Is there a need to Expend $83 Billion on Prosthesis surgery?
In the
Journal of Arthritis
Dr. J. Cabrera gives insight into why the
costs associated with Joint prosthesis surgery are unnecessary and reveals innovative
solutions which showcase the way forward
…
Hip replacement surgery is in no doubt one of the most
important orthopaedic breakthroughs over the last 60 years
and has has eased suffering and disability worldwide.
After more than 60 years since its implantation, the time is
now to create modern biotechnology to resurface defects in
joints, similar to what dentists have done with tooth
cavities.
Hip and joint replacement surgery from as early as the 17th
century have been daring in the experimental use of materials
such as; celluloid, silver plates, rubber struts, magnesium,
zinc, glass, pyres, de calcified bones, wax, muscle tissue and
celluloid. Of course there were no long term success stories
recorded whilst experimenting with these materials as the
human body almost always reacted against them. These
materials were also unable to cope with the stresses of
supporting body weight for long periods of time. The early
experimental days did however start paving a way for
surgeons’ attempts towards successful hip replacement
surgery. Primitive operations were performed to replace only
one joint and came with a high risk of infection, inherent before
the advent of antibiotics..
Artificial hips were gradually gaining notoriety and interest
within medical circles circa 1930, though it was rare for
someone to undergo full hip replacement surgery back then.
Experimental attempts to replace joints with Teflon seemed
like a good idea at the time, but Teflon prosthesis wore out
within two to three years and eventually patients suffered
osteolysis, which is when bone starts to dissolve and be
reabsorbed by the body. Even though these hip replacement
surgeries seemed rudimentary, they were considered a better
alternative to the crippling, pain endured by those suffering
arthritis. One of the major problems with experimental
materials was that the articulating surfaces inserted in the
joints were unable to be naturally lubricated by the body
which caused them to wear down and loosen which made it
necessary to replace the joints again via revision surgery.
Artificial joints were eventually manufactured from steel or
chrome which had a better ‘hip life’ due to superior strength
and their non corrosive quality.
Dr McKee
By the early 1950s, DR. McKee, a British orthopaedic surgeon, had designed
prosthesis on the femoral side that articulated with a three claw type cup that screwed
into the acetabulum (the surface of the joint that the ball joint fits into). The initial high
incidences of failure resulted from the loosening of components as there was no
adequate holding cement available to keep the prosthesis in place for long periods of
time.
It was throughout the 1960s that Hip replacement surgery became more widespread
and available to patients. At the XIX World Congress of Surgery/International College
of Surgeons (1974) Dr. McKee presented results from the first 300 total hip prosthesis
and concluded that the most important principle was to obtain the firm fixation of
components in the bone using screws, then later using acrylic cement.
Dr. San Baw
In 1960 a Burmese orthopaedic surgeon, Dr. San Baw who was chief of the orthopaedic
surgery unit at the Mandalay General Hospital in Burma pioneered the use of ivory hip
prostheses to replace united fractures of the neck of the femur.
Dr. San Baw at first bravely used an ivory prosthesis to replace the fractured hip bone of
an 83 year old Burmese Buddhist nun. He continued his work up until the 1980s’ with
considerable success and is now famous for it.
Dr. Peter Ring
Dr. Peter Ring was from Surrey, England. He began practising his clinical experience with
cement-less components and utilising metal-on-metal articulation from 1964.
Dr. Rings early Arthroplasty surgery provided surprisingly good results with up to 97% of
implants lasting for many more years than the previously used materials.
Sir John Charnley
The modern artificial joint owes much to the work of Professor John Charnley from
the Manchester Royal Infirmary. Dr. Charnleys’ work throughout the 1970s’ in the field
of tribology resulted in a design that completely replaced previous designs prior to the
1970s. Charnley's design consisted of three parts which were: a stainless steel metal
femoral component (the ball attached to the femur) which connected to an Ultra high
molecular weight polyethylene acetabular component. Both of these prosthesis were
fixed to the bone using the third and last element; a specially manufactured bone
cement. The replacement joint was known as the Low Friction Arthroplasty and was
lubricated with synovial fluid. The small femoral head on occasion produced wear and
tear problems which made it suitable only for much older patients with less mobility,
however there was a huge reduction in resulting friction which led to excellent clinical
results. For over two decades, the ‘Charnley Low Friction Arthroplasty’ design was the most used system
in the world, far surpassing other available options created by McKee and Ring.
