Chicago Center for Orthopedics at Weiss Enhances Hip Preservation in the “Decade of the Hip”
Oct 12, 2010
Active young adults benefit most from surgical techniques, innovations and research
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CHICAGO (Oct. 12, 2010) – Whether through injury or arthritis, patients in need of a hip surgery are seeing improved care in what orthopedic surgeons at the Chicago Center for Orthopedics at Weiss Memorial Hospital (CCO) are calling the “decade of the hip.” Doctors predict new surgical techniques, prostheses innovations and research on the longevity of joint implants are expected to advance the treatment of the hip like no other time in history.
Arthroscopy technique for labral tears
“Hip arthroscopy is the final frontier of sports medicine,” said Benjamin Domb, M.D., an orthopedic surgeon at CCO, clinical instructor of orthopedic surgery at Loyola University Chicago and a pioneer in a new labral tear repair technique for potentially career-ending hip injuries for athletes—professional and amateurs. “The development of hip arthroscopy has been a tremendous advance for athletes and patients who are too young for a hip replacement. The surgical technique promises an exciting future in sports medicine over the next decade.”
Athletes like New York Yankees third baseman Alex Rodriguez, Arizona Cardinals quarterback Kurt Warner, PGA Tour champion Greg Norman, and New York Mets’ Carlos Delgado, all had labral tears in their hips, which threatened to keep them out of the game for good.
Until recently, labral tears were not well understood, frequently being misdiagnosed as groin strains, sciatica, bursitis, hernias or “early arthritis.” But because of improvements in diagnostic equipment and techniques, athletes are getting a second chance. Labral tears are one of the most frequent causes of pain in the hip. An estimated quarter to half of all patients with hip or groin pain have labral tears with as many as 60 percent of them seeing multiple doctors over the course of a couple of years before being properly diagnosed.
The labrum is a soft piece of cartilage that lines the rim of the hip socket, helping to stabilize the joint. It acts as a shock absorber, joint lubricator and pressure distributor. When a piece of the labrum tears, part of the cartilage can become pinched, causing extreme pain. Symptoms can include clicking, locking or the hip giving way. Labral tears can occur with sports through a specific injury or incident, or may develop over time because of hip impingement, instability or a snapping hip. Damage to the labrum is associated with osteoarthritis.
Arthroscopically repairing the labrum can effectively treat pain, and may restore the lubrication and stability of the hip joint.
Using successful techniques learned from shoulder and knee arthroscopy, the minimally invasive hip arthroscopy procedure involves repairing the torn part of the labrum by sewing it back to the rim, giving patients the pain relief they need with tiny scars. The procedure makes it easier to repair these injuries with minimal recovery time.
“The development of highly specialized procedures in hip arthroscopy over the last few years has created new options for patients with hip pain, hip injuries and early arthritis of the hip,” added Dr. Domb, who also serves as the team physician for the Women’s National Basketball Association’s Chicago Sky. “These procedures bring athletes back to their sport, allow workers to return to work, and often prevent or delay the need for joint replacement.”
Highly crosslinked polyethylene socket liners for artificial hips
For active patients under the age of 55 with end-stage osteoarthritis in need of a total hip replacement, the test of time is revealing the best materials to use in joint implants for life-long preservation of the hip. “I believe the highly crosslinked polyethylene (plastic) hip cup liner will go down in history as the most cost efficient implant having the greatest impact on hip replacement surgery,” said John Martell, M.D., orthopedic surgeon and researcher at the CCO’s Orthopaedic Biomedical Imaging Institute at Weiss and associate professor of surgery at University of Chicago.
For years, it’s been hard for a person under the age of 55 to find a doctor who will perform a total hip replacement. The main consideration for these patients is “wear” on the materials used in the implants—the amount of the material shed due to friction or rubbing, or the amount of wear and tear that takes place during normal use or even active adults. The faster the implant wears down, the sooner a patient will need to endure another surgery to replace it.
In recent years, most surgeons have told patients that these implants will likely last 10-20 years, but there are promising signs that prostheses developed in the last decade will last longer.
Dr. Martell has been studying hip joint wear for more than seven years, looking at how the ball of the joint rubs against the cuplike socket and wears it down. “Research is proving that the metal on plastic implants are the most durable and cost effective for the greatest number of patients,” Dr. Martell added.
All hip implants are made of a combination of polyethylene (highly crosslinked or conventional), metal (cobalt or chromium) or ceramic (aluminum oxide or zirconium oxide). They all have their advantages and disadvantages. Some shed microscopic particles over time that could lead to problems, albeit rare. For example, polyethylene particles in the body could cause joint inflammation or osteolysis, a dissolving of the bone; and metal ion particles could result in a tissue reaction called ALVAL, aseptic lymphocyte-dominated vasculitis associated lesion, or a toxic reaction called pseudotumor. But the advantage of a metal on metal implant is the ability to have a larger femur ball and socket to prevent dislocation in active patients. Ceramic has virtually no distribution of wear products in the body, but is the most expensive of the materials and has been known to “squeak” with every step a person takes. The surgeon should select the best implant for the particular patient.
In addition to the durability of the material used, surgeon experience and technique also plays a role whether a patient needs revision surgery to replace the implant—a misaligned implant might lead to excessive wear, tissue inflammation or dislocation.
The highly crosslinked polyethylene liners have been used since 1999. The manufacturing process involves a short burst of radiation, which forces the layers of plastic to “link up” and help the cup resist wear.
Implant makers are enhancing the plastic by treating it with vitamin E, a natural antioxidant that’s expected to improve the longevity of the implant bearing ball; already it’s shown 95 percent less wear than some other highly crosslinked polyethylene liners.
“All of this research helps us understand the best materials to use to prevent damage to the surrounding bones and tissues and avoid multiple surgeries over a lifetime,” Martell added.
Dr. Martell uses computerized wear measurement techniques in his lab to analyze x-rays of patient hips over time—those from people who are both active and more sedentary. Part of Dr. Martell’s research is published in a recently released study in the Journal of Arthroscopy (2009, The Daily Activity Questionnaire: A Novel Questionnaire to Assess Patient Activity After Total Hip Arthroplasty), which shows the wear is minimal even with a high level of activity.
About 250,000 people get total hip replacements every year, a number expected to reach 572,000 by the year 2030 as Baby Boomers age. It’s a statistic that makes this research even more important, especially for younger, active adults, faced with total hip replacement.
For more information on the Chicago Center for Orthopedics at Weiss, visit www.ChicagoOrtho.com or call (888) 503-ORTHO.