Research Update 2014 to March 2017

In collaboration with the University of Newcastle, an explant analysis of the Biomet Magnum ReCap was performed and the results have been published in Bone and Joint Research. The wear analysis revealed low taper wear, however wear from the articulating surface was found sufficient to cause implant failure. Close monitoring of patients with this device combination is recommended.
Scholes SC, Hunt BJ, Richardson VM, Langton DJ, Smith E, Joyce TJ
Explant analysis of the Biomet Magnum/ReCap metal-on-metal hip joint.
Bone Joint Res 2017;6:113-122
Several metal on metal Poster Presentations have been achieved:
Smith EJ, Koutalos A, Clarke IC
Birmingham Hip Resurfacing Arthroplasty and The Risk of Small Heads
Orthopaedic Research Society
San Diego - March 2017
Koutalos A, Smith EJ, Kourtis A, Scholes S, Joyce T, Clarke IC
Midterm Results of Recap/Magnum Metal on Metal Total Hip Arthroplasty with Retrieval Analysis of Failed Implants. Introduction of Margin of Safety Angle.
Orthopaedic Research Society
San Diego - March 2017
IC Clarke, T Halim, J Shelton, A Koutalos, EJ Smith, TK Donaldson
Simulating Edge Wear of MoM in Subluxing Patient
Poster No. 1023
Orthopaedic Research Society
San Diego - March 2017
Work on an algorithm to assess edge loading undertaken in collaboration with The Donaldson Arthritis Research Foundation has been ongoing. A new margin of safety (MOS) algorithm was developed from simulator studies that can predict the risk of edge loading and subsequent metal wear in MoM implants. The MOS algorithm has been published and is applied in our research.
Clarke I, Donaldson T, Savisaar C, Bowsher JG. New algorithm to accurately depict cup wear-patterns with margin-of-safety in clinical and simulator studies. 28th International Society for Technology in Arthroplasty (ISTA) Annual Congress, 2015. Vienna, Austria, October 2015
An abstract on the midterm results of the ReCap Magnum metal on metal total hip arthroplasty was presented at the 12th European Hip Society Congress in 2016 and was published in Hip International Journal. This was later followed by acceptance of the research for publication also by Hip International. The mid-term results of the ReCap Magnum were found to be modest compared to other bearing articulations, but it was noted that this combination suffers from the same class specific problems as other metal on metal arthroplasties. Concern was raised regarding revisions already performed for ARMD in this study, as well as the high number of positive MARS MRI in asymptomatic patients. It is considered by the authors that the failure rate will increase. The Hip International publication utilised the MOS algorithm.
Koutalos A, Kourtis A, Clarke I, Smith E. Midterm Results of ReCap/Magnum Metal-on-Metal Total Hip Arthroplasty with Mean follow-up of 7.1 years. Hip Int 2016; 26 (Suppl 2): S3-S55 DOI: 10.5301/hipint.5000450 Page 11 & 12
Koutalos AK, Kourtis A, Clarke IC, Smith EJ. Mid-term results of Recap/Magnum/Taperloc metal-on-metal total hip arthroplasty with mean follow-up of 7.1 years. Hip Int 2016; 00 (00): 000-000 DOI: 10.5301/hipint.5000454 
A tribology explant analysis of the Biomet ReCap Magnum metal-on-metal implant was submitted and accepted for abstract presentation at the Institute of Mechanical Engineers:
Scholes SC, Smith E, Joyce TJ. Explant analysis of the Biomet Magnum/ReCap metal-on-metal hip joint. Institute of Mechanical Engineers 2015
A Poster Presentation comparing ceramic-on-ceramic and metal-on-metal retrieval was successful at the 2015 British Hip Society meeting:
Clarke IC, Joyce TJ, Scholes S, Smith E, Grijalva C.
Comparison of CoC and MoM THA retrievals - successful at three decades
British Hip Society
London - March 2015
A publication on femoral offset was published in Hip International Journal:
James R. Berstock, Adrian M. Hughes, Amy M. Lindh, Evert J. Smith. A radiographic comparison of femoral offset after cemented and cementless total hip arthroplasty. Hip Int. 2014; 24(6): 582 – 586
A series of published abstracts were presented at the 2014, 11th European Hip Society Congress and published in Hip International Journal. This research discussed cup impingement, wear damage in hip resurfacing and metal bearing wear from a hip simulator study, corrosion with 28mm metal-on-metal bearings and the five year results of the Exceed ABT 15 degree face-changing acetabular cup for the treatment of the dysplastic hip:
Clarke IC, Smith E, Donaldson TK, Bowsher JG, Savisaar C. Cup impingement and wear damage with hip resurfacing is similar to that in retrieved total hip arthroplasty. Hip Int. 2014; 24 (5): 491 pp.513-4
John A, Clarke IC, Smith E, Donaldson TK, Savisaar C, Bowsher JG. Severe Metal-on-Metal bearing wear triggered by 3rd body metal particulates in hip simulator study. Hip Int. 2014; 24 (5): 491 pp.540
Clarke IC, John A , Smith E, Donaldson TK, Bowsher JG, Savisaar C. Corrosion assessment of 12-14 European tapers used with 28mm metal-on-metal bearings. Hip Int. 2014; 24 (5): 491 pp518
Veettil MP, Ward AJ, Smith EJ. Cementless Acetabular Reconstruction in Dysplastic Hips: Five year results of Total hip Arthroplasty using the 15 degrees face changing cup. Hip Int 2014; 24 (5): 491 pp.537-8
International Conference Presentations
Charity Director, Evert Smith, continues to disseminate knowledge at international forums as a regular invited faculty member. Some presentations in 2015 and 2016 were:
Trends, Challenges and The Future in THR
Rome - February 2015
• Acetabular Cup Position Control: Houston do we have a problem?
• Diagnostic tools in Low Grade Infection of THA

Royal College Surgeons - Primary Hip and Knee Replacement Surgery
London - May 2015
• Cementless Revision
• Health economic and total hip replacement

BHS/EHS International Combined Meeting
Milan - November 2015
• Is squeaking still a reason for concern?

Mayo Arthroplasty Conference
Westport - April 2016
• Never Say Never again: Is there still a role for metal on metal?

Egyptian Pelvis and Hip Society Conference
Cairo - May 2016
• Evidence Based/Registry Data on Cemented/Cementless/Hybrid THA
• Bearing Choice: Evidence Based Literature / Registry Data
• Mini Posterior Approach

17th EFORT Congress
Geneva - June 2016
• Revision of MoM problems – outcome, results
• New approaches to the hip: Direct Superior Approach - The active hip

European Hip Society 12th Congress
Munich - September 2016
• Minor defect revision

British Orthopaedic Association
Belfast - September 2016
• ODEP ratings in relation to implants