Hip Replacements Fail Due to Implant Irregularities, Infection

Contrary to conventional wisdom, total hip replacements fail just as much, if not more so, from implant dislocation or infection than from the wearing out of the bearing surface, according to recent research. While many thousands of people experiencing extreme pain from debilitating hip disease and other hip problems are helped each year with hip replacements that provide long-term relief, the study in the Journal of Bone and Joint Surgery said not much information previously existed about why some hip replacements fail among Americans.

Forty-nine of the 300 patients went on to have arthroscopy, a minimally invasive surgical procedure in which a small incision is made in the joint and a fiber-optic cable with a video lens and light source on the end is inserted to examine possible tissue damage.

In addition, 35 of the arthroscopy candidates were examined with magnetic resonance arthography, a procedure in which a series of X-rays is taken of a joint, followed by an MRI scan that images the contrast fluid that's injected to produce the X-rays. According to Magee, the MRI scans generated no false positives and detected most of the wrist ligament and cartilage tears later found by surgeons during arthroscopy. MRI was a bit less sensitive than MR arthrography, but generated fewer false positives.

The analysis found: -- The 49 patients who had arthroscopy had a total of 51 tears, including 22 triangular fibrocartilage complex (TFCC) tears, 18 tears in the scapholunate (a ligament), and 11 tears in the lunatotriquetral (another ligament). -- MRI detected 19 of the TFCC tears, 16 of the scapholunate tears, and nine of the lunatotriquetral tears.

-- Compared with arthroscopy, MRI sensitivity was 86 percent for triangular fibrocartilage complex tears, 89 percent for scapholunate tears, and 82 percent for lunatotriquetral tears. -- There were no false positives. -- Compared with surgery, MR arthrography sensitivity for detection of ligament and triangular fibrocartilage complex tears was 100 percent. However, there were three false positives.

Contact Dr. Damon Noto, MD for hip replacement alternatives.

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Hip Replacements Fail Due to Implant Irregularities, Infection

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