Hip Replacement Materials - The Best & Worst Kinds To Use (2024)

HomeBlogHip Replacement Materials – A Complete Guide to the Best and Worst

ByChris Centeno, MD

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We like treating hip arthritis with stem cells, but unlike some other areas that we treat, hips with severe arthritis can be a little harder to treat. In those cases, we either recommend the patient move from a same day stem cell procedure to a cultured stem cell procedure, or if the arthritis is very severe, we’ll push the patient toward a hip replacement.

As you can likely tell, we’re not generally in favor of amputating a joint and inserting a prosthesis, which is really what a joint replacement amounts to at the end of the day. However, if you have to have one, what’s the best option? I promised a patient last week that I would perform a medical literature review and post it, in an attempt to try and answer the question about whichtype of device is best.

Hip Replacement Materials - The Best & Worst Kinds To Use (1)

ChooChin/Shutterstock

I have to say that as I updated my literature search for the phenomenon of wear particles (debris from the device created by normal wear and tear) and the havoc they cause, I wasn’t sure exactly what I would find. Regrettably, things in that department have becomeworse and not better.

TheMany Different Materials Used inHip Replacement Devices

Hip replacement devices break into a few big categories:

Metal on Metal (MOM)– These are what they sound like. Both the socket and the ball are made of stainless steel, titanium, chromium, cobalt or some combination of these. One sub-type of a MOM hip is a minimally invasive model which usually is smaller in size, so it can be installed with a smaller incision.

Polyethylene and Metal on Polyethylene (MOP)– Polyethylene is basically plastic, so these hips usually have metal structural pieces and a plastic liner where the ball and socket meet. They can also have a metal ball meeting a plastic socket liner. A sub-type of a polyethylenehip is made with a newer plastic called cross linked polyethylene, which is more durable.

Ceramic on Metal (COM), Ceramic on Ceramic (COC), Ceramic on Polyethylene (COP) – Ceramic hips are made of specialized and more durable versions of the same type of material thatplates and bowls are made from. There are ceramic on metal, ceramic on ceramic, and ceramic on polyethylene versions. While these are durable, they can be vulnerable to fracture and breaking under big stresses.

Wear Particles

If for somereason I would need a hip replacement, my single biggest concern would be wear particles. This phenomenon first came to light about 5 – 7 years ago when surgeons began to replace the first worn out or failed metal on metal (MOM) hips. What they found in somepatients was scary. Basically, the entire area directly around the hip replacement device had turned into a mass of black goo.

Then studies werepublished showing that those microscopic metal shavings were leaching into the blood stream and causing elevated metal ion levels. Additionalstudies began to point out that some people’s tissue was so sensitive to this junk that they formed pseudotumors, which are basically big solid masses of irritated tissues, some of which could press on important nerves. Finally, genetic studies showed that not only was this tissue visibly unhappy, the cells were getting damaged at a genetic level from the wear particles.

When all of this first came to light, it looked like only MOM hips were involved. However, as the research below shows, the issue of wear particles extends to every type of hip made.

ARMD – Adverse Reactions to Metal Debris

Before we begin, it’s worth noting that there is now a name for pissed off tissue caused by wear particles. In a 90s movie, a nuclear war head falls into the wrong hands and the main character is informed that this is called a “Broken Arrow”. He responds to the effect of, “I’m not sure what’s more disturbing, the fact that we just lost a nuclear warhead or that you actually have a name for this”. I feel the same about the fact that the orthopedic joint replacement community now has a name for wear particles that cause problems in patients.

In addition to highlighting research on wear particles, I’ll also look at the durability of each type. So let’s take a look at how to navigate this minefield.

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The Research on the Various Types of Hip Replacement Materials – Focused on Wear Particles and Device Failure

MOM or “Metal on Metal”

The “bad boy” of hip replacement types is clearly MOM hips. The funniest thing is that despite all of the absolutely horrific things published about these devices, you can still find Internet ads for many surgeons who will be happy to implant them. They do this by claiming that these are “minimally invasive” hips. While there’s a tiny kernel of truth in that hogwash (the incisions needed to implant them are smaller), there is nothing minimally invasive about amputating a joint and inserting a prosthesis, no matter how you skin that cat. In addition, the smaller the device, the bigger the wear particle issue.

