Hip Replacement: The Facts
Image of Sir John Charnley "pioneer of total hip replacement in the U.K."
In Paris Professor Robert Judet and his brother designed a partial hip replacement to treat hip fractures whilst in Norwich Mr McKee and Mr Watson-Farrer and in Manchester Professor John Charnley also devised their own hip replacements. Their results, although not perfect, in reality became the first generation of modern hip replacements with further advances in time being made by Professor Muller from Switzerland and Professor Ling in Exeter.
In the United Kingdom over 95,000 primary (first time hip replacements) hip replacements are performed each year with an overall success of this major operation being approximately 92%.
The hip socket (acetabulum) may also be cemented or cementless and the ball articulates usually with a plastic like material – a high density polyethylene.Artists Impression Of A Cemented Hip Replacement, The Green Ink Representing The Cement.
Please click here to enlarge the image.
In younger and very active patients, ceramic modular femoral heads are used along with a cementless stem.
The cementless stem is called the Corail and has been in clinical use for over 30 years. It was originally designed in France but now is in widespread use, not only in the United Kingdom where it is the most commonly used cementless stem, but also in Scandinavia and the USA.
When Mr Charnley uses a cemented hip it is a standard hip replacement called the CPT (Collarless Polished Tapered) which was designed by Professor Ling and has been available for over twenty years.
The results of this hip replacement are equal to, if not perhaps slightly better, than many other standard designs. Research at the Avon Orthopaedic Centre in Bristol, by Mr Gordon Bannister, Secretary of the European Hip Society, has revealed very good results with this hip prosthesis and excellent results are also reported in the Danish Hip Registry.
The alternatives to joint replacement will also be discussed by Mr Charnley, but frequently these have been explored by family doctors in terms of physiotherapy, weight loss, analgesia and anti-inflammatory medication.Complications
The average life span of all hip designs is about a decade.
As with any operation there are acknowledged risks. Most patients are worried about their anaesthetic but modern day anaesthesia is extremely successful with rarely patients not waking up after their anaesthetic, (perhaps a 1 in a million risk). Patients in their 8th decade do have more pre-existing medical problems than younger patients and have thus a raised risk of non orthopaedic post operative medical problems and need to be in good health to consider hip replacement.
Other risks associated with the surgery itself are infection from bacterial organisms and to reduce this Mr Charnley uses antibiotics around the time of surgery as well as using bone cement with antibiotics in it. There is still a chance of one or two patients in every hundred having this complication.
Dislocation, (the ball coming out of the socket), does occur with hip surgery with a reported frequency of 1 - 9%. Mr Charnley uses an incision which has the lowest reported rate of dislocation to try and minimise this problem.
Blood clots in the legs and on the lungs (thrombo-embolism) is also reported in particular in those patients who smoke. It is advisable to give up for at least 6 weeks before the operation, if not for ever, before a hip replacement procedure.
There is a remote chance of damage to the nerves and arteries around the hip (less than 1 in 100), more so with those hips that have had previous surgery or are of a rather abnormal shape.
Fractures around the time of implant insertion, (peri prosthetic fractures) may occur with a frequency of 1%.
Finally following a hip replacement the surgeons performing the operation try and balance the leg lengths of the affected and unaffected sides but this is limited by the more important goals of a stable joint replacement and leg length discrepancies can be satisfactorily treated with orthotic aids.
You will normally be sent home on a pair of crutches once you are safe and not before. The team are happy to give additional information regarding return to work, driving and sexual intercourse.
Mr Charnley and his surgical team perform over 200 hip replacements and partial hip replacements, (hemi-arthroplasties), per year. These are both for various types of arthritis and for fractures around the hip.
The majority of the surgery is performed by Mr Charnley himself, but also by experienced staff grade surgeons plus higher surgical trainees. These latter surgeons will have all been personally trained and supervised by Mr Charnley and by other hip surgeons on their training schemes.
All illustrations on this page are acknowledged and are supplied for patient information by Schering-Plough/Doctor Direct Ltd.
This page was last updated on 06/Mar/2012