what metal are hip replacements made of

Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief.

Arthritis and Hip Replacement Surgery

Arthritis and Hip Replacement Surgery In this Article What Happens During Hip Replacement Surgery? What Happens After Hip Replacement Surgery?

What Activities Should I Avoid After Hip Replacement Surgery? What Can I Do at Home After Hip Replacement Surgery? Is Hip Replacement Surgery Safe? How Long Will My New Joint Last After Hip Replacement Surgery?

The procedure should relieve a painful hip joint, making walking easier. What Happens During Hip Replacement Surgery? Hip replacement surgery can be performed traditionally or by using what is considered a minimally-invasive technique.

The main difference between the two procedures is the size of the incision. Continue Reading Belowyou might like During standard hip replacement surgery, you are given general anesthesia to relax your muscles and put you into a temporary deep sleep. This will prevent you from feeling any pain during the surgery or have any awareness of the procedure.

A spinal anesthetic may be given to help prevent pain as an alternative. The doctor will then make a cut along the side of the hip and move the muscles connected to the top of the thighbone to expose the hip joint. Next, the ball portion of the joint is removed by cutting the thighbone with a saw. Then an artificial joint is attached to the thighbone using either cement or a special material that allows the remaining bone to attach to the new joint.

The doctor then prepares the surface of the hipbone -- removing any damaged cartilage -- and attaches the replacement socket part to the hipbone. The new ball part of the thighbone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid.

The doctor then reattaches the muscles and closes the incision. While most hip replacement surgeries today are performed using the standard technique (one 8 to 10 inch cut along the side of the hip), in recent years, some doctors have been using a minimally-invasive technique.

In the minimally-invasive approach, doctors make one to two cuts from 2 to 5 inches long. The same procedure is performed through these small cuts as with standard hip replacement surgery.1 2 3 View All Next Article Joint Fusion Surgery Osteoarthritis Guide Overview & Facts Symptoms & Types Diagnosis & Tests Treatment & Care Living & Managing Tools & Resources

. The same materials are used for hip implants—the stem portions of most hip implants are made of metal alloys, the ball portions are made from metal alloys or polished ceramic, and the acetabular sockets are made from metal, polyethylene (plastic), a combination of polyethylene backed by metal, or ceramic.

What are artificial joints made of?

Brent W. D'arc, MD on behalf of Riverside Community Hospital Orthopedic Surgery Joint replacement parts are made of plastic and metal that's not reactive to the human body. In this video, Brent d'Arc, MD, an orthopedic surgeon at Riverside Community Hospital, describes the metals and plastics that orthopedic surgeons use.

Scott D. Martin, MDOrthopedic Surgery The components of an artificial knee joint are made from some combination of hard polished metal, hard ceramic, and tough, slick plastic

All materials that are used to construct artificial joints need to meet the following criteria: They must function without provoking a local or systemic immune response. They must be able to resist wear and corrosion in order to retain their strength and shape. They must mechanically duplicate the joint they are replacing.

For example, they must be strong enough to withstand repetitive weight-bearing loads and flexible enough to bear stress without breaking, while allowing smooth movement. Continue Learning about Bone & Joint Injuries Related to Bone & Joint Injuries Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view.

It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs. Trending on Sharecare

r Cobalt is used for a wide range of applications including: The manufacture of super-alloys, the primary application of cobalt produced today. These super-alloys are, in turn, used in turbine blades for jet aircraft engines and gas turbines; medical orthopedic implants like hip and knee replacements; and permanent magnets.

Cobalt Price

Cobalt (symbol: Co; atomic number: 27) is a naturally-occurring free element that, once subjected to reductive smelting, becomes a hard and lustrous metal with a silver-gray appearance. In its natural form, it can only be found in combination with other chemicals (i.e., chemically combined form) except for small deposits found in natural meteoric iron alloys.

Below is the historical Cobalt price per metric ton. Year Price Price (Inflation Adjusted) Change2018 $80,490.68 $80,490.68 54%2017 $37,347.38 $38,243.72 36%2016 $23,861.40 $24,996.06 -42%2015 $33,864.20 $36,290.42 20%2014 $27,102.10 $29,072.89 10%2013 $24,423.54 $26,618.75 -28%2012 $31,234.49 $34,552.50 -23%2011 $38,329.39 $43,291.51 -23%2010 $46,980.42 $54,760.50 -71%2009 $80,420.80 $95,238.51 -16%2008 $93,242.12 $109,980.50 34%2007 $61,120.50 $74,832.08 43%2006 $34,864.44 $43,881.02 14%2005 $30,122.50 $39,125.93 -18%2004 $35,502.50 $47,681.86 -10%2003 $39,213.50 $54,087.92 -13%2002 $44,423.50 $62,683.48 12%2001 $39,239.50 $56,254.53 -6%2000 $41,590.50 $61,294.47 -6%1999 $44,231.50 $67,403.02 -7%1998 $47,245.00 $73,579.09 -9%1997 $51,455.83 $81,419.21 -9%1996 $56,217.81 $91,000.09 -15%1995 $64,396.95 $107,366.91 16%1994 $54,365.93 $93,180.51 44%1993 $30,401.71 $53,461.81 -66%1992 $50,551.94 $91,563.14 26%1991 $37,302.17 $69,591.17 40%1990 $22,244.62 $43,242.70 24%1989 $16,843.30 $34,510.84 7%1988 $15,630.76 $33,563.70 7%1987 $14,462.31 $32,327.94 -14%1986 $16,512.60 $38,239.80 -53%1985 $25,198.81 $59,464.04 9%1984 $23,016.23 $56,268.88 45%1983 $12,698.61 $32,379.83 -49%1982 $18,871.55 $49,659.88 -83%1981 $34,546.40 $96,544.03 -39%1980 $48,104.81 $148,281.39 -50%1979 $72,377.67 $253,220.35 25%1978 $54,057.28 $210,495.76 77%1977 $12,389.96 $51,912.43 20%1976 $9,854.65 $43,973.62 11%1975 $8,774.39 $41,424.15 13%1974 $7,650.03 $39,402.57 12%1973 $6,702.04 $38,317.00 19%1972 $5,401.32 $32,795.09 10%1971 $4,850.16 $30,390.98 0%1970 $4,850.16 $31,728.18 13%1969 $4,232.87 $29,268.41 4%1968 $4,078.55 $29,752.43 0%1967 $4,078.55 $31,002.03 11%1966 $3,637.62 $28,507.58 1%1965 $3,593.53 $28,978.75 8%1964 $3,306.93 $27,094.25 0%1963 $3,306.93 $27,446.47 0%1962 $3,306.93 $27,803.28 0%1961 $3,306.93 $28,081.31 -3%1960 $3,395.11 $29,118.40 -15%1959 $3,902.18 $34,036.27 -13%1958 $4,409.24 $38,728.25 -2%1957 $4,475.38 $40,409.84 -27%1956 $5,687.92 $53,053.13 -1%1955 $5,732.01 $54,266.34 0%1954 $5,732.01 $54,049.28 7%1953 $5,357.23 $50,868.94 1%1952 $5,291.09 $50,642.85 9%1951 $4,806.07 $46,874.56 17%1950 $3,968.32 $41,761.42 2%1949 $3,880.13 $41,364.17 6%1948 $3,637.62 $38,313.54 4%1947 $3,483.30 $39,659.89 5%1946 $3,306.93 $43,073.65 0%1945 $3,306.93 $46,648.76 0%1944 $3,306.93 $47,721.69 0%1943 $3,306.93 $48,532.95 0%1942 $3,306.93 $51,493.46 0%1941 $3,306.93 $57,106.25 0%1940 $3,306.93 $59,961.57 7%1939 $3,086.47 $56,355.91 3%1938 $2,998.28 $53,979.21 5%1937 $2,843.96 $50,125.71 0%Brief History Since ancient times, man has used cobalt compounds in giving glaze, glass and ceramics a rich blue color, thus, the term cobalt blue.

The element has also been used across civilizations, such as in Persian jewelry and Egyptian sculpture from the third millennium B. C., as well as in the Pompeii ruins dating back to 79 A. D. and in China since the Tang Dynasty.

The rich blue color was even used in adding vibrant hues to glass in the Bronze Age!But it was only around 1735 that cobalt was shown to be a distinct metal from bismuth, among other metals that it was usually found with on the Earth’s crust.

Georg Brandt (1694–1768), a Swedish chemist, is credited with its discovery. Cobalt is distinguished from all other metals known to man because it’s the first metal discovered by man since the pre-historical period. All the known metals, such as iron, silver, copper, lead, gold, silver, and mercury, don’t have discoverers on record. The metal’s name is derived from “kobalt”, a German word that means “goblin” since the cobalt ore was connected to the supernatural creature.

The ore was also notorious for its extremely volatile and toxic nature, no thanks to the presence of arsenic in cobalt’s primary ores. When the primary cobalt ore undergoes the smelting process, the arsenic became arsenic oxide, a harmful chemical. Today, the mining and manufacturing methods used for cobalt are safer, as well as more effective and efficient for the miners and manufacturers.

Price History The producers of cobalt have largely set the price of the metal in the market. Keep in mind that cobalt is a rare metal and, thus, its prices tend to be higher because of the supply-and-demand law.

But since the industries that use cobalt have also established effective and efficient ways of recycling the metal, as well as in using cobalt-free alternatives, the metal’s prices are relatively stable considering its scarcity. Before World War II, the producers agreed that cobalt supply should be controlled but that cobalt prices should be uniform.

The main producers then were Belgium, the United Kingdom, Canada, Finland and France. After World War II, the Belgian Congo producers quoted the price and the rest of the producers generally followed it. When the producers controlled the cobalt market, the majority of its sales occurred as direct transactions between the producers and the consumers. Sales agents were also oftentimes used by both parties. When it’s a free market, which sometimes happens, the sales can be between independent traders and consumers, as well as between merchants and their fellow merchants. In this case, the cobalt can come from several sources including official and unofficial producers, releases from government stockpiles, and consumers with excess stocks. The cobalt prices in a free market can sometimes change so rapidly that investors have reason to be worried. But historically, the prices of cobalt in the market have remained relatively stable except for the rapid price increases in the last 1970s. Known as the cobalt crisis, the period was preceded by the limited cobalt production capacity worldwide, cessation of sales by the U. S. government, and the issues of supply from the Zaire cobalt mining region, among others. Today, Zambia and Zaire are cooperating to stabilize the prices of cobalt in the world market. The two countries limit sales of the metal to the free market and establish a producer price. Use as an Investment Interested individuals can invest in cobalt in two ways, namely: Cobalt futures are traded on the London Metal Exchange (ticker symbol: CO). These have been traded since early 2010 with their quotes made in U. S. dollars per ton. Investors have the opportunity to make bets because of the average 15-month contract period. Cobalt stocks are available in a wide range of options. But emphasis must be made that U. S.-based exchanges offer fewer options so the better alternative is to find them in foreign exchanges, such as Canada. What It’s Used Fo

The production of batteries (e.g., lithium ion battery cathodes) and catalysts, to name a few. With the valuable quality of cobalt, you’re well-advised to invest in it. But be sure to study the cobalt price trends to maximize your returns on investments and minimize your risks.

Because titanium itself is non-toxic and not rejected by the body, the medical industry has embraced it for implants such as hip and joint replacements. Despite the upsides, much concern has been expressed about the use of titanium compounds as a food and cosmetic additive.

The Health Risks of Titanium

The Health Risks of Titaniumby Dr. Edward Group DC, NP, DACBN, DCBCN, DABFMLast Updated on September 10, 2013Titanium is the ninth most abundant element in the Earth’s crust. This abundance and its status as a corrosion resistant, strong metal have landed it many industrial applications where its best features can be fully taken advantage of. Some uses include airplane motors, jewelry, and heat exchange systems.

How Does Titanium Exposure Happen? Exposure to titanium often happens by way of titanium compounds that are added to cosmetics, sunscreens, paints, and food. Titanium dioxide nano particles is usually the compound in question and safety concerns have been expressed.

Unfortunately, you don’t have a choice in whether or not you’re exposed. Even if you avoid products that contain titanium dioxide nano particles, the other nano particles that everyone else uses will be excreted or washed away into the sewage system and into the environment.

Even with a low exposure, this may manifest into a range of effects. Another matter of concern is that titanium dioxide is an ingredient in food coloring… and the foods with the highest content are candy and gum.

A Monte Carlo analysis found that children have the greatest exposure because of high titanium content in sweets. Personal care products such as toothpastes and sunscreens often contain titanium too. [ 1]Are Titanium Nano Particles Safe? The safety profile of nano particles for infants and the unborn is not known. Some studies have suggested the concern over titanium nano particle safety to be “overblown”.

I disagree. Titanium oxide nano particles have been shown to induce emphysema and lung redness in adult mice. Furthermore, exposure of developing lungs to nano particles may lead to chronic irritation and negative effect on lung development, increasing the risk of respiratory disorders.

No thanks! [ 2]Inhaling titanium nano particles is bad for your lungs. Researchers at the National Institute for Occupational Safety and Health in Morgantown West Virginia observed significantly elevated levels of lung injury in rats that had inhaled titanium compounds.

[ 3]Titanium’s Effect on Your Brain Titanium exposure may be harmful to your brain. Titanium nano particles can enter directly into the hippocampus region of the brain through the nose and olfactory bulb.

During hip replacement, a surgeon removes the damaged sections of your hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.

Overview

Overview

Also called total hip arthroplasty, hip replacement surgery may be an option for you if your hip pain interferes with daily activities and more-conservative treatments haven't helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement. Mayo Clinic's approach Why it's done Conditions that can damage the hip joint, sometimes necessitating hip replacement surgery, include: Osteoarthritis.

Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly. Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.

Osteonecrosis. If there is inadequate blood supply to the ball portion of the hip joint, the bone may collapse and deform. You might consider hip replacement if you're experiencing hip pain that: Persists, despite pain medication Worsens with walking, even with a cane or walker Interferes with your sleep Affects your ability to go up or down stairs Makes it difficult to rise from a seated position Request an Appointment at Mayo Clinic Risks Risks associated with hip replacement surgery may include: Blood clots.

Clots can form in your leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to your lung, heart or rarely your brain.

Your doctor may prescribe blood-thinning medications to reduce this risk. Infection. Infections can occur at the site of your incision and in the deeper tissue near your new hip. Most infections are treated with antibiotics, but a major infection near your prosthesis may require surgery to remove and replace the prosthesis. Fracture. During surgery, healthy portions of your hip joint may fracture. Sometimes the fractures are so small that they heal on their own, but larger fractures may need to be corrected with wires, pins, and possibly a metal plate or bone grafts.

Dislocation. Certain positions can cause the ball of your new joint to become dislodged, particularly in the first few months after surgery. If the hip dislocates, your doctor may fit you with a brace to keep the hip in the correct position.

If your hip keeps dislocating, surgery is often required to stabilize it. Change in leg length. Your surgeon takes steps to avoid the problem, but occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a contracture of muscles surrounding the hip. In this case, progressively strengthening and stretching those muscles may help. Loosening. Although this complication is rare with newer implants, your new joint may not become solidly fixed to your bone or may loosen over time, causing pain in your hip. Surgery might be needed to fix the probl

em. Need for second hip replacement Your prosthetic hip joint may wear out eventually, so if you have hip replacement surgery when you're relatively young and active, you eventually may need a second hip replacement. However, new materials are making implants last longer, so a second replacement may not be needed. Metal-on-metal complications

All hip resurfacing operations use a metal-on-metal bearing hip. Most total hip replacements are not metal-on-metal bearings and use other materials including ceramic and high density polyethylene. Your hospital will always have a record of your operation and what implants were used.

Metal-on-metal hip replacement Q & A

Metal-on-metal hip replacement Q & AAnswers provided by John Skinner, consultant orthopaedic surgeon at Royal National Orthopaedic Hospital, Stanmore, UK, and Alister Hart, professor of orthopaedic surgery at UCL and Royal National Orthopaedic Hospital, London, UK. What are the concerns about metal-on-metal hips? When they work well, metal-on-metal hip resurfacing and total hip replacements give years of trouble-free use with very low levels of wear.

However, some metal-on-metal implants can fail, increasing the amount of wear and producing small amounts of debris. This debris is particles (ions) of cobalt and chromium that make up the implant. This debris can trigger a response in your body, which can cause erosion of bone and loosening of the implants.

The National Joint Registry states that 3% of implants loosen after 9 years. However, implants fail for other reasons too, so the overall failure rate is about 1% per year.

In most people the metal ions are absorbed into the bloodstream, then filtered by the kidneys and passed out in the urine.

By measuring the concentration of these ions in the blood we can discover how the hip is wearing. These levels are very low and are measured in parts per billion (ppb). However, the concentration of metal ions in the fluid around the hip joint can be much higher. It's these high local concentrations of metal ions that cause damage to the tissues, either by local toxicity or by your body's response as it tries to get rid of them.

While all hip debris causes some reaction in the nearby tissues, often with no major problems, in some people it can cause extensive tissue damage and in some rare cases death of tissue cells, including those of the muscles, tendons, nerves and bones.

Which hip implants have been recalled? In 2010, the UK Medicines and Healthcare Regulatory Agency (MHRA) issued three safety alerts, one for all metal-on-metal hips and two for ASR (Articular Surface Replacement) hips.

The Australian and UK National Joint Registries also reported high failure rates for ASR hip replacements and all large diameter metal-on-metal bearing total hip replacements. De Puy International then recalled all their ASR hip resurfacings and ASR XL total hip replacements. The MHRA has advised that all metal-on-metal hips are followed up for 5 years and all ASR / ASR XL hips be followed up for the life of the implant.

