Hip Resurfacing or Hip Surface Replacement

Hip Resurfacing X-ray (from JRI site)

Wright Conserve Plus Implant (from JRI site)

Nearly all major implant makers either have in production or are developing metal-on-metal hip resurfacing components:

	Wright Medical Technology makes the Conserve Plus resurfacing implant which is being marketed in Europe and Asia and awaiting FDA approval in the United States.
	Smith and Nephew recently purchased Midland Medical Technologies and they are marketing the Birmingham Hip Resurfacing globally.
	Corin Medical, Ltd. makes the Cormet hip resurfacing implant. Stryker Corporation has an agreement to market Corin's Cormet hip resurfacing device in the United States. The Corin Cormet was approved for marketing in the United States by the FDA on July 3, 2007.
	Biomet has a resurfacing device named ReCap and has a clinical trial of a metal-on-metal Re-cap underway in the United States.
	Zimmer makes a hip resurfacing implant that is called the Durom in North America (outside the US) and Bonesave in the UK.
	Depuy (a division of Johnson and Johnson) markets a resurfacing device in Canada, Europe, India and Australia under the brand nameASR (Articular Surface Replacement).
	Finsbury Orthopedics, Ltd of Surrey, England , who manufacture the BHR device for Smith and Nephew have their own branded resurfacing device in their ADEPT line which includes a matching large-diameter total hip replacement.
	ICON, a German manufacturer, markets a resurfacing device and minimally-invasive surgical approach in Europe.
	Nemoto Shokai (Japan) and Tornier (France) are two other manufacturers with a hip resurfacing offering, either hemi-resurfacing or metal-on-metal.

Advantages of Hip Resurfacing

• Femoral head is preserved.
• Femoral canal is preserved and no associated femoral bone loss with future revision. Also, the risk of microfracture of femur with uncemented stem implantation is eliminated.
• Larger size of implant "ball" reduces the risk of dislocation significantly.
• Resurfacing patients are more likely than total hip replacement patients to recover a natural gait.
• Stress is transferred in a natural way along the femoral canal and through the head and neck of the femur. With the standard THR, some patients experience thigh pain as the bone has to respond and reform to less natural stress loading.
• Use of metal rather than plastic reduces osteolysis and associated early loosening risk.
• Use of metal has low wear rate with expected long implant lifetime.

Special Risks of Hip Resurfacing

• There is some risk of the femoral neck breaking. This risk can be nearly eliminated by proper patient selection, correct angle of implantation of the device and avoiding notching the neck when preparing the femoral head in surgery.
• Lack of long-term track record. Current device has only been used for about 10 years.
• Despite known low wear rate, longevity and longterm effects of wear debris are unknown.
• For some surgeons, the procedure has a longer surgical time. The procedure requires somewhat more skill of surgeon. Because of this, a learning curve" has been documented where it is common for a surgeon to have more complications in his first series of patients.

Special Requirements of Resurfacing Patients

• Solid bone in femoral head to hold resurfacing component. A few cysts or slight AVN collapse may be acceptable.
• Healthy kidneys to process any bloodborne metal ions from debris products.

Hip Resurfacing in the United States and Around the Globe

Wright Medical Technology has recently completed a clinical trial of the Conserve Plus resurfacing device. The participating surgeons have been allowed continued access to the devices for use while they await results from the clinical trial. A few other surgeons are using the Conserve Plus as an "off-label" application. During this time the device is classified as a Class-B, Non-experimental, Investigational Device by the US FDA. Contact WMT for further info.

An application has been made to the FDA for approval to market the Wright Conserve Plus in the United States. The company has told shareholders that approval is expected soon. Approval could come in 2007.

Corin Medical, Ltd., of the U.K., has recently completed a clinical trial of a metal-metal hip resurfacing implant, the Cormet (sometimes called Cormet 2000) , in the United States and Canada. Click here for the list of surgeons who participated inCorin's clinical trial and are currently in the continuing access phase. The Cormet 2000 is classified as a Class-B, Non-experimental, Investigational Device by the FDA. The Cormet device was recommended for approval by an FDA Panel on February 22, 2007. Contact Mikey Langford at Corin for further information (813-977-4469).

Biomet has recently begun a clinical trial of its metal-on-metal ReCap hip resurfacing device using instrumentation developed in part by Dr. Thomas Gross of Midlands Orthodpedics. For a list of surgeons in the Biomet ReCap clinical trial, click here.

Resurfacing of the femoral head only (for patients with good acetabular cartilage, generally those with AVN without secondary OA) is approved for general use in the US by the FDA. This hemi-resurfacing can be done with Wright Medical Technology's Conserve device or the Revival device from Corin Medical, Ltd.

