's best surgeons over the past several years and is able to pass on your x-rays and, quite quickly (on the order of days) get a preliminary consultation/ review of your case. Always helps tohave a second or third opinion, especially if your case is not the "norm." Just curious, how many hip resurfacings has your surgeon done (both total and how many per month for the last year)? Also, have they published the results of their surgeries (i.e. how many successes and failures)? Take care and best of luck to you in your decision. :)
Don
Nothing yet but awfully close
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On Tue, 14 Feb 2012 09:46:54 -0700, Amy Stengel <...@gmail.com
Elizannmarie,
I did not mean to sound rude or dismissive about your surgeon but I am
just trying to offer a suggestion based on the fact that you are very young
and deserve to have the best possible chance at an active life. I know that
Dr. Gross in South Carolina has done a number of young patients in their
20s and even teens and has also performed resurfacing on people with pins
in their femurs. Before you make what is undoubtedly a life-altering
decision I would highly suggest you consider at least getting more opinions
from the top resurfacing surgeons. Just because you are a young female does
not mean that you won't have an excellent result with resurfacing. There
are many women on this site who have had great results.
Good luck in whatever you choose.
On Tue, Feb 14, 2012 at 9:15 AM, Moseman Don <...@aol.com
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On Sun, 29 Jan 2012 11:13:25 -0500, "Jennifer Bolan" <...@embarqmail.com
Here is a yahoo message group that I would post this question to as well:
Hipr...@yahoogroups.com. I have found this group enormously
helpful as well. Please, please, please be very careful on whom you choose
to do the resurfacing and which device is being used. It will make all the
difference in your future. I would post on
Hipr...@yahoogroups.com the name of the surgeon you have your
resurfacing scheduled with. Here is a site that helped me greatly
http://www.hipresurfacingsite.com/ you can ask Vicky anything. She is a
wealth of information. I just had mine done 1.21.12 by Dr. Su at Hospital
for Special Surgery in New York http://www.edwinsu.com/
He is one of the top resurfacing doctors in the nation. Hospital for
Special Surgery is the number one orthopedic hospital in the nation. Do not
pick your doctor based on convenience.
The best of luck to you!
Jennifer
From: surf...@yahoogroups.com [mai...@yahoogroups.com] On
Behalf Of elizannmarieb
Sent: Sunday, January 29, 2012 1:51 AM
To: surf...@yahoogroups.com
Subject: [surfacehippy] Need Advice From Young Adults Who Have Had Hip
Resurfacing (25yrs or younger)
I am having hip resurfacing surgery in less than a month on my left hip and
am only 20 years old. I'd like to know how the experience was undergoing hip
resurfacing at such a young age, current activity level now, outcome, ect.
Some of my major concerns are still being limited in exercise/activity after
surgery because of the fear that my implant will wear faster.
For some background: I am a female, 20 yrs old and I have AVN in both hips
caused by side effects of chemotheraphy (my right hip is currently at stage
1, left hip has collapsed a little). A year and a half ago I had a CORE
Decompression in both hips, and a screw placed in my left femoral head
because it had collapsed some. I've decided that the pain and limited
activity have very negatively affected my quality of life to the point where
I need a joint replacement. My doctor is one of the leading Pediatric
Orthopaedic Oncology Surgeons at the University of Minnesota.
Thank you all very much :)
-elizannmarie
[Non-text portions of this message have been removed]
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On Tue, 14 Feb 2012 05:41:40 -0000, "elizannmarieb" <...@yahoo.com
Thank you for your reply.
I trust my doctor fully, he was recommended by my oncologist. That is not neccessarily the advice I was looking for, but the experience of hip resurfacing surgery. I understand the concern though.
I have decided to have a total hip replacement rather than hip resurfacing (I have a screw in the afflicted hip that would increase the risk of the neck of the femur breaking). I've posted my situation onto the Total_Joint_Replacement board and they have responded well.
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On Sun, 19 Feb 2012 01:45:27 -0000, "vitreophile2" <...@yahoo.com
Best wishes to you. Please understand that this is a controversial Topic.
