move! - Mathys AG Bettlach

move! a new way of thinking about everyday life
in medicine and in the clinic
Stimuli from orthopaedics and the professional field – For physicians, specialists and executives
“It‘s easy to implant
and nothing ever goes wrong”
The RM cup celebrates its 30th anniversary
– reason enough to let our thoughts wander
across to the distant New Zealand, where
move! interviewed Professor Geoffrey Horne,
a true expert when it comes to the tried and
tested RM cup. We asked him about the idi-
osyncrasies of the New Zealanders and the
new developments in hip arthroplasties.
Professor Horne, you have many years of
experience with the RM cup. How many
exactly and when do you implant it?
I‘ve been using the RM cup now for over 24
years, since 1981. I use it all the time actually,
for all primary total endoprosthetic hip operations
and for most revisions as well. For revisions
I only use other cups in about 10 per cent
of all cases – if there is a heavy loss of bone
substance in the pelvis.
At the beginning of the 1980s the cup didn‘t
have a titanium coating. This caused problems
on occasions. But in most cases it proved to be
very stable, even in those days. As a matter of
fact, I happen to have removed two of these
cups this morning. I implanted them in 1984.
So, as you see, they have been doing a good
job for more than 20 years, and since the day
when the titanium-coated cup came onto the
market, the results have simply been splendid.
What exactly are the advantages of this
cup?
It‘s a very “forgiving” implant. It‘s easy to implant
and nothing ever goes wrong. It can be
used for all types of hips. It‘s extremely flexible.
It hardly ever causes any trouble. Our studies
show very pleasing survival rates – but you can
expect that from a good polyethylene cup.
Even more important: the cup doesn‘t cause
osteolysis in the pelvis. Even after 10 or 15
years there seems to be very little abrasion. You
can‘t say that about every cup. It may be to
do with the special polyethylene mixture that
Mathys uses in manufacturing the cup. At any
rate, that‘s a distinct advantage.
»
Here in New Zealand we‘re
conservative in the most
positive sense of the term
On top of all this, the RM cup, being a monoblock
implant, is relatively low-cost. This is
good for the budgets of both my private
patients and our public health system here in
New Zealand. There‘s no evidence that the expensive,
modular cups are even a jot better.
What heads do you use with the cup?
«
Issue 21 / Nov./dec. 2005
When I started to use it in the middle of the
1980s there were some people who claimed
that with ceramic on plastic there is less wear
than with metal-plastic pairs. But you can use
metal heads just as well with the RM cup.
Here in New Zealand they are even a little bit
cheaper. But I still use ceramic heads.
Continued on next page > > >
Professor Geoffrey Horn
learned his orthopaedic skills In New Zealand
and Canada. Today this hip and knee specialist
is Professor for Surgery’ at the Wellington
School of Medicine (Otago University) and a
consultant and surgeon at Wakefield Hospital,
Wellington‘s leading private clinic and the
largest surgical establishment in central New
Zealand.
His scientific expertise is also uncontested – so
far the former President of the New Zealand
Orthopaedic Association (NZOA) has more than
100 publications in international journals to
his name.

Continuation
Professor Horne, most of our readers don‘t
think much about New Zealand. Is there
anything that you would say are special
New Zealand idiosyncrasies, a certain philosophy
in endoprosthetics?
As far as joint replacements are concerned, I
think that we‘re somewhere between Europe
and North America, although we tend to use
more European makes rather than American
or British ones. Far fewer ceramic components
are implanted in this country – simply because
they‘re very expensive. Here in New Zealand
we‘re conservative in the most positive sense
of the term. Most surgeons here stick to
proven surgical techniques and implants for
many years. Here we are less industry-driven
than the Americans, for example, and only
switch over to new techniques if this is good
for our patients.
