It was very interesting to observe how doctors appear from the point of view of doctors, but from our side is quite different. When we look at it as our bodies, they open up, it changes the whole look. The following is my opinion as a patient. Vicky
This review of the conference, which I attended in Belgium, June 25-28, 2008, are notes that I took during presentations and sessions, as well as my personal opinions and thoughts on this issue. This is in no way scientific evidence. Summing up the conference in two sentences, I will give Mr. McMinn, one of the authors of BHR (Birmingham Hip Resurfacing): Bad Resurfacings Results - Result of Poorly Performed Resurfacing - Derek McMinn I will also bring Dr. Cohen DeSmet, a surgeon who has done more hip fractures, than most surgeons in the world. WELL DONE resurfacing works well, but it is TECHNICAL DIFFICULT. - Cohen DeSmet McMinns' quotation was repeatedly declared throughout the conference and mainly concerned technical difficulties in terms of surfacing in general. It became clear to me again after attending my third orthopedic conference that the above statement was true, and was strengthened in several sessions at this conference. It seems that many of the problems that exist today are associated with the surgeon and technique. As in the case of real estate, three important factors are location, location, location, with the advent of the hip joint, this is experience, experience, experience. And I will add to this SKILL.
My thoughts: I know a lot of new patients who post Yahoo Surface Hippy on the message board and prefer to go to newer surgeons, or ultimately have no choice because of financial issues or insurance restrictions that are upset by those of us who keep repeating the importance of choosing a surgeon with an experience. I would like these patients to simply understand that many of us take hours from everyday life to help people. Wrong appeal to a new inexperienced surgeon is NOT my definition of helping someone. When the question is asked, well, then who will be in the doctors at first 100? I will tell you who, those who do not want to spend time researching alternatives. Those who like that I stumbled upon this were assigned to THR, and when I told him to return to his answer, his doctor did not do them, and he trusted his doctor. Gala, published a week ago, said that after a few days she had a THR, and he wanted to talk to others who had been through her. I e-mailed her offline and, no matter what I told her, she was not going to postpone the surgery on Monday, she was just going to let her surgeon give her THR. A surgeon who did not even tell her what an autopsy was and she was over 30 years old! Well, these are the patients who may be in the first 100 doctors, those who enter the doctors' office and just listen to what they are told, and ultimately get what they get. As a poor woman, many of us met at the De Smet ranch in the Federation Council. She could barely walk with crutches, because Hemi-prosthesis with a large femoral stem device that her doctor placed inside her, said Demet, said he would never use such a device to anyone else, it was a woman in the late 90s, he he knew that he would still be a wheelchair, and he had very few years left. This woman was in her 40s and was there to consult with De Smet. The last thing I heard, she will return to the same doctor who did it with her, first of all, to fix it, if you can believe it! As far as I know, those who spend time searching for information and find their way to a bulletin board on a hippie surface or on a specified website or email me for reference, well, they deserve to know the truth. Not my truth, but the truth, they say, even all top managers. There is a learning curve with the appearance of the hip joint. HRA is a completely different procedure than THR, completely different. Now that I learned at the conference and my notes. Dr. Amstutz - Technique - Crucial. In general, most of the problems arising from hip fracture are associated with surgeons. Improper placement of cups, placement of the femur components, can cause lesions, neck fractures, and thinning of the femoral neck
Contraindications for re-grinding the hip joint
Age - Some doctors still use age as a possible contraindication. It seems that the more experience a surgeon has, the more open they are dealing with cases for elderly patients, some doctors will look only at the density of patients' bones - quality and not worry about age. Amstutz accepts much older patients more and more now. He strongly believes that ever hip joint inversion will always be the first choice for any patient without a patient's condition. Amstutz started the hip joint 35 years ago, and in 1987 it began with a large-diameter head. He made several patients who might not have to appear, but if they ask him, he will tell them about the risks and probably still will. My personal opinion - I was very impressed with Dr. Schmalzried, we spent a lot of time and discussion of the problem of THR and Resurfacing. In general, I thought that he added a lot to the entire conference and the sessions he adjusted, I felt that he brought a good balance to what could have turned into hot debts, where he could bring the panels to some form of agreement in such a way came to the conclusion for the surgeons who were there to learn how to allow them to remove something from this session and learn from it. As for my personal conversations with Dr. S., I definitely agree with him until a certain point, since some patients, THR will be the best option and solution for them. There are three cases, in particular, that come to my mind. A friend for whom I received permission to publish her photos from her surgery,
To see photos of one patient (very clearly on the link site, clicking "Stories-43-year-old patient"). I must warn you, the photographs are very graphic images of live surgery.
