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Hip Replacement: Choosing the hip for you

Mr Stephen Kearns

Consultant Orthopaedic Surgeon, Galway University hospitals

Mr Stephen Kearns gives insight on technology versus track record when it comes to hip replacement.

The science of hip replacement has progressed significantly since its inception and remain one of the most successful medical procedures ever devised. There is a huge choice of devices from multiple manufacturers available, but the newest or most expensive are not always the best choice.

“Patients often ask for the newest technology but hips have to last as long as possible. So, in fact, the best choice balances the latest technology with a proven track record and take into account the individual patient,” says Mr Stephen Kearns, Consultant Orthopaedic Surgeon, Galway University hospitals.

The options available for hip replacements in Galway

A total hip replacement consists of a metal and/or plastic cup to replace the natural socket and a ball replacing the natural head of the femur.

Support for the artificial head comes from a stem placed in the cavity of the femur. The most commonly used in Ireland today are those with a metal ball and a polyethylene (‘poly’) cup. Hips can be implanted as an all ceramic combination or just a ceramic femoral head.

There is however one other option: the ceramicised metal ball and poly cup. The ceramicised ball is created by heating metal to high temperatures, converting the surface layer into a ceramic.

The best choice balances the latest technology with a proven track record.

To clarify which is the best option surgeons worldwide have been collecting data on patients after hip replacement in joint registries. Data from one of these, the Australian Joint Registry, shows that after ten years ceramicised metal on poly joints require revision (replacement) in 3.3% of cases whereas for metal on poly the figure is 4.3%. Hips comprising ceramic on poly had a  4.6% revision rate and ceramic on ceramic 5.1%. Worldwide registries see similar trends.

Possible issues with hip replacements in Galway

The type of poly also makes a difference. Modified, cross-linked poly appears more wear-resistant. Ceramicised balls with cross-linked poly-lined cups appear to be the best option.”

The use of cement is also an issue.Ireland and Galway predominantly use cement for hip replacements. Cement secures the pin into the cavity of the femur. However the cement can cause cardiac issues in rare cases by releasing chemicals into the bloodstream. But cement isn’t always necessary tor hip implants. Bones grow onto the stem of the hip implant due to a special coating.

Cement may be a good choice where the bone is thin or the cavity of the femur is very wide. However both cemented and uncemented hip components have demonstrated excellent results.

Overall, he insists: “No one material or procedure suits everyone. The choice should be based on the individual patient and the experience of the surgeon.”

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