Hip Replacement
Hip replacements have helped millions of patients in the U.S. and around the world in gaining mobility and relieving severe pain. Hip replacement, or 'arthroplasty,' is a surgical procedure done to remove dysfunctional or diseased parts of hip joints, replacing them with new, artificial components, or 'prosthetics.' According to the Centers for Disease Control and Prevention (CD), more than 300,000 hip replacements are performed yearly in the U.S., often when less-invasive, more conservative treatments fail. Hip arthroplasty can improve a patient's quality of life when these other methods are deemed ineffective. Hip replacement surgery is most often recommended when pain and immobility affect a patient's ability to perform normal activities of daily living. Medical conditions such as osteoarthritis and trauma are most often associated with the need for hip replacement, as the inflammation that can occur causes stiffness, swelling, and pain.
History of hip replacements
Joint replacement, or 'arthroplasty,' dates back as far as the 19th century. Dr. John Rhea Bartonii was the performed the first recorded surgery involving a fused hip joint in 1826. Unfortunately, though the operation was deemed successful for a few months afterward, several years following the patient lost all motion in the joint involved. Several decades following this surgery, Czech surgeon Vitezlav Chlumsky further experimented with various types of materials as prosthetics, including rubber, zinc, decalcified bones and wax. In the late 1800s, a German professor, Dr. T. Gluck, used an ivory ball and socket affixed with nickel-plated screws for surgical implants before Dr. Austin Moore was credited with performing the first hip replacement using metal in 1942. The world's first total hip replacement was performed by Sir John Charnley, whose patients had an 85 percent chance of living for 20 years or more following surgery. Today, computer-assisted orthopedic surgery (CAOS) is enjoying rapid growth, as procedures are becoming less invasive and more successful.
Types of implants
Varying types of hip implants include ceramic-on-ceramic, metal-on-metal, metal and polyethylene, and metal and plastic.
Ceramic-on-ceramic: These implants are designed to be among the most wear resistant of all hip prosthetics. Because ceramic is more scratch resistant, these can be smoother than other implants, especially metal-on-metal. There are concerns, however, that ceramic implants can break inside the human body.
Metal-on-metal: These implants do not wear as quickly as some others, such as metal and plastic. Constructed from cobalt-chromium alloy, metal implants recently have been discovered to release ions into the body and can potentially be harmful, with lawsuits ensuing. Metal implants, however, can erode, and this is a concern for these prosthetics.
Metal and highly-crossed polyethylene: This type of implant is becoming one of the more commonly used currently because of the new types of 'highly-crossed' plastic designed to be wear resistant. Their track record is not as traceable, however, since they have not been on the market as long as some other types of implants.
Metal and plastic: These are perhaps the most commonly used implants. The ball and socket of the hip joint are replaced with a metal prosthesis, and then a plastic spacer is placed in between. Metal implants can be a concern, as they can erode.
Pharmaceutical regulations relating to compliance
The Food and Drug Administration, in response to recent concerns and lawsuits regarding hip replacements (especially metal implants) has strengthened regulations as well as communications with the orthopedic surgery community in the U.S. Because of what it calls the 'unique risks' of using metal implants, including rubbing against each other during walking or running, soft tissue damage, pain, implant loosening, device failure, and need for revision surgery, the FDA is dedicating itself to additional communications with U.S. orthopedic surgeons in order to establish greater safety and effectiveness of these implants. Some of these recommendations include conducting clinical evaluations every six months for patients suffering side effects, monitoring metal ion levels, and considering soft tissue imaging such as MRI and CT for symptomatic patients. In addition, Congress recently granted the FDA power to deal with such medical devices, and the FDA responded by requiring all manufacturers of metal-on-metal devices to go through a stringent pre-market approval process. This FDA proposal was established after an estimated 500,000 patients nationwide received hip implants that can fail early.
History of hip replacements
Joint replacement, or 'arthroplasty,' dates back as far as the 19th century. Dr. John Rhea Bartonii was the performed the first recorded surgery involving a fused hip joint in 1826. Unfortunately, though the operation was deemed successful for a few months afterward, several years following the patient lost all motion in the joint involved. Several decades following this surgery, Czech surgeon Vitezlav Chlumsky further experimented with various types of materials as prosthetics, including rubber, zinc, decalcified bones and wax. In the late 1800s, a German professor, Dr. T. Gluck, used an ivory ball and socket affixed with nickel-plated screws for surgical implants before Dr. Austin Moore was credited with performing the first hip replacement using metal in 1942. The world's first total hip replacement was performed by Sir John Charnley, whose patients had an 85 percent chance of living for 20 years or more following surgery. Today, computer-assisted orthopedic surgery (CAOS) is enjoying rapid growth, as procedures are becoming less invasive and more successful.
Types of implants
Varying types of hip implants include ceramic-on-ceramic, metal-on-metal, metal and polyethylene, and metal and plastic.
Ceramic-on-ceramic: These implants are designed to be among the most wear resistant of all hip prosthetics. Because ceramic is more scratch resistant, these can be smoother than other implants, especially metal-on-metal. There are concerns, however, that ceramic implants can break inside the human body.
Metal-on-metal: These implants do not wear as quickly as some others, such as metal and plastic. Constructed from cobalt-chromium alloy, metal implants recently have been discovered to release ions into the body and can potentially be harmful, with lawsuits ensuing. Metal implants, however, can erode, and this is a concern for these prosthetics.
Metal and highly-crossed polyethylene: This type of implant is becoming one of the more commonly used currently because of the new types of 'highly-crossed' plastic designed to be wear resistant. Their track record is not as traceable, however, since they have not been on the market as long as some other types of implants.
Metal and plastic: These are perhaps the most commonly used implants. The ball and socket of the hip joint are replaced with a metal prosthesis, and then a plastic spacer is placed in between. Metal implants can be a concern, as they can erode.
Pharmaceutical regulations relating to compliance
The Food and Drug Administration, in response to recent concerns and lawsuits regarding hip replacements (especially metal implants) has strengthened regulations as well as communications with the orthopedic surgery community in the U.S. Because of what it calls the 'unique risks' of using metal implants, including rubbing against each other during walking or running, soft tissue damage, pain, implant loosening, device failure, and need for revision surgery, the FDA is dedicating itself to additional communications with U.S. orthopedic surgeons in order to establish greater safety and effectiveness of these implants. Some of these recommendations include conducting clinical evaluations every six months for patients suffering side effects, monitoring metal ion levels, and considering soft tissue imaging such as MRI and CT for symptomatic patients. In addition, Congress recently granted the FDA power to deal with such medical devices, and the FDA responded by requiring all manufacturers of metal-on-metal devices to go through a stringent pre-market approval process. This FDA proposal was established after an estimated 500,000 patients nationwide received hip implants that can fail early.