Newswise — Sinai Hospital's Rubin Institute for Advanced Orthopedics (RIAO) now offers a new surgical option called the ceramic-on-ceramic total hip replacement that may have the lowest wear rate of any total hip replacement on the market. This technology was developed for the younger, more active patient with arthritis or other joint problems. The implant was FDA-approved for use in the United States in February 2003 and has recently become available at Sinai Hospital.
"The difference is in the material," said Michael Mont, M.D., orthopedic surgeon and co-director of the Center for Joint Preservation and Replacement at the RIAO. "The special ceramic material developed for this implant has proven to be very strong, creating in some cases a 99 percent reduction in friction and wear. For this reason, it's possible the implant will last for the lifetime of a patient."
Mont was the first to perform the surgery employing the new implant at the RIAO. His colleagues, Barry Waldman, M.D., co-director, and Gracia Etienne, M.D., Ph.D., of the Center for Joint Preservation and Replacement, both of whom specialize in hip replacement surgery, are performing this surgery as well.
The ceramic-on-ceramic implant consists of a ceramic ball bearing that fits into a ceramic-lined socket that is covered by a metal cap. During surgery, the head of the hip bone, or femoral head, is removed and the socket, where the head of the hip used to fit, is resurfaced. The surgeon may secure the metal cap in the socket using cement or screws before placing the ceramic liner inside the cap. Next, the femoral head is replaced with the implant that is composed of a metal stem and a ceramic ball. The new ceramic ball and ceramic-lined socket are joined to form the new hip joint.
The components of a hip implant move together, imitating the motion of the natural hip ball and socket. This action in prosthetic devices has been known to produce minimal amounts of very fine wear debris. The components of traditional artificial hip replacements, which feature metal-on-plastic surfaces, can wear over time, releasing debris into the joint and surrounding tissues. This wear debris can cause loss of bone around the implant, a leading cause of prosthetic loosening and failure. The ceramic-on-ceramic implant has been shown to produce far less wear debris than the traditional hip replacements. "At Sinai, our fastest growing patient populations for total hip replacements are ages 40 to 59," said Mont. "They can now benefit from a hip replacement while they are young enough to still enjoy their favorite activities, like tennis, biking or golf. The possibility for a long-term solution to living with hip pain is greater with a ceramic-on-ceramic implant."
When conservative treatments are exhausted and no longer adequately address the symptoms of osteoarthritis or avascular necrosis, a disease that causes the bone to die, surgical solutions are then considered. The selection of the implant is determined by the physician, and depends on various patient factors including medical history, weight and lifestyle goals, among others.
Sinai Hospital has the fastest growing orthopedic program in the state of Maryland. It is estimated that about 300,000 people in the United States undergo hip replacement surgery each year.
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