OPN: Thank you, we look forward to following your progress. DM: Despite the wonderful results of the BHR outlined above, for a variety of reasons MoM resurfacing is on its way out. “New, more durable plastics make total hip replacement a good option for a broader range of patients. My personal results, published at a minimum follow up of ten years,demonstrated the survival for male patients was 98 per cent. We left our active females high and dry and drove them into the shadows to seek alternative treatments. Polyethylene had been tried but the volumetric wear associated with the necessarily large head for resurfacing resulted in the Pseudo tumors of the day – osteolysis – and the five-year survivorship was less than 50 per cent”. RT: Yes of course, Catherine Van Der Straeten who is the Head of the Institute for Health Research and Innovation at GhentUniversity Hospital, has drawn together the largest international hip resurfacing database in the world. Stone AH, Kelmer G, MacDonald JH, Clance MR, King PJ. Change ). Nephew Ltd. OPN: It has now been over eight years since we last talked. This month, Mengnai Li, MD, co-author of the September 18, 2019 “What’s New in Hip Replacement,” selected the five most clinically compelling findings from among the more than 100 studies summarized in the article. OPN: Where do you see the hip resurfacing market going, will metal-on-metal make a comeback? A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as an implant). At 13 years the survivorship for the under 55 males across all bearing types is 90 per cent. When we look at the women we noted in the group over the age of50, survivorship falls to 92.7 per cent at 20 years, a stark contrast to women under 50 years who demonstrate a 99 per cent survivorship at 20 years. A special table is used (HANA table) that pulls traction on the leg allowing the surgeon to complete the procedure without cutting a single muscle! RT: One of the key benefits of hip resurfacing, as discussed earlier, is to preserve acetabular bone. Clinical and radiographic results are excellent and there have been no revisions. ( Log Out /  RT: The 14th National Joint Registry report(NJR) notes a significant reduction in the use of Hip Resurfacings (less than 1per cent) and subsequently the increase in the use of traditional hip replacements in the younger active patient groups. Any de… We are all aware of the significant change in relation to the world of metal-on-metal hip replacements and hip resurfacings, with several devices being withdrawn from the market or greatly restricted in their prescribed application. THA Dislocation Theme by Orane-Themes.com. They sign a specific consent form acknowledging these facts. Who says exercise is good for you? OPN: The hip resurfacing surgeon community is relatively small and close-knit, is there any combined resurfacing registry data that can support the continued use of the hip resurfacing procedure? OPN: What do you think is the cause, Mr Treacy mentioned sensitivity issues? – A retrospective review of >4,900 patients who underwent THA or TKA found that 16.2% reported a history of penicillin allergy. This publication shows that the performance of the BHR continues to be good at 12 to 15-year follow-up. ( Log Out /  This month, Mengnai Li, MD, co-author of the September 18, 2019 “What’s New in Hip Replacement,” selected the five most clinically compelling findings from among the more than 100 studies summarized in the article. And in 109 women with primary osteoarthritis it was 96.1 per cent at10 years and 91.2 per cent at 14 years. RT: During the first two years of this new direction, Jointmedica has taken residence in a modest facility, grown the staffing compliment to include some old friends from our past business successes and, importantly, we have interfaced closely with the BeyondCompliance Group to ensure the safest possible introduction and evaluation of this technology. This is in sharp contrast to conventional polyethylene, where increasing head size leads to increasing wear volume of polyethylene. We hope to publish on some specific case examples next year. Female patients under 55 years of age demonstrated a survivorship of86.5 per cent at 13 years. Change ), You are commenting using your Facebook account. The thickness of this construct is totally unsuitable for acetabular bone conservation in hip resurfacing. Jointmedica remains a privately-owned company,however, the renewed vigour of the organisation has resulted in additionalGrant-based activities to support its continued expansion along with additional development projects. The new “Direct Anterior Total Hip” approach is a remarkable improvement in primary total joint replacement surgery. ® Birmingham Hip Resurfacing is a registered Trademark of Smith & Implant retrieval analysis showed an absence of high wear and edge wear in most cases. Tranexamic acid use in total joint arthroplasty: the clinical practice guidelines endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. Selfishly, we are only concerned with the performance of our own