Derek McMinn

Last updated

Derek McMinn M.D. F.R.C.S.
NationalityBritish
Occupation Orthopaedic Surgeon
Known forHip Resurfacing, Total Hip Replacement, Hip Revision Surgery, Total Knee Replacement, Knee Revision Surgery

"Professor" Derek McMinn is a British orthopaedic surgeon and inventor who practised in Birmingham, United Kingdom at the BMI Edgbaston Hospital until his suspension in 2020. McMinn is currently under police investigation for allegedly keeping the body parts of thousands of patients over a 25-year period. [1]

Contents

McMinn developed one of the successful modern metal-on-metal hip resurfacing [2] 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, [3] markedly improves the health-related quality of life measures [4] and currently makes up around a twentieth of all hip arthroplasty (artificial joint) procedures performed in the United Kingdom. [5] McMinn is also the inventor of several other prostheses for the hip [6] [7] [8] and knee.[ citation needed ]

Derek McMinn is the author of Modern Hip Resurfacing ( ISBN   978-1848000872), published in 2009.

Hip resurfacing

Birmingham Hip Resurfacing

McMinn first began performing hip resurfacing procedures in 1991 using the McMinn Resurfacing, manufactured by Corin. [2] 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 use 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 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 the patient 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 on the world, including Charnley's own centre at Wrightington Hospital in the UK. [9] 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. [10] 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.

The Corin technique of resurfacing employs thin (3–4 mm) metal surfaces to line the patients' own hip. [11] 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. [12] [13] 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. [14] 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. [15] Several other series and national registers also show similar results of around 95% currently with the BHR. [16] The 2009 Australian National Joint Replacement Registry reported a 95% success rate for the BHR. [17]

From 2009 onwards MOM resurfacing came under a cloud, as DePuy marketed the ASR hip resurfacing and persuaded many of their user surgeons to implant it. It had a bearing clearance of 60 microns, in comparison with the BHR's 200+ microns, determined from the Ring explant and other retrievals. With a high early failure rate it was taken off the market within 3 years. More careful surveillance by the UK National Joint Registry indicated that resurfacings in women had a higher failure rate, as any head size of 46mm and less had.

In 2004 John O'Hara worked with Finsbury Orthopaedics to develop the ADEPT hip resurfacing. The implant was very similar and was manufactured on the same machines as the BHR has been since 1997. The major developments were in the instrumentation which were so improved that it became much easier to implant the Adept in an optimal position.

In the most recent UKNJR data, the failure rate for the Adept is slightly better than ceramic on cross linked polyethylene hip replacements and is half that of the BHR in the range of sizes still made.

Short stem hip replacement

Birmingham Mid Head Resection

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. [18]

Total knee replacement

Birmingham Knee Replacement

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 1–5% 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. [19] 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 wear. Early outcomes with the Birmingham Knee Replacement (BKR) are very promising. [20] 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 Dungannon, 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. [21]

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. [22] Recently he released a book entitled Modern Hip Resurfacing, which covers 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.

Related Research Articles

<span class="mw-page-title-main">Orthopedic surgery</span> Branch of surgery concerned with the musculoskeletal system

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

<span class="mw-page-title-main">Hip replacement</span> Surgery replacing hip joint with prosthetic implant

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely between different techniques and implants. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

<span class="mw-page-title-main">Avascular necrosis</span> Death of bone tissue due to interruption of the blood supply

Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. Early on, there may be no symptoms. Gradually joint pain may develop, which may limit the person's ability to move. Complications may include collapse of the bone or nearby joint surface.

Arthroplasty is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.

<span class="mw-page-title-main">Knee replacement</span> Surgical procedure

Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.

<span class="mw-page-title-main">Computer-assisted orthopedic surgery</span>

Computer-assisted orthopedic surgery or computer-assisted orthopaedic surgery is a discipline where computer technology is applied pre-, intra- and/or post-operatively to improve the outcome of orthopedic surgical procedures. Although records show that it has been implemented since the 1990s, CAOS is still an active research discipline which brings together orthopedic practitioners with traditionally technical disciplines, such as engineering, computer science and robotics.

<span class="mw-page-title-main">Joint replacement</span> Orthopedic surgery to replace a joint

Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. Joint replacement surgery is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.