To show how bad the quality of her bones was and how her AVN progressed in such a short period of time. Her hips literally fell apart like chalk during an operation. There was no way she was going to get a BHR or even a BMHR, her only option was a big THM THR. She will really be very pleased with this. Another case is the gallon, which a few months ago published on the Yahoo message board, which woke up hysterically when it learned that THR was over for her, because she felt that this was the end of her world when she knew it. Another young patient contacted me offline in the early thirties, and I e-mailed my X-rays to three doctors to evaluate them. One of the best doctors recommended THR due to the patient's anatomy, as well as several deformities at both hips. Another top doctor thought that there might be a 50/50 chance of polishing on the one hand, but a certain THR on the other. His comment was that it does not make sense to give the patient HRA if he does not restore the patient's anatomy. The third doctor, also the chief doctor, said he would do everything possible to preserve the bones of the patients because of his very young age, but since it was a very difficult case, he could not say until he got to what was best for the patient. One thing that I learned from my past 3 years of research on this board, and probably about 1,000 patients and many surgeons, is that we, as a group, have such a passion for hip joint transfusion as in In many respects, we need BUT, we need to keep in mind that this is not the same size for all solutions.
One industry professional, Martin, stated that there should be a device for each individual patient, and this device should be the best solution for them. Is it a HRA device like a BMHR or THR. The part that I disagree with when it came to my discussion / discussion with Schmalzried is that my faith is similar to Amstutz, which is the same as De Smet, Bose, Su, McMinn, Treacy (who consider that this is anyway), that each individual patient should be considered as a unique individual and evaluate his anatomy, level of bone activity, etc. A doctor should not tell all women over 55 to refuse immediately and even without looking at x-rays, says THR would be the best option I disagree with. So to summarize, I have a completely new level of respect for Dr. Thomas Schmalzrede, having spent a reasonable time talking to him. I agree with him in many things that he says, but one area in which we need to agree to disagree is where this line refers to which patients should appear and which ones should not. He is an excellent surgeon, I have no doubt about this, as well as his dedication to providing his patients with the best care and income, but if you have a difficult case or a woman over 55, I would think about going to another doctor. If you are a woman under the age of 55, a healthy, active man at the age of 40 with a direct case of OA, then by all means, Dr. S will make an excellent choice. “The correction is here - I received an e-mail from Dr. Schmalzried, stating that his position is as follows: July 16, 2008
I gave birth to women at the age of 60 and men at the age of 70. Age is not the main criterion, but a surrogate for bone density and life expectancy on a population basis. Each patient must be evaluated individually to evaluate the relationship between the benefit and the risk for reuse against THR for them. - Thomas P. Schmalzried, MD
On the study of curves
In fact, experienced surgeons all admitted that they are TOTAL studying today. Dr. Amstutz, Dr. De Smet, Dr. Ohara, have all gone through more than 1,000 repeat sessions of the hip joint, and they all agree that the learning curve continues. Amstutz made a comment that NO two heads of the femur are the same.
This technology is still at the initial stage, and they are still improving devices, devices, placement of cups, component angles, soft tissue preservation methods, incision dimensions, anesthesia, rehabilitation protocols. Some said that new doctors have the advantage of learning from the doctors who went before them to avoid the same mistakes. I agree at some point, but although they KNOW that they cut the neck of the femur, why are the new doctors still cut out? It is inevitable that the first few times they do something, even if they know, in order to avoid certain things before they hang themselves, they will be mistaken. Even some of the great people today will still make mistakes from time to time, after all, they are just people. But, most likely, the more experience the doctor has, the less mistakes he will make. Again, Dr. Soo in his video interview ultimately explains the learning curve in stages. Go to the interview with Dr. Sus Sus, where the clock says about 3 minutes near the end of the referendum site in the section “Doctor - video interview”.
The toolkit has been discussed, and it seems that many companies come out with the best and best tools. With some of the designs, this makes it almost impossible for the doctor to cut the neck because of the way the tool is designed to guide the doctor when placing the pin and finding the exact center of the femoral neck.
