An Alternative Conservative Approach to Hip Reconstruction

  • Craig Waller, MD
  • Timothy McTighe, Dr. H.S. (hc)

Abstract

Primary Total Hip Arthroplasty (THA) has been a very effective surgical procedure, with improvements in design and clinical outcomes since the days of Sir John Charnley. [1-4] However, many implant femoral hip designs and surgical approaches have not been considered conservative for bone preservation.

Insertion of a femoral stem in THA does alter the physiological loading of the femur. Often these altered loading conditions can and do lead to bone reaction (stress shielding) and loss of proximal bone. Proximal stress shielding occurs regardless of fixation method (cement, cementless). [5,6]

This stress shielding and bone loss can lead to implant loosening and or breakage of the implant. In an attempt to reduce these boney changes some designers have advocated the conservative concept of “Neck Replacement” THA. [7-9]

This paper is a review of past, present and future development within this narrow classification of Neck Replacement Arthroplasty with highlighted focus on the Silent™ Implant.

Key Words: total hip arthroplasty, tissue-sparing, neck-preserving, and conservative approach.

References

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Moussa, H., Pierre, B., Jacques, D., et al.: Alumina-on- Alumina Total Hip Arthroplasty: A Minimum 18.5 Year Followup Study. J Bone Joint Surg Am 84(1), 69-77, 2002.

Neuman, L., Freund, K.G., and Sorenson, K. H.: Long-term Results of Charnley Total Hip Replacement. J Bone Joint Surg Br 76(2):245-51, 1994.

Teloken, M.A., Bissett, G., Hozack, W.J., et al.: Ten to Fifteen-Year Follow-Up After Total Hip Arthroplasty with a Tapered Cobalt-Chromium Femoral Component (Tri-Lock) Inserted Without Cement. J Bone Joint Surg Am 84-A(12): 2140-4, 2002.

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McTlghe. et al., “Design Considerations for cementless Hip Arthroplasty” Encyclopedic Handbook of Biomaterials and Bioengineering. Part B: Applications Vol I, Marcel Dekker, Inc 1995 pp.587-589

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McTighe, T., Brazil, D., et al.: Design Rationale and Early Clinical/Surgical Observations with a Short Curved Tissue Sparing Hip Implant. Reconstructive Review Vol. I, Number I, 18-32, Oct. 2011.

McTighe, T., Stulberg, S.D., Keggi, J., et al.: JISRF—A Classification System for Short Stem Uncemented Total Hip Arthroplasty. Scientific Poster, International Society for Technology in Arthoplasty, Oct. 2012, Sydney, Australia.

Maheson et al., The Silent™Hip – A New Solution In Primary Total Hip Arthroplasty Short To Mid-Term Results From Two Clinical Studies Across Eight Centers Poster BOA 2009.

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Published
2013-10-01
How to Cite
Waller, MD, C., & McTighe, Dr. H.S. (hc), T. (2013). An Alternative Conservative Approach to Hip Reconstruction. Reconstructive Review, 3(2). https://doi.org/10.15438/rr.v3i2.33
Section
Original Article

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