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The Birmingham Hip Resurfacing and Other Options – The 15 Year Results of the First 1000 BHRs
Derek McMinn presents a talk on the Birmingham Hip Resurfacing (BHR) and the alternative options for hip joint replacement surgery. Starting with the development of the BHR, Mr McMinn goes on to discuss survivorship rates and revisions, cancer, metal ions, the DePuy ASR disaster, Delta Ceramic and new development Polymix. The presentation is dedicated to the late Vicky Marlow, a fantastic patient advocate and voice of support in the hip resurfacing community. The website Vicky founded, http://www.hipresurfacingsite.com/, continues to a fantastic place for patients to learn about hip resurfacing, replacement of the hip and hip joint surgery.
In this lecture, Mr McMinn talks about the development of the metal-on-metal hip resurfacing implants he has designed, looking at survival rates and pilot studies. Press-fit, cemented and un-cemented implants were all tested and the best outcome was a single heat-treated hybrid un-cemented cup and a cemented femoral component. The Birmingham Hip Resurfacing (BHR) was developed by a company formed by Mr McMinn and Ronan Treacy after relationships with earlier hip resurfacing manufacturers didn't work out.
Mr McMinn goes through the outcomes of the first 1000 BHR patients, whose operations date from July 1997 to August 2000. The results are broken down and compared between gender and age, covering areas such as primary diagnoses, implant survival probability, implant head size, failure rates and revision surgery.
Derek McMinn makes three key statements during the lecture, hip resurfacing has better function compared to Total Hip Replacement (THR), BHR in young people has lower revision rate than THR and BHR in men has a lower death rate compared to THR. Mr McMinn discusses the research into these areas by analysing various studies and results. Most notable are the findings of a study into cancer rates in metal-on-metal patients compared to alternative bearings.
Back in 2005, Mr McMinn warned DePuy Johnson & Johnson about the ASR device but was a lone voice. In this talk, he questions why the ASR was so much worse than the BHR and the effect that the ASR recall has had. Click here to watch Mr McMinn warning DePuy at Northern Lights Debate, Helsinki.
An alternative resurfacing implant for patients with sensitivity to metals is a ceramic-on-ceramic resurfacing. Mr McMinn looks at his own unsuccessful series of five ceramic-on-ceramic hip resurfacings and looks at the widely used the pink Delta Motion THR ceramic device made by Ceramtec. Ceramic contains elements of metal and Mr McMinn raises some concern over the potentially harmful type of Chromium produced in the metal debris of a Delta Ceramic in situ.
Looking towards the future, Mr McMinn describes how highly cross-linked polyethylene is potentially the way forward. Polymix is a hybrid cup made of conventional polyethylene and highly cross-linked polyethylene in the wear-zone.