This is to regularly check how much wear has taken place and therefore how likely you are to need revision surgery. Approximately 100,000 of the ASR hips have been implanted worldwide since 2004 and approximately 10,000 in the UK. Anyone who has had an De Puy ASR or ASR XL hip replacement and has any outstanding questions should contact the ASR helpline on 0800 2794865 or 01908 303 195 or go to http://asrrecall.depuy.com/ukpatient Does this apply to hip-resurfacing and total hip replacement?

Yes, it applies to both types of metal-on-metal hip; however, recent evidence suggests that the problem may be greater for large diameter metal-on-metal total hip replacements. What is the difference? A hip resurfacing keeps the ball part of the ball-and-socket hip joint and puts a metal cap over the surface of it.

There's also a metal cup on the pelvis side. In a total hip replacement, the ball on top of the thigh bone (the femoral head) is removed and a stem is fixed into the shaft of the thigh bone using either bone cement or uncemented technology (this means the prosthesis is fixed without using cement to 'glue' the implant in). A ball is then fixed onto a spigot on this stem. Both types involve a metal ball rubbing against a metal cup. How do I know if I have a metal-on-metal hip?

You can contact the hospital directly if your operation was done recently and you’re still under the care of the surgeon. Most hospitals will have tried to contact you already if you have a metal-on-metal hip. Otherwise you can contact your GP and they can help put you back in contact. If you signed a consent form for details of your operation to be sent to the National Joint Register, you can contact them directly and they can tell you details of your implant.

Tel: 0845-3459991 or Email: health_servicedesk@northgate-is.com If I have a metal-on-metal hip, should I contact my GP or orthopaedic surgeon? Most hospitals that have put in a number of metal-on-metal hips will have a system to advise patients. You can try contacting them directly, or your GP can help you and refer you to your orthopaedic surgeon.

Should I be receiving regular check-ups if I have a metal-on-metal hip? Yes, since the safety alerts and recalls the MHRA are advising that all patients with metal-on-metal hips should be followed up annually for 5 years and that all ASR or ASR XL hips (those models that have been withdrawn) should be followed up for the life of the implant.

Patients with hip replacements with head diameter of 36 millimetres or more need to be monitored every year for the life of the hip replacement. Even if you don't need to be formally followed up, if you develop pain or start to limp you should tell your doctor straight away, who will arrange for referral or investigations.

What should these check-ups involve? These can take many forms, and if you aren’t having any problems then an annual telephone conversation or questionnaire may be all that's needed. This will usually be carried out by your surgeon or another practitioner from where you had surgery.

You’ll need a more detailed assessment if you're in pain, if you have an ASR component or if an x-ray shows signs that the implant has caused problems. This assessment may include physical examination, blood tests to measure the concentration of metal in your blood and possibly ultrasound or MRI examinations.

What will happen if there's damage to the hip? Not all pains and problems are due to your body's reaction to metal debris. Other causes of pain that can affect all types of hip replacement include loosening, wear and infection. If there's damage to your hip then you’ll need revision surgery in which the metal-on-metal implants will be removed and new ones inserted.

This may also involve fitting a femoral stem to fix the ball onto (in a total hip replacement). If you already have a stem in place and it’s well fixed and undamaged, then this can often be saved. Your surgeon will discuss this with you. Who regulates the use of hip devices? A national regulator called the Medicines and Healthcare Products Regulatory Agency (MHRA) is in charge of classifying medical devices in the UK.

How would I find out when a type of hip has been recalled? Medical Device Alerts are the MHRA's way of communicating safety information, including recalls.

Alerts are sent out to healthcare professionals and are also published in print and online. The MHRA has an excellent website where you can check for yourself if you’re worried ( www.mhra.gov.uk ). Do I need to report any side-effects to the MHRA as well as my doctor? Anyone can submit a problem with a medical device (such as a hip implant) to the MHRA.

This includes clinicians, healthcare workers, carers, patients and members of the public. By law, manufacturers do have to inform the MHRA when they know of failures that have been revised. This, along with NJR data, ensures that the MHRA can keep abreast of problems. Should I get legal advice if I have a hip that has been recalled?

You first need to see your doctor to check if there’s a clinical problem. Your health must come first if there are problems. With the ASR and ASR XL implants, the manufacturers are - in most cases - paying for all investigations and treatment to put things right.

However, these hips are the subject of legal proceedings worldwide so you should get legal advice to see if you're entitled to compensation. Apart from the recent recall, are there any long-term risks associated with the procedure? There hasn't been much research done on the long-term effects of these hips on either the tissues around the hip or on tissues elsewhere in the body. There are concerns regarding the high levels of heavy metals (cobalt and chromium) in the blood; however, there are very few reports of actual clinical problems.

Are metal-on-metal implants still being used? Yes. It's the only way to perform a resurfacing operation where the thigh bone is simply capped. There’s some clinical evidence that in younger men (under 55 years) or men who are very active, some metal-on-metal hip resurfacing replacements give equal or slightly better results than total hip replacements.

However, overall the use of metal-on-metal hips has reduced very sharply in the last two years. What are the advantages of metal-on-metal hip implants? It allows hip resurfacing and can allow much larger diameter femoral heads to be used in total hip replacement.

Larger heads can also allow a greater range of movement of the hip and give greater stability, making dislocation less likely.

When they're designed and made well, working well, positioned well and lubricated well by joint fluid, metal-on-metal implants show some of the lowest wear rates of any materials used in hip replacement. This is what made them so popular. However, if any of these factors aren't right, then the wear can be extremely high and this leads to the problems caused by metal debris. How do surgeons decide what type and material of hip replacement to use? Most surgeons find two types of hip replacement that they're happy with.

This is usually one for young and active patients and one for the much larger group of older patients (those more likely to need the operation). There are many good hip replacement options that have good follow up and excellent results published in medical literature.

How can I find out what type and material of hip replacement would be best for me? Research is constantly being carried out to try to answer this question. All materials have advantages and disadvantages, but most modern materials are showing excellent results and it’s likely that more than one type may be equally effective for you.

How do I make sure I have a good, experienced surgeon? Your GP is likely to have seen other patients who need hip surgery in your area so they’ll have a very good idea who to recommend to you.

If you have friends, family or other patients who've had hip surgery, they can also give you a 'customer view'. Where can I get more information? Your doctor and your surgeon in particular will be able to discuss all matters related to your hip and hip surgery with you.

The websites of the British Hip Society and the British Orthopaedic Association also be helpful. You can also contact the Arthritis Care on freephone 0808 800 4050 or email info@arthritiscare.org.uk for more support. Share this on Facebook Tweet this on Twitter Save to favourites Related information... Hip replacement surgery During hip replacement surgery, the surgeon replaces the damaged joint surfaces with artificial parts.

It can reduce pain and improve your mobility. Find out More Pain and arthritis Pain can be a major symptom of arthritis.

We give you information and self-help tips on both short-term and chronic pain. Find out More Orthopaedic surgeon Orthopaedic surgeons specialise in surgical treatments for problems affecting the bones, joints and other structures. They’re involved in treating the problems caused by disease and injury. Find out More

Symptoms of Hip Implant Failures A properly functioning hip replacement should last between 10 to 20 years, but there is still a chance that your hip replacement could fail. In Minnesota, the risk for metal on metal hip implant failure is even higher.

Symptoms of Hip Implant Failures

HOME | News & Updates

A registry set up by Minnesota’s Health East Care System recorded four times the average replacement surgeries for patients who received metal on metal implants compared to other types of implants. If you underwent hip replacement surgery, watch for these signs and symptoms that could be associated with implant failure. Warning Signs of Defective Implants If you have a metal on metal hip implant, it’s recommended to periodically visit your doctor or orthopedic surgeon for follow up exams and x-rays.

Not all patients experience symptoms right away, so it’s important to carefully monitor your health post-surgery. According to the University of California San Francisco Joint & Replacement Center, blood clots in the legs and pelvic area are the most common complications associated with hip replacement surgery.

Watch for these additional symptoms that could indicate hip implant failure: Pain and discomfort in hip and groin area, lower back, or legs Swelling and inflammation in the hip area Difficulty when standing or walking Decreased flexibility and mobility/range of motion Creaking or squeaky noise in hip joint area Limping – a limp can happen over time due to the joint degrading Increased pain while performing weight-bearing and/or physical activities Fatigue Who is at Greatest Risk for Hip Implant Failure?

Women Women fall into the highest risk category when it comes to hip implant failure. They are more prone to bone weakness due to osteoporosis which causes bone fractures and damage, especially as they get older.

A woman’s skeletal structure, especially in the pelvic area, is different from men. Women usually have wider hips to assist with childbirth, which equates to larger hip sockets. Because of these bigger hip sockets, hip implants in women are more likely to fail. As a result, the hip implant loosens and dislocates from the socket.

It’s been found that metal on metal implants in women break down faster, because the metal components were shallow and smaller, which did not accommodate for women’s hip sockets. Young, Active People Young, physically active people, especially those who work heavy manual labor jobs or play rigorous sports, will eventually need a second surgery to replace their first implant.

Over the years, more stress is placed on the hip joint, which wears down the implant at a faster rate. Smokers Smoking also plays a significant role in artificial hip failure. The American Academy of Orthopaedic Surgeons reports the failure rate for smokers is 9.1% compared to 3.4% in non-smokers.

Smokers experienced further complications from surgery including: abnormal heartbeat, kidney failure, and blood clots. Overweight Patients According to a study conducted by the University of Iowa, obese patients have bigger thighs, which caused hip implants to fail. Because of the larger thigh size, the thighs push outward, which dislocates the hip implant and forces the joint out of its socket. If you have further questions concerning symptoms related to hip implant failure, contact Meshbesher & Spence today to set up a consultation with our personal injury attorneys. BACK TO NEWS & UPDATES

cts Trunnionosis, Metallosis, and Their Effects What is Trunnionosis? Hip replacements, specifically of the metal-on-metal variety, are composed of several parts, including the ball, the stem, and the prosthesis. In the majority of hip replacements that are produced today, the prosthesis rests on top of the ball.

Trunnionosis, Metallosis, and Their Effects

Trunnionosis, Metallosis, and Their Effects Home Trunnionosis, Metallosis, and Their Effe

This allows the femoral head to be modular, fitting better into the socket joint of the pelvis. The trunnion is the place where the femoral neck tapers off, attaching to the femoral head. As previously stated, the trunnion is necessary in order to attach the femoral neck to the femoral head.

However, a recent development has alerted doctors to a connection between this style of hip implant, (metal-on-metal), and the presence of foreign, malignant metal debris in and around the area of the implant. The movement of the hip implant creates this debris as it wears against itself and sends shards of metal into the surrounding soft tissue.

The wearing away of the metal trunnion is known as “trunnionosis.” The existence of these eroded metals from the trunnion in the body is highly dangerous and painful for those experiencing their effects, and they have been known to cause many adverse consequences, including, (but not limited to), tissue necrosis.

Trunnionosis is also often referred to as “metal l osis,” though in truth, metal l osis is more specifically concerned with the problem of the build-up and the presence of metal debris in the body, while “trunnionosis” refers to the overall process of the trunnion wearing and causing the problem of “metalosis.” However, you may often hear physicians, attorneys, and experts use the two terms “trunnionosis” and “metal l osis” interchangeably What does Trunnionosis (Metal l osis) cause?

Many, if not all patients who suffer from trunnionosis are at a high risk for many other medical problems.

The two metals used most often in metal-on-metal hip implants are Chromium and Cobalt. Negative effects may be experienced by the unintentional presence of both metals in the human body. In addition, Cobalt is highly toxic and poses a serious threat when it migrates into unintended areas of the body.

Specifically, when Chromium and Cobalt invade the vulnerable soft tissue around the hip implant it increases the likelihood that they will be absorbed into the bloodstream, which can lead to many serious issues, including future neurological and cardiac problems. Although the previously mentioned issues may be the most serious, trunnionosis (metal l osis) has also been known to cause joint loosening and dislocation, bone chipping and fracturing, and the development of pseudotumors, all of which are serious medical concerns and should be addressed immediately by a doctor.

What Should I do if I think I have Trunnionosis or Metalosis? In short, we strongly recommend that you seek immediate medical and legal help. If you or a loved one suspect that you are suffering from trunnionosis, metal l osis or if you experience any of the symptoms described above, the first step is to contact a doctor.

It is likely that revision surgery will be necessary to remove the defective (failing) hip implant and replace it with a functioning one, and in this case, it is very important that you be fully educated on revision surgery and what it entails. For a brief synopsis of hip implant revision surgery, click here. After you have spoken with your doctor, the next step is to seek legal help.

Companies everywhere are aware of the dangers of metal-on-metal hip implants, and if you received one of these devices then there is a good chance that you have a right to pursue financial compensation.

We are equipped to help you and would be honored to do so. Do not hesitate to get in touch with us about your problem. You may call us now at (800) 377-7872, or you may also submit the case evaluation form on this page.

We are available to serve you and to help you secure justice. Were you given a defective hip implant? Contact Us For A Free Case Evaluation!Name *Email *Phone Number Tell Us About Your Situation *REVIEW MY CASEThe law firms in our alliance have represented clients in 46 states. Our work has been featured on many major news outlets:

Arthritis damages the cartilage-covered surfaces of the joint so the ball moves less smoothly and less freely within the socket. In a hip replacement or resurfacing operation, the surgeon replaces the damaged surfaces with artificial parts, which may be made of metal, plastic or ceramic materials.

Do I need a hip replacement?

Do I need a hip replacement? Print, Download, Order The hip is a ball-and-socket joint, which allows a wide range of movement.

Hip replacement is most commonly recommended for severe osteoarthritis, but it’s sometimes used for inflammatory conditions such as rheumatoid arthritis or ankylosing spondylitis or for problems with development of the hip during childhood.

Hip surgery may also be needed for fractures of the hip, including those resulting from osteoporosis. You won’t necessarily need a hip replacement if you have arthritis of the hip, but it may be worth considering if your hip is severely damaged and the pain, disability or stiffness are having serious effects on your daily activities.

Your doctors will always try other measures before suggesting a hip replacement – for example, painkillers , physiotherapy and/or walking aids, or occasionally a steroid injection into your hip joint.

There are no age limits for having hip replacement surgery, although the younger you are when you have surgery, the greater the chances that your new joint will eventually wear out. However, it’s usually possible to have another hip replacement later on if you need to. What are the possible advantages of a hip replacement?

Share this on Facebook Tweet this on Twitter Save to favourites Print this page Download our information booklet on hip replacement surgery ( PDF 2.3 MB) Order the printed leaflet on hip replacement surgery Related information... Ankylosing spondylitis (AS)Ankylosing spondylitis is a type of arthritis affecting the joints in your back, but it can also affect other joints and can be linked to a variety of other symptoms including chest pain, eye or bowel inflammation and fatigue.

Find out More Osteoarthritis Osteoarthritis is the most common form of joint disease. It causes joint pain and stiffness. We explain its causes, diagnosis and treatment, and the importance of self-help measures. Find out More Rheumatoid arthritis Rheumatoid arthritis is the second most common form of arthritis in the UK. It causes inflammation, pain and swelling in the joints. We explain more about the symptoms, diagnosis and treatments. Find out More

l). Hip replacement An X-ray showing a right hip (left of image) has been replaced, with the ball of this ball-and-socket joint replaced by a metal head that is set in the femur and the socket replaced by a white plastic cup (clear in this X-ray).

Hip replacement

"From Wikipedia, the free encyclopedianavigation search This article is about human hip replacement. For hip replacement in animals, see Hip replacement (anima

ICD-9-CM 81.51 – 81.53Me SH D019644Medline Plus 002975 [ edit on Wikidata]Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures.

A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently one of the most common orthopaedic operations, though patient satisfaction short- and long-term varies widely.

The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

[1]Contents [ hide ]1 Medical uses2 Modern process3 Techniques3.1 Posterior approach3.2 Lateral approach3.3 Antero-lateral approach3.4 Anterior approach3.5 Minimally invasive approaches4 Implants4.1 Acetabular cup4.2 Femoral component4.3 Articular interface5 Configuration6 Risks6.1 Infection6.2 Dislocation6.3 Limb Length Inequality6.4 Fracture6.5 Vein thrombosis6.6 Osteolysis6.7 Loosening6.8 Metal sensitivity6.9 Metal toxicity6.10 Nerve palsy6.11 Chronic pain6.12 Death6.13 Metal-on-metal hip implant failure7 Alternatives and variations7.1 Conservative management7.2 Preoperative care7.3 Hemiarthroplasty7.4 Hip resurfacing7.5 Viscosupplementation8 Prevalence and cost9 History10 See also11 References12 External links Medical uses [ edit]Total hip replacement is most commonly used to treat joint failure caused by osteoarthritis.

Other indications include rheumatoid arthritis, avascular necrosis, traumatic arthritis, protrusio acetabuli, certain hip fractures, benign and malignant bone tumors, arthritis associated with Paget's disease, ankylosing spondylitis and juvenile rheumatoid arthritis.

The aims of the procedure are pain relief and improvement in hip function. Hip replacement is usually considered only after other therapies, such as physical therapy and pain medications, have failed.

Modern process [ edit]Main components of a hip prosthesis [2]A titanium hip prosthesis, with a ceramic head and polyethylene acetabular cup The modern artificial joint owes much to the 1962 work of Sir John Charnley at Wrightington Hospital. His work in the field of tribology resulted in a design that almost completely replaced the other designs by the 1970s.

Charnley's design consisted of three parts:stainless steel one-piece femoral stem and headpolyethylene (originally Teflon ), acetabular component, both of which were fixed to the bone using PMMA (acrylic) bone cement The replacement joint, which was known as the Low Friction Arthroplasty, was lubricated with synovial fluid. The small femoral head ( 7⁄ 8 in (22.2 mm)) was chosen for Charnley's belief that it would have lower friction against the acetabular component and thus wear out the acetabulum more slowly.

