Derek McMinn
Encyclopedia
Derek McMinn is a British orthopaedic surgeon and inventor who practises in Birmingham, United Kingdom at the BMI Edgbaston Hospital. Mr. McMinn developed the first successful modern metal-on-metal hip resurfacing
and the instrumentation and surgical technique to implant it. Hip resurfacing is a bone-conserving, less invasive alternative to total hip replacement (THR) for young patients and currently makes up around a tenth of all hip arthroplasty
(artificial joint) procedures performed in the United Kingdom. McMinn is also the inventor of several other prostheses for the hip and knee.
Derek McMinn is the author of Modern Hip Resurfacing (ISBN 978-1848000872), published in 2009.
Mr. McMinn first began performing hip resurfacing procedures in 1991 using the McMinn Resurfacing. The rationale behind the procedure was that it would be a bone-conserving alternative to THR for patients with higher activity demands i.e. young patients with severe hip arthritis who are otherwise in good health. This would buy time until they reached an age at which they would be more suitable for a THR. THRs utilise small diameter metal-on-polyethylene bearings which have a high rate of dislocation and revision in this group of patients.
Sir John Charnley originally developed the conventional THR in the 1950s, which proved to be one of the most successful operations in the world. In this procedure the 'ball' part of the hip joint (femoral head) and a portion of its neck are removed and the 'socket' part (acetabulum) is grated in preparation. These are replaced with an artificial ball and socket with a long stem in the thigh bone. This and other designs of THRs have since transformed the quality of life of millions of old patients with severe hip arthritis. Because these devices contained polyethylene as one of the rubbing surfaces, Charnley was justifiably very wary of using it in young patients. He warned against the use of a THR in any young patient unless there were other physical restraining factors which would stop her/him from getting back to high activity levels. True to his prediction when these THRs were used in young patients they failed early even in the best centres around the world, including Charnley's own centre at Wrightington in the UK. The Swedish Hip Register shows that in young patients, 19% of THRs failed 10 years after the operation and 67% had failed by 16 years. Because these patients are young, early failure implies the need for repeated revision operations using progressively more invasive and more complex devices. It was therefore always attractive to surgeons to employ a bone conserving procedure in young patients initially. When they need a revision there is more useful bone preserved to fix the new device to.
McMinn's technique of resurfacing employs thin (3 to 4mm) metal surfaces to line the patients' own hip. In contrast to a THR, the femoral head and neck are retained in this procedure. These large diameter resurfacings match the patient’s own anatomy. Because they do not contain polyethylene, these bearings wear at a much lower rate, provided they are manufactured according to specifications, and are implanted well. These allow the patients to return to higher levels of activity after the operation without the fear of early wear. Furthermore, because the devices have the same diameter as the patients' own, they are less prone to dislocation.
Over the following years, McMinn further improved the design and operative technique, eventually developing the Birmingham Hip Resurfacing (BHR). The first BHR was implanted in July 1997, in Birmingham
, England
. Over the next few years its success spurred surgeons all over the United Kingdom, Europe, Australia and many parts of Asia to start performing the procedure. On 9 May 2006, the FDA approved the BHR for medical use in the United States. Following thirteen years of usage McMinn reports 96% success with his BHRs in all patients and all diagnoses. These resurfacings are particularly successful in young patients who are the worst group for THRs. His success rate of the BHR in this age group is 98% at 13 years. Several other series and national registers also show similar results of around 95% currently with the BHR. The 2009 Australian National Joint Replacement Registry reported a 95% success rate for the BHR.
In the early 2000s, McMinn found that the results of the BHR are excellent in all types of hip arthritis except one. In a condition called osteonecrosis, in which the ball part of the hip joint suffers a loss of blood supply and becomes non-viable, the results of hip resurfacing are not good (less than 90% success 10 years after their operation). Osteonecrosis can occur from a variety of reasons including fracture of the femoral neck, or patients who received high dose steroids due to any medical condition or those suffering from alcohol abuse. In such patients the quality of bone in the femoral head (the ball part of the hip) is compromised and progressively crunches leading to a failure of resurfacing. For such patients with poor quality femoral head bone stock, who are unsuitable for a regular hip resurfacing, McMinn developed a conservative and more versatile metal-on-metal arthroplasty, the Birmingham Mid Head Resection (BMHR) device. The BMHR is demonstrating good medium term results in such high risk patients.