1.This site has had the greatest number of patients with hip resurfacing, and the members who have had the procedure with good results have moved on with their lives. As members have moved on, new persons are now choosing among various other groups which have breen organized by former members here.
2. Two former members have developed data base sites, often with postings initially extracted from here. Those individuals are well meaning , but have strong personal points of view. One has developed a discussion group where as moderator, that point of view is not contested.
3. Several of the Total Hip Replacement groups are strongly opposed to resurfacing, and thus are quite biased.
4. One of the main reasons that Metal-on-metal resurfacing was developed, and the same alloys used for some total hip replacements, was because of the failure of Total hips, and resurfawing with plastic liners. The debris from the plastic wear caused failures because of foreign body reaction, and resorption of surrounding bone. This was much more common than the same process is today with M-O-M devices.
5. Also Total hips were avoided in young persons, because of faiure requiring replacement 3-4 times in a persons life. Total hips were not originally designed for young active persons. There are many young persons who have had BHR placement (The earliest device) lasting more than 15-20 years. THRS cause localisd osteoporosis, due to stress at the tip of the intramedullary portion (the femoral shaft) This is a common cause of fracture and early failure. It is much harder to fix. I have seen this many times in my Diagnostic Radiologist career.
6. there are political divisions amoung orthopedists, often the older ones who don't want to try new things. Some teaching programs run by these individuals have refused to allow the new devices to be used.
7. The surgeons who were early adopters, and their trainees are the most experienced, and had the best success.
8. I had my C+ left hip done as part of the Clinoical trial at age 58, 3/31/03. I was back to work in a few weeks, skiing at 11 months & no problems at almost 9 years.
Resurfacing is probably your best bet, it can be revised to a THR many years later if necessary. It won't be recommended by a surgeon, no matter how talented, if he hasn't had much experience with it.
Michael (MD in NC) (L) C+ 3/31/03
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On Sun, 19 Feb 2012 03:32:16 -0000, "ruthz2006" <...@sbcglobal.net
Hello Michael:
I appreciate your post. I would like to respond to several statements below.
Statement #2. Yes, it is true that each of us has a personal point of view - hopefully that is a valid, defensible one, formed by knowledge and experience gained in the particular subject in question. I believe this to be true in the case of one other hip resurfacing patient support group. I was a recipient of that knowledge and am grateful for it.
Statement #3. You are right about some sites being very anti-resurfacing. That is not helpful and presents a skewed viewpoint. This applies also to sites that are very anti-THR. In some cases, a THR is the better choice for a certain person contemplating hip surgery. My young nephew did not have a choice. Due to a catastrophic injury, he had to have a ceramic on ceramic THR. Is he unhappy with the result? No.
Statement #4. There are many instances of metal particles being shed in incorrectly placed MoM devices. These particles cause damage to surrounding tissue and bone and are a direct cause of early failure, just as in the case of shedding of plastic particles with some THR components. We know that resurfacing is not an easy surgical procedure to get "right". Component placement is crucial. I consulted with several surgeons, when researching options for my revisions. All said the same thing - it is easier to "get it right" with a THR than with a resurfacing. My bilateral acetabular cup failures at 5 1/2 years out are a direct result of this. I understand from others who have had the same type of failure and from studies I have read, that this is not as rare an occurance as one might hope it to be. For those of us who have had revisions to some form of THR, it is helpful to know that there are many people with THR's who also have had 15-20 problem-free years with their devices.
I am not advocating a young person reject considering resurfacing. I am hoping only to add another view point to this discussion.
Ruth Z
Dr. Su bilateral revisions to Stryker Dual Mobility 10/13/2011
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On Sun, 19 Feb 2012 06:10:01 -0000, "elizannmarieb" <...@yahoo.com
Thank you for your points on the opinions of the forums.
I was given both options (THR and Hip Resurfacing) by my surgeon.
However I was strongly advised against Hip Resurfacing for several
reasons.
1. The metal ions released from the implant can cause problems with
fertility for females.
2. I have a screw placed in the effected hip that would increase the
risk of the neck of the femur breaking (added onto the risk females
already carry for the neck breaking). It goes from the bottom of the
neck on the outer part of my femur up into the femoral head.
