Periprosthetic osteolysis (PPO) gradually became the single dominant late failure mechanism of total hip replacements. It afflicted 1 million patients worldwide, leading to countless, difficult revision operations. The widespread adoption of highly cross-linked polyethylene (XLPE) drastically reduced that disease. But going beyond that remarkable reversal, two further substantial consequences have resulted: A) a major reduction in revision operations and B) a major reduction in aggregate costs of total replacement surgery. This paper assembles data on the decrease in revision rates and uses them to estimate the massive reduction in total hip surgery costs. Review the literature produced registry data and controlled studies data establishing that XLPE reduced the “all cause” revision rate over the first 15 years of follow-up of total hip replacements at least in half, and often more. A conservative estimate of the number of revisions annually in the United States is 50,000. A conservative estimate of the average, integrated cost for a THR revision in the United States is $50,000, meaning that the costs of these revisions annually is at least $2.5 billion. Using a very conservative figure of just 40% for the percent reduction in revision surgery resulting from the use of XLPE reduces this burden by at least $1 billion annually.Introduction
Methods
1. The early signs of Paget's disease of the acetabulum and femur are described. 2. The pattern of arthritis is presented in 199 hips in which Paget's disease of bone occurred in either the femur, the acetabulum or both bones. Distinct patterns of disease occur with different bone involvement. 3. Selective narrowing of the medial segment of the joint is common and is particularly associated with pelvic disease. Why the narrowing occurs here preferentially is unexplained. 4. Protrusio acetabuli occurred in only 25 per cent of hips and usually when both the femur and the acetabulum were involved. This may be due to the presence simultaneously of weakened bone and coxa vara, the latter leading to an alteration in the direction of the resultant force across the hip joint. 5. Degenerative arthritis was present with Paget's disease in 14 per cent of hips but it may be a chance relationship in half of these hips.
