What new technologies and developments are on the horizon?

The most promising new technologies being developed are bearing surfaces that do not wear out quickly, even with high stress activities. Three main technologies are now either being used or are in the final stages of testing:

Highly crosslinked polyethylene has been available for a few years and is approved by the FDA. Although the wear studies from the laboratory look very promising, there have been a few reports of problems with certain brands of crosslinked polyethylene. Newer types of highly crosslinked polyethylene are still being introduced, and hopefully, these new formulations will provide all of the wear advantages of highly crosslinked polyethylene while minimizing the potential risks (such as cracking and breakage). The new material holds promise of lasting much longer than standard polyethylene, may allow the use of larger prosthetic heads, and should decrease the risk of dislocation. Nevertheless, some caution is still exercised when deciding to use crosslinked polyethylene due to the fact that long-term follow-ups are not yet available. Read more

Metal-on-metal total hips utilize a ball and socket both made of a cobalt-chromium metal alloy. The patient’s own joint fluid lubricates the surfaces of the joint to give the hip smooth motion. Metal-on-metal hips have been used in various forms for several years and are approved by the FDA. The main controversy with metal-metal hips is the high concentration of metal ions found in the blood, tissues, and urine of patients having metal-metal hips. Unfortunately, we do not know the long-term consequences of high tissue concentrations of cobalt or chromium, but many believe that they could potentially lead to complications down the road Nevertheless, those receiving a metal-metal hip (even young, heavy, or active patients) can expect to see minimal wear of the bearing surface over many years. Read more

Ceramic-on-ceramic total hips utilize a ball and socket both made of alumina, a very hard, smooth material. Ceramic-ceramic hips differ from metal-metal hips in that ceramic is extremely biocompatible and debris does not spread into the tissues, blood, or urine of the patient. The risk of a systemic problem, such as cancer, is extremely low. Ceramic-ceramic hips have been used in various forms for several years and were approved for general use by the FDA in February of 2003. The main concern with ceramic-ceramic has been breakage of the brittle material, particularly if a patient falls, landing on the hip. This risk of breakage has significantly decreased over the years due to improvements in manufacturing techniques. Recent studies suggest that the risk of a ceramic fracture is around 1 in 10,000 or so. However, it is critical that the components be positioned correctly because any malpositioning of the components can increase the risk of fracture. Newer ceramics (such as Ceramtec’s Biolox Delta) provide the wear durability of alumina but are much tougher, reducing the risk of fracture. Read more

Most recently, squeaking has become a concern with ceramic-on-ceramic total hip replacements. This problem really did not surface until the FDA approved 2 ceramic total hips made by Stryker Orthopedics and Wright Medical in 2003. Many causes for the squeaking have been proposed. However, in a recent study by Dr. Swanson, it appears that problematic squeaking is a problem with only 1 unique design of ceramic hips. Read more

The second area of development in total hip replacement is the surgical technique. Minimally invasive techniques are used in many other areas of surgery including arthroscopy, laparoscopy, some types of spine surgery, and even some open-heart surgeries. Minimally invasive techniques have now been developed for total hip replacement surgery as well.

The advantages of minimally invasive surgery are:

  • Shorter operative time and anesthesia
  • Less operative blood loss with much reduced need for transfusions
  • Less post-operative pain and need for pain medications
  • Shorter hospital stay
  • Quicker recovery
  • Nearly every patient undergoing total hip replacement with Dr. Swanson is a candidate for the minimally invasive technique as the incision length used is based on patient size and weight and may vary from 3 inches in the very thin, petite patient to 5 inches in the large, heavy patient. Most patients require a 3 1/2 to 4 inch incision.

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