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Medical Forum / Diseases and Disorders / Arthritis / July 2004

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question on hip replacement

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DCHAM - 15 Jul 2004 21:00 GMT
a friend is visiting and her husband, 51, has problems with his hip due to a
problem from childhood. docs have told him he shouldn't have it replaced yet
because the new hips only last 7 years. is this accurate?? meanwhile, he's in
increasing pain.

diane
Jo Firey - 15 Jul 2004 21:15 GMT
> a friend is visiting and her husband, 51, has problems with his hip due to a
> problem from childhood. docs have told him he shouldn't have it replaced yet
> because the new hips only last 7 years. is this accurate?? meanwhile, he's in
> increasing pain.
>
> diane

Not hardly.  Do an internet search using the words hip replacement and last.

It really depends on how much his hip is currently limiting his life.  Even
if the seven year rule were true, if someone asked me to choose seven years
out of the rest of my life to be pain free, I'd choose the next seven years.

Jo
rokolya - 15 Jul 2004 22:55 GMT
Jo,

the sevens years estimate may be a bit low, but there are certain
conditions that can make THR less than routine.

I was born with bilateral hip dysplasia which is just one of a group of
skeletal problems that lead to early arthritis.  Slipped capital
epiphysis is another.  The problem is that there are additional,
sometimes subtle, sometimes not so subtle anatomic abnormalities such as
scoliosis, difference in the limb length, contracted tendons,
asymmetrical muscles, etc.

THR surgery for these people requires a lot of additional planning.  I
think that most surgeons choose the traditional, long incision for these
people, as opposed to the minimally invasive surgery, to get a better
exposure and outcome.  There are questions of matching leg length,
necessity of bone grafting for rebuilding the acetabulum, placement of
acetabulum, geometry of the femoral canal, whether to release some of
the tight tissues, etc.

The outcomes have been improving, but  do not equal those with relative
uncomplicated anatomy. There is also the success rate of the second
replacement to consider.

On the other hand, your comment about quality of life is right on the
money.  Ultimately, the patient is the one who must balance quality of
life against anticipated future problems.

Diane,

I wish your friend the best.

Aniko

>  
>
[quoted text clipped - 30 lines]
>
>  
Thelma Lubkin - 16 Jul 2004 07:08 GMT
: Jo,

: the sevens years estimate may be a bit low, but there are certain
: conditions that can make THR less than routine.

: I was born with bilateral hip dysplasia which is just one of a group of
: skeletal problems that lead to early arthritis.  Slipped capital
: epiphysis is another.  The problem is that there are additional,
: sometimes subtle, sometimes not so subtle anatomic abnormalities such as
: scoliosis, difference in the limb length, contracted tendons,
: asymmetrical muscles, etc.

: THR surgery for these people requires a lot of additional planning.  I
: think that most surgeons choose the traditional, long incision for these
[quoted text clipped - 3 lines]
: acetabulum, geometry of the femoral canal, whether to release some of
: the tight tissues, etc.

: The outcomes have been improving, but  do not equal those with relative
: uncomplicated anatomy. There is also the success rate of the second
: replacement to consider.

          I had a lopsided gait from legs of different length.
          I was told that my hip surgery was particularly complex
          because it involved congenital anatomical irregularities.
          Minimally invasive surgery was not an option anyway because
          I had hardware [Richards screw] that had to be removed
          before the replacement could be put in.

          My surgeon has a healthy ego and informed me that
          there were only 3 orthopaedists in the city capable of the surgery
          that he would do on me. You *want* a surgeon with that kind of
          confidence. The surgery was completely successful--hospital
          bed to walking with no aids in six weeks [and that's
          because the longer cut needs more time to heal, and also
          because I didn't dump the crutches until he said it was ok
          even though it was already ok a little time before then]
          ...and I'm not lopsided anymore.

          I'm back to 8 mile walks and 40 mile bike rides.

                                --thelma
: I wish your friend the best.

: Aniko
Harvey R. Stone - 16 Jul 2004 14:24 GMT
>            ...and I'm not lopsided anymore.
>
>            I'm back to 8 mile walks and 40 mile bike rides.
>
>                                  --thelma

Wow,,,  I am up to three mile walks at a fast pace and I have never had a
hip operation.  Keep on keepen on.
Harv
Richard Pini - 28 Jul 2004 05:19 GMT
> My surgeon has a healthy ego and informed me that
>            there were only 3 orthopaedists in the city capable of the surgery
[quoted text clipped - 5 lines]
>            even though it was already ok a little time before then]
>            ...and I'm not lopsided anymore.

I agree wholeheartedly. My wife was born with bilateral hip displaysia
and had her left hip replaced in 1991; she was 40. She just had the
right hip done 5 weeks ago and was walking with a cane within 2 days.
Today she chased the dog around the bedroom a bit (no cane) and is
constantly amazed and grateful for the lack of pain. The surgeon has
told us (and we believe him) that this replacement will last
essentially for life.
spodosaurus - 16 Jul 2004 01:11 GMT
> a friend is visiting and her husband, 51, has problems with his hip due to a
> problem from childhood. docs have told him he shouldn't have it replaced yet
> because the new hips only last 7 years. is this accurate?? meanwhile, he's in
> increasing pain.
>
> diane

Rokolya has a valuable perspective on this. My persepctive is that I had
my first THR at ...hmm... I think I was 26 at the time. I was told it
should last about 15 years, maybe more (titanium-ceramic). I'm glad I
had it done. However, I was walking around on a femoral head that was in
pieces at the time...your friend may not be as restricted as I was.