<span class="mw-page-title-main">Microfracture surgery</span> Cartilage repair technique

Microfracture surgery is an articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone. This causes new cartilage to develop from a so-called super-clot.

<span class="mw-page-title-main">Hip resurfacing</span>

Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a 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 articulating surfaces of the person's hip joint and removing very little bone compared to a THR. When the person moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position. The surgeon's level of experience with hip resurfacing is most important; therefore, the selection of the right surgeon is crucial for a successful outcome. Health-related quality of life measures are markedly improved and the person's satisfaction is favorable after hip resurfacing arthroplasty.

<span class="mw-page-title-main">Unicompartmental knee arthroplasty</span>

Unicompartmental knee arthroplasty (UKA) is a surgical procedure used to relieve arthritis in one of the knee compartments in which the damaged parts of the knee are replaced. UKA surgery may reduce post-operative pain and have a shorter recovery period than a total knee replacement procedure, particularly in people over 75 years of age. Moreover, UKAs may require a smaller incision, less tissue damage, and faster recovery times.

Minimally invasive hip resurfacing (MIS) is a total or partial hip surgery that can be carried out through an incision of less than 10 cm without imparting great forces on the anatomy or compromising component positioning.

Ankle replacement, or ankle arthroplasty, is a surgical procedure to replace the damaged articular surfaces of the human ankle joint with prosthetic components. This procedure is becoming the treatment of choice for patients requiring arthroplasty, replacing the conventional use of arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.

Metallosis is the medical condition involving deposition and build-up of metal debris in the soft tissues of the body.

Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high-grade bone sarcomas, and vascular conditions such as diabetic foot ulcers. As the techniques for chemotherapy, radiation, and diagnostic modalities improve, there has been a trend toward limb-sparing procedures to avoid amputation, which has been associated with a lower 5-year survival rate and cost-effectiveness compared to limb salvage in the long-run. There are many different types of limb-sparing techniques, including arthrodesis, arthroplasty, endoprosthetic reconstruction, various types of implants, rotationplasty, osseointegration limb replacement, fasciotomy, and revascularization.

<span class="mw-page-title-main">William H. Harris (orthopaedic surgeon)</span> American orthopaedic surgeon

William H. Harris, is an American orthopaedic surgeon, Founder and Director Emeritus of the Massachusetts General Hospital Harris Orthopaedics Laboratory, and creator of the Advances in Arthroplasty course held annually since 1970.

The following outline is provided as an overview of and topical guide to trauma and orthopaedics:

<span class="mw-page-title-main">Index of trauma and orthopaedics articles</span>

Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.

Sarah Muirhead-Allwood (FRCS), is a British orthopaedic surgeon known for performing complex hip resurfacings and unusual hip replacements. Those she has operated on include The Queen Mother and Andy Murray.

Justin Peter Cobb is a British professor of orthopaedic surgery at Imperial College London, known for introducing medical robotics into orthopaedic surgery. He is a member of the Royal Medical Household and was royal orthopaedic surgeon to the Queen. He is on the staff at King Edward VII's Hospital (KEVII) and is civilian advisor in orthopaedics to the Royal Air Force (RAF). His research has also included themes relating to designing new devices such as for ceramic hip resurfacing, 3D printing in orthopaedics, and training in surgical skills. He is a director of the MSk laboratory based in the Sir Michael Uren Hub.

