Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 To some extent, I take issue with this statement. According to a US orthopod with whom I consulted prior to my first resurf (left), I had avascular necrosis in the left femoral head. In addition, I could personally see multiple bone cysts on the x-rays of both of my hips, especially the left. Mr. Treacy informed me that he encountered large cysts during the resurf of the left and used bone grafts/patch to fill them in. While he certainly does choose his patients carefully, that should be standard operating procedure for any surgeon. My opinion is that the surgical technique of the Birmingham docs has been refined by their substantial experience, and that they were excellent surgeons to begin with. This, together with a reliable prosthesis (the BHR) and intelligent selection of patients has led to their excellent results. Good surgical technique necessarily subsumes proper selection of patients. This should not be interpreted to mean I think there is anything wrong with the other prostheses or other surgeons. (Who cares what I think anyway?) I simply believe the author of this article took a bit of a flyer with opinions and conclusions expressed. I'm troubled by the allegation that Mr. McMinn excluded from his statistics, patients who purportedly had badly manufactured prosthesis. What this comes down to is it illustrates the three kinds of lies - lies, damned lies and statistics. I learned that throughout my academic career many years ago. I also learned that it is a simple matter to present a point of view with the purposeful use of language. The language should never substitute for careful thought and analysis. Des Tuck LBHR Oct. 2001 RBHR May 2003 In a message dated 6/10/2004 12:42:59 PM Pacific Standard Time, kliner020711@... writes: On the other hand, the Birmingham patient group consisted of very closely selected patients with only one diagnosis: idiopathic hip osteoarthritis. The hip joints of these patients have had no deformities, cysts, bone necrosis or other defects in the skeleton; these patients did not have previous operations, hip fracture or other joint diseases that increase the risk of failure of the surface hip replacement. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 To some extent, I take issue with this statement. According to a US orthopod with whom I consulted prior to my first resurf (left), I had avascular necrosis in the left femoral head. In addition, I could personally see multiple bone cysts on the x-rays of both of my hips, especially the left. Mr. Treacy informed me that he encountered large cysts during the resurf of the left and used bone grafts/patch to fill them in. While he certainly does choose his patients carefully, that should be standard operating procedure for any surgeon. My opinion is that the surgical technique of the Birmingham docs has been refined by their substantial experience, and that they were excellent surgeons to begin with. This, together with a reliable prosthesis (the BHR) and intelligent selection of patients has led to their excellent results. Good surgical technique necessarily subsumes proper selection of patients. This should not be interpreted to mean I think there is anything wrong with the other prostheses or other surgeons. (Who cares what I think anyway?) I simply believe the author of this article took a bit of a flyer with opinions and conclusions expressed. I'm troubled by the allegation that Mr. McMinn excluded from his statistics, patients who purportedly had badly manufactured prosthesis. What this comes down to is it illustrates the three kinds of lies - lies, damned lies and statistics. I learned that throughout my academic career many years ago. I also learned that it is a simple matter to present a point of view with the purposeful use of language. The language should never substitute for careful thought and analysis. Des Tuck LBHR Oct. 2001 RBHR May 2003 In a message dated 6/10/2004 12:42:59 PM Pacific Standard Time, kliner020711@... writes: On the other hand, the Birmingham patient group consisted of very closely selected patients with only one diagnosis: idiopathic hip osteoarthritis. The hip joints of these patients have had no deformities, cysts, bone necrosis or other defects in the skeleton; these patients did not have previous operations, hip fracture or other joint diseases that increase the risk of failure of the surface hip replacement. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 That's y'all, Jeff. I can tell from your accent you're not from Texas. Des In a message dated 6/10/2004 1:52:28 PM Pacific Standard Time, jjg@... writes: You all are the quietest bunch ever! