Evolution of Technology

Total Hip Replacement

Joint replacement surgeries have been performed for hundreds of years and techniques as well as component technologies and manufacturing techniques continue to evolve. Currently the most common material used for hip replacement implants are various metal alloys to include titanium, cobalt-chrome, and stainless steel as well as high grade plastics known as high molecular weight polyethylene or simply “poly”.

Most systems consist of three parts, the femoral component which replaces the native femoral head and neck, the acetabular component which replaces the acetabulum or “socket” portion of the ball and socket hip joint, and the poly which rests between these two component and acts as the new cartilage or bearing surface. Many different companies produce components used in total hip replacement and all of the currently used implants have been extensively studied and approved to be safe for use by the Food and Drug Administration.

Regardless of the implant chosen by the surgeon, due to the improvements in technology and material properties throughout the history of total joint procedures, current implants are the best that we have ever had and demonstrate improved wear rates, longer survivorship, higher success rates, more anatomic designs, and decreased need for revision surgery due to wear.

Evolution of Procedure

Hip Replacement Surgery

Hip replacement surgery is a surgical procedure designed to resect disease bone and cartilage of the hip joint and replace it with metal and plastic components.  The surgery can be performed through on of many commonly accepted surgical approaches to the hip.  The most commonly performed hip approaches consist of posterior, anterior and lateral approach although there are many variations. 

All standard hip approaches have been shown to be relatively equal with regards to post-operative function and stability of the hip although there are some advantages and disadvantages to each technique.  Typically, the decision for how the procedure will be performed is left to the surgeon and his or her comfort with the various techniques.  Hips replacement surgery can be performed wither under general or spinal anesthetic and the surgery generally takes one to two hours to perform. 

Post-operatively patients can typically walk on their new hip the same day, barring any complications with the surgery and are generally discharged from the hospital within 24-48 hours post-op although this can change based on an individual patient’s post-operative course. 

Evolution of Diagnosis

Osteoarthritis Of The Hip

Osteoarthritis of the hip is a degenerative condition of the joint which causes progressive loss of articular or joint lining cartilage.  The disease process occurs over many years and is typically a result of natural aging and “wear and tear” over time although it can be accelerated by things such as a history of traumatic injury (ie. Prior hip fracture), or chronic problems such as developmental hip dysplasia or avascular necrosis.

Risk factors include previous injury to the hip as stated above as well as increased body mass index, obesity, abnormal cholesterol and triglycerides, high blood pressure and diabetes.  The condition affects women more commonly than men.  There are multiple treatment options to attempt to improve symptoms of hip pain and loss of function associated with hip arthritis. 

These include physical therapy, weight-loss, activity modification and injections into the joint.  Ultimately, these options simply treat the symptoms of the disease and do not cure the underlying cause, which is loss of cartilage, and eventually if symptoms progress surgery is needed.  To date the only indicated surgery for osteoarthritis affecting the entire hip joint is total hip replacement, also known as total hip arthroplasty.