Hip Arthroplasty Chris Oser Presentation Why hip replacement

Hip Arthroplasty Chris Oser

Presentation • Why hip replacement? • How? –Surgery! • Different materials • Pros and Cons • Resurfacing • Patient post-op

Reasons for Hip Replacement • • • #1: Osteoarthritis Rheumatoid arthritis Trauma - Injury Osteonecrosis Bone tumors that break down the hip joint.

Who needs a THR • Generally acknowledged indications: – Joint pain – Functional limitation – Radiographic evidence of joint damage

Which hip needs a replacement?

Shortening

Prosthesis • • • Femoral Stem Femoral Neck Femoral Head (Liner) Acetabular Cup

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

Materials • • Metal-on-Metal-on-Poly Ceramic-on-Ceramic-on-Poly

Metal on Metal - Pros • • Strong! Very low wear properties -10 X 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. • 100 x 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 The New Kid on the Block

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.

THR Resurfacing

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

THE (rear)END

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

Post-Surgical Activities