Artificial Hip

Joint/Hip
Replacement
MUHAMMAD AKMAL QAISAR
08-PWMCT-0056
MECHANICAL ENGG DESIGN
 Hip Replacement?
• Surgical repair of an aged or injured natural hip
joint by adding an artificial joint, or implant

• Reasons include fracture, arthritic hip, wearing

down of the joint over time, obesity, Avascular
necrosis (loss of blood supply).

• Results in severe pain

• Goal is to reduce pain and increase mobility,

improve the function of the hip joint
 Indications
• Treatments like physical therapy and pain
medication fail to fix a hip problem

• Pain not responding to analgesics or anti-

inflammatories.

• Limitations of daily activities including activities,

sport or work.
• Pain keeping you awake at night.

• Stiffness in the hip making mobility difficult.

 Artificial Hip Joint
• A stem that is inserted into the femur (thighbone)
• A ball that attaches to the top of the femur
• A cup that attaches to the pelvis
• A liner, which fits inside the socket
 Hip Replacement
Procedures
• Total Hip Replacement:
o Entire hip structure is replaced
o Stem is inserted into the patient’s femur for stability
o Ball replaces the head
o The socket is also replaced with an artificial cup

• Partial Hip Replacement:

• Socket or cup is left intact and the head of the femur is
replaced with a ball
• Some partial hip replacements only address the acetabulum
(Socket or cup)
• Used to correct a hip fracture occurring at the neck of the
femur.
 Hip Replacement
Procedures
• Hip Resurfacing:
o Hip resurfacing is done to avoid bone loss
o Delay a total hip replacement in younger recipients
o Replaces the socket with an artificial cup
o Resurfaces the head of the femur instead of removing it
o Hip resurfacing is often used to help with arthritis.
• http://www.drugwatch.com/hip-replacement/
 Implant Materials
• Large number of hip implant devices present in the
market
• Each manufacturer has different models

• Style falls into one of four basic material categories:

o Metal on plastic (polyethylene or UHMWPE)
o Metal on metal (MoM)
o Ceramic on plastic (UHMWPE)
o Ceramic on ceramic (CoC)
 Implant Materials
• Metal-Ball-Plastic Cup:
• Longest tried and tested bearing.
• The stem is constructed of metal (usually a cobalt
chrome alloy)
• The cup is made of a plastic called polyethylene.
• Modifications in design have been made
• Ultra High Molecular Weight PolyEthylene (UHMWPE)
• Durable and good performance
• Least expensive bearing
 Implant Materials
• All implants shed debris as they wear, which results
in infection
• Leads to osteolysis

• Technological advances have reduced the risk of

wear in Metal-on-Polyethylene implants.
• They wear at a rate of about 0.1 millimeters each
year
 Implant Materials
• Metal-Ball-Metal-Cup (MoM):
• Used even longer than metal-on-plastic implants
• MoM bearings (cobalt chromium alloy, titanium
alloy or sometimes stainless steel)

• Greatly reduced wear, with less inflammation and

less bone loss

• Available in many sizes (28 mm to 60 mm)

• MoM components allow the largest heads
throughout the entire range of implant sizes
 Implant Materials

• Large ball heads increases range of motion, greater

stability, significantly reduce the risk of hip dislocation
• MoM implants have a potential wear rate of about
0.01 millimeters each year

• MoM hip implants shed metal particles, causing

serious health issues like metallosis

• Raised concerns about long-term bio-compatibility

 Implant Materials
• Ceramic-on-Ceramic (CoC):
• Ceramic is the 21st century answer to hip
replacement
• All-ceramic hips are known for their durability and
reliability

• Metal ball and polyethylene liner are replaced by a

high-strength ceramic bearing

• Has the reputation for ultra low wear performance

• Clinical studies, monitored by the FDA begun in 1998,
have demonstrated excellent performance
 Implant Materials
• Two issues related with ceramics hips are shattering
and squeaking noise

• Wear rate is almost immeasurable amounts (1000

times less than Metal-on-polyethylene, about 0.0001
millimeters each year)

• Usually no inflammation or bone loss, nor systemic

distribution of wear products in the body

• New ceramics offer improved strength and more

versatile sizing options.
 Implant Materials
• Ceramic-Ball-Plastic-Cup:
• Ceramic heads are harder than metal and are the
most scratch-resistant implant material.
• Greatly reduce the wear rate, about 0.05 millimeters
each year

• Which is less 50% than Metal-on-Polyethylene

• More expensive

• Reduction of fracture rates (0.01%)

• Newer designs, highly cross linked polyethylene liners
have wear rates as little as 0.01 millimeters each
year.
 The Decision
• There is no consensus in the orthopedic community
regarding the single “best” material.

• The choice generally comes down to your surgeon’s

preference.
• Each surgeon has innumerable reasons
• Personal experience as well as tool and implantation
method preferences

• Only a qualified orthopedic surgeon can determine

which implant system is best for your unique situation
 Revision Surgery
• Hip implants are not designed to last more than 15-
20 years
• Hip replacements at a younger age, wearing away
of the joint surface becomes a problem

• More difficult than first-time, more bone must be

removed and new implant parts inserted

• Doctors consider revision surgery for two reasons

o Medication and lifestyle changes do not relieve pain and
disability,
o X rays of the hip show damage to the bone around the artificial
hip that must be corrected before it is too late