Dr. Pete Rose

Joint Replacement

Joint Replacement

Total = Ball + Socket

Ball/Socket Replacement

CHARNLEY THA: 30 YEAR MINIMUM F/U

Results

CP1046688-1Years since THAYears since THA

Survival Survival free (%)free (%)Survival Survival free (%)free (%)

0

20

40

60

80

100

0 3 6 9 12 15 18 21 24 27 30

30 Year Survivorship Free of Any Component

Removal or Revision For Any Reason: 81.4%

Specific Issues in Hip Surgery for Younger Patients

• “Minimally Invasive Surgery”

• Resurfacing Operations

• Bearing Surfaces

M.I.S. Surgery

• Marketing rather than a scientific term

• Effort to perform joint surgery through smaller incisions– Goal of speeding patient

recovery

My Advice – Proceed with Caution

• You’re in this for the 20 year rather than the 20 day outcome– Very subtle differences in artificial hip and knee

alignment have a big impact in how long they last

– Scientific studies of MIS surgery have shown less predictable alignment than standard surgery

– Equal or greater damage to underlying muscles

– Computer assistance may erase this difference

Resurfacing Operations

vs

Resurfacing

• Potential Benefits– More normal loading of the

femur bone– Less bone resected– Easier revision surgery– Less dislocation

• Reasonable option if no deformity present

Bearing Surfaces

• Total hips are mechanical ball in socket joints– Wear debris leads to losening and failure

Bearing SurfacesBearing SurfacesHighly Cross-Highly Cross-

Linked PELinked PE

• VersatileVersatile• Small headsSmall heads

• WearWear• DislocationDislocation

Metal on metalMetal on metal

• Less wearLess wear• Head diameterHead diameter• IonsIons

• WomenWomen• YoungYoung

• AllergyAllergy

Ceramic on ceramicCeramic on ceramic

• Less wearLess wear• Limited optionsLimited options

• InsertsInserts• NeckNeck

• FractureFracture• SqueakingSqueaking

Joint Replacements

• Important points to remember- Joint replacements (arthroplasty) treat arthritis

well- Not a predictable treatment for weakness or

motion