Total Hip Replacement

Total joint replacement remains one of the most predictable and successful surgical procedures in history. Developed by Sir John Charnley in the early 1960s it has developed through numerous upgrades and advances into what an extremely successful and reliable option for those suffering from endstage hip or knee arthritis.

The surgery consists of dislocating or removing the existing ball from the socket or cup, then honing out the cup or acetabulum with a hemispheric reamer in order to remove old scar and cartilage. A new metallic cup with a rough outer surface is then impacted into the prepared raw bony surface which in time allows bone to grow into the cup's backing achieving a biologic lock. Within this cup is snapped a liner made of various materials. The first cups were made entirely of polyethylene plastic, and many modern cups still retain a liner made of this material, strengthened through gamma irradiation to prevent wear. More expensive and durable liners today are made of steel or ceramic materials. The deformed ball or femoral head is then removed and the hollow space within the thigh bone prepared to except a metallic stem/head combination. The final head/stem component is then reduced or placed back into the new liner/cup construct and the soft tissues surgically repaired.

Surgery today requires approximately 90 minutes to perform and a 3 to 4 day hospital stay. Patient must watch what positions they place their leg in for about 6 weeks while the joint capsule and muscles heal (hip precautions). Weight bearing is usually allowed immediately, and patients are able to get by on pain pills after only a few days. Most patients can resume driving after about 3-4 weeks, and can return to all but very strenuous work activities after about 6 weeks.

Total joint surgery is performed not as the first option, but as the last option in treating patients with arthritis of the hip and knee. Exercise, weight loss, diet, anti inflammatory drugs, injections and activity modifications can all extend the lifespan of an arthritis hip in many instances years, before surgical replacement is necessary.

The newest technologies include extended wear bearing surfaces of metal on metal and ceramic on ceramic design. These implants although much more expensive have greatly decreased wear rates and subsequent implant failure. Current designs with alternative bearing surfaces promise decades of active trouble free use.

The greatest threat to joint replacement these days comes not from the science of joint replacement, but from its economics. Currently, the cost of these implants is paid to manufacturers by hospitals, who must cover the cost of the implants and the cost of operating room, anesthesia, and postoperative recovery, all out of the capped  DRG payment they receive from Medicare. Depending upon the market, this payment is between 9-10K. The increased cost and complexity of these implants is causing many hospitals to lose money if they allow them to be performed inside their walls.  Cost containment efforts are underway which have already limited patient and surgeon choice regarding what implant they may receive, thus placing some of the newest technologies out of the reach of many patients, even if they are willing to pay the difference.

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                                                    Last modified: 04/04/06