Hip Replacement: Materials for Hip Ball and Socket Surgery
If a patient is diagnosed with significant osteoarthritis of the hip with significant pain that is not responding to non-operative treatment, which includes medications, the use of a cane, and staying active and fit, then the consideration is that of a hip replacement.
So why are there different options for the bearing surface in hip replacement? In the old days, the traditional bearing surface, and when I say bearing surface, I mean the articulation of the hip, and the hip being a ball and a socket joint, so what is the material of the ball or the femoral head and the socket, which is the liner of the acetabulum.
Traditionally, this has been metal on plastic. And over the years, we have learned that plastic can wear with time, and the byproducts of the plastic wear can lead to significant bone loss and failure of the hip joint, leading to fairly catastrophic revisions.
In the late 1990s, the old traditional plastics that we were using, which were ultra-high molecular weight polyethylene that was sterilized using gamma radiation and air, were replaced with what’s now called highly cross-linked polyethylene. And the vast majority of patients in North America now would get this highly cross-linked polyethylene.
What we have learned over the past decade is that the newer highly cross-linked polyethylene wears much, much less than the previous generations of plastic. And now we are no longer seeing the catastrophic wear and the catastrophic failures that we were seeing 15 and 20 years ago.
And that has been very, very encouraging. And ceramic on ceramics were also an alternative to metal on plastic because of the older problems with wear of the plastic. With more current data, up to 10 years, the failure rate of ceramic on ceramic and metal on plastic is exactly the same.
However, some surgeons still recommend ceramic on ceramic for very young patients because of the potential less wear at 20, 30 and 40 years. So for really young patients, it may be an attractive option, although there is no evidence to support that it is better than metal on plastic.
There are two potential complications with ceramic on ceramic that are not present with metal on plastic. They’re rare, but they can happen. And that’s squeaking, so audible squeaking that can be quite bothersome in rare events.
And also very rarely, the ceramics can fracture and need a revision. They’re rare events, but they can still happen. And this is why the standard of care in North America remains metal on plastic. Local Orthopedic Surgeons
Once a decision has been made to perform a hip replacement, the patient should discuss the various treatment options for a hip replacement with the surgeon.
Local Practitioners: Orthopaedic Surgeon
Dr. Masri specializes in hip and knee arthroplasty and has been in academic practice in Vancouver, British Columbia for the past 18 years. He completed his residency in Orthopaedics at The University of British Columbia (UBC) and subsequently completed a fellowship in Musculoskeletal Oncology at UBC and a fellowship in Hip and Knee Surgery at the Hospital for Special Surgery in New York prior to returning to Vancouver to start his practice at Vancouver General Hospital.
He is also Professor of Orthopaedics and Head of the Department of Orthopaedics at UBCH since 2006. Prior to that, he has Associate Professor and Head of the Division of Lower Limb Reconstruction and Oncology. In addition, he is the Head of the Department of Orthopaedics at Vancouver Acute Health Services, which is the largest hospital system in British Columbia. He is also the Surgeon-in-Chief at Vancouver Acute, and the Medical Director of the Centre for Surgical Innovation, which in combination with the Hip and Knee program at Vancouver General Hospital is the largest arthroplasty program in Canada with a combined volume of 2780 cases in the fiscal year 2012-2013.
Dr. Masri has had an interest in Infection and was the co-inventor of the Knee PROSTALAC, which is the prototypical articulated spacer for the management of infected knee arthroplasty. He also helped develop the Vancouver Classification system for periprosthetic fractures along with Dr. Clive Duncan.
Dr. Masri has been involved in multiple research projects leading to numerous presentation and publication. At last count, he was a visiting professor or guest speaker on 152 occasions throughout the world, including Canada, USA, United Kingdom, South Africa, New Zealand, Saudi Arabia, Lebanon, Japan and China. He has given 279 invited presentations and 227 scientific presentation. He has published 178 peer-reviewed published articles, and 47 book chapters.
He has been involved in the training of 106 post-graduate trainings, including fellows, graduate students and post-doctoral fellows, in addition to many more residents.
Dr. Masri’s work has been honored with the Charnely Award by the Hip Society on two occasions and by the Stinchfield Award by the Hip Society once. He is a member of a number of prestigious scholarly societies (by invitation only) including the Hip Society, the Knee Society and the International Hip Society. In addition, he is a member of many other societies.