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 Gotta delurk for a few here. [censored]????!!!!!! I went to McMinn from the US *sepcifically* because he had a good success rate with dysplasia in athletes. I had all sorts of nasty things in my hip (cysts and such, since it had been bone on bone for oh so long). They even had the standard dysplasia cup ready in the operating room. Turns out they didn't quite need it, although I did need all sorts of bone grafts. Yes, my ball was badly deformed (sort of like a lopsided mushroom) and took lots of reshaping. I have it on film, so I know what it looked like for sure. >On the other hand, the Birmingham patient group consisted of very >closely selected patients with only one diagnosis: idiopathic hip >osteoarthritis. The hip joints of these patients have had no >deformities, cysts, bone necrosis or other defects in the skeleton; >these patients did not have previous operations, hip fracture or >other joint diseases that increase the risk of failure of the surface >hip replacement. > >Moreover, doctor McMinn excluded from the study 30% of his patients >who have had high failure rates! He says that these excluded >patients have had a wrongly manufactured surface replacement device >that caused the high failure rates. > My, oh my, 30% is a tragically high number. Funny, he (McMinn) didn't mention that to me. As a matter of fact when I asked him, he informed me that of the nearly 1500 resurfacing he'd done since 1995 he had not had one failure. There was no qualification. Must have slipped his mind to mention that 30%, so c'mon, which of the 450 of you he did that this procedure failed on are on the list? You all are the quietest bunch ever! Probably what is being cited was the pre-1995 BHR. This did have several loosenings in the early control group (small control group + a few failures ==> 30%), but this was rectified. Almost the first of the new BHR recipients was , who is something of a poster child for this procedure and is still going strong in Judo. Finally, the Japanese study was on people with brittle/deficient bones to show what we've come to accept: The implant is as good as the bone. If you have lousy bone stock, you should get a THR. McMinn stated there was another, more iteresting Japanese study that showed that up to 2 years post-op the bone around the implane (and be inference, under the cap) continued to grow and strengthen. Sorry, this sounds pretty partisan. No I don't care if he (the author of the site) is a doctor, I think he's being awfully selective in what he cites and rather breathlessly generalizes/extends it as needed.. Cheers, Jeff rBHR Aug. 1, 2001 Mr. McMinn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 Gotta delurk for a few here. [censored]????!!!!!! I went to McMinn from the US *sepcifically* because he had a good success rate with dysplasia in athletes. I had all sorts of nasty things in my hip (cysts and such, since it had been bone on bone for oh so long). They even had the standard dysplasia cup ready in the operating room. Turns out they didn't quite need it, although I did need all sorts of bone grafts. Yes, my ball was badly deformed (sort of like a lopsided mushroom) and took lots of reshaping. I have it on film, so I know what it looked like for sure. >On the other hand, the Birmingham patient group consisted of very >closely selected patients with only one diagnosis: idiopathic hip >osteoarthritis. The hip joints of these patients have had no >deformities, cysts, bone necrosis or other defects in the skeleton; >these patients did not have previous operations, hip fracture or >other joint diseases that increase the risk of failure of the surface >hip replacement. > >Moreover, doctor McMinn excluded from the study 30% of his patients >who have had high failure rates! He says that these excluded >patients have had a wrongly manufactured surface replacement device >that caused the high failure rates. > My, oh my, 30% is a tragically high number. Funny, he (McMinn) didn't mention that to me. As a matter of fact when I asked him, he informed me that of the nearly 1500 resurfacing he'd done since 1995 he had not had one failure. There was no qualification. Must have slipped his mind to mention that 30%, so c'mon, which of the 450 of you he did that this procedure failed on are on the list? You all are the quietest bunch ever! Probably what is being cited was the pre-1995 BHR. This did have several loosenings in the early control group (small control group + a few failures ==> 30%), but this was rectified. Almost the first of the new BHR recipients was , who is something of a poster child for this procedure and is still going strong in Judo. Finally, the Japanese study was on people with brittle/deficient bones to show what we've come to accept: The implant is as good as the bone. If you have lousy bone stock, you should get a THR. McMinn stated there was another, more iteresting Japanese study that showed that up to 2 years post-op the bone around the implane (and be inference, under the cap) continued to grow and strengthen. Sorry, this sounds pretty partisan. No I don't care if he (the author of the site) is a doctor, I think he's being awfully selective in what he cites and rather breathlessly generalizes/extends it as needed.. Cheers, Jeff rBHR Aug. 1, 2001 Mr. McMinn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 > To some extent, I take issue