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I offer both prosthesis to my
patients, as I am trained to do both.
The changes on the ASR are such that they have taken the good points
of the BHR (so in the long term the result should be the same as the
BHR), and eliminated some weaknesses of the BHR (so that in the long
term the results might be better!). So all in all, it appears that
the ASR should do better. When the BHR started, people did have
concerns about it at that time, and that would happen to anything
new. The ASR is not brand new! It has been around in clinical
practice for 1.5 years now, and as part of research trial prior to
that.
If you look at it a little differently - would you choose say an
average resurfacing surgeon (but who does the BHR) or a brilliant
surgeon (but who does the ASR?), if at all you were in such a
scenario?
Taking into account the patient perspective and the doctor
perspective, I think its important to select a good resurf surgeon
first. If that surgeon offers both prosthesis, you can choose. And
if he does not, then stick to the good surgeon and go by whatever
prosthesis he uses.
I know there is no fixed correct answer here (and you know that
too!!!). These are just perspectives.
Regards
Ameet Pispati
May 18, 2005
Subject: Further on ASR vs. BHR
Dr. Pispati - I frequent the Yahoo SurfaceHippy group
and at that site I posed a question regarding
ASR vs. BHR, to which you graciously responded (message 48962,
copied below). You suggested that although the ASR and BHR are
equally good prostheses in practice, you prefer the ASR. You cite
the putative advantages of ASR, regarding wear and "eliminating any
possible weaknesses of the BHR".
I have severe post-traumatic osteoarthritis in my right hip, and
must choose a therapeutic course. At least, in this age of
information, part of the responsibility for this choice falls on me!
Resurfacing is clearly indicated. The ASR is attractive, but it
seems to have detractors who support the BHR. Basis: lack of follow-up data on the ASR, as compared to JBJS (Br) Vol 87-B, #2, Feb 2005
article by Treacy et al that described 98-99% survival with BHR at a
minimum of 5 years.
If you could entertain the patient's perspective for a moment: How
might you resolve this choice for yourself? Would you jump in with
both feet, on the basis of the "promise" of the ASR? Or - is it
prudent to stick with that about which there seems to be the most
data - the BHR?
Thanks for any comments, AND for your presence at SurfaceHippy.
There, I assure you, you have a very attentive and appreciative
audience!
Best regards - B
Surface Hippy Message 48962:
"Frankly I think the ASR and BHR are
equally good prosthesis. When I
trained in Birmingham, UK, I used the BHR. I now use either the BHR
or the ASR.The ASR does have several design advantages (in terms of
metal wear).
It was designed incorporating the advantages of a BHR and eliminating
any possible weaknesses of the BHR. The instrumentation is a lot
easier for the surgeon and increases surgeon comfort. There are more
sizes available on the ASR than on the BHR. Personally, I prefer the
ASR, but when my patient insists on a BHR
the I perform a BHR cause I am equally well trained at both.
I also think that its better a surgeon uses what he is comfortable
with because in practice the ASR and BHR are equally good.
Dr Ameet Pispati
Consultant Orthopaedic Surgeon, Mumbai, India
Specialist in Hip Resurfacing
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