MOM hips produce metal wear particles locally that are then taken up in the bloodstream. In general, smaller MOM hip devices (usually those used for small framed women) have a higher likelihood of producing metal wear particles.This study showed more metal ions in the blood with MOM devices compared to conventional hip replacement prostheses. This randomized trialagain demonstrated more metal ions in the blood of women with MOM hips when compared to conventional hip replacement, but also noted that pseudotumors occurred both around these MOM devices and the more conventional MOP devices as well. This recent study showed that metal debris was present in both large and small MOM hip replacement devices.

The latest 2015 consensus guidelines are now not to perform a MOM hip replacement in small women or anybody with a known metal allergy.The latest study on MOM hips and pseudotumors concludes, “Adverse reactions to metal debris in MOM hips may not be as benign as previous reports have suggested.” Not good.

Polyethylene andMetal on Polyethylene (MOP)

When I initially began this literature search, I thought that MOP hips maybe better in the wear particle department. After all, you don’t have metal rubbing on metal, but usually metal on plastic. However, I was wrong.

To see how bad things can get with MOP wear particles, I didn’t have to look far.This recent study from 2014 showed an awful side effect of both polyethylene and metal wear particles, a pseudotumor that invaded awoman’s vagin*l tissues.This 2015 study was very concerning in that it compared MOP hips to MOM hips with regard to metal levels and chromosome damage in cells. It couldn’t conclude that one was better than the other.Based on this 2014 study, MOP hips wear less, but their wear particles produce slightly more tissue reaction than MOM hips. This is all consistent with a recent study I blogged on, showing that conventional polyethylene wear particles reduced stem cell activity in bone marrow and muscle.

If there is one bright spot in this category, it’s likely the newer highly cross linked polyethylene (HCLP). Based on this recent study, HCLP hips produced fewer wear particles than regular polyethylene. In another study of shoulder replacement devices, the lower debris for these devices was confirmed. In addition, based on this 2014 study HCLP devices seem to withstand unexpected wear and part failure better.

Ceramic on Metal (COM), Ceramic on Ceramic (COC), Ceramic on Polyethylene (COP)

Maybe ceramic is the way to go? After all, what could go wrong with installing a hip replacement device made of the same substance as dinner plates?

This 2015 randomized trial showed that COM hips still regrettably produced metal wear particles that ended up in the blood stream. Some good news for COM hips could be found in this 2015 study. It concluded that while there was swelling around these devices, when compared to minimally invasive MOM hips, there were no pseudotumors seen in COM hips. However, based on this analysis of many studies, there doesn’t seem to be any advantage of COC compared to COP.How does COM and COC compare? Ceramic on metal doesn’t seem to have the same durability as ceramic on ceramic based on this study.

Is Your Surgeon Being Paid to Promote a Certain Type of Hip?

One of the real challenges in navigating this landscape is that regrettably, joint replacement devices have been one of the worst areas of payola in medicine. As reimbursem*nts have declined for the surgical procedures of installing and replacing devices, many surgeons have figured out that they can keep their cash flow stable by taking money from the device manufacturers. This has been the subject of many Department of Justicelawsuits through the years.

The big issue for patients is how toknow if their surgeon is recommending a hip device because theyreally feel that it’s the best, or because they’regetting paid by the company making the device. This Propublica web-site will allow you to research your surgeon’s payment history.

Correct Sizing is Key!

It’s very clear from reviewing the medical research on this topic that a poorly sized hip deviceis a huge problem for many reasons. First, it will reduce the longevity of the device. Perhaps more importantly, it virtually guarantees more harmful wear particles. And sincewe’re talking about replacing your hip, a good fit is common sense.

Given the modular nature of these hip devices and the wide array of options, a poor fit should never happen. However, in my experience, hardware fitting issues usually happen when the operating room and/or hospital don’t have the correct size in stock on the day of the surgery. So agree before hand onthe size of the components and make sure the staff has double-checked to make sure the hospital has that size in stock.

