hip 5 min read

What is a Total Hip Replacement

Hip replacement techniques have evolved, and whilst there are many different methods, some have stood out to be meaningful changes that can translate to improvements for surgeons who choose to use them. In this article I will discuss my own techniques.

Dr Chien-Wen Liew
Orthopaedics 360

Hip replacement techniques have evolved, and whilst there are many different methods, some have stood out to be meaningful changes that can translate to improvements for surgeons who choose to use them. In this article I will discuss my own techniques.

01

Dr Liew's Surgical Approach

Over the years I have been exposed to almost every form of hip replacement. I trained predominantly in the Posterior Approach for total hip replacements and the Lateral Approach for trauma hip replacements or partial (hemi) hip replacements. In 2012, I made the decision to transition into Total Hip Replacements performed via the Direct Anterior approach. This led me on a journey across the world, with highlights from Switzerland, France, UK and USA, where I saw some of the very best surgeons in the world perform the most elegant surgery. Fast forward to now, and I have performed the direct anterior approach exclusively for my patients for over 10 years. The direct anterior approach is a fantastic operation, providing a safe and effective method for performing hip replacements.

A hip replacement is only required once you have reached a point where your quality of life is impaired. It is something that you should never jump into, but once you have noticed that your quality of life is impaired, it will be a suitable option for you.

I utilise a hip replacement that comes in 4 main parts. I have a video about materials here. The stem, ball, cup, and liner. There are some variations to this, including the dual mobility system which we use for patients with neuromuscular disorders, or who are at very high risks of dislocation. This may include those with severe connective tissue disorders. I do not tend to use the dual mobility implant for standard patients as its longevity is not as studied as the conventional hip replacements which have very long term data.

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Dr Liew - What is a Total Hip Replacement
Watch - Dr Liew Explains
What is a Total Hip Replacement

Dr Chien-Wen Liew explains what a total hip replacement is, when it is considered, and the four parts that make up the implant.

Read transcript

0:00 · Introduction

Hi, I'm Dr Chien-Wen Liew from Orthopaedics 360. I'm a hip and knee replacement surgeon, and today I'd just like to talk to a little bit about what a total hip replacement is. It is very important for us to go over this prior to you seeing me or prior to any further surgery as it is something that's really important to know as there can be many different types of hip surgeries out there. A total hip replacement in general is performed when someone has osteoarthritis of the hip.

0:34 · When is a Total Hip Replacement performed

This means that the hip has degenerated to the point where it is no longer functioning in its normal way. The other cohort of patients who may need a hip replacement are those who fracture their hips. A hip replacement is something where we actually take out the diseased ball and prepare the acetabulum. Now, these parts of the body constitute the ball and socket joint of the hip.

1:06 · Where is the hip

Whilst many people think of the hip as up here where, for example, you may place your belt on, a hip joint is actually a little bit lower. Often patients with hip arthritis will complain of groin pain. Now, a hip replacement is designed to replace the ball and socket with metal, ceramic, or plastic.

1:28 · How I perform my THR’s

Now, when I perform all of my hip replacements, the articulating surface between both the ball and liner are often ceramic on ceramic or ceramic on plastic.

1:39 · About the prosthesis

A hip replacement is composed of four parts in general. It includes a stem, a head, a liner, and a shell. Certainly, when I perform a hip replacement, we almost always put four parts in. But, this can change depending on the type of prosthesis that is used. I like to use a modular prosthesis, which means that each prosthesis has different elements that can be placed onto it to change the orientation, size, and position.

That means that the head size can be changed, the head length can be changed, and the socket is placed to match the anatomical position and shape of a patient's own size and anatomy. A hip replacement is held in by the surrounding muscles, tendons, and ligaments. This is why I choose to perform all of my hip replacements using the direct anterior approach. A little bit more about the direct anterior approach in another video, but that is the method that I use for all of my hip replacements to maintain the ligaments, tendons, and muscular structures as best as possible around the hip.

2:54 · What you can do after a THR

Once a hip replacement has been performed, you can almost always perform many of the normal activities that you were doing before. With the one exception of long-distance road running, which as a surgeon I have as a limitation for my patients who have hip or knee replacements. You certainly can run around and play tennis and run around and throw frisbees and play bit of soccer with kids, but you wouldn't be performing at the elite level with your running capabilities.

Hip replacement has well-documented long-term results in the published literature and in the Australian joint replacement registry. To learn a little bit more about hip replacements, please watch our channel or follow us on Facebook.

