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…

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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 replacement surgery from as early as the 17th century has been experimental with the use of materials such as celluloid, silver plates, rubber struts, magnesium, zinc, glass, pyres, de calcified bones, wax, muscle tissue celluloid and other failed materials. Unfortunately no long term success stories have been recognised whilst experimenting with these materials as patients biological systems reacted against them. These materials were also unable to cope with the stresses of supporting body weight for long periods. The early experimental days did however pave a way for surgeons who endured to perfect hip replacement surgery. Primitive surgeries were carried out to replace joints and were plagued with a high risk of infection, which was inherent before the wide advent of antibiotics.. Artificial hips gradually gained notoriety and an interest in medical and public knowledge, though it was rare for someone to undergo full hip replacement surgery. Experimental attempts to replace joints with Teflon seemed like a good idea at the time, but the Teflon wore out within two to three years and eventually patients suffered osteolysis; as the bone started to dissolve and then re- absorbed by the body. Though historical hip replacement surgery appears to be rudimentary, it was considered a better alternative compared to the crippling pain endured by arthritis. Another problem with these experimental materials was that the articulating surfaces inserted between joints were unable to be lubricated by a patients body, which created wear and tear, thus making it necessary to replace joints with revision surgery. Artificial joints were eventually manufactured from steel and chrome which had a better ‘surface life’ due to superior strength and being non corrosive. 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, from Surrey, England began practising with cement-less components and utilising metal-on-metal articulation since 1964. Dr. Rings early Arthroplasty surgery provided surprisingly good results with up to 97% of implants remaining more than previously used materials. Sir John Charnley The modern artificial joint owes much to the work of Professor John Charnley from Manchester Royal Infirmary.Dr. Charnleys’ work throughout the 1970s’ in the field of tribology resulted in a design that completely replaced previous designs. Charnley's design consisted of three parts which included a stainless steel metal femoral component (the ball attached to the femur) 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, surpassing other available options created by McKee and Ring. From the years of extensive training whilst working in the UK, Dr. Javier M. Cabrera Contreras performed the worlds first recorded cemented total hip prosthesis implant surgery within a private clinic. At the time this was big news so it was widely reported by journalists, radio stations and television stations all throughout South America. Members from the International College of Surgeons XIX, (Sept 1974) which consisted of the worlds most renowned orthopaedic surgeons were subsequently informed of Dr. Cabreras achievements and the notoriety he gained throughout South America for introducing a much needed change. From this time forward, the FDA approved and granted the use of acrylic cement for prosthesis surgery world-wide. 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 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 early complications that resurfacing surgery created. Improvements over the last two decades have made hip resurfacing surgery more attractive and is has become a better option for patients, especially younger, more active people. Hip resurfacing surgery is vastly 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.

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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.

Increasing Costs In the US alone, 332,000 total hip implants were performed. Similar surgical procedures on damaged joints were performed in greater numbers, including knees, shoulders and elbows being the most common in need of repair.

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.

Hip replacement Surgery and its countless problems and risks.

With over 35 years experience in orthopaedic/spinal surgery, Dr. Javier Cabrera patents the Bio Total Hip

Modern Day Prosthesis Surgery

Dr. Javier Cabrera

The innovative design and technology creating a brighter future for Hip Surgery.

History in the making…