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AAOS Conference Hip Society Meeting
General Overview
By Vicky Marlow
March 8, 2008
There was a lot
of discussion about placement of the cup
position.
Cup position
with large open angles will cause more metal
debris. It was agreed that in the past the
doctors were more concerned about the placement
of the femoral component but they are finding
out that patients are having more long term
problems with ROM (Range of Motion) or lack of
ROM if the cup placement is off. The cup
position is crucial to avoid impingement; they
need to watch the anteversion and the
orientation of the lip. The doctors should also
take care to remove any osteophytes.
On a side note,
this is an old email I received from Dr. Bose
when I was still doing my research. At that
time I was reading so many posts from patients
experiencing groin pain so I asked Dr. Bose
about it. When he sent me this email, I was
still pre-surgery. Apparently the problem
continues today since I still read many posts
from patients experiencing groin pain. It looks
like the majority of doctors are now finally
beginning to recognize this as a possible
problem caused by placement of the cup, but as
you can see Dr. Bose knew this back in 2005.
From:
Vijay C.Bose [mailto:bose5vijay@hotmail.com]
Sent: Monday, October 17, 2005 6:53 PM
To: Vicky Marlow
Subject: Re: Post Op PT
Vicky,
Yes, psoas tendinitis is an important reason for
groin pain in resurfacing surgery.
This is peculiar to resurfacing as the cup for
resurfacing is a very large profile i.e. half a
sphere. Nearly all THR cups are only portions (
arc) of a hemisphere.
Hence if the antero-posterior orientation i.e.,
version of the cup is marginally off the ideal,
it would not be a problem with THR. However in
resurfacing, due to the very large profile, if
the version is less than ideal the ant edge of
the cup will protrude out of the bony front wall
of the acetabulum. The psoas tendon will rub on
this and patients will typically complain of
pain when attempting to lift their leg in a
standing position
For this reason we now take extra care to get
the version right and most resurfacing
surgeons leave a 3mm rim of osteophytes over the
ant edge as a safety precaution to avoid this
problem.
with best regards
vijay bose
chennai
As far as
selecting the ideal candidate it was brought up
that gender should make no difference in
selecting a patient for resurfacing, what really
matters is the width of the patients’ femoral
neck.
There was still
a lot of talk about computer navigation and many
doctors are very skeptical about that. The
experienced surgeons still find more accurate
placement without the use of computer
navigation.
McMinn was in a
debate with another surgeon on THR vs. Hip
Resurfacing. He said that he wanted to let the
entire ortho community know that he was not
completely against THR’s. He then showed a
slide of a 97 year old woman that he had
performed a THR on. He got quite a laugh from
the audience of over a thousand orthopedic
surgeons. McMinn really has quite the sense of
humor.
He also stated
that there is really no difference between the
two procedures as far as operating time or blood
loss. (Vicky- Of course mileage may vary
depending on the experience of the doctor)
McMinn felt the
learning curve for doctors was 150 hip
resurfacings. He also felt that doctors that do
a low volume (majority in the U.S.) of hip
surgeries per year should not be attempting to
do resurfacing. Only the large volume hip
doctors should do resurfacing.
McMinn’s take on
some other devices were
His prior
experience with the Cormet 2000, also known as
the Corin or Strykers’ device and the double
heat treatment they started to do in 1996. You
can learn more about it on his site rather than
repeat what he stated by clicking here and going
to Lectures – “10 Year Survival of Double Heat
Treated Hip Resurfacing from 1996”
http://www.mcminncentre.co.uk/
On the Zimmer Durom he said it had a 7% revision rate in the
first year and felt that it was not as good of a
device due to the device having a sharper lip
and higher titanium level.
He then
mentioned that as far as the ASR goes, he could
not possibly begin to cover all of the problems
with it and left it at that. You can read more
about his opinion on the link above to McMinn’s
site under Lectures – Northern Lights Debate.
A really
interesting part of the whole meeting was a
statement made about return to activities after
hip resurfacing.
It was stated
that doctors will tell their patients what the
restrictions are, and they are finding out more
and more that the patients are not listening to
the restrictions and just going out and doing
what they want to anyway.
With the
growing number of younger active patients
getting hip resurfacing, they are seeing things
they never would have imagined someone doing
after hip surgery before. Doctors are learning
that the patients are the one’s now teaching the
doctors exactly what a well placed hip
resurfacing is capable of doing.
Vicky -
Interesting concept, patients educating doctors
on what is possible with resurfacing.
Thanks to all of the Dru Dixon's (first surface
hippy to compete and finish an Ironman after BHR
surgery) Michael Montgomery's (completing an
Ironman at 6 1/2 months post op); Scott Tinley's (surfing full out at six weeks post op)
http://www.surfacehippy.info/athletes.php
and Joan Gunnes
(teaching yoga at 13 days post op) of the world.
http://www.surfacehippy.info/hipstories07/joangunness07.php
And that wraps
up my overview of the AAOS conference.
Vicky
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