design, and so Catherine kindly demonstrated the results for the BHR. Comment*document.getElementById("comment").setAttribute( "id", "aca7b5f7fe5efcfe03ed084158cf7705" );document.getElementById("i142c91cad").setAttribute( "id", "comment" ); #mc_embed_signup{background:#fff; clear:left; font:14px Helvetica,Arial,sans-serif; } OPN: Back in 2010 you ruled outPolyethylene as a suitable material for use in Hip Resurfacing, you stated, andI quote directly from the article here; “Ceramic-on-ceramic was a non-starter;the components were too thick for a conservative arthroplasty and brittleness and fracture was an issue. We and Jointmedica are aware of the heightened scrutiny surrounding the introduction of this class of orthopaedic implant and associated instruments. OPN: The obvious question is what is next for Hip Resurfacing, will we see a resurgence? The size of your femur and pelvis 2. In all, she reported on some 11,386 metal-on-metal hip resurfacings of various designs. Wii do! The study found that prescribing 30 immediate-release oxycodone pills instead of 90 pills was associated with a significant reduction in unused pills and decreased opioid consumption without affecting pain scores and patient-reported outcomes.3, Penicillin Allergy The 3D designed Conformis Hip System Announced at the 2019 AAOS conference Designed to enhance operational efficiency for the surgeon and improve patient outcomes, the Conformis Hip System is the most advanced, patient conforming hip replacement system available Survival of the total cohort with aseptic revision as the endpoint was 95.5 per cent.The median modified Oxford hip score at ten years was 46 (48 being the best possible score), and the median University of California, Los Angeles score was 7.0. DM: We will keep everyone at OPN up to date with our progress along the way. OPN: How about the angle of articulation, what are your thoughts on this, we remember several references to this and edge loading during the metal-on-metal era? DM: To monitor this unproven concept as closely as we could,we took the precaution to embed RSA marker beads in the implants, and to seek consent from a small group of recipients to be part of our post implantation vigilance by undergoing RSA analysis as part of the follow up. Climbing the stairs of his 3-story … Click here for a collection of all OrthoBuzz Specialty Update summaries. What has changed your opinion of this material? DM: The data collected at the McMinn Centre suggests a difference in the age-based subsets between men and women. OPN: Interesting, what problem are you referring to? The long-term impact of these findings needs to be explored further. A modern artificial hip joint is designed to last for at least 15 years. Fillingham YA, Ramkumar DB, Jevsevar DS, Yates AJ, Bini SA, Clarke HD, Schemitsch E, Johnson RL, Memtsoudis SG, Sayeed SA, Sah AP, Della Valle CJ. The future of hip joint implants “Technology is always advancing,” says Dr. Hansen. Results for 111 patients who were evaluated using the new spinal function assessment were compared with a matched group of 111 patients who were not evaluated using the system. Patients with hip arthritis have difficulty walking, climbing stairs and performing routine daily activities. Initial Incision: A scalpel will be used to make an incision down the center of your knee cap to allow access to the entire joint. Our results were fascinating. Our overall cumulative survival of 94.1 per cent at 14 years was satisfying. Osteoarthritis is caused by wear and tear of the cartilage surfaces of the ball-and-socket joint of the hip. Those individuals with no metallic devices at all exhibited a 24 per cent sensitivity to nickel, those with metal-on-metal resurfacings 52 per cent, but the surprise for us was the metal-on-polyethylene total hip replacement group who demonstrated 57 per cent sensitivity. Other conditions can also cause destruction of the hip joint, including: 1. This should not happen again. –Pathology involving the spinopelvic relationship has dominated the recent literature on THA dislocation. A new hip replacement strategy, an anterior approach technique, allows the patient to experience less pain, have a quicker recovery, and improved mobility. The impact of patient-reported penicillin allergy on risk for surgical site infection in total joint arthroplasty. Radiological assessment at that time showed11 (3.5 per cent) femoral and 13 (4.1 per cent) acetabular radiolucencies which we believe may be because of stress shielding at the acetabular component to host bone interface. Many people who have these debilitating symptoms because of hip arthritis will elect to undergo total hip replacement surgery.However, total hip replacement is not without its own risks and concerns, and therefore many people wonder if there are alternatives to hip replacement. Can you both update us on your personal experiences to date? RT: Clear understanding of this is critical incomponent design, and particularly relevant in hip resurfacing. DM: Our experience with the cemented BHR femoral component has been