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Arthroplasty. Current Research New England Baptist Hospital Daniel M. Ward, M.D. October 1, 2008.

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Presentation on theme: "Arthroplasty. Current Research New England Baptist Hospital Daniel M. Ward, M.D. October 1, 2008."— Presentation transcript:

1 Arthroplasty

2 Current Research New England Baptist Hospital Daniel M. Ward, M.D. October 1, 2008

3 Areas of Interest Total hip replacement Total hip replacement Revision total hip replacement Revision total hip replacement Deep Vein Thrombosis Deep Vein Thrombosis New polymers in total hip replacement New polymers in total hip replacement

4 Total Hip Replacement Hips over time fail for may reasons Hips over time fail for may reasons –Plastic wear –Bone destruction –Fracture –Infection –Recurrent dislocation

5 Total Hip Replacement Number of total hip replacements in the US is increasing about 15- 20% a year Number of total hip replacements in the US is increasing about 15- 20% a year Earlier intervention Earlier intervention More active population More active population Need better equipment components Need better equipment components

6 Total Hip Replacement Study involving a new plastic shell/liner Study involving a new plastic shell/liner High density plastic manipulated with heat/gamma radiation to harden plastic and reduce wear High density plastic manipulated with heat/gamma radiation to harden plastic and reduce wear Hopefully reducing wear and osteolysis- bone destruction Hopefully reducing wear and osteolysis- bone destruction

7 Total Hip Replacement Study involves 25 patients from multiple institutions Study involves 25 patients from multiple institutions 5 years of follow up with yearly xrays,data sheets,phone calls 5 years of follow up with yearly xrays,data sheets,phone calls Paper to be submitted at 5 years Paper to be submitted at 5 years Hopefully funding to continue to 15 years Hopefully funding to continue to 15 years

8 Total Hip Replacement Bearing are modular plastic, metal, ceramic Bearing are modular plastic, metal, ceramic This study focused of plastic. This study focused of plastic. Called X3 because of the plastic preparation process Called X3 because of the plastic preparation process Now at 2 years Now at 2 years

9 Hip Replacement Study Ceramic Ceramic hip replacement Ceramic hip replacement Dr. Bierbaum and about 10 other institutions. Study now entering 12 years of follow up. Dr. Bierbaum and about 10 other institutions. Study now entering 12 years of follow up. Bone destruction seen is less than 1% Bone destruction seen is less than 1% –Expect about 22% based on controls Revision for all reasons is less than 2%- equal to the best data we have about total hip replacement today. Revision for all reasons is less than 2%- equal to the best data we have about total hip replacement today.

10 Revision Hip Replacement Reconstruction of the socket can be challenging Reconstruction of the socket can be challenging In some cases almost no bone is left in the acetabulum In some cases almost no bone is left in the acetabulum Need fixation in the cup-socket that allows for long term fixation Need fixation in the cup-socket that allows for long term fixation

11 Revision Hip Replacement

12 10 total sites in the US 10 total sites in the US NEBH closed enrollment at 6 months. NEBH closed enrollment at 6 months. Initial goal was 18 months to have 180 patients enrolled Initial goal was 18 months to have 180 patients enrolled

13 Revision Hip Replacement Now at 2 years of follow up Now at 2 years of follow up NO cups have been revised for loosening NO cups have been revised for loosening No osteolysis No osteolysis Very early follow up Very early follow up Will need to follow these people for 10-15 years Will need to follow these people for 10-15 years

14 Revision Hip Replacement Different types of stems available for hip replacement Different types of stems available for hip replacement Issues with many are intraoperative fracture Issues with many are intraoperative fracture Orientation of the stem may not be optimal Orientation of the stem may not be optimal Fixed length of the stem Fixed length of the stem

15 Revision Hip Replacement Study looks at a modular stem that can asses modularity, leg length, ease of placement, significantly decreased fracture fate Study looks at a modular stem that can asses modularity, leg length, ease of placement, significantly decreased fracture fate Over 100 patients Over 100 patients Retrospective study Retrospective study Preliminary review looks promising Preliminary review looks promising

16 Revision Hip Replacement

17 Study looks at a modular stem Study looks at a modular stem

18 Revision Hip Replacement

19 Revision Total Hip Will add significantly to the current literature about revision total hip Will add significantly to the current literature about revision total hip Helps validate a current method of treatment Helps validate a current method of treatment Significant improvement to post operative management Significant improvement to post operative management Weight bearing as tolerated, decrease dislocation rate, improve hip function Weight bearing as tolerated, decrease dislocation rate, improve hip function Decrease patient morbidity Decrease patient morbidity

20 Deep Vein Thrombosis DVT Significantly affects patient outcomes after Total hip replacement (THA) Significantly affects patient outcomes after Total hip replacement (THA) Can become a Pulmonary Embolus-PE Can become a Pulmonary Embolus-PE PE can be a cause of death of THA PE can be a cause of death of THA Mandated by Federal Programs that all patients have a specific treatment for DVT after THA and TKA Mandated by Federal Programs that all patients have a specific treatment for DVT after THA and TKA

21 Deep Vein Thrombosis DVT Study randomly and prospectively places patients into a protocol to prevent DVT Study randomly and prospectively places patients into a protocol to prevent DVT The Baptist has been aggressively treating DVT pre-op for a week and then post op for a total of treatment to be 6 weeks The Baptist has been aggressively treating DVT pre-op for a week and then post op for a total of treatment to be 6 weeks

22 Deep Vein Thombosis DVT Three arms to study Three arms to study –1. Coumadin for 1week before surgery at 1mg and then continued post op at 1mg. –2. Arixtra 2.5mg post op for one month –3.Adjusted dose coumadin post-op for one month –All arms have been proven effective with DVT,PE and death as the outcomes

23 Deep Vein Thombosis DVT Three arms to study Three arms to study –The study will hopefully identify that low dose coumadin will be as effective as the other 2 arms at preventing DVT,PE, death. –Benefits-no blood monitoring,extremely low cost, no bleeding into new joint –Less infection due to lower blood loss into joint –Significantly safer for patients.

24 Deep Vein Thombosis DVT Patients will need post op duplex ultrasound at 1 month after procedure at NEBH-non invasive study Patients will need post op duplex ultrasound at 1 month after procedure at NEBH-non invasive study Blood drawn at follow up and as needed for adjusted dose coumadin arm Blood drawn at follow up and as needed for adjusted dose coumadin arm Arixtra medication is free Arixtra medication is free Potentially one of the most significant studies in modern orthopedics. Potentially one of the most significant studies in modern orthopedics. Extremely well controlled. Significant cost to perform this study. Need the help of both surgeons and patients Extremely well controlled. Significant cost to perform this study. Need the help of both surgeons and patients

25 THANK YOU


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