Approaches were discussed and controversy re-emerged among surgeons as to which approach was better, it was concluded that the best approach for the doctor to get the best results that the doctor could get for his patient was the best approach that would be used by the doctor. Dr. De Smet said during his lively operation with a video that he hated watching patients with his arrival in a year or two face a poorly set prosthesis due to the fact that he had a lateral lateral approach and damage muscle gluteus medius.
Preserving the cervix capsule during the De Smets operative operation, he stressed the importance of NOT cutting through the capsule, just release it to save the vascular system. Doctors who remove soft tissue will see more neck. It was interesting to see that many of the doctors on the panel removed either the entire cervical capsule, or most of it. Hopefully, after this course, they will recognize the importance of preserving the neck capsule.
Metal ions
The jury is still not working on this issue. Pat Campbell is now independently conducting implantation studies. I believe that any patient diagnosed with "metal allergy" as a cause of pain or ALVAL should insist that their doctor send their remote device to the Pats laboratory for a full study to see if this was really the reason for the failure. What worries me is that there will be doctors who have poorly placed devices that cause a blow and higher wear of the metal, and then turn around and accuse him of metal allergies when this may be a reaction to the high wear of the metal due to a faulty implant. It is easier to blame it on patients than to accept the idea that the surgeon placed the device incorrectly or cut the neck, and the bone under the lid collapsed as a result and has nothing to do with metal allergies.
They do have tests for lymphocytes, but they are rare. Not sure what they will prove. I personally volunteered as an example due to the fact that I have a sensitivity to extreme metals, and now I have BHR for more than 3 years, so I have already passed the 2-year danger zone for ALVAL.
As for metal ions on women carrying the age of children, both Amstuza and De Smet agree that this should not be a problem for women carrying the age when many doctors will not implant MoM (Metal on Metal) regeneration. The question is, is poly wreck better for an unborn fetus?
Amstutz did not have evidence in patients with a high level of sensitivity to the metal, without any problems. It is very important to remember that there are TWO for discussion of metal ions.
The wearing problem (Metalios) is very different from the sensitivity of the metal. (Hypersensitivity, inflammatory lymphocytes)
They found that the activity has no correlation with metal ions.
HRA issues
· Impipe
· Problems with the outlet
The following was a slide in relation to the conclusions made on metal ions.
conclusions
· Significant differences between current generation re-grinding devices
· These differences are less important than extremely high levels due to improper component placement.
· Some patients have an increased level of ions before surgery for an unknown reason.
· No correlation between levels and activity
· Proper positioning of components is cruel. Acetabular. Localization. Early problems - dislocation, later problems.
Lessons to learn
Comparison of components leads to an increase - even dramatic - wear
Not gradual, but step by step
Implant positioning (tilt, anteversion, relative positioning)
Very early failures: head
Late setbacks: cup (wear) bursae
Painful Resurfacing - Dr. Schmalzried led this discussion and started it, saying: people look as if we have very bad news. From what he heard during the discussions, the biggest problem with resurrections was the problem of overvoltage. It was technical in nature. So back to the McMinns quotes and back to what I and many others on board, such as Alan Ray, Chris Saunders, and I say again and again, EXPERIENCE. The more experienced the surgeon, the better your chances of a successful grinding, which will last a lifetime without any problems with a lesion or long-term problems with pain, such as continued groin pain, etc.
appliances
There are many different devices, each has its own pros and cons. Obviously, the Conserve Plus, Durom and ASR device have stems proportional to the size of the device. With BHR, the stem has the same exact size, regardless of the size of the component. The smaller the neck of the femur, the less it should be suitable for protection against stress. If the size of the component is less than 42, which I have, BHR should not be used. Therefore, 40 or 38 should always be used with one of the other devices due to the size of the BHR stem. From what I understand, the C + device was not available in India, so Dr. Bose uses ASR in these cases. Dr. De Smith decides to use different devices. He believes that the best grinding machines there now are BHR and C +. You will see his explanation in my last video interview I did with him in Belgium. См. Упомянутый веб-сайт в разделе «Врачи»> «Видео-интервью». Райт C + с материалом класса A, который недавно был запатентован, по-видимому, имеет самый низкий износ металла всех имплантов, доступных там. Пожалуйста, смотрите видео-интервью доктора Амстуца для получения дополнительной информации о устройстве C +. Стебель также меньше, чем у BHR-основы, и поэтому он будет лучше работать у пациентов с меньшим количеством костей. Или пациенты, у которых есть размеры шейки бедренной кости.