3. The AVN has effected a large amount of my femoral head, causing very
little left of healthy bone to be left if they were to cut away the
diseased bone for a resurfacing. This would also increase the risk for
the neck of the femur to break.
I do trust my surgeon because he is a Pediatric Orthopedic surgeon,
which reflects his experience with my age range. I'm thinking that is
why there is substantial debate between this thread, because most of the
members of joint replacement (any type) threads are within the adult
category. My situation is a little bit different that is why I was
looking primarily for experiences of others post surgery.
--- In surf...@yahoogroups.com, "vitreophile2" <...@...wrote:
Topic.
resurfacing, and the members who have had the procedure with good
results have moved on with their lives. As members have moved on, new
persons are now choosing among various other groups which have breen
organized by former members here.
postings initially extracted from here. Those individuals are well
meaning , but have strong personal points of view. One has developed a
discussion group where as moderator, that point of view is not
contested.
to resurfacing, and thus are quite biased.
developed, and the same alloys used for some total hip replacements,
was because of the failure of Total hips, and resurfawing with plastic
liners. The debris from the plastic wear caused failures because of
foreign body reaction, and resorption of surrounding bone. This was
much more common than the same process is today with M-O-M devices.
requiring replacement 3-4 times in a persons life. Total hips were not
originally designed for young active persons. There are many young
persons who have had BHR placement (The earliest device) lasting more
than 15-20 years. THRS cause localisd osteoporosis, due to stress at
the tip of the intramedullary portion (the femoral shaft) This is a
common cause of fracture and early failure. It is much harder to fix.
I have seen this many times in my Diagnostic Radiologist career.
ones who don't want to try new things. Some teaching programs run by
these individuals have refused to allow the new devices to be used.
most experienced, and had the best success.
58, 3/31/03. I was back to work in a few weeks, skiing at 11 months &
no problems at almost 9 years.
years later if necessary. It won't be recommended by a surgeon, no
matter how talented, if he hasn't had much experience with it.
wrote:
is not neccessarily the advice I was looking for, but the experience of
hip resurfacing surgery. I understand the concern though.
resurfacing (I have a screw in the afflicted hip that would increase the
risk of the neck of the femur breaking). I've posted my situation onto
the Total_Joint_Replacement board and they have responded well.
<jenniferbolan@as well:
enormously
you choose
all the
have your
She is a
Hospital
Hospital for
nation. Do not
[mai...@yahoogroups.com] On
Hip
left hip and
undergoing hip
outcome, ect.
exercise/activity after
both hips
at stage
CORE
head
limited
point where
Pediatric
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On Sun, 19 Feb 2012 07:38:44 -0000, "vitreophile2" <...@yahoo.com
Hi,
Obviously you trust your surgeon. The main point I question is #1. There is no evidence of fertility problems related to the metal ions. In fact, most people don't have metallosis, foreign body reactions, or even elevated Chromium levels after the 1st 2 years. No Medical procedure is without risk, and the failure rate for THR in young persons is not better overal than for the M-O-M resurfacing products not subject to overall recall.
The FDA has decided to ask for long term followup for many devices, and drugs because of recent episodes in which approved products have been found to have problems not orriginally thought to be of consequence.
Some manufacturers use the same metal alloys for THR & resurfacing prostheses. I have been a member of this group since 2002. Over the years we have had postings fromm many young men & women who have had this procedure, with excellent re4sults. I recall one in particular who had a BHR in Great Britain, and has had 3 children since then. When she last posted she was stll riding horses, & had no revision at least 15 years later.
anecdotes alone are meaningless. I would like to see the scientific peer reviewed published paper which indictes any fertility problems.
It happens that 95% of on line group members are lurkers who don't post. After more than 10 years, most of the memberts of this group rarely look here. I myself only look every 4-6 weeks, and rarely post anymore. Some people have been driven away by some very vitrolic flaming.
Thus the most active members are those who are now looking for information prior to surgery, and some who may return due to failures, and revisions. I know that you have "made your decision", but I think that you might ask how many resurfacing procedures your surgeon has actually performed. If it's less than 100 I would definitely get an opinion & review of your images by an experiened resufacing physician.
