Total Hip Replacement.
What do you need to know about Total Hip Replacement? (THR). Like anything else in life, look at history, because it tends to repeat itself and you may avoid making the same mistakes as others.
Early pioneers devised Hip Replacements made of various materials including acrylic cement, ceramics, metal and polyethylene. The first repeatably reliable & successful THR was devised and promoted by Sir John Charnley around 1960. This was a cemented device using a metal stem and head with a polyethylene socket (acetabular component). The Charnley Hip and similar devices dominated the field of THR from 1960's and different concepts were gradually abandoned. Unfortunately these early THRs all suffered from one common flaw that was impossible to get around: after being in place for several years, the plastic would wear and tiny particles would attack the interface between the cement and the bone. This would cause bone to resorb and a new disease was born: aseptic loosening.
To learn more about aseptic loosening, click here.
http://www.thehipclinic.co.uk/aseptic_loosening.htm
Aseptic loosening was poorly understood at first. Some labelled it 'cement disease' and blamed acrylic bone cement for what was being seen on patients' X-rays. This led to the development of cementless THR especially in North America. When even these devices suffered from a similar problem it was labelled 'osteolysis'. This is the same process of bone being eaten away but the pattern is slightly different. It took a long time for scientists to understand what was happening and why. We still do not know everything about this mysterious process! Further attempts to avoid aseptic loosening and osteolysis have led Orthopaedic surgeons to use materials such as titanium, hydroxyapatite, and oxinium. Ceramics have had a resurgence of interest after golfer Jack Nicklaus received such a device and his experience was used in a high profile media campaign in the USA. The field however remains in turmoil! Be very careful about what you read and believe, especially if it comes from a commercial source.
So what does the layman do to decide? First read the link on Myths, Facts and Fictions.
If you are over 75 yrs of age, it probably does not matter which hip you get. A cemented hip is reliable and generally much cheaper if this is an issue. Choose your surgeon by experience and reputation. Ask about minimal incision hip surgery but do not insist on this. Allow your surgeon to make a bigger hole if he/she has to! If you are between 65 and 75 years of age, you must ask what hip you will be getting and why. Cemented THR of the Exeter, Charnley, Lubinus, Stanmore or Muller type remain the 'Gold Standard' and have improved enormously since the 1960's There are good uncemented devices but there are also some that gave spectacularly bad results. Ask about metal-on-metal or ceramic-on-ceramic. The size of your hip scar is not the most important issue! If you are under 65 yrs do not rest until you find an experienced Hip Resurfacing surgeon. See section on Hip Resurfacing http://www.thehipclinic.co.uk/hip_resurface.htm