Derek McMinn describes himself as primarily a knee surgeon who digressed into hip surgery for a few years in the past couple of decades. His colleagues acknowledge him as one of the finest knee surgeons in the world. In addition to performing many complex primary and revision knee operations in the past three decades, he also designed and developed a revision total knee replacement (TKR) for extensive bone loss in the mid 1990s.
Current evidence shows that although knee replacements survive almost as long as hip replacements, the outcome of available designs of knee replacements are not as good as hip replacements. While only 1 to 5% of patients with a THR or a hip resurfacing are unhappy with their outcomes in the early years, nearly 20% of patients who undergo a knee replacement are dissatisfied with their outcome. In an attempt to improve the functional outcome following knee replacements McMinn developed a high performance knee which closely mimics the movement, stability and function of the natural knee to a greater extent. The world-class laboratory where the BKR was bench-tested reported that of all the artificial knees tested thus far, the BKR generated the least volume of war. Early outcomes with the Birmingham Knee Replacement (BKR) are very promising. Of course only time will tell if the long-term satisfaction of patients with BKRs match those with hip resurfacings.
, Northern Ireland where he captained the 1st XV rugby team and represented Ulster Schools XV. He qualified from St Thomas' Hospital
Medical school in London in 1977, having captained the 1st XV rugby team and won the Cheselden medal and 1st prize in surgery. He has practised as a Consultant Orthopaedic Surgeon since 1988.
McMinn personally trains surgeons from around the world in operative techniques. He is frequently invited to lecture at academic conferences around the world. He was given the honour of delivering the Presidential Guest Lecture at the Hip Society Open Meeting during the 75th Anniversary Meeting of the American Academy of Orthopaedic Surgeons in San Francisco in 2008.
McMinn was also invited to deliver the 2008 Sir John Charnley
Lecture at the British Orthopaedic Association and the 2008 Sir Robert Jones Lecture at the New York University Hospital for Joint Diseases in New York City, USA. In addition he has delivered guest lectures at conferences in various countries from Japan to Australia to the Asia Pacific Orthopaedic Association, the European Federation of Orthopaedic Societies, the American Academy, the Argentinian Orthopaedic Association etc. He has addressed the Select Committee of the House of Commons in the United Kingdom apprising the members of parliament and senior civil servants of recent developments and strategies of healthcare as it applies to orthopaedics.
McMinn has published extensively on the topic of hip arthritis and several other related orthopaedic topics. Recently he released a book entitled, Modern Hip Resurfacing, which is a fascinating work on the development of resurfacing; and describes in detail all the nuances of the operative technique, in addition to being a treatise on the whole subject of resurfacing and its effects.
In 2009, in recognition of his contribution to the medical profession, McMinn was awarded the degree of Doctor of Medicine (MD) Honoris Causa by the University of Birmingham
.
Hip resurfacing
Hip resurfacing has been developed as a surgical alternative to total hip replacement . The procedure consists of placing a cobalt-chrome metal cap, which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup is placed in the acetabulum , replacing the...
and the instrumentation and surgical technique to implant it. Hip resurfacing is a bone-conserving, less invasive alternative to total hip replacement (THR) for young patients and currently makes up around a tenth of all hip arthroplasty
Arthroplasty
Arthroplasty is an operative procedure of orthopedic surgery performed, in which the arthritic or dysfunctional joint surface is replaced with something better or by remodeling or realigning the joint by osteotomy or some other procedure.-Background:Previously, a popular form of arthroplasty was...
(artificial joint) procedures performed in the United Kingdom. McMinn is also the inventor of several other prostheses for the hip and knee.
Derek McMinn is the author of Modern Hip Resurfacing (ISBN 978-1848000872), published in 2009.
