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What is a Total Hip Joint Replacement?

Circumstances vary, but generally, patients are considered for total hip replacements if : -

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Cementless Hydroxyapatite Coated Hip Prostheses - …



The acetabular component of a cementless total hip replacement also has a coated or textured surface to encourage bone growth into the surface.

Preparing for a total hip replacement begins several weeks before the actual surgery.

Total hip joint replacement is one of the great orthopaedic surgical advances of this century. It resulted from the pioneering efforts of Sir John Charnley, an orthopaedic surgeon who worked with engineers to develop the techniques and materials used in hip joint replacement.

a human total hip prosthesis for chemical fixation to ..

With failed surgery or advanced arthritis (wear and tear), partial knee replacement or total knee replacement are the only options.

The cost-effectiveness profile of cemented prostheses was found to be similar to that of cementless implants for the surgical management of hip arthritis and femoral neck fractures in a theoretical elderly population based on RIPO report data. The average cost difference was € 2060.44 in 2006 euros, without differences in QALY.

The model is sensitive to revision rates, implant costs, perioperative mortality and infection rates, and utility values. Analysis of 5-year follow-up data reported in the RIPO register revealed that, with a 1.4% annual probability of revision, cementless prostheses becomes less costly. With an incremental cost-effectiveness ratio above € 50,000 per QALY threshold, cemented implants do not become cost-inefficient. If the probability of revision of cemented THA is held constant, cementless implants do not become less costly. In fact, even if the annual revision rate of total cementless prostheses were 0% (i.e. no revisions), the cost of each additional QALY gained by choosing a cementless device is greater than $ 50,000 per QALY, the commonly accepted threshold for cost-effective interventions. This suggests that, under our assumptions, cementless THA may not be more cost-effective, regardless of its revision rates.

Cementless Techniques for Total Hip Arthroplasty; THA …

To assess the cost-effectiveness of three types of prosthesis for elective total hip replacement in adults with osteoarthritis.

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This website and the general handout I provide in the office will outline all the general principles of hip and knee replacement surgery, the realistic outcomes and things you need to be aware of. This handout provides extra information that you may find useful.
BEFORE SURGERY

Before surgery you will need to attend a pre-admission clinic at the hospital where you will meet a clinical nurse who will go over the basic admission process and post operative course. In addition there are routine pre-operative blood tests and an ECG that are performed. Occasionally a chest X-ray is needed.
If any significant abnormality is detected in your pre-operative visit, the appropriate action/referral will occur to investigate and treat any issue needing attention.
If you see a cardiologist routinely and are on a regular blood thinner, please advise your cardiologist you are having a joint replacement and that you need to stop blood thinners such as warfarin, plavix/clopidigrol and aspirin. I am happy to perform the replacement under low dose aspirin (100mg) if your cardiologist insists.

MEDICATION YOU NEED TO STOP

Please stop all anti-inflamatories (mobic, celebrex, nurofen, voltaren etc ) 1 week before surgery.
Herbal medication (fish oils, garlic, echinacea, kava, glucosamine etc ) need to be stopped 1 week before surgery as they can cause excessive bleeding.

If you are diabetic it is important that your diabetes is under proper control. Your GP will usually see to this.
Dental issues. If you have any major dental issues requiring attention please get this done before your joint replacement.
If you have any prostate issues (Males), please inform me as every patient needs a urinary catheter for 24-48 hrs and prostate problems can result in a difficult catheterisation therefore it is best to have a urologist consult if need be.

ANTISEPTIC SHOWER SOAP

You will be given an antiseptic soap at the pre-admission clinic that you need to shower with for the 2 days prior to surgery. This will reduce the risk of a skin infection after surgery.
Please DO NOT shave hair around the hip or knee before surgery. The hospital nursing staff will shave the area if needed using special clippers that do not cut the skin.

THE SURGERY

The surgery is usually carried out under a combined spinal anaesthetic and light general / sedation. Spinal anaesthesia is safe and has been shown to assist in reducing complications during joint replacement surgery. It provides excellent post operative pain relief. The Anaesthetist will discuss this with you in detail.
A urinary catheter is used in all cases. Patients with a spinal as well as those who don't have a spinal but get morphine for pain relief, will invariably have difficulty passing urine for 12-18 hrs and hence the need for a catheter. It is much easier to pass a urinary catheter when you are sedated just before surgery than to pass a catheter when you are awake on the ward with a full bladder.
Removing a catheter is a very easy process done by the ward nurses and is not painful at all.
Antibiotics are given intravenously for 24-36 hrs and your IV cannula will remain in your arm for this period. The cannula is also often attached to a PCA machine which allows you to administer pain killers when needed. I do not use a PCA in all patients as often (such as in the minimally invasive hip approach) the local anaesthetic and oral pain tablets are sufficient.
You will be given the appropriate pain relief regime that the anaesthetist will order. This regime is tailored to each individual's needs.

