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
• 2nd Surgery – Not as effective as 1st

-Added cost
-Additional down-time and recovery
-Loss of faith in procedure
 Materials
• Metal-on-Metal
• Metal-on-Poly
• Ceramic-on-Ceramic
• Ceramic-on-Poly
 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
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