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Innovations in Total Hip Replacement

This page charts the rapid advance of total hip replacement design and development, especially for younger patients.

Exceeed acetabular cup

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Hip Components

A hip implant (or prosthesis) consists of four components that replicate the hip joint:

All of the implant components can be engineered from different materials. Your surgeon will recommend components with materials that suit your life-style, will last, and help you recover quickly.

Shell

The shell fits into the hip joint socket and needs to be fixed in place. The materials used for the shell are crucial to enable the implant to be fixed to the hip socket effectively.

Porous metal

Porous metal shell

Shells are made from metal. For the last twenty years cobalt chrome or titanium alloys have been the most popular materials. However, recent advances using porous metals have significantly improved the ability of the bone to grow quickly into the outer surface of the shell.

The shells are made from pure titanium or tantalum with pores in the metal that mimic coral. This helps the living bone to grow into the coral-like porous metal. These two materials are highly bio-compatible, but at the same time they are strong and flexible and are ideal for revision hip surgery.

Liner

Shell liner

The liner is fixed inside the shell. It acts as a bearing surface for the head or ball which is attached to the stem. Movement causes friction between the lining and the head. Therefore, the materials that form the lining are crucial to reduce wear to a minimum. The articulating surfaces must be exceptionally smooth but also very hard-wearing.

Head component

The head or ball articulates with the liner and can be manufactured from metal or ceramic. The head is inserted on the morse taper at the top of the stem.

Plastic (polyethylene)

Acetabular cup liner made from polyethylene

Polyethylene liners are resilient and manufactured to be incredibly smooth. However, until recently they were the Achilles heel of the operation. Over time constant friction creates wear particles and debris builds up which sometimes results in bone resorption (osteolysis). However, recent break-throughs in polyethylene technology have diminished this effect, reducing the wear rate significantly, making polyethylene an attractive option for the majority of patients.

E-Poly is a breakthrough technology. It is processed below melting temperature and irradiated. Vitamin E (α tocopherol), which is a naturally occurring antioxidant, is infused into the plastic, and stabilises free radicals by donating a hydrogen atom from the –OH groups; free radicals from the plastic are transferred to the vitamin chemical structure. This chemical interaction dramatically reduces the wear rate by up to ten fold when compared with conventional polyethylene. Laboratory trials have confirmed the excellent wear characteristics and now E-Poly is being used for bearing surfaces in hip replacements.

The massive reduction in wear is a giant step forward in controlling one of the most important failure mechanisms in joint replacements and is particularly important in active patients.

Stem

Metal stem component

The stem is fixed into the thigh bone (femur).

A cemented stem is held in place by a type of acrylic cement that acts as a grout, filling the bone marrow space between the metal stem and the bone.

A cementless prosthesis has a fine mesh, beaded or porous surface which abuts against living bone. Bone grows into these uneven depressions on the surface of the implant. Surface coatings such as hydroxyapatite (HA) may also be applied to the irregular surface of cementless stems.

Implant Selection

A prosthesis is chosen by the surgeon on a case by case basis. A patient’s specific circumstances are considered in depth. These will include the medical indications or contra-indications, and the lifestyle and age of the patient.

Appointments

To make an appointment e–mail Sue Misir, secretary to Mr Evert Smith, or telephone:

  • 0117 907 4228 (private)
  • 0117 323 5194 (NHS)

For an NHS appointment your GP will need to refer you. How?

Clinic locations and directions

Evert Smith is an Orthopaedic Surgeon in whom I have absolute faith and confidence.

Bob Gibbons, 2007.

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