Be-WEAR!!! Wear leads to failure -Shedding of materials due to friction -Causes: -Irritation -Pain -Decreased Mobility -Joint Failure “Aseptic loosening due to wear debris-induced osteolysis has been identified as the leading cause of late failure in total hip arthroplasty”
Revision 2 nd Surgery – Not as effective as 1 st -Added cost -Additional down-time and recovery -Loss of faith in procedure
Metal on Metal - Pros Strong! Very low wear properties -10X Longevity Greater diameter femoral head. Dancers, Athletes, who value an extended mobility and stability. Younger Patients.
Metal on Metal - Cons Lose ability to affix with screws. Shedding of metal ions – Cobalt – Chromium Pregnant women or renal impaired, loss of hip bone.
Metal on Poly - Pros Most common 10 yrs - 90% functioning well 20 years – 80% Liner replacement Highly cross-linked poly vs. non. -Decreased wear with cross-linked, even with larger heads. -Aids in decreasing chances of revision Older patients (majority), less bone, trauma pts.
Metal on Poly - Cons Large amount of particles shed -> osteolysis and aseptic loosening. Highly cross-linked poly liners: – Cost of being more susceptible to fatigue fracture. Younger patients
Ceramic on Ceramic - Pros Strongest! Most inflexible surface. 100x less wear than Metal on Poly Aluminum Oxide Ceramic Same as Metal on Metal. Younger Patients.
Ceramic on Ceramic - Cons Can become a surgeon’s worst nightmare! -Fracture -Impingement -Ease of revision -Squeaking! Older patients. Those with risky behavior.
Ceramic on Poly - Pros Many of same properties of Metal on Poly Decreased wear on Poly liner Less ceramic on the joint, less to fracture. Younger patients. Especially younger Women
Ceramic on Poly - Cons Poly Wear --> Osteolysis Ceramic fracture. – Less ceramic to fracture, but it still can! Older patients. Those with risky behavior.
Resurfacing New Alternative – Acetabulum and Femoral Head. – Preserves the femoral neck and avoids exposing the femoral canal. – Unsuccessful early with liner use, now all metal – In use for about 10 years. – Usually less than 55. – If not had deformity due to arthritis.
Resurfacing - Pros Expected high longevity out of them, even in younger patients ~ 30 yrs. Preserve femoral neck and canal. Critical for success of a revision surgery. Larger size of the implanted head reduces the risk of dislocation. More likely than total hip replacement patients to recover a natural gait. Younger patients, good hip bone strength.
Resurfacing - Cons Metal on metal articulation: – Ion shedding. – Inability to affix the acetabular head with screws. Possibility that the femoral neck can break. Lack of a long-term track record: ~10 years Longer surgical time and requires somewhat more skill. –Still a learning curve. Older, Pregnant, Poor Bone Strength.
Outcome For the majority of people who have hip replacement surgery, the procedure results in: a decrease in pain increased mobility improvements in activities of daily living improved quality of life. 92% success rate
Post-Op Instructions 3-4 Day recovery in hospital For atleast 6 weeks, NO: Lifting Twist or squat Extreme movements Cross your legs Lift your knee higher than your hip Sporting activities (golf). Drive Bath – Showers only