Hip replacement (total hip arthroplasty) is surgery to replace a worn-out or damaged hip joint. The surgeon replaces the old joint with an artificial joint (prosthesis). This surgery may be a choice after a hip fracture or for severe pain because of arthritis.

So the most common reason for hip pain that we see in middle-aged individuals is osteoarthritis.  And the condition is caused by loss of what we call the articular cartilage. So the articular cartilage is a thin layer of cartilage that lines the surfaces of the joint. It lines the femoral head and it lines the socket.

                                

And it’s a shock absorber. It’s a very, very slippery surface that’s similar to in a car engine when you lubricate the pistons to allow them to move freely, and that allows the joint to move freely. With time and with certain either degenerative conditions or injuries or developmental conditions, you can start to wear away that surface. In treating this condition, often seeing a local massage therapist for muscle tension, a local personal trainer for muscle strength and a physiotherapist for release and conditioning is a good option. Getting a referral to a rheumatologist or your local pharmacist is also important in dealing with Arthritic conditions.  

And as that surface wears away, you lose that lubrication in the joint and you lose that smooth movement. The thing about cartilage is that it has no nerve supply. So when you pound the cartilage, it doesn’t hurt.
As soon as you lose that surface, you expose the bone, and the bone does feel pain, and you start to feel pain because you’ve lost that cushioning in the joint.

Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

Local Practitioners: Orthopaedic Surgeon

If a patient is diagnosed with significant  osteoarthritis of the hip with significant pain that is not responding to non-operative treatment, which includes medications, the use of a cane, and staying active and fit, then the consideration is that of a hip replacement. So why are there different options for the bearing surface in hip replacement? In the old days, the traditional bearing surface, and when I say bearing surface, I mean the articulation of the hip, and the hip being a ball and a socket joint, so what is the material of the ball or the femoral head and the socket, which is the liner of the acetabulum.

Traditionally, this has been metal on plastic. And over the years, we have learned that plastic can wear with time, and the byproducts of the plastic wear can lead to significant bone loss and failure of the hip joint, leading to fairly catastrophic revisions.In the late 1990s, the old traditional plastics that we were using, which were ultra-high molecular weight polyethylene that was sterilized using gamma radiation and air, were replaced with what’s now called highly cross-linked polyethylene. And the vast majority of patients in North America now would get this highly cross-linked polyethylene.

What we have learned over the past decade is that the newer highly cross-linked polyethylene wears much, much less than the previous generations of plastic. And now we are no longer seeing the catastrophic wear and the catastrophic failures that we were seeing 15 and 20 years ago.And that has been very, very encouraging. And ceramic on ceramics were also an alternative to metal on plastic because of the older problems with wear of the plastic. With more current data, up to 10 years, the failure rate of ceramic on ceramic and metal on plastic is exactly the same.

However, some surgeons still recommend ceramic on ceramic for very young patients because of the potential less wear at 20, 30 and 40 years. So for really young patients, it may be an attractive option, although there is no evidence to support that it is better than metal on plastic. Often getting a referral from your local family phyisican, doctor to a orthopedic surgeon or physiotherapists is often wher you strt with hip pain. 

There are two potential complications with ceramic on ceramic that are not present with metal on plastic. They’re rare, but they can happen. And that’s squeaking, so audible squeaking that can be quite bothersome in rare events.And also very rarely, the ceramics can fracture and need a revision. They’re rare events, but they can still happen.  And this is why the standard of care in North America remains metal on plastic.

Once a decision has been made to perform a hip replacement, the patient should discuss the various treatment options for a hip replacement with the surgeon. Local Rheumatologist 

Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

 Now Health Network Local Practitioners: Orthopaedic Surgeon