Unfortunately, the smaller head dislocated more easily. Alternative designs with larger heads such as the Mueller prosthesis were proposed. Stability was improved, but acetabular wear and subsequent failure rates were increased with these designs.

The Teflon acetabular components of Charnley's early designs failed within a year or two of implantation. This prompted a search for a more suitable material. A German salesman showed a polyethylene gear sample to Charnley's machinist, sparking the idea to use this material for the acetabular component. The ultra high molecular weight polyethylene or UHMWPE acetabular component was introduced in 1962. Charnley's other major contribution was to use polymethylmethacrylate (PMMA) bone cement to attach the two components to the bone.

For over two decades, the Charnley Low Friction Arthroplasty, and derivative designs were the most used systems in the world. It formed the basis for all modern hip implants. The Exeter hip stem was developed in the United Kingdom during the same time as the Charnley device.

Its development occurred following a collaboration between Orthopaedic Surgeon Robin Ling and University of Exeter engineer Clive Lee and it was first implanted at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1970.

[3] The Exeter Hip is a cemented device, but with a slightly different stem geometry. Both designs have shown excellent long-term durability when properly placed and are still widely used in slightly modified versions.

Early implant designs had the potential to loosen from their attachment to the bones, typically becoming painful ten to twelve years after placement. In addition, erosion of the bone around the implant was seen on x-rays. Initially, surgeons believed this was caused by an abnormal reaction to the cement holding the implant in place.

That belief prompted a search for an alternative method to attach the implants. The Austin Moore device had a small hole in the stem into which bone graft was placed before implanting the stem.

It was hoped bone would then grow through the window over time and hold the stem in position. Success was unpredictable and the fixation not very robust. In the early 1980s, surgeons in the United States applied a coating of small beads to the Austin Moore device and implanted it without cement. The beads were constructed so that gaps between beads matched the size of the pores in native bone.

Over time, bone cells from the patient would grow into these spaces and fix the stem in position. The stem was modified slightly to fit more tightly into the femoral canal, resulting in the Anatomic Medullary Locking (AML) stem design.

With time, other forms of stem surface treatment and stem geometry have been developed and improved. Initial hip designs were made of a one-piece femoral component and a one-piece acetabular component. Current designs have a femoral stem and separate head piece. Using an independent head allows the surgeon to adjust leg length (some heads seat more or less onto the stem) and to select from various materials from which the head is formed.

A modern acetabulum component is also made up of two parts: a metal shell with a coating for bone attachment and a separate liner. First the shell is placed. Its position can be adjusted, unlike the original cemented cup design which are fixed in place once the cement sets.

When proper positioning of the metal shell is obtained, the surgeon may select a liner made from various materials. To combat loosening caused by polyethylene wear debris, hip manufacturers developed improved and novel materials for the acetabular liners. Ceramic heads mated with regular polyethylene liners or a ceramic liner were the first significant alternative.

Metal liners to mate with a metal head were also developed. At the same time these designs were being developed, the problems that caused polyethylene wear were determined and manufacturing of this material improved. Highly crosslinked UHMWPE was introduced in the late 1990s. The most recent data comparing the various bearing surfaces has shown no clinically significant differences in their performance. Potential early problems with each material are discussed below. Performance data after 20 or 30 years may be needed to demonstrate significant differences in the devices.

All newer materials allow use of larger diameter femoral heads. Use of larger heads significantly decreases the chance of the hip dislocating, which remains the greatest complication of the surgery. When currently available implants are used, cemented stems tend to have a better longevity than uncemented stems. No significant difference is observed in the clinical performance of the various methods of surface treatment of uncemented devices. Uncemented stems are selected for patients with good quality bone that can resist the forces needed to drive the stem in tightly. Cemented devices are typically selected for patients with poor quality bone who are at risk of fracture during stem insertion.

Cemented stems are less expensive due to lower manufacturing cost, but require good surgical technique to place them correctly. Uncemented stems can cause pain with activity in up to 20% of patients during the first year after placement as the bone adapts to the device.

This is rarely seen with cemented stems. Once an uncommon operation reserved for frail patients with a limited life expectancy, hip replacement is now common, even among active athletes including race car drivers Bobby Labonte and Dale Jarrett, and the 8-time Major-winning American golfer Tom Watson, who shot a 67 in the opening round of the Masters Tournament in the year following his operation.

Techniques [ edit]There are several incisions, defined by their relation to the gluteus medius. The approaches are posterior (Moore), lateral (Hardinge or Liverpool), [4] antero-lateral (Watson-Jones), [5] anterior (Smith-Petersen) [6] and greater trochanter osteotomy.

There is no compelling evidence in the literature for any particular approach, but consensus of professional opinion favours either modified anterolateral (Watson-Jones) or posterior approach.

[ citation needed]Posterior approach [ edit]The posterior (Moore or Southern) approach accesses the joint and capsule through the back, taking piriformis muscle and the short external rotators of the femur. This approach gives excellent access to the acetabulum and femur and preserves the hip abductors and thus minimizes the risk of abductor dysfunction post operatively.

It has the advantage of becoming a more extensile approach if needed. Critics cite a higher dislocation rate, although repair of the capsule, piriformis and the short external rotators along with use of modern large diameter head balls reduces this risk.

Lateral approach [ edit]The lateral approach is also commonly used for hip replacement. The approach requires elevation of the hip abductors ( gluteus medius and gluteus minimus) to access the joint. The abductors may be lifted up by osteotomy of the greater trochanter and reapplying it afterwards using wires (as per Charnley), [ citation needed] or may be divided at their tendinous portion, or through the functional tendon (as per Hardinge) and repaired using sutures.

Although this approach has a lower dislocation risk than the posterior approach, critics note that occasionally the abductor muscles do not heal back on, leading to pain and weakness which is often very difficult to treat. Antero-lateral approach [ edit]The anterolateral approach develops the interval between the tensor fasciae latae and the gluteus medius.

The Gluteus medius, gluteus minimus and hip capsule are detached from the anterior (front) for the greater trochanter and femoral neck and then repaired with heavy suture after the replacement of the joint. Anterior approach [ edit]The anterior approach uses an interval between the sartorius muscle and tensor fasciae latae.

Dr. Joel Matta and Dr. Bert Thomas have adapted this approach, which was commonly used for pelvic fracture repair surgery, for use when performing hip replacement. When used with older hip implant systems that had a small diameter head, dislocation rates were reduced compared to surgery performed through a posterior approach. With modern implant designs, dislocation rates are similar between the anterior and posterior approaches.

[7] The anterior approach has been shown in studies to variably improve early functional recovery, with possible complications of femoral component loosening and early revision compared to other approaches [8] [9] [10] [11] [12] [13]Minimally invasive approaches [ edit]The dual incision approach and other minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision.

However, component positioning accuracy and visualization of the bone structures can be significantly impaired as the approaches get smaller.

This can result in unintended fractures and soft tissue injury. The majority of current orthopedic surgeons use a ""minimally invasive"" approach compared to traditional approaches which were quite large comparatively. Computer-assisted surgery and robotic surgery techniques are also available to guide the surgeon to provide enhanced accuracy.

Several commercial CAS and robotic systems are available for use worldwide. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques. [14] [15]Implants [ edit]Metal on metal prosthetic hip Cement-free implant sixteen days after surgery. Femoral component is cobalt chromium combined with titanium which induces bone growth into the implant.

Ceramic head. Acetabular cup coated with bone growth-inducing material and held temporarily in place with a single screw. The prosthetic implant used in hip replacement consists of three parts: the acetabular cup, the femoral component, and the articular interface.

Options exist for different people and indications. The evidence for a number of newer devices is not very good, including: ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups. [16] Correct selection of the prosthesis is important. Acetabular cup [ edit]The acetabular cup is the component which is placed into the acetabulum (hip socket). Cartilage and bone are removed from the acetabulum and the acetabular cup is attached using friction or cement.

Some acetabular cups are one piece, while others are modular. One-piece (monobloc) shells are either UHMWPE ( ultra-high-molecular-weight polyethylene) or metal, they have their articular surface machined on the inside surface of the cup and do not rely on a locking mechanism to hold a liner in place.

A monobloc polyethylene cup is cemented in place while a metal cup is held in place by a metal coating on the outside of the cup. Modular cups consist of two pieces, a shell and liner. The shell is made of metal; the outside has a porous coating while the inside contains a locking mechanism designed to accept a liner.

Two types of porous coating used to form a friction fit are sintered beads and a foam metal design to mimic the trabeculae of cancellous bone and initial stability is influenced by under-reaming and insertion force. [17] Permanent fixation is achieved as bone grows onto or into the porous coating. Screws can be used to lag the shell to the bone providing even more fixation.

Polyethylene liners are placed into the shell and connected by a rim locking mechanism; ceramic and metal liners are attached with a Morse taper. [ citation needed]Femoral component [ edit]This section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) ( Learn how and when to remove this template message)The femoral component is the component that fits in the femur (thigh bone).

Bone is removed and the femur is shaped to accept the femoral stem with attached prosthetic femoral head (ball). There are two types of fixation: cemented and uncemented. Cemented stems use acrylic bone cement to form a mantle between the stem and to the bone.

Uncemented stems use friction, shape and surface coatings to stimulate bone to remodel and bond to the implant. Stems are made of multiple materials (titanium, cobalt chromium, stainless steel, and polymer composites) and they can be monolithic or modular.

Modular components consist of different head dimensions and/or modular neck orientations; these attach via a taper similar to a Morse taper. These options allow for variability in leg length, offset and version. Femoral heads are made of metal or ceramic material.

Metal heads, made of cobalt chromium for hardness, are machined to size and then polished to reduce wear of the socket liner. Ceramic heads are more smooth than polished metal heads, have a lower coefficient of friction than a cobalt chrome head, and in theory will wear down the socket liner more slowly.

As of early 2011, follow-up studies in patients have not demonstrated significant reductions in wear rates between the various types of femoral heads on the market.

Ceramic implants are more brittle and may break after being implanted. Articular interface [ edit]This section possibly contains original research. Please improve it by verifying the claims made and adding inline citations. Statements consisting only of original research should be removed. (April 2016) ( Learn how and when to remove this template message)The articular interface is not part of either implant, rather it is the area between the acetabular cup and femoral component.

The articular interface of the hip is a simple ball and socket joint. Size, material properties and machining tolerances at the articular interface can be selected based on patient demand to optimise implant function and longevity whilst mitigating associated risks. The interface size is measured by the outside diameter of the head or the inside diameter of the socket.

Common sizes of femoral heads are 28 mm (1.1 in), 32 mm (1.3 in) and 36 mm (1.4 in). While 22.25 mm ( 7⁄ 8 in) was common in the first modern prostheses, now even larger sizes are available from 38 to over 54 mm. Larger-diameter heads lead to increased stability and range of motion whilst lowering the risk of dislocation. At the same time they are also subject to higher stresses such as friction and inertia. Different combinations of materials have different physical properties which can be coupled to reduce the amount of wear debris generated by friction.

Typical pairings of materials include metal on polyethylene (MOP), metal on crosslinked polyethylene (MOXP), ceramic on ceramic (COC), ceramic on crosslinked polyethylene (COXP) and metal on metal (MOM). Each combination has different advantages and disadvantages. Configuration [ edit]Post-operative projectional radiography is routinely performed to ensure proper configuration of hip prostheses. The direction of the acetabular cup influences the range of motion of the leg, and also affects the risk of dislocation. [18] For this purpose, the acetabular inclination and the acetabular anteversion are measurements of cup angulation in the coronal plane and the sagittal plane, respectively.

Acetabular inclination. [19] This parameter is calculated on an anteroposterior radiograph as the angle between a line through the lateral and medial margins of the acetabular cup and the transischial line which is tangential to the inferior margins of the ischium bones.

[19]Acetabular inclination is normally between 30 and 50°. [19] A larger angle increases the risk of dislocation. [18]Acetabular anteversion. [20] This parameter is calculated on a lateral radiograph as the angle between the transverse plane and a line going through the (anterior and posterior) margins of the acetabular cup.

[20]Acetabular anteversion is normally between 5 and 25°. [18] An anteversion below or above this range increases the risk of dislocation.

[18] There is an intra-individual variability in this method because the pelvis may be tilted in various degrees in relation to the transverse plane. [18]Leg length discrepancy after hip replacement is calculated as the vertical distance between the middle of the minor trochanters, using the acetabular tear drops [19] or the transischial line [18] as references for the horizontal plane.

A discrepancy of up to 1 cm is generally tolerated. [19] [18]Center of rotation: The horizontal center of rotation is calculated as the distance between the acetabular teardrop and the center of the head (or caput) of the prosthesis and/or the native femoral head on the contralateral side. [19] The vertical center of rotation instead uses the transischial line for reference. [19] The parameter should be equal on both sides.

[19]Risks [ edit]Risks and complications in hip replacement are similar to those associated with all joint replacements. They can include infection, dislocation, limb length inequality, loosening, impingement, osteolysis, metal sensitivity, nerve palsy, chronic pain and death.

Weight loss surgery before a hip replacement does not appear to change outcomes. [21]Infection [ edit]Infection is one of the most common causes for revision of a total hip replacement, along with loosening and dislocation.

The incidence of infection in primary hip replacement is around 1% or less in the United States. [22] Risk factors for infection include obesity, diabetes, smoking, immunosuppressive medications or diseases, and history of infection. Modern diagnosis of infection around a total knee replacement is based on the Musculoskeletal Infection Society (MSIS) criteria.

[23] They are:1. There is a sinus tract communicating with the prosthesis; or 2. A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; or Four of the following six criteria exist:1.

Elevated serum erythrocyte sedimentation rate (ESR>30mm/hr) and serum C-reactive protein (CRP>10 mg/L) concentration,2. Elevated synovial leukocyte count,3. Elevated synovial neutrophil percentage (PMN%),4. Presence of purulence in the affected joint,5.

Isolation of a microorganism in one culture of periprosthetic tissue or fluid, or6. Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at ×400 magnification. None of the above laboratory tests has 100% sensitivity or specificity for diagnosing infection. Specificity improves when the tests are performed in patients in whom clinical suspicion exists. ESR and CRP remain good 1st line tests for screening (high sensitivity, low specificity). Aspiration of the joint remains the test with the highest specificity for confirming infection.

Dislocation [ edit]Dislocated artificial hip Liner wear, particularly when over 2 mm, increases the risk of dislocation. [24] Liner creep, on the other hand, is normal remoulding. [18]Dislocation is the most common complication of hip replacement surgery.

The most common causes vary by the duration since the surgery. Hip prosthesis dislocation mostly occur in the first 3 months after insertion, mainly because of incomplete scar formation and relaxed soft tissues. [24] It takes eight to twelve weeks for the soft tissues injured or cut during surgery to heal. During this period, the hip ball can come out of the socket. The chance of this is diminished if less tissue is cut, if the tissue cut is repaired and if large diameter head balls are used.

Dislocations occurring between 3 months and 5 years after insertion usually occur due to malposition of the components, or dysfunction of nearby muscles.

[24]Risk factors of late dislocation (after 5 years) mainly include: [24]Female gender Younger age at primary hip arthroplasty Previous subluxation without complete dislocation Previous trauma Substantial weight loss Recent onset or progression of dementia or a neurological disorder Malposition of the cup Wear of the liner, particularly when it causes movement of the head of more than 2 mm within the cup compared to its original position Prosthesis loosening with migration Surgeons who perform more of the operations each year tend to have fewer patients dislocate.

Doing the surgery from an anterior approach seems to lower dislocation rates when small diameter heads are used, but the benefit has not been shown when compared to modern posterior incisions with the use of larger diameter heads. The use of larger diameter head size does in it self decrease the risk of dislocation, even though this correlation is only found in head sizes up to 28 mm, thereafter no additional decrease in dislocation rate is found.

[25] Patients can decrease the risk further by keeping the leg out of certain positions during the first few months after surgery.

Limb Length Inequality [ edit]Most adults prior to a hip replacement have a limb length inequality of 0–2 cm which they were born with and which causes no clinical deficits. [26] It is common for patients to feel a limb length inequality after total hip replacement. [27] Sometimes the leg seems long immediately after surgery when in fact both are equal length.

An arthritic hip can develop contractures that make the leg behave as if it is short. When these are relieved with replacement surgery and normal motion and function are restored, the body feels that the limb is now longer than it was. This feeling usually subsides by 6 months after surgery as the body adjusts to the new hip joint. The cause of this feeling is variable, and usually related to abductor muscle weakness, pelvic obliquity, and minor lengthening of the hip during surgery (<1 cm) to achieve stability and restore the joint to pre-arthritic mechanics.

If the limb length difference remains bothersome to the patient more than 6 months after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction. Fracture [ edit]Bones with internal fixation devices in situ are at risk of periprosthetic fractures at the end of the implant, an area of relative mechanical stress.

Post-operative femoral fractures are graded by the Vancouver classification. Vein thrombosis [ edit]Venous thrombosis such as deep vein thrombosis and pulmonary embolism are relatively common following hip replacement surgery. Standard treatment with anticoagulants is for 7–10 days; however treatment for more than 21 days may be superior. [28] Research from 2013 has on the other hand suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital.

[29]Some physicians and patients may consider having an ultrasonography for deep vein thrombosis after hip replacement. [30] However, this kind of screening should only be done when indicated because to perform it routinely would be unnecessary health care.

[30]Osteolysis [ edit]Many long-term problems with hip replacements are the result of osteolysis. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that come off the cup liner over time.

An inflammatory process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. In an attempt to eliminate the generation of wear particles, ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results.

Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were also developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication.

At the same time that these two bearing surfaces were being developed, highly cross linked polyethylene plastic liners were also developed. The greater cross linking significantly reduces the amount of plastic wear debris given off over time.

