Total Hip Replacement

A total hip joint replacement is an operation that is performed for a painful hip joint that has lost all its cartilage and failed non operative treatment. It is the final treatment in escalating levels of treatment.  Dr Balakumar will expertly perform this procedure based on the patients symptoms, signs, expectations and radiographs. Dr Balakumar is also in a unique position of being able to offer alternative treatments to preserve the hip if possible and will therefore only offer hip replacement after careful consideration.

In total joint replacement the existing joint is cut out and replaced with metallic implants and sophisticated bearing surfaces. Joint replacement literally covers a spectrum of operations from partial joint replacements, resurfacing to total joint replacement.

The problem usually is one of a person whose hip joint has osteoarthrits. This can be primary from “wear and tear”, or secondary from a mechanical problem. In people below 60 it is usually secondary. A joint is where two bones meet and move. This is usually lined with cartilage that allows the joints to move smoothly with minimal friction. As the cartilage wears down the friction in the joint increases and the body reacts by generating painful chemicals. The reality is that no one knows why we get pain with arthritis, however restoring the mechanical environment to being more normal relieves the pain. If the problem is picked up early joint preservation options can be done to restore the mechanical environment to more normal.

However in most circumstances the damage may be too advanced that the patient can no longer have joint preservation options. In this situation the hip or any other joint will usually run a natural course. It will progressively get painful, and then eventually the pain will subside as the joint will automatically stiffen and try to fuse. This is the most advanced stage of arthritis and most of these patients will mainly complain of stiffness.

If one is prepared to live with it, the pain from arthritis usually settles down, leaving the patient with severe stiffness that may result in extra stress on the surrounding joints.

A total hip replacement is the last resort for an arthritic hip that is painful and functionally limiting. It is one of the best operations for improvement in quality of life and function that is available in modern society.  In recent years the types of hip replacements have changed and aggressive marketing from prosthesis companies has lead to certain perceived benefits from certain types of prosthesis.

Overall this operation gives fantastic 30 year results using the original technology. The current updated technology offers certain theoretical benefits but does not have the track record the traditional implants do.

The hip replacement consists of replacing the femoral head (ball) and the acetabulum (socket). Dr Balakumar will choose and individualize this based on the patient age, functional factors, other diseases and surgery and sex. Most of these prosthesis are either titanium or steel. They can be fixed to bone via in growth or cement.

Then there is the bearing surface. This is where the ball and socket meet each other and move. The options for this is huge and varying. The main types of options are metal on polyethelene (plastic), metal on metal, ceramic on polyethelene, and ceramic on ceramic. Each of these bearing surfaces have their advantages and disadvantages. Dr. Balakumar mainly uses the ceramic bearing surface which has the theoretical advantage of lasting for up to 30-40 years.

The next factor in total hip replacement is the surgical approach. One can approach the hip through the front (anterior), side (lateral), or from the back (posterior).

This again depends on surgeon preference and despite the approach, the 10 year follow up is identical.

For more information about surgical approaches read the article
Total Hip Replacement via Anterior Approach

Overall a total hip replacement is a fantastic operation that has stood the test of time to be recognized as one of the most life changing operations available. It is by no means an easy or straightforward operation and has to be carefully chosen by both the patient and the surgeon. However it is a rewarding option and Dr. Balakumar performs this operation frequently in his private practice.