We are all aware of the significant change in relation to the world of metal-on-metal hip replacements and hip resurfacings, with several devices being withdrawn from the market or greatly restricted in their prescribed application. Cost of a hip resurfacing in various countries 2019 Knee replacement procedures conducted in Spain 2004-2018 Number of hip replacements in select countries 2017 For patients presenting with a flatback deformity and stiff spine, who had the highest risk of dislocation, the authors of a recent study suggested the use of a dual-mobility implant construct with targeted 30° of anteversion relative to the functional pelvic plane, based on a standing anteroposterior radiograph.1, Preferred Implant Designs We remain encouraged by the performance of our design. No patients among those with a stated penicillin allergy who were given cefazolin had an adverse reaction. Derek McMinn and Ronan Treacy give OPN an update on the hip replacement and hip resurfacing market. A modern artificial hip joint is designed to last for at least 15 years. – A retrospective review of >4,900 patients who underwent THA or TKA found that 16.2% reported a history of penicillin allergy. Our new design of femoral component addresses both these issues. OPN: How about the angle of articulation, what are your thoughts on this, we remember several references to this and edge loading during the metal-on-metal era? From the OR, we are joined by HSS hip & knee surgeons, Drs. When she looked at the male and female results in isolation, she reported 3,187 male patients with a Kaplan–Meier survivorship of 96.2 per cent to 20.1 years. Our results were fascinating. DM: As you will know, our friend and colleague ProfessorJustin Cobb’s well publicised Ceramic on Ceramic H1 Hip Resurfacing Study is under way. Hannon CP, Calkins TE, Li J, Culvern C, Darrith B, Nam D, Gerlinger TL, Buvanendran A, Della Valle CJ. She presented her findings most recently at the ISTA 2017meeting in Seoul, Korea. We are much more attracted to the idea of titanium porous coated cross-linked polyethylene cups, which have a stiffness closer to bone. The impact of patient-reported penicillin allergy on risk for surgical site infection in total joint arthroplasty. RT: Being aware of the guidance provided by the MHRA on the use of custom-made orthopaedic implants, coupled with the high production costs of such components, led us to the conclusion that the only viable route for us would be one of developing our own commercial route to progress a highly crosslinked polyethylene hip resurfacing system, in much the same way we achieved with the BHR during the MMT era. Building A Successful Practice – IT Matters, Review: Second hip preservation cadaver course. RT: When you consider our hip resurfacing design in isolation, I truly believe the orthopaedic community, and the wider industry in general, threw the baby out with the bath water. The anterior approach is an approach to the front of the hip joint as opposed to a lateral (side) approach to the hip or posterior (back) approach. DM: In the excellent publication from Baylisset al, The Lancet, April 2017, the lifetime risk of revision following a total hip replacement in men aged 50–54 years is 30 per cent. OPN: Thank you, we look forward to following your progress. The new “Direct Anterior Total Hip” approach is a remarkable improvement in primary total joint replacement surgery. Wii do! OPN: It has now been over eight years since we last talked. Those individuals with no metallic devices at all exhibited a 24 per cent sensitivity to nickel, those with metal-on-metal resurfacings 52 per cent, but the surprise for us was the metal-on-polyethylene total hip replacement group who demonstrated 57 per cent sensitivity. DM: The Jointmedica team has managed to secure project funding from the INNOVATE UK organisation. A new hip replacement strategy, an anterior approach technique, allows the patient to experience less pain, have a quicker recovery, and improved mobility. DM: We were motivated to come up with an explanation of potential contributors to this outcome. OPN: When do you expect the product to be commercially available in the UK? OPN: What do you believe to be the optimal thickness of components for hip resurfacing? The long-term impact of these findings needs to be explored further. OPN: You mention you have implanted some custom components, can you expand a little on your experiences with these? In our revision experience we have seen a number of cases of severe acetabular stress shielding behind the BHR cup at long- term follow up. DM: Uncemented total hip replacement cups use a porous coated metal shell and a highly crosslinked polyethylene liner. We know what worked with MoM resurfacing and what added to the early failure of other designs when this issue was not fully appreciated. /* Add your own MailChimp form style overrides in your site stylesheet or in this style block. Osteoarthritis of the hip is the most common diagnosis that leads to hip replacement. Keeping you up-to-date with orthopaedic news, Halt Bisphosphonates in Patients with an Atypical Femoral Fracture, Pediatric Limb-Lengthening: A Cautionary Tale. In all, she reported on some 11,386 metal-on-metal hip resurfacings of various designs. What is minimally invasive total hip replacement surgery and when is this technique used? The study found that prescribing 30 immediate-release oxycodone pills instead of 90 pills was associated with a significant reduction in unused pills and decreased opioid consumption without affecting pain scores and patient-reported outcomes.3, Penicillin Allergy The 3D designed Conformis Hip System Announced at the 2019 AAOS conference Designed to enhance operational efficiency for the surgeon and improve patient outcomes, the Conformis Hip System is the most advanced, patient conforming hip replacement system available The Inaugural International Advances inKnee Arthroplasty Meeting. At that time its attention was directed towards the development and distribution of the Birmingham KneeReplacement (BKR) which I am now proud to say holds an ODEP 7A rating and outstanding survivorship and PROMS scores. Initial Incision: A scalpel will be used to make an incision down the center of your knee cap to allow access to the entire joint. The NJR reports a higher revision rate for young patients having a total hip replacement. We are all aware of the significant change in relation to the world of metal-on-metal hip replacements and hip resurfacings, with several devices being withdrawn from the market or greatly restricted in their prescribed application. What has changed your opinion of this material? There can be no shortcuts to this process. DM: Our experience with the cemented BHR femoral component has been rewarding over the years, we maintain the use of bone cement in this application is reliable and reproducible. ICJR's Emerging Technologies in Joint Replacement meeting, February 7-9, 2019, in Nashville, Tennessee, will explore the latest technology for hip and knee arthroplasty Once we were convinced of highly crosslinked polyethylene’s potential viability in the resurfacing setting, we set off to solve the next problem. My husband is allergic to penicillin, and needs to have hip replacement surgery. The future of hip joint implants “Technology is always advancing,” says Dr. Hansen. A preoperative workup of a “hip-spine” total hip arthroplasty patient: a simplified approach to a complex problem. RT: The Birmingham Hip Resurfacing®(BHR) is now over 21 years old, and both Derek and I have implanted this device since 1997. RT: The 14th National Joint Registry report(NJR) notes a significant reduction in the use of Hip Resurfacings (less than 1per cent) and subsequently the increase in the use of traditional hip replacements in the younger active patient groups. RT: This is a difficult question to answer definitively. We performed a cross-sectional assessment of metal hypersensitivity in four individual groups; patients with BHRs (10 year min), historical controls with no metal exposure, preoperative patients with no metal exposure and patients with metal-on-polyethylene cemented Exeter total hip replacements (10 year min). As the cartilage wears out, pain and stiffness result. 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