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 ociety has convinced us that cobalt is evil: cancer allergy toxicity metalosis “ pseudotumor”

Members of the XLPE Hip S ociety 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 64 0

Problem solved with correct cup position 31 0

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 oung 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 oung patients ( <50 years ) THR Resurfacing 83% 10 year 95% 89% 20 year 50% 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 The XLPE Hip S ociety 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 27