Useful Facts on Hip Replacement Surgery
Hip replacement is a surgical procedure to replace the articular part of the hip joint with an artificial joint. The aim is to take away pain, restore function and preserve anatomy.
Over the last three centuries, treatment of hip arthritis has evolved from rudimentary surgery to modern total hip arthroplasty (THA), which is considered one of the most successful surgical interventions ever developed.
Anthony White (1782-1849) of the Westminster Hospital in London is credited with the first excision arthroplasty in 1821. This procedure ameliorated pain and preserved joint movement but joint instability was a problem resulting from the surgery.
John Rhea Barton (1794-1871) in Philadelphia is credited with performing the first osteotomy on an ankylosed hip in 1826.
Léopold Ollier’s (1830-1900) work at the Hôtel-Dieu hospital in Lyon, France. In 1885, he described the interposition of adipose tissue in uninfected joints.
Berliner Professor Themistocles Glück (1853-1942) led the way in the development of hip implant fixation. In 1891, Glück produced an ivory ball and socket joint that he fixed to bone with nickel-plated screws.
Sir John Charnley (1911-1982) work at Wrightington Hospital. In November 1962 the Charnley hip replacement became practical reality and has become the gold standard for this form of treatment. Clinical and radiographic success of this procedure is now approaching 40 years of follow-up. Charnley's design consisted of two parts a metal (originally stainless steel)) a femoral component and a teflon acetabular component; both were fixed to the bone using bone cement (acrylic).
The current hip joint replacement prosthesis is composed of four major components:
There are two types of implants:
The most common indication for THA is degenerative arthritis (osteoarthritis) of the hip joint. This type of arthritis is generally seen with aging, congenital abnormality of the hip joint, or prior trauma to the hip joint. Other conditions leading to total hip replacement include bony fractures of the femoral neck at the hip joint, rheumatoid arthritis, osteonecrosis (death of the femoral head) and developmental dysplasia of the hip.
There are no absolute contra-indications however, few relative contra-indications can be summarised including:
Different approaches have been used to perform hip joint arthroplasty. To date there is no compelling evidence in literature for any particular approach, but consensus of professional opinion favours either the posterior approach or the modified anterio-lateral approach.
Over the last few years there has been a significant amount of debate over the minimal invasive surgery (MIS). The results of surgeries using this technique has not proven to be better than the standard approaches, in fact some studies show an inferior outcome of MIS compared to standard approach. The use of computer navigation in hip arthroplasty is another controversial subject since it hasn’t shown any significant evidence of a better outcome than using standard approaches.
The common approaches to the hip joint for Hip Replacement are:
I believe that the best approach is the one that the surgeon is more comfortable with as long as optimal visualisation of the joint anatomy is obtained using as minimal soft tissue dissection as possible with efficient time utilisation.
For almost 40 years, hip replacement surgery has been widely used and successful. It has brought about immediate substantial improvement to patients by reducing pain and improving the function and over-all health-related quality of life. Of the 600,000 total hip replacements performed each year throughout the world, approximately 90% will last 10 years or more. Revision surgery may be able to keep people on their feet for even longer. Over the past 20 years, complications have significantly declined due to the use of antibiotics and anticoagulants during and after surgery. Mechanical loosening has decreased due to improvements in prosthesis design and materials, prosthesis implantation, and other aspects of surgical technique.
Although the benefits of successful hip replacement surgery are great, you as the patient have a duty to care for your new artificial hip by avoiding movements that will stress or damage its components. It is particularly important to avoid prohibited positions of the leg and to treat infections that cannot be avoided. If this care is taken, your efforts should be rewarded for years to come.