TOTAL HIP REPLACEMENT: A BRIEF HISTORY

IVORY AND GLASS HIP REPLACEMENT

The modern era of Total Hip Replacement began in the 1960’s, however you might be surprised to learn that the first attempts at hip replacement began in the 1890’s in Germany. In this operation ivory was used to replace the femoral head in patients with Tuberculosis.

During the 1920’s moulded glass was used as a bearing surface, but not surprisingly, this device failed due to the brittleness of the device.

METAL ON METAL HIP REPLACEMENTS

In the 1950’s surgeons from England made a total hip replacement which looks more like the modern day implant. This was invented by George McKee and was a metal on metal bearing surface. The survival rate for this total hip replacement was much better than its predecessors and encouraged the growth of the technology.

Around the same time, French surgeons were experimenting with acrylic femoral head replacements. These devices did not last well in the bone and loosened early.

MODERN ERA OF HIP REPLACEMENT

The modern era of total hip replacement began in the 1960’s when English surgeon Sir John Charnley developed his “Low friction arthroplasty” which consisted of a metal femoral stem and a polyethylene acetabular cup which were seated in the bone using acrylic bone cement. The success of this implant established a gold standard in hip replacement by which newer devices are judged.

Interested surgeons from all over the world visited Charnley’s hospital in Wrightington, England and brought the knowhow home with them. Surgeons in Australia imported his techniques and began hip replacement surgeries in Sydney in the early 1970’s. Since then countless numbers of patients have benefitted from the steady progression of technology, surgical technique and pain management.

TECHNOLOGY DELIVERS BETTER OUTCOMES

The progression of technology has focused on two main areas. The most important is the development of durable bearing surfaces. In Charnley’s total hip replacement, the wear particles generated could cause failure of the device within 10-15 years, especially in younger patients. These days improved biomaterials such as advanced ceramics, cross linked ultra-high molecular weight polyethylene (UHMWPE) can deliver a hip replacement that will last for decades.

The other area of technological development is the removal of cement from the construct. Today many modern hip replacements are placed in the bone without cement. The surrounding bone grows onto the complex roughened implant surfaces to secure the implant for decades. This not only saves time during surgery, but also reduces the rare risk of an allergic type response to the bone cement. 

Ceramic and polyethylene options with uncemented cup.

HIP REPLACEMENT TODAY

Total Hip replacement is now a durable, safe and cost effective procedure which restores mobility and function for patients as young as twenty or as old as ninety. 

Revolutionary Treatment For Total Hip Replacement Surgery

The Improvements made, since ivory was used in 1891 to replace the femoral heads of patients, have been numerous. Skin and other tissues, glass and then stainless steel, have all been used to replace degraded joint surfaces, in an attempt to make the movement of the hip joint smooth and pain-free.

In the 1960's Sir John Charnley, designed what he called a 'low friction arthroplasty', which was in principle the same as the prostheses used today. His prosthesis came in three parts; a metal femoral stem, a polyethylene acetabular cup, fixed with acrylic bone cement. The feature of 'low friction', Charnley managed to achieve by the smaller surface area of his femoral head design.

One of the great surgical advances over the last century is the total hip replacement. Total hip replacement revolutionised the treatment of hip ailments and is today one of the most successful, safe and reliable orthopaedic interventions in practice. 

Orthopaedic Surgeon brief on sub-specialties depending on the region of the body

Orthopaedics is a branch of medical surgery and therapy that treats injuries and diseases of the body’s skeletal system. This includes the bones, joints, muscles, ligaments and tendons. This vast system that enables the uprightness and movement of the human frame is called the musculoskeletal system.

When first practiced orthopaedics treated children with spinal, leg or arm deformities. Though orthopaedic surgeons now help patients of all ages and for a range of different conditions.

Within orthopaedics there are many different sub-specialties depending on the region of the body they treat. Orthopaedic surgeons can specialise in:

Hand surgery

Hand surgery treats a range of conditions from cuts, burns, crushing injuries or diseases of the hand. Some common conditions are congenital deformities; repetitive stress injuries, like carpal tunnel syndrome; arthritis; and tendon repair. The priority for orthopaedic surgeons is to adequately reconstruct the skin, bone, nerves, tendons and joints. This is to protect the anatomy of the hand for recovery of functionality and aid the healing process by limiting the chance of infection. Early intervention is very beneficial.

