Hip Replacement
Hip replacement is one of the most successful operations of the 20th century. It has reliably restored function, relieved pain, and returned mobility to millions of patients around the world since the early 1960’s.
THR can be performed for end-stage arthritis of the hip, which may have resulted from a wide variety of underlying condition such as Osteoarthritis, Inflammatory arthritis, (e.g. Rheumatoid Arthritis, Psoriatic Arthritis, SLE, Juvenile Chronic Arthritis), Treated septic arthritic, Secondary to hip dysplasia, Post-traumatic arthritis (fractures), Avascular necrosis of the femoral head.
It can also be used in treating acute fractures of the femoral head and neck in relatively young or active patients.
The aim is to remove the damaged/diseased portions of cartilage in both the upper part of the femoral neck and head as well as to resurface the inner cartilage lining of the acetabulum. On the femoral side, the femoral head and neck is replaced with a metal stem which is implanted into the bone marrow of the upper femur. The stem is then connected to ball on the top to replace the ball of the femoral head. The ball can be made of a number of different materials including a cobalt-chrome alloy or ceramic. On the acetabular side, the damaged cartilage of the socket of the acetabulum is burred away to allow an acetabular component to be implanted. This can be made purely of a plastic material called polyethylene or alternatively it can have a metal outer backing called a “shell”, which then requires the use of an inner liner that is then locked into the shell. The liner can also be made from polyethylene or ceramic.
The choice of what kind of hip replacement is performed can also be broken down into two broad categories, based on how the implants become fixed or integrated into the bone and the patient’s body. A “cemented” THR technique requires that the patient’s bone is coated with medical bone cement to act as a “grout” on the various bony surfaces and then the implants are lodged into the cement. Alternatively, an “uncemented” technique is where the implants themselves may be coated with a microscopically thin layer of synthetic bone crystal which attracts the patient’s own bone to grow directly onto or into the surface of the implants. This achieves an intimate bond directly between the patient’s bone and the implant. It is also possible in some circumstances to combine the two techniques, making it a “hybrid” THR technique. For instance, Jonathan may implant a femoral component that is designed to be used with bone cement while the acetabular component may be uncemented.
THR can also be performed by entering the hip joint using any one of a number of different pathways (or approaches) through the tissues surrounding the hip. There is no single “best” approach for performing a THR.
When is the Right Time to Have My Hip Replaced?
In general, when you find that your symptoms are intrusive in your day-to-day life, despite having tried all the non-operative treatments, then this is usually a good guide as to when you may want to consider hip replacement. This may include uncontrollable pain despite using analgesics and anti-inflammatories, significant disturbance of sleep, reduced walking distance or endurance, or if there is a progressive deformity or substantial stiffness of the hip such that day-to-day activities such as managing stairs, putting on shoes and socks is a major effort.
Your personalised operation plan and details are best discussed with Jonathan.