A good example is crosslinked polyethylene;
virtually no one in New Zealand uses it and
I personally wouldn‘t implant it in any of my
patients before I‘m convinced that the benefi
ts outweigh the risks. So far there‘s been
no evidence to prove that it behaves better in
the body than traditional polyethylene. On the
contrary, there‘s even reason to believe that
it‘s more harmful due to the peculiarities of its
abrasion particles.
For your use
Preventing percutaneous injuries
By courtesy of
Becton Dickinson GmbH
The RM cup – 250.000 implanted worldwide
Despite all your conservatism – where do
you see new developments?
Well, the trend world-wide is towards smaller
accesses and therefore less traumatic surgery.
The time spent in hospital as an in-patient is
getting shorter all the time. Here in New Zealand
as well, patients are sent home after 2 to
3 days. Hip surgery is changing and continually
developing. In my opinion, however, this
evolution doesn‘t stem from the implants as,
so far, there‘s no convincing evidence that the
new product families are any better than the
older ones.
In Europe alone more than 200,000 percutaneous
injuries from needles are registered
every year and only 30 % of all incidents are reported
at all. Becton Dickinson has developed
a comprehensive range of safety products to
prevent such injuries and the resulting risk of
infection.
The BD Eclipse safety injection device can
be used for all the usual injections with Luer
and Luer Lock syringes; after the skin has been
punctured the integrated safety shield is easily
activated with one hand; the cannula then irreversibly
locks into the safety shield.
Further safety products include blood sample
sets, direct sample adapters for blood cultures,
safety and incision lancets and peripheral
vein access systems (IV therapy).
I also think that there will be a development
away from modular pressfi t cups with a metal
back – simply because of the osteolysis problems
that they cause. In the next few years
we‘ll be seeing a sea change towards mono-
block cups. This will certainly be diffi cult for
the Americans, who see themselves as the
inventors of modular pressfi t cups. But they
won‘t be able to ignore the concerns about
the greater backside wear, either. I think that
the good clinical results of mono-block cups
– including some results that we‘ll soon be
publishing in America – will have an impact
here as well.
Thank you for this interview. __//
Also available: EPINet (Exposure Prevention
Information Network), a free software developed
by the University of Virginia for the documentation
of percutaneous injuries and cuts
and to record all measures for post-exposure
prophylaxis and all follow-up examinations.
Becton Dickinson GmbH
Tullastr. 8-12, D-69126 Heidelberg
Telephone: +49 (0) 62 21- 3 05-0
Fax: +49 (0) 62 21- 3 05-216
More information at: www.mediaform.de
and www.nadelstichverletzung.de

Focus on science
The 30th anniversary of the RM cup:
A modern classic in the shadow of Big Ben
Welcome to London – Mathys had sent out the
invitation and many came. Around 80 orthopaedic
surgeons from 15 countries met in the
old and venerable halls of the Royal Horseguard
Hotel in the British metropolis in the middle of
September in order to exchange their expertise
and discuss current scientifi c fi ndings. The “star
of the show“ was the replacement hip joint
which has successfully provided service for 3
decades: the RM cup.
From the start most delegates had one thing
in common. Their familiarity with an implant
which was fi rst used clinically in 1975 and has
since been used worldwide more than 250,000
times. The hour of its birth actually goes back
to the year 1967 when the Swiss engineer Robert
Mathys developed his vision of a reinforced
plastic implant which would be suitable for
everyone and affordable.
For two days 20 hip specialists from Europe,
Latin America, Israel, Thailand and New Zealand
presented the fi ndings of international studies
and relevant reports based on experience of
the RM cup. Those present were in agreement
about one thing: the cement-free polyethylene
cup is a modern classic which can still convince
today because of its excellent results.