The upshot? All hip replacement devices produce wear particles. Butwhich is best? It’s clear that when metal on metal implants go bad, things can go very bad with a local tissue reaction that can cause pseudotumors and high metal ions levels in the blood. If I had to get my hip replaced, I would cross this type of implant off my list. Ceramics still produce wear particles and have the added problem of fracturing in an active individual. Polyethylene wear particles in a MOP hip can be just as bad as those from a MOM hip. Given that highly cross linked polythylene has the least wear particles, this is likely the winner. However, realize that not as much is known about tissue reaction to cross linked polyethylene, so that recommendation may change with time. In addition, there are newer types of ceramics that once mated with HCLP couldproduce less debris.

The Regenexx-C procedure is not approved by the US FDA and is only offered in countries via license where culture expanded autologous cells are permitted via local regulations.

Hip Replacement Materials - The Best & Worst Kinds To Use (2)

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.View Profile

If you have questions or comments about this blog post, please email us at [emailprotected]

NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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Hip Replacement Materials - The Best & Worst Kinds To Use (2024)

FAQs

What type of hip replacement material is best? ›

Since they were first used in 1970, ceramic-on-ceramic hip implants have been considered by many orthopedic experts the best option for hip prostheses, in terms of quality and durability. Ceramic-on-ceramic hip implants have lower rates of bone deterioration, loosening or dislocation and, ultimately, revision.

What is the best implant for hip replacement? ›

Titanium Implants

Both the ball and the socket of the hip joint are replaced with a titanium implant, and a plastic spacer is placed in between. Titanium metal has a long history of established effectiveness in hip replacement and continues to be preferred by many surgeons.

What are the problems with titanium hip replacements? ›

Titanium toxicity can elicit a number of symptoms, including fatigue, headaches, blurring of vision, respiratory inflammation, lymphedema, and hyperpigmentation of the nails and skin [[12], [13], [14]].

What is the latest technology for hip replacement? ›

The new, head-mounted augmented reality (AR) system projects 3D models of a patient's anatomy, implants, and surgical instruments onto the patient during the procedure. In other words, this gives surgeons “x-ray vision” into the body and improves surgical accuracy.

What are the longest lasting hip replacement materials? ›

Metal on Plastic - The metal femoral head is the most common type of head implant. The metals commonly used include cobalt-chromium, titanium, zirconium, and nickel. Metal-on-plastic is the least expensive type of implant and has the longest track record for safety and implant lifespan.

What is the easiest hip replacement surgery? ›

Anterior hip replacement is a minimally invasive hip surgery performed to replace the hip joint without cutting through any muscles. It is also referred to as muscle sparing surgery because no muscles are cut enabling a quicker return to normal activity.

What is the most common hip implant? ›

The most common type of hip replacement surgery is called a total hip replacement (also called total hip arthroplasty). In this surgery, worn-out or damaged sections of your hip are replaced with artificial implants.

Which surgery is better for a hip replacement robotic or regular? ›

Studies show robotic-assisted hip replacement surgery is five times more accurate at matching leg length and twice as precise at achieving optimal hip joint angle than conventional hip replacement surgery. Other benefits include: Reduced blood loss. More natural feeling after surgery.

Which plate is better titanium or stainless steel? ›

Conclusion: Stainless steel implants have equal or superior biomechanical properties when compared with titanium implants. However, there is clinical evidence that titanium plates have a lower rate of failure and fewer complications than similar stainless steel implants in some situations.

Will a titanium hip set off a metal detector? ›

Hip implant device materials include both plastic and metal. Metals commonly used as orthopedic materials include stainless steel, cobalt chrome, and titanium. Typically, airport screening detectors will identify patients with these metal implants.

Does cold weather affect titanium implants? ›

Cold temperatures may cause pain in a significant number of patients with orthopedic implants. A high proportion of these patients have significant pain (5–10 on a numeric rating scale) related to cold conditions.

What metal is most commonly used in hip replacements? ›

Most used are titanium alloys, stainless steel, special high-strength alloys, alumina, zirconia, zirconia toughened alumina (ZTA), and UHMWPE. Usually, stems and necks are composed of metals, whereas femoral heads can be both metal and ceramic, and the acetabulum can be made of metals, ceramics or polymers.

