Total hip arthroplasty at the rothman institute

Abstract

Background: Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery.

Questions/purposes: This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature.

Methods: The authors performed a review of peer-reviewed articles related to the Rothman Institute's experience with THA.

Results: Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success.

Conclusions: There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.

Keywords: Arthroplasty; Hip; Total.

Fig. 1

Proximal portion of the titanium alloy stem is plasma sprayed for bone ongrowth. ©Stryker 2011. Images courtesy of Stryker. “Howmedica Osteonics Corp. (‘Stryker Orthopaedics’) grants permission for a limited one-time use of this image of its product as shown and retains all copyrights and all other intellectual property for this product. Stryker Orthopaedics also must approve, in advance, any copy that is associated with the use of this image”

Fig. 2

Stem neck trapezoidal. ©Stryker 2011. Images courtesy of Stryker. “Howmedica Osteonics Corp. (‘Stryker Orthopaedics’) grants permission for a limited one-time use of this image of its product as shown and retains all copyrights and all other intellectual property for this product. Stryker Orthopaedics also must approve, in advance, any copy that is associated with the use of this image”