1 / 25

Arthroplasty

Arthroplasty. Current Research. New England Baptist Hospital Daniel M. Ward, M.D. October 1, 2008. Areas of Interest. Total hip replacement Revision total hip replacement Deep Vein Thrombosis New polymers in total hip replacement. Total Hip Replacement.

alka
Télécharger la présentation

Arthroplasty

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Arthroplasty

  2. Current Research New England Baptist Hospital Daniel M. Ward, M.D. October 1, 2008

  3. Areas of Interest • Total hip replacement • Revision total hip replacement • Deep Vein Thrombosis • New polymers in total hip replacement

  4. Total Hip Replacement • Hips over time fail for may reasons • Plastic wear • Bone destruction • Fracture • Infection • Recurrent dislocation

  5. Total Hip Replacement • Number of total hip replacements in the US is increasing about 15-20% a year • Earlier intervention • More active population • Need better equipment components

  6. Total Hip Replacement • Study involving a new plastic shell/liner • High density plastic manipulated with heat/gamma radiation to harden plastic and reduce wear • Hopefully reducing wear and osteolysis-bone destruction

  7. Total Hip Replacement • Study involves 25 patients from multiple institutions • 5 years of follow up with yearly xrays,data sheets,phone calls • Paper to be submitted at 5 years • Hopefully funding to continue to 15 years

  8. Total Hip Replacement • Bearing are modular plastic, metal, ceramic • This study focused of plastic. • Called X3 because of the plastic preparation process • Now at 2 years

  9. Hip Replacement StudyCeramic • Ceramic hip replacement • Dr. Bierbaum and about 10 other institutions. Study now entering 12 years of follow up. • Bone destruction seen is less than 1% • Expect about 22% based on controls • Revision for all reasons is less than 2%- equal to the best data we have about total hip replacement today.

  10. Revision Hip Replacement • Reconstruction of the socket can be challenging • In some cases almost no bone is left in the acetabulum • Need fixation in the cup-socket that allows for long term fixation

  11. Revision Hip Replacement

  12. Revision Hip Replacement • 10 total sites in the US • NEBH closed enrollment at 6 months. • Initial goal was 18 months to have 180 patients enrolled

  13. Revision Hip Replacement • Now at 2 years of follow up • NO cups have been revised for loosening • No osteolysis • Very early follow up • Will need to follow these people for 10-15 years

  14. Revision Hip Replacement • Different types of stems available for hip replacement • Issues with many are intraoperative fracture • Orientation of the stem may not be optimal • Fixed length of the stem

  15. Revision Hip Replacement • Study looks at a modular stem that can asses modularity, leg length, ease of placement, significantly decreased fracture fate • Over 100 patients • Retrospective study • Preliminary review looks promising

  16. Revision Hip Replacement

  17. Revision Hip Replacement • Study looks at a modular stem

  18. Revision Hip Replacement

  19. Revision Total Hip • Will add significantly to the current literature about revision total hip • Helps validate a current method of treatment • Significant improvement to post operative management • Weight bearing as tolerated, decrease dislocation rate, improve hip function • Decrease patient morbidity

  20. Deep Vein ThrombosisDVT • Significantly affects patient outcomes after Total hip replacement (THA) • Can become a Pulmonary Embolus-PE • PE can be a cause of death of THA • Mandated by Federal Programs that all patients have a specific treatment for DVT after THA and TKA

  21. Deep Vein ThrombosisDVT • Study randomly and prospectively places patients into a protocol to prevent DVT • The Baptist has been aggressively treating DVT pre-op for a week and then post op for a total of treatment to be 6 weeks

  22. Deep Vein ThombosisDVT • Three arms to study • 1. Coumadin for 1week before surgery at 1mg and then continued post op at 1mg. • 2. Arixtra 2.5mg post op for one month • 3.Adjusted dose coumadin post-op for one month • All arms have been proven effective with DVT,PE and death as the outcomes

  23. Deep Vein ThombosisDVT • Three arms to study • The study will hopefully identify that low dose coumadin will be as effective as the other 2 arms at preventing DVT,PE, death. • Benefits-no blood monitoring,extremely low cost, no bleeding into new joint • Less infection due to lower blood loss into joint • Significantly safer for patients.

  24. Deep Vein ThombosisDVT • Patients will need post op duplex ultrasound at 1 month after procedure at NEBH-non invasive study • Blood drawn at follow up and as needed for adjusted dose coumadin arm • Arixtra medication is free • Potentially one of the most significant studies in modern orthopedics. • Extremely well controlled. Significant cost to perform this study. Need the help of both surgeons and patients

  25. THANK YOU

More Related