Treatments

Duke’s joint-replacement care is precisely focused on the unique medical and lifestyle needs of each patient. Surgeons select an implant based on criteria such as the individual's age, weight, and activity level.

Hip and knee replacements are most common, but our surgeons’ expertise also extends to shoulders, elbows, ankles, and other joints.

For certain patients, an alternative to hip replacement is offered, while others may qualify for an investigational metal hip implant.

A wide range of techniques, including vascularized bone grafting, arthroscopy of the hip and knee, and osteotomy, are used in an effort to delay the need for an artificial joint. Many of these techniques were pioneered at Duke.

Patients receive a personalized discharge plan designed to allow them to return to their daily lives as quickly as is medically safe. As recovery continues in the months following the surgery, complication rates are low, outcomes are excellent, and patient satisfaction is high.

INBONE and Salto-Talaris Ankle Replacements

People who have a hard time walking because of severe ankle pain -- typically the result of fractures or inflammatory diseases like rheumatoid arthritis -- should consider ankle replacement. As one of the leading ankle replacement centers in the world, Duke offers two types of ankle prostheses -- INBONE and Salto-Talaris.

The INBONE ankle is unique in that it is aligned with a rod that is inserted up the heel bone into the lower leg. Surgeons insert the components into the ankle piece by piece, building a stem that goes up into the lower leg, then placing a shorter stem on the other side of the ankle. The two pieces of metal are separated by a high density piece of plastic. James DeOrio, MD, a surgeon on Duke's foot and ankle specialty team, has performed more INBONE ankle replacements than anybody else in the world.

The Salto-Talaris ankle is modeled after the Salto ankle, which has been used in France for many years. It has a shorter, pedestal-like stem that goes into the lower leg, and another piece of metal that is built to cover the dome and lateral side of the ankle bone. It also has a high density piece of plastic separating the two pieces of metal.

Patients are having the surgery with as little as one night's hospital stay and a cast for three weeks. Although the risks of ankle replacement are somewhat higher than hip or knee, the results have been extraordinary for many patients.

An Alternative to Hip Replacement

Younger patients with avascular necrosis may benefit from the free vascularized fibular graft. If bones lose their blood supply, a person may develop avascular necrosis. This death of bone tissue can cause joint surfaces to collapse. Avascular necrosis is most common for long bones such as the femur, which is the bone that runs from your hip to your knee.

Artificial hips have an average lifespan of about 15 years, which means that young patients would likely need multiple joint replacements during the course of their lives.

The procedure, which was developed by Duke orthopaedic surgeons, avoids the possibility of multiple replacements by using the patient's own tissue to reconstruct a new joint.

Dead bone is removed and replaced with bone from the fibula and its accompanying blood supply.

Investigational Metal Hip Implant

Some patients may wish to participate in a study to evaluate the safety and effectiveness of the CONSERVE Plus Total Resurfacing Hip System. This metal implant requires less of the patient’s own thigh bone to be removed and may last longer than traditional implants.

Please note that this is an investigational device and not everyone is eligible to participate.

An experimental all metal hip implant that is investigational (one that has not been cleared or approved by the US Food and Drug Administration) is compared to published information on standard hips that have been cleared or approved by the US Food and Drug Administration.

The experimental all metal hip implant (CONSERVE Plus Resurfacing Hip System) has two components:

  1. A socket: the metal CONSERVE Plus hip joint socket shell that is implanted in the hip socket
  2. A head: the metal CONSERVE Plus hip joint ball resurfacing component that is implanted into the head at the top of the thigh bone. This implant does not require as much of my thigh bone to be removed as the standard hip implant does

The following complications are specific to all metal implants and in addition to complications associated with a total hip replacement:

  1. Release of metal debris (metallosis) can occur with all metal implants. These implants produce corrosion products that are biologically active and may cause chronic inflammatory reactions that can lead to loosening of the implant. It is reported that the concentration of metal debris is higher if the prosthesis is worn or loose, or if the joint is infected. It is not clear what the normal levels of ions in human tissue should be; however, animal studies show that cobalt doses up to 1000 times normal may be tolerated. Larger doses than that can induce anemia, loss of appetite and weight, an increase in the number of red blood cells, lesions in mucous membranes, local malignant skin tumors, and death.
  2. Although inconclusive, there is concern that extensive metal ion release may cause changes to the immune function which may lead to lymphomas and leukemias.

Benefits: There may not be any additional benefits for participating in this clinical study except the expected benefit of a hip implant designed to replace your hip. While there can be no guarantee of success, benefits can include relief from pain and restoration of the normal use of your hip. If you receive the experimental all metal hip implant, less of your own thigh bone will be removed. There is also the potential for the experimental all metal hip implant to last much longer than the standard hip implant currently available to you.

Physicians

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About This Page

Published: 09/12/2006
Updated: 11/08/2007
URL: http://www.dukehealth.org/Services/JointReplacement/Treatments/index