A painful hip can severely affect your ability to lead a full active life. Over the last twenty five years, major advancements in hip replacement have improved the outcome of the surgery greatly. This Patient's Guide discusses the Anatomy, Symptoms, Diagnosis and Treatment regarding an artificial hip. Highly Reputable

This process occurs when tiny particles are generated at the bearing couple of a joint replacement. Since most joint replacements use polyethylene (a type of plastic) as one of the bearing surfaces, and since this is usually the softer material, most of the tiny particles will be polyethylene. The ones that cause the most trouble are so small that their size is measured in microns ( thousandths of a millimeter) or even nanometres (thousandth of a micron). Aseptic loosening can also be caused by tiny particles of cement, metal or ceramic. It is the size and number of particles that counts rather than the actual material of which they are made. A typical joint replacement will generate millions of these particles every year, even if functioning as designed. Very little plastic will be worn away as the particles are so very small. The plastic wear will therefore not be detectable by ordinary X-rays. Everyone believes that all is well ... The particles attract a cell type called a macrophage. These cells try to engulf and digest the particles that are seen as 'foreign' to the body, much as they would a bacterium. i.e. this is a natural and essential part of the human body's defence mechanism. Unfortunately plastic causes macrophages a fatal case of indigestion and these cells die, releasing enzymes and other chemicals. It is these enzymes and chemicals that cause the bone to be eaten away. If only a few macrophages die and release their chemicals, little harm is done. The problem is most joint relacements release millions or billions of particles so a corresponding number of macrophages may be attracted and die. It is all about numbers Aseptic loosening shows on X-rays as lines appearing around the prostheses or isolated cavities. When the problem was first observed affecting early joint relacements in the 1960's ,70's and 80's; it was initially poorly understood. Microscopes to see the tiny particles were not available. Many thought the problem was caused by acrylic bone cement and the term 'cement disease' was used. The North American market was therefore dominated by cementless designs in an effort to avoid the problem (a situation that remains!). When cementless designs began to fail as well, this was labelled osteolysis. Osteolysis is the same basic process as aseptic loosening, just a slightly different pattern. In summary, all joint replacements whether cemented or uncemented are at risk of failing as a result of aseptic loosening/osteolysis. This is especially true of designs using polyethylene as one of the bearing surfaces. Bad designs or poor technique can greatly accelerate the rate of particle production and therefore increase the risk. The risk is time dependant and therefore older patients will die before aseptic loosening/osteolysis becomes a problem. This group is also less active and will generate fewer particles than a younger patient per annum because they will tend to use their joint replacement less. Good designs (cemented or uncemented) and good surgical technique, in contrast, will give survival rates of>95% at 18 to 20 years. Expert

Definition Hip replacement is a procedure in which the surgeon removes damaged or diseased parts of the patient's hip joint and replaces them with new artificial parts. The operation itself is called hip arthroplasty. Arthroplasty comes from two Greek words, arthros or joint and plassein, "to form or shape." It is a type of surgery done to replace or reconstruct a joint. The artificial joint itself is called a prosthesis. Hip prostheses may be made of metal, ceramic, plastic, or various combinations of these materials. Encyclopedia of Surgery: A Guide for Patients and Caregivers Expert

Hip Resurfacing Birmingham Hip Resurfacing (BHR) restores the hip to near the patients original anatomy, avoiding some of the problems of THR e.g. leg lengthening and dislocation. Patients who have had a THR on one side and a BHR on the other report that the BHR feels stronger and more natural.

Hip Revision Unfortunately, not all conventional Total Hip Relacements (THR's) continue to work indefinitely. Infection, dislocation,leg length changes and loosening are all reasons why patients may need to have the THR redone (revised). Expert

Definition Hip revision surgery, which is also known as revision total hip arthroplasty, is a procedure in which the surgeon removes a previously implanted artificial hip joint, or prosthesis, and replaces it with a new prosthesis. Hip revision surgery may also involve the use of bone grafts. The bone graft may be an autograft, which means that the bone is taken from another site in the patient's own body; or an allograft, which means that the bone tissue comes from another donor. Encyclopedia of Surgery: A Guide for Patients and Caregivers Expert

It is now possible in the majority of older patients to perform Total Hip Replacement through an incision approximately 3 inches in length. Patients who have unusual anatomy or fixed contractures may not be suitable. At the end of the day, it is more important that the components used are correctly orientated and firmly fixed in place than the length of the scar. Expert

Surface Hippy is a Patient to Patient Guide to Hip Resurfacing. A large selection of articles, medical studies, doctors and personal stories about hip resurfacing are available. Patient Provider

