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Total Hip Replacement Implants

M2a-Magnum Hip Replacement Implant (Biomet) A total hip replacement replaces your arthritic hip joint and eliminates the damaged bearing surfaces that are causing you pain. The design of the implant offers you renewed stability and minimizes the wear process. The traditional metal and polyethylene implants have been in use since the 1960s but technological advances since then have made other materials such as ceramic increasingly popular. During a hip replacement, the head of the femur (thigh bone) is first removed. Then a metal liner or cup is placed in the socket (acetabulum) which sometimes is fixed into the socket with 2 or 3 screws. Into this is placed a plastic, metal or ceramic liner. The femur has a metal stem inserted then a ball fitted on top. This ball can be anything from 28mm to 58mm in diameter and made from metal or ceramic. The ball is fitted into the cup and the new joint is created. In terms of fixation, your surgeon has the choice of anchoring the hip implants securely to bone using either cement fixation

or fixation by bone ingrowth. Your surgeon will select the design of the hip replacement and size of femoral ball to give you the range of motion and stability that you need to function. There are several different choices of hip implants to consider, each using varying materials and having different pros and cons: Metal Ball and Polyethylene Liners Ceramic Ball and Polyethylene Liner Metal Ball and Metal Liner Ceramic Ball and Ceramic Liner

Choices of Hip Replacement Implant Material: Polyethylene, Metal, or Ceramic?

One of most common problems with replacement hips is the wear and tear that takes place through normal use. Depending on the specifics of your situation (age, size, level of activity, surgeons experience with particular implants, etc.), your hip replacement implant may be made of metal, polyethylene (plastic) or ceramic. For example, if you are a very active individual or a relatively young patient, your surgeon may prescribe an all-ceramic hip joint or all metal hip joint. Metal Ball and Polyethylene (Plastic) Liners

Metal-on-Polyethylene (Zimmer Orthopedics) The standard metal ball and polyethylene cup have been in use since the early 1960s. Scientific studies indicate the use of improved polyethylene liners, called highly crosslinked bearings, result in overall decreased wear of the implant. Because of its durability and performance, Metal-on-Polyethylene has been the leading artificial hip component material chosen by surgeons since hip replacement surgeries have first been performed. The metal ball is cobalt chrome alloy and the liner is polyethylene. Polyethylene is the most understood and used of all the liner materials, offering the surgeon a range of options to obtain stability in the body while the operation is underway. This ability to adapt and customize during the surgical procedure is an important attribute of polyethylene. It is also the least expensive bearing.

All implants shed wear debris. Your body has to cope with any wear debris that is released when you use your hip implant, unlike your car engine that has special filters to remove the wear products. Currently, wear resistant polyethylene liners, called highly crosslinked polyethylene are in use which, during the manufacturing process, have been treated with a short burst of radiation to help the cup resist wear. Over time, the body may see polyethylene wear particles as invaders or a source of infection. As the body starts to attack them, this leads to osteolysis, a dissolving of the bone, which may result in having to replace the implant (known as revision). Metal-on-Polyethylene implants wear at a rate of about 0.1 millimeters each year. Ceramic Ball and Polyethylene (Plastic) Liner

Ceramic-on-Polyethylene Vitamin E stabilized liner (Biomet Inc.) Ceramic heads are harder than metal and are the most scratch resistant implant material. The hard, scratch resistant, ultrasmooth surface can greatly reduce the wear rate on the polyethylene bearing. The potential wear rate for this type of implant is less than Metal-on-Polyethylene. Ceramic-on-Polyethylene is more expensive than Metal-on-Polyethylene, but less than Ceramic-on-Ceramic. In the past, there had been incidents of fractures, but newer, stronger ceramics have resulted in considerable reduction of fracture rates (0.01%) compared to the original brittle ceramics. Some ceramic-on-polyethylene implants utilize a vitamin E-stabilized, highly crosslinked polyethylene bearing material. Vitamin E, a natural antioxidant, is expected to improve the longevity of the implant bearings used in total joint replacements. In laboratory testing, these liners have demonstrated 95-99% less wear than some other highly crosslinked polyethylene liners. Ceramic-on-Polyethylene implants have a potential wear at a rate of about 0.05 millimeters each year, i.e. 50% less than Metal-on-Polyethylene. The newer, highly crosslinked polyethylene liners have shown potential wear rates as little as 0.01 millimeters each year. Metal Ball and Metal Liner

Metal-on-Metal (Biomet Inc.) Metal-on-Metal bearings (cobalt chromium alloy and sometimes stainless steel) were in use from as far back as 1955 though they were not approved for use in the U.S. by the FDA until 1999. They continue to offer the potential for greatly reduced wear, with less inflammation and less bone loss. Metal bearings are available in many sizes (28 mm to 60 mm); there are also several neck lengths available. Only metal-on-metal components allow the largest heads throughout the entire range of implant sizes. Large ball heads provide increased range of motion and greater stability, which can significantly reduce the risk of hip dislocation, a crucial factor in the long term success of an implant. Although wear is reduced with Metal-on-Metal implants, the wear products (sub-microscopic particulates, soluble metal ions) are distributed throughout the body. This has raised concerns about long-term bio-compatibility. At present these are only concerns, for there have been no definitive clinical findings that these wear products are harmful. It should also be noted that this issue arises fairly rarely. Metal-on-Metal implants have a potential wear rate of about 0.01 millimeters each year.

Metal-on-Metal Big Femoral Head (Wright Medical) Because the human femoral (ball) head is naturally large, it makes sense to implant a large, anatomic replacement. This was not possible in the past because traditional design parameters made smaller femoral heads necessary. However, with the introduction of metal-on-metal implant components, liners may be eliminated, allowing surgeons to use large femoral heads. Use of a larger ball head has been shown to increase the range of motion an individual may experience as well as decrease the possibility of dislocation. Ceramic Ball and Ceramic Liner

Ceramic-on-Ceramic (DJO Surgical) If you are a very active individual or a relatively young patient, your surgeon may prescribe an all-ceramic hip joint. Allceramic hip joints have been used in Europe since the 1980s but have only more recently received the FDAs approval for marketing in the United States. In these hip joints, the traditional metal ball and polyethylene liner are replaced by a high-strength ceramic bearing that has the reputation for ultra low wear performance. Clinical studies, monitored by the FDA and begun in 1998, have demonstrated excellent performance although it should be noted that ceramic has been used in hip replacements for many years prior to that.

Ceramic-on-Ceramic (DJO Surgical) Ceramic is the hardest implant material used in the body, and has the lowest wear rate of all, to almost immeasurable amounts (1000 times less than Metal-on-polyethylene). Consequently, there is usually no inflammation or bone loss, nor systemic distribution of wear products in the body. New ceramics offer improved strength and more versatile sizing options. Ceramic-on-Ceramic implants have a potential wear rate of about 0.0001 millimeters each year.

Modularity & Customization

You may also want to consult with your doctor about the design of the implant. Modular systems offer the ability to

interface different sizes of femoral heads to fit over the stem; angles, sizes, and lengths of the implant are made to fit your anatomy. Modular systems may give a patient more flexibility. In certain instances, some surgeons may recommend gender-specific hip implant designs or another custom-sized implant. Learn more about Specialized and Custom-Fit Hip Implants>>

The Decision
The final choice of implant will be based upon health factors specific to you as well as your surgeons experience, education and expertise with the specific manufacturers products. Be sure to talk with your surgeon about which implant type he or she intends to use in your hip replacement and the reasons for the specific implant chosen. Filed Under: Hip Implants
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