Keep the Bone: Preservation is the Key Resurfacing is the way to go! - - PowerPoint PPT Presentation

OS ET 2017 Bellagio Las Vegas

Keep the Bone: Preservation is the Key Resurfacing is the way to go! Avoid the Nay S ayers

Thomas Gross 10:19 AM 30

Undeniably MM HRA

Preserves the Bone

Advantages of MM HRA

Advantages of MM HRA

Reasons not to do resurfacing

 A mini stem anterior THR is quicker for the same

reimbursement

 HRA is technically difficult and I difficult to master  The XLPE Hip S

• ciety has convinced us that cobalt is evil:

cancer allergy toxicity metalosis “ pseudotumor”

Members of the XLPE Hip S

• ciety proclaim:

“ THA is the operation of the century” “ Never again metal”

 THA are not really that good

Residual pain Instability Difficulty with athletics Poor survivorship in young patients

 Problems with Metal Bearings

The DePuy AS R The Zimmer Durom Oxford Resurfacing technique Trunionosis (large heads with small trunions)

Cobalt is scary: Cancer?

 Cobalt in t issue cult ure leads t o DNA changes.  Visuri 30 year st udy shows no difference in cancer rat es  Oswest ry regist ry  Brit ish j oint regist ry

Cobalt is scary Allergy?

 Willert and Campbell described lymphocyte

response around failed metal bearings.

 Oxford had a 4%

rate of HRA failure at 8 years due to “ Pseudotumors” which they claimed were allergic reactions.

 Anecdotal reports of skin rashes with

implants

Cobalt is scary Allergy?

 In 5000 HRA I have never seen a case of “ allergy”  Neit her skin pat ch t est ing nor LTT has been shown t o

predict a higher failure rat e

 Over 500,000 cobalt chrome TKR are done annually in

t he US wit hout any fear of allergy

 How many CC head THR are st ill done annually and how

many CC st ems were implant ed in t he past wit hout “ allergy” arising?

 Bot h TKR and CC head THR have been shown t o release

cobalt and chromium ions

Cobalt is scary: toxicity?

 Beer drinkers in Canada got t oxic from cobalt

supplement s t o maint ain frot h Their blood cobalt levels were not report ed

 Case report s of cobalt ism wit h THR

2/ 4 involve fract ured ceramic heads 2/ 4 Depuy AS R THR

Cobalt is scary: toxicity?



Mild sympt oms of cobalt t oxicit y were seen at a higher rat e t han baseline aft er Co level exceeded 20ug/ L Van der S t raet en & DeS met

 S

ympt oms of cobalt t oxicit y are vague and are seen in nat ural aging: neuropat hy, t innit us, hearing loss, heart failure

Cobalt is scary: metalosis?

This is the real deal!

 Oxford reported 4%

pseudotumors at 8 years in 1400 cases with disastrous outcomes on revision

 30-50%

failure rate of DePuy AS R HRA and THA largely due to metalosis and failure of cup ingrowth

Cobalt is scary: metalosis?

We reported :

 1%

AWRF at 10 years in 2600 cases Hip Intl 2013

 Excellent outcomes on revision

JOA 2014

 RAIL guidelines for cup positioning to prevent

metalosis JOA 2013

 Validation of RAIL with 1800 consecutive HRA since

2012 meeting RAIL guidelines and no metalosis IS TA 2017

Disadvantage of Resurfacing malposition  metalosis

640

Problem solved with correct cup position

310

Advantages of MM HRA

THR is not adequate for young people

 NICE crit eria 2014 95%

10-year implant survivorship

 S

wedish regist ry implant survivorship 83% @ 10 years in pat ient s under 50

We need to set a benchmark for young patients

International Resurfacing S tudy Group

International Resurfacing S tudy Group

28 surgeons

International Resurfacing S tudy Group

 11,386

METAL ON METAL Resurfacing

 All pat ient s UNDER 50  28 surgeons  12 different implant s  3-22 year follow-up

International Resurfacing S tudy Group

 11,386

METAL ON METAL Resurfacing



All patients UNDER 50

 28 surgeons  12 different implants  3-22 year follow-up

Establish a benchmark for the young patient

International Resurfacing S tudy Group

20 year implant survivorship: 93% men, 82% women

Implant S urvivorship in Y

• ung patients

( <50 years )

THR Resurfacing 10 year 83% 95% 20 year 50% 89% S wedish Register IHRS G 15,454 cases 11,386 cases

Implant S urvivorship in Y

• ung patients

( <50 years )

THR Resurfacing 10 year

83%

95% 20 year 50%

89%

S wedish Register IHRS G 15,454 cases 11,386 cases

A new benchmark has been set

age<50

Implant survivorship: 95% 10-year 89% 20-year

Metal on Metal Resurfacing is the Gold S tandard for young patients

27

The XLPE Hip S

• ciety is wrong.

Our “ thought leaders” are misleading us. Give patients a more durable and functional hip Allow them to reap the proven benefits of exercise