Hip Resurfacing
BIRMINGHAM HIP RESURFACING (BHR)Mr. McMinn first began performing hip resurfacing procedures in 1991 using the McMinn Resurfacing. The rationale behind the procedure was that it would be a bone-conserving alternative to THR for patients with higher activity demands i.e. young patients with severe hip arthritis who are otherwise in good health. This would buy time until they reached an age at which they would be more suitable for a THR. THRs utilise small diameter metal-on-polyethylene bearings which have a high rate of dislocation and revision in this group of patients.
Sir John Charnley originally developed the conventional THR in the 1950s, which proved to be one of the most successful operations in the world. In this procedure the 'ball' part of the hip joint (femoral head) and a portion of its neck are removed and the 'socket' part (acetabulum) is grated in preparation. These are replaced with an artificial ball and socket with a long stem in the thigh bone. This and other designs of THRs have since transformed the quality of life of millions of old patients with severe hip arthritis. Because these devices contained polyethylene as one of the rubbing surfaces, Charnley was justifiably very wary of using it in young patients. He warned against the use of a THR in any young patient unless there were other physical restraining factors which would stop her/him from getting back to high activity levels. True to his prediction when these THRs were used in young patients they failed early even in the best centres around the world, including Charnley's own centre at Wrightington in the UK. The Swedish Hip Register shows that in young patients, 19% of THRs failed 10 years after the operation and 67% had failed by 16 years. Because these patients are young, early failure implies the need for repeated revision operations using progressively more invasive and more complex devices. It was therefore always attractive to surgeons to employ a bone conserving procedure in young patients initially. When they need a revision there is more useful bone preserved to fix the new device to.
McMinn's technique of resurfacing employs thin (3 to 4mm) metal surfaces to line the patients' own hip. In contrast to a THR, the femoral head and neck are retained in this procedure. These large diameter resurfacings match the patient’s own anatomy. Because they do not contain polyethylene, these bearings wear at a much lower rate, provided they are manufactured according to specifications, and are implanted well. These allow the patients to return to higher levels of activity after the operation without the fear of early wear. Furthermore, because the devices have the same diameter as the patients' own, they are less prone to dislocation.
Over the following years, McMinn further improved the design and operative technique, eventually developing the Birmingham Hip Resurfacing (BHR). The first BHR was implanted in July 1997, in Birmingham
Birmingham
Birmingham is a city and metropolitan borough in the West Midlands of England. It is the most populous British city outside the capital London, with a population of 1,036,900 , and lies at the heart of the West Midlands conurbation, the second most populous urban area in the United Kingdom with a...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
. Over the next few years its success spurred surgeons all over the United Kingdom, Europe, Australia and many parts of Asia to start performing the procedure. On 9 May 2006, the FDA approved the BHR for medical use in the United States. Following thirteen years of usage McMinn reports 96% success with his BHRs in all patients and all diagnoses. These resurfacings are particularly successful in young patients who are the worst group for THRs. His success rate of the BHR in this age group is 98% at 13 years. Several other series and national registers also show similar results of around 95% currently with the BHR. The 2009 Australian National Joint Replacement Registry reported a 95% success rate for the BHR.
Short Stem Hip Replacement
BIRMINGHAM MID HEAD RESECTION (BMHR)In the early 2000s, McMinn found that the results of the BHR are excellent in all types of hip arthritis except one. In a condition called osteonecrosis, in which the ball part of the hip joint suffers a loss of blood supply and becomes non-viable, the results of hip resurfacing are not good (less than 90% success 10 years after their operation). Osteonecrosis can occur from a variety of reasons including fracture of the femoral neck, or patients who received high dose steroids due to any medical condition or those suffering from alcohol abuse. In such patients the quality of bone in the femoral head (the ball part of the hip) is compromised and progressively crunches leading to a failure of resurfacing. For such patients with poor quality femoral head bone stock, who are unsuitable for a regular hip resurfacing, McMinn developed a conservative and more versatile metal-on-metal arthroplasty, the Birmingham Mid Head Resection (BMHR) device. The BMHR is demonstrating good medium term results in such high risk patients.
