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Hip Resurfacing News

Dr. Su Interview

Updated 11/17/2011

Dr. Edwin Su
1800 Hip Resurfacings to date
Hospital for Special Surgery
541 East 71st Street
New York, NY 10021
212-606-1128
877-606-1555 (toll-free)
Dr. Su's Website

Dr. Su's  Medical Profile


Dr. Su's experience with hip resurfacing shows 1.3% complication rate

November 16, 2011

Original Link http://www.orthosupersite.com/view.aspx?rid=89618

The retrospective study, which analyzed 925 hip resurfacings performed by Edwin Su, MD, between 2004 and 2009 with a minimum follow-up of 2 years, looked at three implants: Wright Medical’s Conserve Plus Total Resurfacing Hip System, Biomet Orthopedics’ ReCap Femoral Resurfacing System and Smith & Nephew’s Birmingham Hip Resurfacing System. Conserve Plus and the Biomet ReCap were used as part of clinical trials, while the Birmingham hip was used after FDA approval of the implant in 2006. Clinical scores and radiographs were obtained at 1 month, 3 months, 1 year, and every subsequent year. The hips in the study had a minimum of 2 year follow up, both radiographically and clinically.

"[The Conserve Plus hip] was not FDA approved by our government between 2004-2008, so we had to petition for each patient to have the device, limiting the numbers of patients receiving that implant," Su, from the Hospital for Special Surgery in New York, said during his presentation at the 12th EFORT Congress 2011.

Su received training from some of the pioneers of hip resurfacing, in both California and Europe, to gain the experience necessary to perform the procedures. He used a posterior approach during the procedures and was careful to preserve the retinacular vessels and soft tissues to prevent the need for reoperation. The implant specific guides were used to ensure central positioning within the neck to prevent notching, and cemented femoral fixation was used, the study stated.

The study showed 12 revisions (1.3%) at a minimum follow-up of 24 months. The K-M survival curve overall for the procedure, using all 3 different implants, was 98.6% at 68 months. Su noted that these results compared favorably to other published papers that describe short-term failure rates of 8% and 13% for the procedure. The Conserve Plus series had six revisions out of 157 cases (3.8%), which involved two cup loosenings, three femoral loosenings and an adverse metal reaction. The Birmingham series had six revisions out of 748 cases (0.8%), and the ReCap had no revisions.

Limitations for the study include the limited amount of data collected for certain implants, such as the ReCap, which had 20 implants compared to the Conserve Plus (157 implants) and the Birmingham series (748 implants). The Conserve Plus series also had a longer follow-up compared with the Birmingham series.

"For a surgeon contemplating adopting resurfacing, one must be concerned about the learning curve," Su said. "The exposure is more difficult, it is more time-consuming, and it is more sensitive to technical errors." However, with careful patient selection, proper surgical training, and a good implant, the success rate can be excellent.

Reference:

•Su E. A single US surgeon experience with the adoption of hip resurfacing using 3 different implants. Paper #1140. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.
•Berend KR, Lombardi AV, Adams JB and Sneller MA. Unsatisfactory surgical learning curve with hip resurfacing. J Bone Joint Surg Am. 2011; 93S:89-92.
•Mont MA, Seyler TM, Ulrich SD, et al. Effect of changing indications and techniques on total hip resurfacing. Clin Orthop, 2007;465:63-70
•Edwin Su, MD, can be reached at the Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021; 202-606-1128; email: sue@hss.edu.
•Disclosure: Su provides consulting services for Smith and Nephew Inc. on hip resurfacing products. Smith and Nephew Inc. and Biomet Inc. have provided research support for studies involving hip resurfacing.


Read Dr. Su's response to the NY Times article "Concerns over 'Metal on Metal' Hip Implants" (March 4, 2010)

Dr. Su's response:

I have read and re-read this article with dismay. The writer has chosen to focus upon rare occurrences of problems with metal on metal joints. Most of these problems are avoidable with good implant design and precise surgical technique. Nonetheless, I do think it is important for yearly checkups with me, x-rays of your hip, and blood metal level monitoring. I've written a letter in response below, but I fear they will not publish it, due to their preconceived biases.

Letter to the Editor

I would like to comment on the article entitled "Concerns over 'Metal on Metal' Hip Implants", dated March 4, 2010. As a hip surgeon who uses both metal on metal hip resurfacing and total hip replacement implants, I feel it is necessary to provide perspective on the issues raised in this article.

First of all, metal on metal hip replacements have a rich clinical history dating back to the 1970's. Cobalt and chromium have been in use in hip surgery for over 30 years because of their durability. In the last 5 years, the use of metal on metal hip replacements has increased because of the ability to create an artificial hip with a larger ball, allowing for a greater stability to the joint and a high activity level for patients.

While it is true that a metal on metal joint is less forgiving, the key point is that the implants must be properly positioned to ensure good function. Surgeons who are experienced with the use of metal on metal hip implants will have a low incidence of the problems described in the article. At Hospital for Special Surgery, we have performed over 2000 metal on metal hip resurfacings and replacements, with less than a 1% incidence of problems requiring revision surgery.

Secondly, all artificial joint materials are subject to the creation of debris; all debris material can be bioreactive, leading to tissue and bone damage. This is not unique to metal on metal hip implants, but can occur more rapidly if the implants are not positioned well. I have revised many more metal on polyethylene hips with tissue and bone damage, than metal on metal implants!

Finally, there are patients for whom a metal on metal hip implant may be a better choice than other materials. At present, all hip resurfacing devices consist of these metals. For these patients for whom bone preservation is paramount, the metal surfaces are the only option.

I believe that focusing upon the rare, negative aspects of metal on metal hip implants without highlighting the benefits, is a case of "throwing the baby out with the bathwater".


Link to Frequently Asked HR Questions Answered by Dr. Su

Link to General Hip Resurfacing Questions Answered by Dr. Su

Link to Pre-Op Surgical Questions Answered by Dr. Su

Link to Surgical Questions Answered by Dr. Su

Link to Post-Op Questions Answered by Dr. Su

 

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