Total hip arthroplasty

Abstract

Primary total hip arthroplasty has become one of the most successful surgical procedures over the past 50 years and is currently performed worldwide with similar techniques and excellent results. Despite variations in technique and implant selection, medium and long term outcome studies have demonstrated over 90% implant survival at 15 to 25 years. Previous problems with implant fixation have now been reduced, and the focus has shifted to the selection of improved bearing surfaces to limit wear, hip replacement options for younger patients, and improved surgical and anesthetic techniques. Current surgical approaches to the hip rely most often on direct lateral or posterolateral exposure. The most commonly utilized bearing surface for both hip replacement and hip resurfacing in Canada is a metal (cobalt-chrome) femoral head combined with a second-generation cross-linked polyethylene, combined with cementless implant fixation. Alternative bearings such as ceramic-on-ceramic and metal-on-metal may be considered for hip replacement in younger patients. Although it has not been determined which surface will prove best for younger patients in the long term, there is no question about the benefits of total hip arthroplasty. With current techniques, the results are favorable, and patient satisfaction, pain relief, and long-term implant survival are excellent.