Will Hydroxyapatite ceramic coated (HAC) arthroplasty perform well in patients under the age of fifty? This is a study of 269 Hydroxyapatite ceramic coated (HAC) hip arthroplasties in patients under, the age of fifty with annual review using Harris Hip Score (HHS) and plain X-rays. Assessments were over a maximum of 19 years. Early patients (46) had implants with ceramic/plastic bearings. Later patients (223) all had ceramic on ceramic bearings.Aims
Methods
One of the common frustrations for staff in hospital clinics is the frequent disruption caused by failure of patients to turn up for their booked appointments. DNA high rates have an enormous impact on the healthcare system in terms of cost and waiting time, significantly adding to delays along the patient pathway. We need to know the most common causes for non attendance and hence modify or put new protocol to deal with this problem. 70 (DNAs) patients from orthopaedic clinics during May 2008 were contacted by phone to ascertain the reasons for non-attendance. After six months, after implementing our new protocol, the rates of non-attendance were rechecked on our system.Introduction
Methods
Cemented Total Hip Arthroplasty gives good results for 10 or more years, but is too often complicated by a combination of mechanical loosening, wear debris and osteolysis. Patients require an implant which will last the rest of their life. Cemented hips may not survive and a better alternative is needed. Furlong hydroxyapatite ceramic coated (HAC) implants have been used for more than 19 years and to date there are 2248 primary hip arthroplasties. Fixation of the implants with HA ceramic is entirely satisfactory; histological studies from post-mortem specimens have confirmed that there is good cancellous bone fixation to the HA. The hydroxyapatite behaves like bone and is replaced by creeping substitution. This results in a Perfect Fit with no intervening fibrous tissue. Fixation is therefore maintained. Aseptic loosening is rare; eleven components. Polythene wear is a problem. Those patients with ceramic/polythene couples who have now reached about 15 years since surgery are showing wear of the liner evidenced by eccentricity of the ceramic head in the liner. Three of these have completely destroyed the liner and the titanium shell. Ceramic/ceramic bearings do not seem to wear, although there have been occasional fractures of alumina. For the last two years Biolox Delta, a stronger compound ceramic material, has been available from Ceramtec. There are no reports of any fractures. Patients who have a life expectancy of more than 10 or 15 years should be fitted with an HA coated implant with ceramic bearing surfaces. This may provide the answer for the long-lasting hip prosthesis.
