1. Hip Arthroplasty Chris Oser

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

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

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

5. Which hip needs a replacement?

6. Shortening

7. Prosthesis Femoral Stem Femoral Neck Femoral Head (Liner) Acetabular Cup

11. 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”

12. Revision 2 nd Surgery – Not as effective as 1 st -Added cost -Additional down-time and recovery -Loss of faith in procedure

13. Materials Metal-on-Metal Metal-on-Poly Ceramic-on-Ceramic Ceramic-on-Poly

14. 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.

15. 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.

16. 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.

17. 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

18. 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.

19. Ceramic on Ceramic - Cons Can become a surgeon’s worst nightmare! -Fracture -Impingement -Ease of revision -Squeaking!  Older patients. Those with risky behavior.

20. 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

21. Ceramic on Poly - Cons Poly Wear --> Osteolysis Ceramic fracture. – Less ceramic to fracture, but it still can!  Older patients. Those with risky behavior.

22. Resurfacing The New Kid on the Block

23. 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.

24. THR Resurfacing

25. 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.

26. 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.

27. 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

28. THE (rear) END

29. 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

30. Post-Surgical Activities