Total Hip Replacement : A solution for young arthritic hip
Dr Deepak Kumar Mishra goes over the benefits of the procedures
Arthritis in one ’ s hip joint can lead to difficulty walking and performing life ’ s daily chores . Primary arthritis of the hip joint is uncommon in Asian , Hispanic , or black populations . Patients in these ethnicities will mostly suffer from secondary arthritis due to trauma , hip dysplasia , avascular necrosis , inflammatory arthritis , or an infection in the hip joint . Due to the secondary nature of the disease , they often appear at an earlier age , maybe as early as one ’ s 20s . This early onset poses increased morbidity for the patient and a surgical challenge for the orthopaedic surgeon . The inability to perform normal activities at a young age produces feelings of hopelessness in patients and worsens their physical and financial output . Due to a lack of awareness , and at times remote access to healthcare systems , patients will delay seeking medical advice from an orthopaedic surgeon .
Total hip replacement surgery , since its inception in the 1960s , has been a reliable and proven technique for underlying arthritis . It ’ s been called the “ operation of the century ” as it ’ s helped improve the lives of countless patients suffering from debilitating arthritis . There ’ s also been a continuous improvement in design and material for acetabular and femoral components , along with the method of fixation to the host bone . The success rate for total hip replacement has improved from approximately 77 percent survivorship for Charnley ’ s arthroplasty to almost 92-95 percent for modern day implants . Over the last four or five decades , total hip replacement surgery has gradually improved outcomes and patient satisfaction . Continuous advancements in metallurgy and bearing technology have made this success possible .
Advancements in surgical techniques and in the field of anaesthesia have improved the pain management and post-op rehabilitation in these patients .
Total hip replacement implants mainly fall into two categories – cemented and uncemented . In cemented implants , antibiotic laden polymethyl-methacrylate is used to fix the implant to the bone . In uncemented implants , it directly fixes to the bone . Uncemented implants have larger global acceptance today . Another major advancement has occurred in the “ bearing surface ” between the acetabular and femoral implant . This is the surface on which the hip joint moves after surgery . Sir John Charlney introduced high density polyethylene as a bearing surface and revolutionized replacement surgery as a result . Later , metal-on-metal bearing was introduced in the 1960s . Failure rates were higher than acceptable with these two bearing surfaces . The bearings commonly in use now are highly crossed linked polyethylene with cobalt chrome metal , highly crossed linked polyethylene with delta ceramic , and delta ceramic on delta ceramic . All three have a proven record and are used worldwide . There is a general consensus for using ceramic on ceramic in younger patients and in older patients who are physically active .
Patients with hip arthritis present with pain around their hip joint and have difficulty walking . They also have difficulty sitting on the floor or squatting . Few patients present with complaints of being unable to perform marital obligations . When first seeing a patient , a detailed history is taken to ascertain the underlying cause , and a proper examination is performed to assess movements in the affected
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