The "screw" you describe sounds like a pin placed through the Greater trochanter, and femoral neck into the Femoral head to stabilize a fracture. The images would have to be reviewed by an experienced resurfacing surgeon to formulate an opinion. Cyst formation copuld in fact rule out resurfacing depending upon the size & location.
It's true that small framed women are at greater risk of neck fracture, but youger women who don't have osteoporosis are somewhat lesser risk. If you have a THR, the fermoral head & neck are no longer present. The range of motion of a THR is less than with resurfacing, and dislocation is more common, after a THR. Once the THR has been performed you can't go back again.
Bestb wishes,
Michael (MD in NC) (L) C+ 3/31/03.
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On Sun, 19 Feb 2012 06:28:03 -0800, Moseman Don <...@aol.com
Elizannmarie:
I agree with Michael on point #1. From what I've read the past few years, the primary reason for high metal ion levels is installation of the resurfacing device at an incorrect angle (i.e., surgeon error). If you get a very good surgeon, installation angle shouldn't be a source of high blood metal ion levels. As Michael mentioned, there is a young lady who just celebrated her 20th anniversary with her resurfacing device. I believe she was quite young as well when she had her resurfacing. I think her name is Katie though others on the group can correct me if I'm wrong and hopefully direct you to her. Others on the group are most definitely of child bearing age and I'd hope that they can respond as to how the dealt with your concern of potentially affecting your newborn with high metal ions levels.
#2: I can't comment on the screw in your affected hip except to say you should get the opinion of at least a few very highly regarded surgeons (preferably that do both resurfacing and total hip replacement (THRs)). May I ask in what part of the world you live?
#3: The AVN could affect your ability to have enough viable bone in your femoral head for adequate/ strong placement of the femoral component (cap) upon your femoral head. So, I can see why your surgeon would be giving serious consideration to a THR. However, I've read post after post wherein the surgeon is not entirely sure of the extent, or lack thereof, of damage until they actually open us up, lay eyes on our femoral head and start to ream its surface for device placement. So, they go with the approach that they will decide upon the device type (i.e., THR or resurfacing) once they open us up and can see/ touch the femoral head to gauge whether it has the integrity to handle resurfacing or whether they need to remove it and install a THR. Michael - As a Radiologist, I'd be real curious as to your take on this comment as I was a bit surprised that, with the various imaging methods available that surgeons are still "surprised" to see the amount of damage they do when opening us up. The surgeon's "surprise" indicates to me either limitations in the imaging techniques, the imaging technician, or their own inability to request appropriate images/ image type.
Regarding your trust of your pediatric orthopedic surgeon, I can understand how you/ we would trust doctor's with which we are familiar. However, the most important criterial to consider for the surgeon that is to perform your surgery is how many of these specific types of surgeries have they performed successfully (i.e. total and how many per month) and that their numbers be backed up by retrospective studies on their part (i.e., what percent of their patients have to come back later to have their surgery redone (revised)) and whose device are they using (i.e., look for published, peer reviewed articles comparing how long these devices are lasting). High numbers alone definitely don't tell the whole story which is why groups like these are so important for prospective patients like us.
It took me almost 16 months and several surgical consults to feel like I had a solid plan..a path forward. So, I know it's not easy. All I can say is read, read, read.....get a few more surgical consults from very strong surgeons and best of luck to you in your decision. Take care and keep posting. :)
Don
Nothing yet but awfully close
=======================
Elizannmarie's Previous Post
=======================
Thank you for your points on the opinions of the forums.
I was given both options (THR and Hip Resurfacing) by my surgeon.
However I was strongly advised against Hip Resurfacing for several
reasons.
1. The metal ions released from the implant can cause problems with
fertility for females.
2. I have a screw placed in the effected hip that would increase the
risk of the neck of the femur breaking (added onto the risk females
already carry for the neck breaking). It goes from the bottom of the
neck on the outer part of my femur up into the femoral head.
3. The AVN has effected a large amount of my femoral head, causing very
little left of healthy bone to be left if they were to cut away the
diseased bone for a resurfacing. This would also increase the risk for
the neck of the femur to break.
