Total Hip replacement (THR)
Conventional hip replacement involves removing the damaged femoral head and acetabulum and replacing them with prosthetic components. Metal, plastic and ceramics are used for the various components. The most common reason for a THR is osteoarthritis of the joint. It can also be performed for other problems such as rheumatoid arthritis and fractures around the hip.
THR is a highly successful procedure for treating arthritis of the hip and patients should expect predictable relief of pain and stiffness. Early, first generation, polyethylene (plastics) often wore out and required replacing after 10 years or so. Modern highly crosslinked plastic hasn’t shown these problems and observations at 20 years post surgery have shown virtually no wear.
The operation requires either general or spinal anaesthesia and it is important that your general health is optimised prior to surgery. This may require review by a specialist physician. The operation usually takes about an hour depending on the complexity. How long you will be in hospital depends mainly on your age, general health and strength pre operatively. 2-5 nights would be an average. It is important that you are up and about walking as soon as possible to prevent complications.
It is major surgery and there are multiple potential complications. These include infection, dislocation, blood clots, bone fracture and leg length inequality (among others). Every individual’s risk is different depending on numerous factors and these will be discussed with you at your consultation.
Resurfacing surgery involves re-capping of the femoral head rather than replacing it. The most tried and true resurfacing designs are me.al on metal prostheses. Resurfacing carries the advantages of a large diameter head (which decreases the risk of dislocation) and a ‘hard-on-hard’ bearing surface that is self polishing and associated with low wear if properly positioned.
Resurfacing was extremely popular 10 years ago but received a bad name due to numerous documented problems from accelerated metal wear (with disastrous results) and femoral neck fracture due to poor implant positioning.
Time and careful study have demonstrated that resurfacing is a procedure that should only be performed in young, active males at risk of dislocation such as sportsmen and surfers. The results in women have not been predictable. The specific risks (relative to conventional hip replacement) are the generation of metal debris, femoral neck fracture and soft tissue irritation from the large heads and prominent cups. These problems can be minimised by using a successful prosthesis, carefully selecting appropriate patients and meticulous surgical technique. This procedure is very intolerant of mal-position and use of computer navigation helps to prevent this.
If you are interested in hip resurfacing it is important to discuss these risks in detail and this can be done at your consultation.
Revision hip replacement
Patients undergoing hip replacement in Australia and New Zealand should feel confident. Our long term registry data shows survivorship of around 92% at ten years. Unfortunately, this means that some will need to be revised. Modern bearings have almost removed the problems or “wearing out” and most revisions now are due to infection, dislocation, fracture or loosening of cementless implants. Whilst this may be obvious, sometimes the only problem may be pain.
Revision surgery is complex and it is important to examine all information and plan carefully. Often further investigations such as CT scans, bone scans or even joint aspirations will be needed before any further surgery is undertaken.
The risks associated with revision surgery are substantially higher than those from the primary procedure. Your surgeon needs to be familiar not just with what has happened, but what could happen. If you have a problematic joint replacement or require revision, it should be performed by someone trained and familiar with current reconstructive treatment options.