Total hip replacement

Hip replacement was developed by Sir John Charnley in the 1960’s and it has been described by some as the most successful operation of the 20th century. Since then there have been many advances in both the surgical technique and manufacturing processes. In addition patients and health economists want shorter hospital stays, faster recovery times and longer lasting implants.

Nowadays there is a huge array of implants and surgical approaches. In general the components can be cemented or uncemented and the bearing surface can be metal on poly, ceramic on ceramic or metal on metal. We believe it is essential that the pros and cons of each of these options are fully explained. A final decision is mutually agreed with you based on several factors including: your age & general health, the quality of your bone and your functional demands.

There has been a lot of media interest in the mini-incision hip replacement and the Birmingham hip. Your surgeon is trained in the use of both these techniques and will be happy to discuss them with you. Some examples of the various types of total hip replacement are illustrated below. More information can be found at the following links:

Spire Healthcare

NHS Direct

BUPA

Arthritis Research Campaign

A 50 year old woman with arthritis of the hip due to avascular necrosis. She is a keen hill walker. She was given an uncemented hip with a large metal on metal bearing surface. This has the advantages of giving her increased stability for walking on uneven ground and should last longer than a conventional cemented hip.

A 73 year old man with a painful arthritic hip has had a cemented total hip replacement similar to the type originally designed by Charnley. This hip would be expected to survive for about 15 years. A forty year old man who had previous surgery to his hip now has arthritis combined with abnormal alignment of the hip. The joint had to be replaced and at the same time the alignment had to be corrected. He was given a custom made hip replacement manufactured at the Centre for Bio-medical Engineering based at the Royal National Orthopaedic Hospital. A successful outcome was achieved.

The mini-incision hip replacement

With recent advances in surgical instruments, hip replacements can now be performed through incisions under 10cm in length. This allows surgeons to perform surgery with much less trauma to the soft tissues around the hip. The implants used in mini-incision surgery are exactly the same as those used in conventional hip replacement. Your surgeon is trained in this technique and will be happy to discuss it with you. The advantages of the mini-incision hip include:

  • Smaller incision
  • Less damage to the soft tissues
  • Less blood loss
  • Less post-operative pain
  • Faster recovery
  • Shorter hospital stay

A 65 year old woman with arthritis of both hips. She has had mini-incision hip replacements on both sides and has regained her quality of life.

Hip resurfacing
(The Birmingham Hip)

In conventional hip replacement the neck of the femur is cut and the femoral head (the ball part of the ball and socket joint) is completely removed. In hip resurfacing, the head and neck of the femur are retained, the arthritic surface is removed and a new new metal “ball” is applied (see right). The cup is replaced as for a conventional hip replacement. The main advantage of this technique is the fact that it is bone conserving. If and when the implant loosens, revision surgery is technically easier and the bone stock is better. This operation is particularly good for younger men with strong bone. It is not recommended for anyone with osteoporosis or women of child baring age.

The Birmingham Hip

Revision hip replacement

Hip replacements have a life span of 10-15 years after which they tend to loosen. When this happens the hip becomes painful on exercise and revision surgery is often required. The old components are removed and a new hip is inserted. Revision surgery is more challenging than replacing an arthritic hip first time around. The operation takes longer (about 2 hours) and recovery is slower. Contrary to popular belief, however, there is no limit to the number of times a hip can be revised.

MRI scan of the hip showing a front view Original hip replacement on the left with revision hip replacement on the right