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Hip replacement: landmark surgery in modern medical history
Stephen J Mellon1, Alexander D Liddle, Hemant Pandit
1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom. stephen.mellon@ndorms.ox.ac.uk
Insights
Total hip replacement (THR) effectively treats severe osteoarthritis pain and immobility. This surgery, involving replacing hip joint components, remains a highly successful and cost-effective intervention for millions.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Rheumatology
Background:
- Total hip replacement (THR) is a primary surgical intervention for end-stage symptomatic osteoarthritis.
- Patients commonly experience debilitating pain, reduced mobility, and joint stiffness due to advanced osteoarthritis.
Purpose of the Study:
- To provide an overview of the Total Hip Replacement (THR) procedure.
- To highlight the evolution of bearing surfaces in THR over recent decades.
- To emphasize the enduring success and cost-effectiveness of THR in managing osteoarthritis.
Main Methods:
- Description of the surgical steps involved in THR, including femoral head and neck excision, acetabular cup insertion, and femoral component placement.
- Discussion of component fixation methods: cemented versus cementless (press-fit).
- Review of advancements in bearing surface materials, particularly in the last twenty years.
Main Results:
- Metal on polyethylene remains the predominant bearing surface for most THR cases.
- Low wear-rate bearing surfaces are increasingly utilized for younger, active patients.
- THR has consistently demonstrated significant efficacy in pain alleviation and mobility restoration since the 1960s.
Conclusions:
- Total hip replacement is a cornerstone surgical treatment for advanced osteoarthritis, offering substantial improvements in patient quality of life.
- Continuous innovation in bearing surfaces enhances THR outcomes, especially for active individuals.
- The procedure's proven cost-effectiveness solidifies its status as one of the most successful surgical interventions available.
Abstract:
Total hip replacement (THR) is most often performed to treat end-stage symptomatic osteoarthritis. Patients typically present with increasing pain, restricted mobility and stiffness. In this procedure, the femoral head and part of the femoral neck are excised. The acetabulum is enlarged and an acetabular cup is inserted. The femoral head is replaced by a femoral component, the stem of which is inserted into the medullary canal of the femur. The components can be either cemented in place or press-fit (cementless). The THR concept was popularised by Sir John Charnley in the 1960s and although, over half a century of development has resulted in incremental improvements, the procedure is not dramatically different from the one he described. However, over the last two decades there have been significant changes in the types of bearing surfaces used. Metal on polyethylene continues to be the workhorse for the majority of cases. In the young and active, bearing surfaces with low wear rate are increasingly used. Since the early 1960s, THR has played an important role in alleviating pain and restoring mobility to millions of people. The cost-effectiveness of THR in treating advanced osteoarthritis makes it one of the most successful of all surgical interventions.
