Arthroplasty

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

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

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

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

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

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

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

Hip Replacement Study Ceramic Ceramic hip replacement Dr. Bierbaum and about 10 other institutions. Study now entering 12 years of follow up. 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 Hip Replacement Reconstruction of the socket can be challenging In some cases almost no bone is left in the acetabulum Need fixation in the cup-socket that allows for long term fixation

Revision Hip Replacement

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

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

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

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

Revision Hip Replacement

Revision Hip Replacement Study looks at a modular stem

Revision Hip Replacement

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

Deep Vein Thrombosis DVT Significantly affects patient outcomes after Total hip replacement (THA) Can become a Pulmonary Embolus-PE 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

Deep Vein Thrombosis 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

Deep Vein Thombosis DVT 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

Deep Vein Thombosis DVT 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.

Deep Vein Thombosis DVT 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 Arixtra medication is free 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

THANK YOU