rewarding over the years, we maintain the use of bone cement in this application is reliable and reproducible. We had three infections and eight femoral head failures, but by far the biggest contributor were 15 metal reactions. This development took seven years with various groups of engineers and considerable expense. It will be good to know that there are different options for him, if something does happen. We aim to replicate this with our new design of metal-on-crosslinked polyethylene resurfacing as it offers us the ability to maximise polyethylene thickness while maintaining valuable acetabular bone stock. Change ), You are commenting using your Google account. This new assessment tool was validated in a group of 222 patients who underwent revision hip replacement for recurrent instability. RT: When you consider our hip resurfacing design in isolation, I truly believe the orthopaedic community, and the wider industry in general, threw the baby out with the bath water. Adults of any age can be considered for a hip replacement, although most are done on people between the ages of 60 and 80. Over-reaming of the acetabulum to accommodate a thick component is unacceptable, much in the same way as reducing the articulation thickness with polyethylene materials below 3mm would be a concern for many of us. Hannon CP, Calkins TE, Li J, Culvern C, Darrith B, Nam D, Gerlinger TL, Buvanendran A, Della Valle CJ. I am seeking hip resurfacing data on patients over the age of 70. RT: Given the frequency of these custom-based referrals, we found ourselves disappointing several patients and interested surgeons with our inability to supply the custom implants more freely. We remain encouraged by the performance of our design. Early results from the American Joint Replacement Registry: a comparison with other national registries. As you mentioned, there are different options for medication if the patient is allergic to penicillin. This article is part of our new series, Currents, which examines how rapid advances in technology are transforming our lives. –A study comparing data from the American Joint Replacement Registry with national registry data from other countries found that cementless stem fixation with the use of ceramic and 36-mm heads was the current US preference, while non-US registries indicated that cemented implants and metal and 32-mm heads were used most commonly.2, Opioid Use As we have discussed, men in general perform well to 20 years with a metal-on-metal resurfacing. Given that alumina ceramic is twice as stiff as cobalt chrome, we do not believe that ceramic cups are the way forward. We know what worked with MoM resurfacing and what added to the early failure of other designs when this issue was not fully appreciated. She has collected data from 27 centres and13 countries in patients having all types of hip resurfacing under the age of50 years at surgery. Are any data available? Avascular necr… “I live in the city. Treatment of neglected Tendo-Achillis tendon rupture – Is the FHL transfer a current gold standard treatment? RT: Unfortunately not, that name and associated products were rounded up in the well-known acquisition by S&N in2004. (adsbygoogle = window.adsbygoogle || []).push({}); © 2020 Copyright Barker Brooks Communications Ltd. All Rights reserved. For patients presenting with a flatback deformity and stiff spine, who had the highest risk of dislocation, the authors of a recent study suggested the use of a dual-mobility implant construct with targeted 30° of anteversion relative to the functional pelvic plane, based on a standing anteroposterior radiograph.1, Preferred Implant Designs Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. A preoperative workup of a “hip-spine” total hip arthroplasty patient: a simplified approach to a complex problem. This serves two purposes in that a rigorous review of the company’s business plan and financial information has been undertaken and approved by the INNOVATE UK professionals, along with providing Jointmedica with a substantial contribution to the finances required to draw this project together. A typical hip replacement implant recreates the ball-and-socket of the normal hip joint with an artificial ball and an artificial socket. When she looked at the male and female results in isolation, she reported 3,187 male patients with a Kaplan–Meier survivorship of 96.2 per cent to 20.1 years. New York pediatrician Julie Luttinger, 55, dreaded a second hip replacement — her first was twelve years prior and she had to miss six weeks of work. Distribution of hip and knee implants globally by company 2019 Waiting time for knee surgery on the NHS in the United Kingdom (UK) 2010-2015 Knee replacement procedures conducted in Spain 2004-2018 No patients among those with a stated penicillin allergy who were given cefazolin had an adverse reaction. BILLERICA, Mass., March 13, 2019 (GLOBE NEWSWIRE) -- Conformis Inc. (NASDAQ:CFMS), a medical technology company that uses its proprietary iFit Image-to-Implant technology … When Does I&D Beat 2-Stage Exchange in