Hip replacement surgery is commonly used to overcome and remedy severe damage and pain caused by arthritis of the hip. Arthritis is a disease in which cartilage (the cushion between bones that helps bones to easily move against each other) breaks down. With damaged cartilage, the bones rub against each other and become worn.
Your hip joint is made up of a ball and socket. The ball is the top of the thighbone (femoral head). The socket area (acetabulum) is inside the pelvis. The surfaces of the ball and socket are covered with cartilage that enables them to move easily.
In hip replacement surgery, an artificial, synthetic prosthesis which naturally mimics the hip joint, is used to replace the joint or part of it.Â
But what types of hip replacement surgery are available and what do they involve?
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Types of Hip Replacement Surgery
Total Hip Replacement: What does it involve?
A total hip replacement removes both the ball and socket from the damaged joint and replaces it with a prosthesis which is an artificial part. This is done via an anterior (front), posterior (back) or lateral (side) approach. The anterior approach is more technically challenging whereas the posterior and lateral approaches provide the surgeon with a better view of the hip joint.
The surgery usually takes around two hours.
Procedure
- 1. Making an incision on the hip: Your surgeon makes an incision of about 30cm usually over the side or back of your hip to expose the hip joint. Anterior hip replacement surgery uses an incision at the front of the hip and can allow for access to the hip joint with minimal cutting of the muscles.
- 2. Dislocating the hip joint: The surgeon dislocates the hip joint, removing the femur’s head from its socket (acetabulum).
- 3. Preparing the acetabulum: The surgeon prepares the acetabulum (socket) by grinding and shaping it to place the acetabular cup prosthesis.
- 4.Placing the acetabular cup prosthesis: The surgeon places the acetabular cup prosthesis into the reshaped socket.
- 5.Placing the acetabular liner: The surgeon places the acetabular liner inside the acetabular cup. The liner facilities the smooth movement within the new hip joint.
- 6. Preparing the femur bone: By using a bone saw, your surgeon will cut down the arthritic femur head. The channel inside the femur is hollowed out to insert the prosthetic femoral stem into it.
- 7.Placing the femoral stem: The surgeon inserts the femoral stem into the prepared femur bone with the help of cement. The top of the femoral stem is designed to hold a prosthetic ball that replaces the head of the femur.
- 8. Attaching the prosthetic ball: Once the femoral stem gets fixed into the femur bone, the surgeon attaches a prosthetic ball to the top of the femoral head (to fit into the socket). After that, the surgeon makes sure the artificial hip joint has ease of motion and does not dislocate.
- 9. Finalising the procedure: To assure proper positioning and sizing of the prosthesis, X-rays may be taken. The hip muscles and other soft tissues that were cut are repaired. After that the skin incision is stitched back together.
Results
Partial Hip Replacement: What does it involve?
In partial hip replacement surgery, your surgeon replaces the femoral head (ball) and not the socket. This type of surgery is used to treat certain femoral head fractures or to treat local cartilage defects of the femoral head in order to postpone the need for total hip replacement surgery. The surgery will typically take one to two hours.
Procedure
- 1. Making an incision: The surgeon makes an incision diagonal to the hip joint.
- 2. Preparing the femur bone: The surgeon removes the damaged femoral head and trims the end of the femoral neck in order to insert a prosthetic femoral stem into it.
- 3. Inserting the femoral stem: The femoral stem is inserted in a similar manner to that in total hip replacement surgery and can be cemented or non-cemented. The acetabulum (socket) is not replaced as it is in a satisfactory condition. The top of the femoral stem is designed to hold a prosthetic ball that replaces the head of the femur.
- 4. Attaching the prosthetic ball: The surgeon attaches a prosthetic ball to the top of the femoral head (to fit into the socket).
- 5. Finalising the procedure: To assure proper positioning and sizing of the prosthesis, X-rays may be taken. The hip muscles and other soft tissues that were cut, are repaired. After that the skin incision is stitched back together.
Results
Hip Resurfacing: What does it involve?
In hip resurfacing, the femoral head and neck are not removed. Instead the femoral head is trimmed and capped with a smooth metal covering. The damaged bone and cartilage within the socket are replaced with a metal shell, just as in total hip replacement. The surgery can usually last from 1-1/2 to 3 hours.