The newer ceramic and metal prostheses do not always have the long-term track record of established metal on poly bearings. Ceramic pieces can break leading to catastrophic failure. This occurs in about 2% of the implants placed.

They may also cause an audible, high pitched squeaking noise with activity. Metal-on-metal arthroplasty releases metal debris into the body raising concerns about the potential dangers of these accumulating over time. Highly cross linked polyethylene is not as strong as regular polyethylene. These plastic liners can crack or break free of the metal shell that holds them. Loosening [ edit]Hip prosthesis displaying aseptic loosening (arrows)Hip prosthesis zones according to De Lee and Charnley, [31] and Gruen.

[32] These are used to describe the location of for example areas of loosening. On radiography, it is normal to see thin radiolucent areas of less than 2 mm around hip prosthesis components, or between a cement mantle and bone. However, these may still indicate loosening of the prosthesis if they are new or changing, and areas greater than 2 mm may be harmless if they are stable.

[33] The most important prognostic factors of cemented cups are absence of radiolucent lines in De Lee and Charnley zone I, as well as adequate cement mantle thickness.

[34] In the first year after insertion of uncemented femoral stems, it is normal to have mild subsidence (less than 10 mm). [33] The direct anterior approach has been shown to itself be a risk factor for early femoral component loosening. [9] [35] [8]Metal sensitivity [ edit]Concerns are being raised about the metal sensitivity and potential dangers of metal particulate debris. New publications [36] [37] have demonstrated development of pseudotumors, soft tissue masses containing necrotic tissue, around the hip joint.

It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. Metal hypersensitivity is a well-established phenomenon and is common, affecting about 10–15% of the population.

[38] Contact with metals can cause immune reactions such as skin hives, eczema, redness and itching. Although little is known about the short- and long-term pharmacodynamics and bioavailability of circulating metal degradation products in vivo, there have been many reports of immunologic type responses temporally associated with implantation of metal components.

Individual case reports link hypersensitivity immune reactions with adverse performance of metallic clinical cardiovascular, orthopedic and plastic surgical and dental implants. [38]Metal toxicity [ edit]Most hip replacements consist of cobalt and chromium alloys, or titanium. Stainless steel is no longer used. All implants release their constituent ions into the blood. Typically these are excreted in the urine, but in certain individuals the ions can accumulate in the body.

In implants which involve metal-on-metal contact, microscopic fragments of cobalt and chromium can be absorbed into the patient's bloodstream. There are reports of cobalt toxicity with hip replacement patients. [39] [40]Nerve palsy [ edit]Post operative sciatic nerve palsy is another possible complication.

The incidence of this complication is low. Femoral nerve palsy is another but much more rare complication.

Both of these will typically resolve over time, but the healing process is slow. Patients with pre-existing nerve injury are at greater risk of experiencing this complication and are also slower to recover. Chronic pain [ edit]A few patients who have had a hip replacement suffer chronic pain after the surgery. Groin pain can develop if the muscle that raises the hip ( iliopsoas) rubs against the edge of the acetabular cup.

Bursitis can develop at the trochanter where a surgical scar crosses the bone, or if the femoral component used pushes the leg out to the side too far.

Also some patients can experience pain in cold or damp weather. [ citation needed] Incision made in the front of the hip (anterior approach) can cut a nerve running down the thigh leading to numbness in the thigh and occasionally chronic pain at the point where the nerve was cut (a neuroma).

Death [ edit]The rate of death for elective hip replacements is significantly less than 1%. [41] [42]Metal-on-metal hip implant failure [ edit]See also: Implant failure By 2010, reports in the orthopaedic literature increasingly cited the problem of early failure of metal on metal prostheses in a small percentage of patients. [43] Failures may relate to release of minute metallic particles or metal ions from wear of the implants, causing pain and disability severe enough to require revision surgery in 1–3% of patients.

[44] Design deficits of some prothesis models, especially with heat-treated alloys and a lack of special surgical experience accounting for most of the failures. Surgeons at leading medical centers such as the Mayo Clinic have reported reducing their use of metal-on-metal implants by 80 percent over the last year in favor of those made from other materials, like combinations of metal and plastic.

[45] The cause of these failures remain controversial, and may include both design factors, technique factors, and factors related to patient immune responses (allergy type reactions).

In the United Kingdom the Medicines and Healthcare Products Regulatory Agency commenced an annual monitoring regime for metal-on-metal hip replacement patients from May 2010.

[46] Data which are shown in The Australian Orthopaedic Association's 2008 National Joint replacement registry, a record of nearly every hip implanted in that country over the previous 10 years, tracked 6,773 BHR (Birmingham Hip Resurfacing) Hips and found that less than one-third of one percent may have been revised due to the patient's reaction to the metal component.

[47] Other similar metal-on-metal designs have not fared as well, where some reports show 76% to 100% of the people with these metal-on-metal implants and have aseptic implant failures requiring revision also have evidence of histological inflammation accompanied by extensive lymphocyte infiltrates, characteristic of delayed type hypersensitivity responses.

[48] It is not clear to what extent this phenomenon negatively affects orthopedic patients. However, for patients presenting with signs of an allergic reactions, evaluation for sensitivity should be conducted. Removal of the device that is not needed should be considered, since removal may alleviate the symptoms.

Patients who have allergic reactions to cheap jewelry are more likely to have reactions to orthopedic implants. There is increasing awareness of the phenomenon of metal sensitivity and many surgeons now take this into account when planning which implant is optimal for each patient.

On March 12, 2012, The Lancet published a study, based on data from the National Joint Registry of England and Wales, finding that metal-on-metal hip implants failed at much greater rates than other types of hip implants and calling for a ban on all metal-on-metal hips.

[49] The analysis of 402,051 hip replacements showed that 6.2% of metal-on-metal hip implants had failed within five years, compared to 1.7% of metal-on-plastic and 2.3% of ceramic-on-ceramic hip implants.

Each 1 mm (0.039 in) increase in head size of metal-on-metal hip implants was associated with a 2% increase of failure. [50] Surgeons of the British Hip Society are recommending that large head metal-on-metal implants should no longer be performed.

[51] [52]On February 10, 2011, the U. S. FDA issued an advisory on metal-metal hip implants, stating it was continuing to gather and review all available information about metal-on-metal hip systems. [53] On June 27–28, 2012, an advisory panel met to decide whether to impose new standards, taking into account findings of the study in The Lancet. [40] [54] [55] No new standards, such as routine checking of blood metal ion levels, were set, but guidance was updated.

[56] Currently, FDA has not required hip implants to be tested in clinical trials before they can be sold in the U. S. [57] Instead, companies making new hip implants only need to prove that they are ""substantially equivalent"" to other hip implants already on the market. The exception is metal-on-metal implants, which were not tested in clinical trials but because of the high revision rate of metal-on-metal hips, in the future the FDA has stated that clinical trials will be required for approval and that post-market studies will be required to keep metal on metal hip implants on the market.

[58]Alternatives and variations [ edit]Conservative management [ edit]The first line approach as an alternative to hip replacement is conservative management which involves a multimodal approach of medication, activity modification and physical therapy.

[59] Conservative management can prevent or delay the need for hip replacement. Preoperative care [ edit]Preoperative education is currently an important part of patient care. There is some evidence that it may slightly reduce anxiety before hip or knee replacement, with low risk of negative effects. [60]Hemiarthroplasty [ edit]Hemiarthroplasty is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre-operative) state.

This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture of the neck of the femur (a hip fracture ). The procedure is performed by removing the head of the femur and replacing it with a metal or composite prosthesis.

The most commonly used prosthesis designs are the Austin Moore prosthesis and the Thompson Prosthesis. More recently a composite of metal and HDPE which forms two interphases (bipolar prosthesis) has also been used. The monopolar prosthesis has not been shown to have any advantage over bipolar designs. The procedure is recommended only for elderly and frail patients, due to their lower life expectancy and activity level. This is because with the passage of time the prosthesis tends to loosen or to erode the acetabulum.

[61]Hip resurfacing [ edit]Hip resurfacing is an alternative to hip replacement surgery. It has been used in Europe for over seventeen years and become a common procedure.

Health-related quality of life measures are markedly improved and patient satisfaction is favorable after hip resurfacing arthroplasty. [62]The minimally invasive hip resurfacing procedure is a further refinement to hip resurfacing. Viscosupplementation [ edit]Current alternatives also include viscosupplementation, or the injection of artificial lubricants into the joint. [63] Use of these medications in the hip is off label. The cost of treatment is typically not covered by health insurance organizations.

Some believe that the future of osteoarthritis treatment is bioengineering, targeting the growth and/or repair of the damaged, arthritic joint. Centeno et al. have reported on the partial regeneration of an arthritic human hip joint using mesenchymal stem cells in one patient.

[64] It is yet to be shown that this result will apply to a larger group of patients and result in significant benefits. The FDA has stated that this procedure is being practiced without conforming to regulations, but Centeno claims that it is exempt from FDA regulation.

It has not been shown in controlled clinical trials to be effective [ citation needed], and costs over $7,000. Prevalence and cost [ edit]Total hip replacement incidence varies in developed countries between 30 (Romania) and 290 (Germany) procedures per 100,000 population per year.

[65] Approximately 0.8% of Americans have undergone the procedure. [66]According to the International Federation of Healthcare Plans, the average cost of a total hip replacement in 2012 was $40,364 in the United States, $11,889 in the United Kingdom, $10,987 in France, $9,574 in Switzerland, and $7,731 in Spain.

[1] In the United States, the average cost of a total hip replacement varies widely by geographic region, ranging from $11,327 (Birmingham, Alabama) to $73,927 (Boston, Massachusetts). [67]History [ edit]The earliest recorded attempts at hip replacement were carried out in Germany in 1891 by Themistocles Gluck (1853–1942), [68] [69] who used ivory to replace the femoral head (the ball on the femur), attaching it with nickel-plated screws, Plaster of Paris, and glue.

[70]On September 28, 1940 at Columbia Hospital in Columbia, South Carolina, American surgeon Dr. Austin T. Moore (1899–1963) [71] performed the first metallic hip replacement surgery. The original prosthesis he designed was a proximal femoral replacement, with a large fixed head made of the cobalt-chrome alloy Vitallium.

It was about a foot in length and bolted to the resected end of the femoral shaft (hemiarthroplasty). A later version, the so-called Austin Moore Prosthesis which was introduced in 1952, is still in use today, although rarely. Like modern hip implants, it is inserted into the medullary canal of the femur, and depends on bone growth through a hole in the stem for long-term attachment.

See also [ edit]Abductor wedge Femoral Acetabular Impingement Gruen zone Hip examination2010 De Puy Hip Recall References [ edit]^ a b ""2012 comparative price report"" (PDF). International Federation of Health Plans. Retrieved 4 October 2015.^ Andrew Still (2002-11-02). ""Total Hip Replacement"". University of Southern California. Retrieved 2017-01-05.^ Timperley, A John (20 October 2017). ""Robin Ling obituary"".

The Guardian. Retrieved 22 October 2017.^ Pai VS (1997). ""A comparison of three lateral approaches in primary total hip replacement"". Int Orthop. 21 (6): 393–398. doi: 10.1007/s002640050193. PMC 3619565. PMID 9498150. Archived from the original on 2002-01-08.^ ""Anterolateral Approach to Hip Joint: (Watson Jones) – Wheeless' Textbook of Orthopaedics"".

Retrieved 2007-11-26.^ ""Anterior Approach to the Hip (Smith Petersen) – Wheeless' Textbook of Orthopaedics"". Retrieved 2007-11-26.^ Maratt, Joseph D.; Gagnier, Joel J.; Butler, Paul D.; Hallstrom, Brian R.; Urquhart, Andrew G.; Roberts, Karl C. (September 2016). ""No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty"". The Journal of Arthroplasty. 31 (9): 127–130. doi: 10.1016/j.arth.2016.02.071.^ a b Meneghini, R. Michael; Elston, Addison S.; Chen, Antonia F.; Kheir, Michael M.; Fehring, Thomas K.; Springer, Bryan D. (January 2017).

""Direct Anterior Approach"". The Journal of Bone and Joint Surgery. 99 (2): 99–105. doi: 10.2106/JBJS.16.00060. PMID 28099299.^ a b Eto, Shuichi; Hwang, Katherine; Huddleston, James I.; Amanatullah, Derek F.; Maloney, William J.; Goodman, Stuart B. (March 2017). ""The Direct Anterior Approach is Associated With Early Revision Total Hip Arthroplasty"". The Journal of Arthroplasty. 32 (3): 1001–1005. doi: 10.1016/j.arth.2016.09.012. PMID 27843039.^ Christensen, Christian P.; Jacobs, Cale A.

(September 2015). ""Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study"". The Journal of Arthroplasty. 30 (9): 94–97. doi: 10.1016/j.arth.2014.12.038.^ Higgins, Brendan T.; Barlow, Daniel R.; Heagerty, Nathan E.; Lin, Tim J.

(March 2015). ""Anterior vs. Posterior Approach for Total Hip Arthroplasty, a Systematic Review and Meta-analysis"". The Journal of Arthroplasty. 30 (3): 419–434. doi: 10.1016/j.arth.2014.10.020.^ Meermans, G.; Konan, S.; Das, R.; Volpin, A.; Haddad, F. S. (June 2017). ""The direct anterior approach in total hip arthroplasty"". The Bone & Joint Journal. 99–B (6): 732–740.

doi: 10.1302/0301-620X.99B6.38053.^ Graves, Sara C.; Dropkin, Benjamin M.; Keeney, Benjamin J.; Lurie, Jon D.; Tomek, Ivan M. (30 November 2015). ""Does Surgical Approach Affect Patient-reported Function After Primary THA?"". Clinical Orthopaedics and Related Research®. 474 (4): 971–981. doi: 10.1007/s11999-015-4639-5.^ Parsley, Brian S. (February 2018). ""Robotics in Orthopedics: A Brave New World"".

The Journal of Arthroplasty. doi: 10.1016/j.arth.2018.02.032.^ Jacofsky, David J.; Allen, Mark (October 2016). ""Robotics in Arthroplasty: A Comprehensive Review"". The Journal of Arthroplasty. 31 (10): 2353–2363. doi: 10.1016/j.arth.2016.05.026.^ Nieuwenhuijse, M. J.; Nelissen, R. G. H. H.; Schoones, J. W.; Sedrakyan, A.

(9 September 2014). ""Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies"". BMJ. 349 (sep09 1): g5133–g5133. doi: 10.1136/bmj.g5133.^ Amirouche, Farid (2014). ""Factors influencing initial cup stability in total hip arthroplasty"". Clinical Biomechanics. 29 (10): 1177–85. doi: 10.1016/j.clinbiomech.2014.09.006. PMID 25266242.^ a b c d e f g h Iain Watt, Susanne Boldrik, Evert van Langelaan and Robin Smithuis.

""Hip - Arthroplasty -Normal and abnormal imaging findings"". Radiology Assistant. Retrieved 2017-05-21.^ a b c d e f g h Vanrusselt, Jan; Vansevenant, Milan; Vanderschueren, Geert; Vanhoenacker, Filip (2015). ""Postoperative radiograph of the hip arthroplasty: what the radiologist should know"". Insights into Imaging.

6 (6): 591–600. doi: 10.1007/s13244-015-0438-5. ISSN 1869-4101. PMID 26487647.^ a b Shin, W. C.; Lee, S. M.; Lee, K. W.; Cho, H. J.; Lee, J. S.; Suh, K. T. (2015). ""The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty"".

The Bone & Joint Journal. 97–B (5): 611–616. doi: 10.1302/0301-620X.97B5.34735. ISSN 2049-4394.^ Smith, TO; Aboelmagd, T; Hing, CB; Mac Gregor, A (September 2016). ""Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients?

Systematic review and meta-analysis"". The bone & joint journal. 98–B (9): 1160–1166. doi: 10.1302/0301-620x.98b9.38024. PMID 27587514.^ Bozic, Kevin J; Kurtz, Steven M; Lau, Edmund; Ong, Kevin; Vail, Thomas P; Berry, Daniel J (January 2009). ""The Epidemiology of Revision Total Hip Arthroplasty in the United States"". The Journal of Bone and Joint Surgery.

American Volume. 91 (1): 128–133. doi: 10.2106/JBJS. H.00155.^ Parvizi, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Della Valle, Craig J.; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G. (22 September 2011).

""New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society"". Clinical Orthopaedics and Related Research®. 469 (11): 2992–2994. doi: 10.1007/s11999-011-2102-9.^ a b c d Daniel J. Berry, Jay Lieberman (2012). Surgery of the Hip. Elsevier Health Sciences. p. 1035. ISBN 9781455727056.^ Hailer, Nils P.; Weiss, Rüdiger J.; Stark, André; Kärrholm, Johan (October 2012). ""The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis.

An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register"". Acta Orthopaedica. 83 (5): 442–448. doi: 10.3109/17453674.2012.733919. ISSN 1745-3682. PMC 3488169. PMID 23039167.^ Knutson, Gary A (2005). ""Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance"".

Chiropractic & Osteopathy. 13 (1): 11. doi: 10.1186/1746-1340-13-11.^ Maloney, William J; Keeney, James A (June 2004). ""Leg length discrepancy after total hip arthroplasty"". The Journal of Arthroplasty. 19 (4): 108–110. doi: 10.1016/j.arth.2004.02.018.^ Sobieraj, DM; Lee, S; Coleman, CI; Tongbram, V; Chen, W; Colby, J; Kluger, J; Makanji, S; Ashaye, AO; White, CM (May 15, 2012).

""Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review"". Annals of Internal Medicine. 156 (10): 720–7. doi: 10.7326/0003-4819-156-10-201205150-00423. PMID 22412039.^ Jørgensen, Christoffer C.; Jacobsen, Michael K.; Soeballe, Kjeld; Hansen, Torben B.; Husted, Henrik; Kjærsgaard-Andersen, Per; Hansen, Lars T.; Laursen, Mogens B.; Kehlet, Henrik (2013). ""Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study"".

BMJ open. 3 (12): e003965. doi: 10.1136/bmjopen-2013-003965. ISSN 2044-6055. PMC 3863129. PMID 24334158.^ a b American Academy of Orthopaedic Surgeons (February 2013), ""Five Things Physicians and Patients Should Question"", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Orthopaedic Surgeons, retrieved 19 May 2013, which cites Members of 2007 and 2011 AAOS Guideline Development Work Groups on PE/VTED Prophylaxis; Mont, M; Jacobs, J; Lieberman, J; Parvizi, J; Lachiewicz, P; Johanson, N; Watters, W (Apr 18, 2012).

""Preventing venous thromboembolic disease in patients undergoing elective total hip and knee arthroplasty"". The Journal of Bone and Joint Surgery. American Volume. 94 (8): 673–4. doi: 10.2106/JBJS.9408edit. PMC 3326687. PMID 22517384.^ John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash (2007). The Adult Hip, Volume 1.

Lippincott Williams & Wilkins. p. 958. ISBN 978-0-7817-5092-9.^ Neumann, Daniel R. P.; Thaler, Christoph; Hitzl, Wolfgang; Huber, Monika; Hofstädter, Thomas; Dorn, Ulrich (2010). ""Long-Term Results of a Contemporary Metal-on-Metal Total Hip Arthroplasty"". The Journal of Arthroplasty. 25 (5): 700–708. doi: 10.1016/j.arth.2009.05.018. ISSN 0883-5403.^ a b Roth, Trenton D.; Maertz, Nathan A.; Parr, J. Andrew; Buckwalter, Kenneth A.; Choplin, Robert H. (2012).

""CT of the Hip Prosthesis: Appearance of Components, Fixation, and Complications"". Radio Graphics. 32 (4): 1089–1107. doi: 10.1148/rg.324115183. ISSN 0271-5333.^ Steffen Breusch, Henrik Malchau (2005). The Well-Cemented Total Hip Arthroplasty: Theory and Practice. Springer Science & Business Media.

p. 336. ISBN 978-3-540-24197-3.^ Angerame, Marc R.; Fehring, Thomas K.; Masonis, John L.; Mason, J. Bohannon; Odum, Susan M.; Springer, Bryan D. (February 2018). ""Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?"". The Journal of Arthroplasty.

doi: 10.1016/j.arth.2018.01.014.^ Pandit H, Glyn-Jones S, Mc Lardy-Smith P, et al. (July 2008). ""Pseudotumours associated with metal-on-metal hip resurfacings"". J Bone Joint Surg Br. 90 (7): 847–51. doi: 10.1302/0301-620X.90B7.20213. PMID 18591590.^ Boardman DR, Middleton FR, Kavanagh TG (March 2006).

""A benign psoas mass following metal-on-metal resurfacing of the hip"". J Bone Joint Surg Br. 88 (3): 402–4. doi: 10.1302/0301-620X.88B3.16748. PMID 16498023. Korovessis P, Petsinis G, Repanti M, Repantis T (June 2006). ""Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up"". J Bone Joint Surg Am. 88 (6): 1183–91. doi: 10.2106/JBJS. D.02916. PMID 16757749.^ a b Hallab N, Merritt K, Jacobs JJ (March 2001).

""Metal sensitivity in patients with orthopaedic implants"". J Bone Joint Surg Am. 83–A (3): 428–36. PMID 11263649.^http://www.epi.hss.state.ak.us/bulletins/docs/b2010_14.pdf^ a b ""FDA seeks more advice on metal hip implants"".

Reuters. 29 March 2012. Retrieved 20 May 2012.^ Coté, John (July 22, 2007). ""Hip replacement is not viewed as high-risk surgery; Death is rare, but underlying medical condition a factor"". San Francisco Chronicle.^ Medscape Conference Coverage, American Academy of Orthopaedic Surgeons (AAOS) 2009 Annual Meeting, AAOS 2009: Certain Factors Increase Risk for Death After Total Hip Arthroplasty, Barbara Boughton, March 3, 2009.^ Mikael, Mark M.; Hanssen, Arlen D.; Sierra, Rafael J.

(2009). ""Failure of Metal-on-Metal Total Hip Arthroplasty Mimicking Hip Infection"". The Journal of Bone and Joint Surgery. American Volume. 2009 (91): 443–446. doi: 10.2106/JBJS. H.00603. PMID 19181991. Retrieved 2010-05-07.^ Meier, Barry (March 3, 2010).

""As Use of Metal-on-Metal Hip Implants Grows, Studies Raise Concerns"". The New York Times.^ Meier, Barry (March 3, 2010). ""Concerns Over 'Metal on Metal' Hip Implants"". The New York Times.^ ""Medical Device Alert: All metal-on-metal (Mo M) hip replacements"".

Medicines and Healthcare products Regulatory Agency. 22 April 2010. MDA/2010/033. Archived from the original on 25 April 2010. Retrieved 2010-05-07.^ Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2008^ Milosev I, Trebse R, Kovac S, Cör A, Pisot V (June 2006). ""Survivorship and retrieval analysis of Sikomet metal-on-metal total hip replacements at a mean of seven years"". J Bone Joint Surg Am. 88 (6): 1173–82. doi: 10.2106/JBJS. E.00604. PMID 16757748.^ Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW (March 2012).

""Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales"". Lancet. 379 (9822): 1199–204. doi: 10.1016/S0140-6736 (12)60353-5. PMID 22417410.^ Gallagher, James (13 March 2012). ""Metal-on-metal hip replacements 'high failure rate ' "". BBC. Retrieved 20 May 2012.^ Pijls, B. G.; Meessen, J. M. T. A.; Schoones, J. W.; Fiocco, M.; Heide, H. J. L. van der; Sedrakyan, A.; Nelissen, R. G. H. H. (2016).

""Increased Mortality in Metal-on-Metal versus Non-Metal-on-Metal Primary Total Hip Arthroplasty at 10 Years and Longer Follow-Up: A Systematic Review and Meta-Analysis"".

PLOS One. 11 (6): e0156051. doi: 10.1371/journal.pone.0156051. ISSN 1932-6203. PMC 4905643. PMID 27295038.^ Roberts, Michelle (5 March 2012). ""Surgeons call for end to metal hip replacements"". BBC. Retrieved 20 May 2012.^ ""Metal-on-Metal Hip Implants"". Food and Drug Administration. February 10, 2011. Retrieved January 4, 2012.^ ""Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee Meeting Announcement"". Food and Drug Administration. 27 March 2012. FDA-2012-N-0293. Retrieved 20 May 2012.^ FDA Executive Summary Memorandum – Metal-on-Metal Hip Implant System (PDF) (Report).

Food and Drug Administration. 27 June 2012. Retrieved 15 March 2013.^ ""Concerns about Metal-on-Metal Hip Implants"". Food and Drug Administration. 17 January 2013. Retrieved 15 March 2013.^ http://media.jamanetwork.com/news-item/study-suggests-women-have-higher-risk-of-hip-implant-failure/^ Rising, Joshua P.; Reynolds, Ian S.; Sedrakyan, Art (2012). ""Delays and Difficulties in Assessing Metal-on-Metal Hip Implants"". New England Journal of Medicine. 367 (1): e1. doi: 10.1056/NEJMp1206794. PMID 22716934.^ Cibulka MT, White DM, Woehrle J, et al. (April 2009).

""Hip pain and mobility deficits—hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association"". J Orthop Sports Phys Ther. 39 (4): A1–25. doi: 10.2519/jospt.2009.0301. PMC 3963282. PMID 19352008.^ Mc Donald, S; Page, MJ; Beringer, K; Wasiak, J; Sprowson, A (2014).

""Preoperative education for hip or knee replacement"". The Cochrane Database of Systematic Reviews (published 13 May 2014) (5): CD003526. doi: 10.1002/14651858. CD003526.pub3. PMID 24820247.^ van der Meulen, M. C. H.; Allen, W. A.; Giddings, V. L.; Athanasiou, K. A.; Poser, R. D.; Goodman, S. B.; Smith, R. L.; Beaupré, G. S. ""Effect of hemiarthroplasty on acetabular cartilage"".

1996 Project Reports. VA Palo Alto Health Care System's Bone and Joint Rehabilitation Research and Development Center.^ Koutras C, Antoniou SA, Talias MA, Heep H (19 May 2015).

""Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis"". J Arthroplasty. 30 (11): 1938–52. doi: 10.1016/j.arth.2015.05.014. PMID 26067708.^ van den Bekerom MP, Lamme B, Sermon A, Mulier M (August 2008). ""What is the evidence for viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature"". Arch Orthop Trauma Surg. 128 (8): 815–823. doi: 10.1007/s00402-007-0447-z. PMID 17874246.^ Centeno CJ, Kisiday J, Freeman M, Schultz JR (July 2006). ""Partial regeneration of the human hip via autologous bone marrow nucleated cell transfer: A case study"". Pain Physician. 9 (3): 253–6. PMID 16886034. Archived from the original on 2009-02-12.^ Kurtz SM, Ong KL, Lau E, Widmer M, Maravic M, Gómez-Barrena E, de Pina Mde F, Manno V, Torre M, Walter WL, de Steiger R, Geesink RG, Peltola M, Röder C (2011). ""International survey of primary and revision total knee replacement"". Int Orthop. 35 (12): 1783–9. doi: 10.1007/s00264-011-1235-5. PMC 3224613. PMID 21404023.^ Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ (2015). ""Prevalence of Total Hip and Knee Replacement in the United States"". J Bone Joint Surg Am. 97 (17): 1386–97. doi: 10.2106/JBJS. N.01141. PMC 4551172. PMID 26333733.^ ""A study of cost variations for knee and hip replacement surgeries in the U. S."" (PDF). Blue Cross Blue Shield Association. 21 January 2015. Archived from the original (PDF) on 22 October 2015. Retrieved 4 October 2015.^ http://slideplayer.com/slide/1659480/^ Brand, RA; Mont, MA; Manring, M (2011). ""Biographical sketch: Themistocles Gluck (1853–1942)"". Clin. Orthop. Relat. Res. 469 (6): 1525–1527. doi: 10.1007/s11999-011-1836-8. PMC 3094624. PMID 21403990.^ Gomez PF; Morcuende JA (2005). ""Early attempts at hip arthroplasty—1700s to 1950s"". Iowa Orthop J. 25: 25–9. PMC 1888777. PMID 16089067.^http://orthopedics.about.com/cs/jointreplacement1/p/austinmoore.htm External links [ edit]Edheads Virtual Hip Surgery + Surgery Photos AAOS Hip Replacement [ hide]v t e Orthopedic surgery, operations/ surgeries and other procedures on bones and joints ( ICD-9-CM V3 76–81, ICD-10-PCS 0P–S)Bones Facial Jaw reduction Dentofacial osteotomy Genioplasty / Mentoplasty Chin augmentation Orthognathic surgery Spine Coccygectomy Laminotomy Laminectomy Laminoplasty Corpectomy Facetectomy Foraminotomy Vertebral fixation Percutaneous vertebroplasty Upper extremity Acromioplasty Lower extremity Femoral head ostectomy Astragalectomy Distraction osteogenesis Ilizarov apparatus General Ostectomy Bone grafting Osteotomy Epiphysiodesis Reduction Internal fixation External fixation Tension band wiring Cartilage Articular cartilage repair Microfracture surgery Knee cartilage replacement therapy Autologous chondrocyte implantation Joints Spine Arthrodesis Spinal fusion Intervertebral discs Discectomy Annuloplasty Arthroplasty Upper extremity Shoulder surgery Shoulder replacement Bankart repair Weaver–Dunn procedure Ulnar collateral ligament reconstruction Hand surgery Brunelli procedure Lower extremity Hip resurfacing Hip replacement Rotationplasty Anterior cruciate ligament reconstruction Knee replacement / Unicompartmental knee arthroplasty Ankle replacement Broström procedure Triple arthrodesis General Arthrotomy Arthroplasty Synovectomy Arthroscopy Replacement joint imaging: Arthrogram Arthrocentesis Categories: Implants (medicine) Orthopedic surgical procedures Pelvis Prosthetics "

n. Metal on metal (Mo M) hip replacements have been known to cause metal poisoning. If you have had a Mo M hip replacement and you develop symptoms of metallic taste in your mouth I recommend you see your primary or orthopedic physician.

Metallic Taste in Your Mouth?

Home Health & Wellness Body, Mind & Spirit Dental & Oral Q & AMetallic Taste in Your Mouth? I’ve heard that a metal taste in the mouth means something about health, but I can’t remember what it was. Can you help?– December 15, 20160 shares 4 min A metallic taste in the mouth is a common complaint and can be due to a variety of causes – from medication you may be taking to dental problems.

In the absence of other symptoms, it is unlikely that a metallic taste in your mouth indicates serious disease.

But if you haven’t had a thorough general checkup recently, I would suggest seeing your doctor to rule out any health problems such as issues with your liver and kidneys, hyperparathyroidism, or undiagnosed diabetes. You also might consider visiting your dentist, because the funny metallic taste in your mouth could be a symptom of gum disease.

Even if you don’t have gum problems, poor oral hygiene can affect taste. Be sure to brush your teeth carefully at least twice a day and use a tongue scraper to remove the bacteria and debris that can collect on your tongue. Dental work done in the past can break down and alter taste, so your dentist will probably look at that as well.

Not drinking enough water can also contribute to problems with this strange taste in your mouth. Increase your intake and see if it helps. While you don’t necessarily have to drink the standard recommendation of eight 8-ounce glasses of water a day, my rule of thumb is to drink as much of that amount as you can comfortably consume and more than you think you need.

Among the drugs that can cause a metallic or coppery taste in your mouth are antibiotics like Biaxin (clarithromycin); Flagyl (metronidazole) , used to treat a wide variety of infections; drugs used to treat an overactive thyroid; captopril, used to treat high blood pressure ; griseofulvin, used to treat skin infections; lithium, used in bipolar disorder; penicillamine, used for rheumatoid arthritis or to prevent kidney stones; and some drugs used in cancer treatment.

Ayurvedic supplements from India have been found to exceed acceptable amounts of metal such as mercury, lead, or arsenic and I would be cautious about purchasing them online. Multivitamins containing copper, zinc, or chromium, as well as iron or calcium supplements might cause a temporary taste of metal, but typically subside as it’s being processed by your digestive system.

This taste can be symptomatic of a vitamin D overdose , but with most of the population being vitamin D deficient and extremely high dosages (over 10,000 IUs) required, I doubt this is of any great concern. A metal taste is actually more commonly associated with a deficiency of vitamin B12, D, or zinc. While a metallic taste can be a symptom of acute metal poisoning, it’s rare since our bodies are quite efficient at sequestering and neutralizing the contaminants that it’s not able to expel through the skin, liver, and kidneys. Heavy metal poisoning such as having too much lead or copper in the body due to conditions such as Wilson’s Disease, being around fungicides containing copper sulfate, or contaminated drinking water require intervention such as chelation therapy, so consider possible exposures when speaking with your physicia

A taste disorder called dysgeusia could potentially be at the root of phantom flavors as well. When taste cells are stimulated, messages are sent through three specialized nerves to the brain to identify. Sometimes these wires get crossed in cases of dementia, head injury, or as the result of radiation therapy.

Pregnancy hormones can also cause temporary bouts of dysgeusia, especially in the first trimester. Eating citrus fruits or vinegar-marinated foods will help counteract the taste and activate salivation to dilute the unsavory taste of metal.

With such a strong tie between the sense of smell and taste, respiratory infections such as sinusitis can also throw your taste buds for a loop and give you the false perception of a metallic taste. If you rule out all of these possible causes, have been medically evaluated, and still have the metallic taste in your mouth, it might be worthwhile to consult with a practitioner of Chinese medicine.

That system might have an answer for you. Andrew Weil, M. D. Sources: http://jama.jamanetwork.com/article.aspx?articleid=182460 http://livertox.nih.gov/Penicillamine.htm http://www.mayoclinic.org/drugs-supplements/metronidazole-oral-route/precautions/drg-20064745 http://www.mayoclinic.org/drugs-supplements/vitamin-d-and-related-compounds-oral-route-parenteral-route/side-effects/drg-20069609 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011638/?report=details#side_effects http://www.webmd.com/kidney-stones/kidney-stones-medications https://health.clevelandclinic.org/2015/04/8-possible-causes-for-that-metallic-taste-in-your-mouth/ https://www.nidcd.nih.gov/health/taste-disorders https://www.nlm.nih.gov/medlineplus/druginfo/meds/a681039.html https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682823.html https://www.nlm.nih.gov/medlineplus/druginfo/meds/a692005.html https://www.urmc.rochester.edu/encyclopedia/content.aspx? Content Type ID=167&Content ID=total_copper_blood Selfhealing Newsletter, July 2008, pg 7 Selfhealing Newsletter, Nov 2008; pg 2Advertisement Related Weil Products The Weil Vitamin Advisor If you are interested in supplementing your diet, but don’t know where to begin, take the Weil Vitamin Advisor.

Start now!

A: Quick Answer Pure titanium is bright, silvery white. It's a very strong metal that's used to make items requiring extra-tough material, such as jet engine and rocket parts. Titanium is also nonallergenic and doesn't rust, so it's also used to make prosthetics, such as artificial hip and knee joints.

What Color Is Titanium?

Science Colors Q: What Color Is Titanium?

Continue Reading Keep Learning How Do You Download a Color Wheel? What Color Do Green and Purple Make? What Makes the Color Black? Credit: Karl Baron CC-BY-2.0Full Answer Titanium is used to make posts for dental implants because it's biocompatible with the human body.