Account of the benefits of hip replacement surgery Highly Reputable

Educational Website Devoted to Educating Patients About Hip Disease, Hip Injury, Total Hip Replacement Surgery, and Revision Hip Surgery

Fiction: Hip replacement is easy. Even registrars (residents) can do them without supervision. Fact: Most hip replacements are easy. In elderly patients minor errors of technique will be tolerated quite well as long as hip stability is enough to prevent dislocation. It is when the pathology is even a little unusual or the patient is young that things can unravel and this is when there is no substitute for experience. Myth: Hips need to be redone because they "wear out". Fact: Hips need to be redone because they loosen with time. Fact: Metal-on-metal Hip Resurfacing has changed the ground rules regarding age and hip arthroplasty. Patients can be considered for surgery when they need it regardless of age. Fiction: Outpatient Physiotherapy (Physical Therapy) is always required after hip replacement to get the best out of the operation. Fact: Most patients do splendidly on their own at home. Some may benefit, especially if there was unusual stiffness or deformity/scarring beforehand. Myth: Hips can only be redone once or twice. Fact: Hips can be redone several times. It does get more tricky and bad revisions lead tomore surgery…………. Fact: Epidural or regional anaesthesia greatly reduces morbidity and mortality. Myth: Hip prostheses are all basically the same. Surgeons know which to use appropriately. Fact: Field of Hip Arthroplasty is littered with examples of bad choices! It is still in turmoil. Myth: Surgeon knows how long patient should be off work, before they can drive a car etc. Fact: Depends largely on patient perception, motivation and personality. Fact: Cause of Primary osteoarthritis of Hip remains completely unknown. Fiction: Patients needing Hip replacement are getting older as population ages. Fact: Patients are getting both older and younger. We are not sure why younger. Myth: Hip replacements only last 10 to 12 years. Fact: If Surgeon is not getting survival of>95% at 18 to 20 yrs something is not right! Fiction: OA of the Hip is easy to diagnose. Diagnosis is rarely missed. Fact: Often masquerades as knee pain. Can be exquisitely difficult to differentiate between low back or sacro-iliitis and OA of Hip. Fiction: X-ray tells Surgeon when to operate. Fact: We treat patients not X-rays! Often no correlation between X-ray and symptoms. Fact: some NSAID’s unfriendly to cartilage: can cause accelerated degeneration." Dissolving Hip" . Naproxen probably best known and worst! Fiction: Leg length is easy to measure intra-operatively and so if there is a discrepancy post-op the Surgeon is negligent. Fact: Intra-operative leg length measurement is crude and errors are very easy to make. Fact: Leg length discrepancy is better tolerated if leg is made slightly short than even very slightly long. Best of all is to get it just right! Experience is best teacher. 1Fact: All the important, major developments in the field of Hip Arthroplasty over the last 40 years have mostly been British! Myth: Hip replacements are a commodity that can be bought or sold like groceries. Fact: It is more like buying a good car: look at the manufacturers reputation, the dealer efficiency and cleanliness as well as the after sales service and spare parts supply! Myth: Small incision= better. Fact: This is only true if size of incision does not limit Surgeon’s ability to fix everything in properly and if appropriate implants used for age and activity. Fiction: Small incision= faster recovery, earlier discharge. Less bruising. Fact: These are influenced more by general fitness and therefore age than anything else. Also heavily influenced by patient attitude, personality. Bruising often more with small incision because of need to stretch skin to get implants in. Expert

The most common disorder to affect the hips is osteoarthritis (OA), which erodes cartilage and exposes the bone beneath.. Advanced cases of hip OA require surgery. Other diseases that can badly damage the hip joint include: Inflammatory arthritis, such as rheumatoid arthritis, which actively corrodes cartilage and bone, and osteonecrosis, where the femoral head and neck die as a result of disrupted blood supply caused by a fracture or long-term steroid use or long-term alcohol abuse. Highly Reputable

UK Hip Surgeon, Dr Bloomfield What do you need to know about Total Hip Replacement? (THR). Like anything else in life, look at history, because it tends to repeat itself and you may avoid making the same mistakes as others. -The Runnymede Hospital, Chertsey. -Princess Margaret Hospital, Windsor. -Woking Nuffield Hospital. Hip Clinic Rowley Bristow Orthopaedic Unit Ashford & St Peter's NHS Trust, Guildford Rd. Chertsey KT16 0PZ Expert

Hip replacement surgical options and alternatives. Suggestions and links for pre- and post-op care of joints.

n overview of osteonecrosis including prevention, symptoms, diagnosis and surgical,non-surgical treatments. Sponsored by the Johns Hopkins University.