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Your Complete Guide to Hip Replacements

Elderly woman holding hip in pain

One of our expert hip specialists, Mr Simon Mellor, met virtually with Robert Shanks from SpinePlus to discuss what you need to know if you are considering a hip replacement. More than 100,000 hip replacements are carried out in the UK each year. This guide covers different surgical techniques for total hip replacements, different implants available and hip revision surgery.

What is a Total Hip Replacement?

A total hip replacement is when the entire hip joint is replaced with an artificial one, which could be made of metal, ceramic or other surgical grade material. Hip replacements are often recommended for patients that have hip arthritis or severe wearing of the hip joint, which is often causes pain, stiffness and lack of mobility.

There are several surgical techniques available including the Posterior and Anterior approaches. When you are considering or have been recommended to get a hip replacement, your surgeon will discuss the options available to you and why they recommend a certain approach.

Types of Hip Replacement Techniques

The traditional posterior surgical method involves an incision several inches long over the hip joint, followed by the detachment of muscle and tendons from the thigh bone. This often requires several night’s stay in hospital and several month’s recovery. There are also minimally invasive procedures available, such as the Anterior Approach Hip Replacement, which involves a much smaller incision, and no muscles are cut during the procedure. Recovery times can be much quicker than the traditional surgical method.

Posterior Approach Hip Replacements

The posterior approach is one of the most common approaches used to perform a total hip replacement in the UK. For this approach, an incision is made on the side of the hip while the patient lays on their side. The surgeon goes through muscle and detaches some of them from the “ball and socket” of the hip joint. To the best of their ability, the surgeon will preserve the muscle as best as possible and will later reattach the tendons to the bone.

The posterior approach has been used successfully as is the traditional approach for hip replacements due to the success rates and ease of surgery. However, more recovery time is needed because tendons do need to be cut and then reattached, which requires more time to heal.

Anterior Approach Hip Replacements

Although the traditional Posterior Approach Hip Replacement works well, new surgical techniques are available with proven results. The Anterior Hip Replacement causes no muscle damage, as the tendons and muscles are simply moved out of the way during surgery. The muscles will simply flop back into place, and only a few stitches are required to close the small incision, which improves the cosmetic appearance. Consequently, less pain and quicker recovery time is possible after the procedure.

This Anterior Approach hip replacement allows for an incredibly quick recovery in comparison to the traditional type of hip replacement. A patient can be up and walking on the same day as the surgery. This speedy turn around after surgery means a prompt return to normal life, with little interruption to your schedule. It is also possible that this approach reduces the risk of dislocation, since no muscles or tendons are damaged. In addition, as the procedure is done with the patient lying on their back, it is possible for x-rays to be used during the surgery, meaning the surgeon can be assured that the hip replacement is ideally positioned.

Mr Simon Mellor discusses the Anterior Approach Hip Replacement

Types of Hip Replacement Implants

Implant types for Anterior Approach Hip Replacements

For the Anterior Approach Hip Replacement, the implant used is normally an un-cemented, two-part socket, made of a metal shell with a hydroxyapatite coating and a polyethylene inner ‘liner’. The hydroxyapatite coating will encourage bone growth onto it. On the thigh bone side, a curved implant is preferred with the Anterior Approach, as it fits the bone more easily. The implant in the thigh bone may be similarly coated with hydroxyapatite, or it may be ‘cemented’ in to the thigh bone with a special acrylic bone cement to secure it in place.

Mr Simon Mellor discusses the types of implants that can be used for the Anterior Approach Hip Replacement

Ceramic on Ceramic Hip Replacement Implants

Ceramic is used routinely for the ball of the hip replacement, and once polished lubricates well, allowing for a slippery surface. However, one issue with using ceramic for both the ball and socket is a squeaky feeling or noise once healed, the ball and socket rub atypically. However, using ceramic for both the ball and socket avoids the use of any polyethylene. The decision about the use of ceramic or polyethylene for the socket is made on a case-by-case basis, and depends on the surgeon’s opinion.

Revision surgery after a Hip Replacement

Over the last few decades, revision surgery has become easier. The type of hip replacement originally done should not impact the complexity of the revision surgery. Plus, the rebuilding of a failed or worn-out hip replacement has become a much more straightforward procedure as technology has vastly improved.

To watch the full webinar with Mr Simon Mellor and Robert Shanks, click here.

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Mr Simon Mellor

Mr Simon Mellor is the Lead for the Hip and Knee Unit at the Royal Free London NHS Foundation Trust and he has worked in Trauma and Orthopaedic surgery since 1996. He is one of the UK’s most prominent Anterior Approach Hip Replacement Surgeons, having utilised this muscle-sparing technique for hip replacements since 2012.

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