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Total hip replacement

Information for patients needing a Total Hip Replacement 

Do I need joint replacement surgery? If so, when is the right time to have surgery?

The right time to have joint replacement or arthroscopic surgery is when the pain you experience is interfering with your life and you really want something done about it. Some people decide to have surgery because they are no longer able to work and this surgery can make a significant difference to their lives. Some cannot walk around the golf course and cannot bear the thought of being unable to play. Others will put up with pain and wait a long time, choosing only to have surgery when they can no longer walk from the bed to the bathroom. It’s a personal and very subjective decision. I always advise patients to take their time, really think it over and have surgery when it suits them

Timing of Surgery

The timing of hip replacement surgery is a decision that you as the patient must make. The need for surgery is a quality of life decision and the aim of the surgery is to eliminate your hip pain. As an added bonus you will likely get a better range of motion, your limp may reduce or disappear and your quality of life should improve significantly.

If you feel that you can manage with your current pain levels then there is no urgency to have your arthritic hip replaced. Simple analgesics (eg.Panadol) or anti-inflammatories (eg.voltaren, celbrex etc) may be sufficient to provide you with a relatively painfree hip. These drugs will not improve stiffness and the arthritis will continue to progress and at some point the drugs will no longer have their pain relief affect.

Alternative medicines (eg. Glucosamine and chondroitin, fish oil etc) may have a role in helping with pain but scientific studies have proven that the claim that they “prevent arthritis or progression of the disease” is false. These medicines whilst not doing you major harm will not stop your hip continuing to wear out.

If you are overweight, weight loss may help in reducing your hip pain. Low impact exercises (walking, cycling and swimming) help maintain muscle tone and thereby control the arthritis pain.

Physiotherapy is often useful in helping strengthen surrounding muscles and maintaining good muscle tone and pelvic balance. Try to avoid overstretching the joint as this will only cause discomfort.

Things you need to know about Hip Replacements and Hip Resurfacing Replacements (see my other article on Hip resurfacing for more detail on this subject)

Total Hip Replacement, Hip Resurfacing Replacement or “mini stem” Hip Replacement are simply different designs of prosthesis. They all replace your hip and therefore are collectively termed Hip Replacements. Some prosthesis (Birmingham Hip Resurfacing) are more bone conserving but these prosthesis still replace the acetabulum (socket) and either resurface the femoral head (ball) or replace the head but preserve more bone lower down.

What Replacement should you have?

This can be a most complex topic particularly in discussing the options and correct choice in a young patient.

It is important to get an understanding of what’s available and in which patient group you are best placed.

The key to a successful hip replacement is the surgical skill of the surgeon implanting the prosthesis and the type of bearing used in the ball and socket joint.

Modern day hip prosthesis may well last a patient a lifetime. It is most likely that a well recognized, tried and tested implant will not wear out in patients over the age of 70 provided the surgery is performed correctly. The key to implant longevity apart from good surgical technique is the materials used in the bearing (the actual parts that move).

Facts about bearings

The traditional hip bearing is a metal head (chrome cobalt ball) that moves on a polyethelene liner (“plastic” liner). Modern day plastic liners have very low wear rates unlike the material used 30 years ago. Studies show that modern day liners will probably take about 30 years to wear out. It is for this reason that it is likely that an artificial hip joint implanted in a patient over the age of 70 will last them a lifetime. Off course should the lining wear out sooner a new plastic lining can be inserted.

In an effort to develop bearings that last longer than the traditional “plastic” lining, a number of other alternatives are available. These include the following:

  1. Ceramic on Ceramic
  2. Metal on Metal

These bearings were developed to allow younger patients to have hip replacements as they may last longer than traditional metal on plastic bearings and hopefully last a “lifetime”.

Ceramic on Ceramic

The ceramic – ceramic bearings have been around for over 20 years. They have extremely low wear rates (1000 times less than plastic) and if implanted correctly may last 40 years or more.

Unfortunately ceramics are not perfect in that there is a 1 in 20 000 incidence of breakage / fracture (ceramic is more brittle than metal) and a very rare chance that the hip can develop a squeak.

In general however ceramic on ceramic bearings are an excellent choice to use in the young patient (under the age of 65). Surgical technique is critical.

Metal on Metal

These bearings have been around for over 30 years and regained popularity with the introduction of modern designed hip resurfacing replacements.

The wear rate of metal on metal bearings is only slightly higher than ceramic on ceramic but like ceramics is significantly lower than metal on plastic bearings. Metal on metal bearings are very tough and are not susceptible to breakage (fracture).

The disadvantage of metal on metal bearings is that they produce metal ion particles and if the implant is not functioning properly these metal ions can invoke a significant inflammatory response in and around the hip joint which can cause hip pain and swelling.

Some patients are allergic to metal on metal implants but this is extremely rare. Some metal on metal bearings squeak but this is usually a temporary phenomenon.

Metal on Metal Bearings should only be used in resurfacing replacements in young very active males

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