What THR devices do you use?
What device is best for younger active patients?
What limitations do they have after they have healed?
Dr. Brooks Responds:
I use Smith and Nephew total hips.
Stems and sockets are rarely cemented. Very rarely in my
practice.
Stems also come in 3 basic designs: cylindrical,
tapered, and anatomic (rights and lefts). The incidence of thigh - pain
is least with the tapers - no surprise there.
So, I use a cementless tapered stem, with a cementless socket.
From there, the only choice is the bearing.
My bearing for young people that would otherwise have a
BHR hip resurfacing, is ceramic on ceramic. There is no bearing with
better wear properties than COC. I have had no incidence at all of
ceramic fracture and no squeaking either. Squeaking seems to be
sensitive to the actual brand of hip, and may have something to do with
malposition as well.
In older patients I would tend to use metal on plastic,
and as the plastics have improved I have increased my head diameter
somewhat.
In nickel-sensitive patients I either do a COC or an
Oxinium on plastic bearing.
After surgery I advise no running, jumping or heavy
lifting indefinitely (unlike with resurfacing BHR who have no
restrictions at all after 1 year).
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