Hi All,
I noticed that surgeon data, including McMinn's data published on the McMinn Centre website, tends to project about 97% survival rate at 15 years.
This remarkable statistic, though, pertains to a span of years during which a certain number of devices were implanted, and accounts only for revisions ocurring at the date of publishing.
In otherwords, the 97% figure assumes that all remaining devicies will survive to the 15 year mark.
So, my question is: do we have data that tells exactly how long a certain cohort of devices has in fact lasted over say, a 10 or 15 year period, without any assumptons?
Hope this is clear. Just a little confused.
Thanks,
CI
I think that the 2 men from Birmingham have the best longest data out there maybe email Mr McMinn?
Hi Canadian Ice
I guess I'm not sure what you mean. What an empirical study should do is look at the available data and count. For example, if we look at 400 hips that where resurfaced 15 years ago and 388 of them still have the same device in place then that means we see a 97% survival rate at 15 years. A good empirical study does nothing more than this. I don't know what is being "extrapolated" on the McMinn website, but if they are doing something more than reporting what they see then of course that should be taken into consideration.
Cheers
Tim Bratten
I could be wrong, but my understanding of the "97% at 15 years" statement does cover exactly what you are looking for. It looks at cases that are at least 15 years old, and shows that 97% of the prostheses are still in place. The study does not cover devices implanted during the past 15 years, but it covers devices that were implanted at least 15 years ago. The study itself makes no assumptions, but it would lead to assumptions about devices that have been put in place more recently than 15 years ago, leading us to believe that they will have at least the same survival rate.
When you look at the surgeon information, you obviously look at that particular surgeon's practice and experience with the devices they selected, used on the patients that they selected, with both the surgeon's skill and recovery practices.
They are heavily influenced by the choices made, and would be much better for more skilled surgeons in all instances.
The best source of information for the opposite, a compendium of all surgeons of all skills with all possible patients, all sources of the disease (OA, dysplasia, etc...) and all devices comes from the national registries.
These are necessarily more diffuse in their analysis, since you are dealing with hard statistics without taking surgeon skill, etc. into account. They also blend in the results from devices that have been found wanting for different reasons - devices that may be fine in the hands of more skilled surgeons, but have a penchant for being put in improperly by less experienced, so they were recalled.
With those caveats, the Australian registries are probably the best aggregate of data that we have to date. Unfortunately the US does not keep a registry.
so,
I've attached
- the total cumulative revisions for HRs over an (about) ten year's span.
- total HR revisions by reason. This the percentage of all failures. So if the total failures is 6% over the 10 year span, the percentage of that 6%
- What I think you asked for, the cumulative percentage failure over time per device.
This is the cumulative amount at a particular year. If you want to know the total number that failed, just read the year's value. You don't add it across the years.
Hope that helps. If you're interested in this, check out the national registries information that Pat has set up on the site. This is from the 2012 registry information.
Hern - you make some excellent points. However, for a simple perspective in support of someone looking at HR as an option, I think Tim and John's summaries are answering Ice's orginal question. I guess, if we assume that the patient will go to a very experienced surgeon, then they would most likely fall in a similar range of stats/success that we see in the McMinn dataset, which we know shows better success than the national registries due to dilution from less experienced surgeons and a host of other factors. I tend to rely on the McMinn study/dataset as a top end of what a surgeon and HR can do. I think we also assume that most experienced surgeons will have a similar success rate.
Not quite sure where I was headed with that, but this is often what comes to my mind when we discuss successs of HR, or BHR in the case of McMinn and many other surgeons.
Oh, I agree completely. It also points out the measurable increase in success when you compare a top surgeon's results to those leavened by the less skilled, etc.
Hey Guys,
I guess what I'm getting at is:
Individual variable factors aside, what is the chance of MY (or any one's) resurfacing lasting 15 years?
The data suggests a less than 97% chance, because it is quite possible that some of the resurfacings doing between 1997 and 2010 in the McMinn study, will fail before they reach the 15 year mark. For instance, some of those done in 2010, will require revision by 2025. Some of those done in 2009, by 2024, and so on.
