While the basic steps of hip replacement surgery are similar, many variables depend on the patient, the surgeon, and the type of prostheses that are used. Below are some common surgical variables patients may encounter.

Minimally Invasive
Hip Replacement Surgery

Minimally invasive hip replacement surgery is defined differently by different people. Some surgeons define it by the actual size of the skin incision, with a smaller incision indicating a more minimally invasive procedure. Others define a minimally invasive surgery as one that uses techniques and modified tools to avoid cutting some of the muscle and other soft tissue around the hip; these approaches to the hip are theoretically more "muscle sparing."

It is important to recognize that, however it is defined, minimally invasive surgery can be both technically challenging as well as pose a unique set of risks and complications if the surgeon is not trained in the specific surgical methods being used.

advertisement

Computer-Assisted Hip Replacement Surgery

Some surgeons use computers during surgery to help with prosthesis alignment. Early studies indicate that computer-assisted surgery provides better prostheses alignment than conventional approaches, though more research needs to be done regarding the clinical impact, the long-term outcomes and efficacy.1,2

Types of Prostheses

The socket ("cup") and the femoral stem of the hip replacement, which are the two components in contact with the bone, are most often made of some type of metal. The femoral head ("ball") and the liner of the socket, which is the interface for movement in the hip is comprised of some combination of the following materials: metal, plastic (polyethylene), and/or ceramic.

There is no definitive scientific evidence showing one type of hip prosthesis to be better than another,3 and experts continue to research and debate this issue. However, recently there is an increasing number of studies demonstrating the complications associated with a ‘metal on metal’ interface (i.e. both a metal femoral head and metal liner) surface.4,5 Ultimately, the type of prosthetic used will depend on the surgeon’s preference and possibly the patient’s age, anatomy and lifestyle.

Cemented versus Cementless Prostheses

Another difference among prostheses is how they are affixed to the bone. Components may be attached with bone cement or they may be "cementless," allowing existing bone to grow into them. Each type has relative advantages and disadvantages. Cementless fixation is the most common technique currently used for both primary and revision hip replacement in North America.

advertisement

Whether a surgeon uses cemented or uncemented prostheses (or a combination) will depend on the surgeon’s preference and the patient’s lifestyle and physiology.

Patients will want to consider these variables but keep in mind that surgical experience remains one of the most important factors. For example, an experienced surgeon who has expertise in a traditional surgical approach may offer better outcomes than a surgeon who is using the latest technology and methods but has little experience.

References

  • 1.Beckmann J, Stengel D, Tingart M, Götz J, Grifka J, Lüring C. Navigated cup implantation in hip arthroplasty. Acta Orthop. 2009 Oct;80(5):538-44. Review. PubMed PMID: 19916685; PubMed Central PMCID: PMC2823338.
  • 2.Gandhi R, Marchie A, Farrokhyar F, Mahomed N. Computer navigation in total hip replacement: a meta-analysis. Int Orthop. 2009 Jun;33(3):593-7. Epub 2008 Apr 3. PubMed PMID: 18386003; PubMed Central PMCID: PMC2903082.
  • 3.Rajan Anand, Stephen E. Graves, Richard N. de Steiger, David C. Davidson, Philip Ryan, Lisa N. Miller, Kara Cashman, “What is the Benefit of Introducing New Hip and Knee Prostheses? The Journal of Bone & Joint Surgery (Am.), Dec 2011; 93 (Supplement_3); 51-54. doi: 10.2106/JBJS.K.00867
  • 4.Hart AJ, Satchithananda K, Liddle AD, Sabah SA, McRobbie D, Henckel J, Cobb JP, Skinner JA, Mitchell AW. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am. 2012 Feb 15;94(4):317-25. doi: 10.2106/JBJS.J.01508. PubMed PMID: 22336970.
  • 5.Natu S, Sidaginamale RP, Gandhi J, Langton DJ, Nargol AV. Adverse reactions to metal debris: histopathological features of periprosthetic soft tissue reactions seen in association with failed metal on metal hip arthroplasties. J Clin Pathol. 2012 May;65(5):409-18. doi: 10.1136/jclinpath-2011-200398. Epub 2012 Mar 15. PubMed PMID: 22422805.
Pages: