Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently the most common orthopaedic operation, though patient satisfaction short and long term varies widely.
Avoiding the hip dislocation during a hip replacement surgery is accomplished by preparing the femoral bone first. In situ femoral preparation refers to reaming, broaching and implanting the femoral component without cutting the femoral neck and without dislocating the hip joint. Since the femoral head remains in the socket, the hip joint helps stabilize the leg during the femoral preparation. Because the femoral neck remains intact during the femoral preparation, the femur is stronger and less likely to fracture.
Interestingly, every orthopedic surgeon has at one time or another implanted a femoral IM nail into the femoral shaft without cutting the femoral neck or dislocating the hip joint. This in-situ femoral preparation just utilizes the same skill set every orthopedic surgeon already has for trauma cases (broken bones) and applies it to joint replacement cases.
The SuperPATH approach is a combination of the Superior approach championed by Stephen Murphy in Boston and the PATH approach (percutaneous assisted total hip) championed by Brad Penenberg in Los Angeles. I did my joint replacement fellowship with Dr. Murphy and became very comfortable with this technique. Dr. Murphy has multiple publications on the supercap topic.
Gerald Friedl, M.D., and colleagues from the Medical University of Graz in Austria randomly assigned 50 patients who had undergone cementless total hip arthroplasty with osteonecrosis of the femoral head to a single infusion of 4 mg of zoledronic acid or a saline solution.
During a median follow-up of 2.8 years, the researchers found that a single dose of zoledronic acid minimized migration of the acetabular component (the cups) in both the transverse and vertical directions but did not significantly reduce subsidence of the stem. Although both groups had rapid increases in the Harris hip-rating score with time, the increase was more pronounced in the zoledronic acid group, the authors note.
ONE consequence of the high cost of medical care in the United States has been the rise of medical tourism. Every year, thousands of Americans undergo surgery in other countries because the allure of good care at half the price is too good to pass up.
Average total fees at well-regarded hospitals like Apollo and Wockhardt in India are 60 percent to 90 percent lower than those of the average American hospital, according to a 2007 study by the consulting group Mercer Health and Benefits (where Dr. Milstein is affiliated). Even compared with low-cost American hospitals, the offshore fees are 20 percent to 50 percent lower.
Hip replacement is one of the most successful operations in all of medicine, which prompts many orthopedic surgeons to think, as one leader in the field put it, “Why change something that doesn’t need fixing?”
But that leader, Dr. Robert Berghoff; his colleagues at Arizona Orthopedic Associates in Phoenix; and other orthopedic surgeons around the country believed that improvements were possible, especially with regard to reducing complications and speeding recovery.
The technique these surgeons use is called anterior hip replacement, one of several minimally invasive operations that are associated with a shorter hospital stay, smaller incision, less trauma to muscles, less pain and blood loss, reduced risk of dislocation after surgery, faster healing and a quicker return to normal activities.
Concerns Over ‘Metal on Metal’ Hip Implants (March 4, 2010)
But in the last two years, broader concerns have emerged amid research reports that the metal debris can ignite severe inflammatory reactions that can damage or destroy muscles, tendons and other soft tissue.
Your hip is one of the largest weight-bearing joints in your body. When it’s working properly, it lets you walk, sit, bend, and turn without pain. To keep it moving smoothly, a complex network of bones, cartilage, muscles, ligaments, and tendons must all work in harmony. The hip is a very stable ball-and-socket joint: A ball (femoral head) at the top of the thighbone (femur) fits into a rounded socket or cup-like cavity (acetabulum) in your pelvis. Bands of tissues called ligaments form a capsule connecting the ball to the socket and holding the bones in place.
In another controversy involving all-metal hips, an influential group has found that there is insufficient evidence to show that an alternative technique known as hip resurfacing is as safe and effective as a traditional replacement.
A Guide for Patients with Metal-on-Metal Total Hip Replacements
The Mass General Center for Metal-on-Metal Total Hip Replacement provides state-of-the-art comprehensive care to patients with metal-on-metal total joint replacements and conducts cutting-edge research. Our physicians and researchers have transformed basic discoveries into clinical practice and provide critical evaluation for and specific advice for metal-on-metal implants.
Because some patients with Metal-on-Metal (MoM) hip replacements develop unexplained pain, and because a few develop abnormal tissue reactions to the wear of the implants and require a reoperation, we established a Center that patients could rely on for comprehensive clinical evaluation.
In the majority of cases, conventional pre-operative tests (plain radiographs and standard blood tests) do not reveal any abnormality. Thus, the ordinary follow up evaluation may be of limited value. The mission of Mass General Center for Metal-on-Metal Total Hip Replacement is to provide excellence in clinical care to MoM patients by integrating various specialized tests (analysis of blood samples for metal ions, and imaging studies) in order to establish if an adverse reaction to MoM THR implants is present and to formulate the best way to treat these problems.