The only years for which the actual 15 year survival data is known, are 1997-98. But that's not on the chart.
Am I reading this correctly?
Just went to post it, but the graph is gone. Oops.
Still think results are good. Just trying to get a sense of how long any given device, individual factors aside, is likely to last.
Hello
This is our first time posting on the forum, but we hope to contribute often and share our vast resources at The McMinn Centre.
The McMinn Centre have a lot of data on the BHR and we recently added a new lecture to our website and it's also available on this website, it's called 'BHR & Other Options.
In this lecture Mr McMinn talks about his results with the BHR at 15 years. The results are based on a cohort of the first 1000 BHRs (886 patients (598 Men, 288 Women)). These patients have had their BHRs 12-15 years and were operated on between July 1997 and August 2000. All of the procedures were done by Mr McMinn.
This cohort of patients are producing a survivorship of 95.8% at 15 years (both genders, all ages, all diagnoses). When broken down male survivorship is 98% and female survivorship is 91.5% at 15 years. These results are then broken down by gender and age and into diagnoses and head sizes also.
Hopefully this first post will help Canadian-Ice and the rest of you understand our latest data on the BHR.
Any questions don't be shy to ask!
Patricia Walter added url to page discussed above:
http://www.surfacehippy.info/mcminn-lecture-bhr-2013.php (http://www.surfacehippy.info/mcminn-lecture-bhr-2013.php)
What a fantastic reply! Great to see the McMinn centre on here! ;)
Welcome and thank you for your work to help us hippies regain our lives!
Danny
Excellent news! Guess this post really paid off. Thanks to all and thanks to the McMinn Centre for posting!
Those results are highly encouraging. 91.5% and 98% survivorship of 1000 BHRs over 15 years clearly suggests the vast majority of recipients will not need revisions in their lifetimes! That's just an amazing result.
Since more questions are welcomed, may I ask for the results breakdown for various demographics? ie. average sized (175lbs) males who have a resurfacing in their mid 40s?
Also woundering what data might be available on any controllable factors that might influence longevity, such as continuing to do hip strengthening exercises and engaging in impact sports?
I've noticed many people on this site are very active. A lot of competitive athletes who sprint, marathon, bike, swim, and do martial arts very seriously, from the recreational to the elite. I run, myself, sprinting and long distance.
Any info. recognizing any impact differences between recreational and elite athletes, such as runners?
And lastly, woundering about those 5% who do require revision for whatever reason at 15 years. Do we have survivorship data for post-BRH Revision THRs? Considering if one is relatively young, say 60 years old, and a revision THR is necessary, can they expect that to last 10-15 years?
Thanks so much for any and all information! And again, to second Danny, thanks for ALL that you do. Even for those of us without a resurfacing yet, it gives us such hope and peace to know this solution is available.
CI
Here are some comments elsewhere on this site by various surgeons on running after resurfacing. Dr. Amstutz's comments include reference to a study in which he involved.
http://www.surfacehippy.info/running-after-hip-resurfacing.php
The "BHR & Other Options" lecture by Mr. McMinn on the McMinn Centre website runs just over 1 hour, but it provides a LOT of information and is VERY interesting. When you have a chance, take the time to view it.
Hi
Unfortunately I can't get the breakdown demographics of the results you quite wanted Canadian-Ice. However, I can tell you from our 12-15 Year results of the first 1000 BHRs... Over 20% are aged between 40-50 years and that males under 60 have 98% survivorship at 15 years (over 60s have 99%!) There has only been 13 male revisions in this cohort.
Activity wise I would like to direct you to our facebook page, where there is an excellent infographic explaining what percentages of patients do what types of sports. It should help show that a lot of our patients are very active and continue to do well 12-15 years down the line. The infographic is at...
https://www.facebook.com/photo.php?fbid=551608094896123&set=pb.114693228587614.-2207520000.1375348616.&type=3&theater (https://www.facebook.com/photo.php?fbid=551608094896123&set=pb.114693228587614.-2207520000.1375348616.&type=3&theater)
You don't have to be on facebook to see the image, but if you are then why not 'Like' the page anyway and keep updated!
