What is Hip Replacement? A Review of Total Hip Arthroplasty, Hip Resurfacing, and Minimally-Invasive Hip Surgery.

Figure 1 - Typical hip replacement components.

Figure 2 - Typical hip replacement components in their position relative to the hip and pelvis.

Summary

Did you know...?

• That modern total hip replacement was first performed in the early 1960s, and the surgeon who pioneered the procedure was honored with knighthood by the Queen of England?


• That traditional total hip replacement--similar in many ways to the procedure performed over 40 years ago--is considered by many to be the most important operation developed in the 20th century, in terms of the amount of human suffering it has relieved?


• That a wide variety of materials have been used in the manufacture and insertion of hip replacements--including Teflon (tm)--but that only a few seem to work very well?


• That in hip replacement, as in so many other areas of life, newer is not always better...

What are the key points about total hip arthroplasty, hip resurfacing, and minimally-invasive hip surgery for hip arthritis?

Total hip replacement (THR) is a surgical procedure that relieves pain from most kinds of hip arthritis, improving the quality of life for the large majority of patients who undergo the operation.

Patients commonly undergo THR after non-operative treatments (such as activity modifications, medications for pain or inflammation, or use of a cane) have failed to provide relief from arthritis symptoms. Most scientific studies that have followed patients for more than 10 years have found “success rates” of 90 percent or more following traditional THR.

Distilled to its essentials, THR involves surgically removing the arthritic parts of the joint (cartilage and bone), replacing the “ball and socket” part of the joint with artificial components made from metal alloys, and placing high-performance bearing surface between the metal parts (see figures 1 and 2). Most commonly, the bearing surface is made from a very durable polyethylene plastic, but other materials (including ceramics, newer plastics, or metals) have been used. Patients typically spend a few days in the hospital after the procedure (3 to 5 days is most typical), and some patients benefit from a short inpatient stay in a rehabilitation facility after that to help transition back to living independently at home. Most patients will walk with a walker or crutches for 3 weeks and then use a cane for another 4 weeks; after that, the large majority of patients are able to walk freely.

A bewildering number of different implant designs, bearing surface materials, and surgical approaches have been tried to achieve one seemingly straightforward goal: improving the quality of life for patients who have hip arthritis. As with any important life decision, it makes good sense to get educated on those issues as they pertain to your hip.

The purpose of this article is to outline the essentials from a patient’s perspective: who should think about having THR done, what questions should a prospective patient ask the doctor, and why one surgical approach or type of THR implant might be good for one patient but not for another.

Surgery for hip arthritis at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

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