Its silvery color also makes it a popular choice for jewelry. Titanium is an abundant metal both on Earth and throughout the universe. It's found in stars, in the sun, in meteorites and on the moon; however, it's expensive because of the difficulty involved in refining it.

Learn more about Colors Sources: webelements.com en.wikipedia.org Related Questions Q: What Is a Split-Complementary Color Scheme? A: A split-complementary color scheme combines one base color with the two colors directly adjacent to its opposite or complementary color and not with the co... Full Answer >Filed Under: Colors Q: Why Does Something Appear Black?

A: Wavelengths are reflected off an object, and the human eye recognizes these wavelengths as color. When an individual sees the color black, he is seeing an ... Full Answer >Filed Under: Colors Q: What Does Blue Symbolize? A: The color blue symbolizes many things, including depth and stability. Often considered a male color, blue is also considered to be correlated with cold or ... Full Answer >Filed Under: Colors Q: What Colors Can Someone Mix to Make Sage Green?

A: Sage green can be made by mixing the colors next to green on the color wheel, which are blue and yellow.

However, sage green is a particular green and to f... Full Answer >Filed Under: Colors You May Also Like Q: What Colors Make Black? Q: What Color Is Used for a 100th Anniversary? Q: What Two Colors Make Maroon? Q: How Do You Use Ion Hair Color? Q: What Colors Make White Paint? Q: What Color Is Tiffany Blue?

Recently, titanium, used in orthopedic devices and oral implants, considered as an inert material, can induce toxicity or allergic type I or IV reactions. These reactions to titanium could be responsible for unexplained successive failure cases of dental implants in some patients (named ""cluster patients""

What makes titanium implants toxic and cause allergic and autoimmune reactions?

"Question Asked 5 years ago Nikola Ilankovic40.07 University of Belgrade

What makes titanium implants toxic and cause allergic and autoimmune reactions? Dental implants are made of titanium because of biocompatibililty. Dental implants give titanium toxicity allergic and autoimune reactions.

Dental Implants Titanium Allergy immunology Allergology Clinical Toxicology Share1 Recommendation All Answers ( 11)5 years ago Blake Jane Sapienza University of Rome Thank you for asking this question, I would like to illustrate the begining of this discussion with this article abstract.

[Allergies to dental metals. Titanium: a new allergen]. [Article in French]Evrard L, Waroquier D, Parent D. Abstract Oral allergies are underdiagnosed by dental health professionals.

Patients with an oral allergy complain of various symptoms such as burning or tingling sensations, with or without oral dryness or loss of taste, or of more general symptoms such as headache, dyspepsia, asthenia, arthralgia, myalgia.

The signs of oral allergy include erythema, labial oedema or purpuric patches on the palate, oral ulcers, gingivitis, geographical tongue, angular cheilitis, perioral eczematous eruption, or lichenoid reactions localized on the oral mucosa. There is an increase in the prevalence of oral allergies to metals used in dental materials. Allergy to gold included in dental prosthesis has been well documented since the years eighties.

. Every hip implant has a distinct set of benefits and risks. The key design features of each implant including size, material and dimensions make each system unique. In addition, the same hip implant system will have different outcomes in different patients. It is also important to recognize that hip implants may need to be replaced eventually. Factors that influence the longevity of the device include the patient’s age, sex, weight, diagnosis, activity level, conditions of the surgery, and the type of implant chosen. In the United States, there are currently five types of total hip replacement devices available with different bearing surfaces. These are: Metal-on-Polyethylene: The ball is made of metal and the socket is made of plastic (polyethylene) or has a plastic lining.

Hip Implants

Hip Implants Share Tweet Linkedin Pin it Email Print Hip implants are medical devices intended to restore mobility and relieve pain usually associated with arthritis and other hip diseases or injuries

Ceramic-on-Polyethylene: The ball is made of ceramic and the socket is made of plastic (polyethylene) or has a plastic lining.

Metal-on-Metal: The ball and socket are both made of metal. Ceramic-on-Ceramic: The ball is made of ceramic and the socket has a ceramic lining. Ceramic-on-Metal: The ball is made of ceramic and the socket has a metal lining. An orthopaedic surgeon should determine which hip implant will offer the most benefit and least risk for each patient.

When making a recommendation, orthopaedic surgeons should consider several factors such as the patient’s age, weight, height, activity level, and cause of hip pain.

Hip surgery may involve total hip replacement or it may involve hip resurfacing. During total hip replacement surgery, the damaged portions of the hip joint are removed. The ball (femoral head) is removed and replaced with a prosthetic ball made of metal or ceramic, and the socket (acetabulum) is removed and replaced with a prosthetic cup.

The cup consists of one or two components made of metal, ceramic or plastic. A stem is also placed in the femur to support the femoral head. The femoral head attaches to the taper of the stem. During hip resurfacing surgery, the femoral head is not removed.

Instead the femoral head is trimmed and capped with a metal covering. Any damaged bone and cartilage within the socket are removed and replaced with a metal shell. In hip resurfacing surgery, both components are made of metal. Hip surgery, like any medical procedure, carries risks. The risks of surgery include: A reaction to the anesthesia Heart attack Wound infection Excessive bleeding Blood clots

There may be adverse events after surgery, regardless of the type of hip system implanted including: Hip dislocation, when the ball of the thighbone (femur) slips out of its socket in the hip bone (pelvis)Bone fracture Joint infection Local nerve damage with numbness/weakness Device loosening or breakage

Hip Implants

The implant for a total hip replacement is composed of 3 parts: the stem, the ball, and the socket. The stem is made out of metal, usually cobalt-chrome or titanium, and is placed within the native thighbone. The ball is usually made out of polished metal or ceramic, and fits on top of the stem.

Arthritis of the Hip - Total Hip Replacement (Arthroplasty) and Other Treatments at HSS

"Hip/Knee and Surgical Arthritis Services The Hip Joint Arthritis of the Hip Treatment Total Hip Replacement Frequently Asked Questions Hip/Knee and Surgical Arthritis Services The Hip/Knee and Surgical Arthritis Services are teams of orthopaedic surgeons, nurses, and physiotherapists dedicated to the treatment of adult patients with disorders of the hip and knee. Such conditions include cartilage damage, meniscal tears, ligament injuries, bursitis, and arthritis. Each of the orthopaedic surgeons on the Hip/Knee and Surgical Arthritis Services has undergone extensive specialty training in this field.

They utilize years of experience, cutting edge technology and proven surgical techniques to maximize patient results. Over 4000 procedures are performed yearly at the Hospital for Special Surgery by the surgeons of the Hip and Knee service. Their familiarity with all types of disorders of the hip and knee allows them to effectively treat problems with fewer complications. If you have a problem pertaining to the hip or knee, make an appointment to see one of our hip and knee physicians.

They will formulate an individualized plan combining physical therapy, medications, and/or surgical treatment to remedy your problem. The Hip Joint The hip joint is a ball and socket joint made up of the femur (ball) and the acetabulum (socket).

Illustration of hip joint The ends of the bone are covered with a smooth, glistening layer called articular cartilage. The articular cartilage is what allows the bones to glide smoothly with less resistance than ice sliding on ice.

The articular cartilage can be seen on x-ray as the space in between the ball and the socket. X-ray of hip joint The geometry of the hip joint allows for a large range of motion, and the hip is by nature a very stable joint because of the large contact area between the femur and acetabulum.

In addition, there is a special cartilage surrounding the hip joint called the labrum, which also contributes to stability. Arthritis of the Hip Arthritis of the hip is a condition in which there is loss of the articular cartilage of the femoral head and acetabulum.

This can be seen on x-ray as a loss of the space between the two ends of bone. X-Ray of arthritic hip Because of the loss of the gliding surfaces of the bone, people with arthritis may feel as though their hip is stiff and their motion is limited. Sometimes people actually feel a catching or clicking within the hip. Generally, loading the hip joint with activities such as walking long distances, standing for long periods of time, or climbing stairs makes arthritis pain worse.

The pain is usually felt in the groin, but also may be felt on the side of the hip, the buttock, and occasionally into the knee. Arthritis of the hip usually occurs in people as they enter their 60’s-70’s, but this is variable depending upon factors such as weight, activity level, and hip anatomy. Arthritis may be caused by a variety of factors, including simple wear and tear, inflammatory disorders such as lupus or rheumatoid arthritis, infections, and trauma.

The end result of all these processes is a loss of the cartilage of the hip joint, leading to bone rubbing against bone. Another cause of hip arthritis in younger patients is femoroacetabular impingement, in which abnormal anatomy leads to premature cartilage deterioration. Treatment Depending upon the severity of arthritis and the patient’s age, hip arthritis may be managed in a number of different ways.

Treatment may consist of non-operative or operative methods, or a combination of both. Non-operative The first line of treatment of hip arthritis includes activity modification, anti-inflammatory medication, hip injections, and weight loss.

Giving up activities that make the pain worse may make this condition bearable for some people. Anti-inflammatory medications such as ibuprofen,naprosyn and the newer Cox-2 inhibitors help alleviate the inflammation that may be contributing to the pain.

Furthermore, studies have shown that walking with a cane in your opposite hand significantly decreases the forces across the hip joint. Finally, weight loss helps decrease the force that goes across the hip joint. A combination of these non-operative measures may help ease the pain and disability caused by hip arthritis. Operative If the non-operative methods have failed to make your condition bearable, surgery may be the best option to treat hip arthritis.

The exact type of surgery depends upon your age, anatomy, and underlying condition. Some examples of surgical options to treat arthritis include an osteotomy, which consists of cutting the bone to realign the joint; total hip replacement, and hip resurfacing. X-Ray of THAAn osteotomy is a good alternative if the patient is young and the arthritis is limited to a small area of the hip joint.

It allows the surgeon to rotate the arthritic bone away from the hip joint, placing weightbearing on relatively uninvolved portions of the ball and socket.

The advantage of this type of surgery is that the patient’s own hip joint is retained and could potentially provide many years of pain relief without the disadvantages of a prosthetic hip. The disadvantages include a longer course of rehabilitation and the possibility that arthritis could develop in the newly aligned hip.

Hip implant Hip replacement surgery involves cutting away the arthritic bone and inserting a prosthetic joint. Both the arthritic ball and socket are replaced, usually with a metal ball and a plastic socket. The ball is placed upon a stem that is implanted within the femur (thigh bone), with or without cement.

The socket is inserted within the native acetabulum after removing the arthritic surface. Implant in hip Total Hip Replacement History Total hip replacement surgery has evolved over the years into a reliable and effective way to relieve disabling pain and allow patients to resume their active lives.

Many of the advances in total hip replacement surgery were pioneered by Sir John Charnley, a British orthopaedist, in the early 1960’s. Dr. Charnley’s great contributions to this procedure include creating the first low-friction total hip arthroplasty by replacing the arthritic hip joint with a metal ball and polyethylene plastic socket.

He fixed the prosthesis to the bone with polymethylmethacralate cement, which acted as a grouting to bond the implant to the native bone.

Today, many of his principles form the foundation of modern total hip replacement surgery. Many patients who have had their hip replaced using Dr. Charnley’s technique still have a functioning prosthesis after over 30 years.

The surgeons of the Hip and Knee service utilize the surgical techniques of Sir John Charnley as the foundation of modern total hip replacement surgery, along with modern modifications designed to make the implants last longer. Today, approximately 150,000 total hip replacements are performed annually in the United States. Decision to have surgery People often wonder when and why they should have their hip replaced. This is an individualized question that depends upon a person’s activity level and functional needs.

Many people with arthritis live with pain that prevents them from participating in activities that they love, or pain that interferes with their sleep; others are so debilitated that they have difficult putting on their shoes and socks.

Total hip replacement offers a solution to the problem of arthritis and is performed with the goal of pain relief and resumption of activity. A consensus statement by the National Institutes of Health stated ""total hip replacement (THR) is one of the most successful surgical procedures and provides immediate and substantial improvement in a patient's pain, mobility, and quality of life.

Compared to treatments for other chronic debilitating diseases, THR is highly cost effective"" (1994). A total hip replacement is considered a major operation, and the decision to undergo total hip replacement is not a trivial one. People usually decide to undergo surgery when they feel they can no longer live with the pain of their arthritis. The prosthetic implant

The implant for a total hip replacement is composed of 3 parts: the stem, the ball, and the socket. The stem is made out of metal, usually cobalt-chrome or titanium, and is placed within the native thighbone. The ball is usually made out of polished metal or ceramic, and fits on top of the stem.

The socket is usually a combination of a plastic liner and a cobalt-chrome or titanium backing. All together, the components weigh about 1 to 2 lbs. They are fixed to the bone either with bone-ingrowth surfaces or with cement. There are alternative materials to metal and plastic, namely ceramic-on-ceramic, and metal-on-metal. Each of these material combinations has advantages and disadvantages; learn more about each of these bearing materials by reading our piece on implant bearing surface materials.

The procedure The total hip replacement is performed in an operating room with a special laminar airflow system, which helps reduce the chance of infection. Your surgeon will be wearing a ""spacesuit"", also designed to reduce the chance of infection. The entire surgical team will consist of your surgeon, two to three assistants, and a scrub nurse.

The anesthesia for a total hip replacement is given through an epidural catheter, which is a small tube inserted into the back. This is the same type of anesthesia given to women in labor. You will be made numb from the waist down so that you will not feel anything.

The catheter stays in for 1-2 days after the surgery to help with your post-operative pain control.

During the course of the operation, you can be as awake or as sleepy as you want to be. For more information regarding anesthesia for hip surgery, read our article entitled Your Total Hip Replacement at HSS: What to Expect. After the epidural block is administered, you will be placed on your side. The incision for a total hip replacement is made along the side of your hip.

The incision will measure anywhere from 4 to 10 inches, depending upon your anatomy. It is well-covered by undergarments and is usually not visible when wearing clothes.

The arthritic ball and socket are exposed and removed with power instruments. The bone is prepared to receive the artificial hip joint, and then the prosthesis is inserted. During the closure, two drains may be inserted around the operated area to assist with the evacuation of blood.

A combination of staples and/or sutures are used to close the skin. The entire operation will take from 1 to 2 hours. Afterwards, you will be brought to the recovery room, where your blood work will be checked, and an x-ray of your new hip will be taken.

Most patients can be brought to a regular room within a few hours; others will need to stay overnight in the recovery room, as determined by your surgeon and anesthesiologist. Patients generally stay in the hospital for 3 to 4 days following total hip replacement surgery. Younger, more fit patients may be able to leave within 48 hours of surgery if deemed safe by our doctors and therapists.

Learn more about our Fast Track program here. Risks Some of the risks of the surgical procedure include the loss of blood, formation of a clot in your leg, and the chance of infection. The overall incidence of these risks is very small. They should be discussed with your surgeon prior to proceeding with the operation.

Some of the risks of having a prosthetic hip include: The chance that the ball will dislocate (come out of the socket)The parts may loosen or wear out over time The prosthesis may become infected Again, these issues will be discussed with you by your surgeon.

Longevity A total hip replacement has a lifespan much like anything with mechanical parts. Its longevity depends upon a variety of factors, including: Patient weight Patient activity The mechanical properties of the prosthesis The question of how long a prosthesis will last has been studied in detail over the years. Current studies indicated that about 80% of prostheses will function well for 20 years. New developments Many new developments are occurring in the area of hip surgery. The Hip and Knee service is comprised of world-renowned surgeons who have made countless contributions to the advancement of the field.

A few of the areas of interest include: The use of a special radiographic technique to assess stability and wear of the prosthesis Examining the soft tissue structures after surgery with ultrasound to assess healing Prevention of deep vein thrombosis after hip replacement surgery The Hip/Knee and Surgical Arthritis services have numerous physicians who specialize in total hip replacement.

For more information, click on the links to their biographical sketches. Pre-operative orientation Some patients will be asked to donate a pint of their own blood in the weeks preceding hip replacement surgery. This helps reduce the need for a blood transfusion from our blood bank. Almost all of the patients will receive the donated blood as a transfusion after surgery. Rarely, an additional transfusion is necessary from our blood bank. The blood from the blood bank is carefully screened to the best of our ability to detect any infectious diseases.

You will be asked to see a medical doctor at HSS prior to your surgery. This is a precaution to make certain that you are healthy enough to undergo hip replacement surgery.

In the course of this workup, you may be asked to have additional testing to examine your heart and lung function. After your surgery, this medical doctor will see you in the hospital. Post-operative course Immediately after total hip replacement surgery, you will be in the recovery room.

Most patients are able to go to a regular room after a few hours, when the sensation returns in your legs. You will be given a pain pump connected to your epidural catheter which will allow you to control when you are given pain medicine.

Most people are quite comfortable with the pain pump in place. On the day of surgery, you may do some of the exercises as instructed by your physical therapist, including buttock clenches and moving the feet up and down.

You will be allowed to take some ice chips after surgery to wet your mouth, but drinking liquids or eating may cause you to become nauseated. You will have a catheter in your bladder so that you do not have to worry about urinating. Once you regain the movement in your feet, you may be allowed to sit up, stand, and take a few steps with the assistance of a walker and a therapist.

The first day after surgery will be an active one, designed to help you get more mobile. You will meet our physiotherapists, who will instruct you in more exercises to perform while in bed.

In addition, they will help you stand and take a few steps with a walker. You will be taught the positions to avoid with a hip replacement, as well as the safe positions. Generally, you will be allowed to drink clear liquids. In the next few days, you will find it easier and easier to move about. You will be freed up from the pain and urinary catheters. Pain medication will be given in the form of tablets.

Eventually you will progress to walking with a cane or crutches. On the second day after surgery, if your bowels have shown evidence of recovery, you will be allowed to eat regular food.

