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Arthroplasty Arthroplasty
Current Research Current Research
New England Baptist HospitalNew England Baptist Hospital
Daniel M. Ward, M.D.Daniel M. Ward, M.D.
October 1, 2008October 1, 2008
Areas of InterestAreas of Interest
Total hip Total hip replacementreplacement
Revision total hip Revision total hip replacementreplacement
Deep Vein Deep Vein ThrombosisThrombosis
New polymers in New polymers in total hip total hip replacementreplacement
Total Hip ReplacementTotal Hip Replacement
Hips over time fail for may Hips over time fail for may reasonsreasons– Plastic wearPlastic wear– Bone destructionBone destruction– FractureFracture– InfectionInfection– Recurrent dislocationRecurrent dislocation
Total Hip ReplacementTotal Hip Replacement
Number of total hip Number of total hip replacements in the replacements in the US is increasing US is increasing about 15-20% a yearabout 15-20% a year
Earlier interventionEarlier intervention More active More active
populationpopulation Need better Need better
equipment equipment componentscomponents
Total Hip ReplacementTotal Hip Replacement
Study involving a Study involving a new plastic shell/linernew plastic shell/liner
High density plastic High density plastic manipulated with manipulated with heat/gamma heat/gamma radiation to harden radiation to harden plastic and reduce plastic and reduce wearwear
Hopefully reducing Hopefully reducing wear and osteolysis-wear and osteolysis-bone destructionbone destruction
Total Hip ReplacementTotal Hip Replacement
Study involves 25 Study involves 25 patients from patients from multiple institutionsmultiple institutions
5 years of follow up 5 years of follow up with yearly with yearly xrays,data xrays,data sheets,phone callssheets,phone calls
Paper to be Paper to be submitted at 5 years submitted at 5 years
Hopefully funding to Hopefully funding to continue to 15 yearscontinue to 15 years
Total Hip ReplacementTotal Hip Replacement
Bearing are modular Bearing are modular plastic, metal, plastic, metal, ceramicceramic
This study focused This study focused of plastic.of plastic.
Called X3 because Called X3 because of the plastic of the plastic preparation processpreparation process
Now at 2 yearsNow at 2 years
Hip Replacement Hip Replacement StudyStudy
CeramicCeramic Ceramic hip replacementCeramic hip replacement Dr. Bierbaum and about 10 other Dr. Bierbaum and about 10 other
institutions. Study now entering 12 institutions. Study now entering 12 years of follow up.years of follow up.
Bone destruction seen is less than 1%Bone destruction seen is less than 1%– Expect about 22% based on controlsExpect about 22% based on controls
Revision for all reasons is less than Revision for all reasons is less than 2%- equal to the best data we have 2%- equal to the best data we have about total hip replacement today.about total hip replacement today.
Revision Hip Revision Hip ReplacementReplacement Reconstruction of the socket can Reconstruction of the socket can
be challengingbe challenging In some cases almost no bone is In some cases almost no bone is
left in the acetabulumleft in the acetabulum Need fixation in the cup-socket Need fixation in the cup-socket
that allows for long term fixationthat allows for long term fixation
Revision Hip Revision Hip ReplacementReplacement
Revision Hip Revision Hip ReplacementReplacement 10 total sites in 10 total sites in
the USthe US NEBH closed NEBH closed
enrollment at 6 enrollment at 6 months.months.
