By Manish Patel

Columnist

A question from a current patient: I have lived a very active lifestyle for the past 54 years. I have been diagnosed with severe arthritis of the hip.

I have tried physical therapy, medicine, and injections with no relief. I have seen an orthopedic doctor who recommends I get a total hip replacement.

Someone mentioned that there are new hips that last longer. Can you tell me what my options are?

It sounds as though this patient has severe arthritis and now needs a total hip replacement. He is a bit young for the hip replacement, but needs it.

Like any joint replacement surgery, the implants placed in the body don’t come with a lifetime warranty. There is a lot of wear and tear that occurs over time. Someone younger tends to put more wear and tear and can potentially wear down the hip quicker, eventually requiring further surgery.

Traditionally a total hip had a metal socket with a plastic liner and a metal ball. The metal ball articulates with the plastic socket. This type of material is still used today for low-demand total hips. The friction between the ball and the socket determines partly how quickly a hip wears down. There are numerous other factors that can help reduce total hip wear.

In the recent years, total hip surgery has made great improvements. To reduce the wear between the ball and socket there are now metal ball on metal sockets and also a ceramic ball and socket. Metal on metal hips have a great track record.

The big concern with metal on metal hips is the metal debris that forms can cause metallosis in the body. There are no proven studies showing long-term detrimental effects from this.

The ceramic hips have the slowest wear rate, but don’t have a great track record long term and can crack easily.

For you I would recommend a metal on metal hip. Please talk to your surgeon to see what options are most appropriate for you.