Procedure
- 1. Making an incision: To reach the hip joint, the surgeon makes an incision in the thigh area.
- 2. Preparation of femoral head: Firstly, the femoral head is dislocated out of the socket and then its head is trimmed.
- 3. Inserting the metal cup: A metal cup is inserted over the prepared femoral head. The metal cup is then pushed into the socket and held in place.
- 4. Finalising the procedure: Once the metal cup is in place, the femoral head is relocated back into the socket and the incision is closed.
Results
Hip Implants
Hip implants are medical devices intended to replace the defected hip joint. These are made up of metal, plastic, titanium, stainless steel, cobalt-chromium, polyethylene, ceramic materials or a combination of these materials.
These are the components of hip implants:
- 1. Femoral Stem: The femoral stem is a narrow shaft made up of metal that fits several inches down inside the femoral bone. There are two parts of the stem; the section that fits inside your thighbone and the section that extends outside. The top of the femoral stem is designed to hold a prosthetic ball that replaces the head of the femur.
- 2. Prosthetic Ball: The ball component is made of highly polished strong metal or ceramic material. It replaces the round head of the femur (thighbone).
- 3. Acetabular Component: The acetabular component is bowl or cup-shaped component that replaces the acetabulum (socket). This component fits into your reshaped socket. It is typically made of metal but occasionally made of a combination of metal and plastic or ceramic.
- 4. Acetabular Liner: This component is made of plastic. It acts like a bearing that fits into the acetabular component. It allows the femoral head (ball) to glide smoothly and naturally in the socket.
Implant Designs
Implant designs have unique features such as shape, size, material and dimensions that closely mimic the motion of the normal hip joint. Each design has benefits and risks. The surgeons may have a preference for a particular implant, depending on your hip anatomy. Several companies produce high-quality hip implants but the most popular of them are Stryker, Smith+Nephew, Zimmer, and DePuy.
- 1. Exchange Neck Prostheses: An exchangeable neck prosthesis has two sections, the section that fits inside your thighbone and the section that extends outside. They are put together once the stem is in position. This prosthesis enables your surgeon to slightly vary the position of the head section after the stem has been positioned to fits your needs. This is not possible with the standard femoral stem in which the neck and the stem are in one piece.
- 2. Mini Stem Prostheses: This type of prosthesis has a very short stem that is fixed to the top of the femur, unlike the standard femoral stem that expands almost halfway down the femur. The mini stem reduces the rate of bone loss at the top of the femur and the pain associated with a longer stem. It is also beneficial if your femur anatomy is abnormal.
- 3. Constrained Acetabular Component: This prosthesis has a locking technology that holds the femoral head in the socket. The standard acetabular prosthesis does not have this mechanism because the femoral head is usually constrained by the surrounding muscles and tissues. This prosthesis reduces the chance of dislocation.
- 4. Dual Mobility Acetabular Component: This has an insert that fits into the acetabular component. Unlike the single mobility acetabular component, this can move slightly as your hip moves. This provides a greater range of motion and a superior head-to-neck ratio resulting in a lower risk of instability. It also reduces the rate of dislocation.
Latest Developments in Hip Replacement Surgery
Stryker Mako® Robotic-Arm Assisted Technology
Mako robotic-arm assisted surgery is performed with the assistance of a robotic arm for greater precision, better results and short recovery time. In traditional hip arthroplasty, information from static imaging such as X-rays, CT scans, or an MRI taken before surgery, allows your surgeon to plan the overall procedure. With Mako robotic-arm assisted surgery, the surgeon takes a CT scan and uploads it to Mako software to develop a 3D virtual model of your hip joint.
