Past (in order to come up with solutions, we need to first understand

the history)
THA (total hip arthroplasty) one of the most successful
orthopaedic inventions
In1925,theAmericansurgeonMariusSmithPetersencreatedthefirstmold
arthroplastyoutofGLASS
Despiteglassbeingabiocompatiblematerial,itfailedtowithstandthegreat
forcesgoingthroughthehipjointandshattered.
MariusSmithPetersen,alongwithPhilipWiles,laterwentontotrialthecurrent
materialofchoicestainlesssteeltocreatethefirsttotalhipreplacement
thatwasfittedtobonewithboltsandscrews
Hislowfrictionarthroplastydesignedintheearly1960sisidentical,inprinciple,
totheprosthesesusedtoday.Itconsistedofthreeparts
1. ametalfemoralstem
2. apolyethyleneacetabularcomponent
3. acrylicbonecement
Present

MetalonPolyethylene(MonPE)
o Mostwidelyusedandmostfollowedup
o CostEffective
o Predictablelifespan
o ThemainconcernforMonPEprosthesisisPEdebriswhichcreates
periprostheticosteolysisbythereleaseofcytokinesandproteolytic
enzymesultimatelyleadingtoimplantfailureasepticloosing

Withoutinfection,nobondformedbetweenprostheticandbone
o REGENEREX
Metal on Metal (M on M)
o LongerlifespanthanMonPE
o Largerfemoralheadlower#ofdislocations
o Metallosis:cobaltandchromiumionbloodlevelstendingtobe35times
higherthanthosepatientswithMonPEprostheses
Potentialcarcinogenicriskfromthesemetalsbutnoevidence
supportsthatclaimYET
o OPTIMOM
Ceramic on Ceramic
o hydrophilicprosthesescreateimprovedlubrication,thereforelowfriction
andlowdebrisparticles
o Expensive
o Requires excellent surgeon insertion technique, otherwise
it increases risk of dislocation or devastating wear and tear
o Increase risk of fractures
o Can produce noise
o STRYKER
Hybrid prosthesis
o Fromacementedfemoralstemandacetabularcupfixedinplacewith
cementlesstechniques.
o Target group: young, active patients since it prevents
pelvic bone loss
o Poor clinical date for follow up care
Cementless Techniques
o Cementlessprosthesishaveaspecializedcoating,hydroxyapatite,that
allowsingrowthofboneandthusfixationoftheprosthesis
o Cementlesstechniquesallowforeasierplanningofhiprevisionsurgery,
particularlyintheyoungerpatients,withgreaterpreservationofbone
tissue

Intraoperative complications
Nerve damage (0-3%)
Vascular injury (0.2-0.3%)
Cement related hypotension (<5%)
Post-operative complications
Thromboembolic disease= DVT (ranges between 8% 70%)
Infection (0.4- 1.5%)
Dislocation (0-2%)
o A posterolateral approach utilizing a posterior capsular
repair can reduce the dislocation rate to less than 1
percent

Osteolysis (long-term issue)

o Osteolysis is a process in which bone is resorbed as a
biologic response to particulate debris.
Aseptic loosening (loss of fixation)
Leg length discrepancy (BIGGEST LAWSUITS AGAINST
SURGEONS)

BEST 3D Printing material

Polyamides
Polyethylene on Ceramic

GOALS
o Cost effective
o Predictable/long lifespan
o Easy follow up care
o Fewer dislocations
o No foreign debris (like PE)
o Comfortable (no noise/low friction/proper
orientation)
Clinical and Medical Risk Assessment
1. Familiarize yourself with the medical conditions that would lead to
the need or desire for the implant described
2. Familiarize yourself with the current standard of care for the
condition
3. Evaluate the medical benefits as compared to the current standard
of care for the implant. How can these benefits be measured?
4. Evaluate the potential risks of the new method as compared to the
current standard of care. How can these risks be mitigated?
5. Is the risk-benefit analysis sufficiently in favor of the new method or
device to convince a practicing doctor to learn and adopt the new
treatment?

***Thursday September 3rd 4-7 pm