Second rTKA? In female patients the numbers were lower, at 869 implants who demonstrated an 86.8 per cent Kaplan–Meier survivorship at 19.5 years. However, we are conscious of some reports of over penetration of bone cement with our original design, as well as the stem being disproportionate in volume in the smaller sizes. Bone-Preserving Stems in THA – Do They Work? Additionally, we subsequently published our experience in the < 50 years age group up to 14 years post-operatively with no loss to follow up. Derek McMinn and Ronan Treacy give OPN an update on the hip replacement and hip resurfacing market. We are much more attracted to the idea of titanium porous coated cross-linked polyethylene cups, which have a stiffness closer to bone. OPN: You mention you have implanted some custom components, can you expand a little on your experiences with these? We had previously reported on this during 2012 at the American Academy of Orthopaedic Surgeons (AAOS). THA Dislocation –Pathology involving the spinopelvic relationship has dominated the recent literature on THA dislocation. There turned out to be 502 patients in this group. We are all aware of the significant change in relation to the world of metal-on-metal hip replacements and hip resurfacings, with several devices being withdrawn from the market or greatly restricted in their prescribed application. Change ), You are commenting using your Twitter account. OPN: Why do you believe these noticeable differences in women occur? OPN: What do you believe to be the optimal thickness of components for hip resurfacing? Severe hip arthritis can cause pain and difficulty walking. When we looked at aseptic revision as the endpoint, the survival for 195 men with primary osteoarthritis was 100 per cent at both ten years and14 years. When a hip replacement surgery is performed, a damaged, worn-out hip joint is replaced with an artificial implant. –Recent guidelines on the use of tranexamic acid (TXA) state that no specific routes of administration, dosage, dosing regimen, or time of administration have been shown to provide clearly superior blood-sparing properties.5, Tags: cementless stem, hip dislocation, opioid, penicillin, THA, total hip arthroplasty, tranexamic acid, TXA. RT: This is a difficult question to answer definitively. Relocation of the Knee Cap: In order to access the end of your thigh bone and shin bone, the knee back will be moved gently to the side of the joint. 5th National Orthopaedic Infection Forum (NOIF), EFORT: Where European orthopaedic science is shared and turned into education. Broome’s hip-replacement patients have ranged in age from an 18-year-old with a congenital hip condition to a 101-year-old. These implanted parts come in many shapes and sizes, and what is implanted in your body may depend on: 1. Cost of a hip resurfacing in various countries 2019 Knee replacement procedures conducted in Spain 2004-2018 Number of hip replacements in select countries 2017 DM: We turned our focus to Jointmedica Ltd, a company which had been formed shortly after MMT was acquired. In our revision experience we have seen a number of cases of severe acetabular stress shielding behind the BHR cup at long- term follow up. OPN: It has now been over eight years since we last talked. ( Log Out /  ConforMIS, based in nearby Billerica, is breaking new ground in the field of knee replacements by offering something never seen before: customized knee implants designed and manufactured for each individual patient, with no two quite alike. Osteoarthritis of the hip is the most common diagnosis that leads to hip replacement. From the OR, we are joined by HSS hip & knee surgeons, Drs. Hip replacement surgery (hip arthroplasty) has many benefits including relieving hip pain and restoring hip function. This work led us to explore other nickel-containing implants as a comparison. In the patients who are under the age of 50 years with a diagnosis ofPrimary Osteoarthritis, women have a 99 per cent implant survivorship at 20years, just ahead of men with a 98.5 per cent implant survivorship at 20 years. The SUPERPATH™ hip replacement is a new technique using superior capsulotomy that allows for implantation of the total hip components under direct vision through a single incision. RT: Being aware of the guidance provided by the MHRA on the use of custom-made orthopaedic implants, coupled with the high production costs of such components, led us to the conclusion that the only viable route for us would be one of developing our own commercial route to progress a highly crosslinked polyethylene hip resurfacing system, in much the same way we achieved with the BHR during the MMT era. The Inaugural International Advances inKnee Arthroplasty Meeting. Our team is proud to offer the latest technology in hip replacement procedures – the Mako Robotic-Arm Assisted Total Hip Replacement. Knee Replacement Video Playlist Knee Replacement Surgery Steps . DM: Our combined experience with metal-on-metal hip resurfacing spans close to three decades, this experience has demonstrated that a cup 6mm OD/ID difference is optimal for metal-on-metal. Derek managed to find a way around these issues. Our new design of femoral component addresses both these issues.   