Операция De Smets live
Он держит пациентов кровяное давление обычно около 60 - 65. Есть так много шагов он делает, чтобы убедиться, что пациент получает правильную анатомию. Измерение, повторное измерение, углы, глубины, размещение, количества, удаленные для поддержания одинаковой длины ног, нейтральное положение направляющего штифта. Предотвращение остеосинтеза, размещение защитной ткани для защиты ткани от фрагментов кости, верьте или нет, не все врачи делают это, просто наблюдайте за некоторыми из живых видеоопераций, доступных онлайн для просмотра, и вы увидите разницу между неряшливой и исключительной работой. Удаление остеофитов, если вы не удалите их, пациент будет падать. Поэтому некоторые из вас, жаловавшиеся на боль, могли иметь остеофиты, которые доктор оставил в вас. Опять же, важность выбора опытного хирурга для этого. Де Смет пересмотрел около 63-65 нерегулярных повторных исследований других врачей. Д-р De Smet теперь использует меньший разрез, чем раньше, примерно в два раза меньше, чем раньше.
recovery
Д-р De Smet случайно встретил пулевую терапию. Он обнаружил, что его пациенты собирались в бассейн в Holiday Inn со специальной водонепроницаемой повязкой STERILE, и они восстанавливались быстрее, чем когда-либо прежде. Именно по этой причине он принял это в своем протоколе post op rehab now и для Hugo, начав виллу для сеансов аква-терапии, начиная со второго дня после операции для всех пациентов.
Д-р Ким в Оттаве не поощряет бег или большое влияние на любого из его пациентов.
Amstutz полагает, что пациент может сделать что-либо с имплантатом, он будет иметь более короткий срок службы имплантата, так же, как вы бы надевали нормальное бедро с более высоким воздействием, вы также будете носить металлический бедро или кость вокруг него.
Ниже были сняты слайды, которые были представлены, что я сделал снимок:
анестезиолог
Переливание крови
2004 г. 5,9%
2005 5.1% контрольная гипертония
2006 2.5% Хранитель ячейки
2007 1,0% Tranexamic acid
MM Resurfacing
Conserve Plus
Изменения в технике
3-е поколение (текущий метод n = 329)
· Интертракторное всасывание (с 1/04)
· Carbojet (с 4/04)
· Тонкие раковины (с 10/03)
· Увеличенная фаска (Европа остается -170 °)
· Цементирующий стержень для больших (> 1 см) кист и небольшого размера компонента. Безцементированный
Amstutz опасается, что покрытие на стебле устройства Cormet по-прежнему вызывает защиту от стресса на голове, один из участников панели поднял, что бы вы не сказали об этом методе цементирования стебля? Он сказал, что он не видит в этом того же самого, что видит цементирование стебля как частичную наполнителя. Он сделал серию слепого исследования из 400 контролируемых групп половин стеблей, зацементированных наполовину невостребованным, и пока никакой разницы между ними не было. Не один провал еще в цементированном стволе, который длится 8 лет. Теперь он просто цементирует только те пациенты, которых он в противном случае сделал бы THR.
По бесцементному он говорит, что должна быть идеальная подгонка между костью и компонентом. Консенсус в отношении цементирования заключается в том, что он прекрасен. Основание кости должно быть достаточно хорошим для без цемента. Было много обсуждений толщины цементной мантии, которая вошла в детали. Вы можете увидеть слайды позже на веб-сайте Pat под документами д-ра Шмальзридса.
Подведем итог всей конференции, опять же, я процитирую Дерека Макминна и Коена Де Смета
Плохие результаты Resurfacings - результат плохого шлифования - Дерек Макминн
WELL DONE resurfacing работает хорошо, но ТЕХНИЧЕСКИ ТРУДНО. - Коэн ДеСмет
Пойдите к опытному хирургу, у которого нет проблем с продолжением обучения методам и продолжите учиться у других врачей, достигнув этих конференций и обменявшись тем, что они узнали.
Спросите своего врача об опыте и продолжении обучения в области тазобедренного сустава. Много новых достижений произошло, и без врачей идут на эти курсы и изучают их, они не могут знать. Отправьте их по этой ссылке и сообщите им, что они должны зарегистрироваться в Интернете. На этой конференции была представлена тонна информации, и теперь она доступна всем. Нажмите на второй упомянутый сайт, чтобы посетить веб-сайт Advanced Course Resurfacing
И ... это подводит итог этим пациентам.