Initial goal was Initial goal was 18 months to 18 months to have 180 have 180 patients enrolled patients enrolled
Revision Hip Revision Hip ReplacementReplacement Now at 2 years of follow upNow at 2 years of follow up NO cups have been revised for NO cups have been revised for
looseningloosening No osteolysisNo osteolysis Very early follow upVery early follow up Will need to follow these people Will need to follow these people
for 10-15 yearsfor 10-15 years
Revision Hip Revision Hip ReplacementReplacement Different types of stems available Different types of stems available
for hip replacementfor hip replacement Issues with many are Issues with many are
intraoperative fractureintraoperative fracture Orientation of the stem may not Orientation of the stem may not
be optimalbe optimal Fixed length of the stemFixed length of the stem
Revision Hip Revision Hip ReplacementReplacement Study looks at a modular stem that Study looks at a modular stem that
can asses modularity, leg length, can asses modularity, leg length, ease of placement, significantly ease of placement, significantly decreased fracture fatedecreased fracture fate
Over 100 patientsOver 100 patients Retrospective studyRetrospective study Preliminary review looks promisingPreliminary review looks promising
Revision Hip Revision Hip ReplacementReplacement
Revision Hip Revision Hip ReplacementReplacement Study looks at a Study looks at a
modular stemmodular stem
Revision Hip Revision Hip ReplacementReplacement
Revision Total HipRevision Total Hip
Will add significantly to the current Will add significantly to the current literature about revision total hipliterature about revision total hip
Helps validate a current method of Helps validate a current method of treatmenttreatment
Significant improvement to post Significant improvement to post operative managementoperative management
Weight bearing as tolerated, decrease Weight bearing as tolerated, decrease dislocation rate, improve hip functiondislocation rate, improve hip function
Decrease patient morbidityDecrease patient morbidity
Deep Vein ThrombosisDeep Vein ThrombosisDVTDVT
Significantly affects patient outcomes Significantly affects patient outcomes after Total hip replacement (THA)after Total hip replacement (THA)
Can become a Pulmonary Embolus-PECan become a Pulmonary Embolus-PE PE can be a cause of death of THAPE can be a cause of death of THA Mandated by Federal Programs that all Mandated by Federal Programs that all
patients have a specific treatment for patients have a specific treatment for DVT after THA and TKADVT after THA and TKA
Deep Vein ThrombosisDeep Vein ThrombosisDVTDVT
Study randomly and prospectively Study randomly and prospectively places patients into a protocol to places patients into a protocol to prevent DVTprevent DVT
The Baptist has been aggressively The Baptist has been aggressively treating DVT pre-op for a week treating DVT pre-op for a week and then post op for a total of and then post op for a total of treatment to be 6 weekstreatment to be 6 weeks
Deep Vein ThombosisDeep Vein ThombosisDVTDVT
Three arms to studyThree arms to study– 1. Coumadin for 1week before surgery at 1. Coumadin for 1week before surgery at
1mg and then continued post op at 1mg.1mg and then continued post op at 1mg.– 2. Arixtra 2.5mg post op for one month2. Arixtra 2.5mg post op for one month– 3.Adjusted dose coumadin post-op for 3.Adjusted dose coumadin post-op for
one monthone month– All arms have been proven effective with All arms have been proven effective with
DVT,PE and death as the outcomesDVT,PE and death as the outcomes
Deep Vein ThombosisDeep Vein ThombosisDVTDVT
Three arms to studyThree arms to study– The study will hopefully identify that low The study will hopefully identify that low
dose coumadin will be as effective as the dose coumadin will be as effective as the other 2 arms at preventing DVT,PE, death.other 2 arms at preventing DVT,PE, death.
– Benefits-no blood monitoring,extremely Benefits-no blood monitoring,extremely low cost, no bleeding into new jointlow cost, no bleeding into new joint
– Less infection due to lower blood loss into Less infection due to lower blood loss into jointjoint
– Significantly safer for patients.Significantly safer for patients.
Deep Vein ThombosisDeep Vein ThombosisDVTDVT
Patients will need post op duplex ultrasound Patients will need post op duplex ultrasound at 1 month after procedure at NEBH-non at 1 month after procedure at NEBH-non invasive studyinvasive study
Blood drawn at follow up and as needed for Blood drawn at follow up and as needed for adjusted dose coumadin armadjusted dose coumadin arm
Arixtra medication is freeArixtra medication is free Potentially one of the most significant studies Potentially one of the most significant studies
in modern orthopedics.in modern orthopedics. Extremely well controlled. Significant cost to Extremely well controlled. Significant cost to
perform this study. Need the help of both perform this study. Need the help of both surgeons and patientssurgeons and patients
THANK YOUTHANK YOU