Picture this scenario: You’ve endured hip- or knee-replacement surgery and are feeling pretty confident that you’re going to be much better off than before—even better off than other people you know who have had similar surgery. Why? Because your orthopedic surgeon suggested you use the latest type of artificial joint—a “ceramic-on-ceramic” implant that includes a ceramic (instead of metal or plastic) socket and ball bearing that fits into it. Now, three days after surgery, you’re ready to take your first steps. The nurse helps you out of bed and you go for it. You take a step. Then another. Then another. “Did you hear that?” you ask your spouse. Everyone around you stops and listens. You take another step, and it’s undeniable. Your new joint is squeaking!

Squeaking, which has been reported in up to 8% of patients with ceramic-on-ceramic artificial joints, is more of a nuisance than a safety issue, but it’s just one of a number of problems seen with the latest hip- and knee-replacement devices, according to Art Sedrakyan, MD, PhD, associate professor in health-care policy and research at Weill Cornell Medical College in New York City.

Don’t get me wrong. The older types of artificial joints that have been used for many years are not free from issues such as loosening, premature wear and instability either, and one would think newer devices would aim to be an improvement over the old. But when Dr. Sedrakyan and his colleagues reviewed 118 published studies on hip- and knee-replacement devices, they found that newer, so-called high-tech versions, including ceramic-on-ceramic hips and high-flexion knees, which promise the ability to move the knee more deeply and fluidly, weren’t any more effective than older products and that some were more often associated with the need for revision surgery (surgery to correct a complication of surgery).

DEFYING LOGIC?

A major reason why new devices are not necessarily improvements on the old, according to Dr. Sedrakyan, is that joint-replacement devices are usually not approved by the Food and Drug Administration based on scientific studies in humans but on engineering data and information on the materials used for the devices, he said. Doctors, assuming that new must be better—and safer—then recommend the newer devices to patients without being fully informed about how effective or safe they are in real-world use. Without clinical trials, no one really knows how effective or safe these devices are until years later when side effects and complications are tallied up.

HOW TO PROTECT YOURSELF

Dr. Sedrakyan is currently spearheading a program to get doctors, device manufacturers and government agencies to develop stricter standards for approving new medical implants. In the meantime, he offered this advice for Daily Health News readers…

  • Ask lots of questions. If you are going to have a joint replaced, fully discuss the procedure with your surgeon and don’t be shy about grilling the surgeon on the different types of device that could be used.
  • Be sure to ask why your surgeon favors a particular device. Question whether evidence shows that a recommended implant is better than others in real life. And make sure the information is explained to you in a way that you understand. It needs to make sense to you. Do not blindly trust your surgeon—he/she may have the best of motives, but he may not have all of the facts.