Hope this helps answer some of your questions, I will try and find some answers to the others.
Thanks
The McMinn Centre
The amstutz paper only discusses the use of the conserve plus device and high impact. The bhr is pretty different and is line to line unlike the C+. Mr McMinn has published a paper on the subject of high impact post bhr although I can't find it at present.
Danny
It's hugely reassuring to have The McMinn Centre onboard and posting - many thanks for taking the time to do so.
Hi TheMcMinnCentre, do you know how those 10-15 year statistics would compare to a similar cohort who still have their native hips? I always wondered which is more likely, a BHR patient needing a revision, or a native hip owner needing their first hip arthroplasty. If 95.6% of BHR patients are surviving without revisions to THR can the native hip population be that durable as well? I guess you could call it a native hip revision rate?
Chuckm
Quote from: chuckm on August 01, 2013, 10:47:09 AM
Hi TheMcMinnCentre, do you know how those 10-15 year statistics would compare to a similar cohort who still have their native hips? I always wondered which is more likely, a BHR patient needing a revision, or a native hip owner needing their first hip arthroplasty. If 95.6% of BHR patients are surviving without revisions to THR can the native hip population be that durable as well? I guess you could call it a native hip revision rate?
Chuckm
I can give a sort of reasonable answer to this question by using some easy to find data on the internet, but to get a number I will need to make various assumptions. First off I focus on the US population (obviously there is a much higher rate of hip replacement in the US than in India or China, for example). More importantly, I will not consider the entire US population. For example, if we consider people younger than 18 y.o. (years old), almost no one in this group will need a hip replacement over a 15 year period, yet we are talking about 24% of the total population. Including this group, would make the chance of needing a hip repalcement very small. As a sort of arbitary cut-off (and because the data is available) I will take the value to be 45 years of age (or more). Since I imagine that almost everyone in the BHR study group was > 44 y.o. for their first surgery I suppose this is not unreasonable.
According to the Center for Disease Control there were 332,000 hip replacments in the US in 2010. Extrapolating over a 15 year period this gives 15x332,000= 4,980,000 hip replacements (roughly 5,000,000). On the other hand, according to the US Census Bureau, in 2010 there were 121,758,429 people (roughly 120,000,000) in the US whose age was > 44 y.o. This gives (approximately) 240,000,000 hips. Now we make more simplifying assumptions: no-one in the > 44 y.o. group has a hip replacement at the start of the 15 years (observe I've already taken away more than 3 million hips by rounding down) and the 5,000,000 procedures over the next 15 years all get handed out to these 240,000,000 hips. Obviously these assumptions are false, but the error involved will be be very small compared to these large numbers.
That means 5/240 =1/28 which is almost 4% of these hips will need to be replaced over 15 years. In other words: if you have your natural hips, live in the US and are more than 44 y.o. than you have roughly a 4% chance of having a hip repalcement in the next 15 years.
Chuck, Tim, that's just awesome.
That's great Tim, otherwise I don't think I would have had an answer for Chuck! In our first 100 BHRs series I think it's something like 87% were between 40-70 at time of surgery (A slide in the lecture shows the correct amounts) so your >44 y.o. assumption was a fairly good one.
From your calculations it appears the survivorship of natural hip is similar to the BHR in that wide age range. I assume once you narrow it down to 40-50, 50-60, 60-70 etc the odds would probably favour the BHR. Remember in men 60+ y.o. at time of operation the survivorship in Derek McMinn's first 1000 BHRs series is 99%!!
Having read as much data as I could lay my hands on I have come to the conclusion that having had the bhr installed by Mr Treacy when I was 28 I will probably need a redo at some point however I'm confident that this will last me till I have slowed down ;)
Having seen that the thr's made from the same alloy can last over 40 years is very very encoraging
Dannywayoflife and Canadian-Ice, I had been pressing this issue early on in my rehab because my own investigation led me to believe that the BHR (properly installed in a good candidate) is going to be unaffected by any level of activity, despite reports implying that activity level was directly related to lifespan of hip resurfacing devices. No one was ever investigating the subject when considering"properly implanted" resurfacing devices.
