With the advice of Doctor Giandomenico Logroscino, lecturer at the Catholic University and Specialist in Hip Prosthetic Surgery, Shoulder Prosthetic Surgery and Traumatology at the Gemelli Hospital, Rome; let’s see the news on hip prostheses.
Until the mid-1990s it was difficult to imagine the development of a surgical technique that presented considerable risks and low percentages of duration: l‘plant of a hip prosthesisin fact, it was considered a major surgery, therefore important, which it did not necessarily guarantee stable results over time and involved high social costs.
Since then, considering the cost-benefit ratio, a real one has occurred in the medical field Revolution which has led to innovating the techniques of the intervention and above all to having prostheses, also made with different materials, of smaller dimensions (minimally invasive) and therefore more conservative and bone-saving, to the benefit of the patient. The Professor explains how all this has changed Giandomenico Logroscino, lecturer at the Catholic University and specialist in hip prosthetic surgery at the Gemelli Polyclinic in Rome.
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How is the surgery performed?
Unlike what happened in the past, there are substantially less invasive treatments: this translates, in practical terms, into a smaller cut for the operation, and this represents on the one hand an aesthetic advantage, and on the other a factor that facilitates wound healing.
Intervening without excessively invading the tissues is possible thanks to the use of innovative prostheses which have smaller dimensions, allow a greater preservation of the bone and lower the percentage of cases of post-operative infection.
Spare the bone, when a hip prosthesis is implanted, it is essential because it protects it from normal wear in contact with the prosthesis and allows, if necessary for the patient’s health, to subsequently intervene with the implantation of a new prosthesis.
“Keep in mind”, the professor specifies, “that the hip prosthesis has a duration of at least twenty years and this makes it plausible, in the most serious or younger cases, to intervene a second time with the implantation of a new prostheses “.
State-of-the-art prosthetics from Europe
Between prosthesis most used for the intervention, we find the ‘stemless’, from the English stemless that from the beginning of 2000, the period in which they entered the practice of Professor Logroscino, have not registered any complications and no removal: they are particularly small and minimize the risk of infection.
In general, the prostheses are made of titanium, but also with regard to the materials enormous progress has been made: these have been improved and made safer and the use of so-called prosthesis ‘modular ‘, which allow to better reconstruct the joint geometry and facilitate joint mobility.
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The latter can be made with different materials and based on the combination of the two parts that make up the prosthesis, cup and femoral stem, there are basically three types of coupling:
- metal-polyethylene, the original coupling from the sixties, which with the improvement of polyethylene, is the most tested and has great reliability margins;
- ceramic-ceramic, a European invention that despite the first failures of the 1980s due to fragility, today presents very low risk of breakage. It is the material that wears the least and wears little bone due to the fact that it causes almost no inflammation;
- metal-metal, a great Anglo-Saxon tradition, invoked by young people, proposed for low consumption, in reality it is a model halfway between those described above. It is a prosthesis whose debris inflames the bone more, and worries about the release of metal ions into the blood, especially in the long term, even if alleged carcinogenic effects have never been demonstrated.
Finally, the better prosthesis it is the one obtained with a hybrid coupling, such as with the ceramic head and the polyethylene insert: with this type of prosthesis, the risk of breakage is reduced and the advantages of ceramics are maintained.
Either way, the big news is to use materials more durable over time, an element that allows to overcome the weak point of the prostheses to be identified, using specific terms, in the rubbing of the insert with the head which determines, in the long term, a resorption of the bone and consequently the failure of the surgical treatment.