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RoseB - 16 Jul 2004 01:54 GMT
I think I was 26 at the time. I was told it
>should last about 15 years, maybe more (titanium-ceramic). I'm glad I
>had it done. However, I was walking around on a femoral head that was in
>pieces at the time...your friend may not be as restricted as I was.

I was 28 when I had my hip replaced because in the doctor's words,
"There was nothing left even resembling a joint". I am now at the
golden age of 50 and have not yet had a revision. Because of the
condition of the joint I required grafting, and bone was wired into
place.

Since that time the surgical procedure has been revised, and the
prosthesis itself has undergone several improvements. One would expect
that a replacement done now would have greater longevity than one done
in the early 1980s.

Having said that th ough, I recognize that each case is different, and
the reasons for the thr may impact the success and longevity of the
procedure. I am aware also that thrs done for OA tend not to last as
long because those people tend to be more active than someone who has
RA and has multiple joints affected.

Diane, I think that your friend should get a second opinion. Quality
of life is important, and while waiting there can be further
deterioration of the joint that impacts the success of a thr.

Rose

@}>-->>>
Please remove "Ima" to reply privately!
Nann Bell - 16 Jul 2004 02:25 GMT
a longtime friend of the family had both hips replaced in her early 50s.  
They thought her problem was degenerative, as the result of many years of
dancing. (she is currently the resident coreographer of Dance Alive! -
Gainesville's professional dance company  http://www.dancealive.org/).

When they got in to her hips, it turned out to be a congenital problem of
some sort.  They told her that because it was congenital rather than
degenerative, she shouldn't need to have the replacement done again down the
road.  I have no idea if this wouuld apply in your friend's case, and I don't
know anymore details of Judy's situation, but it seems to me that he'd do
well to ask some more orthopods.

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Nann
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Simply the thing I am shall make me live --- William Shakespeare

Char - 16 Jul 2004 04:19 GMT
> docs have told him he shouldn't have it replaced yet
>because the new hips only last 7 years. is this accurate??

Of course not.  When in the world are all of the doctors (which I find shameful
in the extreme) finally get the latest information on the improvements in
prosthetics which allows them to last way longer than they did, even just 5
years ago.

Tell your friend to get a second or third or fouth opinion.  Or as many as it
takes to find a doctor who us up to date on procedures and prosthetics.
Char

"Remember, I'm pulling for ya'. We're all in this together." Red Green
DCHAM - 16 Jul 2004 05:14 GMT
hmm, very interesting responses. i was particularly interested in rokolya's,
since my friend's husband's problem had to do with a childhood disease (or
condition) that runs in irish families (can't think of the name of it. . . )
and it did leave one leg shorter than the other. so it sounds as though he
might have a rougher time with replacement. i agree with those recommending a
2nd opinion, tho.
thanks for the input,

diane
Harvey R. Stone - 16 Jul 2004 14:21 GMT
> hmm, very interesting responses. i was particularly interested in rokolya's,
> since my friend's husband's problem had to do with a childhood disease (or
> condition) that runs in irish families (can't think of the name of it. . . )

Its called Pubitis.   It comes from putting the same foot forward when
leaning on the bar.

> and it did leave one leg shorter than the other. so it sounds as though he
> might have a rougher time with replacement. i agree with those recommending a
> 2nd opinion, tho.
> thanks for the input,
>
> diane

LOL  sorry,,, could not resist.
Harv
tinlizzie - 16 Jul 2004 07:09 GMT
I think they last much longer than that.  They are using much better
replacements now-a-days.
Lorrie F
>a friend is visiting and her husband, 51, has problems with his hip due to a
>problem from childhood. docs have told him he shouldn't have it replaced yet
>because the new hips only last 7 years. is this accurate?? meanwhile, he's in
>increasing pain.
>
>diane
triel31@hotmail.com - 16 Jul 2004 13:32 GMT
> a friend is visiting and her husband, 51, has problems with his hip due to a
> problem from childhood. docs have told him he shouldn't have it replaced yet
> because the new hips only last 7 years. is this accurate?? meanwhile, he's in
> increasing pain.
>
> diane
===============================
Technologically Advanced "50-Year Hip" Now Available at Glendale
Adventist Medical Center

Glendale Adventist Medical Center is one of only a small number of
hospitals in Southern California to currently (Summer 2003) offer an
exciting new option for hip replacement: The Trident® Acetabular
System.

The breakthrough in this new system is a recently FDA-approved joint
made of a specially manufactured ceramic, which gives the artificial
joint the longest lifespan of any hip prosthesis on the market.

What is so special about the new ceramic-on-ceramic joint?

