Bone density key to success of hip resurfacing. Osteoporosis need not apply

Written by admin on June 3, 2013 – 8:07 pm -

Histological, Histomorphometric and Microtomographic Analyses of Retrieval Hip Resurfacing Arthroplasty Failed at Different Times
Francesca Salamanna, Milena Fini, Annapaola Parrilli, Matteo Cadossi, Nicolò Nicoli Aldini, Gianluca Giavaresi, Deianira Luciani, Sandro GianniniDisclosures

BMC Musculoskelet Disord. 2013;14(47)

Conclusions
The objective of the study was to examine the characteristics of bone quality and its microarchitecture in retrieved metal-on-metal HR by a specific quantitative histomorphometry and μCT method. The results showed that the morphometric parameters considered were crucial for a good understanding of the mechanical properties of HR and may be of significant and essential importance in the pathogenesis of HR failure particularly in the development of late fractures. Although there are several good reports on the survival rate of HR at mid-term follow up, the biological changes of the femoral head underlying the implant over time should always be considered. It remains to be seen whether other late failures will occur. HR is still a good indication for young and active patients; nevertheless good bone quality remains the crucial element to support the implant at longer follow-up.


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Pushing Limits…

Written by admin on February 26, 2013 – 2:14 pm -

Younger Patients Choose Surgery; Some Sports Are OK, But Which Are Too Much?

(WSJ, April 19, 2011)

John Jeffries, a 49-year-old money manager in Dover, Mass., had hip-resurfacing surgery in 2008 and is now coaching his son’s basketball team and long-distance cycling.

Alex Douglas, a Wall Street software architect, had both knees replaced last year at 39 after years of sports injuries. He can’t wait to go kite-boarding this weekend. “I’ve been cleared to have fun,” he says.

Hard charging baby boomers and Generation X-ers are wearing out their joints at younger ages and turning to joint replacement surgery. But is it a quick fix? WSJ’s health columnist Melinda Beck discusses with Kelsey Hubbard.

Joint-replacement patients these days are younger and more active than ever before. More than half of all hip-replacement surgeries performed this year are expected to be on people under 65, with the same percentage projected for knee replacements by 2016. The fastest-growing group is patients 46 to 64, according to the American Academy of Orthopaedic Surgery.

Many active middle-agers are wearing out their joints with marathons, triathlons, basketball and tennis and suffering osteoarthritis years earlier than previous generations. They’re also determined to stay active for many more years and not let pain or disability make them sedentary.

To accommodate them, implant makers are working to build joints with longer-wearing materials, and surgeons are offering more options like partial knee replacements, hip resurfacing and minimally invasive procedures.

More younger people also need joint-replacement surgery due to obesity, and some orthopedists refer them for weight-loss surgery first to reduce complications later.

Even the most fit patients face a long period of rehabilitation after surgery and may not be able to resume high-impact activities.

“There is, to be honest, some irrational exuberance out there,” says Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn., and president of the American Academy of Orthopedic Surgeons. “People may be overly optimistic about what joint replacement can do for them.”

One big unknown: How long will the replacement joints last? In the past, many doctors assumed implants would wear out in about 10 or 15 years, and they urged young patients to put off surgery as long as possible to minimize the risk of needing a costly and difficult revision surgery—or even two. (A total knee replacement typically costs $15,000 to $22,000. A revision can be $45,000 or more, with a higher risk of complications.)

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Posted in Hip, Joint Replacements, Knee | No Comments »