Thank you for your time today for this short excerpt about hip replacements. I look forward to seeing you again for our future videos.

Transcript edited lightly for readability.

02

The Modular Prosthesis

We use a modular prosthesis for all of our total hip replacements. This means that the prosthesis comes in 4 main parts. This allows for finer adjustments of position, size, and optimises matching of the prosthesis geometry to the patients native anatomy. The stem can have different size, shapes and geometries to accurately reproduce the correct replication of your own anatomical nuances. This is al determined during our 3D pre-operative scan, which allows us to simulate surgery before the actual day.

The stem and acetabular shell are composed in general of Niobium, Vanadium, Titanium alloy.

The ball and liner articular are in general - Ceramic on Ceramic.

This type of prosthesis has been shown to have a very long survivability with significant improvements in the ability to match a patient's own anatomy with the implant. My own philosophy of matching the alignment to how a patient was born is fulfilled with the huge inventory of implants we now have available.

03

Implant Variations and Considerations

This may change for those with Dual mobility implants, or those requiring cementation of their implants.

To learn about the materials used, please follow this link. WHAT IS MY HIP REPLACEMENT MADE OF

Whilst cement can be used, I do not routinely use cement for my hip replacements. If your bone quality is very low with osteoporosis, then cement may be a good option for this. My aim is to place an uncemented prosthesis to allow biological fixation between the bone and the stem. The implants are coated with a material that allows bone to grow into it.

04

Frequently Asked Questions

Do I need surgery?+
In most cases, surgery is considered only after non-operative measures have been optimised. This can include the use of walking aids, simple pain medications, activity modification and physiotherapy. When pain becomes more constant, begins to disturb your sleep, or significantly limits day-to-day activities such as walking, putting on shoes, climbing stairs or work-related tasks, it may indicate that joint replacement is appropriate. The decision is individual; during your consultation we will discuss your symptoms, examination findings and imaging to determine whether surgery is the right option for you at this time.
Who is a candidate for hip replacement?+
Hip replacement is generally considered for patients with arthritis or other hip joint conditions who have ongoing pain and stiffness despite appropriate non-operative treatment. Common underlying causes include osteoarthritis, avascular necrosis and other conditions that lead to progressive damage of the hip joint. You are more likely to benefit from a total hip replacement if your pain is present most days, limits your walking distance, interferes with simple tasks such as putting on socks and shoes, and is not controlled with simple measures. Age alone is not the deciding factor; overall health, expectations and functional goals are more important than a specific age cut-off. These factors will be discussed in detail at your appointment to determine if a hip replacement is appropriate.
How long does it take to fully recover from a total hip replacement?+
Most people are walking with a frame or crutches the same day of surgery. Many patients are back to most normal daily activities by about 6 weeks, but it can take 6–12 months to achieve the "forgotten hip".
How long will my new hip last?+
Modern hip replacements are designed to be very durable, and many last 15–20 years or longer. How long your hip lasts will depend on your age, bone quality, weight, activity level and the type of implant used. Currently the Australian Joint Replacement Registry states a 92% survival of hip replacements performed for arthritis, at 20 years post implantation.
What activities and sports can I do after hip replacement?+
You can usually return to almost anything, but I limit high-impact activities such as long-distance running and jumping. Anything else is effectively fine. Don't take up any new extreme sports.
What are the main risks or complications of total hip replacement?+
Risks include infection, blood clots, dislocation, leg length difference, fracture around the implant, stiffness and ongoing pain. Serious complications are uncommon, and steps such as antibiotics, blood-thinning medication and early mobilisation are used to reduce these risks as much as possible.
How should I prepare my home for after hip replacement surgery?+
Before surgery, it helps to clear any loose rugs or clutter, set up a firm chair with arms, and keep important items within easy reach so you don't need to bend or twist. You may also find a raised toilet seat, shower chair, long-handled shoehorn and grabber useful, and your therapist can advise you on what to organise before you go home.
Dr Chien-Wen Liew
MBBS · FRACS (Ortho)
Orthopaedic Surgeon, Adelaide
Exclusively Total Hip Replacements and Total Knee Replacements. Refined focus in Minimally Invasive, Patient Specific Adelaide Joint Replacement Surgery.

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Medical Disclaimer: This content is for educational purposes only. Individual outcomes vary. AHPRA Registered Specialist.