Hip Resurfacing | Right Patient | Right Implant
Total hip replacement has given us one of the most successful surgical procedures in history. With the British Orthopaedic Surgeon Sir John Charnley having opened the door, over fifty years ago, to the ‘modern era’ we can now look back on a long & satisfying experience. During that time we have seen some wonderful progress with hip implants. Charnley’s breakthrough with UHMWPe (Ultra High Molecular Weight Polyethylene) had allowed a viable plastic on metal articulation to be achieved in the 1960s. That, along with the prosthesis developed by the Exeter Group, gave us what came to be considered the ‘the gold-standard’ for hip implants - a femoral ‘rod’ with metal head & a plastic acetabular component (cup). In more recent years modifications to UHMWPe & the development of stabilised ceramics has given us hip implants that facilitate both enhanced mobility & longevity.
Despite generally working so well conventional hip replacements require important bio-mechanical compromise. The head of the femur (ball) must be removed & space developed for a device that will fit inside the femoral canal. This is achieved by using various instruments. The acetabulum (cup) must also be prepared to receive a prosthetic device. In younger patients that cup is usually referred to as a ‘two piece device’ meaning it comprises a metal shell & a plastic or ceramic insert (bearing). Conventional hip replacement, despite the procedure enjoying such technical success & declared patient satisfaction, can’t replicate the natural femoral head to acetabular recess relationship. This has, however, markedly improved since the early days of The Charnley which was confined to a very small (by today’s standard) head at just 22.225mm.
From the earliest days, extending right back to Themistocles Glück in the 1800s, the aspirant position has been to ‘resurface’ the damaged anatomy. Knee replacement can be described as just such a procedure. The hip has been more challenging in terms of resurfacing because of both surgical technique & materials demands. Buechel & Pappas identified in the late 1980s that hip resurfacing design could repose on a non MOM (metal on metal) approach. Today, advances in both materials & PSI’s (patient specific instruments) mean hip resurfacing for for your painful, stiff, or swollen hip might deliver the optimal solution. Dr Wyatt is always influenced by peer reviewed science & meticulous research rather than orthopaedic fashion. He believes there is a developing case for non-metallic (Ceramic on Ceramic) hip resurfacing based on the precautionary principle of the right research, the right patient, & the right implant.
Despite generally working so well conventional hip replacements require important bio-mechanical compromise. The head of the femur (ball) must be removed & space developed for a device that will fit inside the femoral canal. This is achieved by using various instruments. The acetabulum (cup) must also be prepared to receive a prosthetic device. In younger patients that cup is usually referred to as a ‘two piece device’ meaning it comprises a metal shell & a plastic or ceramic insert (bearing). Conventional hip replacement, despite the procedure enjoying such technical success & declared patient satisfaction, can’t replicate the natural femoral head to acetabular recess relationship. This has, however, markedly improved since the early days of The Charnley which was confined to a very small (by today’s standard) head at just 22.225mm.
From the earliest days, extending right back to Themistocles Glück in the 1800s, the aspirant position has been to ‘resurface’ the damaged anatomy. Knee replacement can be described as just such a procedure. The hip has been more challenging in terms of resurfacing because of both surgical technique & materials demands. Buechel & Pappas identified in the late 1980s that hip resurfacing design could repose on a non MOM (metal on metal) approach. Today, advances in both materials & PSI’s (patient specific instruments) mean hip resurfacing for for your painful, stiff, or swollen hip might deliver the optimal solution. Dr Wyatt is always influenced by peer reviewed science & meticulous research rather than orthopaedic fashion. He believes there is a developing case for non-metallic (Ceramic on Ceramic) hip resurfacing based on the precautionary principle of the right research, the right patient, & the right implant.
The Ceramic Resurfacing Implant:
|
The Resurfacing Implant favoured by Dr Wyatt was researched & is manufactured by U.K. Orthopaedic company MatOrtho Limited. Mike Tuke founded the company & he is considered one of the pioneers of modern joint replacement. With Recerf® a fully ceramic implant is available which infers two important benefits for patients - high biocompatibility & very low wear.
To help patients with a basic appreciation of what hip resurfacing involves we have provided a photograph of the implant & three clickable-links. These allow access to a PDF Patient Guide & two videos that show the patient resurfacing experience. |
ReCerf® has a 5A ODEP Rating:
Click above to see the ReCerf® ODEP entry.
ODEP refers to the UK Orthopaedic Data Evaluation Panel. Dr Wyatt is influenced by ODEP advice. Latest ODEP ratings can be found at www.odep.org.uk
|
Click above to read the Patient Guide
|
Click above to watch the video
|
Click above to watch the video
|
It is both desirable & clinically important that advances in orthopaedic prosthesis are supported by peer-reviewed publication. Case numbers for Ceramic on Ceramic Hip Resurfacing in Australia are growing, as they are in other parts of the world. For patients who have a hip Resurfacing in NSW & beyond there is also the reassurance that details are recorded in Australia's long-established 'Joint Registry'. Brief abstracts of two published clinical publications are shown below with the full papers being accessible via clicking on the grey buttons.
|
Prospective international multicentre data for a cohort of 200 patients demonstrates significant improvements in pain, function and activity levels of patients up to 2 years after their operation, with no radiographic evidence of implant loosening or migration and a low early revision rate. These findings support the early safety and performance of ceramic-on-ceramic hip resurfacing in an active patient population:
|
International multicentre results for a cohort of 604 patients demonstrate 98% survival at five years, with consistent functional improvement and no significant influence of head size or sex on revision risk. These findings support the use of ceramic-on-ceramic resurfacing across a broader patient population:
|
