In the December 15, 2010, issue of the Journal of Bone and Joint Surgery, Dr. Huo, et al, reviewed recent developments in hip replacement. They reviewed data from 2009 and 2010. The topic of resurfacing was discussed and the conclusion made that objective clinical data shows that the results of hip resurfacing are no different than those of total hip arthroplasty with regard to pain, function, and other parameters.
Use of various bearing surfaces was discussed. The concerns regarding metal-on-metal hip replacements with regard to metal wear and potential adverse tissue reaction was reviewed. The importance of appropriate implant position to avoid increased wear was stressed. Similar concerns about ceramic-on-ceramic bearings with regard to fracture and squeaking were noted and have been previously reviewed in my blogs.
The concern about access to surgeons for joint replacement in light of the increasing number of patients requiring this procedure was also reviewed. Resource utilization was also discussed, and the fact that an increasing number of obese patients are requiring joint replacement. From a variety of data, it was found that obese individuals require seven to nine percent greater resource utilization to care for after their procedure.
Other factors associated with outcomes, including patient care pathways, dedicated joint centers, and other factors, were reviewed.
Hip replacement continues to be a very reliable procedure with regard to pain relief and improvement in function. The majority of hip replacements performed in the United States currently utilize cementless fixation of the cup and stem. The most common bearing surface is a highly cross-linked polyethylene with a cobalt chrome head, and multimodal pain management and care pathways have sped the recovery as have alternative surgical techniques such as the anterior approach to the hip.
Stay tuned for more details in the months ahead.
—William P. Barrett, MD