References

  1. ↑ "Derek McMinn: Licence restrictions for surgeon who 'kept bones'". BBC News. 31 October 2020.
  2. 1 2 McMinn, D; Treacy, R; Lin, K; Pynsent, P (1996). "Metal on metal surface replacement of the hip. Experience of the McMinn prothesis". Clinical Orthopaedics and Related Research (329 Suppl): S89–98. doi:10.1097/00003086-199608001-00009. PMID   8769326. S2CID   1745602.
  3. ↑ The Birmingham Hip Resurfacing
  4. ↑ Koutras C, Antoniou SA, Talias MA, Heep H (19 May 2015). "Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis". J Arthroplasty. 30 (11): 1938–52. doi:10.1016/j.arth.2015.05.014. PMID   26067708.
  5. ↑ "National Joint Registry 2009". Archived from the original on 1 March 2012. Retrieved 10 November 2010.
  6. ↑ Willemse P, Castelein RM, Bom PL, Verburg A, Verheyen CC. Clinical and radiological results of the stemmed Mc Minn cup in hip revision surgery. Acta Orthopedica Belgica 2010 Feb;76(1):58-62
  7. ↑ Badhe NP, Howard PW. Partially hydroxyapatite-coated stemmed acetabular cup and nonstructural bone-graft in the management of severe acetabular deficiency. Journal of Arthroplasty. 2000 Jan;15(1):63-8
  8. ↑ Schmalzried, T. P.; Fowble, V. A.; Ure, K. J.; Amstutz, H. C. (August 1996). "Metal on metal surface replacement of the hip. Technique, fixation, and early results". Clin. Orthop. Relat. Res. (329 Suppl): S106–14. doi:10.1097/00003086-199608001-00011. PMID   8769328. S2CID   1955856.
  9. ↑ Joshi, AB; Porter, ML; Trail, IA; Hunt, LP; Murphy, JC; Hardinge, K (1993). "Long-term results of Charnley low-friction arthroplasty in young patients". The Journal of Bone and Joint Surgery. British Volume. 75 (4): 616–23. doi: 10.1302/0301-620X.75B4.8331119 . PMID   8331119.
  10. ↑ "Henrik Malchau, Peter Herberts, Peter Söderman, Anders Odén, Department Of Orthopaedics, Göteborg University, Sweden., www.jru.orthop.gu.se" (PDF). Archived from the original (PDF) on 4 July 2007. Retrieved 28 November 2010.
  11. ↑ Dehn, Tom (2005). "Controversial topics in orthopaedics: the best bearing couple for hip arthroplasty". Annals of the Royal College of Surgeons of England. 87 (6): 411–418. doi:10.1308/003588405X71090. PMC   1964129 . PMID   16263007.
  12. ↑ McMinn, D; Daniel, J (2006). "History and modern concepts in surface replacement". Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 220 (2): 239–51. doi:10.1243/095441105X68944. PMID   16669391. S2CID   23841310.
  13. ↑ Daniel, J; Pynsent, PB; McMinn, DJ (2004). "Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis". The Journal of Bone and Joint Surgery. British Volume. 86 (2): 177–84. doi: 10.1302/0301-620X.86B2.14600 . PMID   15046429. S2CID   31555063.
  14. ↑ FDA Approval for the BHR
  15. ↑ McMinn, DJ; Daniel, J; Ziaee, H; Pradhan, C (2010). "Indications and results of hip resurfacing". International Orthopaedics. 35 (2): 231–237. doi:10.1007/s00264-010-1148-8. PMC   3032116 . PMID   21079954.
  16. ↑ Carrothers, AD; Gilbert, RE; Jaiswal, A; Richardson, JB (2010). "Birmingham hip resurfacing: the prevalence of failure". The Journal of Bone and Joint Surgery. British Volume. 92 (10): 1344–50. doi: 10.1302/0301-620X.92B10.23504 . PMID   20884969. S2CID   3242804.
  17. ↑ "2009 Australian National Joint Replacement Registry" (PDF). Archived from the original (PDF) on 14 December 2010. Retrieved 10 November 2010.
  18. ↑ McMinn, Derek J. W.; Daniel, Joseph; Ziaee, Hena; Pradhan, Chandra (2010). "Mid-Head Resection Technique for Complex Deformity". Techniques in Orthopaedics. 25: 33–8. doi:10.1097/BTO.0b013e3181d2a969. S2CID   75648575.
  19. ↑ Scott, CE; Howie, CR; MacDonald, D; Biant, LC (2010). "Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients" (PDF). The Journal of Bone and Joint Surgery. British Volume. 92 (9): 1253–8. doi:10.1302/0301-620X.92B9.24394. hdl: 20.500.11820/09c9e57a-0fd6-42df-969b-38c0943b48a4 . PMID   20798443.
  20. ↑ McMinn, Derek. Novel Strategies for TKR, London Knee Meeting Presentation, 2010.
  21. ↑ "Program for the Meeting of the Hip Society, 8 March 2008". Archived from the original on 26 July 2011. Retrieved 10 November 2010.
  22. ↑ Search Results for author McMinn DJ on PubMed .
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