The majority of joint replacements performed are hip and knee replacements. Less commonly required joint replacements include shoulder and elbow replacements.
The specific prosthesis/implanted joint used in a replacement depends on a variety of factors, such as the underlying disease process (for example osteoarthritis, rheumatoid arthritis, post-traumatic arthrosis, avascular necrosis etc), the age of the patient, the body weight, the radiological assessment, the clinical assessment, the expected wear-and-tear on the prosthesis and the expected longevity of the prosthesis.
Prostheses vary widely in design as well as pricing. The most expensive system on the market costs approximately four times the amount of the least expensive. Therefore, to a certain extent we can utilize the best prosthesis that the patient can afford. We only use prostheses that have a well established track record and which have been well documented in orthopaedic literature.
As mentioned, the prosthesis is selected for each patient depending on their individual requirements. However, the system that we use most commonly for hip replacements is a combination of a Synergy uncemented stem and a Reflection uncemented acetabular cup, both produced and marketed by Smith and Nephew. When using cemented prostheses we use either a Spectron stem (Smith and Nephew) or a Charnley C-Stem (De Puy), which we all hope represents the next step forwards in stem design. It has been touted as the "30 year stem" by Professor Wrobleski, who is the designer and successor to Professor Charnley at Wrightington Hospital. By this he expects the stem to last 30 years after being successfully implanted.
Another system that we use, for the appropriate patients, is the Birmingham Hip Resurfacing (BHR) / McMinn prosthesis, marketed in this country by Smith and Nephew. This is a resurfacing rather than a total hip replacement, and despite the fact that the long-term (10-20 years) results have yet to be