96.7% survival rate after 15 years
“It can be used for all types of hips. It‘s extremely
fl exible. It hardly ever causes any trouble”,
– this is how Prof. Horne of the Wakefi eld
Hospital, New Zealand described it. A view
shared by Dr Markku Yli-Jama from Mikkeli,
Finland and his Russian colleague Dr Vladimir
Danilyak. They divided the secret of the implant’s
success into three important points:
its elasticity in conformity with the acetabulum
(1000N/mm 2 ),
the mono-block design which is accompanied
by a very strong PE coating and facilitates
implantation without unnecessary bone loss in
the pelvis, and
The host: Robert Mathys, Hugo Mathys
its special titanium coating which ensures
permanent anchoring in the bone without the
risk of osteolysis.
The reward is above average serviceable life.
At the London Conference survival rates of
96.7% after 15 years were announced for the
TiCP coated RM cup. “The cup has stood the
test of time”– this is how one of the participants
in the conference accurately formulated
it. At the end of the two-day symposium it was
only a question of calling out to the experts
present and especially the many wearers of the
RM cup around the globe: Keep moving!

Familiar, personal and serious
In addition to product quality and technical expertise the
partnership between doctors and Mathys is defi ned by
trust, the ability to communicate and the willingness to
provide service. At least this is what the comments of the
participants of the symposium in London verify.
“Mathys stands out well from the large marketingdriven
American manufacturers: familiar, personal and
serious – just as it should be.”
Dr Everth Merida Herrera, Mexico
“I am an enthusiastic Mathys user – not as a local patriot
but because of the products. The competence and
the standard of care which I experience with Mathys is
incomparable.”
Dr Lukas Schatzmann, Switzerland
“We are used to Mathys’ excellent service. But we are
also excellent customers.”
Dr Maarten Spruit, the Netherlands
“With Mathys it is not merely a question of business.
I have known the company personally for more than 25
years and do not regard myself as a customer but more
as a friend and part of a family.”
Dr Suthorn Bavonratanavech, Thailand
For your use
Hippocrates:
the ethics debate
Outdated tradition or a valid code of morals?
Today many physicians see the Hippocratic
Oath as no more than a relic from an antiquated
and overbearing approach to medical
ethics. Steven Miles, on the other hand, in his
new and interesting book, makes the effort
to free the Hippocratic Oath from the dust of
the centuries and points out its signifi cance for
modern medicine in a different way.
His intellectual approach: the Hippocratic
Oath still lays down valid principles for the relationship
between the physician, society and
the individual patient.
Each chapter looks at a passage of the Oath
and discusses it from the point of view of a real
medical case in modern times. Even the often
quoted parts that prohibit “the use of lethal
substances“ and “abortifacients“ are not seen
as a maxim against euthanasia and abortion,
but are put into a modern context, taking account
of their original intention.
The author is a practising internist, a pioneer
in the fi eld of medical ethics and, as a committed
health politician, has stood for election to
the US Senate.
The New England Journal of Medicine
wrote: “Miles‘ interpretation of the Oath is
enlightening“; recommendable for everyone
in the medical profession who would like to
refl ect on the historical background and the
ethics of their profession.
Steven H. Miles: Hippocratic Oath
And The Ethics of Medicine
Paperback, 232 pages
Oxford University Press 2005
Price: from 16.95 EUR / 19.95 USD
ISBN: 0195188209
More information at: www.oup.com

From the professional field
Interior design at the hospital:
Creating a place in which to get well
The clinics of today are intended to be health centres, but the first impression already
raises doubts. Many hospital buildings still come across as depressing, functional, cold,
colourless and soulless. The framed colour prints in the corridors are like a feeble attempt
at a cosmetic touch. These are the architectural burdens from the past, which are all the
more serious today because we know that good architecture and interior design at a hos-
pital have a positive effect on both the healing of the patients and the work of the staff.
“People are often preoccupied with the
thought of being ill,“ says Dr Rotraud Walden
from the Psychological Institute at the University
of Koblenz, describing the way people
feel when they are in hospital. “You are under
observation by physicians and nurses, you are
in an alien environment, and you have to be
considerate towards others.“ A homely atmosphere
can do wonders in overcoming the feeling
of unease. However, good architecture and
interior design not only further the well-being
of the patients, but also help visitors and hospital
staff to feel at ease. Therefore they become
a positive image factor for a hospital in an
increasingly competitive environment. When
new hospitals are built or existing hospitals
are reconstructed, it is therefore increasingly a
question of combining functional requirements
and medical facilities with concepts for interior
design that take account of the human aspect.
