Table of Contents
2. Total Hip Replacement (THR)
The need for hip replacement continues to shrink as the complication rate for resurfacing falls. Hip resurfacing started out as a temporizing measure for younger patients to preserve bone. Most surgeons still prefer plastic bearing hip replacement to hip resurfacing. My first choice is usually hip resurfacing. In the few patients that are not good resurfacing candidates, my next choice used to be large metal bearing total hip replacement. Hip dislocations are completely eliminated by this choice
Other surgeons are reluctant to use these implants because of a fear of adverse metal wear related failure (AWRF). This has been a common failure mode among some brands (DePuy ASR recall 2010). But this a rare problem with the Biomet design. Because of decreased demand for large metal bearing THR, Zimmer-Biomet has discontinued the sale of this implant several years ago. I now use the best alternative which is a dual mobility ceramic/polyethelene bearing which is nearly as good.
With the large metal bearing Biomet Magnum THR, I have a 97% 15-year implant survivorship (for patients average age 60) with no dislocations, which far surpasses registry benchmarks (approximately 92% 10-year survivorship for a similar age group). Also a standard total hip carries a 3% dislocation risk and a 1-5% trunion corrosion and requires permanent restrictions. I generally perform hip replacement in the very obese (BMI > 35), patients older than 70 years, those with severe osteoporosis, or severe bone deformities.
Failures in 211 cases – TOTAL: 2.8% raw failure rate 16 years postoperative
|Failure of acetabular ingrowth||2|
|AWRF due to acetabular malposition||1|