Moderator Berry: Now we’re going to talk about a couple of things that both of you said. Don, you said taper corrosion is the huge issue. But is it really a huge issue? Are we making a big deal about a 0.5% problem?
Dr. Garbuz: In terms of incidence it’s probably not a high incidence, but for the individual patient the reactions tend to be quite severe. But the problem as I mentioned is it’s unpredictable and from what we can see so far…manufacturer dependent.
Moderator Berry: Fair enough. I think you did a nice job of framing that by saying it’s probably not terribly common for most types of implants, but when it does happen it can be a pretty big deal Andy, will you give him that point or no?
Dr. Engh: It’s a bad problem. But like the problem that we had with metal-on-metal, we have gotten better at recognizing it. What we have to remember is when a patient comes in with pain, we can’t send every patient out saying they’ve got trochanteric bursitis. We probably have to measure metal levels and pick these up before it’s a catastrophic problem. They still need a revision, but it’s not catastrophic anymore.
Moderator Berry: So, Andy maybe Don would say to you, “Well, if every time you’ve got a patient that comes in with pain, you have to check metal levels, if they’ve got a cobalt chrome head, why not just use a ceramic head so you don’t have to check for cobalt chrome levels every time somebody comes in with pain and gets told it’s trochanteric bursitis?”
Dr. Engh: It’s just going to cost more.
Moderator Berry: No doubt about it. Ceramic-on-crosslinked polyethylene is tending to be used in higher demand patients. If you look at the AJRR data, it’s used disproportionately in younger patients more than older patients. Is that driven by logic or is it driven by some misinformation about demand matching. For some types of demand matching we can make the case that the problem is less common in an older patient than a younger patient. Is it true that taper corrosion is less common in old patients? Furthermore, doesn’t taper corrosion, when it happens, happen relatively early? Old patients, in theory, would be just as at risk for it as young patients. Why not just do it in everybody? As Don has decided to do.
Dr. Engh: I agree with those 2 points. You can’t predict who it’s going to be. It’s not age-specific and it’s not demand matching. I do demand matching, again, because my hospital loses money on Medicare patients and they make money on private insurance. It’s not strictly age. And I don’t go strictly by Medicare. It’s individualized. It’s judicious use and for, what in my experience has been a 10th of a percent, you can’t justify the cost at this time.
Moderator Berry: All right, please join me in thanking the panelists for an excellent discussion on a timely topic.
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