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Panelists debate hip arthroplasty technology

Issue: February 2012

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WAILEA, Hawaii – Whether total hip arthroplasty is the only treatment needed for osteoarthritis was debated at theOrthopedics Today Hawaii 2012 meeting, here.

“Total hip replacement [THR] has evolved incrementally over 40 years and provides reliable pain relief and function, a low complication rate and 95% survivorship at 15 years. There is little room for improvement, so why mess with success,” Michael D. Ries, MD, said during the Hip Arthroplasty: Technology in Debate session.

He told attendees that total hip arthroplasty (THA) — the implants and the surgical technique — has evolved during the past 40 years. Multiple randomized prospective studies have shown favorable wear comparable to in vitro prediction, Ries said.

Michael D. Ries

Large numbers of highly crosslinked ultra-high molecular weight polyethylene (UHMWPE) THAs have been used in the past 10 years. He noted that UHMWPE is the most common bearing surface in THA and shows reduced wear in clinical studies, has a small risk of fracture which has been addressed in the implant design, does not produce an audible “squeak” like ceramics, and does not cause adverse metal hypersensitivity reactions. In addition, Swedish Hip Registry data have shown 90% survivorship at 15 years and 80% survivorship at 30 years.

“It is the most success orthopedic intervention we do now, and I see little reason to make a change,” Ries said.

Thomas P. Schmalzried

Thomas P. Schmalzried, MD, countered that hip resurfacing is highly functional and durable in appropriate patients, especially for those patients at increased risk for THR failure. Also, similar to unicompartmental knees, patient selection and surgical technique are the keys to success, and the materials will evolve, he said.

“Do not throw the baby out with the bathwater,” he said.

References:

• Ries MD. A total hip is all you need for osteoarthritis: Pro. Schmalzried P. A total hip is all you need: In opposition. Both presented at Orthopedics Today Hawaii 2012, Jan. 15-18. Wailea, Hawaii.
• Disclosures: Ries is a consultant for Smith & Nephew and Stryker; Schmalzried receives royalties from DePuy and research funds from DePuy, Wright Medical and Corin.

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