Total hip replacement

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Total hip replacement surgery

A total hip replacement is a surgical procedure in which the arthritic or damaged joint is removed and replaced with an artificial joint (prosthesis).

Although an artificial hip will never be better than a normal healthy joint, in the vast majority of cases surgery will alleviate pain and stiffness and allow you to return to general daily activities, generally including sports and moderate physical work.

Hip replacements have been performed for over 40 years and are considered to be one of the most successful surgical procedures.

At least 50,000 hip replacement operations are carried out in the UK each year, with a success rate of 97%. Around 96% of hip replacements last for ten years, while at least 85% last for 20 years (national figures).

Mini-incision surgery

Primary (first time) uncomplicated total hip replacement surgery at the London Hip Unit is performed using a minimally invasive technique. Surgery is carried out through a single scar of around 6-10cm (compared to 20-30cm in conventional surgery). Miss Muirhead-Allwood helped to develop this technique, which is available only available by a limited number of experienced surgeons in the UK.

The benefit of a smaller incision is that less supporting tissue is disrupted during surgery. This results in reduced blood loss and reduced surgical pain. The final scar will be much less noticeable.

What happens in total hip replacement surgery?

When developed by Charnley hip replacements were generally cemented in, with improved technology the use of uncemented prosthesis has superseded cemented replacements except in a few rare circumstances. Now the majority of hip replacements in the USA and Europe are uncemented.

Miss Muirhead-Allwood has been a dedicated advocate of the cementless technique for over 20 years and currently operates almost exclusively without cement in all primary and revision hip replacements.

In an uncemented hip replacement, the arthritic head of the femur (the ball) and the lining of the acetabulum (the socket) are removed. A femoral component is inserted into the healthy section of the patient's thighbone and a hemispherical socket is inserted into the pelvis. The surface of the artificial hip prostheses is textured and coated with a compound that stimulates the bone to grow onto its surface using the same mechanism that occurs when a broken bones heals itself, so the patient is essentially making their own glue.

Once the bone has grown into the prosthesis an extremely firm bond is made which virtually eliminates any loosening, a major cause of failure of hip replacement surgery.

A large variety of different prostheses are available from different manufacturers. Miss Muirhead-Allwood will choose the one that best fits your anatomy, the strength of your bones and your level of activity.

The ball and socket of the new joint can be made from a variety of materials. All prostheses used by Miss Muirhead-Allwood use materials incorporating the latest developments. These offer much harder surfaces and reduce the possibility of wear, a major reason for needing revision surgery.

Miss Muirhead-Allwood is also the UK's leading expert in fitting 'cad cam' hips. These are tailor-made computer-designed prostheses that are used only occasionally when a patient's anatomy fails to fit any ready-made hips.

Total hip replacement x-ray

In addition to total hip replacement surgery, two other main types of procedure are also available at the London Hip Unit:

Hip resurfacing
Revision hip replacement

Further information on total hip replacement surgery can be found at:

The National Institute for Clinical Excellence gives guidelines on single mini-incision surgery: www.nice.org.uk

The National Joint Registry provides an annual report on performance of hip replacements: www.njrcentre.org.uk

The British Medical Journal provides patient information leaflets based on best practice: www.besttreatments.bmj.com

The Arthritis Research Campaign also has patient information leaflets on hip replacement and more information on arthritis: www.arc.uk

NHS direct provides patient information on hip replacements: www.nhsdirect.nhs.uk

Miss Muirhead-Allwood

All surgery at The London Hip Unit team is carried out by Miss Sarah-Muirhead-Allwood BSc FRCS, an internationally renowned specialist hip surgeon. Miss Muirhead-Allwood is supported by a team of registrars, nurse specialists and medical secretaries.

Hip surgery

Miss Muirhead-Allwood is renowned for her expertise in the three main types of hip surgery.