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Focal osteolysis in total hip replacement: ..

The biggest disadvantage of hip resurfacings is that the early failure rate is much higher than that after total hip replacement. Although in the innovators’ hands, failures are less likely, the risk of a femoral neck fracture (the ball breaking off of the femur bone) in the first year is significant, as high as 3% or more. Fractures are often related to surgeon error, most commonly notching of the femoral neck or placing the artificial ball in a position which is too low (called “varus malpositioning.”). An additional factor may be disruption of the blood flow to the remaining femoral head, a condition known as avascular necrosis. A review of the published literature shows that the short term survival rates with resurfacing replacements vary from 75-100% while most well-designed total hip replacements have short and mid-term survival rates exceeding 95%, even in young, active patients.

Focal osteolysis in total hip replacement: CT findings

The principal disadvantage of metal on plastic is that the metal head wears away the plastic liner over time. Small particles of plastic accumulate within the joint, and the white blood cells in the body try to swallow and dissolve these particles. However, when the white blood cells are unsuccessful at digesting these artificial particles, the white blood cells may burst, releasing the chemicals (enzymes) used to dissolve foreign bodies and bacteria into the bone around the prosthesis. Over time, this causes large cysts to form and areas of loosening occur around the prosthesis, called osteolysis, that frequently leads to a revision surgery at some point as the hip replacement becomes loose.

In conclusion, focal osteolysis of hip prosthesis on CT.

Studying 19 retrieved prostheses, abrasion of the rim was deeper in hips with osteolysis than those without it.

Probably the most disconcerting yet still uncertain potential complication of any metal-on-metal replacement is metal ion toxicity. Conventional hip replacements can utilize a variety of bearing surface combinations including metal-metal, ceramic-ceramic, metal-polyethylene, and ceramic-polyethylene. Polyethylene may be either standard or highly crosslinked (a more durable form of polyethylene). Resurfacing prostheses today are only able to utilize a metal femoral cap paired with a metal acetabular socket, although eventually other bearing surfaces will likely become available.

The classification system of the American Academy of Orthopaedic Surgeons (AAOS) of acetabular and femoral deficiencies in total hip replacement [-].

Osteolysis and particle disease in hip replacement A review.

If leg lengthening occurs following the total hip replacement the patient may require a heel raise for the other leg.

The most common situations that lead to the need for a revision hip replacement are instability / dislocation, mechanical loosening and infection. According to one national review study, instability issues account for 22% of all revision hip replacements, aseptic loosening for 20% and infection the cause of 15% of yearly revision hip replacement surgeries [3]. Periprosthetic fracture, component failure and osteolysis-related wear are the causes for the remaining revision hip replacements done each year. Of great concern looking forward is that infection by the year 2030 will account for 48% of all revision hip replacements that will be done [4]. This has grave economic implications as infection is one of the most expensive complicating events related to joint replacement surgery.

Bone preservation is often noted as one of the main advantages of hip resurfacing. Because the femoral head is resurfaced rather than removed, some of the ball is left intact, and the femoral canal is left untouched for the most part, thus preserving femoral bone. While conserving bone on the femoral side, some resurfacing hip sockets require that a bit more bone be removed from the acetabulum than in a conventional total hip replacement to allow the resurfaced femoral head to fit within the socket. Recently, manufacturing companies have begun addressing this issue by producing thinner acetabular shells for their resurfacing prostheses. Most important, proponents of hip resurfacing stress that because the femoral head has not been removed and the femoral canal has been left largely untouched, when it comes time to revise the prosthesis, it can be done very easily because of minimal bone loss.

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In total hip replacement, the Express yourself

Each of these symptoms should be evaluated by the surgeon to help determine if the hip replacement has something wrong with it or if it is functioning as expected. A variety of tests are available to the surgeon and often many of them are necessary to sort out the issues that have left the primary hip replacement dysfunctional. Many of the common causes for failed total hip which would lead to the need for a revision of part or all of the prosthetic implant are discussed below.

Failed Total Hip Replacement - John Clohisy MD.

Despite the success achieved with most primary total hip procedures, factors related to implant longevity and a younger, more active patient population have, for a variety of reasons, led to a steady increase in the number of failed total hip replacements seen every year. In these cases a revision hip replacement will be necessary to replace or revise the failed first replacement. The increasing demands placed on these implants by patients in terms of expected longevity and durability; and the insistence of patients to maintain their active lifestyles, even with a hip replacement, has presented a considerable reconstructive challenge to the surgeon. Currently, it is estimated that 18% of all hip replacement surgeries done each year are revision hip replacement surgical procedures [1].

Total Hip Replacement - OrthoInfo - AAOS

The goals of total hip replacement are to relieve pain and correct the functional deficit. In doing so, the surgeon sometimes needs to correct leg length discrepancies which may be present prior to the surgery. However, he also needs to avoid creating a leg length discrepancy as a result of the surgery.

Total hip replacement is an effective procedure that ..

“Stress shielding” refers to bone loss (osteoporosis) caused by lack of use of certain parts of the body’s skeleton. The resurfaced hip replacement more closely approximates a natural hip because the upper femur is largely left intact and therefore sees stresses that more closely resemble those in a normal hip than does the femur after a total hip replacement. Many advocates of resurfacing say that bone density at the head/neck junction (just at the base of the hip ball) is maintained and, in many cases, increased with use of the hip, although not all studies agree. However, although the real answer may not be entirely clear, it stands to reason that the more naturally the hip is loaded, the more likely stress shielding will be minimized.

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