Shoulder and elbow

The shoulder is a complex and unstable joint which can get injured easily. The elbow is vulnerable to deterioration from age or injury related conditions as well. The orthopaedic surgeon has many means of treating the muscles, connective tissue, or damaged joints that come from the overuse or injury of the shoulder or elbow. Some common procedures are arthroscopy or arthroplasty.

Arthroscopy is a form of keyhole surgery that magnifies and creates a visualisation of the interior of the body around the joint being operated on. While arthroplasty is the surgical removal and replacement of a joint or a section of the joint.

Hip and Knee

The hips and knees are the largest joints in the body. They are designed to work in close coordination to provide the mobility most people take for granted. The hip is a large ball and socket joint susceptible to both injury and disease. Some of the most common forms of hip disease are:

• Osteoarthritis
• Rheumatoid arthritis
• Post-traumatic arthritis
• Avascular necrosis

As with the shoulder and elbow, both the knee and the hip can be successfully treated by either arthroscopy or arthroplasty. Hip and knee replacement are two of the most common and successful procedures available to patients.

Pediatric orthopaedics

The pediatric orthopaedic surgeon specialises in children’s musculoskeletal problems. As children are still growing, the body's response to injuries, infections, and deformities can be quite different from the recovery of adults. Some of the conditions particular to this specialty are:

• Limb and spine deformities, (clubfoot, scoliosis, limb length differences)
• Gait abnormalities (limping)
• Broken bones
• Bone or joint infections and tumors

Foot and Ankle surgery

The treatment of the the foot and ankle is a sub-specialty of both orthopaedics and podiatry. The surgeon treats conditions that range from:

• Trauma: such as fractures to the malleolar, tibial pilon, calcaneus, navicular, metatarsal, phalangeal

• Arthritis: joints of the tarsals, metatarsals and phalanges, etc.

• Congenital and acquired deformities: flatfoot, non-neuromuscular foot deformity, diabetic foot disorders, hallux valgus and several common pediatric foot and ankle conditions.

Spine Surgery

The are many potential causes for the need for spinal surgery. There is aging, improper body mechanics, trauma and structural abnormalities. These conditions can lead to back pain and symptoms such as leg pain and/or numbness or leg weakness. The most common procedures conducted are:

• Discectomy or Micro-discectomy: removal of a herniated intervertebral disc.
• Laminectomy: removal of the thin bony plate on the back of the vertebra called the laminae.
• Laminotomy: removal of a portion of the vertebral arch, (lamina), that covers the spinal cord.
• Foraminotomy: removal of bone or tissue at/in the passageway where nerve roots branch off the spinal cord.
• Disc replacement: the injured disc is replaced with an artificial one.
• Spinal fusion: technique used to join two vertebrae.

The three sub-specialties of orthopaedics not based on the body region where they occur are:

• Musculoskeletal oncology, (cancer treatment)
• Surgical sports medicine, (activity based injury)
• Orthopaedic trauma, (accident based injury)

Hip Replacement Recovery

In large part, the pace and quality of your recovery post a total hip replacement is down to how well you follow the advice given by your surgeon. The first weeks after an operation are crucial to the success of your recovery and the advice you are given should be followed.

Sometimes feeling well can put you in a state of mind where you are less likely to be cautious. This can lead to unnecessary accidents and setbacks, but equally, being too cautious can limit the return of your flexibility and your capacity for activity overall. Provided you are not taking risks the exercises should be done routinely even if you are feeling a little unwell.

There are many aspects to your homecare regimen. The first concern of hip replacement recovery is taking care of the healing process of the incision site. Usually, at around two weeks the stitches or staples will be removed. During this first fortnight, it is very important to keep the area dry at all times. Special waterproof patches can be bought, partners or relatives can help, or you can organise general homecare assistance.

Some people overlook that during their hip replacement recovery they might experience a loss of appetite. This reaction can last several weeks into the recovery process and if not countered can contribute to poorer recovery rates. The main reason is that a good diet promotes the healing process and will restore muscle strength. Often the loss of muscle strength is a contributing factor to any unwillingness to perform the necessary exercises crucial to regaining mobility. Iron supplements are also recommended.

The exercises you are assigned to do during your hip replacement recovery are particularly important. For the first few weeks post surgery, the care and regularity of your exercises will contribute to its overall success.

Normally, patients will have a customised exercise routine recommended by their doctor, but some of the more common exercises are:

• A graduated walking program to slowly increase mobility

• Slowly taking on normal household activities; like sitting, standing, and climbing stairs

• Tailored exercises several times a day.

