TOTAL HIP REPLACEMENT
What is arthroplasty? - Answer- It is the surgical replacement (or reconstruction) of a joint
Many joints can be replaced with artificial ones
•Hips
•Knees
•Shoulders
•Ankles
•Finger/toe
Why do people get joint replacement surgery? - Answer- •Pain
•Limited mobility
•Deformity
•All of which can lead to a difficulty with ADL's and quality of life
Who is having Hip arthroplasty? - Answer- •Most common is patients with Osteoarthritis
•Femur fractures (not able to be repaired by ORIF)
•AVN
•Rheumatoid arthritis
•Paget's disease
•Ankylosing spondylitis
Hip osteoarthritis - Answer- •Worn cartilage
•osteophytes (growth of bone spurs)
Avascular necrosis - Answer- Blood supply to hip is compromised leading in bone cell death
•Dislocations
•Fractures (femoral head)
•Other causes not covered 10D
Hip prosthesis components - Answer- •Ball-replaces head of femur
•Stem-inserted in femur for stability
•Cup/shell-fits into acetabulum
•Liner-goes in between the shell and the ball
Types of hip arthroplasty - Answer- •Hip resurfacing
•Partial hip replacement (hemiarthroplasty)
•Total hip replacement (THR or THA)
THA - Answer- total hip arthroplasty
who would get a hip resurfacing? - Answer- •Used in younger, active patients
pros of hip resurfacing - Answer- •Preservation of bone on the thigh bone, potentially making
revision surgery easier.
•Reduced risk for dislocation (Better stress distribution to the top of the femur by reducing the
amount of stiff metal inside the marrow cavity.
•More resilient for activities of life such as sports, running, skiing etc.
, •May last longer in younger patients than a full hip replacement.
cons of hip resurfacing - Answer- •Only made in metal-on-metal articulation.
•The metal-on-metal bearing produces metal debris that release metal (cobalt and chromium) ions
into the body.
•There are few data on what will happen to these devices beyond 8 years.
•There is a 1-2% risk of fracture of the femoral neck. This risk is greatest in older females with
bone of sub-optimal quality.
•The surgery is more difficult and more exacting than hip replacement surgery and is therefore not
performed by many surgeons.
Partial hip arthroplasty - Answer- •Doesn't replace cup/shell
•Performed less often
•Usually reserved for young patients
•No arthritis, damage to acetabulum
Total hip arthroplasty (THA): implants (prosthesis) - Answer- cemented, cementless, hybrid
Cemented - Answer- •Bone cement allows for immediate fixation of joint
•Allows for full weight bearing
•Last around 15 years
•Cement will wear over time so revision surgery most likely needed
•Recommended for older adults with comprised bone strength
Cementless - Answer- •In response to cement deterioration
•Fixed in place with screws/spikes
•Allows for growth of new bone in the joint
•Weight bearing limited for first 6 weeks
•Usually for younger more active people
•Most have good bone quality
Hybrid (not used often) - Answer- •Femoral ball is cemented
•Acetabular (shell) is uncemented
•Allows for full weight bearing
Surgical procedure: Surgical approach may be dictated by
how did surgeon access that joint? - Answer- •surgeon preference
•prior incisions
•obesity
•risk for dislocation
•implant selection
•degree of deformity
minimally invasive - Answer- Single incision,two-incision
traditional (most often used) - Answer- •direct anterior
•anterolateral
•direct lateral
•posterior
What is arthroplasty? - Answer- It is the surgical replacement (or reconstruction) of a joint
Many joints can be replaced with artificial ones
•Hips
•Knees
•Shoulders
•Ankles
•Finger/toe
Why do people get joint replacement surgery? - Answer- •Pain
•Limited mobility
•Deformity
•All of which can lead to a difficulty with ADL's and quality of life
Who is having Hip arthroplasty? - Answer- •Most common is patients with Osteoarthritis
•Femur fractures (not able to be repaired by ORIF)
•AVN
•Rheumatoid arthritis
•Paget's disease
•Ankylosing spondylitis
Hip osteoarthritis - Answer- •Worn cartilage
•osteophytes (growth of bone spurs)
Avascular necrosis - Answer- Blood supply to hip is compromised leading in bone cell death
•Dislocations
•Fractures (femoral head)
•Other causes not covered 10D
Hip prosthesis components - Answer- •Ball-replaces head of femur
•Stem-inserted in femur for stability
•Cup/shell-fits into acetabulum
•Liner-goes in between the shell and the ball
Types of hip arthroplasty - Answer- •Hip resurfacing
•Partial hip replacement (hemiarthroplasty)
•Total hip replacement (THR or THA)
THA - Answer- total hip arthroplasty
who would get a hip resurfacing? - Answer- •Used in younger, active patients
pros of hip resurfacing - Answer- •Preservation of bone on the thigh bone, potentially making
revision surgery easier.
•Reduced risk for dislocation (Better stress distribution to the top of the femur by reducing the
amount of stiff metal inside the marrow cavity.
•More resilient for activities of life such as sports, running, skiing etc.
, •May last longer in younger patients than a full hip replacement.
cons of hip resurfacing - Answer- •Only made in metal-on-metal articulation.
•The metal-on-metal bearing produces metal debris that release metal (cobalt and chromium) ions
into the body.
•There are few data on what will happen to these devices beyond 8 years.
•There is a 1-2% risk of fracture of the femoral neck. This risk is greatest in older females with
bone of sub-optimal quality.
•The surgery is more difficult and more exacting than hip replacement surgery and is therefore not
performed by many surgeons.
Partial hip arthroplasty - Answer- •Doesn't replace cup/shell
•Performed less often
•Usually reserved for young patients
•No arthritis, damage to acetabulum
Total hip arthroplasty (THA): implants (prosthesis) - Answer- cemented, cementless, hybrid
Cemented - Answer- •Bone cement allows for immediate fixation of joint
•Allows for full weight bearing
•Last around 15 years
•Cement will wear over time so revision surgery most likely needed
•Recommended for older adults with comprised bone strength
Cementless - Answer- •In response to cement deterioration
•Fixed in place with screws/spikes
•Allows for growth of new bone in the joint
•Weight bearing limited for first 6 weeks
•Usually for younger more active people
•Most have good bone quality
Hybrid (not used often) - Answer- •Femoral ball is cemented
•Acetabular (shell) is uncemented
•Allows for full weight bearing
Surgical procedure: Surgical approach may be dictated by
how did surgeon access that joint? - Answer- •surgeon preference
•prior incisions
•obesity
•risk for dislocation
•implant selection
•degree of deformity
minimally invasive - Answer- Single incision,two-incision
traditional (most often used) - Answer- •direct anterior
•anterolateral
•direct lateral
•posterior
