现代髋关节表面置换 - 罗伯特·琼斯爵士讲座

Modern Hip Resurfacing -- Sir Robert Jones Lecture - Derek McMinn 2008 New York The McMinn Centre

发布时间：2013-07-29

Mr Derek McMinn presents the Sir Robert Jones Lecture in New York, 2008. Mr McMinn talks about Birmingham, the history of hip resurfacing and survivorship rates. The reasons behind implant failure are explored, comparing Birmingham Hip Resurfacing (BHR) patient outcomes with Total Hip Replacement (THR) patient results.

The Sir Robert Jones Lecture dates back to 1930 and is the oldest continuous orthopaedic lecture series in North America. Introduced by Dr Joseph D. Zuckerman MD, the lecture represents a who's who of orthopaedic surgeons throughout the world. Sir Robert Jones is considered to be one of the fathers of modern orthopaedic surgery. In this talk, Derek McMinn MD FRCS discusses Modern Hip Resurfacing.

In 1991, the first of the modern generation of metal-metal resurfacings were being developed by Mr McMinn. Unbeknownst to him at the time, Professor Heinz Wagner was also working on a similar implant and they were both being used and tested. The first McMinn hip resurfacing was a smooth press fit with no porous coating, no hydroxyapatite (HA) and no cement. However, patients reported pain which was caused by micromotion and the subsequent loosening of the implant was a big problem.

The survivorship curve from this first series showed an unacceptable outcome. In response to this, the cup was modified to allow it to be cemented. The femoral component was not modified but was also cemented. This combated the implant loosening but led to cement debris and osteolysis. After 3 years, a hybrid implant was developed using a hydroxyapatite cup and a cemented femoral component. These produced very good results.

In 1996 however, things started to go wrong when the manufacturer began double heat-treating the metal implants. This process seriously depletes carbides in the metal and removes the wear resistance. The reasons for implant failure were explored, looking at inclination angles and cup introducers, but the double heat treatment was the culprit. Mr McMinn has tirelessly warned against using double heat treated metal implants -- most notably in his 2005 Northern Lights Debate Lecture