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December 11, 2002
Indiana resident Luke Pascale runs two pizza restaurants and had worked out three times a week. He also enjoyed long bike rides with his wife, but last year, the pain in his hip became so severe he couldn't stay on a bike for more than five minutes.
"I'm very active so the thought of having hip surgery was not pleasant," said the 53-year-old father of four from St. John, Ind. Instead of receiving the traditional hip replacement surgery, which uses a metal ball bearing in a polyethylene and titanium socket to ensure strength and stability, Pascale chose to enroll in a new study using a ceramic-to-ceramic hip implant.
"Metal-to-polyethelene hip transplants have done yoeman's work for most patients, but after about 15 years, the metal begins to wear the plastic down, creating in some patients, osteolysis in the hip, which occurs when particles break off from the implant," said Dr. Steven Gitelis, orthopedic surgeon at Rush. He is one of the few orthopedic surgeons in Chicago testing the ceramic implant as part of a research protocol that may lead to more extensive use of the ceramic hip implants. "With more people living longer, the expectation is that hip replacements should last longer, too," he added.
To address this durability and wear issue, researchers and manufacturers began testing a ceramic-to-ceramic hip implant in 1997. Results from wear testing and examinations post mortem have suggested that ceramic hips are more durable than metal on metal hip replacements and significantly more durable that metal on polyethelene.
A large-scale clinical trial was recently completed of 1,196 total hip replacements performed between 1997 and 2002. Of these, 405 hips were followed for a minimum of 24 months. The results showed no postoperative bearing fractures and no particles flaking off that might cause complications. Also, researchers performed wear studies on ceramic hip materials with a walking and motion simulator that showed ceramic hips are 4,000 times more durable than metal on polyethylene.
The ceramic implant is not approved by the Food and Drug Administration but Gitelis believes that once it is approved, patients will have more choices of materials.
"If I'm treating a patient in his 80s, I would probably still give them the metal to polyethylene implant," Gitelis said. "But, if I have younger patient who requires a total hip replacement, I would recommend the ceramic material as it gives the patient the best chance to avoid wear and adverse effects over the long term."
Some researchers also believe that the bacteria Staphylococcus epidermis adheres more strongly to polyethylene than ceramic, though Gitelis indicated that had not yet been proven scientifically. Use of the new ceramic material will not require any new technique nor will it force surgeons to use a different socket as the new ceramic bearing is designed to fit into existing socket.
Pascale had his surgery on June 11 and now reports little discomfort and is happy he chose ceramic over traditional metal to polyethelene.
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