As hip replacement steadily increasing, patients need to know the facts before procedure: Surgeons

On the golf course, in the garden, or at the shopping mall, most people want to stay active, regardless of age. As the number of Americans reaching their 60s grows daily, the demand for mobility-restoring procedures, such as hip replacement, is steadily increasing.

Total joint replacement is thought to be among the most valued developments in the history of orthopedics. It has evolved into a reliable and effective way to relieve pain and restore function to joints that have been damaged or destroyed by arthritis or injury. Joint replacement makes it possible for patients to resume their active lives, say the Adult Reconstruction and Joint Replacement experts at Hospital for Special Surgery in New York, a world leader in orthopedics and rheumatology.

Although the best weight-bearing surface is human cartilage, when the damage is too great, manmade materials, in the form of an artificial joint, become an option. Before undergoing a joint replacement procedure, it's important for people to learn from their doctor, what is involved in the surgery and to have realistic expectations.

The team at Hospital for Special Surgery, whose surgeons have performed more hip replacements and knee surgeries than any other institution in the world, emphasize that it is a major operation. Hip replacement also can be life-changing for someone who is debilitated by severe joint damage.

One of the important developments in hip replacement is the number of options available for artificial joints. Patients considering hip replacement surgery should count on their surgeon to work with them in selecting the right type of implant design and material. When planning for surgery, the doctor and patient should consider a range of factors, such as the patient's age, weight, bone strength, the shape of the person's bones, as well as a patient's lifestyle and activity level.

Type of Implants
Today, a new joint can be made out of polished metal or ceramic, with some featuring a combination of plastic liner and cobalt-chrome or titanium backing.

Metal and Plastic
Metal and plastic implants are the most commonly used hip replacements. One of the most often used bearing surface combinations is metal on polyethylene, a form of plastic that provides marked durability.

Ceramic
Ceramics are used in total joint replacements, specifically to provide more wear-resistant bearing surfaces. Because of their hardness, ceramics can be polished to a very smooth finish and remain relatively scratch resistant while in use. Ceramic bearings are more subject to fracture than other materials. Most patients whose active lifestyles subject them to repetitive impact are not good candidates for ceramic bearings, nor are patients with high body weight.

Metal-on-Metal
Metal-on-metal implants have been developed to function without a plastic piece inserted between them. These implants do not wear out as quickly as the plastic/metal versions and work well with young, active patients. There is concern that normal use may result in the release of microscopic metal particles that can lead to inflammation and loosening. Tests have also found elevated levels of metal ions in the blood but so far it hasn't been shown that these levels result in harm.

Although researchers are constantly seeking ways to improve implant design and durability, today there is no clear-cut kind of implant that is viewed as superior. Most surgeons will agree that the decision about joint implant materials is individual and should be decided by the patient and doctor together.

Says Dr. Mark P. Figgie, chief of the Surgical Arthritis Service at Hospital for Special Surgery, "I always spend a lot of time with my patients going over all the options and listening to them to learn what their needs and expectations are. The patients find the time we spend together talking about their needs and expectations invaluable. Once this process is completed and I feel that they are sufficiently informed, it is always up to the patient to decide."