Part Two: Hip Resurfacing vs Conventional Total Hip Replacement

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1 Part Two: Hip Resurfacing vs Conventional Total Hip Replacement Mr. Mark Bloomfield Consultant Orthopaedic Surgeon Harley St Clinic, London Princess Margaret Hospital, Windsor

2 Save the femoral head! Conventional Total Hip Replacement (THR) is effectively an amputation of the head and neck of the femur.

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5 So What s s the Problem? Poor long term results with THR in the younger, more active patient. Why are they failing? Many causes but most common LONG TERM cause is aseptic loosening with recurrence of pain. Mr M Bloomfield

6 Joint revision is most commonly required because... MYTH: the components wear out with time FACT: the components loosen with time

7 Aseptic Loosening: Mysterious process Poorly understood process

8 Aseptic Loosening Mr M Bloomfield

9 Aseptic Loosening Starts here Mr M Bloomfield

10 loosening

11 Aseptic Loosening Accelerating factors Particle size generated from joint articulation Total number of particles Load across bone-cement or implant interface Quality of initial fix

12 Aseptic Loosening Particle size generated from joint articulation Total number of particles Load across bone-cement or implant interface Quality of initial fix Accelerating factors Therefore: Young, Active, Overweight are at risk Mr M Bloomfield

13 SO THE IMPORTANT ISSUES ARE: The primary fix to bone Wear from the bearing couple How much bone is removed Puts the other side issues into perspective eg cemented vs uncemented Titanium or stainless steel, hydroxyapatite, ceramics, crosslinked polyethylene etc. Mr M Bloomfield

14 What do Surgeons do with the young active patient?

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18 Hip Resurfacing : Advantages Bone preserving: easier revision. Larger, more anatomical head: more stable, better proprioception. Feels more natural. Less risk of dislocation Less problems with leg length adjustment, anteversion, offset. Mr M Bloomfield

19 Mr M Bloomfield

20 Hip Resurfacing : Advantages Less invasion of femoral canal at surgery: less fat embolism and therefore less DVT/ PE. Greater range of movement, stronger hip. No need to remove fixation devices left in proximal femur by previous surgery. No need to correct proximal femoral deformity Mr M Bloomfield

21 E.R. 47yrs. Post-op 8/52

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25 Indications: Young, active patient with good bone stock. How to assess bone stock? What is young? What is active? Mr M Bloomfield

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27 Hip Resurfacing : So What s the Catch? Maybe metal ion toxicity? Not all hips can be resurfaced Femoral neck fracture still possible. Difficult, marginally longer operation. Expensive! (But so are other prostheses). Longer scar than THR. Mr M Bloomfield

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32 J.D. 62yrs female 30/05/02

33 J.D. 62yrs female 15/06/02

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35 F.H. DOB: 28/03/1922

36 F.H. DOB: 28/03/1922

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39 Rehabilitation & Recovery Stability & natural feel of resurfacing allows normal rules of hip replacement to be broken. NO special restriction on movement, bending, crossing legs etc. Patient choice! NO mandatory raised toilet seats, chairs. NO sleeping only on back. Can sleep on side. NO restriction on sporting activity after 3 months. (6 months for extreme types) Crutches optional. (Except when osteoporotic)

40 Running, Fishing,Hill Walking, Dryskiing, Archery, Hunting, Clay pigeon shooting Weight training, Yoga, Motorcycling,Tennis,Squash,Circle dancing Tread mill, Football, Power walking, Horse riding, Gym, Skiing, Skittles Circuit training, Golf, Rowing,Motor racing, Table tennis,water Skiing Greek dancing,surfing,jogging,snooker,flat green bowling Sailing,Chi Kung,Cycling,Basketball,Rock climbing Mountain biking, Paragliding, Fencing, Rugby, Hockey Walking Badminton.Jiving,Cricket,Aerobics,Fell walking,swimming

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45 Official Announcement! Mr Mark Bloomfield is now seeing patients at: 78 or 81 Harley St. London W18 7HJ [Harley St Clinic premises] And soon at St John s & Lizzies in St John s Wood

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