Total hip arthroplasty.
Refers to replacement of both the acetabulum and the femoral head. to relieve pain and increase function.
Indications include: osteoarthritis, rheumatoid arthritis, avascular necrosis, traumatic arthritis, hip fractures, dislocation of the hip, arthritis associated with
Paget’s disease of the bone, and ankylating spondylitis.
Cemented stems commonly used in older patients because of lower costs, while cementless stems used more commonly in younger patients since they are longer lasting and for more physically active individuals.
Rates of complications occurring within 90 days after replacement are 1.0% for mortality, 0.9% for pulmonary embolism, 0.2% for wound infection, 4.6% for hospital readmission and 3.1% for hip dislocation.
More than 500,000 primary THAs were performed in the US in 2018.
More procedures are performed on women than on men.
Risk of pulmonary embolism approximately 0.1%.
In the absence of prophylactic measures, risk of deep vein thrombosis has been reported to range from 39% to 74% and the risk of fatal pulmonary embolism, from 0.19% to 3.4%.
Venous embolism most common complication following surgery.
National average mortality 0.3%.
Risk of acute myocardial infarction following total hip or knee replacement was elevated during the first two weeks after the procedure (Lalmohamed A et al).
In the above study thee absolute six-week risk of acute myocardial infarction was 0.51% for hip replacement, and 0.21% for knee replacement.
Complications frequently relate to osteolysis from acrylic bone cement debris and or wear related debris.
Bone resorption is caused by inflammation causing loosening or fracture that will require revision surgery.
Various incisions are used in relation to the gluteus medius: anterior, posterior, lateral, antero-lateral and greater trochanter osteotomy.
No clinical study evidence for any particular approach, but modified antero-lateral and posterior are generally favored approaches.
In a study of 5986 patients an anterior surgical approach compared with posterior or lateral approach was significantly associated with a higher risk of major surgical complications within one year, 2% versus 1%, respectively (Pincushion D).
Failure rates for hip implants is 29% higher for women than men in a large U.S. registry study after controlling for a variety of factors including device type.
In the above study of 35,140 patients with a median follow-up of three years, 2.3% of women and 1.9% of men had undergone revision surgery (Ignacio MC et al).
In the above study the major reasons for failure were instability, infection, aseptic loosening, and periprosthetic fracture.
The National Joint Registry of England and Wales found higher implant failure rates in women than men when using metal on metal implants after adjusting for age and femoral head size.
Rheumatoid arthritis patients have a higher risk of dislocation, and infection following hip replacement surgery than patients with osteoarthritis (Ravi B et al).