I do trust my surgeon because he is a Pediatric Orthopedic surgeon,
which reflects his experience with my age range. I'm thinking that is
why there is substantial debate between this thread, because most of the
members of joint replacement (any type) threads are within the adult
category. My situation is a little bit different that is why I was
looking primarily for experiences of others post surgery.
=======================
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On Sun, 19 Feb 2012 14:31:07 -0000, "ruthz2006" <...@sbcglobal.net
Michael:
With my Stryker Dual Mobility, I have a design range of motion that exceeds my former resurfacing components, and I have an extremely low chance of dislocation. If you go the the website for this device, you'll see the specs.
I am allowed to go back to full splits both front and middle and all other dancing activities, with no restrictions.
I just thought you would like to know things are not all that grim for those of us post-resurfacing.
I do agree there is no risk to fertility with any MoM device.
Ruth Z
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On Sun, 19 Feb 2012 21:14:43 +0000, Michelle Steffen <...@hotmail.com
I"d like to concur. My ROM was no different after my THRs than it was before my hips started to go south. I also have a very low risk of dislocation due to choice of prosthesis.
To: surf...@yahoogroups.com
From: kenr...@sbcglobal.net
Date: Sun, 19 Feb 2012 14:31:07 +0000
Subject: [surfacehippy] Re: Need Advice From Young Adults Who Have Had Hip Resurfacing (25yrs or younger)
Michael:
With my Stryker Dual Mobility, I have a design range of motion that exceeds my former resurfacing components, and I have an extremely low chance of dislocation. If you go the the website for this device, you'll see the specs.
I am allowed to go back to full splits both front and middle and all other dancing activities, with no restrictions.
I just thought you would like to know things are not all that grim for those of us post-resurfacing.
I do agree there is no risk to fertility with any MoM device.
Ruth Z
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On Sun, 19 Feb 2012 15:30:48 -0700, Amy Stengel <...@gmail.com
I want to jump in here and add a few comments to the discussion. I don't
think anyone is trying to sound critical or dismissive of THRs - I believe
most of the members on this forum acknowledge that THRs have come a long
way in the last ten years and that in many instances they are performing as
well as HR in certain patients.
I wanted first to respond to the statement from the pediatric surgeon that
hip resurfacing is linked to fertility problems in young women. As the
others said, this is simply not true. You will not find a shred of evidence
out there supporting this claim. There haven't been any studies related to
fertility and metal ions but that is because until recently there have not
been that many younger females who have undergone resurfacing. There is a
theoretical *risk* that metal ions could cross the placenta in a pregnant
women and there is no information on the impact this might have on a
developing fetus. However, there are now many women who have gone unto have
babies after resurfacing - in Europe and the UK more than in the States. I
looked into this issue extensively because I am still child-bearing age
(36) and I may decide at some point to have another biological child. I was
told to wait 18 months - 2 years to allow the metal ions to stabilize.
Again, as you will hear over and over, if your implant is placed properly
by an experienced surgeon, there should not be an issue with high metal
ions. It sounds as if you have already made up your mind but I felt it
necessary to correct this incorrect statement in regards to fertility and
resurfacing. It is simply not true.
I believe I mentioned in an earlier post that there are a number of people
who have had pins in their femurs from accidents, trauma, etc and have
still been able to have resurfacing. I know that Dr. Gross has worked on a
handful of patients like this who were able to have successful resurfacing.
You may have already made up your mind but if I were your age I would
definitely get a few more opinions from other surgeons before proceeding
with a THR. I've learned the hard way with prior surgeries that it is never
safe to rely solely on one doctor's opinion - things can end quite badly.
Always get more than one if not 3 or 4 opinions.
It sounds like the issue with your femoral head and the AVN is the most
likely reason why you may not be a candidate for resurfacing. This may be
the case but I would still encourage you to get some more opinions.
On Sun, Feb 19, 2012 at 2:14 PM, Michelle Steffen <...@hotmail.com
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On Sun, 19 Feb 2012 23:20:18 -0000, "ruthz2006" <...@sbcglobal.net
Hi Amy:
This statement in a previous post is what I was responding to:
"The range of motion of a THR is less than with resurfacing, and dislocation is more common, after a THR".