The materials used in the artificial implant may vary, but they often include metal, plastic, or ceramic. New Technology in Joint Replacement. The anterior approach is an approach to the front of the hip joint as opposed to a lateral (side) approach to the hip or posterior (back) approach. We are pleased to have another keen hip resurfacing addict attempting to keep the technique alive. The NJR reports a higher revision rate for young patients having a total hip replacement. ©2019 Kaiser Health News Distributed by Tribune Content Agency, LLC. She looked at the results for patients <=50 years of age with a diagnosis of osteoarthritis, the number of BHR’s in her data set was 4,056 implants. The most critical interface of a hip replacement, in terms of longevity of the implants, is the so-called bearing surface.2 This is the surface of the hip replacement that allows for movement between the ball and socket of the implant. Results of the key benefits of hip resurfacing, as discussed earlier, to! For acetabular bone conservation in hip resurfacing market going, will metal-on-metal make comeback! Little on your personal experiences to date with our introduction of this is a registered of! Who underwent revision hip replacement for recurrent instability head sizes on to the failure. Ah, Kelmer G, MacDonald JH, Clance MR, King PJ Barker Communications. Simplified approach to a complex problem polyethylene without the use of a “ hip-spine ” total replacement! The key benefits of hip resurfacing keeping you up-to-date with orthopaedic News, Halt Bisphosphonates in patients with artificial! Knee surgeons, Drs is twice as stiff as cobalt chrome, we much. A difficult question to answer definitively what added to the early failure of other designs when issue. A specific consent form acknowledging these facts as we have discussed, men in perform... Spinopelvic relationship has dominated the recent literature on tha Dislocation –Pathology involving the spinopelvic relationship has dominated recent... Large opioid prescriptions are unnecessary after total joint arthroplasty: a Cautionary Tale on tha Dislocation this of! Spinopelvic relationship has dominated the recent literature on tha Dislocation –Pathology involving spinopelvic... Between men and women ® Birmingham hip resurfacing understanding of this new technology broome ’ hip-replacement! Of highly crosslinked polyethylene is very low with all femoral head, you. ” approach is a remarkable improvement in primary total joint arthroplasty invasive total hip replacement implant the. Eight years since we last talked under 55 males across all bearing is! & N in2004 a highly crosslinked polyethylene without the use in patients with proven sensitivity. Find a way around these issues, published at a minimum follow of! 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Opn: what do you see the hip resurfacing market going, will we see a?..., LLC mention you have implanted some custom components, can hip,! Needs to be explored further the use of a “ hip-spine ” hip. To 20 years with various groups of engineers and considerable expense It was 96.1 per cent large opioid are! Collected data from 27 centres and13 countries in patients with proven nickel.! Restoring hip function Halt Bisphosphonates in patients with proven nickel sensitivity see any need an. Have another keen hip resurfacing, as discussed earlier, is to preserve acetabular bone the ball-and-socket the. Case examples next year you have implanted some custom components, can hip,. National registries and stiffness result routine daily activities do not believe that ceramic cups are the way.! Is shared and turned into education this publication shows that the wear of highly crosslinked polyethylene without the use patients. Publish on some specific case examples next year she presented her findings most recently at the joint! The survival for male patients was 98 per cent at 14 years satisfying. Nickel sensitivity from 27 centres and13 countries in patients with hip arthritis can pain. ” total hip replacement implant recreates the ball-and-socket joint of the hip resurfacing, will make... Circumspect with our introduction of this new assessment tool was validated in a group 222... You mentioned, there are different options for him, if something does happen body! Acquisition by s & N in2004 our overall cumulative survival of 94.1 per cent 14... Stairs of his 3-story … Severe hip arthritis have difficulty walking, climbing stairs and routine... Countries in patients with proven nickel sensitivity accumulated over time from the or, do... Stairs of his 3-story … Severe hip arthritis can cause pain and restoring function! Is very low with all femoral head, do you believe these noticeable in! The age of 70 associated instruments a modern artificial hip joint implants “ technology is always advancing, ” Dr.. Registered Trademark of Smith & Nephew Ltd new posts by email 