Saturday, January 29, 2011

Continuing Medical Education Panel sponsored by the American Orthopedics Association for Surgeons: Total hip Atheroplasty: Is there a MOM bearings controversy?

Part One of Five (my notes on the lectures)

Panelists:
Josh Jacobs MD:  Professor and Chairman of Rush Medical Center Orthopedics
Robert Barrack MD:  Professor of Orthopedics Washington University School of Medicine St Louis Mo
John Cuckler MD:   Professor at U of Alabama
Hollis Potter MD: Professor of Radiology at Cornell
Jerry Leiken MD:  Professor of Medicine and Pharmacology at Rush Medical Center and University of Chicago (Medical Toxicologist)

Poling questions for the audience of orthopedic surgeons attending this CME course:

1)      Do you use MOM bearings in your practice?
a.       2/3rds of the audience used MOM hips in their practice

2)      What percent of hip replacements are MOM bearings in your practice?
a.       60% said under 20%
b.      13% said 21-40%
c.       7% said 41-60%
d.      7% said 61-80%
e.      6% said over 80%

3)      How many patients have you treated with adverse soft tissue damage with respect to MOM hips in the last year?
a.       69% said none
b.       27% said Under 5
c.       3% said 6-10
d.      1% said greater than 10

4)      Options (will come back and fill this in on the site later/course didn’t have the tally by percents of participants choosing each of the following statements prior to my publishing this post:)
a.      There is a definite  role for MOM hip replacements for definite indications
b.      There is a role but there needs to be additional research to define the indications
c.       There is no role for MOM in hip replacement
d.      The reported results and complications are design specific, so no generalizations can be made.
 Section 1: Robert Barrack MD-Indications for MOM hips
·     Incidence of occurrence of issues surrounding the MOM hips is “hotly debated.”
·     Given that selection and technique are both issues with this hip, there needs to be some clinical advantages to warrant the use of this MOM technique
o   Dislocation is lower
o   Less thigh pain
o   Higher level of functioning
·     Not much evidence for the above  advantages in the literature though given the limitation of prior studies
o   One study showed that 43% of patients had all of their expectations met with no limping being most important
o   Second study on ability to perform various functions after the “modern implants” were used (mom, ceramic/poly)


Standard Total hip replacement (under 32 MM head)
Large THR (greater than 36MM head)
Resurfacing
No limp last 30 days
46%
50%
70%
Able to walk greater than 1 hour
52%
62%
68%
Tried to run
74%
69%
94%
Run greater than 1 mile
9%
14%
25%
Run for exercise
27%
33%
47%


·         Not a lot of differences between the groups
·         Resurfacing on the whole was most successful
·         You lose about 8% bone density with Total Hip replacement vs resurfacing
·         Warrants continued exploration of the use of resurfacing
Who is the best candidate?
·         Best results obtained in young males
·         Data on age and gender is not definitive
·         Stronger evidence of the importance of component size and implant type
·         Osteo Arthritis as a diagnosis has the best results
·         Revision stats below after 4 years:


Resurface
Resurface
Conventional
Conventional
Age
Male %
Female %
Male %
Female %
Less than 55
1.9
3.9
2.2
3.2
56-64
2.2
6.4
2.2
2.7
65 and greater
4.0
11.0
2.2
2.3


Overall conclusions from Dr. Barrack:
·         There is data indicating the clinical advantage for MOM artheroplasty
·         The data is more compelling for resurfacing rather than total hip replacement
·         Major issues:  indication, surgical technique and informed consent.

You can buy this course on line at the association.  It is a 1.5 hour video and costs about $100.

 I will publish the next 4 sections wiover the next 4 days on the site.
Connie

No comments:

Post a Comment