We can't make good decisions when we are working with incomplete or outdated information, and it is a really good thing that there are so many options available now, for people facing hip surgery.
Thanks for your kind words.
Happy dancing,
Ruth Z
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On Mon, 20 Feb 2012 02:53:58 -0000, "vitreophile2" <...@yahoo.com
Hi Ruth, I changed the heading because this complex subject is heading
in a new direction.
It is impossible to discuss the huge range of devices which have been
introduced, just in the field of hip joint surgery. There is no one
perfect device (Even our native hips have failed). My comments were
refering to the most commonly used THR type which are of simple designs.
I have seen many Bipolar THR designs, which were meant to reduce the
problems of mobility and dislocation. Your device is an uncommon
tripolar design, which is not the usual 1st choice, but is an excellent
solution to unual anatomy, the unexpected failure of other devices, or
surgical complications. It is wonderful that this was available to
return your life to you, after the unfortunate failure of your
resurfacing devices. I appreciate your point that there is much more to
offer if , and when our resurfaced hips much be revised or replaced. .
This is the goal of everyone here. Every patient is a unique situation
as I have learned in my (is it possible?) over 40 years as a practicing
diagnostic radiologist. There is no such thing as "State of the
art", or ultimate in anything. Things evolve slowly, some old ways are
abandoned. I am including 3 of many articles I reviewd about the
tripolar devies like the one which has worked well for you. There are
technical failures, and complications as with all devices, but things
are inproving. I included links so that the images of this design can
be view by anyone here with interest.
Best wishes, ( Michael MD in NC) (L) C+ 3/31/2003
Here is a link to the article below so that the appearance of the
TRI-Polar device is evident. I cant post images here.
http://www.springerlink.com/content/j8h8874401654046/
<http://www.springerlink.com/content/j8h8874401654046/
Clinical Orthopaedics and Related Research®
<file:///content/0009-921x/
Volume 467, Number 2, 465-472, DOI: 10.1007/s11999-008-0476-0
Unconstrained tripolar hip implants provide an additional bearing using
a mobile polyethylene component between the prosthetic head and the
outer metal shell. Such a design increases the effective head diameter
and therefore is an attractive option in challenging situations of
unstable total hip arthroplasties. We report our experience with 54
patients treated using this dual mobility implant in such situations. We
ascertained its ability to restore and maintain stability, and examined
component loosening and component failure. At a minimum followup of 2.2
years (mean, 4 years; range, 2.26.8 years), one hip had
redislocated 2 months postoperatively and was managed successfully
without reoperation by closed reduction with no additional dislocation.
Two patients required revision of the implant because of dislocation at
the inner bearing. Technical errors were responsible for these failures.
Three patients had reoperations for deep infections. The postoperative
radiographs at latest followup showed very satisfactory osseointegration
of the acetabular component because no radiolucent line or osteolysis
was reported. Use of this unconstrained tripolar design was successful
in restoring and maintaining hip stability. We observed encouraging
results at short-term followup regarding potential for loosening or
mechanical failures.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for
Authors for a complete description of levels of evidence.
One or more of the authors (OG, VP, JBH) certifies that he has or may
receive payments or benefits from a commercial entity (Amplitude, 01707
Neyron, France) related to this work.
Each author certifies that his institution either has waived or does not
require approval for the human protocol for this investigation and that
all investigations were conducted in conformity with ethical principles
of research.
LINK TO ARTICLE BELOW:
http://www.springerlink.com/content/gv44mx5801145684/
<http://www.springerlink.com/content/gv44mx5801145684/
International Orthopaedics <file:///content/0341-2695/
Volume 33, Number 4 <file:///content/0341-2695/33/4/10.1007/s00264-008-0589-9
Société Internationale de Chirurgie Orthopédique et de
Traumatologie <http://www.sicot.org/
Remi Philippot <file:///content/?Author=Remi+PhilippotCamilleri <file:///content/?Author=Jean+Philippe+CamilleriBoyer <file:///content/?Author=Bertrand+Boyer<file:///content/?Author=Philippe+A dam<file:///content/?Author=Frederic+Farizon
The use of a dual-articulation acetabular cup system to prevent
dislocation after primary total hip arthroplasty: analysis of 384 cases
at a mean follow-up of 15 years
Abstract
The concept of a dual articulation acetabular cup was developed by Prof.
