total hip arthroplasty

total hip arthroplasty
Mikael Häggström, M.D. Author info - Reusing images- Conflicts of interest: Non · CC0 · source
Name	Total hip arthroplasty

Contents

total hip arthroplasty is a surgical procedure that replaces the hip joint with prosthetic components to relieve pain and restore function. It is performed worldwide by orthopedic surgeons in hospitals associated with institutions such as Mayo Clinic, Cleveland Clinic, Johns Hopkins Hospital, and university centers like Harvard Medical School and University of Oxford. Indications, techniques, implants, outcomes, and rehabilitation pathways are influenced by guidelines and research from organizations including the World Health Organization, National Institutes of Health, American Academy of Orthopaedic Surgeons, and specialty journals affiliated with The Lancet and New England Journal of Medicine.

Medical uses

Total hip arthroplasty is indicated for end-stage degenerative and destructive hip disease such as osteoarthritis, rheumatoid arthritis, avascular necrosis, and post-traumatic arthritis. Patients referred from clinics linked to Mayo Clinic or Mount Sinai Hospital often present after failed conservative care involving pharmacotherapy guided by formularies used at National Health Service trusts like Guy's and St Thomas' NHS Foundation Trust and rehabilitation protocols modeled on programs from Stanford University School of Medicine. Indications also include femoral neck fractures treated at centers like Massachusetts General Hospital and tumor resections performed in oncology centers such as Memorial Sloan Kettering Cancer Center. Patient selection considers comorbidities documented in cohorts from databases maintained by Centers for Disease Control and Prevention and outcomes registries such as the National Joint Registry (UK).

The procedure can be performed via anterior, anterolateral, lateral, or posterior approaches, techniques refined at academic centers including Oxford University Hospitals, Hospital for Special Surgery, Johns Hopkins Hospital, and Karolinska University Hospital. Modern workflows integrate perioperative pathways developed at Virginia Mason Medical Center and enhanced recovery protocols originating from research at University College London Hospitals. Components are implanted using cemented or uncemented fixation influenced by research from institutes like Mayo Clinic and manufacturers that collaborate with regulatory agencies such as the Food and Drug Administration. Intraoperative guidance may involve imaging systems designed by companies that work with Massachusetts Institute of Technology and navigation platforms trialed at University of California, San Francisco. Surgical teams often follow standards promulgated by professional bodies including the American Academy of Orthopaedic Surgeons and European Federation of National Associations of Orthopaedics and Traumatology.

Implants vary by femoral stem design, femoral head size, and acetabular component, produced by manufacturers with partnerships involving Johnson & Johnson, Zimmer Biomet, and Stryker Corporation; devices are evaluated in registries like the National Joint Registry (UK) and studies from institutions such as Ludwig Maximilian University of Munich. Materials include metal-on-polyethylene, ceramic-on-ceramic, and metal-on-metal bearings; ceramic components trace metallurgy and ceramics science collaborations with laboratories at Imperial College London and ETH Zurich. Cemented prostheses utilize bone cement developed with companies that have interacted with Baxter International, while porous coatings for biologic fixation were advanced in research at Duke University School of Medicine and University of Toronto. Modular designs and dual-mobility constructs were influenced by work at centers like Institut Mutualiste Montsouris and Aarhus University Hospital.

Reported outcomes draw on long-term data from registries such as the National Joint Registry (UK), the Australian Orthopaedic Association National Joint Replacement Registry, and cohort studies at Johns Hopkins Hospital and Mayo Clinic. Typical benefits include pain relief and improved mobility comparable to results published in The Lancet and New England Journal of Medicine, while complications include dislocation, infection, aseptic loosening, periprosthetic fracture, and leg length discrepancy. Management strategies for periprosthetic joint infection reference protocols from Infectious Diseases Society of America and surgical revisions studied at centers like Hospital for Special Surgery and Charité – Universitätsmedizin Berlin. Risk factors reported in analyses from Centers for Disease Control and Prevention and epidemiologic studies conducted at University of California, Los Angeles influence perioperative risk stratification.

Rehabilitation protocols are informed by enhanced recovery after surgery concepts popularized at Royal Marsden Hospital and Virginia Mason Medical Center, and physical therapy regimens developed at rehabilitation centers affiliated with Spaulding Rehabilitation Hospital and Kessler Institute for Rehabilitation. Early mobilization, weight-bearing recommendations, and thromboprophylaxis regimens are guided by guidelines from American College of Chest Physicians and research from Cochrane reviews coordinated with academic centers like University of Toronto. Return-to-activity advice is individualized, with outcomes measured in function scales validated in multicenter trials involving Oxford University Hospitals and Harvard Medical School investigators.

The modern era of hip replacement evolved through pioneers whose work is preserved in archives at institutions such as Imperial College London and University of Edinburgh, with historical milestones chronicled in reports from Royal National Orthopaedic Hospital and exhibitions at museums like the Science Museum, London. Epidemiological trends show rising procedure volumes in aging populations tracked by national health services in countries including United Kingdom, United States, Australia, and Canada, and policy analyses by agencies such as the Organisation for Economic Co-operation and Development and World Health Organization. Contemporary research continues at major centers including Mayo Clinic, Hospital for Special Surgery, Johns Hopkins Hospital, and Karolinska Institute to refine indications, implants, and care pathways.