with this statement. Which statement? I'm looking at the Medline abstract for the McMinn article, and it is entitled: Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. One therefore assumes that the patient cohort reported on in the article (whose full text I cannot access) consists of patients under the age of 55 with osteoarthritis. That doesn't imply that McMinn, et al, haven't operated on other patients (since we know they have), merely that they did not report on those patients in this article. That's a perfectly reasonable thing to do. Only 65% of Amstutz's patients had a primary diagnosis of osteoarthritis. In addition, patients up to the age of 77 were included in Amstutz's paper In other words, the papers are about 2 different subjects. The problem comes when other people: 1) start comparing McMinn's apples to Amstutz's oranges and drawing conclusions about devices and/or surgical technique therefrom, and 2) start attributing sinister motives to the fact that McMinn is reporting on the success of resurfacing with a group of patients with a specific diagnosis, while Amstutz is reporting on *all* the patients in his initial resurfacings, regardless of diagnosis. These papers do not constitute a head-to-head comparison of the C+ and the BHR, because it wasn't the objective of either author to conduct such a comparison. It would be interesting to see what percentage of Amstutz's failures consisted of patients who were similar to those examined by McMinn (i.e., <55 years with primary OA), but I don't have that information. Perhaps Chuck could obtain that for us. Steve (bilat C+ 4/20/04, Amstutz) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 Amen. In a message dated 6/10/2004 7:43:09 PM Pacific Daylight Time, ecrow@... writes: Short of taking a pair of identical twins, with identical lives I suspect most information ends up being little more than a rough guide....... and if it was being followed as a road map most would get lost............. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 Amen. In a message dated 6/10/2004 7:43:09 PM Pacific Daylight Time, ecrow@... writes: Short of taking a pair of identical twins, with identical lives I suspect most information ends up being little more than a rough guide....... and if it was being followed as a road map most would get lost............. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 Hi Des, In my past life I worked for a time in our federal statistics agency............ and your statement about lies and stats is so very true............ I have long watched people argue things with statistics I know to have little foundation to start with, statistics that come from surveys that have poor foundation in set up of trials etc.............. It has always beaten me just how one could do much with hip figures because so often the ages of people, what they do before and after, the state of their hip bones and rest of the body doesn't appear as information within the survey and could have 90% bearing on the outcome............ That's without the particular surgeons skill i.e. some work magic in difficult situations and others would stuff up the best of situations, hospitals record for infection etc if we just go across the random population and what happened........... Short of taking a pair of identical twins, with identical lives I suspect most information ends up being little more than a rough guide....... and if it was being followed as a road map most would get lost............. Edith LBHR Dr. L Walter Syd Aust 8/02 > What this comes down to is it illustrates the three kinds of lies - lies, > damned lies and statistics. I learned that throughout my academic career many > years ago. I also learned that it is a simple matter to present a point of view > with the purposeful use of language. The language should never substitute for > careful thought and analysis. > > Des Tuck > LBHR Oct. 2001 > RBHR May 2003 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 Hi Des, In my past life I worked for a time in our federal statistics agency............ and your statement about lies and stats is so very true............ I have long watched people argue things with statistics I know to have little foundation to start with, statistics that come from surveys that have poor foundation in set up of trials etc.............. It has always beaten me just how one could do much with hip figures because so often the ages of people, what they do before and after, the state of their hip bones and rest of the body doesn't appear as information within the survey and could have 90% bearing on the outcome............ That's without the particular surgeons skill i.e. some work magic in difficult situations and others would stuff up the best of situations, hospitals record for infection etc if we just go across the random population and what happened........... Short of taking a pair of identical twins, with identical lives I suspect most information ends up being little more than a rough guide....... and if it was being followed as a road map most would get lost............. Edith LBHR Dr. L Walter Syd Aust 8/02 > What this comes down to is it illustrates the three kinds of lies - lies, > damned lies and statistics. I learned that throughout my academic career many > years ago. I also learned that it is a simple matter to present a point of view > with the purposeful use of language. The language should never substitute for > careful thought and analysis. > > Des Tuck > LBHR Oct. 2001 > RBHR May 2003 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 10, 2004 Report Share Posted June 10, 2004 As much as we have all come to loathe the cumbersome FDA approval process here in the U.S., it could be these same stringent guidelines to the approval process that protect us from such " deviations " in reporting protocol as discussed in this article. Chris > I was doing some research for my soon to be filed appeal for my soon > to be received denial from my insurance company for resurfacing. I > came across an interesting article that I thought I would share with > the group since comparisons have been made the last couple of days. > Also, the site where I found the article is a nice site for > information. There are several other articles that were interesting > and most likely will be others in the future. This may have already > been shared but I missed it. Sorry if it is repetitive! > > The site I found > it was: > http://www.totaljoints.info/what_new1.htm > > It's called TEST/News > > " > March 2004 > > 24 / 03 / 2004 > > THE BIRMINGHAM SURFACE HIP – more details > > The report about the excellent results of the Birmingham surface hip > replacement device (see the 19/03 2004 NEWS: Surface hip replacement) > raised several questions among the readers of the NEWS page (see also > the Opinion page). > > Many readers were surprised by the difference between the results of > the American (Amstutz 2004) and the British ( 2004) surgeons. > > According to doctor Amstutz report, 94.4% of his entire surface hip > group survived for four years; in the Birmingham group 99.7% of all > surface hips survived seven years. > > Doctor Amstutz observed both surface hip dislocations and fractures > of the femoral collum stump; no such complications were observed in > the Birmingham patient group. > > Doctor Amstutz used the Conserve Plus model manufactured by MT > Company, the British surgeon doctor McMinn used the Birmingham Hip > Resurfacing devices manufactured by MMT Company. Naturally, the > question arises whether the two different surface hip models in some > way influenced the results, if the one resurfacing hip model is > better than the other one. > > I do think that the difference in the results between doctor Amstutz > group and the doctor McMinn patient groups does not depend on the > type of the surface replacement device used. The difference in the > results depends in my opinion on different patients selection by the > two surgeons. > > Doctor Amstutz's patients have had a wide range of hip diseases. Only > two thirds of them have had primary osteoarthritis of the hip as the > reason for surgery; 10% of them have had severe osteonecrosis of the > femoral head, 8% have had previous hip fracture, and 6% have had > previous surgery. These diagnoses are known to bear greater risk for > eventual failure of the surface replacement. > > On the other hand, the Birmingham patient group consisted of very > closely selected patients with only one diagnosis: idiopathic hip > osteoarthritis. The hip joints of these patients have had no > deformities, cysts, bone necrosis or other defects in the skeleton; > these patients did not have previous operations, hip fracture or > other joint diseases that increase the risk of failure of the surface > hip replacement. > > Moreover, doctor McMinn excluded from the study 30% of his patients > who have had high failure rates! He says that these excluded > patients have had a wrongly manufactured surface replacement device > that caused the high failure rates. > > In my belief the excellent " 99% + " results of the Birmingham hip can > be reproduced only on patients with the idiopathic osteoarthritis of > the hip joint. Patients with other hip joint diseases and > deformities, such as developmental hip dysplasia, avascular necrosis, > rheumatoid arthritis, and previous fracture should rather expect the > more realistic results achieved by doctor Amstutz. > > Actually, there are reports about very disappointing results with the > McMinn Resurfacing Hip Arthroplasty. Japanese surgeons published a > report that demonstrated 3 failures among 11 patients operated on > with the McMinn Resurfacing Hip Arthroplasty. (Watanabe 2000). Two of > their patients sustained femoral neck fractures, and the third > developed loosening in the acetabular component early after the > surgery. The Japanese surgeons believe that this surface replacement > device is not appropriate for patients with brittle or soft bones > because of its biomechanical characteristics. > > Doctor Amstutz discusses extensively the