Return to Sporting Activity After Total Hip Arthroplasty-A Survey of Members of the British Hip Society.

BACKGROUND: Total hip arthroplasty is increasingly performed in younger, more active patients. Thirty-five percent of patients are involved in sports preoperatively, and a desire to return to sporting activity is now a major expectation. Sporting activity potentially risks premature failure of the implant, and there is no consensus or guidelines among British or European surgeons performing total hip arthroplasty in sporting patients. METHODS: The current practice of British Hip Society members was explored through a Web-based survey. Of the 260 members surveyed, 109 responded. RESULTS: The majority of respondents (33%) would perform uncemented, 29.1% would perform hybrid, 15.5% would perform fully cemented, and 11.7% would perform a resurfacing hip arthroplasty for sporting patients. The preferred approach is the standard posterior (68.9%) and preferred bearing couples are ceramic-on-ceramic (39.8%) and ceramic-on-polyethylene (36.9%). Half of respondents would opt for a femoral head smaller than 36 mm, whereas 22.3% would use a head 36 mm or larger. A third would allow patients to return to sports between 6 and 12 weeks after surgery, whereas 43.7% advise patients to wait until 3 months postoperatively. All respondents allow patients to return to low-impact activities, but significant caution is exercised with regard to taking part in high-impact activities. CONCLUSION: We report the practice of a specialist group of hip surgeons, the majority of which consider themselves young adult hip specialists. We believe that these data may be of use to help inform the practice of our colleagues when performing arthroplasty in sporting patients and may serve to inform future consensus guidelines.

Total hip replacement.

This article provides an overview of total hip replacement and the nurse's role in caring for patients undergoing this procedure.

Wear debris from two different alumina-on-alumina total hip arthroplasties.

We compared wear particles from two different designs of total hip arthroplasty with polycrystalline alumina-ceramic bearings of different production periods (group 1, before ISO 6474: group 2, according to ISO 6474). The neocapsules and interfacial connective tissue membranes were retrieved after mean implantation times of 131 months and 38 months, respectively. Specimen blocks were freed from embedding media, either methylmethacrylate or paraffin and digested in concentrated nitric acid. Particles were then counted and their sizes and composition determined by SEM and energy-dispersive x-ray analysis (EDXA). The mean numbers and sizes of most alumina wear particles did not differ for both production periods, but the larger sizes of particle in group 1 point to more severe surface destruction. The increased metal wear in group 2 was apparently due to alumina-induced abrasion of the stems. In this study the concentrations of particles in the periprosthetic tissues were 2 to 22 times lower than those observed previously with polyethylene and alumina/polyethylene wear couples.

Population requirement for primary hip-replacement surgery: a cross-sectional study.

BACKGROUND: There has been a long-standing failure in many countries to satisfy the demand for several elective surgical treatments, including total hip replacement. We set out to estimate the population requirement for primary total hip replacement in England. METHODS: We undertook a cross-sectional study of a stratified random sample of 28,080 individuals aged 35 and over from 40 general practices in inner-city, urban, and rural areas of Avon and Somerset, UK. Prevalent disease was identified through a two-stage process: a self-report screening questionnaire (22,978 of 26,046 responded) and subsequent clinical examination. Incident disease was estimated from the point prevalence by statistical modelling. The requirement for total hip replacement surgery was estimated on the basis of pain and loss of functional ability, with adjustment for evidence of comorbidity and patients' treatment preferences. FINDINGS: 3169 people reported hip pain on the screening questionnaire. 2018 were invited for clinical examination, and 1405 attended. The prevalence of self-reported hip pain was 107 per 1000 (95% CI 101-113) for men and 173 per 1000 (166-180) for women. The prevalence of hip disease severe enough to require surgery was 15.2 (12.7-17.8) per 1000 aged 35-85 years. The corresponding annual incidence of hip disease requiring surgery was estimated as 2.23 (1.56-2.90), which suggests an overall requirement in England of 46,600 operations per year for patients who expressed a preference for, and were suitable for, surgery; the recent actual provision in England was about 43,500. INTERPRETATION: This research suggests that the satisfaction of demand for total hip replacement, given agreed criteria for surgery, is a realistic objective.

Cemented femoral component surface finish mechanics.

A cemented femoral component's surface finish may influence implant function through variations in cement adhesion and abrasion properties. Morphologic characterization of historic and current femoral hip prosthesis surface finishes show greater than x 20 range in implant roughness. Early implants typically had relatively smooth surfaces, whereas many of the more recent implants have rougher surface finishes. Smoother implant surfaces have lower cement-metal interface fixation strength, whereas rougher surfaces have greater fixation strength. With interface motion, the smoother surfaces are less abrasive of bone cement, whereas rougher implant surfaces are more abrasive. Because of enhanced bone cement attachment, rougher implant surfaces may have a lower probability of interface motion, while at the same time, a higher debris generation consequence if motion occurs. In contrast, smoother implant surfaces may have a higher probability of interface motion with a lower debris generating consequence of that motion. The prolonged use of cemented total hip replacement may be approached by either extending the duration of implant function after cement-metal interface loosening with smooth surfaced implants or, in contrast, by extending the duration of cement-metal interface adhesion with rougher surfaced implants.

Policy implications of contracting out care: the case of total hip replacements.

Research performed by Nicholl and his colleagues at Sheffield University has shown that private health care provision in the United Kingdom trends to be concentrated among certain activities, in particular those activities falling under the broad heading of elective surgery. Consequently although total private provision is dwarfed by the aggregate provision of health care under the national health service, whether measured in bed availability, expenditure or throughput, the private sector is found to be a much more significant supplier of certain procedures. In this paper the findings of the Sheffield "team" are considered along with the policy issues that they give rise to for one particular activity, total hip replacement (THRs).