Different Prostheses for Hip Replacement - Which one is better for me?
What is a hip replacement?
Hip replacement also called hip arthroplasty, is a safe and effective surgical procedure done to address the pain that involves the surgical removal of the damaged sections of the hip and replacement with artificial implants mostly constructed from metal, hard plastic, and ceramics.
Hip replacement surgery includes the replacement of one or both parts. The goal of the procedure is to restore natural joint alignment and allow you to resume daily activities with little or no pain.
What are the Types of Hip Replacement Surgery?
The type used depends on;
A. Which part needs to be replaced? (2)
Total hip replacement (THR) - In this surgery, the ball and the socket joints are replaced using artificial components. During this procedure, the surgeon inserts a stem into the patient’s femur for stability. They replace the femoral head with a ball and replace the socket in the hip joint with an artificial cup.
Partial Hip Surgery or Hemiarthroplasty - This surgery only involves replacing the ball (the head of the femur). A metal or ceramic ball is attached to the top of a stem that is inserted into the femur. This surgery is performed to repair certain types of hip fractures.
Hip resurfacing - This surgery is done to help relieve pain from cartilage loss. The surgeon trims out growth spurs and damage from the ball at the top of the femur. After that has been done, the surgeon then renews it with a smooth metal covering. The bone socket of the hip is also lined with a metal or shell.
B. How will the surgeon access the hip?
Anterior approach to hip replacement (From the front)- the surgeon enters the hip by cutting the frontal part of the hip. It is becoming prevalent for minimally invasive approaches.
Lateral approach to hip replacement (incision made from the side of the hip). Mainly used for Partial hip replacement or hemiarthroplasty.
Posterior approach to hip replacement (from the back)- Most commonly used approach for total hip replacement. The surgeon makes the entry cut at the side back of the hip. This approach is used because it enhances better visibility of the hip joint.
C. Recovery Time
Staged hip replacement
A staged hip replacement may be done if both hips require replacement. Your surgeon will replace one hip at a time, allowing you to recover from the initial surgery, before doing the second one. It is mostly done for the elderly so they can handle one surgery at a time. The advantage of this is that the patient will not lose so much blood and will not have to stay under anesthesia for long. The disadvantage is, that the patient goes to the operation twice. (3)
Bilateral Hip Replacement
Bilateral hip replacement involves replacing both hips at the same time. This type of surgery usually involves younger, active, and healthy patients who can handle more rigorous exercise and physical therapy after the surgery.
Generally, a unilateral (one side) total hip arthroplasty leaves the patient standing the day after surgery. Patients need to use the walker for 2-4 weeks, following which they can walk without support.
Choosing a prosthesis for your surgery
When choosing a prosthesis for hip surgery, there are a few things to keep in mind.
If the joint lasts 15-20 years.
If your surgeon has used the implant before.
If the material is safe to use (That is if it causes wear particles into the bloodstream).
If the material allows you to perform your normal activities properly.
If the used material has a proven long track record
These are the different types of materials used for hip surgery (4):
Cemented total hip replacement
In cemented THR, bone cement is used to hold the components of hip replacement. Most commonly used, and has a proven track record.
Uncemented total hip replacement
In uncemented THR, no bone cement is used. A specially made prosthesis surface holds the bone tightly.
The majority of hip arthroplasty done today in the USA is uncemented hip, whereas cemented THR is still mostly done in the UK. Your doctor will decide which one is best for you.
Ceramic-on-polyethylene (COP)
Currently one of the most popular hip replacement materials. It doesn’t make squeaky sounds like the ceramic on ceramic and does not wear into the bloodstream. Due to the low wear rate, ceramic on poly becoming a commonly used material for THR.
Metal-on-metal (MOM)
MOM was introduced due to its excellent range of motion and low wear. This type of replacement device is no longer in use in the United States as approved by the FDA. This is because they release metal ions into your bloodstream that can cause kidney problems. People who had MOM prostheses need periodic monitoring and estimation of blood metal ion levels.
Metal-on-polyethylene (MOP)
The most commonly used material as it is the cheapest option available. However, polyethylene produces wear particles, which can cause loosening of the implant.
Ceramic-on-metal (COM)
Any material made with metal usually results in metal wear particles in the bloodstream. Not commonly used.
Ceramic-on-ceramic (COC)
This is one of the most commonly used materials due to the least wear rate. It has a fewer risk of failure and has no allergic reaction. However, this is the costliest implant.
The National Joint Registry (UK) graph below shows trends in different combinations of hip replacement surfaces.
References
4. https://www.bioxcellerator.com/blog/hip-replacement-materials-best-to-worst
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