Procedure
| - | Steps | Description |
|---|---|---|
| 1 | Customized Patient’s Surgical Plan | The first step is patient-personalized surgical planning. Before the Mako-assisted surgery, a 3D virtual model is developed by taking a specialized CT scan of your hip joint to evaluate your: • Bone structure • Alignment of the hip joint • Surrounding tissues This information helps your surgeon determine the desired implant size, orientation, placement, and accurate positioning of the implant based on your unique anatomy. |
| 2 | Continued assessment | Mako provides real-time data to your surgeon throughout the procedure. This allows your surgeon to continually assess the joint movements and tension in order to adjust the surgical plan if desired. |
| 3 | Preparing the Bone | Your surgeon follows the personalized surgical plan while preparing the bone for the implant. The surgeon uses tracking pins along the hip that help the robot "see" your anatomy. After that, Mako's arm positions itself according to those measurements to create a virtual boundary so that your surgeon can guide Mako’s robotic arm to remove the arthritic bone and cartilage. A virtual boundary helps your surgeon to stay within the boundary as defined in your surgical plan. |
| 4 | Positioning the Implant | The Mako robotic arm guides the implant at the desired angle defined in the surgical plan. This ensures the alignment and placement of the implant with high precision (as defined in the surgical plan). |
Mako Robotic Assisted Hip Surgery In The UK
| Hospital Name | City/Town | Consultants | Cost |
|---|---|---|---|
| The Princess Grace Hospital (6) | London |
| £12,363 excluding indicative consultant fee (7) |
| Sulis Hospital Bath (8) | Bath |
| £13,910 |
| Nuffield Hospital Cambridge (9) | Cambridge |
| £16,210 (10) |
| Spire Cambridge Lea Hospital (11) | Histon and Impington |
| £14,330 (12) |
| Spire Manchester Hospital (13) | Manchester |
| £13,480 (14) |
| Manchester Hip Clinic (15) | Manchester |
| ----- (16) |
| Fortius Clinic (17) | London |
| £1250 (excluding hospital fees) |
| London Hip Practice (18) | London |
| £2600 – £4100 (19) (excluding hospital fees) |
| The Beardwood Hospital (20) | Blackburn |
| £15,000 |
| The Albyn Hospital (21) | Aberdeen |
| £16,710 (22) |
| The Alexandra Hospital (23) | Cheadle |
| £15,200 (24) |
| The Princess Margaret Hospital (25) | Windsor |
| £14,425 |
| Woodlands Hospital (26) | Darlington |
| £13,000 (27) |
| The BMI Winterbourne Hospital The BMI Harbour Hospital The Nuffield Hospital | Dorchester Poole Bournemouth |
| £10,500 - £13,000 (28) |
| Spire Little Aston Hospital (29) | Birmingham |
| £13,569 |
Smith+Nephew CORI Surgical System
Procedure
| - | Steps | Description |
|---|---|---|
| 1 | Hip Navigation (Pre-operative Planning) | Before surgery, the surgeon will create a 3D representation of the unique shape and profile of your hip joint without the need for a pre-operative CT scan or MRI. This 3D representation helps your surgeon finalise and verify the right size implant for you. This will enable them to create a detailed surgical plan for how your replacement will be placed to optimize movement and function. |
| 2 | Advanced image-free Smart mapping | CORI technology uses RI. HIP NAVIGATION that enables:
CORI technology also uses RI. HIP MODELER that helps:
|
| 3 | Preparing the Bone | After collecting patient-specific data, the CORI sends precise information about your hip joint to the robotic-assisted hand piece more than 300 times per second. This allows your surgeon to remove damaged surfaces, balance your joint and position the implant with accuracy. |
| 4 | Positioning the Implant | After preparing the site for the prosthesis, the surgeon will precisely position the implant. |
OrthAlign® Surgical System
- Live navigation for cup placement
- Patient-specific approach
- Assessment tools for leg length
- Track pelvic tilt
- Open implant platform meaning that it is compatible with all standard implants
- No pre-operative imaging required, making it more cost-effective
HipAlign helps determine the orientation of an acetabular cup and assess changes in leg length for total hip replacements. It also displays the abduction and anteversion angles (range of motion angles) during acetabulum cup placement and assesses changes in leg length while trialing and during final implantation.
For a comprehensive guide to the cost of hip replacement surgery in every hospital in your area, follow this link to our recent article:
Hip Replacement Surgery: Should you Stick with the NHS or go Private?
Conclusion
Hip replacement is a surgery focused on reducing pain and getting you back to normal activities. Modern advancements in hip replacement technology and the types of hip replacement surgery are having a big effect on the success rate of the surgery.
However, deciding to undertake a hip replacement is a decision that should not be taken lightly. There are possible risks and complications that you should be aware of, and a full recovery can take months. But if other treatment options have failed to provide adequate pain relief, it may be a decision well worth making in the long term.