Old buildings can also be made considerably
more attractive, sometimes with only a few
simple measures.
Short routes: many hospitals have grown
organically. In order to get to the diagnosis and
treatment facilities, patients, staff and providers
of transport services often have a long way
to go. Moving the radiology department from
the basement to the centre of the building, for
example, is not only more considerate towards
the patients, but also saves time and money. It
is ideal in the interests of efficiency to arrange
the departments along the lines of the medical
workflow and the organisational routines as far
as this is possible.
Signs / guide systems: nothing is worse
for a hospital than people not being able to
find their way round. The signs should therefore
be detailed and clear. Guide systems must
“pick up“ patients and visitors at the entrance
and lead them to where they want to go without
any ambiguity. Colour coding for individual
wards or facilities are more easily remembered
than numbers or abbreviations. With guide
systems you can also enforce the separation of
routes for visitors, for patients who are independently
mobile and for patients who cannot
move around on their own. This makes it easier
to transport patients around the hospital, for
example.
Light, air and colour: these are very important
factors in creating a feeling of well-being.
Climatic buffers in front of the windows,
for example, ensure pleasant air and light conditions
as well as acting as a sound insulator.
There should be sufficient daylight wherever
this is possible. Lights must be bright enough
for examinations, but they should not dazzle.
When furnishing patient rooms and common
For further reading
Robert Wischer, Hans-Ulrich Riethmüller:
Zukunftsoffenes Krankenhaus
– Ein Dialog zwischen Medizin und
Architektur; Springer Verlag 2004, ISBN
3211258949
Antje Monz, Johan Monz: Design
als Therapie – Raumgestaltung in Krankenhäusern,
Kliniken, Sanatorien; Verlagsanstalt
Alexander Koch 2001, ISBN
3874226271
rooms preference should be given to materials
and colours that are natural and warm. Due
to their well-known psychological effect, it is
particularly important that colours are used to
create effect at the clinic. Blue, for instance,
has a calming effect, but it is also a cold colour,
while yellow stimulates and produces a feeling
of happiness and red has a strong invigorating
effect, for example in places of movement such
as sports places, kitchens and stairways.
Personal self-determination: patients do
not like to feel that they are helplessly at the
mercy of the hospital routines. They wish to
take a personal influence on life at the hospital.
This means that they should be able to adapt
their rooms to their own personal needs. It
should be possible for them to independently
operate more of the things in their rooms (e.g.
regulating the heating or setting the height of
the bedside tables). They should be able to put
up personal belongings like pictures. Television,
radio, telephone and perhaps even an internet
connection must be within easy reach from a
patient‘s bed. In addition to their own bathrooms,
it is essential that four-bed rooms also
have an additional wash basin.
Communicative rooms: the opportunity
for communication and interaction increases
the quality of life during a stay at the clinic.
For this reason there should also be inviting
common rooms outside the patient rooms with
sitting areas or atriums where patients can get
together and pass the time of day. In addition
to the now obligatory kiosk, cafeteria, hairdresser
and cash machine, other meaningful
and attractive facilities could be created inside
the clinic, such as a bookshop or an orthopaedics
workshop.
Richard L. Miller, Earl S. Swensson:
Hospital and Healthcare Facility Design;
W. W. Norton & Company 2002, ISBN
0393730727
Cynthia A. Leibrock: Design Details
for Health - Making the Most of Interior
Design‘s Healing Potential; Wiley 1999,
ISBN 0471241946
Janet R. Carpman, Myron A. Grant:
Design That Cares - Planning Health
Facilities for Patients and Visitors; Jossey-
Bass 2001, ISBN 0787957399

Product in focus
Metal sliding pair:
1 million movements, less than 0.002 mm of wear
Increasingly high standards of quality and the growing number
of young and active patients call for increasingly longer lifetimes
for total hip replacements. Revisions as a result of wear should
be avoided in long-term use. Materials scientists are paying
more and more attention to what are known as hard pairs – including
metal-metal articulations. (These allow an improvement
in wear behaviour.)
