Revision Hip Arthroplasties: The burdens created due to physical compromise and biofilm formation

Revision hip procedures represent a large financial burden on hospitals and the problem will continue to worsen as the baby boomer generation ages and life expectancy goes up. The future problem is a complex issue that bridges scientific and anecdotal evidence and must be solved. A review of the current total hip arthroplasty procedure in regards to the physical properties of the materials used for hip prostheses is given. Revision procedures can be caused by infection or basic wear and tear from the stress that that implant is subjected to daily. Infections on these implants often present themselves as medical biofilms. The mechanisms of biofilm formation include a complex system of enzymes that work to initiate a phenotypic response based on an established quorum sensing within the colony of bacteria. Surgical methods to treat infection include irrigation and debridement as well as loading drug cement spacers with antimicrobial in hopes of delivering the antibiotic locally. Research is being done to better model the transport of drug through the tissue surrounding the implant, and will hopefully one day be available for use in individual patients.