In this section you will find answers to the most frequently asked questions we receive regarding hip resurfacing at the Joint Replacement Institute.
20.Q.Does the debris generated from metal-metal bearings cause cancer or other systemic organ disease?
A. Metal-metal bearings have advantages for active patients because their wear resistance is much greater than that of polyethylene, they do not fracture and they perform better with larger diameter balls. It has been known for three decades that the serum and urine levels of cobalt and chromium (the main elements in a metal-metal hip bearing) are increased in patients with a metal-metal bearing. The health impact of such ion levels has not been established and continues to be debated. Trace element analysis requires very sensitive equipment since the levels are in parts per billion (ppb). Absent some environmental exposure, serum and urine levels of cobalt and chromium are effectively zero in people with no metallic implants. In patients with a well-functioning total joint with a metal-on-polyethylene bearing, the serum levels are generally less than 1 ppb. In patients with a well-functioning prosthesis with a metal-metal bearing, the ion levels are generally between 1 and 5 ppb. These levels are very low and are 1/10th to 100 times less than posted industrial toxic levels. If there is any increase in overall health risk to patients with a metal-metal bearing prosthesis and none has been proven today , it must be very low, given the thousands of MM implants used since their reintroduction 20 years ago. The JRI continues to closely monitor patients with metal-metal bearing prostheses to better define the benefits and risks of this technology.
21 Q. How long will a hip resurfacing last?
A. We simply cannot predict how long the hip resurfacing implants will last forseveral reasons. Durability is directly related to several factors including the quality of the femoral bone, implant design,
the patient’s unique anatomy patient’s activity level and most importantly the surgeon’s skill in performing the surgery. It is difficult and inappropriate to prognosticate about a device’s performance and longevity without long-term clinical data. In the absence of
speculative. However the comprehensive follow-up the Conserve®Plus procedures have enabled us to carefully follow up patients beyond 11 years and their survivorship data, even with the earliest technique and most seriously affected hip with severe cystic disease, is better than 90.5%. Now with improved techniques we would be disappointed if that figure did not reach 98% We also have identified signs of impending failure and in the absence of any of these signs, very long-term survivorship is possible.
22. Q. What is my first step in having hip resurfacing surgery at the JRI?
A. The first step in the process is to have a consultation with one of our surgeons. As a matter of convenience for out-of-state patients, we offer consultations by telephone. It is JRI policy that consultations by telephone are not billable to insurance plans and, therefore, the patient must pay for this service in advance. To request a telephone consultation, please contact the JRI at jovitaortega@dochs.org and a member of our staff will contact you. For a telephone consultation, we would mail you forms to complete and ask that you return the completed forms with recent hip x-rays (i.e., < 3 months) and the fee payment. The respective surgeon’s patient coordinator would then contact you to schedule the date and time for the consultation.
To schedule an in-office appointment with one of our surgeons, please call the JRI at (213) 484-7600 for both Dr. Amstutz or Dr. Schmalzried.
23. Q. If I have hip resurfacing surgery at the JRI and I am traveling from out of state, how long is my stay in Los Angeles?
A. The time in LA is typically 3-6 nights which includes a 2-3 night hospital stay (3-4 nights for bilateral surgery); and 1-2 days in advance of surgery to undergo a medical examination, pre-op visit with the surgeon, sign paperwork,
register at the hospital, etc... Arrangements may be made to stay pre-op, during hospital stay by family member or post-op at St Vincent’s Guest Facility Seton Hall. See the St Vincent Medical Website or contact our office for additional information.On occasion, the internist will ask you to spend an additional night following hospital discharge for routine monitoring associated with our anti-coagulation protocols. A subcuticular wound closure is generally performed and sealed with dermabond. If staples are used, then they are generally removed 8-10 days following surgery and can be removed by your family physician.
24. Q. Following discharge from the hospital, am I transferred to an extended stay, rehabilitation or skilled nursing care facility?
A. Rarely is a JRI patient transferred to another facility following hospital discharge regardless of the type of joint replacement they received. In other words, our patients are almost always discharged directly to home. Occasionally, a patient is transferred to a transitional care unit at St Vincent’s medical Center or rehabilitation or skilled nursing facility if the surgeon feels that it would be beneficial, such as in the case of elderly patients who are less ambulatory or stable or if they have other medical conditions that require closer post-operative monitoring
25. Q. Do I need to donate blood for my surgery?
A. As with many surgeries, bleeding can occur during hip surgery and you may require a blood transfusion. However, due to advances in operative and anesthesia techniques, the need for blood donation prior to hip resurfacing or THR has been eliminated or significantly reduced. For example, blood donation prior to surgery is typically not required for male patients. Small female patients may donate one unit of blood for unilateral surgery (one hip) because their effective blood volume and hence reserve is less. Two units are suggested for bilateral surgery (both hips) for both men and women. Revision surgery will typically be required to donate blood prior to surgery although the number of units may vary depending upon the anticipated complexity of the patient’s case. Refer to “Planning for Your Surgery” in the Hip Replacement section of the website for detailed information regarding the types of blood donation. If your surgeon recommends that you donate one or more units of blood, then our office will fax an order signed by the surgeon to the blood donation facility that you designate.
References
1. 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.
2. Eastaugh-Waring S, Seenath S, Learmonth D, Learmonth I. The practical limitations of resurfacing hip arthroplasty. J Arthroplasty. 2006;21:18-22.
Copyright 2005 Joint Replacement Institute Los Angeles, CA · (213) 484-7600 · JRIinfo@dochs.org
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