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Hip arthroplasty pioneer calls for continued progress in surgery, research

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ORLANDO, Fla. — The incorporation of antibiotics in crosslinked polyethylene is among the advances that may be in store in the future for hip arthroplasty, orthopedic surgeon and pioneer in hip arthroplasty surgery and research, William H. Harris, MD, DSc, said at the Current Concepts in Joint Replacement Winter Meeting.

William H. Harris

In his lecture, Harris, whose memoir about solving the mystery of osteolysis in total hip replacement, Vanishing Bone: Conquering a Stealth Disease Caused by Total Hip Replacements, was published this month, articulated how far his specialty – THR – has come.

“The extraordinary majesty of THR, as it burst on to the scene 60 years ago, both dazzled and blinded” surgeons and patients alike, he noted in the abstract of his speech.

Harris discussed the six major disadvantages to THR at its introduction compared to today, including prosthetic joint infection (PJI), failure of fixation, dislocation, periprosthetic osteolysis and prolonged hospitalization.

Fatal pulmonary emboli had an original rate of 2%.

Harris said, “What else do you do for benign disease that carries with it death for one out of 50 patients that you have recommended have a surgery?” Today, “pulmonary emboli, instead of 2%, it is three out of 1,000,” he said.

Harris continued, fixation failure is practically nonexistent today compared to the 20% to 30% rate of occurrence at the outset of THR. Dislocation rates, which once were 5%, are down to 0.5%. For PJI, the incidence in the early days was 10%.

“Think about the trouble you have with one septic case,” Harris said.

“For a brief peek into the future, big data from big registries now and in the future, will become critical to our progress. Major advances in reducing PJI await in the immediate future, including vastly improved diagnoses and the antibiotics in the crosslinked polyethylene,” he said. – by Susan M. Rapp

Reference:

Harris WH. Paper #76. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 13-16, 2017; Orlando, Florida.

Disclosure: Harris reports he receives royalties from Zimmer Biomet for crosslinked polyethylene.