Hip Replacement Surgery
Hip replacement is one of the commonest treatments for moderate to severe hip arthritis and gives one of the largest improvements of quality of life measurements of all medical interventions. Over 50,000 such operations are performed in the UK every year and hip replacement surgery is a now a routine and predictable method of managing severe hip pain.
Hip replacement causes include osteoarthritis, rheumatoid arthritis, infections, avascular necrosis, fractures of the hip region and congenital abnormality of the hip ball and socket, known as hip dysplasia.
The vast majority of patients for the various types of hip replacement are elderly, over 65 years of age and suffering from degenerative changes in their hip, from osteoarthritis. Osteoarthritis is the commonest joint disease in the world and one of the major reasons for hip surgery.
Hip replacement methods vary and there are several schools of thought on which of the different types of hip replacement joints is most suitable, the surgical approach and postoperative care. The gold standard is total hip replacement which has been developed continually over the last 40 years or more.
The hip arthroplasty definition is an operation in which the arthritic joint surfaces of the joint are removed and replaced by artificial components made of metal or plastic. Further information on hip replacement surgery is available at the hip replacement page on Wikipedia and at NHS Choices.
There are a number of types of total hip replacements performed today:
Cemented hip replacement
Cemented hip replacement is the commonest type and the earliest to be fully developed. The surgery is usually done from the side or from behind the hip and the upper femur is removed, the cavity drilled out and cleaned in preparation for insertions one of the hip prosthesis types. Cement is then pressurised into the cavity to force it into the spaces in the bone and when the cement has hardened to a degree the femoral metal component is pushed into the cavity and held until the cement hardens.
Once the operation is completed then the patient will cooperate with the physiotherapist to complete the hip replacement therapy programme, which might include hip replacement exercises, hip replacement stretches and exercises for joint pain.
Uncemented hip replacement
Uncemented hip replacement was developed to get around the problems of loosening associated with early cementing methods. The surfaces of the components have a porous coated surface which is designed to encourage bone to grow up to and into the prosthesis to give it increased stability with time. This is one of the hip replacement types favoured in younger patients.
Hip resurfacing was developed in Birmingham, UK, and replaces the arthritic surfaces of the hip joint with two hemispheres of metal which are placed as caps on the cut surfaces. Far less bone is removed with this operation than with standard hip replacement, allowing bone conservation for potential future operations. This operation is claimed to be better for younger people as early activity is allowed, dislocation is less likely and most of the hip bone is conserved. Hip resurfacing exercises may be more easily employed to restore ranges of motion and strength to the joint.
In choosing the best of the types hip replacement prosthesis, it is important to ask about the published, long term results which that particular prosthesis has, as success rates may vary significantly between different types