Hip Replacement

About Hip Replacement

Total hip arthroplasty replaces a damaged hip joint with an artificial femoral stem and head and an acetabular cup. It is one of the most successful and commonly performed operations in orthopedics, and numbers continue to grow as populations age. Osteoarthritis is by far the most common indication, followed by inflammatory arthritis, avascular necrosis of the femoral head, certain hip fractures and developmental dysplasia. The modern low friction arthroplasty was developed by the British surgeon John Charnley in the 1960s, who introduced acrylic bone cement and a polyethylene socket. Surgical approaches include posterior, lateral and anterior, each with advantages and drawbacks regarding dislocation risk, muscle damage and exposure. Bearing surfaces include metal or ceramic heads articulating with highly cross linked polyethylene, and ceramic on ceramic. Large diameter metal on metal implants have been largely abandoned because of adverse reactions to metal debris. Components can be fixed with cement or press fit to allow bone ingrowth. Enhanced recovery pathways have shortened hospital stays, and some patients go home on the day of surgery. Recognized complications include dislocation, infection, blood clots, leg length difference, fracture around the implant and gradual loosening or wear, which may eventually require revision surgery. Most modern implants last many years.