Total hip replacement
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| Total hip replacement | |
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| Name | Total hip replacement |
| Syn | Total hip arthroplasty |
| Specialty | Orthopaedics |
Total hip replacement is a surgical procedure in which a diseased or damaged hip joint is replaced with prosthetic components to relieve pain and restore function. It is commonly performed for advanced degenerative joint diseases, traumatic injury, and certain congenital or inflammatory conditions. Outcomes depend on patient selection, surgical technique, implant design, and rehabilitation.
Medical uses
Total hip replacement is indicated primarily for end-stage osteoarthritis, severe rheumatoid arthritis, and advanced post-traumatic arthritis where conservative measures have failed. It is also used for displaced femoral neck fractures in elderly patients, some cases of avascular necrosis, and deformities from developmental dysplasia treated when pain and disability persist. Indications are guided by clinical practice guidelines from organizations such as the American Academy of Orthopaedic Surgeons, the National Institute for Health and Care Excellence, and specialty societies involved in musculoskeletal care.
Contraindications and patient selection
Absolute contraindications are uncommon but include active deep joint infection and uncorrectable severe medical instability managed by institutions like tertiary referral centers or trauma centers. Relative contraindications encompass poorly controlled diabetes mellitus, severe peripheral vascular disease referenced in vascular surgery literature, morbid obesity discussed in bariatric surgery publications, and neuromuscular disorders described in neurology texts. Patient selection involves multidisciplinary evaluation with input from orthopaedic surgeons trained in arthroplasty, anesthesiologists familiar with perioperative risk assessment, and physiotherapists affiliated with rehabilitation departments at major hospitals.
Surgical technique
Techniques vary by surgical approach, commonly the posterior, lateral (Hardinge), and anterior (Smith-Petersen) approaches taught in orthopaedic residency programs and used in operating rooms across academic centers such as university hospitals. The procedure includes femoral head resection, acetabular reaming, and insertion of acetabular and femoral components; cemented fixation often references insights from materials science and orthopedic engineering collaborations. Intraoperative imaging and navigation systems developed by medical device companies and engineers are sometimes used, and perioperative protocols reflect standards from anesthesia textbooks and perioperative medicine guidelines.
Prosthesis types and materials
Prostheses differ by fixation method (cemented, uncemented, or hybrid), bearing surfaces (metal-on-polyethylene, ceramic-on-ceramic, ceramic-on-polyethylene), and modularity concepts advanced by implant manufacturers and biomedical researchers. Materials are selected based on biocompatibility studies from institutes and governmental regulatory agencies, and include cobalt-chromium alloys, titanium alloys, polyethylene formulations, and alumina or zirconia ceramics. Design evolution has been influenced by contributions from pioneering surgeons and biomedical engineers affiliated with academic centers and research institutions.
Postoperative care and rehabilitation
Early mobilization protocols are implemented by multidisciplinary teams including physiotherapists, occupational therapists, and nursing staff in acute care units and community rehabilitation facilities. Weight-bearing status and activity progression reference clinical pathways used in health systems and rehabilitation programs at tertiary centers. Thromboprophylaxis regimens draw on guidelines from professional societies, and follow-up schedules often align with standards advocated by orthopaedic associations and specialty registries.
Complications and outcomes
Complications include prosthetic dislocation, periprosthetic fracture, infection, aseptic loosening, and wear-related osteolysis, issues discussed in orthopaedic literature and addressed by revision surgery specialists. Outcome measures commonly used in trials and registries include pain scores, functional indices, and implant survivorship reported by national joint registries and academic studies in major journals. Long-term outcomes are influenced by patient comorbidities and surgical volume, trends monitored by public health agencies and professional organizations.
History and epidemiology
The development of hip arthroplasty involved milestones associated with surgeons, institutions, and industrial partners referenced in surgical histories and museum archives. Epidemiological patterns show rising procedure volumes with aging populations and increasing prevalence of degenerative joint disease tracked by national health statistics agencies, university research centers, and global health organizations. Registries and longitudinal cohort studies conducted by national arthroplasty registries and orthopedic research networks provide data on utilization, implant performance, and demographic trends.