Depending upon your age, pre-operative physical condition, and insurance coverage, you may be a candidate for short-term placement in a rehabilitation facility. Otherwise, you will be discharged home and a physiotherapist will come to your house to continue rehabilitation. A case manager will discuss these options with you and help you plan for your eventual return home.

Your return to activity will be guided by your surgeon and therapists. Generally, patients are able to walk as much as they want by six weeks post-operatively. Patients are able to resume driving at six weeks. At eight weeks, patients are able to resume playing golf and swimming; at 12 weeks, they may play tennis. Your surgeon will help you decide what activities you may resume. Frequently Asked Questions Q: What is arthritis and what causes it?

A: Arthritis is an umbrella term for a number of disease entities in which the joints become inflamed and the cartilage that lines the bones deteriorates. Eventually, bone on bone wear occurs. As the disease progresses, patients often experience pain, stiffness, and disability.

The vast majority of people diagnosed have osteoarthritis and in most cases the cause of their condition cannot be identified. One or more joints may be affected. Rheumatoid arthritis (and other forms of inflammatory arthritis) is a disease that affects the entire system and multiple joints.

This type of arthritis is an autoimmune disorder in which the body perceives the cartilage to be a foreign substance and attacks it. Q: If I have arthritis in one hip, will I get it in the other? A: If you have been diagnosed with osteoarthritis, having an affected hip does not mean that you will develop arthritis in the opposite hip.

In contrast, patients with rheumatoid arthritis often develop problems in both hips. Q: Can I have joint replacement on both hips at the same time?

A: Yes, healthy patients younger than 75 years old, with no cardiopulmonary disease, may be candidates for such surgery. Your orthopaedist can tell you more about what is involved. Q: What is a prosthetic hip made of? A: The implant for a total hip replacement is composed of 3 parts: the stem, the ball, and the socket.

The stem is made out of metal, usually cobalt-chrome or titanium, and is placed within the native thighbone. The ball is usually made out of polished metal or ceramic, and fits on top of the stem. The socket is usually a combination of a plastic liner and a cobalt-chrome or titanium backing.

A more detailed discussion of materials can be found by reading our piece on implant bearing surface materials. Q: Will my new hip set off the metal detector at the airport? A: While hip implants generally do not set off metal detectors, more sensitive machines may register the presence of the implant. Some physicians give their patients cards to show at the airport that explain that the bearer has received a hip implant containing metal.

Q: How soon after surgery can I resume driving? A: Most patients can resume driving at six weeks after surgery. Q: How long will the replacement last? A: Current studies indicated that about 80% of prostheses will function well for 20 years. If your prosthesis wears out you may be a candidate for a second hip replacement. Updated: 6/14/2010Diagnostic imaging examinations provided by HSS Radiologists Images © Zimmer, Inc. Used by permission only. "

Recently, cobalt poisoning has been seen from the wear and tear of some cobalt/chromium metal-on-metal hip implants. This type of implant is an artificial hip socket that is created by fitting a metal ball into a metal cup.

Cobalt poisoning

Cobalt poisoning Cobalt is a naturally occurring element in the earth's crust. It is a very small part of our environment and very small amounts are needed for many animals and humans to stay healthy. Cobalt poisoning can occur when you are exposed to large amounts of cobalt. There are three basic ways that cobalt can cause poisoning.

You can swallow too much of it, breathe too much into your lungs, or have it come in constant contact with your skin.

Sometimes, metal particles (cobalt) are released as the metal ball grinds against the metal cup when you walk. These metal particles (ions) can get released into the hip socket and sometimes the bloodstream, causing cobalt toxicity. This article is for information only.

Cobalt poisoning

In a traditional total hip replacement, the head of the thighbone (femoral head) and the damaged socket (acetabulum) are both removed and replaced with metal, plastic, or ceramic components. In hip resurfacing, the femoral head is not removed, but is instead trimmed and capped with a smooth metal covering.

Disadvantages of Hip Resurfacing

Patients with advanced arthritis of the hip may be candidates for either traditional total hip replacement (arthroplasty) or hip resurfacing (hip resurfacing arthroplasty).

Each of these procedures is a type of hip replacement, but there are important differences. Your orthopaedic surgeon will talk with you about the different procedures and which operation would be best for you. Description

The damaged bone and cartilage within the socket is removed and replaced with a metal shell, just as in a traditional total hip replacement. (Left)right,Advantages of Hip Resurfacing The advantages of hip resurfacing over traditional total hip replacements is an area of controversy among orthopaedic surgeons. A great deal of research is currently being done on this topic. Hip resurfacings may be easier to revise. Because the components (called implants) used in hip replacements and hip resurfacings are mechanical parts, they can — and do — wear out or loosen over time.

This typically occurs between 10 and 20 years after the procedure, although implants may last longer or shorter periods of time.

If an implant fails, an additional operation may be necessary. This second procedure is called a revision and it can be more complicated than the initial operation. Because hip resurfacing removes less bone from the femur (thighbone) than a traditional hip replacement, many surgeons believe it is easier to exchange implants that fail after hip resurfacing.

Decreased risk of hip dislocation. In hip resurfacing, the size of the ball is larger than in a traditional hip replacement, and it is closer to the size of the natural ball of your hip.

Because of this, it may be harder to dislocate. This stance is controversial because several factors can affect the risk of dislocation, such as surgical approach, and the type and size of the implants used.

More normal walking pattern. Several studies have shown that walking patterns are more natural following hip resurfacing compared to traditional hip replacement. These differences in walking are quite subtle, however, and special instruments are needed to measure them. Disadvantages of Hip Resurfacing Femoral neck fracture. A small percentage of hip resurfacing patients will eventually break (fracture) the thighbone at the femoral neck. If this occurs, it is usually necessary to convert the hip resurfacing into a traditional hip replacement.

A femoral neck fracture is not possible with a traditional hip replacement because the femoral neck is removed during this procedure. However, fractures around the implants can still occur with a traditional hip replacement. Metal ion risk.

In hip resurfacing, a metal ball moves within a metal socket. Over time, this leads to the production of tiny metal particles called ions. Some patients may develop sensitivity or allergy to the metal particles, which may cause pain and swelling.

Also, there are concerns that the metal particles may increase the risk of cancer, although this has never been proven. Some types of traditional hip replacements also consist of a metal ball and a metal socket and these replacements run the same potential risks. Ask your doctor for more information about metal-on-metal implants. Hip resurfacing is a more difficult operation. Hip resurfacings are more difficult than total hip replacements for surgeons to perform. As such, a larger incision is usually required for a hip resurfacing.

Related Articles Diseases & Conditions Osteoarthritis of the Hip Recovery Activities After Hip Replacement Treatment Preparing for Joint Replacement Surgery Treatment Patient Story: Hip Resurfacing Candidates for Surgery Your doctor may recommend surgery if you have more advanced osteoarthritis and have exhausted the nonsurgical treatment options.

Surgery should only be considered if your hip is significantly affecting the quality of your life and interfering with your normal activities. Unlike hip replacement, hip resurfacing is not suitable for all patients. Generally speaking, the best candidates for hip resurfacing are younger (less than 60), larger-framed patients (often, but not always male) with strong, healthy bone. Patients that are older, female, smaller-framed, with weaker or damaged bone are at higher risk of complications, such as femoral neck fracture.

A comprehensive evaluation by your orthopaedic surgeon will help you determine if you are a good candidate for hip resurfacing.

Your Surgery Before Surgery You will likely be admitted to the hospital on the day of surgery. Before your procedure, a doctor from the anesthesia department will evaluate you. He or she will review your medical history and discuss anesthesia choices with you. You should also have discussed anesthesia choices with your surgeon during your preoperative clinic visits.

Anesthesia can be either general (you are put to sleep) or spinal (you are awake but your body is numb from the waist down). Your surgeon will also see you before surgery and sign your hip to verify the surgical site. Surgical Procedure A hip resurfacing operation typically lasts between 1 1/2 and 3 hours.

Your surgeon will make an incision in your thigh in order to reach the hip joint. The femoral head is then dislocated out of the socket. Next, the head is trimmed with specially designed power instruments. A metal cap is cemented over the prepared femoral head.

The cartilage that lines the socket is removed with a power tool called a reamer. A metal cup is then pushed into the socket and held in place by friction between the bone and the metal.

Once the cup is in place, the femoral head is relocated back into the socket and the incision is closed. After the surgery you will be taken to the recovery room, where you will be closely monitored by nurses as you recover from the anesthesia. You will then be taken to your hospital room. Complications As with any surgical procedure, there are risks involved with hip resurfacing.

Your surgeon will discuss each of the risks with you and will take specific measures to help avoid potential complications. Although rare, the most common complications of hip resurfacing are: Blood clots. Blood clots in the leg veins are the most common complication of hip resurfacing surgery.

Blood clots can form in the deep veins of the legs or pelvis after surgery. Blood thinners such as warfarin (Coumadin), low-molecular-weight heparin, aspirin, or other drugs can help prevent this problem. Infection. You will be given antibiotics before the start of your surgery and these will be continued for about 24 hours afterward to prevent infection.

Injury to nerves or vessels. Although it rarely happens, nerves or blood vessels may be injured or stretched during the procedure. Femoral neck fracture Dislocation Risks of anesthesia Recovery In most cases, patients go home 1 to 4 days after surgery. You may begin putting weight on your leg immediately after surgery, depending on your doctor's preferences and the strength of your bone.

You may need a walker, cane, or crutches for the first few days or weeks until you become comfortable enough to walk without assistance. You can expect some pain and discomfort for at least a week after surgery. Your doctor may prescribe pain medicine, if needed. Many types of pain medication are available to help control pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics.

Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster. Opioids can provide excellent pain relief, however, they are a narcotic and can be addictive. It is important to use opioids only as directed by your doctor.

You should stop taking these medications as soon as your pain starts to improve. A physical therapist will give you exercises to help maintain your range of motion and restore your strength. You will continue to see your orthopaedic surgeon for follow-up visits in his or her clinic at regular intervals. You will most likely resume your regular activities of daily living by 6 weeks after surgery. To Top

In fact, titanium alloys are widely used in both medicine and dentistry, for dental implants, pacemakers, stents, orthodontal brackets, and orthopedic implants (e.g., hip, shoulder, knee, or elbow). Not only is titanium strong, but many consider it biocompatible: it forms an oxide layer when exposed to air, and this purportedly results in reduced corrosion and superior osseointegration.

Titanium Implants Can Cause Cancer

"Posted in: Cancer Titanium Implants Can Cause Cancerhttp://articles.mercola.com/sites/articles/archive/2009/08/08/Be-VERY-Careful-When-Replacing-Missing-Teeth.aspx Be VERY Careful When Replacing Missing Teeth By Dr. Lina Garcia A dental implant is one option for replacing missing or badly diseased teeth.

It is composed of an artificial root that looks like a post or screw and is covered with a dental crown. Treatment involves the surgical placement of the implant into the jawbone, where it is allowed to fuse to the bone in a process called “osseointegration.”Once healed, the implant acts as an anchor for an artificial replacement tooth, or crown.

The crown is made to blend in with your other teeth and is permanently attached to the implant. A typical dental implant is made of pure titanium and/or a titanium alloy.

So why should you reject the standard titanium metal implant? Titanium is NOT Biologically Inert Titanium implants release metal ions into your mouth 24 hours a day, and this chronic exposure may trigger inflammation, allergies, and autoimmune disease in susceptible individuals. They are a precursor to disease. Cases of intolerance to metal implants have been reported over the years, and the removal of this incompatible dental material has resulted in reduced metal sensitivity and long-term health improvement in the majority of patients.

Titanium has the potential to induce hypersensitivity as well as other immunological dysfunctions. One study investigated 56 patients who developed severe health problems after receiving titanium-based dental implants. These medical problems included muscle, joint, and nerve pain; chronic fatigue syndrome; neurological problems; depression; and skin inflammation.

Removal of the implants resulted in a dramatic improvement in the patients’ symptoms, as well as a decrease in many patients’ sensitivity to titanium. For example, a 54-year-old man with a titanium dental implant and four titanium screws in his vertebra was so sick that he could not work. He suffered from chronic fatigue syndrome, cognitive impairment, Parkinson-like trembling, and severe depression.

Six months after the removal of the implants and screws, he was able to return to work. In another case, a 14-year-old girl developed inflammatory lesions on her face six months after being fitted with titanium orthodontal brackets. She was also mentally and physically exhausted, and her reactivity to titanium skyrocketed. Within nine months of replacing the brackets with a metal-free material, her facial lesions had almost completely healed, she was healthy and active, and her sensitivity to titanium returned to a normal level.

Titanium Implants Can Cause Cancer Another complication of the use of implanted titanium is its potential to induce the abnormal proliferation of cells (neoplasia), which can lead to the development of malignant tumors and cancer. Through rare, it is a well-known complication of orthopedic surgery that involves the implantation of metallic hardware.

Furthermore, researchers recently uncovered the first reported case of a sarcoma arising in association with a dental implant. As described in the August 2008 issue of JADA (The Journal of the American Dental Association), a 38-year-old woman developed bone cancer eleven months after receiving a titanium dental implant. Luckily, she was successfully treated with chemotherapy, but the authors recommended further research into the tumor-causing potential of dental implants in light of their increasing popularity and their ability to last for longer periods of time.

Why You Want to Avoid ANY Kind of Metal in Your Mouth Finally, the presence of any metal in your mouth sets the stage for “galvanic toxicity,” because your mouth essentially becomes a charged battery when dissimilar metals sit in a bed of saliva.

All that is needed to make a battery is two or more different metals and a liquid medium that can conduct electricity (i.e., an electrolyte). Metal implants, fillings, crowns, partials, and orthodontics provide the dissimilar metals, and the saliva in your mouth serves as the electrolyte. An electric current called a galvanic current is then generated by the transport of the metal ions from the metal-based dental restorations into the saliva.

This phenomenon is called “oral galvanism,” and it literally means that your mouth is acting like a small car battery or a miniature electrical generator.

The currents can actually be measured using an ammeter!Oral galvanism creates two major concerns. First, the electric currents increase the rate of corrosion (or dissolution) of metal-based dental restorations. Even precious metal alloys continuously release metal ions into your mouth due to corrosion, a process that gnaws away bits of metal from the metal’s surface.

These ions react with other components of your body, leading to sensitivity, inflammation, and, ultimately, autoimmune disease. Increasing the corrosion rate, therefore, increases the chance of developing immunologic or toxic reactions to the metals.

Second, some individuals are very susceptible to these internal electrical currents. Dissimilar metals in your mouth can cause unexplained pain, nerve shocks, ulcerations, and inflammation, and many people also experience a constant metallic or salty taste, or a burning sensation in their mouth.

Moreover, there is the concern that oral galvanism directs electrical currents into brain tissue and can disrupt the natural electrical current in your brain. New Alternatives to Titanium Implants In recent years, high-strength ceramic implants have become attractive alternatives to titanium implants, and some current research has focused on the viability of materials such as zirconia (the dioxide of zirconium, a metal close to titanium on the periodic table).

Metal-free zirconia implants have been used in Europe and South America for years, but they have only recently become available in the U. S. Zirconia implants are highly biocompatible to the human body and exhibit minimum ion release compared to metallic implants.

Studies have shown that the osseointegration of zirconia and titanium implants are very similar, and that zirconia implants have a comparable survival rate, thereby making them an excellent alternative to metal implants. Moreover, zirconia ceramics have been successfully used in orthopedic surgery to manufacture ball heads for total hip replacements.

Therefore, given that titanium dental implants can induce metal sensitivity, inflammation, autoimmunity, and malignant tumors, while zirconia implants are metal-free but just as durable, why invite chronic metal exposure? Your body would surely benefit from choosing the biocompatible, ceramic dental implant over the standard, titanium metal implant.

Dr. Lina Garcia, a committed holistic dentist for 25 years, has dedicated her practice to using dental materials that will support your health and not disease. In her practice, she offers only metal-free restorative materials, including zirconia implants. References: Chaturvedi TP. An overview of the corrosion aspect of dental implants (titanium and its alloys). Indian J Dent Res 2009; 20:91-8.

Depprich R, Zipprich H, Ommerborn M, Mahn E, Lammers L, Handschel J, Naujoks C, Wiesmann H, Kubler NR, Meyer U. Osseointegration of zirconia implants: an SEM observation of the bone-implant interface. Head & Face Medicine 2008, 4:25. Huggins, H. It’s all in your head: the link between mercury amalgams and illness. 1993, Avery Publishing Group Inc., Garden City Park, New York. Lambrich M, Iglhaut. Vergleich der Überlebensrate von Zirkondioxid- und Titanimplantaten.

(“Comparison of the survival rates for zirconia and titanium implants.”) Zeitschrift für Zahnärztliche Implantologie (Journal of Dental Implantology) 2008; 24 (3). Mc Guff HS, Jeim-Hall J, Holsinger FC, Jones AA, O’Dell DS, Hafemeister AC. Maxillary osteosarcoma associated with a dental implant.

JADA 2008; 139:1052-59. Muller KE, Valentine-Thon E. Hypersensitivity to titanium: Clinical and laboratory evidence. Neuro Endocrinol Lett. 2006; 27 (Suppl1): 31–35. Muris J, Feilzer AJ. Micro analysis of metals in dental restorations as part of a diagnostic approach in metal allergies. Neuro Endocrinol Lett. 2006; 27 (Suppl 1): 49–52. Stejskal VD, Hudecek R, Stejskal J, Sterzl I. Diagnosis and treatment of metal-induced side-effects. Neuro Endocrinol Lett 2006; 27 (Suppl 1): 7–16. Stejskal J, Stejskal VD. The role of metals in autoimmunity and the link to neuroendocrinology.