Bousquet in 1974. This concept has been shown to provide high stability
after revision and primary total hip arthroplasty. The aim of our study
was to evaluate the incidence of prosthetic instability in a consecutive
homogeneous series of 384 primary dual mobility cups. Incidence of
instability and implant survival were evaluated. Mean follow-up was 15.3
years (range, 1220). There was no early or late instability. On the
acetabular side there were 13 aseptic loosenings, 14 intraprosthetic
dislocations, and seven polyethylene wear cases that required
replacement of the liner. The cumulative survival rate of the
dual-articulation acetabular cup using surgical revision for aseptic
loosening as the endpoint was 95.9%â±â4.1% at 18 years
postoperatively. Our series proves the good long term behaviour of
dual-articulation acetabular components in primary arthroplasty. Their
excellent survivorship rate and the absence of episodes of prosthetic
instability increase our confidence in this concept.
LINK TO ARTICLE BELOW
http://www.springerlink.com/content/m426287774w365q3/
<http://www.springerlink.com/content/m426287774w365q3/
International Orthopaedics <file:///content/0341-2695/
Volume 35, Number 2 <file:///content/0341-2695/35/2/10.1007/s00264-010-1156-8
Abstract of article 0ctober 2010
Société Internationale de Chirurgie Orthopédique et de
Traumatologie <http://www.sicot.org/
The dual mobility socket concept: experience with 668 cases
Claude Vielpeau <file:///content/?Author=Claude+Vielpeau<file:///content/?Author=Benoit+Le bel<file:///content/?Author=Ludovic+Ardouin<file:///content/?Author=Gilles +Burdin<file:///content/?Author=Christine+Lautridou
Long-term results of a retrospective series of primary arthroplasty with
the original cementless dual mobility socket (A) and the midterm results
with the second generation (B) are reported. In series A (follow-up 16.5
years) 437 total hip arthroplasties (THA) were included and in series B
(follow-up five years) 231 hips. The 15-year survival rate was 84.4 ±
4.5% (revision for any reason as endpoint); 30 hips (6.8%) were revised
for aseptic loosening. Five THA were revised for dislocation: two early
and three after ten years or more. With the second generation socket
neither dislocation nor revision for mechanical reasons were observed.
The survival rate was 99.6 ± 0.4% (revision for any reason). The
prevalence of revision for dislocation was very low in our series. This
concept does not avoid wear and aseptic loosening, especially in young
active patients, but the long-term stability has been confirmed. Dual
mobility can be recommended for patients over 70 years of age and for
younger patients with high risk of dislocation.
--- In surf...@yahoogroups.com, "ruthz2006" <...@...dislocation is more common, after a THR".
We can't make good decisions when we are working with incomplete or
outdated information, and it is a really good thing that there are so
many options available now, for people facing hip surgery.
don't
believe
long
performing as
surgeon that
the
evidence
related to
have not
is a
pregnant
unto have
States. I
age
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stabilize.
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it
fertility and
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resurfacing.
would
proceeding
is never
badly.
most
may be
was
With my Stryker Dual Mobility, I have a design range of motion that
low
you'll
all other
for
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On Sun, 19 Feb 2012 07:36:07 -0800, Moseman Don <...@aol.com
Elizannmarie/ Ruth:
For the past few years, I've spent quite a bit of time looking into several options for dealing with my left hip. I'm a middle-aged guy (48) who was quite physically active before my hip started degenerating (running, Judo, wrestling, lifting, etc.). What I concluded, for my particular situation, was the following "path" for my hip (Presented in order of least risk to most risk):
1. Do Nothing: Doing absolutely nothing was the best approach as it presented no additional side affects or risks, except perhaps the risk of losing the ability to do most physical activities as my hip further degenerated. I could and still can put up with the pain (a mild 3 - 4 out of 10) for several years (presuming I don't see the rapid downslide some on the group have told me about).
