An Alternative Conservative Approach to Hip Reconstruction
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.
Engh, C.A. Jr., Culpepper W.J., and Engh C.A.: Long-term results of use of the anatomic medullary locking prosthesis in total hip arthroplasty. J Bone Joint Surg Am 79:177, 1997.
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.
I. J. BiomecbaDIcJ b1.17, No. 4pp. 241-249 1984
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
Learmonth, I.D.: Conservative Hip Implants. Current Orthopaedics 19:255-262, 2005.
Pipino, F., Keller, A.: Tissue-sparing surgery: 25 years’ experience with femoral neck preserving hip arthroplasty. J Orthop Traumatol 7(1):36–41, 2006.
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.
Waller oral presentation to Australian Arthroplasty Society, 2009.
Silent™ Hip DePuy International Publication, 9476-58001 version 2 2010.
Copyright (c) 2014 Craig Waller, MD, Timothy McTighe, Dr. H.S. (hc)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.