EARLY MOBILISATION

The key to preventing thrombosis is mobilisation and exercise . Every patient is fitted with a calf compressor after surgery. This machine compresses the calf intermittently which promotes venous blood flow back to the heart and prevents clots. The compressors are used whilst in bed for the first 48 hrs. The sooner you get out of bed and walk the less the risk of a thrombosis.
In addition to early mobilisation and calf compressors you will either be given oral aspirin or clexane injections to assist in reducing the incidence of thrombosis.
I encourage 2 walks a day whilst in hospital. The more you can manage the better but don't overdo things.
Whilst the risk of a thrombosis is low despite all preventative measures they can still occur and are treated accordingly. I do not perform a routine Doppler scan to check for thrombosis as all studies have shown that routine scanning is a waist of time.

ANTIBIOTIC POLICY FOR PROCEDURES FOLLOWING JOINT REPLACEMENT

The risk of getting an infection in your replaced joint is extremely rare following routine procedures such as dental work and colonoscopies.
DENTAL procedures:
For routine dental cleaning after joint replacement surgery there is no need to take antibiotic prophylaxis. For major dental work after a joint replacement ( such as root canal etc) I recommend a single dose of 2gm amoxicillin 1 hour before provided you are not allergic to amoxil.
COLONOSCOPY, Prostate, Bladder or Gynaecological procedures after joint replacement :
Routine colonoscopy without any major biopsies or risk of bleeding do not require prophylactic antibiotic cover.
Surgery to the bladder, bowel, gynaecological and prostate surgery require a single intravenous antibiotic dose that is administered by the surgeon at the time of the procedure. Please advise them that you have a joint replacement.

Some other things about replacements:

All knee replacements have some numbness on the outer side of the wound. This is unavoidable as there is a skin nerve that goes directly across the skin incision and hence is purposefully cut in order to open up the knee joint. It is a minor nerve and the numbness will tend to lighten up over time but is never completely eliminated.
All knee replacements click. This is normal. It is simply the metal and polyethylene parts touching each other and is no cause for alarm. It is how the joint functions. The clicking noise will tend to get quieter over time.
Hip Replacements can occasionally click at the extreme of motion. No cause for alarm. Some ceramic on ceramic hip bearings can squeak (rare) again no cause for alarm.
Intraoperative stability is important in hip replacements. Rarely one may need to tension the hip which can lead to a leg length discrepancy. Various techniques are used to minimise this possibility.
The key to a successful recovery is motivation to mobilise and to do the exercises the physiotherapist will show you. Hip and Knee replacement surgeries have excellent outcomes provided the patients assist in a motivated recovery.

A total knee replacement is designed to resurface the femur, tibia and patella and in-between the femur and tibia is a layer of polyethelene. The polyethelene (plastic shock absorber) is the bearing surface which ALL knee replacements use. Unlike in hip replacement surgery there is no ceramic on ceramic knee replacement bearing. There is also NO metal on metal bearing so the problem that happened with some metal on metal hip replacements does not exist in knee replacements.

Ten to Twelve-Year Results With the Zweymüller Cementless Total Hip Prosthesis
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Total Hip Replacement Complications & Surgery Recovery



An alternative hip prosthesis called a "cementless" total hip replacement has the potential to allow bone to grow into it, and therefore may last longer than the cemented hip.

Clinical application of Zurich Cementless-canine total hip prosthesis

Direct medical costs included initial prosthesis, revision, operation theatre and hospital stay. The unit cost of each prosthesis was stated to have been taken from the prices paid by a typical NHS provider for the most popular implant systems, including all components and instrumentation. Prosthesis costs were calculated by weighting the price for each brand within the different types according to each brand's relative frequency. Costs of operation theatre and hospital stay were based on a national study modified by using the length of stay according to the prosthesis type observed in patient-reported outcome measures, joint registry and hospital episode statistics linked records. The cost of one day in hospital was assumed to be £225. Average total cost of a primary total hip replacement was multiplied by a factor that differed according to the reason for revision (1 or 2 stage; higher factor for two stage) to account for unit costs for revisions being generally higher than primary hip replacements. All costs were reported in 2010-2011 GBP (£). A discount rate of 3.5% was applied.

amplitude hip orthopaedic prosthesis cementless …

In some cases, only one of the two components (socket or stem) may be fixed with cement and the other is cementless and would be called a "hybrid" hip prosthesis.

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