2. Arthroscopy/ Open Surgery: Consulted with some very well respected orthopedic surgeons (Dr. Callandar, Dr. Dickinson, Dr. Sampson, Dr. Safran), two of whom were ready to give it a go (one saying I'd be back for a THR in 1 - 3 years, the other thinking he could give me another 7 - 10 years of good use of my hip) and the other who suggested I not waste my time/ money, that I'd be back to see him anyway in a few years for a resurfacing. I've read hundreds and hundreds of e-mails (Thanks guys/ gals you know who you are! :)) posts from patients who had arthroscopy and, even with the best, the results appeared to be a real mixed bag. Others on this group who have gone down this road can and have shared of their experiences. I opted not to have arthroscopy but would have given it a try had my insurer (BCBS) been willing to pay the 50% out of network I was hoping they'd have paid for Dr. Sampson (They were only wiling to pay 10% of estimated costs).
3. Hip Resurfacing: For a middle-aged active guy, this was a good fit for me and was an approach being touted as having no restrictions once my bone had grown into the device (i.e., bone in-growth into acetabular cup).
3a. Hip Resurfacing Revision: i.e., acetabular cup revision, revise BHR to BMHR) - What I hope can happen if resurfacing doesn't work out.
4. Total Hip Replacement (THR): I'd sat-in on two of these during a research assistant assignment I had when younger. Looked more like one of the construction sites I'd worked on (sawing, hammering...thought I saw a Makita saw or two, etc.). I wasn't anxious to get this one as it is a more invasive procedure (i.e., removal of femoral head, drilling into femur to hammer in place new stem) and I also wasn't keen on the restrictions I was told would accompany it....though I must admit I am intrigued by what I've been hearing recently about less restrictions on THRs and Ruth's comments in particular. I would, however, add that, if these are new THR devices, it remains to be seen what their true long term performance will be so I will think good thoughts, pray, and wish for the best for any of us that get devices that have not been in-service for several (8++) years.
5. THR Revision: This is the least preferable (except for revisions to THR revisions) for any of us. I've heard that (Those that have had THR revision please share of your experience), if the stem requires replacement that this is very difficult and involves cutting the stem from the femur. All I know is that this surgery typically presents more risk than any of the previous surgical types.
5a. THR Revision Revision: I'm sure there are some on this group who have gone down this road. For those interested, you might be able to get input on this also at hipsrus Yahoo group (UK group)
The above path was my effort to reduce risk (i.e., stay alive for my wife and little ones) with the added bonus of being able to continue doing the activities I love. For me, Option#1 (Do Nothing) is now less of a choice as I haven't been able to really do the activities I love for several years and I believe the left hip is causing other orthopedic booboos (i.e., left knee pain came and went, right hip acting up, right foot, etc.). Option#2 (Arthroscopy) I didn't pursue for financial reasons and because I lost confidence in the effectiveness/ rate of success of the procedure. Option #3 (Resurfacing) I will/ am pursuing resurfacing and am very close to picking a surgical date. Option #4 (THR) I'm hoping I never have to do this and am hoping that, if I have to have the resurfacing revised that it's a fix to the acetabular cup or a revision to a Smith & Nephew BMHR. However, per Ruth's comments below, I can see a little ray of sunshine should I to go down this path, especially being that folks like Ruth will have already blazed the trail of use for several years and we should, by then, all have a better picture as to the performance of these devices and the activities folks are able to do long term with them. Option #5 (THR revision) - Hoping not to get here.
So, in short, I am suggesting that you (Elizannmarie) consult with some of the surgeons that are highly respected on this and the hipresurfacingsite yahoo groups so they may determine whether you are a suitable candidate for a resurfacing. I say this as I truly believe it to be a less risky procedure than a THR and that it would provide no restrictions once bone in-growth is secure (i.e., 1 year post-op). Most importantly, for me, it keeps you one step away (see list above) from the remaining surgeries in the above list which I consider to be of greater risk and to have additional activity restrictions.
I know this is a lot to think thru, but please know that we all only have your best interest at heart and want what we believe is best for you and your future little ones. Take care and have a wonderful weekend. :)
Don
Nothing yet but awfully close
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