There are several surgeons doing hip resurfacing in Canada. It is covered by the Ontario Health Insurance Plan (OHIP). Click here for a partial list of surgeons and their contact information. Canadians may also contact Wright Medical Technology Canada, phone 905-826-1600 in Mississauga for further info on the Conserve Plus, or contact Joint Solutions Alliance, phone 905-639-7243 or 877-371-1102, for info about the Corin Cormet in Canada.

A group of Canadian surgeons is also offering the Cormet hip resurfacing at two hospitals in the Cayman Islands. See Canadian Medical Specialists for further information.

Hip resurfacing has been performed for many years in Europe. Derek McMinn and Ronan Treacy at the Royal Orthopaedic Hospital in Birmingham, England have performed several thousand hip resurfacing surgeries in the past decade using the BHR resurfacing implant. The procedure is now being performed by many other surgeons across the UK, for example at St. Anthony's Hospital in London and Hull Nuffield Hospital in Hull.

The distributor for Wright Medical in the United Kingdom is Wright Cremascoli Ortho Ltd, phone +44(0)1244 572120 in Pulford, Chester.

In Belgium resurfacing using the Wright Conserve Plus and the BHR device is being done at the ANCA-Clinic for Hip Surgery by Dr. K. De Smet (phone: +32(9)2525903). Contact Wright Cremascoli-Belgium, the local Wright Conserve Plus distributor, or for information on other surgeons using the Conserve Plus in Belgium.

In France the Wright Medical distributor is Wright Cremascoli OrthoTechnique, phone 011.22.1.45.13.24.40 in Creteil.

For information on surgeons using the Wright Conserve Plus in Germany contact Wright Cremascoli Ortho-Germany, 4941 6174 5130. For information on the BHR resurfacing device in Germany Smith and Nephew Germany Resurfacing is commonly covered by insurance in Germany.

In Switzerland patients may email Smith and Nephew Switzerland for information regarding the BHR device.

In Italy hip patients may contact Wright Cremascoli Ortho SpA, phone 011.39.0250.678.227 in Milano. Or contact Bimar SPA, the MMT BHR distributor in Italy.

In Israel, one of the surgeons doing resurfacing using the Cormet device is Dr. Steve Velkes, MD, (stivenv@clalit.org.il) working from the Rabin Medical Center (Beilinson Campus) and the Herzilya Medical Center. Also, Dr. Daniel Levin M.D. (www.hipsurgery.co.il) performs hip resurfacing in Haifa.

In India there are several options for hip resurfacing, and resurfacing in India was recently featured in a CBS 60-Minutes piece on medical tourism. Click here for a list of surgeons performing hip resurfacing in India. For further information abou hip resurfacing in Inida using the Birmingham Hip email Smith & Nephew India

In Hong Kong information on the BHR can be obtained via email to the Hong Kong Smith and Nephew representative

The distributor for Wright Medical in Japan is Wright Medical Japan K.K. in Tokyo, phone 81-3-6230-1451.

Australians can check the web site at Smith and Nephew Australia for information about hip resurfacing using the BHR device in their country.

In South Africa, Dr. Spike Erasmus and Dr. Evan Williams, at the Panorama Medi-Clinic near Cape Town, are among the surgeons who perform the hip resurfacing surgery using the BHR device. See Smith and Nephew South Africa for BHR surgeons elsewhere in South Africa.

FAQ

• Hip Resurfacing Frequently Asked Questions

Surgeon Lists and Links

• US Surgeons in the Wright Medical Clinical Trial
• US Surgeons in the Corin Clinical Trial
• Experienced BHR docs in the United States
• Hip Resurfacing Surgeons in Canada
• Hip Resurfacing Surgeons in India

Online Hip Resurfacing Resources

• Surfacehippy Hip Resurfacing Patient Discussion Group
  
  • Surfacehippy T-Shirts
• Hips-R-Us hip resurfacing forum for UK patients
• Abstract of Resurfacing Paper in Jan 2004 Journal of Bone and Joint Surgery
• Prepublication Excerpt of 2004 Journal of Bone and Joint Surgery Paper
• Book: Hip Replacement or Hip Resurfacing: A Story of Choices
• AARP Article on Hip Resurfacing
• Wright Medical Technology
• ResurfacingOfTheHip.com, Corin's Resurfacing Site
• MMT Hip Resurfacing Page
• Birmingham Hip Resurfacing Brochure
• Zimmer/Centerpulse Durom Site
• Joint Replacement Institute (JRI) Home
• Richie's Resurfacing Story
• A Proposed Metal Defense Protocol (pdf file)
• Search for Hip Resurfacing Research on PubMed