Who is the best hip replacement surgeon in the world? ›

Best Hip replacement Doctors
  • Rafael González-Adrio Wagner. Orthopedist. ...
  • Petr Juda. Orthopedist. ...
  • Haluk Celik. Orthopedist. ...
  • Erkam Komurcu. Orthopedic oncologist. ...
  • Vladislav Hospodar. Orthopedist. ...
  • Narunas Porvaneckas. Orthopedic surgeon. ...
  • Sasсha Flohé Orthopedist. 2023 years of experience. ...
  • Clayton Kraft. Orthopedist. 25 years of experience.

What is the difference between a hip replacement and a total hip replacement? ›

A hip replacement (or partial hip replacement) only sees the ball part of the joint replaced by either a metal implant. A total hip replacement replaces both the ball and socket with an implant.

At what age is hip replacement not recommended? ›

UH orthopedic surgeon Steven Fitzgerald, MD, says there is no upper age limit for knee and hip replacement surgery. A patient's overall health is the main consideration. “The oldest hip I replaced in the last 10 years was in a man who was 100 years old,” Dr. Fitzgerald says.

What hurts the most after hip replacement surgery? ›

You can expect to experience some discomfort in the hip region itself, as well as groin pain and thigh pain. This is normal as your body adjusts to changes made to joints in that area. There can also be pain in the thigh and knee that is typically associated with a change in the length of your leg.

What time of year is best for hip replacement surgery? ›

Consider spring and fall

Doctors recommend spring and fall as the ideal times for surgery. Moving around and exercising are essential parts of recovery. The weather around this time is perfect for maximizing visits to a physical therapist.

How long does it take to walk normally after a hip replacement? ›

Most hip replacement patients are able to walk within the same day or next day of surgery; most can resume normal routine activities within the first 3 to 6 weeks of their total hip replacement recovery. Once light activity becomes possible, it's important to incorporate healthy exercise into your recovery program.

What is the most frequent complication after a hip replacement? ›

One of the most common serious medical complications related to joint replacement surgery is blood clots. Deep vein thrombosis (DVT) refers to a blood clot in the leg and is called a deep vein thrombosis.

What 3 things should be avoided after hip replacement surgery? ›

Don't cross your legs at the knees for at least 6 to 8 weeks. Don't bring your knee up higher than your hip. Don't lean forward while sitting or as you sit down. Don't try to pick up something on the floor while you are sitting.

Can you still have arthritis after hip replacement? ›

Although they are rare, such problems include: Not enough pain relief. Joint replacement surgery relieves the pain and stiffness of arthritis for most people. Some people may still have some symptoms of arthritis.

Which method of hip replacement is the best Mayo Clinic? ›

In a prospective, randomized study, researchers at Mayo Clinic in Rochester, Minnesota, found that Mayo Clinic patients who underwent DAA had objectively faster recovery than patients who had MPA hip arthroplasty.

Is the new hip replacement method any better than the standard? ›

The answer: In recent years, an increasing number of patients have been choosing the direct anterior approach. And it's certainly true that during the first few weeks and months after the operation these patients tend to get better faster compared with those who have other types of hip-replacement surgery.

Which is better total hip replacement or hip resurfacing? ›

Hip resurfacing is as effective as hip replacement in easing hip pain and improving mobility. Compared to hip replacement, hip resurfacing offers these advantages: Improved mobility: Most people who get hip resurfacing can run, jump and do all activities after they heal.

What are the side effects of titanium screws in the body? ›

Titanium toxicity can elicit a number of symptoms, including fatigue, headaches, blurring of vision, respiratory inflammation, lymphedema, and hyperpigmentation of the nails and skin [[12], [13], [14]].

What are the side effects of titanium plates and screws? ›

It is not considered a toxic metal but it is a heavy metal and it does have serious negative health effects. Titanium has the ability to affect lung function causing lung diseases such as pleural disease, it can cause chest pain with tightness, breathing difficulties, coughing, irritation of the skin or eyes.

What are the side effects of titanium plate surgery? ›

Various complications can result from titanium plate internal fixation, including infection, exposure, pain, cold intolerance, and palpability.

How do you get through airport security with hip replacement? ›

Advise security officers of your implant

Tell the security officers about your joint replacement when you get near the security area. Let them know where your implant is located. A security officer will offer you a private screening that could include screening with a hand-held wand and a pat-down inspection.

