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