Myths, Facts and Fictions about Hip Replacement.
3. The Fact: Metal-on-metal Hip Resurfacing has changed the ground rules regarding age and hip arthroplasty. Patients can be considered for surgery when they need it regardless of age.
1.The Fiction: Hip replacement is easy. Even registrars (residents) can do them without supervision.
The Fact: Most hip replacements are easy. In elderly patients minor errors of technique will be tolerated quite well as long as hip stability is enough to prevent dislocation. It is when the pathology is even a little unusual or the patient is young that things can unravel and this is when there is no substitute for experience.
2. The Myth: Hips need to be redone because they "wear out".
The Fact: Hips need to be redone because they loosen with time.
The Fact: Most patients do splendidly on their own at home. Some may benefit, especially if there was unusual stiffness or deformity/scarring beforehand.
5. The Myth: Hips can only be redone once or twice.
The Fact: Hips can be redone several times. It does get more tricky and bad revisions lead to more surgery………….
6. The Fact: Epidural or regional anaesthesia greatly reduces morbidity and mortality.
7. The Myth: Hip prostheses are all basically the same. Surgeons know which to use appropriately.
The Fact: Field of Hip Arthroplasty is littered with examples of bad choices! It is still in turmoil.
8. The Myth: Surgeon knows exactly how long patient should be off work, how long before they can drive a car etc.
The Fact: Depends largely on patient perception, motivation and personality.
9. The Fact: the cause of Primary osteoarthritis (OA) of Hip remains completely unknown.
10. The Fiction: Patients needing Hip replacement are getting older as population ages.
The Fact: Patients are getting both older and younger. We are not sure why younger.
11. The Myth: Hip replacements only last 10 to 12 years.
The Fact: If Surgeon is not getting survival of >95% at 18 to 20 yrs something is not right!
12. The Fiction: OA of the Hip is easy to diagnose. Diagnosis is rarely missed.
The Fact: Often masquerades as knee pain. Can be exquisitely difficult to differentiate between low back pain or sacro-iliitis and OA of Hip.
13. The Fiction: X-ray tells Surgeon when to operate.
The Fact: We treat patients not X-rays! Often no correlation between X-ray and symptoms.
14. The Fact: some NSAID’s (Non steroidal anti-inflammatories) are unfriendly to cartilage: can cause accelerated degeneration." Dissolving Hip" . Naproxen probably best known and worst!
15. The Fiction: Leg length is easy to measure intra-operatively and so if there is a discrepancy post-op the Surgeon is negligent.
The Fact: Intra-operative leg length measurement is crude and errors are very easy to make.
16. The Fact: Leg length discrepancy is better tolerated if leg is made slightly short than even very slightly long. Best of all is to get it just right! Experience is best teacher.
17. The Fact: All the important, major developments in the field of Hip Arthroplasty over the last 40 years have mostly been British!
18. The Myth: Hip replacements are a commodity that can be bought or sold like groceries.
The Fact: It is more like buying a good car: look at the manufacturers reputation, the dealer efficiency and cleanliness as well as the after sales service and spare parts supply!
19. The Myth: Small incision= better.
The Fact: This is only true if size of incision does not limit Surgeon’s ability to fix everything in properly and if appropriate implants used for age and activity.
20. The Fiction: Small incision= faster recovery, earlier discharge. Less bruising.
The Fact: These parameters are influenced more by general fitness and therefore age than anything else. Also heavily influenced by patient attitude, personality. Bruising often more with small incision because of need to stretch skin to get implants in.