Neuro Endocrinol Lett. 1999; 20 (6): 351–364. Ziff S, Ziff MF. Dentistry without mercury. 1995 ed. Bio-Probe, Inc., Orlando, Florida. Dr. Mercola’s Comments: First, I’d like to thank Dr. Garcia for this excellent review of the problems with metal dental implants, and the emergence of zirconium, which appears to be a far healthier alternative to traditional metal implants.

It goes without saying that your aim should be to avoid getting to the point where an implant is necessary, but if the damage is already done, or if you have an acute oral trauma, you now at least have some information that can help you make safer, healthier choices.

The impact your oral health has on the rest of your body is often overlooked, but that does not make it any less important. Likewise, any work you have done to your teeth can have a serious impact on your health, which I’ll go over shortly. Having a healthy set of teeth is a powerful predictor of your overall health. In my experience, sick patients who display near cavity-free teeth tend to get well fairly quickly.

If, on the other hand, their mouths are full of fillings and root canals, the prognosis is not nearly as good. The Link Between Oral Health and Disease In the 1900s, Dr. Weston A. Price did extensive research on the link between oral health and physical diseases. He was one of the major nutritional pioneers of all time, and his research is just as relevant today as it was back then.

He discovered that native tribes that still ate their traditional diet had nearly perfect teeth and were almost 100 percent free of tooth decay. Certain diseases were also nearly unheard of, such as chronic diseases of the heart, lungs, kidneys, liver, joints, and skin – the types of diseases currently plaguing our society.

Once these tribal populations were introduced to sugar and white flour, their health, and their perfect teeth, rapidly deteriorated. His classic book Nutrition and Physical Degeneration details his fascinating findings and is well worth reading. There’s no doubt that our modern diet has changed the inherent health of our teeth and our bodies, and is the cause of nearly all our modern health challenges.

Today it’s quite rare to find an adult with teeth that has not been marred by dental work of some kind, from mercury amalgams (silver fillings) to crowns, to root canals and bridges and implants. If you eat properly and maintain optimal health, you’re highly unlikely to develop cavities. They really only occur when you’re eating the wrong foods, and growing up, I did not eat the right foods.

As a result, I, as so many others, had a mouth full of mercury fillings. For an excellent illustration of what these fillings do once in your mouth, take a look at this video.

I eventually had them replaced with gold fillings, only to later realize that gold fillings and crowns cause problems too.

So after I’d already made an investment of several thousand dollars, I decided to replace them all again. This time with non-metal crowns, for the most part. Conventional Versus Biological Dentistry Unfortunately, conventional dentistry has generally only evaluated materials to be used for their mechanical characteristics, in large part ignoring the impact that particular material might have on the rest of your body.

Case in point: silver fillings, which are 50 percent mercury, an extremely potent neurotoxin, have been used for over 150 years. Likewise, the fact that various metals have been used for years to fashion tooth implants is by no means an indication of safety.

We are currently fighting to have mercury fillings banned completely in the U. S., as it has been in some other European countries, and hope to be able to get this toxic material off the market in the near future.

Until then, it’s up to you to refuse them, or find a dentist who has switched to safer alternatives. My own struggles with my teeth led me to learn about in the mid 1990s and embrace biological dentistry, also known as holistic or environmental dentistry.

In a nutshell, biological dentistry views your teeth and gums as an integrated part of your entire body, and any medical treatments performed takes this fact into account. The primary aim of this type of holistic dentistry is to resolve your dental problems while impacting the rest of your body as little as possible.

Unknowingly, your health can be significantly impacted by the treatments received at your conventional dentist’s office. Oftentimes the impact is just not immediately noticeable. Implants Can Exacerbate Autoimmune Diseases Currently, implants continue to be done without biocompatibility testing, and they are often used in extraction sites where cavitations (inflammation) are already developing.

Autoimmune diseases seem to be often aggravated or even initiated by metal implants. Additionally, an event called oral galvanism occurs when you place two dissimilar metals in your mouth.

You essentially create a battery that will serve to drive the ions of the metals out of the metal into your mouth and also generate electricity.

You may not realize it, but tiny electrical currents are foundational to the way your body operates biologically, and when you introduce a foreign source of electricity, especially one that is constantly there, you can introduce imbalances that can contribute to health problems. This galvanic toxicity created when the metal in your mouth reacts with your saliva can over-stimulate your brain. This is true whether the metal in your mouth is a silver filling, a metal crown, or a metal dental implant.

Common signs and symptoms of galvanic toxicity include: A metal taste in your mouth A sensation of an electric charge when using metal utensils Chronic insomnia Finding suitable materials to replace the metals currently used is proving to be a challenge.

However, based on Dr. Garcia’s review of zirconium, you may now have access to a far better option if you need to have an entire tooth replaced. Hopefully, by implementing the strategies below, it will never get to that point. Health Implications of Cavities and Root Canals Dental caries (cavities) is a reflection of systemic illness in your body.

And, if you let it go long enough to where the cavity gets into the nerve and blood vessels, bacteria can hide in the tiny tubules of the dentin, causing chronic inflammation and infection that is near impossible to eradicate.

So, never ignore signs like a toothache or a cavity. Also remember that they are major clues that your body is not optimally healthy and lifestyle changes are in order if you want to stop or reverse the damage that is already taking place.

As for root canals, nearly all contain colonies of bacteria that can cause major illnesses in your body. Even antibiotics won’t help in these cases, because the bacteria are protected inside of your dead tooth.

And when these bacteria migrate, via your bloodstream to other areas of your body, they can contribute to or cause more serious ailments such as: Heart and circulatory diseases Arthritis and rheumatism Brain and nervous system diseases Attending to your dental health is just as important as eating right and exercising for physical health.

The two are connected, not separate systems, and each affects the other. Do You Know What Makes for Healthy Teeth?

Although many would like to believe that regular brushing and flossing is all that’s needed for healthy teeth, it’s by no means the most important factor determining your oral health. Others insist fluoride is the key. Don’t believe it! The most important aspect is actually your diet, sans fluoridated water.

Hygiene practices are simply preventive aids that help minimize the destructive effect of a modern, refined diet, and fluoride causes far more health problems than it’s believed to fix. Another alternative to conventional dental fillings worth mentioning is tooth regeneration. The materials used for this procedure include solutions of chemicals that can actually rebuild decayed teeth.

Enamel and dentin, the natural materials that make teeth the strongest pieces of your body, may some day replace conventional fillings. Although this would certainly be a step up from using toxic substances like mercury to fill your teeth, it’s still a type of band aid. If you want to have healthy teeth, and a similarly healthy body, you must start from the inside out, and that means cleaning up your diet. Healthy Diet, Healthy Teeth When Dr. Price studied native diets, he noticed certain similarities in the foods that were keeping them so healthy.

Among them: The foods were natural, unprocessed, and organic (and contained no sugar except for the occasional bit of honey or maple syrup). The people ate foods that grew in their native environment. In other words, they ate locally grown, seasonal foods. Many of the cultures ate unpasteurized dairy products, and all of them ate fermented foods. The people ate a significant portion of their food raw.

All of the cultures ate animal products, including animal fat and, often, full-fat butter and organ meats. When Dr. Price analyzed his findings, he found that the native diets contained 10 times the amount of fat-soluble vitamins, and at least four times the amount of calcium, other minerals, and water-soluble vitamins as that of Western diets at that time.

Their diets were also rich in enzymes because they ate fermented and raw foods (enzymes help you to digest cooked foods). The native diets also had at least 10 times more omega-3 fat than modern diets and FAR less omega-6 fats.

And as some of you may know, a diet that is lacking in omega-3 fats, and heavy on omega-6 fats from vegetable oils (which are consumed so heavily today) is a recipe for disaster. So, if you want to eat your way to healthy teeth, taking a lesson from these previous native generations is essential. You should: Find out your nutritional type, and eat accordingly. This will tell you which foods are ideal for your unique biochemistry. Eat at least one-third of your food raw. Avoid processed foods, sugar, refined flour and all artificial flavorings, colorings, and artificial sweeteners.

Instead, seek out locally grown foods that are in-season. Enjoy fermented foods like natto, kefir and cultured veggies. Make sure you eat enough healthy fats, including those from animal sources like omega-3 fat, and reduce your intake of omega-6 from vegetable oils.

All of the brushing and flossing in the world will not give you the healthy teeth that the above steps will, so if you value your pearly whites, get started eating a healthier diet today. Find a Good Biological Dentist Everyone needs a good dental consultant and, unfortunately, they are hard to find.

There is no shortage of competent skilled caring dentists, but there is of ones who believe in the principles I outlined above. There are several strategies you can use to locate one. Ideally you would ask a friend, relative or neighbor who knows of one. If that fails you can contact several good natural health food stores in your area and ask a number of the employees or even the owner.

Once you obtain the same name a number of times that is typically a good sign. Additionally there are organizations like D. A. M. S and International Academy of Oral Medicine and Toxicology that have referral setups. Do You Make These Mistakes with Your Hand Hygiene? Find Out More Community Comments (26) Loading Please Wait Posted On Jul 20, 2009What a timely article!

My wife recently lost 3 front tetth in a softball accident (the balls aren’t so soft after all) and we were looking into implants. What did they want to use? Titanium. I’ll have to see if there are even any dentists around that do ceramic or zirconia implants.

By the way, I can vouch it’s true what this article says about oral galvanism. My dad was having problems and sores in his mouth years back, and realized all by himself that he could measure an electric current with an ammeter. When he told his dentist that the dissimilar metals were causing the problems the dentist didn’t belive him.

Too many docs and dentists think they know everything and that you can’t teach them anything new. To all the medical professionals out there reading… listen to your patients!Reply Mark as Spam 9 Points Trainer Bob Apprentice User, Joined On 2/2009 Send Message Add as Friendsamurai Savvy User Joined On 4/2007 Send Message Add as Friend Posted On Jul 20, 2009Hi Trainer Bob,If you are interested, my dentist in the Dallas area is such a doc for this type of work.

Let me know if you want his name. Mark as Spam 4 Points Posted On Jul 20, 2009great information. I have a teen with a mouthful of metal for braces.

She is having oral surgery to ""expose"" 3 permanent teeth that are still in her gums. They want to attach a metal bracket to her braces to pull them up and out slowly. I am going to call them now to find out what kind of metal is used. Also if this procedure doesn’t work, she will need up to 3 implants.

I just sent her a link to this article so she can take charge of her own health, now and in a few years.

Reply Mark as Spam 6 Pointsmama bear Apprentice User, Joined On 6/2006 Send Message Add as Friendoutpost Novice User Joined On 3/2009 Send Message Add as Friend Posted On Aug 08, 2009Why did the dentist recommend braces before her permanent teeth were even in yet?

When I was a teen, I had a retainer that caused the one last permanent tooth to grow into the lingual (inside) side of the roof of my mouth. That tooth became useless for the purpose of chewing and I had it removed just recently (30 years later).

Maybe all that metal and moving of her teeth is causing the teeth to not grow. Just a thought. Mark as Spam 0 Pointsmarkus_mom Novice User Joined On 6/2009 Send Message Add as Friend Posted On Aug 08, 2009I had a similar situation with 2 canines in my gums and I was able to resolve this only at the age of 28.

I wish it was done in my teen years but I would definitely do it again if the need was. My 2 teeth did come down but chances of this to happen are pretty low. You can’t put invisiline for this condition it had to be metal braces due to this additional movement of the teeth. I had 2 surgeries because the right tooth was slower than the left one and gums started to heal s we had to open the gum again.

I was in braces for 3.5 years (teeth were coming down for about 2 of them in total) but now have perfect natural teeth and unfortunately I haven’t heard about non-metal alternative treatments for this condition – only a surgery (or two) and metal braces. Mark as Spam 0 Points Posted On Jul 17, 2009I don’t think bridges are the answer either, as they are VERY costly because you destroy TWO healthy adjacent teeth. Reply Mark as Spam 4 Pointssamurai Savvy User, Joined On 4/2007 Send Message Add as Friend Phantom OBanjo Novice User Joined On 6/2006 Send Message Add as Friend Posted On Jul 20, 2009It seems bubble gum and duct tape could be of some use here.

lol Mark as Spam 6 Points Aaltrude Moderator User Joined On 4/2007 Send Message Add as Friend Posted On Jul 20, 2009Bubble gum would be better if it were not for the aspartame that just about all gum is sweetened with and the adverse effects caused by chewing without swallowing any food. Mark as Spam 6 Pointsbeccasnow19952005Novice User Joined On 5/2009 Send Message Add as Friend Posted On Aug 08, 2009I had a temporary bridge for years that held two teeth, which had never came developed in my mouth.

However, I accidentally kept breaking that bridge. My (now deceased) dentist chose to drill out all of my front teeth after communicating with my husband (but not letting me know until it was too late –they were gone) and replaced this with a permanent bridge.

While, I haven’t had noticeable problems with it, considering all the other problems I’ve had with my mouth, it would not have been the choice I would have made. They did this before my dental insurance expired…insurance, which we had from my husband’s first employer.

Now, when molars have loosened because of periodontal disease or decay, I simply have them pulled. I have one set of molars on each side, which takes care of the chewing needs I have. I avoid foods that need more chewing. This may not be the solution for everyone, but I’d rather be without than with, in my circumstances.

Mark as Spam 3 Points Posted On Jul 20, 2009First they said mercurry was safe – now we know better. Then they said titatium implants were safe – now there are questions. Who is to say in the future that these new ceramic implants are any safer? There is currently research out of the University of Edmonton about regrowing your own teeth with ultrasound stimulation (. www.canada.com/…/story.html ) One of the promises of stem cell research is that we will be able to regrow teeth. ( www.medicalnewstoday.com/…/7922.php – do a search for other articles) On another note they say that advanced yogis can regrow teeth.

After years of being exposed to toxic denitstry that never resolved the health of my teeth and continued to cause further dental aned health problems – I personnally have bowed out of the dental system (at least on my broken back teeth0 and wait for the day when my body will be able to regenerate its own teeth Reply Mark as Spam 4 Points Cheryl Rounds Apprentice User, Joined On 10/2006 Send Message Add as Friend Phantom OBanjo Novice User Joined On 6/2006 Send Message Add as Friend Posted On Jul 20, 2009Might consider using magnesium oil when brushing your teeth to strengthen what you got left…….. Mark as Spam 3 Points HWealth Novice User Joined On 7/2009 Send Message Add as Friend Posted On Jul 20, 2009I was waiting for years for someone to discover how to regenerate teeth.

Thanks for the info…Mark as Spam 3 Points Phantom OBanjo Novice User Joined On 6/2006 Send Message Add as Friend Posted On Jul 21, 2009I won’t go that far HWealth but it will make them harder. Do a search on here for tooth decay and licorice root. I started using tincture of licorice root in my home made tooth paste.

Dentist said I had small cavity. I blew off making appointment on my next cleaning. He didn’t mention any cavity. lol Showed him!Mark as Spam 3 Points Naxossa Novice User Joined On 3/2008 Send Message Add as Friend Posted On Aug 08, 2009you may also want to check this link. wholehealthsource.blogspot.com/…/dental%20healthapparently it is possible to regrow teeth and you don’t have to wait for stem cell research.

raise the magnesium in your diet and reduce the grain. especially whole grain. oh irony, because the bran is high in phytic acid which prevents you from absorbing the necessary magnesium.

Mark as Spam 3 Points Posted On Aug 08, 2009Good health = Good Teeth just can’t be that simple. My daughter, now 27, was the obsessive brusher and now has several cavities.

Of course she wore braces because of a too small mouth and now has receding gums. My son, now 25, is a Type I diabetic currently using an insulin pump. Growing up he had to be basically held down to get him to brush and now has one very minor cavity. He didn’t wear braces. When he knocked his front teeth in hitting a tree trunk as a child the dentist used a plastic appliance for about 6 months to fix it up.

Reply Mark as Spam 3 Points Fair Lilith Novice User, Joined On 7/2009 Send Message Add as Friend1 2 3 4 Post Your Subcomment (2000 Characters only.) Characters remaining: * Please enter your comment!Edit Your Comment (2000 Characters only.) Characters remaining: * Please enter your comment!Comment deleted violating the aspect of our terms of use Thanks for sharing your feedback!

If your feedback doesn’t appear right away, please be patient as it may take a few minutes to publish – or longer if the blogger is moderating comments. Email this article to a friend Share this article Next Article Would you like to republish this article? Loading Please Wait Privacy Policy | Terms of Use | Contact Us | Testimonials | © Copyright 2009 Dr. Joseph Mercola. All Rights Reserved. If you want to use this article on your siteplease click here. This content may be copied in full, with copyright, contact, creation and information intact, without specific permission, when used only in a not-for-profit format. If any other use is desired, permission in writing from Dr. Mercola is required. * These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using this product. Leave a Reply Message: CAPTCHA Code *Name*: Email*: Website: "

em. Need for second hip replacement Your prosthetic hip joint may wear out eventually, so if you have hip replacement surgery when you're relatively young and active, you eventually may need a second hip replacement. However, new materials are making implants last longer, so a second replacement may not be needed. Metal-on-metal complications

Overview

Overview

During hip replacement, a surgeon removes the damaged sections of your hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.

Also called total hip arthroplasty, hip replacement surgery may be an option for you if your hip pain interferes with daily activities and more-conservative treatments haven't helped or are no longer effective. Arthritis damage is the most common reason to need hip replacement. Mayo Clinic's approach Why it's done Conditions that can damage the hip joint, sometimes necessitating hip replacement surgery, include: Osteoarthritis.

Commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly. Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and occasionally underlying bone, resulting in damaged and deformed joints.

Clots can form in your leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to your lung, heart or rarely your brain.

Dislocation. Certain positions can cause the ball of your new joint to become dislodged, particularly in the first few months after surgery. If the hip dislocates, your doctor may fit you with a brace to keep the hip in the correct position.