Will my artificial hip set off airport security? ›

Over 90% of implanted total hip and knee arthroplasty devices will set off airport metal detectors. Many implants now include ceramic and plastic materials in addition to metal, and the metal will still likely cause an alarm in the metal detector.

Does titanium show up on airport xray? ›

Titanium Does Not Set Off Most Metal Detectors

The metal detectors used by TSA create an electromagnetic field, which reacts with magnetic metals and sets off an alarm.

Can you go through airport security with titanium implants? ›

The majority of metal detectors used by the TSA work by creating an electromagnetic field, which sets off an alarm when it detects any nearby magnetic metals. In most cases, modern dental implants are primarily made from titanium, a non-magnetic metal. So, titanium dental implants should rarely trigger metal detectors.

Can you get sick from titanium implants? ›

One of the causes of implant failure can be attributed to allergic reactions to titanium. There have been reports of hypersensitive reactions such as erythema, urticaria, eczema, swelling, pain, necrosis, and bone loss due to titanium dental implants [15, 67, 68].

Do magnets affect titanium implants? ›

Titanium may obscure specific areas of an image, but it is not affected by even strong magnetic fields. Not all metallic elements are attracted to magnets, and most orthopedic implants are made of nonmagnetic alloys.

What is the safest material for hip replacement? ›

Since they were first used in 1970, ceramic-on-ceramic hip implants have been considered by many orthopedic experts the best option for hip prostheses, in terms of quality and durability. Ceramic-on-ceramic hip implants have lower rates of bone deterioration, loosening or dislocation and, ultimately, revision.

What is the gold standard hip replacement? ›

Cemented. Cemented total hip replacements are considered gold standard in many countries. The stem is fixed in position inside using bone cement, which holds it securely in position inside the femur.

What are the side effects of metal-on-metal hip replacement? ›

Metal-on-metal hip implants have the same adverse effects as other types of hip implants, including infection, loosening, bone loss, device or bone fracture, and joint dislocation.

What is the newest hip surgery? ›

What Is Anterior Hip Replacement Surgery? The anterior approach is a newer minimally invasive technique now being performed by some surgeons. This approach uses a smaller incision near the front of the hip and avoids muscle cutting to access and replace the joint.

What is the most advanced hip replacement surgery? ›

The surgical technique for a SUPERPATH® Hip Replacement was developed as an advancement to traditional total hip replacement. The SUPERPATH® technique is a tissue-sparing procedure which aims to get patients back on their feet within days (possibly hours) instead of weeks or months.

Who is not a good candidate for hip replacement surgery? ›

Who Is NOT a Good Candidate for Hip Replacement? You may not be a good candidate if: You have a chronic disorder, such as Parkinson's disease or a condition that causes severe muscle weakness. You have a severe illness or infection.

Which hip replacements are being recalled? ›

Exactech first recalled their GXL brand of hip-liners in the summer of 2021.

Which type of hip surgery is best? ›

The best hip replacement operation out there, is through the anterior approach. Anterior - meaning from the front of your hip. Most of the country traditionally goes from the posterior approach. The posterior approach works, but post-operative dislocations are higher than the anterior approach.

How long does it take a 75 year old to recover from a hip replacement? ›

You'll likely be able to return to most of your daily activities, including driving, in about 6 weeks. Full recovery may take 1 year or more. It's important to talk to your doctor about how to prepare for this surgery and what the recovery period involves.

Can you ever cross your legs after hip replacement? ›

No Leg Crossing

For at least two months after hip replacement surgery, avoid crossing your legs. This is particularly a risk if you bring your knee across your body. Putting a pillow between your legs while sleeping can prevent inadvertent leg crossing during sleep.

What are the three types of hip replacement surgery? ›

Types of surgical approaches

the back of the hip – the posterior approach. the side of the hip – lateral or anterolateral approach. the front of the leg – anterior approach.

What are the three types of total hip replacement? ›

What are the Three Approaches for Total Hip Replacement Surgery? Dr. Dan Albright, orthopedic surgeon discusses the three approaches to hip replacement surgery: anterior, lateral and posterior and which approach he feels has the quickest recovery.

Can your body reject a titanium hip replacement? ›

When it comes to organ transplants, your body can reject the new and foreign organ for any number of reasons. However, with hip or knee replacements, rejection to the metal is exceedingly rare.

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