Issue # 12021
Prof. Justin P Cobb
Isn’t technology wonderful? Vaccine engineering is rescuing the world from the pandemic of Covid-19. On a smaller scale, technology may bring about a revolution in the dusty old world of hip arthroplasty. Two ceramic hip resurfacing products are showcased in this edition of CeraNews – truly innovative devices, in a world where innovation is hard to achieve. The existential battle between conservatives and progressives has been resoundingly won by the conservatives over the last decade as quite a few of the recent ‘improvements’ achieved the opposite of improving things.
Large diameter metal-on-metal hip replacements were not a success and many patients had to suffer the consequences. Ceramic was the answer – to avoid any metal-related issues, ceramic femoral heads are now used in most hip replacements worldwide. But thanks to a few pioneers like Harlan Amstutz, who sadly died in May 2021, hip resurfacing has not gone away. Harlan will be sadly missed by his patients, many of whom were prominent athletes. Their return to top-level sport continues to make headlines, backed up by RCT data documenting the significant advantages for resurfaced hips. They enable a faster and more symmetric gait, while patients with THA appear to be slower, with the normal hip doing more of the work1.
The two-incision approach to the hip has also failed the test of time, while the anterior approach to hip arthroplasty with or without a traction table now has a solid evidence base demonstrating quicker and easier recovery, allowing same-day or overnight surgery in selected patients. Metabolic markers of stress confirm the higher levels of function in the early postoperative period2. This elevation of hip arthroplasty to the ambulatory surgery centres will be a major economic driver, as patients can be treated safely at a lower cost.
A ceramic hip resurfacing which combines these two domains has the potential of giving us entirely new options. The muscle sparing approach, avoiding both metal-related issues and a femoral stem, are obviously attractive. However, there is a serious caveat: extended learning curves are well-documented for both the anterior approach and the hip resurfacing procedure. Combining them might even cause additional problems.
Again, new technology could contribute importantly to achieve good outcomes. Virtual Reality training in arthroplasty can support surgeons in acquiring new skills in arthroplasty faster and at a higher level3. A growing range of assistive technologies can help to ensure that the surgery’s targets are achieved4, reassuring both patients and their surgeons. After a long 2020, the summer of 2021 has an optimistic feel: technology is overcoming the pandemic, and is also offering the prospect of a next generation of hip arthroplasty options. In my view, the future is looking rosy, well actually pink.