Healthnet Letter from Consulting Ortho

This was the conulting Orthopedic Surgeons recommendation letter that pushed Healthnet to finally approve my request for hip resurfacing surgery with Dr. Amstutz.  Unfortunately, they sent the letter to me on December 1, the day I was in surgery with Dr. Bose in India.  They never reimbursed me for my surgery since they do not cover surgery overseas.

Letter from Consulting Ortho:

Conserve Plus

At the current time, there has been approval for the femoral component of the proposed device (the Conserve hip is just the femoral side, the Conserve Plus has both sides). The femoral component has been approved and is in use for greater than 10 years.

It is not experimental, it is not investigational, and is approved by the FDA. Similarly, the use of a metal bearing surface on the acetabular side has been in use for several years, and is not experimental or investigational. It is FDA approved, both for Wright Medical (the manufacturer of the Conserve / Conserve-Plus), as well as several other orthopaedic device manufacturers.

There has been extensive work with the Conserve-Plus over the years, initially performed in California, under Dr. Harlan Amstutz, and his associate, Dr. Tom Schmalzried.  This data has been presented at many orthopaedic meetings, and the initial group involved in this study has expanded to include a few other surgeons.  At the current time, the Conserve-Plus is undergoing final consideration for FDA approval.  This is expected within the next few months.  The data on the CONSERVE PLUS is very strong, and especially given the argument that the two parts are both individually approved by the FDA separately, that they should be approved without delay given their use together.  The patient here has specific issues that warrant consideration.  A metal on polyethylene articular surface has a limited lifespan, and the resultant polyethylene wear can cause significant bone loss.  It is for this reason that we have tried to use alternative surfaces, such as ceramic on ceramic, and metal on metal.  As data has become available from the studies using these devices, we have had FDA approval for them.  For a patient who is less than 50, it is desired to avoid a second hip operation or even a third in the patient’s lifetime.  We do have options to offer this patient such as a more conventional total hip with a metal on metal surface, or a ceramic on ceramic.  However, the Conserve-Plus takes away less bone on the femoral side, and has a major advantage over a conventional total hip in this regard.  This device has an advantage of increased stability and range of motion derived from having a larger articulation diameter. This was subsequently “borrowed” in the “BFH” technology, using essentially the same acetabular components with a large femoral head which sits on the total hip stem.

In conclusion, the proposed surgery has the advantages of providing for an alternative bearing surface for increased longevity, sacrificing less bone than a conventional total hip replacement, and providing added stability due to the size of the femoral component (which is favorable in this active patient who has at least some degree of hip dysplasia).

The Conserve Plus is a good option for young patients with hip disease.  It is conservative in terms of bone removal, it uses an alternative bearing surface, and this device combines technology that has been FDA approved in separate parts, just the “whole” package is waiting final approval.  The advantages are listed above, and the procedure should be approved.