An Alternative Conservative Approach to Hip Reconstruction

Abstract

Primary Total Hip Arthroplasty (THA) has been a very effective surgical procedure, with improvements in design and clinical outcomes since the days of Sir John Charnley. [1-4] However, many implant femoral hip designs and surgical approaches have not been considered conservative for bone preservation. Insertion of a femoral stem in THA does alter the physiological loading of the femur. Often these altered loading conditions can and do lead to bone reaction (stress shielding) and loss of proximal bone. Proximal stress shielding occurs regardless of fixation method (cement, cementless). [5,6] This stress shielding and bone loss can lead to implant loosening and or breakage of the implant. In an attempt to reduce these boney changes some designers have advocated the conservative concept of “Neck Replacement” THA. [7-9] This paper is a review of past, present and future development within this narrow classification of Neck Replacement Arthroplasty with highlighted focus on the Silent™ Implant. Key Words: total hip arthroplasty, tissue-sparing, neck-preserving, and conservative approach.