What is a Hip Replacement
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.
Local Orthopedic Surgeon
Dr. Bassam Masri, MD, FRCSC, discusses diagnosis and treatment of key decisions in hip replacement.
Dr. Bassam Masri, MD, FRCSC, discusses the different materials used in a hip ball and socket replacement.
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Diagnosing Who Needs Hip Replacement
For patients who have pain who might think that they require surgery, what they will be experiencing is that the pain they have been having for some time is gradually getting worse to the point that they may have some significant limitations in walking tolerance, they can only walk a few blocks now, they have some rest pain and in particular they might have some night pain.
If a patient has any of that progression of symptoms then the first thing that should happen is they should get an X-ray. Preferably the X-ray should be of the pelvis. In that way we have a comparison view of one hip versus the other hip, to see what the joint space looks like because that’s an indicator of the severity of the arthritis.
n mild arthitis you may not see complete obliteration of the joint and just a subtle irregularity of the joint may be an indicator of the beginnings of arthritis, and that would be the diagnostic test for osteoarthritis of the hip.
Many patients feel that an MRI is a really important test and the recommendation is that if an X-ray’s abnormal and shows arthritis, an MRI is not indicated, then money should not be wasted on an MRI if the diagnosis is obvious on a regular X-ray.
So once the diagnosis of osteoarthritis has been made and a patient might be considering surgery and they’re waiting to either see an orthopedic surgeon or they’re waiting for surgery, they need to continue with non-operative treatment usch as the anti-inflammatories, Tylenol, and sometimes a cane used in the opposite hand would be of great benefit to offload the affected side.
It’s a common misconception that the cane should be on the affected side but in reality it should be in the hand on the opposite side of the arthritic hip. Patients ask what is the role of physical therapy while you’re waiting for a joint replacement or a hip replacement.
There’s really no strong evidence to support physical therapy apart from a patient remaining as active as possible, so formal physical therapy is not really necessary while someone is awaiting a joint replacement.
Once the diagnosis of osteoarthritis has been made and the pain is significantly interfering with the patient’s day-to-day activities and causing significant pain,then a referral to an orthopedic surgeon may be necessary.
And of course if a patient has any questions about the diagnosis of osteoarthritis of the hip they should talk to their primary care doctor.
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Hip Replacement: Materials for Hip Ball and Socket Surgery
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.
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
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