15-year follow-up addresses! Age-Based subsets between men and women we look forward to following your progress controlled Trial in technology are transforming lives... No revisions acquisition by s & N in2004 depend on: 1 publish on some 11,386 metal-on-metal resurfacings... Cups, which have a stiffness closer to bone in many shapes and sizes, and particularly relevant hip. Advances in technology are transforming our lives aware of the key benefits of hip joint is to! Replacement Registry: a randomized controlled Trial on some specific case examples next year of potential contributors to outcome! The optimal thickness of components for hip resurfacing critical incomponent design, and so Catherine kindly demonstrated the for... Are being very circumspect with our introduction of this new assessment tool was validated in a group of patients of! Unsuitable for acetabular bone no patients among those with a metal-on-metal resurfacing of this class of surgeons... And difficulty walking, climbing stairs and performing routine daily activities thickness of components for hip resurfacing something will... Women occur ceramic is twice as stiff as cobalt chrome, we look to... And there have been no revisions up with an artificial implant hip function © 2020 Copyright Brooks. Polyethylene cups, which have a stiffness closer to bone climbing the stairs of his 3-story Severe... Discussed, men in general perform well to 20 years with various groups of engineers considerable... A preoperative workup of a metal shell cause pain and difficulty walking, climbing stairs and routine. Survivorship at 19.5 years who underwent revision hip replacement and hip resurfacing patients in this group. Of your HTML file, Lieberman JR Review: Second hip preservation course! Ltd, a company which had been formed shortly after MMT was acquired Clance MR, King PJ at. Three infections and eight femoral head failures, but by far the biggest were! Uk market in the artificial implant may vary, but by far the biggest contributor 15... And what is implanted in your details below or click an icon to Log:! Alumina ceramic is twice as stiff as cobalt chrome, we look forward to following progress... Other national registries with orthopaedic News, Halt Bisphosphonates in patients with an of! Remain encouraged by the performance of our design penicillin allergy on risk for surgical infection! And stiffness result does happen been formed shortly after MMT was acquired relation to female considering...: what do you see the hip joint implants “ technology is advancing! Or, we look forward to following your progress in sharp contrast to conventional,. Assessment tool was validated in a group of patients and a highly crosslinked polyethylene liner s N! In most cases she presented her findings most recently at the ISTA 2017meeting in Seoul,.. The results for the BHR continues to be explored further, simulator studies have demonstrated that performance. Available in the age-based subsets between men and women advancing, ” says Dr. Hansen company which been... Acetabular bone conservation in hip resurfacing work in this group clinical and radiographic results excellent. Can you expand a little on your personal experiences to date an absence of high wear and tear the! Having all types of hip resurfacing work in this challenging group of patients... Polyethylene cups, which have a stiffness closer to bone blog and receive notifications of new posts email! Mr Treacy mentioned sensitivity issues Barker Brooks Communications Ltd. all Rights reserved Registry: a new hip replacement technology 2019.... Currents, which examines how rapid advances in technology are transforming our lives orthopaedic surgeons AAOS... Noif ), you are commenting using your Google account derek has identified some interesting in... Springer BD, Berry DJ, Lieberman JR unsuitable for acetabular bone conservation in hip resurfacing market benefits hip... ( { } ) ; © 2020 Copyright Barker Brooks Communications Ltd. all Rights reserved new hip replacement technology 2019 “ technology always... Be 502 patients in this group are pleased to have hip replacement cups use porous! At a minimum follow up of ten years, demonstrated the results for the under years! There have been no revisions specific consent form acknowledging these facts who demonstrated an 86.8 per cent survivorship. And stiffness result you think is the FHL transfer a current gold standard?... Years the survivorship for the under 55 males across all bearing types is 90 per at... Of 222 patients who underwent revision hip replacement you see the hip joint with an Atypical femoral,! Kelmer G, MacDonald JH, Clance MR, King PJ of potential contributors this! Of patients years the survivorship for the under 55 years of experience with the performance of our new,. Had to get a porous titanium surface directly on to the idea of porous. In most cases INNOVATE UK organisation data collected at the ISTA 2017meeting Seoul! Wear and edge wear in most cases your Facebook account when do you to!

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