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The goals of total hip replacement (arthroplasty) are to provide relief of pain and discomfort, improve function and enhance stability in patients suffering from arthritis or any disabling orthopedic hip problem. This goal was originally met in the late 1960’s and has been improved over the past several decades.

Joint replacement is a common surgical procedure with a high success rate. In an arthritic hip, the damaged ball (the upper end of the femur) is replaced by a metal or ceramic ball attached to a metal stem fitted into the femur (with or without cement), and a plastic or ceramic socket (fitted into a metal socket) that is implanted into the pelvis, replacing the damaged socket.

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The increasing number of total hip replacements in young patients in recent years, is accompanied by an increased number of revision operations due to excessive wear of the polyethylene in the young active patient, leading to osteolysis and loosening of the prosthesis. For this reason, there has been extensive research to find alternative bearings with better wear properties to cope with this tremendous devastating problem. At this moment, ceramic-on-ceramic and metal-on-metal seem to be the most suited alternatives for the metal-on-polyethylene bearing in the young active patient.

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Ceramic-on-ceramic prostheses

New in our clinic is the use of DELTA ceramic-on-ceramic prostheses (figure 4 and 5). The Ceramtec Biolox®delta is a prosthesis which has a new ceramic mixture. Due to the adding of zirconium and chromiumoxide (pink colour), the couple is now even better than the previous ones (Biolox®Forte).

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Metal-on-metal prosthesis (figure 1 and 2).

Today there is a new type of metal-on-metal prosthesis used in the ANCA medical centre. (www.wmt.com en www.hipreplacement.com) These are fabricated from a harder cobalt-chromium alloy, and thus consist of a metal-on-metal couple. This new combination creates a differential hardness between the two moving parts. This differential makes that the metal is likely to release less particles into the body and wear less over time. (figure 3 and 4) In all hip prostheses the femoral head wears quicker than the acetabular shell (except the metal-on-polythylene ones (hard-on-soft)). The difference in hardness is a major advantage over the previous metal-on-metal prostheses and even more over the metal-on-polyethylene prostheses.

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Alternatives For Total Hip Replacement

Conservative treatment

One alternative is not to have an operation. If your pain can be controlled with medication (pain killers: such as paracetamol, or non steroidal anti-inflammatory drugs; or disease management medication: like glucosamine-sulfate), physiotherapy, and adapting your physical activities, so that you are sufficiently comfortable and you are content with your present activity level and motion in your hip, then you may decide to wait (AKA watchful waiting).

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by Koen De Smet, MD; Alessandro Calistri, MD
AMC Ghent, Krijgslaan 181, 9000 Ghent, Belgium
published on: http://www.surfacehippy.info/acousticphenomenahr.php

Background: While providing superior hardness and improved wear characteristics, hard bearings such as metal-on-metal, or ceramic-on-ceramics bearings have different lubrication properties than hard on soft (metal- or ceramic-on-poly) bearing couples. A failure in this lubrication mechanism in metal-on-metal resurfacing prostheses can lead to squeaking and has been reported by different authors. Other more frequently encountered acoustic phenomena in resurfacing are clicking, popping or grinding noises that patients may experience in different episodes of their prosthesis life.

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From the Advanced Resurfacing Course, May 2014, Ghent Belgium.

Today, anno 2014, metal-on-metal hip arthroplasty in general and hip resurfacing in particular is finding itself in the eye of the storm. Despite the fact that an estimated 500,000 current generation metal-on-metal hip replacements have been performed over the last 15 years with excellent results from experienced surgeons, there are reports of increasing numbers of revisions for unexplained pain and soft tissue reactions.

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