Total Hip Replacement

What could be the cause of Hip Pain?

Generally speaking, Rheumatoid / Inflammatory Arthritis can be the reason behind your painful hip. Post diagnosis, we can either decide to medical manage the disease through drugs or think of a surgical intervention when the pain is more and the X-Rays corroborate the same. Sharp pain in the hip can also be the symptom of Impingement syndrome which is seen especially among young Active Sports people. This is a lesser recognized condition, a diagnostic challenge that needs careful work else it may get ignored. We look at joint preserving surgeries as the treatment.

Also the following can be the reasons for your hip pain:

  • Vascular Necrosis of the Hip Joint
  • Secondary Osteoarthritis
  • Post Traumatic / Injury Arthritis
What are the solutions available to me?

Depending on your age, lifestyle and bone quality, your surgeon can choose a procedure. These are the procedures available at the moment:

  • Total Hip Replacement (THR)
  • Hip Resurfacing Surgery (HRS)
  • BHR- Birmingham Hip Resurfacing
  • Partial (conservative) Replacement
  • Key Hole Arthroscopic
  • Realignment
Total Hip Replacement (THR)

This procedure is suitable for elderly patients. Here, head of femur (thigh bone) is removed and the Articulation is metal with plastic. Hip replacement involves the use of a socket and a ball for the femoral head. These components could be fixed to the bone either with the help of bone cement (cemented THR) or as a press fit (un-cemented THR). Both of these techniques have shown good results over 15-20 years follow up.

Various factors decide the choice between cemented or un-cemented technique, namely, the age, the bone quality, cost issues and to some extent also the surgeon’s preference. However, the experience over the last 40 years worldwide seems to show that the press fit (un-cemented) technique has given the best results for the cup fixation.

The reasons for failure of this surgery are mainly due to the wear of the polyethylene cup. Hence, in the last 10-15 years there has been a renewed interest in the use of other materials which are wear resistant. Current computer aided manufacturing technique enable highly polished surfaces that are ideal for this surgery, like Metal-on-Metal and Ceramic-on-Ceramic. These have shown very low wear rates.

The outstanding problem in conventional Hip Replacement is the young active patient with an arthritic hip. The problem is worse if the patient is male (higher loosening rates with THR), has an active job and wishes to play sport or engage in physical activity to keep himself healthy. Sport is not advised as the life of hip replacement is inversely proportional to the usage. Revision surgery is invariably necessary in younger patients. It is to avoid this unfortunate sequence of events that Hip Resurfacing Surgery (HRS) was developed.