The chemical and physical stability of the
surfaces of the implant have a lot to do with
the success of an artificial hip joint. Articulating
surfaces are therefore subject to stricter
conditions as these are not only permanently
in contact with the body medium, but also
have contact surfaces with additional dynamic
loads. As a material of choice for fully metallic
sliding pairs, hot-worked cobalt alloys
have quite rightly become the norm, as the
fracture-tough basic material, consisting of a
CoCrMo matrix combined with finely distributed,
embedded carbides of extreme hardness,
meets the unusually high requirements for the
material forming an artificial joint. A closer
look shows that various CoCrMo alloys with
different characteristics are used in prosthetics,
differences that mainly become apparent over
the course of time.
A simulator study jointly carried out by the
independent Orthopaedic Research Laboratory
in Los Angeles and the Dr h. c. Robert Mathys
Foundation in Bettlach, for instance, has confirmed
the excellent tribological behaviour of
the Mathys metal sliding pair. On the assumption
that a hip joint in vivo is subjected to strain
on average one million times each year, the
CoCrMo sliding pair, on the ball side, has a
linear wear of less than 0.002 millimetres per
year (Fig.).
Masthead
Publisher:
Mathys Ltd Bettlach • Güterstrasse 5 • 2544 Bettlach • Switzerland
Telephone No.: +41 (0)32 644 1 497 • E-Mail: move@mathysmedical.com
Editor responsible for the magazine:
Regula Haag • Corporate and Market Communication • Mathys Ltd Bettlach
Concept and design:
IFAM Institut für angewandte Marketing-Wissenschaften GmbH • D-40545 Düsseldorf
linear wear [mm]
0,012
0,009
0,006
0,003
0,000
0 1 2 3 4 5
load cycle [m.]
Fig.: Linear wear of a Mathys metal sliding pair expressed as a function of
the number of load cycles (90% serum solution, 1 Hz, load transfer (Paul),
Lmax=2000 N)
Tested in 1999 at LAOH (McKellop): “ ... wear rates among the lowest we have
previously measured“. Tested in 2001 at CRITT: “ ... plaçant ce couple dans les
meilleurs testés actuellement au CRITT“.
Send for your free copy
Showing the way:
Your new design compass
It looks back on a longer history than the RM cup.
The compass was invented in Empire of China back
in 271. In those days it consisted of a piece of Magneteisenstein,
hanging on a thread and was known
as the “Südweiser“. Fortunately, the compass now
waiting for you to send for it at Mathys is brand
new and somewhat more exclusive. It combines
form and function and is not only an extraordinary
accessory, but also a genuine aid in finding your
way around. It will show you the way when you are
out hiking or travelling, precisely and reliably.
Send for your new design compass in the attractive Zinn box free of charge!
Send the enclosed fax form to: +41 (0)32 644 1 460
Or simply send an e-mail to: move@mathysmedical.com
As long as supplies last!
move! is published by Mathys Ltd Bettlach
– your competent partner for total endoprosthetic
treatment in orthopaedics. With
new, useful information, move! is addressed
to specialists in orthopaedics and traumatology
in hospitals and practices, as well as all
specialist and management staff in the medical
field, nursing staff and general management
in hospitals. We would like to thank all
of those who have helped us in realising the
publication of move! by making individual
contributions, or providing information and
photographs. Do you have some news or
tips about orthopaedics and or clinical practice
for us? You would like to make your own
contribution to move! We would be pleased
to hear from you. Please use the enclosed fax
form. Or, you can contact us directly by telephone
or using email.