My Top picks from 2025

LIFETIME HIP & KNEE

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#118: Last Year's Top Papers

Here’s my pick of the papers I read + posted about in 2025

They point to the direction of hip + knee surgery is moving.

I'll do a quick whizz through the latest evidence in the next couple of newsletters. It’s good stuff.. (to me at least 😁)

First up..

1 The Moving Parts

2x papers on the liner of the hip socket..

The first paper looks at the white plastic liner in the picture..

Plastic gets a bad (w)rap nowadays

BUT cross-link it AND highly cross-link it

=> There’s a good chance it’ll last you 20+ years in a hip replacement.

Remember that might be 3 million steps per year 🚶

60 million steps🏃‍♂️🚶‍♀️🚶🏃‍♀️

5x Bodyweight.. 🔨🔨🔨

Wear rates in this paper were:

0.034 mm/yr for new polyethylene (bottom red line)
0.181mm /yr for old polyethylene (top green line)

That gave a 20yr revision rates of:

9/37 for new poly
28/37 for old poly

3x times less for new poly..

..for those still alive and kicking.

This tells the story of the biggest leap forward I’ve seen over my career.

2 Do Ceramic Hips Squeak?💥

The 2nd paper looked at ceramic total hip replacements..

(the pink bits in the pic below)

And asked ‘what % make a noise?

The answer for 2x brands (Trident & Trilogy) of hip replacement at 12 months:

19% + 14%

The orthopaedic community often focuses in on revision rates

Like in the polyethylene paper above

Revision is when joint replacements go badly wrong

Things break, implants fail, joints dislocate, replacements get infected.

AND ceramic hips have a low revision rate

BUT that misses the experience of living with these things.

Could you live with a squeaky hip?

I’d struggle and that 1 in 6 number
It's a risk I’d carefully consider.

Note: this is ceramic on ceramic NOT ceramic on polyethylene

More on that combo later..

3 Porous metal

Paper 3 looked at the game changing porous metal implants..

Cups + augments (wedges of metal)

This stuff has quietly revolutionised revision hip + knee surgery.

Remarkably we’re now able to blow very hot gaseous metal

Onto a porous foam model to make a porous metal material

That’s v similar to porous cancellous bone!

Bone likes these metals to begin with..

(Titanium & Tantulum)

And bone loves these structures even more when they're porous.

AND the porosity makes these implants grippy

They really stick to bone on the way in.

Even if there's a lot of bone loss..

And bone grows onto AND into the implants

They become part of the human skeleton..

At 10 years this paper showed 89-100% stay well fixed..

A truly great result. And good to know if you ever need a revision hip..

It's been another huge leap forward from where we were at the start of my career.

Next week

There's been a change on stem side that we'll look back on..

Here's wishing you a great 2026.
Happy New Year!!

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Duchy Hospital
Truro
TR1 3UP
United Kingdom