Total Knee Replacement
BIRMINGHAM KNEE REPLACEMENT (BKR)Derek McMinn describes himself as primarily a knee surgeon who digressed into hip surgery for a few years in the past couple of decades. His colleagues acknowledge him as one of the finest knee surgeons in the world. In addition to performing many complex primary and revision knee operations in the past three decades, he also designed and developed a revision total knee replacement (TKR) for extensive bone loss in the mid 1990s.
Current evidence shows that although knee replacements survive almost as long as hip replacements, the outcome of available designs of knee replacements are not as good as hip replacements. While only 1 to 5% of patients with a THR or a hip resurfacing are unhappy with their outcomes in the early years, nearly 20% of patients who undergo a knee replacement are dissatisfied with their outcome. In an attempt to improve the functional outcome following knee replacements McMinn developed a high performance knee which closely mimics the movement, stability and function of the natural knee to a greater extent. The world-class laboratory where the BKR was bench-tested reported that of all the artificial knees tested thus far, the BKR generated the least volume of war. Early outcomes with the Birmingham Knee Replacement (BKR) are very promising. Of course only time will tell if the long-term satisfaction of patients with BKRs match those with hip resurfacings.
Career
Derek McMinn went to Royal School DungannonRoyal School Dungannon
The Royal School is a school located in Dungannon, County Tyrone, Northern Ireland. It was one of a number of 'free schools' created by James I in 1608 to provide an education to the sons of local merchants and farmers during the plantation of Ulster. Originally setup in Mountjoy near Lough Neagh...
, Northern Ireland where he captained the 1st XV rugby team and represented Ulster Schools XV. He qualified from St Thomas' Hospital
St Thomas' Hospital
St Thomas' Hospital is a large NHS hospital in London, England. It is administratively a part of Guy's & St Thomas' NHS Foundation Trust. It has provided health care freely or under charitable auspices since the 12th century and was originally located in Southwark.St Thomas' Hospital is accessible...
Medical school in London in 1977, having captained the 1st XV rugby team and won the Cheselden medal and 1st prize in surgery. He has practised as a Consultant Orthopaedic Surgeon since 1988.
McMinn personally trains surgeons from around the world in operative techniques. He is frequently invited to lecture at academic conferences around the world. He was given the honour of delivering the Presidential Guest Lecture at the Hip Society Open Meeting during the 75th Anniversary Meeting of the American Academy of Orthopaedic Surgeons in San Francisco in 2008.
McMinn was also invited to deliver the 2008 Sir John Charnley
John Charnley
Sir John Charnley was a British orthopaedic surgeon. He pioneered the hip replacement operation, which is now one of the most common operations both in the UK and elsewhere in the world...
Lecture at the British Orthopaedic Association and the 2008 Sir Robert Jones Lecture at the New York University Hospital for Joint Diseases in New York City, USA. In addition he has delivered guest lectures at conferences in various countries from Japan to Australia to the Asia Pacific Orthopaedic Association, the European Federation of Orthopaedic Societies, the American Academy, the Argentinian Orthopaedic Association etc. He has addressed the Select Committee of the House of Commons in the United Kingdom apprising the members of parliament and senior civil servants of recent developments and strategies of healthcare as it applies to orthopaedics.
McMinn has published extensively on the topic of hip arthritis and several other related orthopaedic topics. Recently he released a book entitled, Modern Hip Resurfacing, which is a fascinating work on the development of resurfacing; and describes in detail all the nuances of the operative technique, in addition to being a treatise on the whole subject of resurfacing and its effects.
In 2009, in recognition of his contribution to the medical profession, McMinn was awarded the degree of Doctor of Medicine (MD) Honoris Causa by the University of Birmingham
University of Birmingham
The University of Birmingham is a British Redbrick university located in the city of Birmingham, England. It received its royal charter in 1900 as a successor to Birmingham Medical School and Mason Science College . Birmingham was the first Redbrick university to gain a charter and thus...
.
External links
- http://www.mcminncentre.co.uk/