Total hip replacement is one of the most successful operations ever devised in terms of improvement in quality of life. Since the modern era of hip replacements began, around 50 years ago, there has been considerable evolution of the implants and techniques used. There have been some interesting designs that have stood the test of time but equal numbers of problems have been caused by poor choices.
Many of the problems have been caused by using the wrong implant in the wrong patient. Mr Miles believes that the choice of implant can be very important and will go through your history carefully with you to make sure that you get the implant with the best chance of providing you with the longest satisfaction possible.
The major choices are whether to use a cemented or uncemented attachement method for the hip and whether to have a metal or ceramic bearing.
Cemented hip replacements are tried and tested and have the advantage that they are fully attached at the time of surgery. The National Joint Registry results suggest that cemented implants are reliable and longlasting. Uncemented designs remove the need for cementing and use ongrowth of bone onto the implants to achieve attachment. As this is a living attachment, the theory is the potential for everlasting attachment which is why it is popular to use in the younger aged patients.
The bearing surface is the ball and socket that articulate together. This can be ceramic against ceramic, ceramic against plastic or metal on plastic. Ceramic is the hardest material so potentially the slowest to wear away, It is, however, very brittle so can only be made in limited shapes and is at a slightly higher risk of cracking than the other options. Metal against plastic is the most forgiving bearing and copes best with knocks and falls. It is also possible to make in different shapes so can be used to enhance stability of the hip where this is a concern.