These exercises restore movement and strengthen your hip. A lot of people opt for the services of a physical therapist. They can assist you at home for the first few weeks after surgery, or there is also the option of choosing the services of a therapy center instead. In fact, the role of rehabilitation centers in a patients hip replacement recovery can be instrumental, in the rate of recovery and the patients proper understanding of the ‘do’s and don’ts’ of the recovery process.

The standard resumption of light daily duties usually takes anywhere in between 3-6 weeks, with the possibility of discomfort during activity and at night.

Total Hip Replacement

Total Hip Replacement is an operation to remove the acetabulum and femoral head of the hip joint to implant a ball and socket prosthesis to function as a moveable joint as a replacement. Total Hip Replacement is called Arthroplasty.

In a well-functioning hip joint both the acetabulum and the femoral head are lined with surface cartilage, or what is called articular cartilage. This surface layer of cartilage is encapsulated by synovial fluid which acts as a lubricant to assist joint movement. The cartilage acts as a shock absorber and smoothens the roll of the joint and under normal circumstances lasts a lifetime.

When the depletion of cartilage exposes bone to friction, chemical reactions and inflammation occur to degenerate the condition of the cartilage further. The mechanical wear caused by bone on bone friction is the primary condition of osteoarthritis and the source of the associated swelling and pain. 

The prosthesis used in Total Hip Replacement comes in two sections. The upper thighbone, (femoral head), implant is generally made of a metal or ceramic ball attached to a splint inserted into the top of the bone. The socket half of the implant is made of ceramic or a special plastic called polyethylene. Due to the acetabulum being concaved the implant is surrounded by bone surface to adhere to.

As to how the implants are affixed, two standard types of total replacement methods exist. There is the cemented method and the cement-less. The cement used to affix implants to bone is called methyl methacrylate. The cement-less method however uses microscopically porous materials to allow the bone to grow into and adhere to the implant.   

Understanding Total Hip Replacement Surgery

A procedure in which the damaged or broken hip parts or areas are replaced with synthetic and artificial materials with durable and smooth substance to help make joints work properly is called hip replacement. To know what type of surgery is needed, the person that will undergo replacement should be examined by orthopedic surgeon. Nowadays, one of the most effective solutions to recuperate damaged hip due to arthritis or injury is hip replacement surgery.

Understanding Partial and Total Hip Replacement

Understanding hip replacement is important to be able to prepare for the surgery. First, we need to understand the difference between partial and total hip replacement. Now, both partial and total replacement will need a replacement in certain or all areas of the hip. In partial hip replacement, only half of the hip joint needs replacement. This occurs once the ball of the femur gets worn-out hence limiting movement and motion of the leg and creating ache and discomfort while walking. Total hip replacement, however, uses a synthetic joint in order to replace whole damaged hip framework. The process is similar to the partial replacement surgery, just this point the socket is replaced as well with synthetic. 

Some Preparations You Can Do Before Undergoing Hip Replacement Surgery

Oftentimes, when you have made a decision to go for hip replacement surgery, you’ll be given a full physical examination by the GP to make sure you are generally in good health and sufficient to undergo the surgery and find out regardless of whether you have conditions or problems which may affect the procedure or even your healing. Other tests you need to go through like a chest x-ray, cardiogram, and urine and blood samples. If you are taking any medicine, it is important that you let your GP know about this so that they can give you advice prior to the surgery.

It's good to donate blood prior to surgery.  You may need blood while in or following the surgery. Moreover, overweight may increase risks of surgery and will put more force on your artificial joint which could affect to your recovery. Have a dental check-up prior to the surgery. Even regular teeth’s cleaning isn’t recommended for a few months following the surgery. Finally, your skin must not have problems or bacterial infections when you go through surgery. Consult your GP to get a treatment if you are experiencing any of these.

In conclusion, it is important to understand what the hip replacement surgery can affect you. Hip replacement surgery won't allow you to perform greater than was doable before. After the surgery, it is strongly recommended that you refrain from certain actions and high-impact sports such as jogging, basketball or cycling. You should also need to avoid particular posture of hip joint that could result in dislocation.

Hip replacement surgery has become an excellent and efficient treatment to repair hip injury. It is important to consider your alternatives by consulting with your GP so that you could be sure if this procedure suits your current condition.