Dr. Javier Cabrera was the first surgeon to
perform a cemented total hip implant in private hospitals (1972)
disclosed at the XIX World Congress of Surgeons of the
International College of Surgeons (1974).
Inventor of patent GB2344290 "A device for replacing/ repairing
the joints"
Members of the 1974 Congress of
Surgeons..
Members from the
International College of Surgeons including the worlds most
renowned orthopaedic surgeons from England, Australia and a host of European countries gathered. In
the Congress, leading surgeons were asked to present their feedback on hip prosthesis surgery. Dr.
Javier Cabrera LMS.FICS. reported his success in orchestrating and implanting the first cemented total
hip prosthesis throughout private hospitals. From this time forward, the FDA approved and granted the
use of acrylic cement for prosthesis surgery within the US.
Since the 1974 congress millions of patients throughout the world have been treated with cemented total
hip prosthesis within Private Hospitals.
Modern day Prosthesis surgery..
Throughout the last decade, developments have been created in the hope of total hip
replacement procedures. A vast majority of older implants are made of a ceramic material rather
than polyethylene, which some research indicates dramatically reduces joint wear. Metal-on-metal
implants are also gaining popularity in investigated and proven negative ways. Orthopaedic
manufacturers have now abstained from this type of hip prosthesis due to complications these
prosthesis have created, such as metal corrosion and the infiltration of metal particles within the
body, and ultimately the brain.
Most implants are now fixed without cement and the prosthesis has a porous texture into which
newly formed bone grows into. This method however still proves to be too invasive.
Hip Resurfacing Surgery...
Hip resurfacing is generally used as the alternative to total hip
replacement and is often suggested for active patients under the age of
55.
Hip replacement surgery was adapted in the 1970s’ and came with some
success, but surgeons preferred to opt for hip replacement surgery
because of the early complications that resurfacing surgery created.
Improvements over the last two decades have made hip resurfacing
surgery more attractive and is now a better option for patients, especially younger more active people.
Hip resurfacing surgery is very different from hip replacement surgery as the femur head is
reshaped, then resurfaced with a metallic shell. A metal socket is then inserted into the pelvis to support
the newly resurfaced femur joint. This surgical procedure reduces pain and ensures better joint stability.
The chance of dislocation also lowers if resurfacing surgery is performed rather than with a total hip
replacement. Revision surgery from resurfacing is not as complicated, due to less healthy bone removal.
The process of
manufacturing
prosthesis parts
requires large
amounts of energy
which add onto
more unwanted
environmental
pollution.
The innovative design
and technology creating
a brighter future for Hip
Surgery.
1950s
Dr. McKee designs a
prosthesis on the
femoral side that
articulates with a three
claw cup that screwed
into the acetabulum.
1960
Dr. San Baw at the
Mandalay General
Hospital in Burma
pioneers the use of
ivory hip prostheses to
replace united fractures
of the neck of the femur.
1964
Dr. Peter Ring starts a
clinical trial with
cement- less
components with a
metal-on-metal
articulation. 97% of
implants survived the
years of follow up.
1970s
Sir John Charnley
replaces previous
designs prior to the
1970s. Charnley's
design consisted of
three parts which
connected to an Ultra
high molecular weight
polyethylene ace
tabular component.
New York
A team of 35 International bio
scientists, manufacturers and
doctors hold a summit on arthritis.
Among other conclusions they
discuss the Inadequacy of arthritic
classification and a need for new
treatments for the symptoms of
bone cartilage and joint structural
abnormalities in the stages of the
disease. Concerns in the scientific
world about the treatment for
Arthrosis and economical
consequences of Arthroplasty
surgery with its environmental
issues are raised.
Dr. Javier Cabrera
Bio Total Hip
First cemented THP
performed in a private
hospital by Dr. Cabrera.
Dr. Javier M. Cabrera
L.M.S. F.I.C.S.
Information on
Osteoarthrosis and
how the Bio Hip can
help rid the world
from Arthritic pain.
Orthopaedic surgery owes a great deal of its
development to its role in military conflicts
throughout history.
Hip replacement
Surgery and its
countless problems
and risks.
With over 35 years
experience in orthopaedic/
spinal surgery, Dr. Javier
Cabrera patents the
revolutionary Bio Total Hip