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Founding Directors Report |
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As you can see from our Home page there has been a change in the administrative leadership here at the JRI. It was time to elevate Dr. Thomas P. Schmalzried to Medical Director, a post I filled since the inception of JRI in 1991. The Institute is in good hands with Tom. He was an outstanding resident and fellow in my program at UCLA. Following an additional Joint Replacement Fellowship at the MGH he joined the JRI at its inception. There will be many challenges for him and the JRI in the current health care scenario. This move followed the plan we negotiated with St Vincent Medical center two years ago, and it will enable me to focus my time on education, research and my clinical practice.
I end this message with the news that our book on “Hip Resurfacing” has been well received. The book is comprehensive, and it chronicles the development, indications, operative technique, and the results of modern hip resurfacing including complications and methods of prevention as well as disease-specific experience. This volume is published by Elsevier and is available through Amazon.com. Please check the link for more information in regard to my continued enthusiasm for resurfacing with the Conserve® Plus and the latest on the BFH (big femoral head) and note our recent publications. .
Status of Conserve® Plus Hip Resurfacing
Hip resurfacing and the use of a Big Femoral Head, which we have pioneered, have become the main focus of my activities. While many readers now know that resurfacing qualifies as a less invasive procedure (as far as the femur is concerned because the head and neck are preserved), it is also the most tissue-sparing arthroplasty for the hip. But it is technically demanding. For surgeons without sufficient experience with the resurfacing technique and their patients, a total hip replacement with a Big Femoral Head ( to obviate dislocation) remains an excellent option.
I continue to be delighted with the quality of results achieved with the Conserve® Plus metal-on-metal, hybrid hip resurfacing, with some patients over 12 years. For those patients with good bone quality, there have been few failures (<2%) from the initiation of our series in 1996. The recent results of our research have led us to methods enabling us to successfully resurface many patients with risk factors initially thought not to be resurfacable by other surgeons. We have not identified any patient who has had a loosening, or has signs of potential loosening, in over six years, and there have been no patients revised for loosening in the series of hips implanted over the last 6.5 years. This improvement of initial fixation is such that long-term durability is now anticipated with our current technique. Fortunately our excellent results are now being approached by other experienced surgeons who have validated the fundamental design as well as the technique concepts of the Conserve® Plus System.
In addition, with our efforts to improve fixation continuing each operating day, patients with risk factors, such as cystic degeneration, can be successfully resurfaced. For the first time, our results have shown equal durability of resurfacing in hips with secondary arthritis (Slipped Capital Femoral Epiphysis, Developmental Dysplasia of the Hip, Legg-Calvé-Perthes disease, Rheumatoid Arthritis, or Osteonecrosis) irrespective of age or gender when compared to that of primary osteoarthritis5-8.
We continue to collaborate with Dr. Pat Campbell with our retrieval Will Joint program that has led us to our surgical technique modifications. Our data now justifies carefully applying the resurfacing technology to older patients and women.
Finally, I am able to report that FDA approval of the Conserve® Plus system is near. Our IDE investigators have provided the most comprehensive study ever conducted with solid scientific, peer-reviewed evidence of both safety and efficacy. This is occurring at the same time as the FDA-approved BHR socket and its bearing issues are now being debated. (That prosthesis had never been performed in the United States before its approval.)
While the delay has been unfortunate for both surgeons and their patients, the long delay has enabled us to fine tune the instrumentation and technique so that when the release occurs, patients in the U.S. will finally have the benefits that other patients around the world have had for some time.
The advantages of the Conserve® Plus are outlined for your reference and further study.
Harlan C. Amstutz, M.D.
Founding Director
References
Amstutz H, Hip resurfacing: principles, indications, technique and results. Elsevier; 2008.
Amstutz H, Le Duff M. Cementing the metaphyseal stem in metal-on-metal resurfacing: when and why. Clin Orthop Rel Res 2008.
Amstutz H. Present state of metal-on-metal hybrid hip resurfacing. J Surg Orthop Adv. 2008;17-1:12-6.
Amstutz H, Le Duff M, Harvey N, Hoberg M. Improved survivorship of hybrid Conserve® Plus metal-on-metal hip resurfacing for Crowe I&II DDH with 2nd generation bone preparation and cementing techniques
J Bone and Joint Surg 2008 - August Suppl. Get page #
Ball S, Pinsorsnak P, Amstutz H, Schmalzried T. Extended travel after hip arthroplasty surgery. Is it safe? J Arthroplasty. 2007;22-6 suppl 2:29-32. .
Amstutz H, Campbell P, Le Duff M. Metal-on-metal hip resurfacing: what have we learned? AAOS Instructional Course Lecture 2007;56:149-61
Amstutz H, Ball S, Le Duff M, Dorey F. Hip resurfacing for patients under 50 years of age. Results of 350 Conserve® Plus with a 2-9 year follow-up. Clin Orthop. 2007;460:159-64.
Amstutz H, Beaulé P, Dorey F, Le Duff M, Campbell P, Gruen T. Metal-on-metal hybrid surface arthroplasty: two to six year follow-up. J Bone and Joint Surg. 2004;86 A:28-39.
early 3. Beaulé P, Dorey F, Le Duff M, Gruen T, Amstutz H. Risk factors affecting outcome of metal on metal surface arthroplasty of the hip in patients 40 years old and younger. Clin Orthop. 2004;418:87-93.
Amstutz H, Le Duff M, Campbell P, Dorey F. The effects of technique changes on aseptic loosening of the femoral component in hip resurfacing. Results of 600 Conserve® Plus with a 3-9 year follow-up. J Arthroplasty. 2007;22:481-9.
Amstutz H, Su E, Le Duff M. Surface arthroplasty in young patients with hip arthritis secondary to childhood disorders. Orthop Clin North Am. 2005;36:223-30.
Amstutz H, Le Duff M, Dorey F. Hip resurfacing: indications, results, and prevention of complications (for Secondary OA). In: Sofue M, Endo N. Treatment of osteoarthritic change in the hip. Shinano, Japan: Springer; 2007. 195-204.
Campbell P, Beaulé P, Ebramzadeh E, Le Duff M, De Smet K, Lu Z, Amstutz H. A study of implant failure in metal-on-metal surface arthroplasties. Clin Orthop. 2006;453:35-46.
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