For the first time ever, the Food and Drug Administration (FDA) has
given approval for both of the key parts of an artificial hip joint to
be made of ceramic, a specially manufactured form of glass that is
extraordinarily strong and smooth.

Ceramic femoral heads-the end of the leg bone (femur) that attaches to
the hip-have been available for decades. But it took longer for
manufacturers to develop the right formula for a ceramic acetabulum
(pronounced ass-uh-TAB-yuh-lum), the cup-shaped socket at the base of
the hipbone that the femoral head fits into, forming the
"ball-and-socket" configuration of the hip joint.

Although a ceramic acetabulum has been available in Europe for over a
decade, the FDA required very detailed and specific studies before
approving its use in the United States. Now with FDA approval,
surgeons in the U.S. can implant a ceramic-on-ceramic joint where the
moveable head of the femur-the major leg bone-attaches to the
acetabulum.

What are the advantages of the new ceramic-on-ceramic joint?

The exciting news about the new ceramic-on-ceramic joint is its
durability and wear. Only diamonds are harder than the special ceramic
material used in these joints.

Because of the strength and smoothness of this material, there is much
less wear on the ceramic-on-ceramic joint than on any other existing
combinations of joint materials. Less wear means a longer life for the
artificial joint and more time between joint replacement surgeries.

Here's a comparison of the expected length of wear for several hip
replacement options currently on the market:

   * 10 to 15 years for a metal femoral head in a socket made of
conventional plastic. Often, the metal head doesn't have to be
replaced after this time, but the plastic socket does need
replacement.
   * 20 to 25 years for a metal femoral head in a socket made of a
specially manufactured "cross-linked" plastic that is made harder and
smoother by treating it with radiation. This process decreases wear by
about 50 percent-a significant increase, but still not nearly as
long-lasting as ceramic.
   * 25 to 30 years for a ceramic femoral head in a socket made of
cross-linked plastic.
   * 50 to 60 years (estimated) for a ceramic femoral head in a
ceramic socket. Because this combination is so new, there are no
long-term studies on its actual longevity. However, studies have shown
that, over the same period of use, the ceramic-on-ceramic joint shows
100 times less wear than the ceramic head/cross-linked plastic socket
combination.

Another advantage of long-wearing materials

Along with prolonging the life of the artificial hip itself, the
smoother, more durable ceramic-on-ceramic hips may actually preserve
bone.

As an artificial joint wears down, the body sometimes tries to digest
the microscopic particles that flake off from the joint. Studies have
shown that in some people and in some situations, the cells in the
body release enzymes as part of this digestion process that actually
cause bone to dissolve.

Smoother, slower-wearing surfaces-such as ceramic-on-ceramic-minimize
this effect by wearing down much more slowly than conventional
materials used in artificial hips
Janers - 16 Jul 2004 14:01 GMT
well I don't know how long they last, I believe it has to do with the
patients bone structure, activity and what not.
My sis who is 55, over, a little stocky and very active teacher, had hers
done last spring.  Never was told that but was told she could do anything
but cross over her legs so her hip would swing outward.  That might
dislodge the hip replacement.
she is doing great, back teaching NO pain, and it was horrible for her.
She climbs three sets of steps to get to her class room and it totals well
over a 100 steps a day.
As a matter of fact she is out riding on their harley as I type.  Idiot I
know but when you are enjoying life, YOU enjoy it to the fullest, as well
as When you can.  PAIN free.
have him see another doc.  not worth waiting, he is too young to waste his
life like that.  Then when he is older the excuse will be HIS bones are too
brittle and he has osteo, so we can't do it.  Get my drift?  LOL  docs

janers
who is celebrating a NEW granddaughter..
Harvey R. Stone - 16 Jul 2004 14:28 GMT
Well said and congrats....
Harv
> well I don't know how long they last, I believe it has to do with the
> patients bone structure, activity and what not.
[quoted text clipped - 14 lines]
> janers
> who is celebrating a NEW granddaughter..
Greg & Sandy Della-Croce - 16 Jul 2004 17:28 GMT
Greetings!
A good place to find lots of information about hip replacements is
http://members.tripod.com/totallyhip1/

And I agree with several other posters, the husband should find another
surgeon.  Not only do the new hips last much longer, but he also needs to
get his life back from pain!  I know - I had my first hip replaced in my
40's, and the other side done 10 years later, and the pain relief is
wonderful!
Sandy

> a friend is visiting and her husband, 51, has problems with his hip due to a
> problem from childhood. docs have told him he shouldn't have it replaced yet
> because the new hips only last 7 years. is this accurate?? meanwhile, he's in
> increasing pain.
>
> diane
firechief - 22 Jul 2004 00:27 GMT
Diane wrote:

> a friend is visiting and her husband, 51, has problems with his hip due to a
> problem from childhood. docs have told him he shouldn't have it replaced yet
> because the new hips only last 7 years. is this accurate??

That's what my doctors told me (7 years) in 1977-1984.

Any doctor who says that today is 10-15 years behind in
his medical studies.  The current thought is that a THR
will last 15-20 years, or longer.

... MEMORY - The thing I forget with.
 
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