appropriateness of surface > hip replacement for these patient categories, but such discussion is > lacking in the McMinn paper. > > Your opinion? > > ____________ > > References: > > Amstutz H et al.: J Bone Joint Surg-Am 2004; 86-A : 28 - 39 > > J et al.: J Bone Joint Surg- Br 2004; 86- B : 177 – 84 > > Watanabe Y et al: J Arthroplasty 2000; 15: 505 - 11 > > > ------------------------------------------------------------------- --- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2004 Report Share Posted June 11, 2004 At 07:40 PM 6/10/2004 +0000, you wrote: >Japanese surgeons published a >report that demonstrated 3 failures among 11 patients operated on >with the McMinn Resurfacing Hip Arthroplasty. (Watanabe 2000). Two of >their patients sustained femoral neck fractures, and the third >developed loosening in the acetabular component early after the >surgery. The Japanese surgeons believe that this surface replacement >device is not appropriate for patients with brittle or soft bones >because of its biomechanical characteristics. I recall a member here who lived in Japan and was having her hip resurfaced there. IIRC, she had to go into the hospital about two weeks early, then stay for 30 days post-op. All that confinement and lack of activity cannot be good for bone strength, especially if the bone quality may have been iffy to start with. Cindy C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2004 Report Share Posted June 11, 2004 At 07:40 PM 6/10/2004 +0000, you wrote: >Japanese surgeons published a >report that demonstrated 3 failures among 11 patients operated on >with the McMinn Resurfacing Hip Arthroplasty. (Watanabe 2000). Two of >their patients sustained femoral neck fractures, and the third >developed loosening in the acetabular component early after the >surgery. The Japanese surgeons believe that this surface replacement >device is not appropriate for patients with brittle or soft bones >because of its biomechanical characteristics. I recall a member here who lived in Japan and was having her hip resurfaced there. IIRC, she had to go into the hospital about two weeks early, then stay for 30 days post-op. All that confinement and lack of activity cannot be good for bone strength, especially if the bone quality may have been iffy to start with. Cindy C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2004 Report Share Posted June 15, 2004 A friend of mine here in LA who was a Solid Gold dancer (tv music show) and in the Beach Blanket movies was initially told by Dr. McMinn that her bones were too weak. She exercised and made them strong enough to get the surgery. Doing fine now. It's amazing how a little loading can help the bones - and no loading can hinder. Ironic, tho, the Japanese Dr's should have know that. > > >Japanese surgeons published a > >report that demonstrated 3 failures among 11 patients operated on > >with the McMinn Resurfacing Hip Arthroplasty. (Watanabe 2000). Two of > >their patients sustained femoral neck fractures, and the third > >developed loosening in the acetabular component early after the > >surgery. The Japanese surgeons believe that this surface replacement > >device is not appropriate for patients with brittle or soft bones > >because of its biomechanical characteristics. > > > I recall a member here who lived in Japan and was having her hip resurfaced > there. IIRC, she had to go into the hospital about two weeks early, then > stay for 30 days post-op. All that confinement and lack of activity cannot > be good for bone strength, especially if the bone quality may have been > iffy to start with. > > Cindy > C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2004 Report Share Posted June 15, 2004 A friend of mine here in LA who was a Solid Gold dancer (tv music show) and in the Beach Blanket movies was initially told by Dr. McMinn that her bones were too weak. She exercised and made them strong enough to get the surgery. Doing fine now. It's amazing how a little loading can help the bones - and no loading can hinder. Ironic, tho, the Japanese Dr's should have know that. > > >Japanese surgeons published a > >report that demonstrated 3 failures among 11 patients operated on > >with the McMinn Resurfacing Hip Arthroplasty. (Watanabe 2000). Two of > >their patients sustained femoral neck fractures, and the third > >developed loosening in the acetabular component early after the > >surgery. The Japanese surgeons believe that this surface replacement > >device is not appropriate for patients with brittle or soft bones > >because of its biomechanical characteristics. > > > I recall a member here who lived in Japan and was having her hip resurfaced > there. IIRC, she had to go into the hospital about two weeks early, then > stay for 30 days post-op. All that confinement and lack of activity cannot > be good for bone strength, especially if the bone quality may have been > iffy to start with. > > Cindy > C+ 5/25/01 and 6/28/01 Quote Link to comment Share on other sites More sharing options...
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