While recent figures will have been affected by Covid, around 90,000 total hip replacements (THRs) are performed in the UK each year. With the UK National Joint Register (NJR) active since 2003, there is now data from around 1.2 million THRs in that UK Registry. It is important that we understand how patients progress after their surgery. For that reason, data is collected routinely before and after hip surgery from my patients, whether in the NHS or private sectors. I am very supportive of that and hope all my patients are keen to contribute to this important process.
The average age of patients undergoing hip replacement is around 68. While only 12 per cent of patients are under 54 in the National Register, younger patients are not uncommon within my practice. Age should not be a major limitation to surgery, if a patient’s symptoms and limitation is felt to be sufficiently severe to warrant surgery. The youngest patient in whom I have had to carry out joint replacement surgery was only 13 and the oldest 97.
Total Hip Replacement – the basics
Total hip replacement involves dividing the neck of the femur to remove the very proximal part of the bone (the femur) including the damaged femoral head. This allows the surgeon to implant a metal stem into the femur.
Subsequently, the damaged articular cartilage in the socket (the acetabulum) is removed, allowing a new socket to be implanted. A round ceramic or metal femoral head is inserted onto the top of the femoral stem and a polyethylene or ceramic liner into the metal acetabular socket. Thus, a new artificial ‘ball and socket’-type bearing surface is created. (The various components involved are shown and explained within the website.)
There are various techniques and options, from the point of view of implant fixation and bearing surface, that can be used in hip replacement. This gives the surgeon a variety of options that can be used according to the patient’s age, bone quality and required activity levels at work, rest and indeed at ‘play’. There might also be underlying medical issues which can influence the surgeon’s choice of fixation technique and bearing surface options in an attempt to reduce any associated risk.
All options should be considered to ensure that the best and most reliable technique is used to provide a joint replacement. As such, the technical aspects of the procedure are essentially tailored to an individual patient’s anatomy, clinical function and to their desired level of activity post-reconstruction.
These options should be discussed around the time that a decision is taken to proceed with joint replacement surgery, in advance of the surgery itself.
The results of hip replacement surgery are extremely reliable. Patients are expected to return to a very good level of function with good range of movement and excellent pain relief following the procedure.