As usual, Pat Walter came through to shed light by collecting information from top surgeons on the subject. Visit Mr. McMinn's website to hear some of his interviews on the subject. When asked by the late Vicky Marlow about what high impact sport is doing to the BHR's that he implanted (dating back 12 years at the time I believe) his reply was "absolutely nothing!"
So to beat the drum from this site, find a documented top surgeon to implant your resurfacing device and it will work for at least 15 years.
And there is so much evidence now that the few cases that result in failure (or revision) can be traced back to surgeon error, either due to poorly implanted devices or poor patient selection.
Except for the rare metal sensitivity, a failure will be caused by your body falling apart around the device rather than the device failing (which would happen with your native hip as well).
You can find all the answers now on this website.
Chuckm
Chukm - loved the way you summed that up.
Cool having TheMcMinnCentre on board. Not sure they knew what they were getting into with a bunch of nerdy HR enthusiasts spending their day foruming about this stuff. Maybe Hern got a job working for The McMinnCenter, 8)
In all serisousnees, I think having a surgeon or surgeon's rep with the knowledge and experience on the forum will only make these discussions more useful and engaging. Look at how much "press" this topic got.
The url for the McMinn recent video is here:
http://www.surfacehippy.info/mcminn-lecture-bhr-2013.php (http://www.surfacehippy.info/mcminn-lecture-bhr-2013.php)
I also appreciate having comments by the McMinn Center. It gives the members another source of excellent information and comments.
Thank You for your help.
Pat
Average (175lbs) Male. Are you all tiny in Canada? I am an average Male (255 lbs) My perfectly average 14 year old Prop forward is a mere 210 lbs and my runt of the litter 10 year old is a mere 118lbs. ;)
I just look to my Brother for Logevity of BHR, he is coming up to 14 years we think but he can't really remember when.
He had his left hip done by Mr McMinn and has done Karate and worked 6 days a week in the catering industry ever since.
Jas
Ha I think your slightly above average in size terms then jas. ;D it's probably all the Viking DNA we northerner's have in us ;D
Bugger and I thought I lived in Lilliput ;D
Just thinkin', if there is a lower rate of revision for BHR patients after age 60 (99% vs. 98%), wouldn't that suggest wear/impact has some small affect?
Btw Danny, wondering how your recovery is coming along, given your interest in MMA and running?
Quote from: Canadian-Ice on August 07, 2013, 02:42:26 PM
Just thinkin', if there is a lower rate of revision for BHR patients after age 60 (99% vs. 98%), wouldn't that suggest wear/impact has some small affect?
Canadian-Ice could be - I think could also be that the 60 yr olds have a lower life expectancy? - there is a greater chance of their implant outliving them thus creating the small positive effect in revision rate.
Quote from: Canadian-Ice on August 07, 2013, 02:42:26 PM
Just thinkin', if there is a lower rate of revision for BHR patients after age 60 (99% vs. 98%), wouldn't that suggest wear/impact has some small affect?
Btw Danny, wondering how your recovery is coming along, given your interest in MMA and running?
I think the difference was because of the type of issue that caused the hip to be resurfaced in the first place. I think that mr McMinn said in an interview it was because of the patients with AVN.
My recovery is going fine thanks! Still not running purely because I'm still too heavy. I am grinding judo 2-3 times a week and 95% of the time my hip doesn't hold me back. I've said it quite a lot on here recently my job and the hours I work are what is keeping me from returning to full fitness (60-75hrs a week) :( I'm looking for a better job however and hopefully if sucsessfull will be able to cut 20lbs and get back in top shape. Mind I still have a resting heart rate in the low 40's ;)
Hi Danny,
Well it's pretty cool what you're doing. Maybe someday you can post some YT videos of your workouts.
Once I loose my gut I will deffo! ;)
Quote from: chuckm on August 01, 2013, 10:47:09 AM
Hi TheMcMinnCentre, do you know how those 10-15 year statistics would compare to a similar cohort who still have their native hips? I always wondered which is more likely, a BHR patient needing a revision, or a native hip owner needing their first hip arthroplasty. If 95.6% of BHR patients are surviving without revisions to THR can the native hip population be that durable as well? I guess you could call it a native hip revision rate?
Chuckm
Chuck,
That comparison, revision of a resurfaced hip vs. a healthy hip needing to be replaced at some time in the next 15 years is not a good way of looking at it. Of course all of us would prefer to have a natural healthy hip, a more realistic thing to compare would be resurfacing revisions vs. total hip replacement revisions. At least you are looking at a population that has known hip issues. Also you have to consider what difference in quality of life we are looking at for those 15 years and beyond. My doctor has given me one restriction " You'r 50 years old, use common sense for what a 50 year old is capable of doing."
Hi Neild5, thanks for your opinion that the information is not useful to you.
You are like many who have gone through resurfacing. It was a wake up call for you to change your active lifestyle. Pat Walter (our webmaster here) has implied a similar opinion to yours as to what this data means to her and I totally respect her opinion - "Be conservative and your hips will last longer." But that is a given - resurfaced or not. I'm not sure how you define acting 50 for yourself but my definition is to be active if you can be and I'm not 50 yet. Many of us had our hips resurfaced just so we could return to our active lives. Getting hip resurfacing was an attempt to "fix" our hip problems.
So how better to compare how close to being "fixed" we are than by comparing the durability of our hips to people who don't even have hip problems. And while this thread has not given hard statistics about the comparison, it does shed light for many of us about the risks of returning to high activity.
Here's an analogy: If I my car broke down and needed a repair, I know it wouldn't break down again if I never drove it after it was repaired. But I like to know how well the repair will work. Do I compare it to how well another repair method lasts? I might before I selected the type repair and mechanic. And I also would like that if I were selling that repair method. But as the end user, I want to know if the repair is as good new. So if statistics show a particular mechanic using a good replacement parts is lasting just as good as a car that didn't have that problem, it really is useful to me. Maybe not so to you.
Also, there are lots and lots of studies that compare resurfacing to total hip replacement out there. You can find some of them on this website. If you use an experienced surgeon with a good resurfacing device, it clearly outperforms THR and you don't have any activity restriction for life either. Once you have a hip resurfacing, any discussion about THR means nothing anymore unless your other hip goes bad.
Chuckm
Comparing Resurfacing to natural hips makes sense because part of the recovery is psychological. We tend to assume that artificial hips are not as good as natural hips, which may be true to varying degrees, and to compare Resurfacing with the alternative, THR. But the differences are not always as they appear. The reality is that, at this point in history, we do have recourse to get Resurface devices, and perhaps there are ways in which they are superior to a natural hip. Worth considering the rebel line. Note the nuances.
I think if any artificial hip turned out to be better than the original, all those mega rich athletes woulld be booking in for new ones. Instead of all those plastic surgeons for the mega rich it would be Ortho surgeons. ::)
The discussions have always been about how "durable", not if they are better, which would include performance. But, you might be right if surgeons could figure a way to install these things without compromising so much soft tissue. According to Dr. Su, he doesn't see muscle strength return to more than 90% of pre op strength, and that would not be good for pro athletes.
Yes, Canadian-Ice, you are on to what I am getting at. I have a left BHR, but I still have my native right hip which is already showing moderate signs of OA - and I can feel it.
I don't worry any more about my BHR hip anymore, regardless if I go back to playing soccer (which I have by the way). It's my native hip that is the factor I need to consider when choosing my level of activity.
So I sit here with left hip BHR that is 98% sure to still be performing 15 years from now regardless of my activity (totally pain free too) and a native right hip that gets a little sore from activity and will get worse over time even if I choose to sit on the couch every day.
I'm definitely choosing to be active. And when it is time (according to a surgeon), I can resurface the right side too and make it more durable and pain free than it is right this moment.
Chuckm
Perfectly logical comparison.
I used to hope for cartilage repair to over take resurfacing as treatment of choice but gave up on the idea when I realized that being pain free and max functioning is more important than whether my hip is "native" or metal. If resurfacing continues to prove itself over time, it will remain a better option than cartilage repair for many since it will take a generation for any new techniques to prove themselves in the field even after they become widely available.