1. Arthroplasty

2. 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

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

4. Total Hip Replacement 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
Earlier intervention
More active population
Need better equipment components

6. 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

7. 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

8. 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

9. 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.

10. 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

11. Revision Hip Replacement

12. 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

13. 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 years

14. 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

15. 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

16. Revision Hip Replacement

17. Revision Hip Replacement
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
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

20. 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

21. 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

22. 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

23. 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.

24. 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

25. THANK YOU