Arthritis and Total Joint Replacement
Part II: Total Hip Arthroplasty
Total hip replacement surgery was developed in England in late 1950’s with the first surgeries in the early 1960’s. The surgery was performed to replace the diseased ball and socket of the hip joint with an artificial device. While there has been a significant improvement in the development of not only the device used in total hip replacement over the last 40 years, there has also been improvement in the surgical techniques used. In the United States, more than 200,000 total hip replacements are done each year. This operation was first performed in the United States in the early 1970’s in which cement was used to secure the device in the diseased hip. This technique is still used today with further advances in hip replacement surgery beginning the United States in the early 1980’s without the use of bone cement. Over the last 30 years, the standard artificial hip has been constructed of a metal ball or head and a hard plastic cup liner within a metal shell. Over the past few years, there has been new material technology approved for use in hip replacement surgery. There is a ceramic-on-ceramic implant that has been used for several years in Europe and now is becoming more popular in the United States. This type of implant uses a larger ball or head device with a ceramic cup fitting which may lower the risk of dislocation. Dr. Stone, an orthopedic surgeon at Marshfield Clinic Marshfield Center states that this ceramic device is ideal for the young, active patients because of its durability and potential to last indefinitely. The life expectancy of the metal-on-plastic hip implant is typically 10 to 20 years. There is the metal-on-metal implant that has the capabilities of using an even larger head component that can further decrease the chance of dislocation and also provides a longer life expectancy. The newest improvement in hip replacement surgery is the minimally invasive approach. This technique, developed by Dr. Dana Mears of Pittsburgh, Pennsylvania, involves one or two very small incisions that allow the surgeon to cut less muscle, tendon, and ligament to gain access to the hip. This type of surgery also allows for less blood loss and shorter hospital stays and rehabilitation.
Patients that are a good candidate for surgery usually have one or more of the following that limit activity and do not respond to medication: severe arthritis, severe hip pain, stiff hip, or severe walking problems. Benefits of total hip replacement include pain reduction in 90 to 95 percent of patients, reduced stiffness with near normal motion, increased walking speed and distance, and improved activity, allowing patients to carry out many normal activities of daily living. The following factors can affect how long a total hip replacement may last: activity level, body weight, and bone and tissue quality. In general, total hip replacements last longer in lighter people than in heavier people. Most patients will get back to a functional lifestyle within 4-6 weeks following total hip replacement surgery.